BACKGROUND AND OBJECTIVES Early detection of health vulnerabilities in adolescents is integral to promoting healthy behaviors into adulthood. Our objective was to quantify the prevalence of health vulnerabilities among adolescents and examine differences by age and neighborhood opportunity. METHODS In a cross-sectional analysis of electronic health record data for adolescents aged 13 to 18 years with preventive visits in a large pediatric primary care network between September 2021 and September 2022, we examined 5 health vulnerabilities: Tobacco use, substance use, firearm access, condomless intercourse, and depressive symptoms. Health vulnerabilities were assessed via self-reported adolescent health questionnaire and the validated Patient Health Questionnaire-Modified. Prevalence of health vulnerabilities were calculated alone and in combination, and compared by age and by quintile of neighborhood Child Opportunity Index (COI) score. Multivariable logistic regression estimated associations of neighborhood COI with reporting ≥2 health vulnerabilities. RESULTS Among 40 197 adolescents (57.7% aged 13-15 years, 66.3% living in "high"/"very high" COI neighborhoods), 29.7% reported at least 1 health vulnerability and 7.9% reported ≥2 vulnerabilities. Cumulative health vulnerabilities were more prevalent among older adolescents and adolescents from lower opportunity neighborhoods. In adjusted models, lower COI was associated with 65% higher odds of having ≥2 vulnerabilities (odds ratio 1.65, 95% confidence interval 1.43-1.91) compared with adolescents from the highest COI quintile. CONCLUSIONS Understanding the relationship between health vulnerabilities and neighborhood opportunities among adolescents may allow pediatric primary care providers and health systems to offer more tailored community support services and transdiagnostic specialized care navigation to address the health needs of teens with multiple vulnerabilities.

中文翻译：

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按年龄和社区机会划分的青少年累积健康脆弱性。

背景和目标 及早发现青少年的健康脆弱性对于促进成年后的健康行为至关重要。我们的目标是量化青少年健康脆弱性的普遍程度，并检查按年龄和邻里机会划分的差异。方法 在对 2021 年 9 月至 2022 年 9 月期间在大型儿科初级保健网络进行预防性就诊的 13 至 18 岁青少年电子健康记录数据进行横断面分析中，我们检查了 5 个健康漏洞：烟草使用、药物使用、枪支使用、无套性交和抑郁症状。通过自我报告的青少年健康调查问卷和经过验证的患者健康调查问卷修改版评估健康脆弱性。健康脆弱性的患病率是单独和组合计算的，并按年龄和邻里儿童机会指数（COI）得分的五分位数进行比较。多变量逻辑回归估计了邻里 COI 与报告 ≥2 个健康漏洞的关联。结果 在 40 197 名青少年中（57.7% 年龄在 13-15 岁，66.3% 生活在“高”/“非常高”COI 社区），29.7% 报告至少 1 种健康脆弱性，7.9% 报告 ≥ 2 种健康脆弱性。累积健康脆弱性在年龄较大的青少年和来自机会较少社区的青少年中更为普遍。在调整后的模型中，与 COI 最高五分位数的青少年相比，较低 COI 与具有 ≥2 个漏洞的几率高出 65%（比值比 1.65，95% 置信区间 1.43-1.91）。结论 了解青少年健康脆弱性与邻里机会之间的关系可能有助于儿科初级保健提供者和卫生系统提供更有针对性的社区支持服务和跨诊断专业护理导航，以满足具有多种脆弱性的青少年的健康需求。