Background: Chaos, a measure of environmental disorder, has been associated with adverse health outcomes in youth. There is evidence that school chaos and home chaos, independently, contribute to worse adolescent health outcomes. This is the first study that seeks to understand the combined effect of home and school chaos on adolescent health. We hypothesize that the combination of home and school chaos has a multiplicative negative impact on health outcomes. American adolescents are facing an unprecedented mental health crisis, making this study timely and salient. 

Objective: We aim to determine the relationship between home chaos and school chaos and their combined interactive effect on adolescent mental and behavioral health outcomes. 

Methods: A survey-based prospective cohort study of 1270 predominantly Latino/a low-income students in Los Angeles was conducted from 2013 to 2021 to better understand the educational drivers of adolescent health outcomes. A secondary hierarchical linear regression analysis was performed to determine the impact of the interaction of home and school chaos on adolescent health. 

Results: We found that students exposed to high home and school chaos reported significantly worse rates of cannabis misuse (12% increase CI [7.36 - 16.6]), alcohol misuse (16.4% increase for <21yrs CI [11.42-21.5], 5.9% increase for >21yrs CI [2.33-9.47]), delinquency (12.6% increase CI [8.8-16.4]), anxiety 7.8% increase CI [3.24-12.3]), depression (15.5% increase CI [11.8-19.2]), general mental health (10.8% decrease CI [5.7-15.9] and perceived stress (0.3 unit increase for <20yrs CI [0.23-0.37], 2.64 unit increase for >20yrs CI[1.83-3.44]).
Conclusions: The results of this study suggest that chaos may negatively influence adolescent health. Reducing chaos at home, at school, or both might promote better adolescent mental health and behaviors.  

Specialty: Adolescent Medicine

Keywords: chaos; adolescent health; behavioral and mental health