Leveraging Technology to Improve Health in Adolescence: A Developmental Science Perspective

Effectiveness of a Mobile Phone-Delivered Multiple Health Behavior Change Intervention (LIFE4YOUth) in Adolescents: Randomized Controlled Trial

BACKGROUND

Although mobile health (mHealth) interventions have demonstrated effectiveness in modifying 1 or 2 health-risk behaviors at a time, there is a knowledge gap regarding the effects of stand-alone mHealth interventions on multiple health risk behaviors.

OBJECTIVE

This study aimed to estimate the 2- and 4-month effectiveness of an mHealth intervention (LIFE4YOUth) targeting alcohol consumption, diet, physical activity, and smoking among Swedish high school students, compared with a waiting-list control condition.

METHODS

A 2-arm parallel group, single-blind randomized controlled trial (1:1) was conducted from September 2020 to June 2023. Eligibility criteria included nonadherence to guidelines related to the primary outcomes, such as weekly alcohol consumption (standard drinks), monthly frequency of heavy episodic drinking (ie, ≥4 standard drinks), daily intake of fruit and vegetables (100-g portions), weekly consumption of sugary drinks (33-cL servings), weekly duration of moderate to vigorous physical activity (minutes), and 4-week point prevalence of smoking abstinence. The intervention group had 16 weeks of access to LIFE4YOUth, a fully automated intervention including recurring screening, text message services, and a web-based dashboard. Intention-to-treat analysis was conducted on available and imputed 2- and 4-month self-reported data from participants at risk for each outcome respectively, at baseline. Effects were estimated using multilevel models with adaptive intercepts (per individual) and time by group interactions, adjusted for baseline age, sex, household economy, and self-perceived importance, confidence, and know-how to change behaviors. Bayesian inference with standard (half-)normal priors and null-hypothesis testing was used to estimate the parameters of statistical models.

RESULTS

In total, 756 students (aged 15-20, mean 17.1, SD 1.2 years; 69%, 520/756 females; 31%, 236/756 males) from high schools across Sweden participated in the trial. Follow-up surveys were completed by 71% (539/756) of participants at 2 months and 57% (431/756) of participants at 4 months. Most participants in the intervention group (219/377, 58%) engaged with the intervention at least once. At 2 months, results indicated positive effects in the intervention group, with complete case data indicating median between-group differences in fruit and vegetable consumption (0.32 portions per day, 95% CI 0.13-0.52), physical activity (50 minutes per week, 95% CI -0.2 to 99.7), and incidence rate ratio for heavy episodic drinking (0.77, 95% CI 0.55-1.07). The odds ratio for smoking abstinence (1.09, 95% CI 0.34-3.64), incidence rate ratio for weekly alcohol consumption (0.69, 95% CI 0.27-1.83), and the number of sugary drinks consumed weekly (0.89, 95% CI 0.73-1.1) indicated inconclusive evidence for effects due to uncertainty in the estimates. At 4 months, a remaining effect was observed on physical activity only.

CONCLUSIONS

Although underpowered, our findings suggest modest short-term effects of the LIFE4YOUth intervention, primarily on physical activity and fruit and vegetable consumption. Our results provide inconclusive evidence regarding weekly alcohol consumption and smoking abstinence.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN34468623; https://doi.org/10.1186/ISRCTN34468623.

Association between smartphone addiction and sedentary behaviour amongst children, adolescents and young adults: A Systematic Review and meta-analysis

BACKGROUND

The rapid proliferation of smartphones has raised concerns about their impact on physical activity levels, particularly among younger demographics. While smartphones offer numerous benefits, there is growing evidence to suggest that excessive use may lead to sedentary behaviours, potentially impacting physical health adversely. Hence, this review was done to explore the association between smartphone addiction and reduced physical activity amongst children, adolescents and young adults.

METHODS

This meta-analysis systematically reviewed ten studies involving 5195 participants. We employed a random-effects model with DerSimonian-Laird estimation for tau2 to calculate pooled odds ratios (ORs). Subgroup analyses were conducted based on geographical regions, risk of bias, and different measurement tools to assess the robustness and variability of the findings. Publication bias was assessed using funnel plots, Egger's test, and the trim-and-fill method.

RESULTS

The analysis revealed a significant association between smartphone addiction and reduced physical activity, with a pooled OR of 2.19 (95% CI: 1.34 to 3.57, p = 0.002). Notably, subgroup analyses demonstrated a stronger association in studies from the Middle-Eastern region (OR = 4.75; p = 0.026) and among studies employing alternative standardized scales (OR = 3.32; p = 0.044). Sensitivity analyses confirmed the robustness of these findings, and although potential publication bias was detected, it did not materially affect the overall estimates.

CONCLUSIONS

Smartphone addiction is significantly linked with reduced physical activity among younger populations, underscoring the need for targeted public health interventions and longitudinal studies to elucidate causal mechanisms. These findings highlight that mitigating excessive smartphone use may be a critical component in promoting active lifestyles.

The impact of the social media industry as a commercial determinant of health on the digital food environment for children and adolescents: a scoping review

INTRODUCTION

There is emerging evidence that the social media industry contributes to adverse health outcomes by shaping the digital food environment for children and adolescents (aged 0-18). The aim of this scoping review was to determine the extent of research on how the social media industry, including the broader online landscape, influences the digital food environment and affects child and adolescent health.

METHODS

A scoping review was conducted in the electronic databases of PubMed, Scopus and PsycINFO, along with forward and reverse citation searching for peer-reviewed articles published in English between 2000 and May 2023. A qualitative descriptive synthesis of the included articles was performed to identify trends, themes and research gaps in the current literature.

RESULTS

The review identified 36 articles for inclusion. Most research was conducted in high-income countries and publications have increased since 2021. The review found most children and adolescents are exposed to food advertisements on social media and most advertised food is ultra-processed. Heightened by a lack of social media advertising awareness, digital food marketing influences children and youth's consumption and food behaviour. Voluntary children's food marketing regulations are ineffective for the online environment. Countering unhealthy food marketing will require media literacy and government regulation.

CONCLUSION

The social media industry may act as a commercial determinant of health to shape the digital food environment as an extension of the obesogenic environment. Further research should explore approaches to monitor unhealthy food marketing practices and understand social media's role in the digital food environment.

TikTok and teen mental health: an analysis of user-generated content and engagement

BACKGROUND

TikTok is a social media mobile application that is widely used by adolescents, and has the potential to serve as a revolutionary platform for public and mental health discourse, education, and intervention.

OBJECTIVE

Our study aimed to describe the content and engagement metrics of the hashtag #teenmentalhealth on TikTok.

METHODS

In this study, we: (a) conducted a directed content analysis of the Top 100 TikTok videos tagged with #teenmentalhealth, and (b) collected data on video engagements (views, likes, saves, and shares) and computed view-based engagement rates.

RESULTS

The videos collectively garnered 144,320,591 views; 28,289,655 likes; 219,780 comments; 1,971,492 saves; and 478,696 shares. Most of the generated content were from teens and therapists. Engagement metrics revealed strong user engagement rates across user types. The most prevalent content categories represented across videos were personal experience, coping techniques or treatment, humor, interpersonal relationships, and health campaign. The content categories with the highest engagement rates were relatable media representation, health campaign, social isolation, and humor. Only a single video incorporated evidence-based treatment content.

CONCLUSION

TikTok facilitates communication and information dissemination on teen mental health. Future research should focus on improving the quality and credibility of digital content while maintaining engagement through creativity, self-expression, and relatability. Use of popular social media platforms and community-engaged research to disseminate evidence-based content may help bridge the translational research gap.

Mental Health Monitoring for Young People Through Mood Apps: Protocol for a Scoping Review and Systematic Search in App Stores

BACKGROUND

The researchers have used mobile phones to assist in monitoring, analyzing, and managing moods to acquire insight into mood patterns. There is a lack of evidence in their use as clinical tools and interventions, which necessitates a comprehensive review and quality assessment to understand barriers and facilitators for app implementation as an impactful clinical intervention.

OBJECTIVE

This review aims to (1) provide an overview of the recent evidence on mobile mood-monitoring apps that are intended for facilitating self-management and support of mental health in children, adolescents, and young people; and (2) investigate the quality of publicly available apps.

METHODS

The study will first involve a scoping review of the literature on mood-monitoring apps for children, adolescents, and young people followed by an evaluation of features of the apps available in the marketplace. The scoping review will follow the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and search 6 databases- Embase, CINAHL, PubMed, ACM Digital Library, Scopus, and Springer LNCS-for relevant studies and reviews published in the last 3 years. The author will then screen the references, extract data from the included studies, and analyze them to synthesize the evidence on mood apps. Next, the Apple App Store and Google Play Store will be searched for mood apps. A total of 2 independent reviewers will screen the apps based on eligibility criteria, and disagreements will be resolved through consensus. The features of the selected apps will then be evaluated using the Mobile Health Index and Navigation framework, and descriptive analysis will be used to synthesize the findings.

RESULTS

Literature search and screening began soon after submission of the protocol and is expected to be completed by September 2024. The app evaluation will be completed by October 2024.

CONCLUSIONS

Combined, the scoping literature review and app evaluation will provide an in-depth overview of the most recent scientific evidence related to mood apps and the quality of apps actually available for use.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/56400.

Development and testing of a videogame intervention for symptom management among 8-18 years old children with cancer: a study protocol

INTRODUCTION

Evidence shows that cancer treatment-related symptoms could be managed effectively in 8-18 years old children through Digital Health Interventions (DHIs), consequently improving their health-related quality of life (HRQOL). However, limited research is available about digitally mediated educative health interventions for children with cancer from lower-middle income countries like Pakistan. This study aims to develop a videogame intervention for children with cancer and test the clinical efficacy of the videogame concerning HRQOL and cancer treatment-related symptoms. Moreover, the following feasibility outcomes will be recorded: acceptability, appropriateness, cost, feasibility and intervention fidelity.

METHODS AND ANALYSIS

An exploratory sequential mixed methods design is used in this study. In the first phase of the study, we interviewed 28 participants (14 child-parent dyads) and assessed their symptom experiences affecting children's HRQOL. Moreover, their preferences for the development of the videogame were also elicited. Based on the findings from relevant literature and the interviews, we developed the videogame in collaboration with clinical and digital experts in the study's second phase. In the third phase of the study, a pilot randomised controlled trial will be conducted at a Tertiary Care Hospital in Karachi, Pakistan. There will be two groups: the intervention group and the control group. The intervention group children will receive the videogame application for 8 weeks, during which symptom management strategies will be taught to them. Children in the attention control group will receive weekly WhatsApp messages on healthy behaviours.The primary outcome will be the HRQOL of children, and the secondary outcome will be cancer symptoms frequency and distress. These outcomes will be assessed preintervention and 8 weeks post intervention. The feasibility outcomes will be assessed quantitatively and qualitatively through a questionnaire, videogame dashboard, interviews with a subset of intervention group child-parent dyads and a focus group discussion with nurses and doctors, post intervention, respectively.

ETHICS AND DISSEMINATION

The study has been approved by the Ethics Review Committee of the Aga Khan University (2022-6833-21251). Data are accessible only to the research team in a secure form. The findings will be disseminated through publications.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Identifier NCT05796895, registered in April 2023.

Effects of virtual reality-based cognitive training for adolescents with depressive episodes: A pilot randomized controlled study

Cognitive impairment is a common symptom in depression, yet few intervention strategies target adolescents. This study investigated the effects of an attention and working memory cognitive training system based on virtual reality (VRCT) in adolescents with mild to moderate depressive episodes. Adolescents with depression were randomized into a VR training group (VRG, n = 47) or a waitlist control group (WT, n = 46). The VR training consisted of three 10-min tasks per session, conducted three sessions per week for 20 sessions over 7 weeks. Forty-four healthy adolescents participated as a comparison group for baseline cognitive assessment. Cognitive functions and depressive symptoms were assessed using the Das-Naglieri cognitive assessment system, driven by the Planning, Attention, Simultaneous, and Successive (PASS) processing theory, and the Hamilton Depression Rating Scale-24 at pre- and post-intervention. Baseline results indicated significantly lower cognitive scores in patients compared to healthy adolescents. Post-intervention, the VRG demonstrated significant improvements in all four cognitive scales (effect sizes 0.56 to 0.76) and a significant reduction in depressive symptoms compared to the WT. These findings suggest that VRCT holds potential for improving cognitive impairments and alleviating depressive symptoms in adolescents with depression. Further large-scale and follow-up studies are necessary to confirm long-term benefits.

Meeting the Needs of Emerging Adults With Type 1 Diabetes Living in a Rural Area With Mobile Health Interventions: Focus Group Study

BACKGROUND

Emerging adults (EAs; age 18-30 years) with type 1 diabetes (T1D) have more challenges with diabetes management and glycemic control than other age groups. Living in a rural community introduces additional unique diabetes care challenges due to limited access to specialty care and ancillary support services. Yet, few interventions have been developed to improve diabetes management in rural-dwelling EAs with T1D.

OBJECTIVE

This study aimed to understand the diabetes management experiences of older adolescents and EAs (age 16-25 years) with T1D living in a rural area and to assess their perceptions of the acceptability of 4 fully automated mobile health (mHealth) interventions to support diabetes management.

METHODS

EAs were identified by clinical staff through convenience sampling. In total, 8 EAs participated in 1 focus group and 1 EA completed an individual interview; all data were collected over Zoom. Facilitators explored EAs' experiences living in a rural community with T1D and discussed EAs' impressions of, feedback on, and recommendations for improving 4 mHealth interventions to meet the specific needs of EAs with T1D living in rural communities. Discussions were transcribed and analyzed using conventional content analysis.

RESULTS

In total, 9 EAs (aged 18.8, SD 2.7 years; 5, 56% men; 8, 89% White) with a duration of diabetes of 8.6 (SD 4.3) years participated. They described experiences with diabetes stigma (attributing diabetes to poor lifestyle choices) and feelings of self-consciousness (hyperawareness) in their rural communities. They attributed these experiences to the small size of their communities ("everyone knows") and community members' lack of knowledge about diabetes (unable to differentiate between type 1 and type 2 diabetes). In contrast, EAs reported high levels of social support for diabetes and diabetes care from family, friends, and other community members, but low support for medical needs. The location of their diabetes care providers and the limited accessibility of diabetes-specific and general medical care services in their local community created a challenging medical care context. Overall, EAs found mHealth interventions appealing due to their digital delivery and highlighted features that increased accessibility (voiceovers and simple, jargon-free language), individualization (ability to tailor intervention content and delivery), and applicability to their own lives and other EAs with T1D (relatability of vignettes and other content). EAs suggestions for improving the interventions included more opportunities to tailor the interventions to their preferences (greater frequency and duration, ability to adapt content to emerging needs), increasing opportunities for peer support within the interventions (friend and significant other as identified support person, connecting with peers beyond their local community), and making the tone of intervention components more casual and engaging.

CONCLUSIONS

mHealth interventions aligned with EAs' needs and preferences are a promising strategy to support EAs in communities where social support and resources might be limited.

TRIAL REGISTRATION

N/A, not a clinical trial.

Investigating the Use of Serious Games for Cancer Control Among Children and Adolescents: Scoping Review

BACKGROUND

Effective health care services that meet the diverse needs of children and adolescents with cancer are required to alleviate their physical, psychological, and social challenges and improve their quality of life. Previous studies showed that serious games help promote people's health. However, the potential for serious games to be used for successful cancer control for children and adolescents has received less attention.

OBJECTIVE

This scoping review aimed to map the use of serious games in cancer prevention and cancer care for children and adolescents, and provide future directions for serious games' development and implementation within the context of cancer control for children and adolescents.

METHODS

This study followed a combination of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and the JBI (Joanna Briggs Institute) framework for the conduct of scoping reviews. PubMed, CINAHL Plus Full Text, Scopus, Web of Science Core Collection, and American Psychological Association (APA) PsycINFO databases were used for the search.

RESULTS

From the initial 2750 search results, 63 papers were included in the review, with 28 quantitative, 14 qualitative, and 21 mixed method studies. Most of the studies were cancer care serious game papers (55/63, 87%) and a small number of studies were cancer prevention serious game papers (8/63, 13%). The majority of the included studies were published between 2019 and 2023 (cancer prevention: 5/8, 63%; cancer care: 35/55, 64%). The majority of the studies were conducted in Europe (cancer prevention: 3/8, 38%; cancer care: 24/55, 44%) and North America (cancer prevention: 4/8, 50%; cancer care: 17/55, 31%). Adolescents were the most represented age group in the studies' participants (cancer prevention: 8/8, 100%; cancer care: 46/55, 84%). All (8/8, 100%) cancer prevention serious game papers included healthy people as participants, and 45 out of 55 (82%) cancer care serious game papers included patients with cancer. The majority of cancer prevention serious game papers addressed game preference as a target outcome (4/8, 50%). The majority of cancer care serious game papers addressed symptom management as a target outcome (28/55, 51%). Of the cancer care studies examining serious games for symptom management, the majority of the studies were conducted to treat psychological (13/55, 24%) and physical symptoms (10/55, 18%).

CONCLUSIONS

This review shows both the growth of interest in the use of serious games for cancer control among children and adolescents and the potential for bias in the relevant literature. The diverse characteristics of the included papers suggest that serious games can be used in various ways for cancer control among children and adolescents while highlighting the need to develop and implement serious games in underrepresented areas.

Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part I. A Systematic Review of Socioemotional Outcomes and Recommendations

Youth-specific digital mental health interventions (DMHI) represent an emerging field of study, and aim to increase access, improve socioemotional outcomes, and, where required, support triage to targeted interventions. However, prior reviews have reported inconsistent findings on the clinical effectiveness of such interventions in young adults (12-25 years). Further, shortfalls remain for the impact of guided interventions based on the mode of delivery and the type of human support personnel (e.g., professional or peer) guiding the intervention. In response, this systematic review, co-designed with Australia's leading mental health organization, aims to assess the effectiveness of guided digital programs in improving youth socioemotional outcomes. Included studies involve young people experiencing mental ill-health, receiving brief (i.e., 1-12 sessions), digitally delivered (at least partially) psychological interventions that were guided or partially guided, tested in a type of experimental study, with a socioemotional outcome. Specific socioemotional outcomes examined were depression, anxiety, stress, wellbeing, mindfulness, and quality of life. A systematic search of the contemporary published and grey literature identified 22,482 records with 32 relevant records published between 2018 and 2023. A narrative synthesis guided integration of findings. Results demonstrated strong evidence for the effectiveness of guided interventions on socioemotional outcomes (i.e., depression, anxiety, stress) yet these effects were short-lived. When factoring in the use of different control groups (i.e., active vs. inactive), inconsistent effects were observed for the socioemotional outcomes of depression, anxiety, and stress. The mode of delivery (i.e., asynchronous, synchronous, combined) and the type of human support personnel did not appear to impact socioemotional outcomes. Results indicate efficacious brief digital interventions for depression and anxiety include refresher/follow-up content, goal setting content, and relapse prevention content. In contrast, poor efficacy is associated with interventions that include homework tasks, self-monitoring, and log-keeping content.PROSPERO, ID CRD42023405812.

Narrative Play-Promoting Adolescent Health With Interactive Games

This Arts and Medicine feature discusses INSPIRE, a digital health game designed to foster adolescent health behavior change.

Promoting mental health in children and adolescents through digital technology: a systematic review and meta-analysis

Background

The increasing prevalence of mental health issues among children and adolescents has prompted a growing number of researchers and practitioners to explore digital technology interventions, which offer convenience, diversity, and proven effectiveness in addressing such problems. However, the existing literature reveals a significant gap in comprehensive reviews that consolidate findings and discuss the potential of digital technologies in enhancing mental health.

Methods

To clarify the latest research progress on digital technology to promote mental health in the past decade (2013-2023), we conducted two studies: a systematic review and meta-analysis. The systematic review is based on 59 empirical studies identified from three screening phases, with basic information, types of technologies, types of mental health issues as key points of analysis for synthesis and comparison. The meta-analysis is conducted with 10 qualified experimental studies to determine the overall effect size of digital technology interventions and possible moderating factors.

Results

The results revealed that (1) there is an upward trend in relevant research, comprising mostly experimental and quasi-experimental designs; (2) the common mental health issues include depression, anxiety, bullying, lack of social emotional competence, and mental issues related to COVID-19; (3) among the various technological interventions, mobile applications (apps) have been used most frequently in the diagnosis and treatment of mental issues, followed by virtual reality, serious games, and telemedicine services; and (4) the meta-analysis results indicated that digital technology interventions have a moderate and significant effect size (g = 0.43) for promoting mental health.

Conclusion

Based on these findings, this study provides guidance for future practice and research on the promotion of adolescent mental health through digital technology.

Systematic review registration

https://inplasy.com/inplasy-2023-12-0004/, doi: 10.37766/inplasy2023.12.0004.

Acceptability of a Pain History Assessment and Education Chatbot (Dolores) Across Age Groups in Populations With Chronic Pain: Development and Pilot Testing

BACKGROUND

The delivery of education on pain neuroscience and the evidence for different treatment approaches has become a key component of contemporary persistent pain management. Chatbots, or more formally conversation agents, are increasingly being used in health care settings due to their versatility in providing interactive and individualized approaches to both capture and deliver information. Research focused on the acceptability of diverse chatbot formats can assist in developing a better understanding of the educational needs of target populations.

OBJECTIVE

This study aims to detail the development and initial pilot testing of a multimodality pain education chatbot (Dolores) that can be used across different age groups and investigate whether acceptability and feedback were comparable across age groups following pilot testing.

METHODS

Following an initial design phase involving software engineers (n=2) and expert clinicians (n=6), a total of 60 individuals with chronic pain who attended an outpatient clinic at 1 of 2 pain centers in Australia were recruited for pilot testing. The 60 individuals consisted of 20 (33%) adolescents (aged 10-18 years), 20 (33%) young adults (aged 19-35 years), and 20 (33%) adults (aged >35 years) with persistent pain. Participants spent 20 to 30 minutes completing interactive chatbot activities that enabled the Dolores app to gather a pain history and provide education about pain and pain treatments. After the chatbot activities, participants completed a custom-made feedback questionnaire measuring the acceptability constructs pertaining to health education chatbots. To determine the effect of age group on the acceptability ratings and feedback provided, a series of binomial logistic regression models and cumulative odds ordinal logistic regression models with proportional odds were generated.

RESULTS

Overall, acceptability was high for the following constructs: engagement, perceived value, usability, accuracy, responsiveness, adoption intention, esthetics, and overall quality. The effect of age group on all acceptability ratings was small and not statistically significant. An analysis of open-ended question responses revealed that major frustrations with the app were related to Dolores' speech, which was explored further through a comparative analysis. With respect to providing negative feedback about Dolores' speech, a logistic regression model showed that the effect of age group was statistically significant (χ22=11.7; P=.003) and explained 27.1% of the variance (Nagelkerke R2). Adults and young adults were less likely to comment on Dolores' speech compared with adolescent participants (odds ratio 0.20, 95% CI 0.05-0.84 and odds ratio 0.05, 95% CI 0.01-0.43, respectively). Comments were related to both speech rate (too slow) and quality (unpleasant and robotic).

CONCLUSIONS

This study provides support for the acceptability of pain history and education chatbots across different age groups. Chatbot acceptability for adolescent cohorts may be improved by enabling the self-selection of speech characteristics such as rate and personable tone.

Supporting Adolescent Engagement with Artificial Intelligence-Driven Digital Health Behavior Change Interventions

Understanding and optimizing adolescent-specific engagement with behavior change interventions will open doors for providers to promote healthy changes in an age group that is simultaneously difficult to engage and especially important to affect. For digital interventions, there is untapped potential in combining the vastness of process-level data with the analytical power of artificial intelligence (AI) to understand not only how adolescents engage but also how to improve upon interventions with the goal of increasing engagement and, ultimately, efficacy. Rooted in the example of the INSPIRE narrative-centered digital health behavior change intervention (DHBCI) for adolescent risky behaviors around alcohol use, we propose a framework for harnessing AI to accomplish 4 goals that are pertinent to health care providers and software developers alike: measurement of adolescent engagement, modeling of adolescent engagement, optimization of current interventions, and generation of novel interventions. Operationalization of this framework with youths must be situated in the ethical use of this technology, and we have outlined the potential pitfalls of AI with particular attention to privacy concerns for adolescents. Given how recently AI advances have opened up these possibilities in this field, the opportunities for further investigation are plenty.

A Scoping Review of Digital Health Interventions to Promote Healthy Romantic Relationships in Adolescents

Despite a robust field of study in healthy romantic relationship education and risk prevention interventions that employ traditional forms of delivery, the field of digital health interventions (DHIs) in healthy relationship programming for adolescents remains undefined. The purpose of this scoping review was to summarize the scope of published research in DHIs that promote healthy romantic relationships in adolescents. We conducted database searches, 2000-2022; hand searches; reference list and literature review searches, and emailed study authors to identify articles. Included were experimental, development, and feasibility studies. We summarized features of selected studies and their healthy relationship aims/components and identified patterns of emphasis and areas of future need. Sixteen publications describing 15 unique DHIs were reviewed with interventions developed and or trialed in 11 countries. We identified 10 web-based or downloadable applications, four serious game applications, one video-voice program, and one social media-based program. DHIs focused on improving knowledge/attitudes/skills of healthy adolescent romantic relationships directly or through prevention-focused programs. Interventions that measured outcomes found small effects, primarily in healthy romantic relationship communication skills. DHIs offer unique opportunities to provide user-responsive and culturally specified programming for adolescents and to involve adolescents themselves in processes of program design, development, and evaluation. Further research is warranted to define relevant outcomes for adolescents and validated measures to evaluate them. Future research might seek to address the social ecology of adolescent romantic relationships beyond the individual and interpersonal and explore combinations of virtual and adult-moderated in-person delivery to ensure youth are adequately supported.

Using Digital Measurement-Based Care for the Treatment of Anxiety and Depression in Children and Adolescents: Observational Retrospective Analysis of Bend Health Data

BACKGROUND

A growing body of evidence supports the efficacy of measurement-based care (MBC) for children and adolescents experiencing mental health concerns, particularly anxiety and depression. In recent years, MBC has increasingly transitioned to web-based spaces in the form of digital mental health interventions (DMHIs), which render high-quality mental health care more accessible nationwide. Although extant research is promising, the emergence of MBC DMHIs means that much is unknown regarding their effectiveness as a treatment for anxiety and depression, particularly among children and adolescents.

OBJECTIVE

This study uses preliminary data from children and adolescents participating in an MBC DMHI administered by Bend Health Inc, a mental health care provider that uses a collaborative care model to assess changes in anxiety and depressive symptoms during participation in the MBC DMHI.

METHODS

Caregivers of children and adolescents participating in Bend Health Inc for anxiety or depressive symptoms reported measures of their children's symptoms every 30 days throughout the duration of participation in Bend Health Inc. Data from 114 children (age 6-12 years) and adolescents (age 13-17 years) were used for the analyses (anxiety symptom group: n=98, depressive symptom group: n=61).

RESULTS

Among children and adolescents participating in care with Bend Health Inc, 73% (72/98) exhibited improvements in anxiety symptoms and 73% (44/61) exhibited improvement in depressive symptoms, as indicated by either a decrease in symptom severity or screening out of completing the complete assessment. Among those with complete assessment data, group-level anxiety symptom T-scores exhibited a moderate decrease of 4.69 points (P=.002) from the first to the last assessment. However, members' depressive symptom T-scores remained largely stable throughout their involvement.

CONCLUSIONS

As increasing numbers of young people and families seek DMHIs over traditional mental health treatments due to their accessibility and affordability, this study offers promising early evidence that youth anxiety symptoms decrease during involvement in an MBC DMHI such as Bend Health Inc. However, further analyses with enhanced longitudinal symptom measures are necessary to determine whether depressive symptoms show similar improvements among those involved in Bend Health Inc.

Using digital measurement-based care to address symptoms of inattention, hyperactivity, and opposition in youth: A retrospective analysis of Bend Health (Preprint)

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) and associated behavioral disorders are highly prevalent in children and adolescents, yet many of them do not receive the care they need. Digital mental health interventions (DMHIs) may address this need by providing accessible and high-quality care. Given the necessity for high levels of caregiver and primary care practitioner involvement in addressing ADHD symptoms and behavioral problems, collaborative care interventions that adopt a whole-family approach may be particularly well suited to reduce symptoms of inattention, hyperactivity, and opposition in children and adolescents.

OBJECTIVE

The purpose of this study is to use member (ie, child and adolescent) data from Bend Health, Inc, a collaborative care DMHI that uses a whole-family approach to address child and adolescent mental health concerns, to (1) determine the effects of a collaborative care DMHI on inattention, hyperactivity, and oppositional symptoms in children and adolescents and (2) assess whether the effects of a collaborative care DMHI vary across ADHD subtypes and demographic factors.

METHODS

Caregivers of children and adolescents with elevated symptoms of inattention, hyperactivity, or opposition assessed their children's symptom severity approximately every 30 days while participating in Bend Health, Inc. Data from 107 children and adolescents aged 6-17 years who exhibited clinically elevated symptoms at baseline were used to assess symptom severity across monthly assessments (inattention symptom group: n=91, 85.0%; hyperactivity symptom group: n=48, 44.9%; oppositional symptom group: n=70, 65.4%). The majority of the sample exhibited elevated symptoms of at least 2 symptom types at baseline (n=67, 62.6%).

RESULTS

Members received care for up to 5.52 months and attended between 0 and 10 coaching, therapy, or psychiatry sessions through Bend Health, Inc. For those with at least 2 assessments, 71.0% (n=22) showed improvements in inattention symptoms, 60.0% (n=9) showed improvements in hyperactivity symptoms, and 60.0% (n=12) showed improvements in oppositional symptoms. When considering group-level change over time, symptom severity decreased over the course of treatment with Bend Health, Inc, for inattention (average decrease=3.51 points, P=.001) and hyperactivity (average decrease=3.07 points, P=.049) but not for oppositional symptoms (average decrease=0.70 points, P=.26). There was a main effect of the duration of care on symptom severity (P<.001) such that each additional month of care was associated with lower symptom scores.

CONCLUSIONS

This study offers promising early evidence that collaborative care DHMIs may facilitate improvements in ADHD symptoms among children and adolescents, addressing the growing need for accessible and high-quality care for behavioral health problems in the United States. However, additional follow-up studies bolstered by larger samples and control groups are necessary to further establish the robustness of these findings.

Positive Effects of Digital Technology Use by Adolescents: A Scoping Review of the Literature

This study examines the research literature published from 2012 to 2022 on the relationship between increases in adolescent consumption of digital technologies and its impact on multiple areas of development, with a focus on how adolescent immersion in an increasingly ubiquitous digital world engenders positive outcomes in terms of brain, cognitive, and social-emotional development. The literature search yielded 131 articles, 53 of which were empirical studies of the relationship between increases in consumption of digital technology and brain development, cognitive development, or social-emotional development among adolescents. Overall, these studies identify positive outcomes for adolescents who use different types of digital tech, including the internet, social media, and video games.

Silence After Stops? Assessing Youth Disclosure of Police Encounters

Youth-police encounters are common in the United States, with potentially serious mental health ramifications requiring social supports to cope. Still, no research has examined youth disclosure of these experiences to others. Using a national sample of youth stopped by police (N = 918; 56.09% Black, 20.48% Hispanic), we find that more than two-thirds disclosed police encounters-most commonly to mothers. Even so, disclosure became less likely as perceptions of procedural injustice, social stigma, and legal cynicism increased. Among youth who disclosed stops but not to parents, disclosure to friends was common (61.18%), whereas disclosure to nonparent adults was not. Enhanced training for teachers, school counselors, and community leaders may improve youth outcomes by facilitating additional opportunities for disclosure and support.

Associations of Sustainable Development Goals Accelerators With Adolescents' Well-Being According to Head-of-Household's Disability Status-A Cross-Sectional Study From Zambia

Objectives: We examined associations between accelerators (interventions impacting ≥2 SDG targets) and SDG-aligned well-being indicators among adolescents 16-24 years old in Zambia. Methods: We surveyed adults from 1,800 randomly sampled households receiving social cash transfers. We examined associations between accelerators (social cash transfers, life-long learning, mobile phone access) and seven well-being indicators among adolescents using multivariate logistic regressions. Results: The sample comprised 1,725 adolescents, 881 (51.1%) girls. Mobile phone access was associated with no poverty (adjusted Odds Ratio [aOR] 2.08, p < 0.001), informal cash transfers (aOR 1.82, p = 0.004), and seeking mental health support (aOR 1.61, p = 0.020). Social cash transfers were associated with no disability-related health restrictions (aOR 2.56, p = 0.004) and lesser odds of seeking mental health support (aOR 0.53, p = 0.029). Life-long learning was associated with informal cash transfers (aOR 3.49, p < 0.001) and lower school enrollment (aOR 0.70, p = 0.004). Adolescents with disabled head-of-household reported worse poverty, good health but less suicidal ideation. Conclusions: Social cash transfers, life-long learning, and mobile phone access were positively associated with well-being indicators. Adolescents living with disabled head-of-household benefited less. Governments should implement policies to correct disability-related inequalities.

Problematic internet use as a moderator between personality dimensions and internalizing and externalizing symptoms in adolescence

Digital technology use plays an essential role in adolescents' psychological adjustment, impacting their mental health and well-being. In this scenario, Problematic Internet Use (PIU) is a risky condition for developing behavioral addiction in adolescence. Most of the research on PIU in adolescence focus on dimensions that may amplify or buffer it, finding significant associations between PIU and interpersonal problems with peers, maladaptive personality traits, low self-esteem, emotion dysregulation, and increasing psychological difficulties. It has been suggested that PIU might represent a maladaptive coping strategy to tackle problematic psychosocial functioning. In this line, the current cross-sectional study focused on PIU's role in the association between personality dimensions and internalizing/externalizing problems. Two-hundred thirty-one middle and late adolescents (age range 15-19 years; 62% Female) attending public junior high schools in Italy completed the Internet Addiction Test (IAT), the Adolescent Personality Structure Questionnaire (APS-Q), and the Youth Self Report (YSR). Moderation analyses were used to test the hypothesis that higher PIU amplifies the relationship between maladaptive personality dimensions and psychological symptoms. Results indicated that only high PIU influenced the relationship between difficulties in building significant relationships with peers and internalizing problems. Conversely, PIU buffered the relationship between difficulties in adolescents' sense of self (identity) and internalizing problems and the association between aggression regulation and internalizing problems, supporting the role of PIU as a maladaptive coping strategy. These findings encourage accurately evaluating PIU as a risk factor in adolescence: (1) considering how high PIU's presence should impact the relationship between adolescent personality and the quality of their relationships with peers; (2) acknowledging the role of PIU as a regulation strategy for identity difficulties and aggression dysregulation.

Educators' Perspectives on Integrating Technology Into Sexual Health Education: Implementation Study

Background

In the last decade, the use of technology-based sexual health education has increased. Multiple studies have shown the feasibility of technology-based interventions, while a subset has also shown efficacy in improving youths’ sexual health outcomes such as increased condom use and knowledge. However, little is known about health educators’ experiences in integrating technology to augment sexual health curricula.

Objective

The purpose of this study was to assess the perceptions and experiences of health educators regarding the incorporation of technology into a sexual health education program designed for underserved youth in Fresno County, California, and to identify facilitators and challenges to incorporating technology into the in-person curriculum.

Methods

This implementation study used data collected as part of a cluster randomized controlled trial to evaluate In the Know (ITK), an in-person sexual health education curriculum that includes technology-based content, such as a resource locator, videos, and games, which can be accessed through a mobile app or website. Data from implementation logs from each cohort (n=51) and annual interviews (n=8) with health educators were analyzed to assess the health educators’ experiences using the technology and adaptations made during the implementation.

Results

The health educators reported that technological issues affected implementation to some degree: 87% of the time in the first year, which decreased to 47% in the third year as health educators’ familiarity with the app increased and functionality improved. Technology issues were also more common in non–school settings. Successes and challenges in 3 domains emerged: managing technology, usability of the ITK app, and youth engagement. The health educators generally had positive comments about the app and youth engagement with the technology-based content and activities; however, they also noted certain barriers to adolescents’ use of the mobile app including limited data storage and battery life on mobile phones.

Conclusions

Health educators require training and support to optimize technology as a resource for engaging with youth and providing sensitive information. Although technology is often presented as a solution to reach underserved populations, educational programs should consider the technological needs and limitations of the participants, educators, and settings.

International Registered Report Identifier (IRRID)

RR2-10.2196/18060

Delivering Anticipatory Guidance About Technology Use to Adolescents in Primary Care: Rates in a Representative California Sample

PURPOSE

This study aimed to investigate rates of anticipatory guidance about technology use in primary care, as recommended by the American Academy of Pediatrics Bright Futures Guidelines, in a representative sample of California adolescents.

METHODS

Adolescents 12-17 years of age were interviewed as part of the California Health Interview Survey, the largest state health surveillance survey in the U.S. Participants who reported seeing a doctor for a physical examination or checkup in the prior year were asked if their doctor had talked to them about technology use.

RESULTS

Overall, 29.7% of the 742 participants reported that their doctor talked to them about technology use. There were no statistically significant differences in rates by age, sex, race/ethnicity, household income, or family type.

CONCLUSIONS

While the American Academy of Pediatrics recommends that providers deliver anticipatory guidance about technology use to adolescents in primary care, less than one-third of adolescents surveyed reported having conversations about this topic with their doctor. Given concerns about potential impacts of technology use on adolescent health, medical education should facilitate provider screening and counseling of adolescents about technology use in primary care settings.

Using Human-Centered Design to Develop, Launch, and Evaluate a National Digital Health Platform to Improve Reproductive Health for Rwandan Youth

BACKGROUND

A lack of access to evidence-based, unbiased, and youth-friendly family planning and reproductive health (FP/RH) information and care limit young people's ability to prevent unplanned pregnancies and HIV and sexually transmitted infections. This threat-ens their health and is a significant cause of school drop-out, limiting young peoples' well-being, future potential, and employment opportunities. To address these challenges facing youth, YLabs used an end-to-end human-centered design (HCD) approach to create CyberRwanda, a digital platform aiming to improve the health and livelihoods of adolescents (aged 12-19 years) in Rwanda.

DESIGNING FOR DIGITAL WITH YOUTH

From 2016 to 2020, CyberRwanda was designed and piloted using an HCD approach in partnership with more than 1,000 youth, parents, teachers, and public and private health care providers. During the problem recognition phase, HCD revealed participants' beliefs, behavioral preferences, and experiences as they relate to FP/RH specifically and their broader life experiences, motivations, and challenges. Several phases of analog, digital, and live prototyping with youth and key stakeholders were used to codesign, test, and refine the intervention for implementation.

RESULTS

CyberRwanda is a direct-to-consumer platform where adolescents can learn integrated, age-appropriate health, and skills-building information through edutainment behavior change stories and a robust frequently asked questions library, order health products online, and be linked to CyberRwanda's network of private and public health care providers who have been trained to provide adolescent-friendly care.

IMPLICATIONS FOR FUTURE RESEARCH

The HCD process resulted in significant pivots to the design of the digital platform and the implementation model. Using HCD provided a structured methodology to combine technical FP/RH expertise and visual and product design expertise to codesign and iteratively develop a digital health intervention with and for Rwandan youth.

Interventions to Promote a Healthy Sexuality among School Adolescents: A Scoping Review

Schools are particularly suitable contexts for the implementation of interventions focused on adolescent sexual behavior. Sexual education and promotion have a multidisciplinary nature. Nurses' role and the spectrum of the carried-out interventions is not clear. We aimed to identify interventions that promote a healthy sexuality among school adolescents. Our review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and was registered in the Open Science Framework. Published articles on sexuality in adolescents in school contexts were considered. The research limitations included primary studies; access in full text in English, Spanish, or Portuguese; and no data publication limitation. Research was carried out on the EBSCOhost, PubMed, SciELO, and Web of Science platforms; gray literature and the bibliographies of selected articles were also searched. A total of 56 studies were included in the sample. The studies used a broad range of research methods, and 10 types of interventions were identified. Multi-interventional programs and socio-emotional interventions showed a greater impact on long-term behavioral changes, and continuity seemed to be a key factor. Long-term studies are needed to reach a consensus on the effectiveness of interventions. Nurses' particular role on the multidisciplinary teams was found to be a gap in the research, and must be further explored.

Opportunities to Address Obesity Disparities Among High-Risk Latino Children and Adolescents

PURPOSE OF REVIEW

This review highlights obesity-related disparities among Latino children and adolescents, discusses the social determinants of health (SDoH) that drive disparities, and presents case studies of strategies for reducing disparities and promoting health equity.

RECENT FINDINGS

Recommended strategies for reducing obesity-related disparities include the use of culturally grounded programming, multi-sector collaborations, and technology. We present two exemplar studies that demonstrate that integrating cultural values and enhancing the overall cultural fit of prevention programs can increase engagement among high-risk Latino families. We also examine the use of multi-sector collaborations to build community capacity and address key SDoH that impact health behaviors and outcomes. Our last example study demonstrates the utility of technology for engaging youth and extending the reach of prevention strategies in vulnerable communities. To address growing obesity-related disparities, there is an urgent need to develop and test these strategies among high-risk, vulnerable populations like Latino children and adolescents.

Developmentally appropriate transitional care during the Covid-19 pandemic for young people with juvenile-onset rheumatic and musculoskeletal diseases: the rationale for a position statement

BACKGROUND

The importance of developmentally appropriate transitional care in young people with juvenile-onset rheumatic and musculoskeletal disease is well recognised. The Paediatric Rheumatology European Society (PReS) / European League Against Rheumatism (EULAR) Taskforce has developed international recommendations and standards for transitional care and a growing evidence base supports the positive benefits of such care. However, there is also evidence that universal implementation has yet to be realised. In 2020, against this background the COVID-19 pandemic arrived with significant impact on all our lives, young and old, patient, public and professional alike. The unfortunate reality of the pandemic with potential for unfavourable outcomes on healthcare provision during transition was acknowledged by the PReS working groups in a position statement to support healthcare professionals, young people and their caregivers.

AIM

The aim of this review is to present the literature which provides the rationale for the recommendations in the PReS Position Statement. The following areas are specifically addressed: the prime importance of care coordination; the impact of the pandemic on the various aspects of the transition process; the importance of ensuring continuity of medication supply; the pros and cons of telemedicine with young people; ensuring meaningful involvement of young people in service development and the importance of core adolescent health practices such as routine developmental assessment psychosocial screening and appropriate parental involvement during transitional care.

Neuroticism vulnerability factors of anxiety symptoms in adolescents and early adults: an analysis using the bi-factor model and multi-wave longitudinal model

Background

Neuroticism and stress are important vulnerability factors in the development and outcome of anxiety symptoms. However, as neuroticism is a heterogeneity trait, it is still unclear how different neuroticism factors contribute to anxiety symptoms independently or in conjunction with stress. Thus, different factors of neuroticism were extracted in the present longitudinal study using the bi-factor model. The prediction effect of these different factors on anxiety symptoms and their combined effects with stress in both adolescent and adult samples were examined.

Method

Participants (592 adolescents and 638 young adults) in Hunan China were included. In the initial assessment in our longitudinal study, participants were asked to complete measurements that assessed neuroticism, stress, and anxiety symptoms. Next, a monthly assessment of stress and anxiety symptoms was completed for the subsequent 6 months. The bi-factor model was used to extract different factors of neuroticism. The hierarchical linear model was used to analyze longitudinal multi-wave data.

Result

Several model fit indices were used to evaluate the bi-factor model fit for neuroticism (adolescent: Tucker-Lewis index (TLI) = 0.957, comparative fit index (CFI) = 0.973, RMSEA = 0.040, Chi-Square = 80.471; early adults: TLI = 0.957, CFI = 0.973, RMSEA = 0.042, Chi-Square = 88.465). The results of hierarchical linear modeling analyses indicated that the general factor of neuroticism possessed a predictive effect on anxiety symptoms (adolescents: F = 36.77, p < 0.0001, early adults: F = 30.44, p < 0.0001); The negative effect factor only had the prediction effect on anxiety symptoms in early adults (adolescents: F = 0.65, p > 0.05; early adults: F = 4.84, p < 0.05); No prediction of self-reproach factor was found on anxiety symptoms (adolescents: F = 3.79, p > 0.05; early adults: F = 0.02, p > 0.05); the interactive effects of the general factor and stress on anxiety symptoms were only found in early adulthood (adolescents: F = 0.13, p > 0.05; early adults: F = 11.55, p < 0.01).

Conclusion

Our results suggested that the bi-factor model achieved a satisfactory fit for neuroticism measurement and supported that the anxiety symptoms were induced by the main effects of the general factor in both age samples and the negative factor only in adults. The general factor of neuroticism, but not the negative factor could make an additive effect for anxiety symptoms in face of stress, which meant that the homogeneity of neuroticism played a more significant role in further anxiety symptoms than heterogeneity when coping with stress.

Health Issues with Learning to Use Smart Devices in the Digital Age: Using a Grounded Theory Approach

The Korean government has announced a plan for a national policy to deliver smart education among all students. As a result, many people are worried about the possible health-related adverse effects. This qualitative study aimed at analyzing health issues related to middle school students who learn by using smart devices using the grounded theory approach. We conducted in-depth interviews with 30 students at four middle schools who used smart devices for more than a year. The analysis of this research data was based on the constant comparative method, using grounded theory as a theoretical framework. The data analysis revealed many concepts in 28 subcategories and 13 categories related to smart learning health issues, with the central phenomenon being experience with health problems. Students' health-related experiences were classified as physical or psychosocial symptoms. Adverse health effects related to smart learning were related to unsafe smart learning behavior and an inefficient smart learning environment. The consequences appeared to be the formation of diverse digital habits through the ambivalent use of smart devices and differences in ability to control health problems. Our findings suggest that students can form ideal habits for using smart devices if their health issues are well monitored and managed.

Associations between Screen-Based Activities, Physical Activity, and Dietary Habits in Mexican Schoolchildren

Screen-based activities are associated with increased risk of obesity and contribute to physical inactivity and poor dietary habits. The primary aim of this study was to examine the associations among screen-based activities, physical activity, and dietary habits in school-aged children in Guadalajara, Puerto Vallarta, and Mexico City, Mexico. The secondary aim was to examine these associations across sex. The School Physical Activity and Nutrition survey was used to assess screen-based activities (TV watching, video game use, computer use), physical activity, and dietary habits. Organized activity/sports participation, unhealthy dietary habits, and household income were correlated with screen-based activities. While TV watching was associated with decreased participation in organized activity/sports participation, computer and video game use was associated with increased organized activity/sports participation. Boys engaged in more TV watching and video game use compared to girls. All screen-based activities were associated with age among boys; whereas video game and computer use were associated with higher income among girls. These findings suggest a need for sex- and age-specific strategies that acknowledge the differential use of screen-based activities across sex and age. Future research should continue to identify underlying correlates linking screen-based activities with health behaviors to inform strategies to reduce screen-time in Mexican children.

Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview

BACKGROUND

An estimated 1 in 5 adolescents experience a mental health disorder each year; yet because of barriers to accessing and seeking care, most remain undiagnosed and untreated. Furthermore, the early emergence of psychopathology contributes to a lifelong course of challenges across a broad set of functional domains, so addressing this early in the life course is essential. With increasing digital connectivity, including in low- and middle-income countries, digital health technologies are considered promising for addressing mental health among adolescents and young people. In recent years, a growing number of digital health interventions, including more than 2 million web-based mental health apps, have been developed to address a range of mental health issues.

OBJECTIVE

This review aims to synthesize the current evidence on digital health interventions targeting adolescents and young people with mental health conditions, aged between 10-24 years, with a focus on effectiveness, cost-effectiveness, and generalizability to low-resource settings (eg, low- and middle-income countries).

METHODS

We searched MEDLINE, PubMed, PsycINFO, and Cochrane databases between January 2010 and June 2020 for systematic reviews and meta-analyses on digital mental health interventions targeting adolescents and young people aged between 10-24 years. Two authors independently screened the studies, extracted data, and assessed the quality of the reviews.

RESULTS

In this systematic overview, we included 18 systematic reviews and meta-analyses. We found evidence on the effectiveness of computerized cognitive behavioral therapy on anxiety and depression, whereas the effectiveness of other digital mental health interventions remains inconclusive. Interventions with an in-person element with a professional, peer, or parent were associated with greater effectiveness, adherence, and lower dropout than fully automatized or self-administered interventions. Despite the proposed utility of digital interventions for increasing accessibility of treatment across settings, no study has reported sample-specific metrics of social context (eg, socioeconomic background) or focused on low-resource settings.

CONCLUSIONS

Although digital interventions for mental health can be effective for both supplementing and supplanting traditional mental health treatment, only a small proportion of existing digital platforms are evidence based. Furthermore, their cost-effectiveness and effectiveness, including in low- and middle-income countries, have been understudied. Widespread adoption and scale-up of digital mental health interventions, especially in settings with limited resources for health, will require more rigorous and consistent demonstrations of effectiveness and cost-effectiveness vis-à-vis the type of service provided, target population, and the current standard of care.

Context, Development, and Digital Media: Implications for Very Young Adolescents in LMICs

The rapidly expanding universe of information, media, and learning experiences available through digital technology is creating unique opportunities and vulnerabilities for children and adolescents. These issues are particularly salient during the developmental window at the transition from childhood into adolescence. This period of early adolescence is a time of formative social and emotional learning experiences that can shape identity development in both healthy and unhealthy ways. Increasingly, many of these foundational learning experiences are occurring in on-line digital environments. These expanding vulnerabilities and opportunities are being further amplified for young adolescents growing up in low resourced settings around the world. Cultural and contextual factors influence access, use, and appropriation of digital technology. Further, neurobehavioral changes associated with the onset of puberty often coincide with entry into social media and more autonomous use of technology. In low-and-middle-income countries (LMICs), disparities in access, use, and appropriation of digital media can amplify prevailing economic gaps, and compound gender inequalities during early adolescence. In LMICs, adolescents are often the early adopters of mobile technology and social media platforms. While the impact of social media on the well-being, particularly mental health, of young adolescents has been a focus of research in high-income countries (HICs), much less is known about the impacts of social media use on young adolescents in LMICs. In this paper, we review what is known about the interaction between digital media and early adolescent development. We highlight crucial gaps in the evidence in LMICs; and describe some hypotheses and areas for future research to address these compelling issues.

Contributions of Subjective Well-Being and Good Living to the Contemporary Development of the Notion of Sustainable Human Development

The article analyzes the contributions of the notions of Good Living attributable to epistemologies, traditions, and subjective well-being at work, given the current changes in the working context, to enrich the concept of human development. The article is developed with an analytical-descriptive and synthetic approach, reconstructing the concept of Good Living through a theoretical-economic, ontological, and epistemological comparison and its dimensional axes. Methodologically, a systematic review of human development literature is used in Latin America through the Web of Science (WOS), comparing the UNDP Technical Notes (HDI) with the various approaches to Good Living published between 2010 and 2020. These documents were subjected to semantic contrast, with reference to the various dimensions and positions of human development as a generator of subjective well-being for the configuration of public labor policies. The main findings refer to the disagreement points evidenced in the two-axes dimensions of the Good Living measurement systems (mobility and safety, and cultural satisfaction within territories), an important factor being the sumak kawsay, the concept of Good Living. Sumak is fullness, the sublime, excellent, magnificent, beautiful, superior. Kawsay is life, being. However, it is dynamic, changing, and is not a passive question, and is thus not considered by the different evolutionary changes of the HDI.

Study Protocol of a Distance Learning Intervention to Support Social Emotional Learning and Identity Development for Adolescents Using Interactive Mobile Technology

Background: The maturational period from age 10 to 14-often referred to as very young adolescents (VYAs)-represents a dynamic period of learning and neurobehavioral development as individuals transition from childhood to adolescence. This developmental period presents a window of opportunity for strategic investment to improve trajectories of health, education and well-being among young people. More specifically, neurodevelopmental changes during pubertal maturation influence neural circuitry involved in processing emotions, risks, rewards and social relationships. Technology can be leveraged to create social emotional learning experiences for VYAs and provide opportunities for flexible, distance learning in low-income countries. The aim of this study protocol is to detail how insights from developmental science can be used to inform the intervention design, implementation and evaluation of a distance learning, social emotional learning intervention for VYAs. Methods: This study will be delivered to 500 VYAs in Temeke District, Dar es salaam. Study participants will watch culturally-relevant, animated videos on social emotional mindsets and skills and content will be paired with experiential learning activities over a period of 10 weeks. A nested smart-phone based study will practice learning social emotional skills and mindsets through engagement with multi-media material via the WhatsApp messenger application. Surveys and in-depth interviews will be administered to adolescents, their parents/caregivers and teachers before and after the intervention to evaluate the effect of the intervention on study outcomes. Discussion: This study is among the first to provide results on how to effectively design a distance-learning intervention to promote social emotional learning and identity development within a low-resource context. The findings will provide substantial evidence to inform new intervention approaches that are effective in low-resource contexts and strategies to reach scale among similar programs invested in leveraging technology to support adolescent health and development. Clinical Trial registration: Study registered with ClinicalTrials.gov. Identifier number NCT0445807.

A test of the pathway model of problematic smartphone use

BACKGROUND AND AIMS

Problematic smartphone use (PSU) has been described as a growing public health issue. In the current study, we aimed to provide a unique and comprehensive test of the pathway model of PSU. This model posits three distinct developmental pathways leading to PSU: (1) the excessive reassurance pathway, (2) the impulsive pathway and (3) the extraversion pathway.

METHODS

Undergraduate students (n = 795, 69.8% female, mean age = 23.80 years, sd = 3.02) completed online self-report measures of PSU (addictive use, antisocial use and dangerous use) and the psychological features (personality traits and psychopathological symptoms) underlying the three pathways.

RESULTS

Bayesian analyses revealed that addictive use is mainly driven by the excessive reassurance pathway and the impulsive pathway, for which candidate etiopathological factors include heightened negative urgency, a hyperactive behavioural inhibition system and symptoms of social anxiety. Dangerous and antisocial use are mainly driven by the impulsive pathway and the extraversion pathway, for which candidate etiopathological factors include specific impulsivity components (lack of premeditation and sensation seeking) and primary psychopathy (inclination to lie, lack of remorse, callousness and manipulativeness).

DISCUSSION AND CONCLUSIONS

The present study constitutes the first comprehensive test of the pathway model of PSU. We provide robust and original results regarding the psychological dimensions associated with each of the postulated pathways of PSU, which should be taken into account when considering regulation of smartphone use or tailoring prevention protocols to reduce problematic usage patterns.