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: Students exposed to high home and school chaos environments experienced significantly worse health and behavioral outcomes across all measures analyzed (pv<0.01). These included cannabis use, problematic alcohol use, delinquency, depression, anxiety, and perceived stress. Several of these outcomes (cannabis use, problematic alcohol use (< and > 21yrs), and perceived stress) demonstrated a multiplicative interaction between home chaos and school chaos. 
Conclusions: The results of this study underscore the potential significant health benefits of reducing chaos in the lives of adolescents. We offer an argument for why targeting school chaos could be an effective and broad-reaching mechanism for improving adolescent health in the United States. 

Specialty: Adolescent Medicine

Keywords: chaos; adolescent health; behavioral and mental health