Pedro Soto

Background: Tobacco smoke exposure in the home remains common among U.S. families and has been increasingly associated with adverse mental health outcomes, including anxiety and depression, among children and adolescents. Rising rates of youth anxiety and depression, coupled with evidence that secondhand smoke and related psychosocial stressors may disrupt emotional development, underscore the importance of examining household smoking exposures as a modifiable risk factor for youth mental health. This study examines associations between exposure to smoke in households and the likelihood of caregiver-reported anxiety and depression in US children and adolescents aged 6–17 years, using data from the 2022–2023 National Survey of Children’s Health (NSCH). Methods: A retrospective analysis of NSCH data for two age cohorts, children (6–11 years) and adolescents (12–17 years), for the years 2022–2023 was conducted. Descriptive statistics were generated for the selected sample by frequencies and counts for each of the dependent and independent variables, followed by binary logistic regressions for each measured mental health variable based on current diagnosis, severity levels (not severe, mild, moderate, severe) and household tobacco use. Results: This study found significant associations between parental smoking and increased odds of caregiver-reported anxiety and depression in both children and adolescents. Specifically, children living with parents who smoke had 1.55 times the odds of severe anxiety, while adolescents had 1.38 times the odds of currently experiencing anxiety and 1.31 times the odds of currently experiencing depression. Smoking inside the household was not significantly associated with caregiver-reported anxiety or depression. These findings suggest that parental smoking serves as a marker for broader psychosocial and environmental stressors that contribute to youth mental health outcomes. Conclusions: Parental smoking is a significant, modifiable risk factor for anxiety and depression among US children and adolescents. These results emphasize the need for targeted, evidence-based interventions to reduce parental smoking, improve awareness of associated mental health risks, and address social determinants of health. Policies promoting smoke-free households, integrated cessation support, and culturally tailored education programs are essential to mitigate the impact of parental smoking on child and adolescent mental health.

This study uses the National Survey of Children’s Health to examine the nationwide prevalence and severity of US adolescent mental health issues in the 12–17 age group between the years 2022 and 2023 in relation to parental mental health and exposure to adverse childhood experiences (ACEs). We used the NSCH data collected for 12–17-year-old adolescents. Descriptive statistics were generated for the selected sample and binary logistics regressions were conducted to examine influential factors for the presence and severity of adolescent depression and anxiety for the selected year. Adolescents aged 12–17 who experienced neighborhood violence had higher odds of being diagnosed with anxiety (OR = 1.369, p = 0.009) and depression (OR = 1.508, p = 0.004). Those living with someone who was mentally ill, suicidal, or severely depressed showed increased odds of anxiety (OR = 1.642, p < 0.001) and depression (OR = 1.587, p < 0.001). Adolescents judged unfairly due to a health condition or disability had markedly higher odds of anxiety (OR = 3.056, p < 0.001) and depression (OR = 1.835, p < 0.001), including severe forms (severe anxiety OR = 2.569; severe depression OR = 2.238; both p < 0.001). Poorer parental emotional health was consistently associated with higher adolescent anxiety and depression, with “fair” parental emotional health showing the strongest association for depression (OR = 7.320, p < 0.001). These findings demonstrate the need for better tailored mental health efforts towards both adolescents and their caregivers highlighting the harm of long-term environmental and familial stressors, and the gaps in community approaches in this population.

The purpose of this scoping review is to identify major social determinants of health and barriers affecting access to mental health services in pregnant and postpartum women in the United States. It will also examine the scope of existing evidence-based interventions and dissemination and implementation strategies that were developed and implemented to increase accessibility to mental health treatment in high-risk pregnant and postpartum women. The Arksey and O’Malley Framework guided the review process, along with the Joanna Briggs Institute (JBI) recommendations for the extraction, analysis, and presentation of results in scoping reviews. Additionally, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SCR) was used as a reference checklist. A total of 21 studies were used for analysis that were published between 2015 and 2025. An examination of social determinants of health (SDOH) influencing factors of mental health determined that those related to neighborhood and built environment had the highest rates. Using the socioecological model, individual barriers exhibited the highest frequency, with the most common themes to these barriers across all studies being language barriers, cultural barriers, and stigma-related challenges, followed by financial and childcare challenges and transportation challenges. Major findings included important evidence that therapeutic relationships with pregnant women who are depressed can be developed and that telehealth interventions improved access for women living in rural areas. Recommendations from this review will inform evidence-based interventions to address the gap in accessibility and affordability of mental health services in US pregnant and postpartum women residing in underserved communities.