Adolescent Health and Well-Being: Background and Methodology for Review of Potential Interventions

Adolescent health research and initiatives in the occupied Palestinian territory: a scoping review

OBJECTIVE

Adolescence is a period characterised by profound changes that warrant special attention, particularly for adolescents living in conflict-stricken regions. The dearth of available information regarding observational health research and interventions in the occupied Palestinian territory emphasises the need for a comprehensive examination of all accessible data. The aim of this review is to conduct a thorough analysis of the existing literature and initiatives focusing on adolescent health in the occupied Palestinian territory.

DESIGN

Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) framework.

DATA SOURCES

PubMed, Embase, Web of Science, Scopus, CINAHL and PsycINFO, along with grey literature, were searched for the period between 2012 and 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Research studies, programmes or interventions targeting adolescents aged 10-19 years, conducted in the occupied Palestinian territory, and published between 2012 and 2023 were considered. Both peer-reviewed articles and grey literature were included.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers conducted abstract and full-text screening of the selected articles. Discrepancies were resolved through discussion, with a third reviewer consulted when necessary. Data extraction was performed using Excel software by two independent reviewers. Extracted data were categorised as either intervention or observational research. For analysis, the extracted data underwent an explanatory frequency analysis using SPSS software.

RESULTS

Our search yielded 114 research projects and 19 interventions from peer-reviewed and grey literature searches. The most frequently addressed topic was non-communicable diseases, with health awareness being the most common method employed in interventions. The studies targeted both male and female participants, with a particular focus on adolescents aged 10-19 years. The majority of the included studies received funding from international sources and were conducted by foreign and local researchers.

CONCLUSION

This review sheds light on the current framework of adolescent health interventions, identifies areas where research is lacking and advocates for evidence-based practices to enhance the well-being of Palestinian adolescents. Future interventions should encompass the younger age group, and research should strive to provide precise information for each age group independently.

Influence of Smartphone Usage on development of Sexuality among Late Adolescent Boys in Health Sciences Colleges of South India

Background

Better affordability of data plans and an increase in "budget" smartphones have resulted in an exponential rise in internet and smartphone users. The ease of access to sexually explicit material (SEM) coupled with adolescents' impulsivity makes them prone to excessive SEM exposure and may affect the development of sexuality via the perceived realism of such content. This study was done to study the influence between problematic smartphone usage (PSU) and sexuality development among late adolescent boys.

Methods

One hundred and thirty-four adolescents aged 18-19 years, studying in a medical university, participated in this cross-sectional study. Smartphone Addiction Scale - short version (SAS-SV) to evaluate PSU and a content validated semi-structured proforma to evaluate gender identity, sexual orientation, sources of information on pubertal changes, and exposure to pornographic content was used. We expressed results as proportion and summary measures (Mean±SD), Chi-square test to find influence between PSU and adolescent sexuality development.

Results

We found a 45.5% prevalence of PSU. Among study participants, 88% were attracted to the opposite sex, 6% were attracted to the same-sex, and 6% were attracted to both sexes. Three per cent of participants liked wearing clothes of the opposite sex, 7.5% wanted to be members of the opposite sex, whereas 10.4% were not comfortable with their genitalia. They obtained information regarding pubertal changes from friends (85) and media (78). Many had exposure to pornographic content (90%), with the youngest being nine years old.

Conclusion

Nearly half of the late adolescents have PSU. Pornographic contents are accessed through Smartphones.

Rationale and Approach to Evaluating Interventions for Newborn Care in Low- and Middle-Income Countries

INTRODUCTION

The neonatal period is the most vulnerable time in a child's life, contributing to almost half of all deaths in children under 5 years. Many of these deaths are preventable and are mainly caused by preterm birth, birth asphyxia, or serious infections. Over the past decade, the evidence base for interventions to prevent and manage these causes of neonatal mortality and morbidity in low- and middle-income countries (LMICs) has expanded significantly. This growth calls for a comprehensive and systematic approach to synthesizing the available evidence. This paper describes the methodological approach taken before and during the conduct of the systematic overviews and reviews described in the online supplementary material (for all online suppl. material, see https://doi.org/10.1159/000542754).

METHODS

Alongside consultation with a newborn technical advisory group, the overall evidence synthesis approach began with an extensive literature-scoping exercise to establish a universe of interventions that were relevant to neonatal health and survival and to identify the associated systematic reviews examining their effectiveness. Three main approaches were taken to synthesize the evidence based on the availability of prior evidence. New systematic reviews were conducted for topics lacking an existing comprehensive synthesis. Existing systematic reviews with search dates prior to 2020 were updated. High-quality, up-to-date systematic reviews were used without modification. In all cases, trial data from studies conducted in LMICs were sought and prioritized for analysis.

CONCLUSION

A comprehensive approach to summarizing the best available evidence for newborn intervention effectiveness is described.

INTRODUCTION

The neonatal period is the most vulnerable time in a child's life, contributing to almost half of all deaths in children under 5 years. Many of these deaths are preventable and are mainly caused by preterm birth, birth asphyxia, or serious infections. Over the past decade, the evidence base for interventions to prevent and manage these causes of neonatal mortality and morbidity in low- and middle-income countries (LMICs) has expanded significantly. This growth calls for a comprehensive and systematic approach to synthesizing the available evidence. This paper describes the methodological approach taken before and during the conduct of the systematic overviews and reviews described in the online supplementary material (for all online suppl. material, see https://doi.org/10.1159/000542754).

METHODS

Alongside consultation with a newborn technical advisory group, the overall evidence synthesis approach began with an extensive literature-scoping exercise to establish a universe of interventions that were relevant to neonatal health and survival and to identify the associated systematic reviews examining their effectiveness. Three main approaches were taken to synthesize the evidence based on the availability of prior evidence. New systematic reviews were conducted for topics lacking an existing comprehensive synthesis. Existing systematic reviews with search dates prior to 2020 were updated. High-quality, up-to-date systematic reviews were used without modification. In all cases, trial data from studies conducted in LMICs were sought and prioritized for analysis.

CONCLUSION

A comprehensive approach to summarizing the best available evidence for newborn intervention effectiveness is described.

Factors influencing unintended pregnancy and abortion among unmarried young people in Nigeria: a scoping review

BACKGROUND

Unintended pregnancies and abortions among unmarried adolescents in Nigeria are outcomes of the interplay of multifaceted factors. Abortion, a global public health and social issue, impacts both developed and developing countries. This scoping review explored the literature and mapped the risk factors for unintended pregnancies and abortions among unmarried female adolescents in Nigeria.

METHODS

A scoping literature search was conducted across databases, including PubMed, Science Direct, Web of Science, EBSCOhost, JSTOR, African Index Medicus, and Scopus. Inclusion criteria encompassed peer-reviewed articles and reports in English, focusing on unmarried female adolescents. The range of interest included the past incidents of having sex, unintended pregnancies, contraceptive use, and abortions among this demographic. Studies categorized as grey literature were excluded to ensure the reliability and validity of the synthesized information.

RESULTS

A total of 560 articles, 553 identified through databases and 7 through hand search, were subjected to a comprehensive full-text review, resulting in the inclusion of 22 studies that met the criteria for the final review. The scoping review shed light on the past incidents of having sex, unintended pregnancies, contraceptive use, and abortions among unmarried adolescents in Nigeria. The range of incidence for having sex varied from 57.2% to 82.7%, with the prevalence of unintended pregnancies ranging from 23.4% to 92.7%. Contraceptive use was notably low, with 21.5% reporting low usage, contributing to the high incidence of abortions, ranging from 20.2% to 51.0%. Factors influencing unintended pregnancies included a lack of awareness of modern contraceptives and limited access to sexual and reproductive health information. For induced abortions, factors such as the impact on educational career, childbearing outside wedlock and fear of expulsion from school were identified.

CONCLUSION

This scoping review, through a systematic examination of existing literature, contributes to a more robust understanding of the factors influencing unintended pregnancies and abortions among unmarried adolescents in Nigeria. The findings inform future research directions and guide the development of targeted interventions to improve reproductive health outcomes for this vulnerable population.

Utilisation of Reproductive Health Services among Adolescents in Ghana: Analysis of the 2007 and 2017 Ghana Maternal Health Surveys

Early pubertal development induces early sexual activities among adolescents. In Ghana, despite the high sexual activity among Ghanaian adolescents, sexual and reproductive health (SRH) services are underutilised, primarily due to SRH stigma and a lack of SRH knowledge and information. This study examined the use of SRH services among adolescents aged 15-19 years in Ghana over a ten year period. The study utilised data from the 2007 and 2017 Ghana Maternal Health Surveys (GMHSs). Responses from 2056 and 4909 adolescent females captured in the 2007 and 2017 GMHSs, respectively, were used. The results showed a declining utilisation of SRH services among adolescents from 28.3% in 2007 to 22.5% in 2017. The odds of using family planning among sexually active adolescents increased from 2007 [AOR-0.32, CI-(0.135, 0.77), p < 0.001] to 2017 [AOR-68.62, CI-(36.104, 130.404), p < 0.001]. With increasing age at first sex, adolescents were less likely to use a family planning method in 2007 [AOR-0.94, CI-(0.89,0.99) p < 0.001], but this improved in 2017 [AOR-1.26, CI-(1.220, 1.293), p < 0.001]. Despite this, knowledge of sources for family planning was found to predict its lower utilisation in both 2007 [AOR = 0.15 (95% CI-0.081, 0.283), p < 0.0001] and 2017 [AOR = 0.206 (95% CI-(0.099, 0.426), p < 0.001]. The findings show that even though knowledge of family planning methods predicted low utilisation, knowledge of sources, age at first sex, and educational level positively predicted the utilisation of SRH services from 2007 to 2017. Opportunities for both enhancing the clinical environment and health provider attitudes exist and should be explored for improving SRH outcomes among sexually active adolescents in Ghana.

Well-Being Inequality Among Adolescents and Young Adults

PURPOSE

This study aimed to examine patterns of well-being across developmental stages and patterns of inequality in well-being among young adults and adolescents. Well-being exists when adolescents and young adults thrive and can achieve their full potential.

METHODS

We used individual-level survey data from the Gallup World Poll from 164 countries between 2009 and 2017 (N = 446,934). Regression analyses were used to determine associations.

RESULTS

We documented substantial inequality in well-being across three developmental stages (adolescence, early adulthood, young adulthood). Health, education, income, and social relations are strongly associated with mean well-being and well-being inequality. We showed, for mean well-being, the relative importance of these factors varies over life-cycle stages. For inequality, most factors were consistent across developmental groups; however, we identified certain characteristics that were only relevant at certain developmental stages.

DISCUSSION

Given the policy importance of well-being at all stages of life and the significance of adolescence and early adulthood in developing positive health-related behaviors, policies and programs targeting the highlighted characteristics are likely to be effective but require a multisectoral approach.

Barriers and facilitators of parent-adolescent communication on sexual health and relationships among the UK population: A study protocol

Background and Aims

Improving the sexual and reproductive health of adolescents remains a public health priority. Effective communication between parents and adolescents regarding sexual health and relationships is important and could influence adolescents to adopt safer sexual behaviors. However, several barriers can impede this communication in the UK population. The aim of the review is to explore barriers and facilitators, as well as wider determinants of parent-adolescent communication (PAC) on sexual health and relationships. The review will explore possible interventions aimed at promoting PAC on sexual health and relationships.

Methods

The review will focus on exploring barriers and facilitators of PAC on sexual health and relationships in the United Kingdom. This study will synthesize qualitative literature to understand the significance of parent-adolescent sexual and reproductive health communication, the challenges and facilitators to effective communication in the United Kingdom. Using a detailed predetermined search strategy, the study will search for relevant studies from CINAHL, MEDLINE, PsycINFO, EMBASE, SCOPUS, Web of Science, and gray literature on Google Scholar. The Critical Appraisal Skills Program checklist will appraise the included studies' methodological quality. A thematic synthesis approach will be used to synthesize data from included studies.

Conclusion

Findings from the systematic review are expected to give information on the barriers and facilitators of PAC on sexual health and relationships which will further optimize interventions to improve this type of communication and guide future research in understanding this area.

Systematic review registration

The review has been registered with the International Prospective Register of Systematic Reviews CRD (PROSPERO) (CRD42022351697).

Factors associated with adolescent pregnancy and public health interventions to address in Nigeria: a scoping review

BACKGROUND

Adolescent pregnancy is a global public health and social problem that affects both developed and developing countries. Reducing adolescent pregnancy is central to achieving sustainable development goals. In 2021 Nigeria's Adolescent pregnancy was 106 per 1000 and showed an increasing rate. This study, therefore, aims to explore the literature to map the risk factors and interventions against adolescent pregnancy in Nigeria.

METHOD

A scoping review of studies published between January 2007 and December 2022 using PubMed, Web of Science and Africa Journals Online were searched using the keywords' adolescent pregnancy' AND 'Nigeria'. Studies were screened using the eligibility criteria.

RESULTS

A total of 241 articles, of which 229 were identified through the databases and 12 were identified through hand search. After the full-text review, 28 studies met the inclusion criteria and were included in the final review. In Nigeria, the prevalence of adolescent pregnancy is between 7.5 and 49.5%. Associated factors for adolescent pregnancy in Nigeria are multifactorial, including individual, community, societal, school, family, and peer factors. Policies on adolescent sexual and reproductive health exist in Nigeria. Still, the policies need more sponsorship, implementation, and monitoring, while only some interventions on adolescent pregnancy majorly based on contraceptives and education of health providers are available in Nigeria.

CONCLUSION

Associated factors for adolescent Pregnancy in Nigeria are multidimensional, with educational attainment and wealth index being the highest associated factor. Intervention strategies aimed at the educational level have been identified as a critical factor in curbing adolescent pregnancy. Thus, policies on sexual, reproductive, and mental health development specifically targeting adolescents to reduce the cycle of societal dependence by empowering this group economically and educationally are justifiably warranted.

Involving adolescents in the design, implementation, evaluation and dissemination of health research: an umbrella review protocol

INTRODUCTION

A lack of awareness on how to engage adolescents in research has been reported as one of the barriers to meaningful youth involvement in health research. Currently, available guidelines on youth involvement are limited in terms of the scope (e.g., focused on limited health research areas), content (e.g., include broad principles) and context (e.g., most guidelines are from high-income countries) for which the guidelines are applicable. To address this, we will develop a set of comprehensive guidelines based on consolidated evidence on youth involvement in health research. To inform these guidelines, we are first conducting an umbrella review to (1) summarise and synthesise findings from reviews on involving adolescents in health research, (2) consolidate the challenges experienced in youth involvement and the recommendations to mitigate these challenges, (3) identify best practices and (4) identify gaps and methodological weaknesses in the extant literature on involving adolescents in health research.

METHODS AND ANALYSIS

We will include review articles exploring adolescents' involvement in studies aiming to improve their physical or mental health. Databases to be searched include Cochrane Database of Systematic Reviews, Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Embase, PsycINFO, PsycArticles, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Epistemonikos and Health Systems Evidence. A grey literature search will be conducted in Web of Science, ProQuest, Google Scholar and PROSPERO, supplemented by a handsearch of the reference lists of eligible reviews, relevant journals, websites of related organisations and input from experts. Data will be analysed using narrative synthesis.

ETHICS AND DISSEMINATION

Ethical approval is not required as we are not collecting participant data as part of this review. The findings of this umbrella review will be disseminated through peer-reviewed publications, participatory workshops and academic conferences.

PROSPERO REGISTRATION NUMBER

CRD42021287467.

Youth friendly services utilization and associated factors among school youths in North Shewa Zone, Amhara Region, Ethiopia: A mixed-method study

Objective

To assess youth friendly services utilization and associated factors among school youths in North Shewa zone, Ethiopia, 2020.

Methods

Institution-based cross-sectional study complemented with qualitative inquiry was conducted from 25 February to 20 March 2020. Multistage and purposive sampling technique was used. A total of 605 randomly selected students were recruited. Seven in-depth interviews and four focus group discussions were conducted for qualitative study. p-value < 0.05 and adjusted odds ratio with 95% confidence interval were computed to measure the strength of associations between variables. Qualitative data were transcribed verbatim, analyzed manually, and presented in narration.

Result

One hundred ninety-five (32.7%, 95% confidence interval: 29.0%, 36.6%) respondents had used youth friendly services during the survey. Educational level of father (can read and write) (adjusted odds ratio = 3.12, 95% confidence interval: (1.47, 6.65)), being knowledgeable about reproductive health issues (adjusted odds ratio = 4.84, 95% confidence interval: (2.77, 8.47)), discussion on reproductive health issues (adjusted odds ratio = 2.50, 95% confidence interval: (1.49, 4.19)), having sexual exposure (adjusted odds ratio = 3.37, 95% confidence interval: (1.54, 7.39)), perceiving oneself as risky for acquiring HIV/AIDS (adjusted odds ratio = 4.49, 95% confidence interval: (2.63,7.65)), history of sexually transmitted infections (adjusted odds ratio = 4.40, 95% confidence interval: (1.61, 12.04)), favorable attitude toward service providers (adjusted odds ratio = 2.20, 95% confidence interval: (1.16, 4.17)), and ever supported to use the services (adjusted odds ratio = 4.18, 95% confidence interval: (2.51, 6.97)) were factors associated with youth friendly services utilization.

Conclusion

Compared with previous findings, youth friendly services utilization in the study area was relatively low. Knowledge on reproductive health issues, sexual exposure, perceiving as risky of acquiring HIV, history of sexually transmitted infection, ever supported to use the services, and attitude of youth toward youth friendly service providers were among factors associated with youth friendly services utilization. Health facilities and schools should work coordinately to scale up youth friendly services utilization.

"Everything else is going to be ok if your spiritual wellness is well". A qualitative exploration of wellness amongst secondary school students in Fiji

PURPOSE

Adolescent wellness over the years has been a major public health concern. The adolescent period is stated to be a critical phase as developments occur in all areas of the individual. This study aims to explore secondary school students' perceptions on knowledge of wellness, influences of wellness, prioritization of wellness dimensions and ideal adolescent wellness programmes in Fiji.

METHOD

This study qualitatively investigates adolescents in four purposively selected schools in Suva, Fiji. 31 students who enrolled into years 11 to 13 in the selected schools were interviewed in-depthly using a semi-structured, open-ended questionnaire. Data was transcribed and classified into categories, sub-themes and major themes.

RESULTS

Participants' responses indicated wellness perceived as multidimensional with no regard to dimensional balance. Family, peers and school support, social media, nutrition and physical activities are factors perceived to influence wellness. The availability of school counsellors, facilitation of effective school health programmes, and incorporation of wellness into the school curriculum were perceived as ideal ways to increase adolescent wellness.

CONCLUSIONS

This study provides important research findings of adolescent wellness for Fiji's health sector, its policymakers and programme developers. Further studies are needed to understand the broad concept of wellness and its several dimensions.

The Sequential Mediating Effects of Dietary Behavior and Perceived Stress on the Relationship between Subjective Socioeconomic Status and Multicultural Adolescent Health

Studies have examined the impact of social determinants of health on the health behaviors and health statuses of ethnic minority adolescents. This study examines the subjective health of this population by examining the direct effects of multicultural adolescents’ subjective socioeconomic status (SES) and the sequential mediating effects of their dietary behaviors and perceived stress. We utilized secondary data of 500 middle school students from multicultural families who participated in the 15th Korean Youth Health Behavior Survey, 2019. Information about SES, perceived stress, subjective health status, and dietary behavior (measured by the breakfast intake frequency during the prior week) were utilized. For the relationship between the SES and the subjective health status, we confirmed the sequential mediating effects of breakfast frequency and perceived stress using SPSS 25.0 and PROCESS macro with bootstrapping. The results showed that SES had a direct effect on subjective health status and indirectly influenced subjective health status through the sequential mediating effect of breakfast frequency and perceived stress. However, SES had no direct effects on perceived stress. These findings emphasize that broadening the community-health lens to consider the upstream factor of SES when preparing health promotion interventions is essential to achieving health equity for vulnerable populations.

Health promotion through youth empowerment to prevent and control smoking behavior: a conceptual paper

Purpose

This paper aimed to review globally the empowerment programs for the prevention and control of smoking behavior among youths, to examine the role of empowerment in health promotion, to explore the stages of health promotion through community empowerment strategies including planning, implementation and evaluation. Finally, this paper will develop a model of youth empowerment to prevent and control smoking behavior that reflects theory and experience drawn from the literature.

Design/methodology/approach

This review synthesized articles on community empowerment and health promotion, youth empowerment programs for tobacco prevention and control globally from books and electronic databases from the Universitas Gadjah Mada (UGM) library in the publication period 2000–2020. Relevant literature was selected and critically reviewed which reflected the role empowerment in health promotion, stage of community empowerment strategy as described by Laverack and youth empowerment concept in tobacco control as described by Holden.

Findings

Documents that specifically discuss empowerment programs for smoking prevention and control are still limited. The findings document that youth empowerment in tobacco control do not fully integrate the theory empowerment as described by Laverack and Holden. This paper provides information about the stages of youth empowerment, and a conceptual framework of youth empowerment for the prevention and control of smoking behavior. Youth empowerment is done through the direct involvement of youth in programs starting from program design, planning, implementation and evaluation. Indicators of the success of the empowerment process are reflected in the increase in the empowerment domain. Meanwhile, the output of empowerment can be seen from the individual- or group-level changes.

Originality/value

This paper proposes a model of youth empowerment for the prevention and control of smoking behavior among youths based on theory and experience in the field.

Social and early life adversity and chronic health conditions among Tunisian adults

Early life adversities (ELAs) are shown as significant risk factors for chronic health conditions (CHCs). ELAs include multiple types of abuse such as the social abuse (peer, community, and collective violence). The purpose is to describe the relationship between childhood social abuse and chronic conditions in adulthood among a sample of adults in Tunisia and to investigate the role of obesity and tobacco use as mediators of this association. A cross-sectional study was conducted in Tunisia, from January to June 2016 using the Arabic Adverse Childhood Experiences International Questionnaire (ACE-IQ). Items of social abuse (peer violence, witnessing community violence, and exposure to collective violence) were analyzed. A total of 2,120 adults were enrolled. After adjustment for age, gender, and intrafamilial ELA, social adversities were associated significantly with the selected CHC. Experiencing more than two social ELA increase the risk of occurrence of hypertension and coronary diseases. After accounting for the indirect effect of body mass index, statistically significant partial mediation effects were observed for the cumulative number of social ELA as the exposure variable and chronic diseases as the outcome variable (p ≤ .001; % mediated = 44.5%). These findings support an association between many chronic health disorders and childhood social abuse, independently of intrafamilial ACEs.

Nutritional Status of Syrian Refugees in Early Adolescence Living in Turkey

This study evaluated the nutritional status of Syrian refugees in the early adolescent period living in different vulnerable settings. Nutritional assessment of Syrian refugee adolescents is often neglected but essential for a healthy physical, pubertal and mental development. Growth parameters of Syrian refugee adolescents going to a public school in an urban area and in a temporary protection center (TPC) were recorded along with the Turkish adolescents. Stunting percentages were similar between the groups (p = 0.811). While the proportion of children with a BMI over 85th percentile were significantly higher among Syrian adolescents living in TPC, Turkish children have the highest percentage of underweight (p = 0.01). Both food insecurity and unhealthy weight gain continue to be major concerns for refugee adolescents after their resettlement to a host country. The findings suggest that nutritional assessment and intervention at early adolescence is critical for Syrian refugees depending on their living conditions.

Identifying Risk Profiles of School Refusal Behavior: Differences in Social Anxiety and Family Functioning Among Spanish Adolescents

School attendance problems negatively affect students' development. This study attempted to identify different school refusal behavior profiles and to examine their relationship with three dimensions of social anxiety (fear of negative evaluation, social avoidance and distress in new situations, and social avoidance and distress that is experienced more generally in the company of peers) and the perception of family functioning. Participants included 1842 Spanish adolescents (53% girls) aged 15-18 years (M = 16.43; SD = 1.05). The School Refusal Assessment Scale-Revised (SRAS-R), the Social Anxiety Scale for Adolescents (SAS-A), and the Family APGAR Scale (APGAR: Adaptation, Partnership, Growth, Affection, and Resolve) were administered. Latent class analysis revealed four school refusal behavior profiles: non-school refusal behavior, high school refusal behavior, moderately low school refusal behavior, and moderately high school refusal behavior. Analyses of variance (ANOVA) indicated that adolescents' with the profile of high school refusal behavior showed higher scores in all the subscales of social anxiety. In contrast, the non-school refusal behavior group revealed higher scores in the perception of good family functioning, whereas the high school refusal behavior profile obtained the lowest scores in this scale. These findings suggest that students who reject school are at a higher risk of developing social anxiety problems and manifesting family conflicts. These students should be prioritized in order to attend to their needs, promoting self-help to overcome social anxiety and family problems with the purpose of preventing school refusal behaviors.

Educational Curricula and Programs in Adolescent Medicine for Health Workers in Low- and Middle-Income Countries: A Scoping Review

BACKGROUND

Adolescent medicine (AM) has been increasingly recognized as critically important to the health of individuals during their transition to adulthood. On a global scale, AM is often underprioritized and underfunded. In low- and middle-income countries (LMICs), education and AM training is developing, and AM physicians often are from general medicine backgrounds.

OBJECTIVE

The objective of our scoping review was to identify existing training curricula and educational tools designed to teach AM skills to health care workers in LMICs.

METHODS

We followed PRISMA guidelines for scoping reviews for article identification and inclusion. Online databases, including MEDLINE, Embase, CINAHL, and Scopus, were used to identify papers. We included studies that took place in a LMIC, were available in English, and described any of the following: published educational curricula in AM, education-based intervention for HCWs that focused on AM, or a training opportunity in AM located in a LMIC.

RESULTS

Our review includes 14 publications: 5 published curricula and 9 articles describing educational interventions or training opportunities in AM in LMICs. Curricula were relatively consistent in the topics included, although they varied in implementation and teaching strategies. The scholarly articles described educational materials and identified a number of innovative strategies for training programs.

CONCLUSIONS

Our review found existing high-quality AM curricula designed for LMICs. However, there is limited published data on their implementation and utilization. There is a continued need for funding and implementation of education in AM in resource-constrained settings.

Optimizing HIV transition services for young adults

PURPOSE OF REVIEW

A total of 1.8 million adolescents live with HIV and constitute the only age group in which HIV-associated mortality continues to rise. Meeting their healthcare needs as they transition from paediatric services to adult care is vital for their own health and in prevention of onward transmission to partners and offspring. In this review, we discuss the issues around transition, both within HIV health care and the wider transitions adolescents negotiate as they move out of childhood and into adult life.

RECENT FINDINGS

Although transition models vary widely across the globe, the difficulties faced in gathering robust outcome data following transition to adult care and in linkage between paediatric and adult cohorts are universal. Data are particularly sparse for behaviourally infected adolescents outside North America and for key population groups. Poorer health outcomes universal to adolescents may reflect the complex multisystem developmental transition from childhood-to-adulthood, of which transition of healthcare services is a small part.

SUMMARY

The complex needs of this generation are well described and whilst examples of good practice are emerging, how best to support their transition to adulthood requires carefully tailored studies of cost-effective interventions that can be up scaled in resource limited settings.

Correlation between serum transforming growth factor β1, interleukin-6 and neonatal respiratory distress syndrome

Trend and correlation of transforming growth factor β1 (TGF-β1) and interleukin-6 (IL-6) in serum of children with neonatal respiratory distress syndrome (NRDS) were investigated. A total of 75 NRDS children born in the Xiangyang Central Hospital from July 2015 to August 2017 were analyzed retrospectively. A total of 45 NRDS premature infants who received pulmonary surfactant (PS) within 12 h after birth were treated as PS group, 30 who did not receive PS treatment as non-PS group, and 32 premature infants without NRDS in the same period were selected as control group. Serum levels of TGF-β1 and IL-6 were detected by enzyme linked immunosorbent assay (ELISA) at various time points after birth and their correlation was analyzed. The expression level of TGF-β1 in serum of children in PS group was significantly higher than that in control group on days 1 and 3 after birth (P<0.05). The expression level of TGF-β1 in non-PS group increased continuously with the increase of number of days and was significantly higher than that in control group on days 1, 3 and 7 after birth (P<0.05), and significantly higher than that in PS group on days 3 and 7 after birth (P<0.05). The analysis of the correlation between the severity of the disease and the expression levels of TGF-β1 and IL-6 showed that the expression levels were elevated with the increase of the disease severity. The expression levels of TGF-β1 and IL-6 were positively correlated with severity of the disease (r=0.7509, P<0.05; r=0.8056, P<0.05). The expression levels of TGF-β1 and IL-6 in PS and non-PS groups were positively correlated (r=0.9042, P<0.05; r=0.8905, P<0.05). The results showed that serum TGF-β1 and IL-6 were elevated in NRDS children, and there was a positive correlation between them.

Socio-demographic and economic factors are associated with nutritional status of adolescent school girls in Lay Guyint Woreda, Northwest Ethiopia

Objective:

This study was aimed at assessing socio-demographic and economic factors associated with nutritional status of adolescent school girls in Lay Guyint Woreda, Northwest Ethiopia.

Methods:

The school-based cross-sectional study comprising 362 adolescent girls aged 10–19 years was included in the study. Simple random sampling technique with proportional allocation to size was used to select the participants. An interviewer-administered questionnaire and anthropometric measurement were used to collect the data. An anthropometric measurement was converted to the indices of nutritional status using World Health Organization Anthro Plus software.

Result:

The overall prevalence of stunting and thinness among adolescent girls were 16.3% and 29%, respectively. Adolescents aged 14–15 years (AOR = 3.65; 95% confidence interval: 1.87, 7.11), adolescents living in rural areas (AOR = 1.34; 95% confidence interval: 1.24, 2.33), and adolescents who did not have snack (AOR = 11.39; 95% confidence interval: 1.47, 17.8) were positively associated with stunting. Whereas mother’s occupation was negatively associated with stunting (AOR = 0.12; 95% confidence interval: 0.17, 0.87). Similarly, being a rural resident (AOR = 2.40; 95% confidence interval: 1.13, 5.08) and adolescents aged 14–15 years (AOR = 6.05; 95% confidence interval: 2.15, 17.04) were positively associated with thinness. Educational status of adolescent girls was negatively associated with thinness (AOR = 0.13; 95% confidence interval: 0.05, 0.35).

Conclusion:

Stunting and thinness are prevalent among adolescent girls. The age of adolescents, place of residence, having a snack, and mother’s occupation was significantly associated with stunting and thinness. Having at least a one-time snack in addition to the usual diet is strongly recommended.

Effect of education based on protection motivation theory on adolescents' reproductive health self-care: a randomized controlled trial

BACKGROUND

Adolescents should be empowered to improve their reproductive and sexual health needs. The present study aimed to investigate effects of protection motivation theory-based education on student girls' reproductive and sexual health self-care.

METHODS

This randomized controlled trial was conducted in parallel on 90 female students living in dormitories of the Alborz University of Medical Sciences in Iran. The data collection lasted from January 2017 to May 2018. Convenience sampling was performed, and samples were put into intervention and control groups by block randomization. The intervention group received six educational sessions based on the protection motivation theory(PMT). The data collection tool of this research consisted of the protection motivation theory and reproductive health self-care questionnaires.

RESULTS

There was no significant difference between control and intervention groups in demographic characteristics. The results of the repeated measures test indicated that the reproductive health self-care variable had a significant change (p = 0.000), and there was a significant difference between groups (p = 0.000). The total score of the Protection Motivation Theory Questionnaire was not changed over time (p = 0.54) and there was no significant difference between groups (p = 0.51) according to results of the repeated measures test.

CONCLUSION

According to effects of an educational intervention based on the protection motivation theory, it is suggested to utilize this model as an educational framework for adolescents' reproductive and sexual health by healthcare providers, schools and universities as well as holding periodic courses educating adolescents within short-term intervals in order to achieve the higher sustainability of the educational results.

Addictive behaviors and psychological distress among adolescents and emerging adults: A mediating role of peer group identification

Objective

Research suggests the sense of belonging to primary groups functions as an important social resource for youth well-being, but it can be compromised among those dealing with addiction. The current study examined how adolescents' and emerging adults' identification with a primary peer group consisting of friends, mediates the relationship between addictive behaviors and psychological distress.

Method

The study utilized demographically balanced survey data on 1200 Finnish participants aged 15 to 25 (mean age 21.29, 50% female). Measures were included for psychological distress, excessive drinking, excessive drug use, excessive gambling, excessive Internet use, and peer group identification.

Results

All forms of addictive behaviors had a significant direct relationship with higher psychological distress. Excessive drug use, gambling and Internet use were associated with a weaker identification with a peer group, which predicted higher psychological distress. Contrary to the above findings, excessive drinking was linked to stronger peer group identification, mediating psychological distress downwards.

Conclusions

These findings support past research and provide a mediation model explanation onto how weaker social relations add to negative well-being consequences in different addictive behaviors, thus underlining the importance of expanding our understanding of social group outcomes among young individuals.

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Data from a demographically balanced sample (N = 1200) of Finnish youths aged 15 to 25.

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Four different types of addictive behaviors were associated with higher psychological distress.

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Psychological distress was significantly mediated by social identification to a primary peer group.

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The mediating role of social identification varied among different addictions.

Recommendations on Arresting Global Health Challenges Facing Adolescents and Young Adults

BACKGROUND

The health challenges faced by young people are more complex than adults and can compromise their full growth and development. Attention must be paid to the health of this age group, yet adolescents and youth remain largely invisible and often disappear from the major global datasets.

OBJECTIVE

The aim of this paper is to discuss the global health challenges faced by adolescents and youth, global legislations and guidelines pertaining to this particular age group, recommendations to arrest these challenges, and research priorities.

RESULTS

Major direct and indirect global health risks faced by adolescents include early pregnancy and childbirth, femicide, honor killing, female genital mutilation, nutritional habits and choices, social media, and peer pressure. There are no standard legal age cut-offs for adulthood; rather, the age varies for different activities, such as age of consent or the minimum age that young people can legally work, leave school, drive, buy alcohol, marry, be held accountable for criminal action, and make medical decisions. This reflects the fact that the existing systems and structures are focused on either children or adults, with very few investments and interventions directed specifically to young people. Existing legislation and guidelines need transformation to bring about a specific focus on adolescents in the domains of substance use and sexual behaviors, and the capacity for adolescent learning should be exploited through graduated legal and policy frameworks.

CONCLUSION

Sustainable development goals provide an opportunity to target this neglected and vulnerable age group. A multisectoral approach is needed to bring about healthy change and address the challenges faced by adolescents and youth, from modifications at a broader legislative and policy level to ground-level (community-level) implementations.

Interventions for Adolescent Substance Abuse: An Overview of Systematic Reviews

Many unhealthy behaviors often begin during adolescence and represent major public health challenges. Substance abuse has a major impact on individuals, families, and communities, as its effects are cumulative, contributing to costly social, physical, and mental health problems. We conducted an overview of systematic reviews to evaluate the effectiveness of interventions to prevent substance abuse among adolescents. We report findings from a total of 46 systematic reviews focusing on interventions for smoking/tobacco use, alcohol use, drug use, and combined substance abuse. Our overview findings suggest that among smoking/tobacco interventions, school-based prevention programs and family-based intensive interventions typically addressing family functioning are effective in reducing smoking. Mass media campaigns are also effective given that these were of reasonable intensity over extensive periods of time. Among interventions for alcohol use, school-based alcohol prevention interventions have been associated with reduced frequency of drinking, while family-based interventions have a small but persistent effect on alcohol misuse among adolescents. For drug abuse, school-based interventions based on a combination of social competence and social influence approaches have shown protective effects against drugs and cannabis use. Among the interventions targeting combined substance abuse, school-based primary prevention programs are effective. Evidence from Internet-based interventions, policy initiatives, and incentives appears to be mixed and needs further research. Future research should focus on evaluating the effectiveness of specific interventions components with standardized intervention and outcome measures. Various delivery platforms, including digital platforms and policy initiative, have the potential to improve substance abuse outcomes among adolescents; however, these require further research.

Interventions for Adolescent Mental Health: An Overview of Systematic Reviews

Many mental health disorders emerge in late childhood and early adolescence and contribute to the burden of these disorders among young people and later in life. We systematically reviewed literature published up to December 2015 to identify systematic reviews on mental health interventions in adolescent population. A total of 38 systematic reviews were included. We classified the included reviews into the following categories for reporting the findings: school-based interventions (n = 12); community-based interventions (n = 6); digital platforms (n = 8); and individual-/family-based interventions (n = 12). Evidence from school-based interventions suggests that targeted group-based interventions and cognitive behavioral therapy are effective in reducing depressive symptoms (standard mean difference [SMD]: -.16; 95% confidence interval [CI]: -.26 to -.05) and anxiety (SMD: -.33; 95% CI: -.59 to -.06). School-based suicide prevention programs suggest that classroom-based didactic and experiential programs increase short-term knowledge of suicide (SMD: 1.51; 95% CI: .57-2.45) and knowledge of suicide prevention (SMD: .72; 95% CI: .36-1.07) with no evidence of an effect on suicide-related attitudes or behaviors. Community-based creative activities have some positive effect on behavioral changes, self-confidence, self-esteem, levels of knowledge, and physical activity. Evidence from digital platforms supports Internet-based prevention and treatment programs for anxiety and depression; however, more extensive and rigorous research is warranted to further establish the conditions. Among individual- and family-based interventions, interventions focusing on eating attitudes and behaviors show no impact on body mass index (SMD: -.10; 95% CI: -.45 to .25); Eating Attitude Test (SMD: .01; 95% CI: -.13 to .15); and bulimia (SMD: -.03; 95% CI: -.16 to .10). Exercise is found to be effective in improving self-esteem (SMD: .49; 95% CI: .16-.81) and reducing depression score (SMD: -.66; 95% CI: -1.25 to -.08) with no impact on anxiety scores. Cognitive behavioral therapy compared to waitlist is effective in reducing remission (odds ratio: 7.85; 95% CI: 5.31-11.6). Psychological therapy when compared to antidepressants have comparable effect on remission, dropouts, and depression symptoms. The studies evaluating mental health interventions among adolescents were reported to be very heterogeneous, statistically, in their populations, interventions, and outcomes; hence, meta-analysis could not be conducted in most of the included reviews. Future trials should also focus on standardized interventions and outcomes for synthesizing the exiting body of knowledge. There is a need to report differential effects for gender, age groups, socioeconomic status, and geographic settings since the impact of mental health interventions might vary according to various contextual factors.

Systematic Review and Meta-Analysis of Interventions to Improve Access and Coverage of Adolescent Immunizations

Vaccination strategies are among the most successful and cost-effective public health strategies for preventing disease and death. Until recently, most of the existing immunization programs targeted infants and children younger than 5 years which have successfully resulted in reducing global infant and child mortality. Adolescent immunization has been relatively neglected, leaving a quarter of world's population underimmunized and hence vulnerable to a number of preventable diseases. In recent years, a large number of programs have been launched to increase the uptake of different vaccines in adolescents; however, the recommended vaccination coverage among the adolescent population overall remains very low, especially in low- and middle-income countries. Adolescent vaccination has received significantly more attention since the advent of the human papillomavirus (HPV) vaccine in 2006. However, only half of the adolescent girls in the United States received a single dose of HPV vaccine while merely 43% and 33% received two and three doses, respectively. We systematically reviewed literature published up to December 2014 and included 23 studies on the effectiveness of interventions to improve immunization coverage among adolescents. Moderate-quality evidence suggested an overall increase in vaccination coverage by 78% (relative risk: 1.78; 95% confidence interval: 1.41-2.23). Review findings suggest that interventions including implementing vaccination requirement in school, sending reminders, and national permissive recommendation for adolescent vaccination have the potential to improve immunization uptake. Strategies to improve coverage for HPV vaccines resulted in a significant decrease in the prevalence of HPV by 44% and genital warts by 33%; however, the quality of evidence was low. Analysis from single studies with low- or very low-quality evidence suggested significant decrease in varicella deaths, measles incidence, rubella susceptibility, and incidence of pertussis while the impact was nonsignificant for incidence of mumps with their respective vaccines. Further rigorous evidence is needed to evaluate the effectiveness of strategies to improve immunization uptake among adolescents from low- and middle-income countries.

Improving Adolescent Sexual and Reproductive Health: A Systematic Review of Potential Interventions

Adolescents have special sexual and reproductive health needs (whether or not they are sexually active or married). This review assesses the impact of interventions to improve adolescent sexual and reproductive health (including the interventions to prevent female genital mutilation/cutting [FGM/C]) and to prevent intimate violence. Our review findings suggest that sexual and reproductive health education, counseling, and contraceptive provision are effective in increasing sexual knowledge, contraceptive use, and decreasing adolescent pregnancy. Among interventions to prevent FGM/C, community mobilization and female empowerment strategies have the potential to raise awareness of the adverse health consequences of FGM/C and reduce its prevalence; however, there is a need to conduct methodologically rigorous intervention evaluations. There was limited and inconclusive evidence for the effectiveness of interventions to prevent intimate partner violence. Further studies with rigorous designs, longer term follow-up, and standardized and validated measurement instruments are required to maximize comparability of results. Future efforts should be directed toward scaling-up evidence-based interventions to improve adolescent sexual and reproductive health in low- and middle-income countries, sustain the impacts over time, and ensure equitable outcomes.

Interventions to Prevent Unintentional Injuries Among Adolescents: A Systematic Review and Meta-Analysis

Globally, every day, ∼2,300 children and adolescents succumb to unintentional injuries sustained from motor vehicle collisions, drowning, poisoning, falls, burns, and violence. The rate of deaths due to motor vehicle injuries in adolescents is 10.2 per 100,000 adolescents. We systematically reviewed published evidence to identify interventions to prevent unintentional injuries among adolescents aged 11-19 years. We defined unintentional injuries as a subset of injuries for which there was no evidence of predetermined intent, and the definition included motor vehicle injuries, suffocation, drowning, poisoning, burns, falls, and sports and recreation. Thirty-five studies met study eligibility criteria. The included studies focused on interventions to prevent motor vehicle injuries and sports-related injuries. Results suggest that possession of a graduated driver license (GDL) significantly reduced road accidents by 19% (relative risk [RR]: .81; 95% confidence interval [CI]: .75-.88; n = 5). There was no impact of GDL programs on incidence of injuries (RR: .78; 95% CI: .57-1.06; n = 2), helmet use (RR: 1.0; 95% CI: .98-1.02; n = 3), and seat belt use (RR: .99; 95% CI: .97-1.0; n = 3). Sports-related injury prevention interventions led to reductions in the incidence of injuries (RR: .66; 95% CI: .53-.82; n = 15), incidence of injury per hour of exposure (RR: .63; 95% CI: .47-.86; n = 5), and injuries per number of exposures (RR: .79; 95% CI: .70-.88; n = 4). Subgroup analysis according to the type of interventions suggests that training ± education and the use of safety equipment had significant impacts on reducing the incidence of injuries. We did not find any study focusing on interventions to prevent suffocation, drowning, poisoning, burns, and falls in the adolescent age group. The existing evidence is mostly from high-income countries, limiting the generalizability of these findings for low- and middle-income countries. Studies evaluating these interventions need to be replicated in a low- and middle-income country-context to evaluate effectiveness with standardized outcome measures.

Adolescent Health Interventions: Conclusions, Evidence Gaps, and Research Priorities

Adolescent health care is challenging compared to that of children and adults, due to their rapidly evolving physical, intellectual, and emotional development. This paper is the concluding paper for a series of reviews to evaluate the effectiveness of interventions for improving adolescent health and well-being. In this paper, we summarize the evidence evaluated in the previous papers and suggest areas where there is enough existing evidence to recommend implementation and areas where further research is needed to reach consensus. Potentially effective interventions for adolescent health and well-being include interventions for adolescent sexual and reproductive health, micronutrient supplementation, nutrition interventions for pregnant adolescents, interventions to improve vaccine uptake among adolescents, and interventions for substance abuse. Majority of the evidence for improving immunization coverage, substance abuse, mental health, and accidents and injury prevention comes from high-income countries. Future studies should specifically be targeted toward the low- and middle-income countries with long term follow-up and standardized and validated measurement instruments to maximize comparability of results. Assessment of effects by gender and socioeconomic status is also important as there may be differences in the effectiveness of certain interventions. It is also important to recognize ideal delivery platforms that can augment the coverage of proven adolescent health-specific interventions and provide an opportunity to reach hard-to-reach and disadvantaged population groups.

Interventions to Improve Adolescent Nutrition: A Systematic Review and Meta-Analysis

Adequate adolescent nutrition is an important step for optimal growth and development. In this article, we systematically reviewed published studies till December 2014 to ascertain the effectiveness of interventions to improve adolescent nutrition. We found one existing systematic review on interventions to prevent obesity which we updated and conducted de novo reviews for micronutrient supplementation and nutrition interventions for pregnant adolescents. Our review findings suggest that micronutrient supplementation among adolescents (predominantly females) can significantly decrease anemia prevalence (relative risk [RR]: .69; 95% confidence interval [CI]: .62-.76) while interventions to improve nutritional status among "pregnant adolescents" showed statistically significant improved birth weight (standard mean difference: .25; 95% CI: .08-.41), decreased low birth weight (RR: .70; 95% CI: .57-.84), and preterm birth (RR: .73; 95% CI: .57-.95). Interventions to promote nutrition and prevent obesity had a marginal impact on reducing body mass index (standard mean difference: -.08; 95% CI: -.17 to .01). However, these findings should be interpreted with caution due to significant statistical heterogeneity.