Adolescence: a foundation for future health

Drivers of food acquisition practices among adolescents in suburban food environments of Lao People's Democratic Republic

BACKGROUND

Dietary shifts among adolescents in low- and middle-income countries are exacerbating the double burden of malnutrition. Understanding the drivers of adolescent food acquisition and consumption practices and their lived experiences of the food environment is crucial for the effective development of targeted interventions and policies.

OBJECTIVE

To explore drivers of food acquisition and consumption practices among adolescents from two suburban schools in the food environments of Phonhong District, Lao People's Democratic Republic.

METHODS

We implemented a Qualitative-Geographical Information System methodology, featuring participatory photography, follow-up photo-elicitation interviews and focus group discussions with 30 adolescents from April to July 2022. Thematic analysis triangulated key themes from photos, maps, and transcripts.

RESULTS

Drivers of food acquisition and consumption included interactions across external, interpersonal, and intrapersonal domains. The six key themes were food availability and accessibility, product properties and convenience, peers and social media, caregivers and household practices, affordability, desirability, and autonomy, and perceptions, beliefs, and social norms. Consumption of ultra-processed foods was driven by the availability and accessibility of these affordable products in schools. By contrast, consumption of fruits and vegetables was driven by parental food practices at home.

CONCLUSION

A comprehensive multi-scalar approach is required to improve adolescent diets and nutrition in the suburban food environment of Lao PDR. This includes restricting the sale of ultra-processed foods in schools, promoting home gardening, increasing caregivers' awareness and engagement with adolescents about the benefits of healthy food choices, and leveraging social media to encourage healthy eating behaviors.

Climate change menu labels in a university cafeteria: effects on student's diets, perceptions, and attitudes

Climate change is an urgent public health threat that requires robust and multi-sector action, including strategies to shift food choices toward more sustainable options. Climate change menu labels in university settings have the potential to shift food choices over the short- and long-term. In this pre-post-intervention study, we implemented traffic-light style climate impact menu labels communicating the greenhouse gas emissions (GHGE) of foods in two university dining halls at a private university in Maryland, USA. We compared student dietary intake, perceptions, and university dining procurement pre- and post-intervention. Compared to a baseline period with a matching 4-week menu cycle, we found no significant changes students' overall dietary quality, and few differences in students' frequency of consuming key food groups. One in three students (33 %) in the sample (n = 186) noticed the climate change labels on the menus, and nearly half of surveyed students (48 %) said they would like the labels to continue to be displayed in dining halls. The majority of students reported that the labels did not influence their food choices at the dining hall (56 %) or elsewhere (67 %). More than 60 % of students believed a healthy diet includes meat, and ∼40 % believed that meatless meals are not filling. Climate labels are an important strategy for universities to consider to increase student awareness of climate impacts of their food choices, but other strategies, such as shifts in the types of meals offered on the menu, may also be needed to reduce GHGE of university dining programs.

Impact of the best possible self intervention on affective well-being in early adolescence: A randomized controlled online trial

The Best Possible Self intervention (BPS) has demonstrated efficacy in promoting well-being in various populations, yet its impact in adolescence is under-researched. Our study investigated the feasibility and efficacy of the BPS in early adolescence (11-15 years) to promote positive affect and reduce negative affect. We conducted a randomized controlled online trial (N = 200, M age  = 14.01 years, SD = 1.19, 78.5 % female). Participants were assigned to the BPS group (n = 59), a writing control group (n = 68), or a non-writing control group (n = 73). Affect (PANAS-C-SF) was measured immediately before and after the intervention. The BPS demonstrated feasibility in our sample and significantly increased positive affect post-intervention compared to both control groups, suggesting a mood-boosting effect. The BPS did not significantly reduce negative affect post-intervention relative to the control groups. Our findings provide initial evidence that the BPS is a feasible and effective intervention for enhancing positive affect in early adolescence. Future research should explore its long-term effects, repeated administration, and potential for implementation in group settings to maximize its impact.

The prevalence and determinants of physical activity in secondary Vietnamese students: a hierarchical analysis

BACKGROUND

Physical activity (PA) levels among adolescents are low globally and in Vietnam. This study aims to assess the prevalence of PA and identify demographic, psychosocial, and behavioral factors related to PA among secondary school students in Ho Chi Minh City.

METHODS

A cross-sectional study was conducted from March to May 2023, involving 475 6th-grade students. Data were collected through self-reported questionnaires and anthropometric measurements. Psychosocial factors, including self-efficacy, enjoyment, family influence, and belief in PA were measured using validated scales, while teacher influence on PA was evaluated using a custom-designed questionnaire. Sedentary behavior was assessed using the Adolescent Sedentary Activity Questionnaire (ASAQ), and PA levels were determined using the Physical Activity Questionnaire for Older Children (PAQ-C). Gender differences were analyzed using chi-square tests and t-tests. Pearson's correlation coefficient and hierarchical multiple regression were applied to examine associations and factors influencing PA.

RESULTS

Only 36.8% of students met the recommended PA levels, with boys (40.7%) being more active than girls (32.9%). Boys had higher body mass index (BMI) and more screen time, while girls spent more time on cultural and social activities. Positive correlations were found between PA levels and psychosocial factors, especially in self-efficacy (r = 0.761, p < 0.001) and family influence (r = 0.717, p < 0.001). Sedentary behaviors, such as small screen recreation (r = -0.449, p < 0.001) and after-school education (r = -0.380, p < 0.001), negatively correlated with PA levels. Hierarchical analyses showed that BMI, self-efficacy, beliefs, family and teacher influence, and time spent on small screen recreation and after-school education significantly explained PA among adolescents.

CONCLUSION

Vietnamese adolescents have low PA levels, with gender differences. Interventions should enhance support, reduce sedentary behavior, and address gender-specific barriers.

Effectiveness of Educational Interventions on Adolescent Knowledge and Practices for Preventing Noncommunicable Diseases in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Noncommunicable diseases (NCDs) such as cardiovascular diseases, diabetes, and cancers are major global health concerns, disproportionately impacting low- and middle-income countries (LMICs). Adolescents in LMICs are particularly vulnerable due to urbanization, lifestyle changes, and limited preventive care access. This study evaluates the effectiveness of educational interventions in improving adolescents' knowledge, and behaviors, for NCD prevention in LMICs. The systematic review and meta-analysis followed patient, intervention, comparison, outcome and preferred reporting items for systematic reviews and meta-analyses guidelines, targeting studies involving adolescents aged 10-19 who received educational interventions for NCD prevention. A comprehensive search across 5 databases identified 22 eligible studies. Study quality was assessed using the Cochrane risk-of-bias tool, and statistical analyses were conducted in R, with effect sizes expressed as risk ratios and mean differences, calculated with 95% confidence intervals (CIs). Educational interventions significantly improved knowledge about the health benefits of fruit consumption (mean difference: 0.52; 95% CI: 0.31-0.74; p < .001) and awareness of the harms of deep-fried foods (mean difference: 0.60; 95% CI: 0.43-0.76; p < .001). Interventions also reduced screen time (mean difference: 534.09 minutes; 95% CI: 345.39-722.80). However, changes in body mass index (mean difference: 0.04; 95% CI: -0.02 to 0.11; p = .193) and waist circumference (mean difference: 0.06; 95% CI: -0.33 to 0.45; p = .778) were not statistically significant. Multisession interventions involving parents and teachers showed greater improvements in physical fitness, dietary habits, and quality of life. Single-session interventions were effective mainly when involving parents. Educational interventions improve knowledge and reduce screen time among adolescents, laying a foundation for healthier behaviors. However, achieving sustained behavior change requires targeted strategies beyond education alone. Future programs should incorporate skill-building, follow-up, family or community involvement to support adolescents in adopting and maintaining healthy habits. Comprehensive, multicomponent interventions are essential for fostering long-term lifestyle changes and reducing NCD risk among adolescents in LMICs.

A cross-sectional study of variations in schoolwork stress in academic upper secondary school classes in Mid-Norway

AIMS

This paper investigates stress related to schoolwork among students in academic upper secondary schools. The research questions asked are: 1. To what degree does students' schoolwork stress vary between academic classes?; And 2. are perceptions of classroom goal orientation, academic achievement, sex and parental education related to schoolwork stress?

METHODS

A cross-sectional survey was done in the final year of upper secondary school in 71 school classes from 13 schools. A total of 1955 students in academic education programs were invited to participate in the survey, and 1511 completed the survey; the response rate was 77%. The outcome measure was a composite measure of schoolwork stress (alpha = 0.81). Multilevel modeling was used to estimate school class-level effects.

RESULTS

The mean value of schoolwork stress was 4.0, on a scale of 1 (very little schoolwork stress) to 6 (very high schoolwork stress). About half of the students reported a score of 4 or higher. The analysis showed that individual characteristics explained most of the variation in schoolwork stress. Girls experienced a much higher level of schoolwork stress than boys (mean values of 4.3 and 3.6, respectively). There was also a significant class-level effect, estimated to 6% of the variance. Students' perceptions of classroom goal orientation was also associated with schoolwork stress.

CONCLUSIONS

The main contribution was the discovery of significant variations in schoolwork stress between school classes. We also found that higher mastery climate was linked to lower schoolwork stress, whereas higher performance climate was linked to higher schoolwork stress.

Mental Health Disparities Between Both-, Other- and Same-Sex Attracted Adolescents: The Role of Bullying Victimization, Gender and Age

Research shows that both-sex attracted adults have poorer mental health than other- and same-sex attracted adults, but evidence regarding whether similar disparities exist among adolescents remains limited. To investigate this, the current study examines differences in life satisfaction and emotional problems between both-, other- and same-sex attracted adolescents. It also studies whether bullying victimization can explain these differences and whether the associations vary by gender and age. Cross-sectional data from the nationally-representative Dutch Health Behavior in School-aged Children (HBSC) study conducted in 2017 and 2021 were analyzed, including 11,683 adolescents (Mage = 14.7, SD = 1.60; 49.7% girls). Both-sex attracted adolescents (n = 507, 4.3%) report lower life satisfaction and more emotional problems than their other- (n = 10,930, 93.6%) and same-sex attracted peers (n = 246, 2.1%). Bullying victimization partially explains the mental health disparities between both- and other-sex attracted adolescents, yet does not account for differences between both- and same-sex attracted peers. The links between romantic attraction and mental health outcomes were similar across gender and age, but differences existed concerning bullying victimization. The results suggest that both-sex attracted adolescents are a unique group that deserves special attention in the literature on mental health disparities.

What are the consequences of musculoskeletal pain in adolescents? A critical qualitative systematic review and meta-synthesis

There is a paucity of research into the lived experiences of adolescents with musculoskeletal pain. This study synthesised the available qualitative research on musculoskeletal pain consequences in adolescents. CINAHL, EMBASE, MEDLINE, PsycINFO and Research Rabbit were searched, and a critical qualitative systematic review and meta-synthesis was performed (Prospero ID=476626). Screening and data extraction were completed in duplicate. Critical appraisal of included studies and level of confidence in the findings were assessed. A thematic synthesis approach was used to derive analytical themes. Twelve studies were included (n=213). Adolescents (age range 8-22 years) reported functional impediments that impacted daily living, mobility, school, socialising, and sleep. Distress and concern regarding movement, health, isolation, autonomy, support, healthcare experiences, and their future were also reported. Adolescents report complex and burdensome consequences of musculoskeletal pain. The functional impediments and the psychosocial impacts lead adolescents to feel distressed, isolated, and unsupported. Confidence in the findings according to the GRADE-CERQual assessment showed high, moderate and low confidence across the results. This knowledge can be used to develop meaningful communication and understanding in clinical encounters with adolescents, and provide focus for more impactful research, addressing the consequences reported by adolescents.

Incidence, sociodemographic and presenting clinical features of childhood non-infectious uveitis: findings from the UK national inception cohort study

BACKGROUND

We aimed to provide, through the Uveitis in Childhood National Cohort Study, population-based evidence on incidence, distribution and disease characteristics for childhood onset non-infectious uveitis.

METHODS

Eligible children and young people (<18 years) were those newly diagnosed with non-infectious uveitis between 1 March 2020 and 28 February 2023. Cases were identified and recruited through passive surveillance across a multicentre network. Descriptive analysis of demographic, socioeconomic and clinical characteristics at diagnosis is reported alongside incidence rates, relative rates by region and sociodemographic patterning.

RESULTS

468 cases were identified, providing a minimal national disease incidence of 1.89/100 000 (95% CI 1.72 to 2.07). Among the 255 children recruited, anterior uveitis was predominant (76.9%) and 65% of cases were bilateral. Peak incidence was at 11-15 years. Children resident in deprived areas and those from non-White ethnic backgrounds were over-represented (28% and 31% of the cohort). One in seven children (15%) had a diagnosis of juvenile idiopathic arthritis (JIA), and 5% had tubulointerstitial nephritis. Although bilaterally poor vision was uncommon (16.8%), 44.3% had lost some vision in at least one eye.

CONCLUSIONS

There is a need to reconsider how best to deliver paediatric rheumatological and eye care that meets the needs of young people, as well as young children, with uveitis. The predominance of non-JIA-related uveitis calls for a shift in focus. There appears to be socioeconomic drivers of disease risk, which are worthy of future exploration and which have implications on the delivery of care for this chronic and blinding disease.

Impact of a cancer diagnosis on educational, employment, health-related quality of life, and social outcomes among young adults: A matched cohort study of 401 cancer survivors aged 15-24 in England

BACKGROUND

Globally, cancer incidence is rising fastest among young people. Existing literature on acute health shocks, including cancer diagnoses, focuses on older working-aged adults.

METHODS

Matched cohort study involving 401 young cancer survivors (aged 15-24) in the BRIGHTLIGHT study and 765 UK Household Longitudinal Study controls without cancer between 2013 and 2018. Participants were matched on sex, age, ethnicity, index of multiple deprivation (IMD) quintile, non-cancer health conditions, and follow-up duration. Regression models assessed economic, educational, social, health-related quality of life (HRQoL), and mental health outcomes at 6(T1), 12-18(T2), and 24-36 months (T3) post-diagnosis.

RESULTS

Compared to matched controls, those with cancer were: less likely to be in employment, education, or training at T1 (OR = 2.03, p < 0.001) but not at T3 (OR = 0.96, p = 0.18), because transitioning from unemployment or economic inactivity into education was more common (24 % vs 3 % between T1 and T3); less likely to live in parental households at T1 (OR = 0.54, p < 0.001) and T3 (OR = 0.59, p < 0.001); and more likely to experience relationship breakdown (23 % vs 12 % between T1 and T3). Differences in mental health and HRQoL declined over time (mean difference compared to matched controls: T1: -0.07, p < 0.001; T2 and T3: -0.01 p ≥ 0.55). Economic outcomes, mental health and HRQoL utility scores were persistently worse among more severe cancer cases.

CONCLUSIONS

Despite having initially poorer health and economic outcomes, cancer survivors in this cohort caught up with their peers within 3 years. Linked clinical data showed those with more severe diagnoses were affected most, indicating scope for improved psychosocial and economic support.

The effect of stressful life events on depressive symptoms in Chinese university students: Moderated mediating effect of interpersonal relationship and gender

BACKGROUND

This study aimed to examine the impact of stressful life events on the depressive symptoms of Chinese first-year university students, while considering the influence of interpersonal relationships and gender on this association.

METHODS

A total of 8079 first-year Chinese university students were surveyed using the Adolescent Self-Rating Life Events Check List (ASLEC), Beck Depression Inventory (BDI), and Comprehensive Diagnostic Scale of Interpersonal Relationship (CDSIR).

RESULTS

Stressful life event were positively correlated with interpersonal relationships, depressive symptoms, and gender (r = 0.385, 0.264, 0.055, p < 0.001); there was a significant positive correlation between depressive symptoms and interpersonal relationships (r = 0.473, p < 0.001). Stressful life events partially predict depressive symptoms through the mediation of interpersonal relationships, and the proportion of indirect total effect was 63.26 %. The effect of stressful life events on depressive symptoms was moderated by gender. Stressful life events had a positive effect on depressive symptoms in both male and female individuals. Compared with male individuals (simple slope = 0.070, t = 3.467, p < 0.001), female individuals were more susceptible to stressful life events (simple slope = 0.185, t = 9.652, p < 0.001).

LIMITATIONS

The generalizability of the findings is constrained by the composition of the sample. The study's utilization of questionnaire methodology and cross-sectional design poses limitations in establishing definitive causality.

CONCLUSION

The effect of stressful life events on depressive symptoms might be mediated by interpersonal relationships and moderated by gender.

Linked emergence of racial disparities in mental health and epigenetic biological aging across childhood and adolescence

Marginalization due to structural racism may confer an increased risk for aging-related diseases - in part - via effects on people's mental health. Here we leverage a prospective birth cohort study to examine whether the emergence of racial disparities in mental health and DNA-methylation measures of biological aging (i.e., DunedinPACE, GrimAge Acceleration, PhenoAge Acceleration) are linked across childhood and adolescence. We further consider to what extent racial disparities are statistically accounted for by perinatal and postnatal factors in preregistered analyses of 4898 participants from the Future of Families & Child Wellbeing Study, of which 2039 had repeated saliva DNA methylation at ages 9 and 15 years. We find that racially marginalized children had higher levels of externalizing and internalizing behaviors and diverging longitudinal internalizing slopes. Black compared to White identifying children, children living in more racially segregated neighborhoods, and racially marginalized children more affected by colorism tended to have higher age-9 levels of biological aging and more biological age acceleration over adolescence. Notably, longitudinal increases in internalizing and externalizing behavior were correlated with increases in biological aging. While racial and ethnic disparities in mental health were largely statistically accounted for by socioeconomic variables, differences in biological aging were often still visible after including potential mediating variables. These findings underscore the urgency for future research to consider biological aging processes from early life and collect more comprehensive measures of structural racism in developmental cohorts. Programs dedicated to advancing racial health equity must address the psychological and physical effects of structural racism on children and adolescents.

The role of social problem-solving in emerging adult healthcare transition

Objective

Transitioning to independent self-management is an observed challenge for emerging adults with chronic medical conditions (CMCs). Strong healthcare management skills are linked with better health-related quality of life (HRQoL). Social problem-solving skills also contribute to HRQoL, but limited research exists on the role of these skills among emerging adults with CMCs. Therefore, the current study examines the potential mediating role of problem-solving abilities between healthcare management skills and HRQoL among emerging adults with CMCs.

Methods

Emerging adults (N = 279; Mean Age=19.37, SD=1.33; 84.9 % Female; 79.2 % White; 26.9 % first generation student) with a CMC completed online measures of demographics, transition readiness, social problem-solving, and HRQoL. A path analysis estimated the direct and indirect effects of transition readiness on HRQoL, with demographic and illness-related covariates (e.g., sex, illness controllability, COVID time).

Results

The overall path analysis was significant (p < 0.001) and accounted for 28.0 % of the variance in mental (M=-1.46, SD=1.12) and 20.5 % of the variance in physical HRQoL (M=-0.65, SD=0.96). Transition readiness had a significant indirect effect through dysfunctional problem-solving skills on mental (β=0.07, SE=0.03, p = 0.02) and physical HRQoL (β=0.04 SE=0.02, p = 0.04). Constructive problem-solving did not mediate the relationships (ps>0.05).

Conclusions

Findings indicate that dysfunctional problem-solving may impede emerging adults' ability to effectively apply healthcare management skills, and interventions that reduce dysfunctional problem-solving may be needed to improve HRQoL. College campuses may be a suitable environment for providing problem-solving training, and future research should explore opportunities to engage these communities in healthcare transition support.

The influence of social determinants and 5Cs of positive youth development on the mental health of Chilean adolescents

This study analyzes the influence of social determinants (SD) and positive youth development (PYD) on the mental health (MH) of Chilean adolescents. A non-experimental, cross-sectional, correlational-explanatory design was used to analyze data from 612 adolescents (43.46% male and 56.54% female), aged between 11 and 19 years (M = 14.92, SD = 1.50). The assessed SD variables included parental educational level, family affluence, gender, migratory status, and ethnicity. PYD was measured using the 5Cs model (Competence, Confidence, Connection, Character, and Caring). MH was conceptualized through the dual-factor model, which encompasses subjective well-being (SWB) and psychopathological symptoms (PTH). The analyses included confirmatory factor analysis to assess the measurement models and structural equation modeling to examine both the direct and indirect effects of the hypothesized relationships. The findings indicate that family affluence and gender are the factors most consistently associated with the dimensions of PYD and MH. Confidence and connection positively influence MH by enhancing SWB and reducing PTH. Furthermore, these two dimensions act as significant mediators between SD and MH. The study highlights the importance of considering both the socioeconomic context and individual capabilities in mental health promotion strategies, proposing an integrated approach that addresses both the positive and negative aspects of adolescent mental health.

Diet Quality Among Older Adolescent Boys and Girls in the Southeast Asia Region

Adolescence is a period of tremendous physical and neurophysiological change, and today's rapidly changing food system has implications for adolescent nutritional and health outcomes. Ensuring nutritious diets during adolescence requires evidence on what is being consumed by adolescent boys and girls, however, little is known about the dietary patterns among this age group. This study assessed the prevalence of food group consumption and indicators of diet quality among adolescents in the Southeast Asia region and compared these results to the adult population. Secondary analysis of the Gallup World Poll, a population-based survey, was performed using datasets from Cambodia, Indonesia, Laos PDR, the Philippines and Vietnam. Pooled analysis of nine diet quality indicators was conducted among all adolescents 15-19 years of age (n = 479), with comparison to the adult population (n = 4589). Various unhealthy food groups were consumed by one-quarter to one-half of adolescents, with a greater proportion of adolescents consuming instant noodles, sweets, processed meats and salty snacks, as compared to adults. Just over one-third of adolescents (37.4%) consumed all five recommended food groups to meet dietary guidelines, almost two-thirds (62.6%) consumed sweet beverages and over three-quarters consumed unhealthy/ultra-processed foods (76.8%). Overall indicators of diet quality showed that Southeast Asian adolescents' diets were less healthy than adults. This is one of the first studies to explore the healthy and unhealthy aspects of diets among both adolescent boys and girls across the Southeast Asia region, with results indicating that diets are not nutritionally adequate.

Intersectional Dynamics of Race, Ethnicity, and Immigration: Examining Health Outcomes among Black Immigrant Youth through Ethnic-Racial Identity Development and Critical Consciousness

Despite the rise in racial justice and immigrant rights movements in the United States of America (USA), the experiences of Black immigrants at the intersection of these movements remain undertheorized. For Black immigrant youth, these experiences - marked by anti-Black racism and xenophobia - can significantly impact psychological well-being and physical health, particularly during adolescence, a crucial period of identity formation and sociopolitical awareness. We propose the Intersectional Dynamics of Race, Ethnicity, and Immigration (ID-REI) theoretical framework that explores how distal (e.g., structural racism, sociopolitical relations between countries) and proximal (e.g., ethnic-racial socialization, family and individual cultural practices) factors related to race, ethnicity, and immigration interact to influence health outcomes through ethnic-racial identity (ERI) development and critical consciousness. The ID-REI theoretical framework emphasizes the unique challenges faced by Black immigrant youth, while highlighting the developmental assets of ERI and critical consciousness as protective mechanisms to mitigate adverse mental and physical health outcomes.

Adolescents' health literacy perspectives and implications

BACKGROUND

Adolescence is an essential stage of life during which individuals develop knowledge, attitudes, and behaviors that can have significant impacts on their present and future health. Therefore, health literacy issue among adolescents is a pressing matter. Understanding adolescents' perspectives of health literacy is crucial for making informed interventions. However, the topic remains unexplored in developing countries like Ethiopia. This study seeks to explore adolescents' perspectives of health literacy within their socio-environmental context in Ethiopia and draw out the implications.

METHODS

This study employed qualitative research approach, utilizing in-depth interviews and focus group discussions as methods of data collection. Data collection took place from March to October 2023, involving 86 participants (41 male and 45 female) selected through purposive sampling (maximum variation sampling) to capture a wide range of perspectives on the issue. The data analysis followed a thematic analysis approach, using Atlas.ti (version 7.5.18) software.

RESULTS

From the adolescents' perspectives, health literacy or being health literate is regarded as comprising various competencies and qualities essential for health, including health awareness and knowledge, abilities to deal with health information, practicing healthy behaviors, upholding healthy norms and values of the community, and being a responsible citizen. The adolescents regard health literacy or being health literate as highly beneficial in healthcare, disease prevention, health maintenance and enhancement, and in taking responsibility not only for ones' own health but also for the health of others, thereby benefiting those around them and their community and society. However, this study found notable gaps in health literacy among the adolescents, influenced by various factors ranging from individual to community and societal levels.

CONCLUSION

The study explored health literacy from adolescents' perspectives in Ethiopia, and contributed to understanding of the issue. It identified notable gaps in adolescent health literacy and provided insights into the enabling and hindering factors. This study laid the ground for developing a health literacy tool sensitive to the Ethiopian sociocultural context and for broader studies to enhance understanding and to develop effective interventions to improve and promote health literacy among adolescents and within the broad society.

Content validity of a toolkit for measuring teachers' mental health literacy in Vietnam

BACKGROUND

Teachers' mental health literacy will impact the mental health of the teacher and student community. Assessing teachers' mental health literacy requires a toolkit developed specifically for them. This study aimed to adapt and evaluate the content validity of the toolkit developed by Jorm for Vietnamese teachers.

SETTINGS AND DESIGN

Expert panel method with a nondirective approach.

METHODS AND MATERIAL

The toolkit was assessed for content validity according to the expert panel method with a nondirective approach: A content validation form was sent to six experts, and clear instructions were provided; rate each item on a Likert scale ranging from 1 to 4 based on its severity relevance, and assign a score from 1 to 3 indicating its necessity. The relevance assessment was conducted using the content validity index (CVI), content validity index for items (I-CVI), and content validity index for scales (S-CVI), assessing the necessity of each item by the content validity ratio (CVR).

RESULTS

The score for I-CVI ≥ 0.83; S-CVI/Ave = 0.98; S-CVI/UA = 0.89. The score for CVR of 29 items out of 103 was marked as not essential, 21 items were eliminated, and two items were adjusted and replaced. From the initial toolkit with 103 items, throughout the content validation, only 82 items of 13 domains corresponding to four aspects remained.

CONCLUSIONS

The toolkit's content was validated by an expert panel using the CVI and CVR. The toolkit could measure the mental health literacy of teachers in Vietnam.

Bidirectional Associations Between Early Adolescent Internalizing Symptoms and Positive Affect Regulation Strategy Use in Daily-Life: An Experience Sampling Method Study

Disruptions in positive affect (PA) have been found to characterize several internalizing disorders, including depression, social anxiety, and generalized anxiety. One factor that may contribute to disruptions in PA are individual differences in PA regulation, or the tendency to upregulate ("enhance") or downregulate ("dampen") positive emotions in response to pleasant events. Yet, prospective associations between PA regulation and varying forms of internalizing are not well-understood, particularly during adolescence, a period during which risk for the onset these disorders rises. Thus, the present study evaluated bidirectional associations between daily-life PA regulation strategy use and symptoms of depression, social anxiety, and generalized anxiety in a sample of 151 early adolescents (52.0% girls; 48.0% boys; Mage[SD] = 12.72[.86]). Youth symptoms were assessed using self-report questionnaires at baseline and one year later. Daily-life enhancing and dampening were assessed 3-4 times per day for 9 days using experience sampling methods at baseline and 1-year (31 total assessments per time point). Results of multilevel correlation models demonstrated concurrent associations between dampening and symptoms of depression, social anxiety, and generalized anxiety. Multilevel structural equation models indicated that greater baseline dampening predicted increases in depressive symptoms across one year. Results also suggested that greater baseline depressive symptoms may predict prospective increases in dampening. Together, findings indicate that dampening is a common feature of varying internalizing symptoms during adolescence, and dampening and depressive symptoms may demonstrate relatively unique patterns of interrelation over time.

The developmental trajectories and modifiable factors of adolescents' subjective well-being from late adolescence to early adulthood

BACKGROUND

Previous research on adolescents' subjective well-being has not focused on the transition from late adolescence to early adulthood. Moreover, explorations of the factors influencing adolescents' subjective well-being have mostly focused on a single level or variable. This study aimed to identify the different developmental trajectories of adolescents' subjective well-being during this transition period and the influencing factors at different levels.

METHODS

This study used data from the Chinese Family Panel Studies to longitudinally track 625 adolescents aged 16-19 years in 2014 for six years. This study adopted multi-party reports and collected data on four levels of adolescents: individuals, networks, families, and communities. Using the latent class growth model to distinguish the different developmental trajectories of adolescents' subjective well-being. Then, the environment-wide association study (EnWAS) was used to explore the factors influencing the categories of adolescents' subjective well-being trajectories.

RESULTS

This study identified three different developmental trajectories of subjective well-being: High initial level-relatively stable group, Medium initial level-rapidly decreasing group, Low initial level-slowly rising group. The results of EnWAS confirmed that there are 15 modifiable factors associated with the trajectory classification of adolescents' subjective well-being. The final multiple logistic regression model revealed the household book collection, tidiness of the home, desired level of education, future confidence, interpersonal relationships, social trust, sleep duration (marginal condition), all of which have significant impacts on adolescents' subjective well-being.

CONCLUSIONS

Adolescents' subjective well-being trajectories from late adolescence to early adulthood show great heterogeneity. Adolescents' subjective well-being may be more influenced by the personal and family environment. Targeted interventions for various modifiable factors can significantly enhance adolescents' subjective well-being.

Prevalence and correlates of muscle dysmorphia in a sample of boys and men in Canada and the United States

BACKGROUND

Muscle dysmorphia is a significant mental health condition that has been under-researched in epidemiological, community-based studies. Therefore, this study aimed to identify the prevalence and correlates of probable muscle dysmorphia among a sample of Canadian (n = 784) and American (n = 563) boys and men ages 15-35 years.

METHODS

The sample comprised 1,488 boys and men who completed a variety of measures and items to capture sociodemographic characteristics and muscle dysmorphia symptoms. Diagnostic criteria were applied to identify probable muscle dysmorphia among the sample. Unadjusted (e.g., chi-square tests, independent samples t-tests) and adjusted (e.g., logistic regression) analyses were used to determine the sociodemographic factors (e.g., age, body mass index, gender, race/ethnicity, sexual orientation, education, relationship status, and country) associated with cases of probable muscle dysmorphia.

RESULTS

The prevalence of probable muscle dysmorphia was 2.8% (95% confidence interval 2.0-3.7%). Aside from lower body mass index among those with probable muscle dysmorphia, there were no significant demographic differences between those with and without probable muscle dysmorphia across ages, genders, races/ethnicities, and sexual orientations. Those with probable muscle dysmorphia had significantly higher scores on standardized measures of muscle dysmorphia symptomatology and muscularity-oriented attitudes and behaviors compared to those without probable muscle dysmorphia.

CONCLUSIONS

Findings underscore that muscle dysmorphia may be more prevalent among boys and men in Canada and the United States than previously thought, highlighting the need for more research, prevention, assessment, and intervention efforts. The minimal differences across sociodemographic factors are notable, highlighting the need for an inclusive understanding of muscle dysmorphia.

Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

BACKGROUND

Despite the well documented consequences of obesity during childhood and adolescence and future risks of excess body mass on non-communicable diseases in adulthood, coordinated global action on excess body mass in early life is still insufficient. Inconsistent measurement and reporting are a barrier to specific targets, resource allocation, and interventions. In this Article we report current estimates of overweight and obesity across childhood and adolescence, progress over time, and forecasts to inform specific actions.

METHODS

Using established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we modelled overweight and obesity across childhood and adolescence from 1990 to 2021, and then forecasted to 2050. Primary data for our models included 1321 unique measured and self-reported anthropometric data sources from 180 countries and territories from survey microdata, reports, and published literature. These data were used to estimate age-standardised global, regional, and national overweight prevalence and obesity prevalence (separately) for children and young adolescents (aged 5-14 years, typically in school and cared for by child health services) and older adolescents (aged 15-24 years, increasingly out of school and cared for by adult services) by sex for 204 countries and territories from 1990 to 2021. Prevalence estimates from 1990 to 2021 were generated using spatiotemporal Gaussian process regression models, which leveraged temporal and spatial correlation in epidemiological trends to ensure comparability of results across time and geography. Prevalence forecasts from 2022 to 2050 were generated using a generalised ensemble modelling approach assuming continuation of current trends. For every age-sex-location population across time (1990-2050), we estimated obesity (vs overweight) predominance using the log ratio of obesity percentage to overweight percentage.

FINDINGS

Between 1990 and 2021, the combined prevalence of overweight and obesity in children and adolescents doubled, and that of obesity alone tripled. By 2021, 93·1 million (95% uncertainty interval 89·6-96·6) individuals aged 5-14 years and 80·6 million (78·2-83·3) aged 15-24 years had obesity. At the super-region level in 2021, the prevalence of overweight and of obesity was highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and the greatest increase from 1990 to 2021 was seen in southeast Asia, east Asia, and Oceania (eg, Taiwan [province of China], Maldives, and China). By 2021, for females in both age groups, many countries in Australasia (eg, Australia) and in high-income North America (eg, Canada) had already transitioned to obesity predominance, as had males and females in a number of countries in north Africa and the Middle East (eg, United Arab Emirates and Qatar) and Oceania (eg, Cook Islands and American Samoa). From 2022 to 2050, global increases in overweight (not obesity) prevalence are forecasted to stabilise, yet the increase in the absolute proportion of the global population with obesity is forecasted to be greater than between 1990 and 2021, with substantial increases forecast between 2022 and 2030, which continue between 2031 and 2050. By 2050, super-region obesity prevalence is forecasted to remain highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and forecasted increases in obesity are still expected to be largest across southeast Asia, east Asia, and Oceania (eg, Timor-Leste and North Korea), but also in south Asia (eg, Nepal and Bangladesh). Compared with those aged 15-24 years, in most super-regions (except Latin America and the Caribbean and the high-income super-region) a greater proportion of those aged 5-14 years are forecasted to have obesity than overweight by 2050. Globally, 15·6% (12·7-17·2) of those aged 5-14 years are forecasted to have obesity by 2050 (186 million [141-221]), compared with 14·2% (11·4-15·7) of those aged 15-24 years (175 million [136-203]). We forecasted that by 2050, there will be more young males (aged 5-14 years) living with obesity (16·5% [13·3-18·3]) than overweight (12·9% [12·2-13·6]); while for females (aged 5-24 years) and older males (aged 15-24 years), overweight will remain more prevalent than obesity. At a regional level, the following populations are forecast to have transitioned to obesity (vs overweight) predominance before 2041-50: children and adolescents (males and females aged 5-24 years) in north Africa and the Middle East and Tropical Latin America; males aged 5-14 years in east Asia, central and southern sub-Saharan Africa, and central Latin America; females aged 5-14 years in Australasia; females aged 15-24 years in Australasia, high-income North America, and southern sub-Saharan Africa; and males aged 15-24 years in high-income North America.

INTERPRETATION

Both overweight and obesity increased substantially in every world region between 1990 and 2021, suggesting that current approaches to curbing increases in overweight and obesity have failed a generation of children and adolescents. Beyond 2021, overweight during childhood and adolescence is forecast to stabilise due to further increases in the population who have obesity. Increases in obesity are expected to continue for all populations in all world regions. Because substantial change is forecasted to occur between 2022 and 2030, immediate actions are needed to address this public health crisis.

FUNDING

Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.

Health concerns and health-risk behaviors among school-aged children in Saudi Arabia

Childhood and adolescence are profoundly important for the public health future. Children and adolescents experience rapid physical, physiological, and behavioral changes. In addition, there is substantial evidence that the promotion and protection of childhood health are essential to sustainable public health and social and economic development. This review explored research relevant to children and adolescent health-related behaviors to identify key behaviors and behavioral factors for targeting health promotion interventions. We examine what is currently known about health-related behaviors including dietary behaviors, physical activity, smoking, sexual behaviors, violence, and mental health and the health needs of the importance of strengthening children and adolescent health services to meet their needs. The review was conducted using electronic databases of PubMed and Google Scholar and official websites. Most of the studies found were cross-sectional, and they dealt with specific health behaviors. In general, Saudi children and adolescents engage in a wide range of risky behaviors at an alarming rate, including low physical activity, poor dietary behaviors, a high rate of overweight and obesity, smoking cigarettes, and engaging in violent behaviors. However, there is limited information on the magnitude of health-related problems and risky behaviors among children and adolescents in Saudi Arabia. It is imperative to note that similar to adolescents and children around the world, Saudi's young population is at risk of a myriad of communicable and noncommunicable diseases owing to the high prevalence of various health risk behaviors. Although school health services need improvement, we first need more detailed and systematic national data on child and adolescent health-related behaviors in Saudi Arabia.

Adherence to 24-hour movement guidelines in adolescence and its association with lower risk of hypertension in adulthood

BACKGROUND

There is limited research on how adherence to 24 h movement guidelines from adolescence to adulthood affects long-term hypertension outcomes. This study examined the association between sustained adherence to these guidelines and hypertension risk.

METHODS

Analysis was done on data from adolescents 12- to 19-year-olds who took part in Waves I and V of the Add Health Study. Physical activity (PA), screen time, and sleep duration were assessed through self-report questionnaires. Blood pressure (BP) was assessed on the right arm following a 5 min seated rest, utilizing an oscillometric device, and hypertension was defined as systolic/diastolic BP ≥ 140/90 mmHg, physician-diagnosed hypertension, or current antihypertensive medication use.

RESULTS

This prospective study included a total of 3076 participants (60.3% female), and 802 were diagnosed with hypertension. Meeting sleep duration guidelines at Wave I was associated with reductions in systolic [- 0.568 mmHg, 95% bias-corrected and accelerated (BCa) confident interval (CI) - 2.128 to - 0.011, P = 0.044] and diastolic (- 0.331 mmHg, 95% BCa CI - 1.506 to - 0.071, P = 0.043) BP at Wave V. Adherence to PA and sleep duration guidelines at both waves further reduced BP, with the greatest decreases observed among participants meeting all three guidelines: systolic (- 6.184 mmHg, 95% BCa CI - 13.45 to - 0.915, P = 0.040) and diastolic BP (- 3.156 mmHg, 95% BCa CI - 6.413 to - 0.120, P = 0.047). The risk of hypertension was lower among those who met the PA guidelines individually [relative risk (RR) 0.710, 95% CI 0.516-0.976, P = 0.035] or adhered to all three recommendations (RR 0.699, 95% CI 0.311-0.899, P = 0.030) in both waves.

CONCLUSIONS

Our findings highlight the cardiovascular benefits of consistently adhering to healthy movement behaviors from adolescence through adulthood.

A framework for understanding adverse adolescent experiences

Adolescence (ages 10-24) is characterized by cognitive, behavioural and social development. Childhood environments are typically centred on home and care settings, whereas adolescents increasingly engage with peer and community environments. These changing environments confer risks of experiencing specific adversities at different ages. Despite the unique characteristics of adversities in adolescence and potential associations with lifespan outcomes, few frameworks exist to systematize adversities in adolescents. Here we review current research and propose an approach specific to this developmental period: the adverse adolescent experiences (AAEs) framework. Building on existing models (for example, the adverse childhood experiences framework), the AAEs focus on potentially traumatizing experiences during adolescence. The framework builds on Bronfenbrenner's ecological systems theory to conceptualize adversities at intrapersonal, interpersonal, community and societal levels. We argue that this approach can enhance our understanding of adolescent adversity, facilitate the study of its potential effects, and guide prevention and intervention efforts.

Live births and deaths of neonates born to adolescent mothers: analysis of trends and associations from a population study in a region of a middle-income country

BACKGROUND

Adolescent pregnancy is associated with adverse outcomes, and although there has been a global decline in the incidence of teenage pregnancies and neonatal deaths, the absolute number remains significant. This study aimed to evaluate temporal trends in live births and neonatal deaths from adolescent mothers, as well as to identify the effect of adolescent pregnancy on neonatal death.

METHODS

This is a population-based study of all live births from mothers residing in Sao Paulo state, Brazil, between 2004 and 2020. The Prais-Winsten model was used to analyze annual trends for live births from adolescent mothers, neonatal mortality rates, and the percentage of neonatal deaths within specific demographic groups. The Kaplan-Meier survival curve evaluated the time to neonatal death. A Poisson regression model was utilized to identify maternal and neonatal characteristics associated with the risk of neonatal death.

RESULTS

The present study encompassed a total of 9,870,181 live births, with 14.4% occurring to adolescent mothers. There were 75,504 neonatal deaths, with 14,159 (18.8%) of those occurring in the neonates born to adolescent mothers. The annual percentage change in live births to adolescent mothers decreased by -3.03% (95%CI: -4.12% to -1.93%). The neonatal mortality rates showed a declining trend within both adolescent and non-adolescent mothers. Infants born to adolescent mothers had a higher probability of neonatal death and an earlier age of death when compared to non-adolescent mothers' infants. Poisson multiple regression analysis indicated an elevated risk of neonatal death for seven tested variables (adolescent mothers, inadequate prenatal care, multiple gestation, non-hospital delivery, low birth weight, male sex and congenital anomalies) and a reduction on risk of death for neonates born from cesarean section.

CONCLUSIONS

The study showed a reduction in live births to adolescent mothers and neonatal deaths among adolescent mothers from 2004 to 2020 in the state of Sao Paulo. Was also shown a risk association between been born to adolescent mothers and neonatal death.

Association Between Meeting 24-Hour Movement Guidelines and Health-Related Quality of Life in Adolescents

BACKGROUND

Evidence-based 24-hour movement guidelines have been developed to integrate recommendations for time spent on moderate to vigorous physical activity (MVPA), screen time (ST), and sleep. This study investigated the adherence to 24-hour movement guidelines and explored the relationship with health-related quality of life (HRQoL) in adolescents.

METHODS

Cross-sectional findings are based on 1774 adolescents (49.1% female) aged 13-16 years from the Shenyang region of China. MVPA, ST, and sleep duration were self-reported using the International Physical Activity Questionnaire, an ST questionnaire, and a wake-sleep time questionnaire. HRQoL was measured using the Pediatric Quality of Life Inventory, which encompasses physical, psychosocial, and total HRQoL. Adherence to 24-hour movement guidelines was classified by meeting general (eg, none, 1, 2, and 3 guidelines) and specific combinations (eg, MVPA and ST guidelines) within the 3 recommendations. Associations were examined using general linear models adjusted for age, sex, and parents' education.

RESULTS

A total of 5.1% of the sample met all three 24-hour movement guidelines. Additionally, compared with meeting no guideline, meeting all 3 guidelines was associated with better physical (β = 5.37; 95% CI, 0.69-9.49; P = .005), psychosocial (β = 3.76; 95% CI, 0.84-6.68; P = .012), and total HRQoL (β = 4.16; 95% CI, 1.35-6.98; P = .004). Compared with not meeting the specific combination guidelines, meeting MVPA and ST was associated with better physical HRQoL (β = 5.52; 95% CI, 1.30-9.74; P = .01).

CONCLUSIONS

These cross-sectional findings suggest that meeting all three 24-hour movement guidelines were associated with better HRQoL in adolescents. Since a low proportion of this sample was meeting the overall guidelines, future effort should encourage, and perhaps improve adherence to the 24-hour movement guidelines.

The Burden of adolescent depression and the impact of COVID-19 across 204 countries and regions from 1990 to 2021: results from the 2021 global burden of disease study

This study aims to analyze the trends in the burden of depression among adolescents aged 10 to 24 years globally from 1990 to 2021, with a focus on the impact of COVID-19 on adolescent depression and health inequalities. Using data from the 2021 Global Burden of Disease Study, we examined age-standardized prevalence, incidence, and disability-adjusted life years (DALYs) for depression among adolescents aged 10-24 years. Estimated annual percentage change (EAPC) was used to assess temporal trends. Age-period-cohort (APC) analysis estimated age, period, and cohort effects. Bayesian APC (BAPC) analysis projected future trends. Decomposition analysis further explored drivers of changes in depression burden. Slope Index of Inequality (SII) and Concentration Index (CI) were calculated to assess health inequalities across regions and countries. From 1990 to 2021, the global incidence, prevalence and DALY rates of adolescent depression remained stable. Depression incidence and prevalence increased with age, with the 20-24 age group showing the highest rates. The burden of depression was higher in females than in males. The COVID-19 pandemic significantly impacted adolescent depression, with reported prevalence, incidence, and DALY rates in 2020 and 2021 far exceeding predicted values, and the burden of depression is expected to continue rising. Health inequalities between adolescents in high- and low-income regions have widened, particularly following the pandemic. The COVID-19 pandemic significantly exacerbated the burden of depression and intensified health inequalities.

The Impact of Place-Based Approaches Addressing Mental Health and Substance Use Among Adolescents: A Systematic Review of the Literature

Objectives

We systematically appraised peer reviewed evidence assessing the impact of "place-based approaches" (PBAs) - those requiring multi-sectoral action within localities to address complex health challenges - on mental health outcomes among adolescents.

Methods

We searched six databases from inception to May 2023. We defined PBAs as at least two sectors (e.g., local government, health) working collaboratively within a locality. Studies reporting mental health and substance-use among young people (aged 10-24) were included. Two authors independently assessed study quality using MMAT. Heterogeneity in PBAs, study design and outcomes prevented meta-analysis; results were narratively synthesised.

Results

Thirty-three publications presented data from 22 PBA evaluations; 6 evaluations assessed mental health or wellbeing, 16 appraised substance use. Higher quality evaluations found no impact on mental health outcomes (n = 4), and some evidence for delayed initiation (n = 4) and reduced point-in-time use (n = 10) of alcohol. Evidence for impact on binge-drinking and drug use was mixed.

Conclusion

Based on very few published studies of mixed quality, PBAs have not improved mental health or wellbeing among adolescents. More evidence exists to suggest PBAs can improve certain alcohol use outcomes in young people.

Sociodemographic characteristics on behavioural risk factors of noncommunicable diseases in adolescents in Luxembourg

BACKGROUND

Non-communicable diseases (NCDs) accounted for 89% of deaths in Luxembourg in 2019, aligning with Europe's figures but exceeding the global average of 74%. Behaviours play a critical role in NCD management, with unhealthy lifestyles-like poor diets, physical inactivity, tobacco use, and alcohol consumption-posing significant risks, especially when combined. The present study aims to explore sociodemographic characteristics of adolescents presenting behavioural risks for NCDs in Luxembourg.

METHODS

A representative sample of 8117 adolescents (11-to-18-years-old) took part in the 2022 Health Behaviour in School-aged Children (HBSC) Luxembourg survey. We measured physical inactivity, daily sugar consumption, cigarette use and alcohol consumption, and their combination (1, 2 or 3 ≥ risks). The sociodemographic characteristics investigated were sex, age, migration background, family structure and perceived wealth. Binomial logistic regression crude and adjusted were performed with sociodemographic characteristics for each risk behaviour. In addition, multinomial logistic regression crude and adjusted were used to analyse the association between the combination of risk behaviours and the sociodemographic information of the adolescents in Luxembourg.

RESULTS

Girls had higher odds of physical inactivity (OR = 2.06) than boys, and older age groups exhibited elevated odds of physical inactivity (OR = 2.99), cigarette smoking (OR = 25.00), and alcohol consumption (OR = 35.56). Migration background emerged as a protective factor against alcohol consumption (parents' migration OR = 0.60; self-immigrated OR = 0.45) but a risk factor for physical inactivity (parents' migration OR = 1.50; self-immigrated OR = 1.72). Adolescents who did not live with both parents were more likely to be physically inactive (OR = 1.37), consume sugar daily (OR = 1.33), smoke cigarettes (OR = 1.26) and consume alcohol (OR = 1.80). Adolescents that reported their families were not well off had higher odds to be physically inactive (OR = 2.12) and to consume sugar daily (OR = 1.39). The simultaneity of risk behaviours reveals a worrying trend of increasing risk with age, highlighting the need for preventive interventions throughout adolescence. Furthermore, the results in relation to family structure and perceived wealth highlights the complexity and interrelationship of these factors in adolescent behavioural health.  CONCLUSIONS: The study provides guidance to create more effective interventions aiming to promote healthy behaviours in adolescents.

Young people and parent or carers views on type 2 diabetes mellitus care in England and Wales: analysis of parent and patient-reported measures survey

BACKGROUND

The prevalence of type 2 diabetes mellitus (T2DM) in children and young people (CYP) is increasing in the UK and worldwide. Little is known about the experience young people and their families have when attending for their diabetes care. The aim of this study is to analyse the responses to the Parent and Patient Reported Experience Measures (PREM) survey 2021-2022 for patients with T2DM and their families to inform care.

METHODS

As part of the National Paediatric Diabetes Audit (NPDA) (2022), the NPDA PREM survey was open online between August 2021 and January 2022. The data have previously been analysed collectively for all diabetes; however, we specifically analysed the data for patients living with T2DM.

RESULTS

9.2% (105/1144) of young people living with T2DM in England and Wales responded to the NPDA PREM survey, mostly aged 12-16 years (61.9%) and the majority were female (67.6%). 87% of patients and 95% of carers said that they would recommend their diabetes team, and 73% of patients felt happy after appointments. Only just over half of the patients and parents felt well prepared for transferring to adult care. Only 38% of patients felt that their school or college often had the necessary information to support them with their diabetes.

CONCLUSIONS

This analysis describes the experience of CYP and their parents/carers of T2DM care and highlights areas for improvement. These findings may help to inform recommendations about the development of better patient-centred care for young people with T2DM.

Effects of a school-based physical activity intervention on mental health indicators in a sample of Brazilian adolescents: a cluster randomized controlled trial

PURPOSE

To test the effects of a physical activity intervention program on symptoms of mental disorders among adolescents.

METHODS

This study is a 12-week cluster randomized controlled trial. The sample consisted of 306 adolescents (45,8% male, age: 13,6 [0,72] years; 54.2% female, age: 13.5 [0.69] years), randomized into an intervention group (N = 165) and a control group (N = 141). The physical activity program involved sessions including muscle strengthening and cardiorespiratory exercises and lifestyle guidance. The mental health indicators analyzed were: anxiety, depression, sleep, and psychological well-being. Intervention effects were analyzed by generalized estimating equations.

RESULTS

After 12 weeks, no significant improvements were observed in the intervention group for sleep; anxiety; depression, and psychological well-being. In the subgroup analysis, significant group×time interactions were observed for adolescents who were classified with moderate symptoms of depression (mean difference: -0.97, p = 0.002) and anxiety (mean difference: -3.03, p = 0.01) with favorable effects for intervention group.

CONCLUSION

After the 12-week intervention period, it can be concluded that 12 weeks of school-based physical activity intervention significantly reduced symptoms of anxiety and depression in adolescents with moderate/severe symptoms. Furthermore, the intervention contributed to the maintenance of psychological well-being, since the control group showed a significant reduction in this mental health indicator.

Clustering Patterns of Unhealthy Lifestyle Behaviours Among Adolescents: A Multilevel Analysis of a Nationally Representative School-Based Survey from 73 Countries

Background: Adolescence is a crucial stage when young people adopt various lifestyle behaviours that can impact their health. However, the broader determinants of these behaviours remain underexplored. This study aimed to investigate clustering patterns of lifestyle behaviours, including physical activity, sedentary behaviour, and dietary habits, among adolescents and examine their determinants across individual, community, and societal levels. Methods: This study utilised nationally representative Global School-based Student Health Survey data. The lifestyle behaviours were dichotomised based on specific definitions, and the clustering patterns of multiple unhealthy behaviours were compared at various levels of factors. Multilevel logistic regression analysis was employed to identify individual, community, and societal level determinants of multiple unhealthy behaviours. Results: The study included 293,770 adolescents from 73 countries and territories across five World Health Organization (WHO) regions. The overall prevalence of one, two, three, four, and five unhealthy behaviours was 6.9%, 29.9%, 36.5%, 21.5%, and 4.5%, respectively. The odds of multiple unhealthy behaviours (defined by ≥4) increase with age and are higher among female adolescents [(AOR: 1.06, 95% CI:1.05, 1.07); (AOR: 1.16, 95% CI: 1.14, 1.19)], respectively. Adolescents from supportive families, peer environments, or food-secure households had lower odds of engaging in these behaviours [(AOR: 0.84, 95% CI: 0.82, 0.86); (AOR: 0.96, 95% CI: 0.94, 0.98); (AOR: 0.91, 95% CI: 0.87, 0.95)], respectively. The odds of exhibiting multiple unhealthy behaviours were significantly higher among adolescents in countries with high (0.7-0.79) and very high (0.8-1.0) Human Development Indexes (HDI) compared to those in low (<0.55) HDI countries [(AOR: 1.84, 95% CI: 1.16, 2.94); (AOR: 3.00, 95% CI: 1.48, 6.08)], respectively. Conclusion: The study findings reveal that multiple unhealthy lifestyle behaviours, including insufficient physical activity, sedentary behaviour, inadequate fruit and vegetable consumption, frequent soft drink intake, and fast-food consumption, are globally prevalent among adolescents. These behaviours have distinct clustering patterns associated with individual characteristics, family and peer environments, and broader socio-economic and societal contexts.

Social Media and the Adolescent Transplant Recipient

INTRODUCTION

Social media is interwoven into adolescents' daily lives. Many adolescents utilize digital technology in their healthcare journeys, as do their caregivers. Health systems increasingly seek ways to leverage these new tools toward supporting and caring for patients. These approaches may be of particular importance of adolescents, as well as healthcare systems, in providing care for chronic and serious illness including transplant patients.

METHODS

This review article will begin with an overview of adolescent social media use. We will then consider ways in which social media may impact adolescents' healthcare experience including identity development and adherence.

RESULTS

Caregivers may leverage social media for information seeking. Families may use social media to seek social support, as well as potential donors. For healthcare systems, social media may enhance research efforts as well as information delivery.

DISCUSSION

Future directions include studies examining how social media can support adolescent transplant patients. incorporation of youth voice into these studies may enhance application of findings to clinical practice.

Could physical activity promote indicators of physical and psychological health among children and adolescents? An umbrella review of meta-analyses of randomized controlled trials

BACKGROUND

We performed an umbrella review to synthesize evidence on the effects of physical activity (PA) interventions on indicators of physical and psychological health among children and adolescents, including body mass index (BMI), blood pressure (BP), depressive symptoms, and cognitive function.

METHODS

PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched from inception through 31 July 2023. We included meta-analyses of randomized controlled trials exploring the effects of PA interventions on BMI, BP, depressive symptoms, or cognitive function in healthy or general children and adolescents. Standard Mean Difference (SMD) was calculated for continuous outcome indicators, while Relative Risk (RR) was calculated for categorical outcome indicators.

RESULTS

A total of 21 meta-analyses were included. The evidence for the effects of PA interventions on reducing BMI [n = 68,368, SMD = - 0.04, 95% confidence interval (CI) = - 0.07 to - 0.01, P = 0.012, I2 = 46.6%], relieving diastolic BP (n = 8204, SMD = - 1.16, 95% CI = - 2.12 to - 0.20, P = 0.018, I2 = 83.1%), preventing depressive symptoms (n = 5146, SMD = - 0.21, 95% CI = - 0.31 to - 0.12, P < 0.001, I2 = 29.0%), and promoting cognitive function (n = 19,955, SMD = 0.40, 95% CI = 0.27-0.54, P < 0.001, I2 = 88.0%) was all weak but significant (class IV evidence). Subgroup analyses demonstrated that school-based and after-school PA interventions, curricular PA interventions, and PA interventions emphasizing enjoyment were more effective in reducing BMI, while curricular PA and sports programs achieved greater executive function.

CONCLUSION

PA interventions could weakly reduce BMI, relieve BP, prevent depressive symptoms, and promote cognitive function in general children and adolescents. Targeted interventions on PA should be a priority to promote physical and psychological health for children and adolescents, especially the curricular PA emphasizing enjoyment in the school settings.

Longitudinal coupling of emotional wellbeing in parent-adolescent dyads: Evaluating the role of daily life positive affect socialization processes

This study evaluated the role of bidirectional micro- and macro- level positive affect-related processes in the longitudinal coupling of depressive symptoms in parent-adolescent dyads. Using a measurement-burst design, including dyadic experience sampling methods (ESM) and monthly follow-ups over one year, this work investigated associations between (1) parental depressive symptoms and anhedonia and parental daily-life enhancing and dampening responses to youth positive affect; (2) parental daily-life enhancing and dampening and trajectories of youth positive affect, negative affect, and depressive symptoms across one year; and (3) youth developmental trajectories and prospective parental daily-life enhancing and dampening, and parental depressive symptoms and anhedonia at one-year follow-up. Participants included 146 early adolescents (52.1% girls, 47.9% boys; Mage[SD] = 12.71[.86]) and 139 parents (78.7% mothers; Mage[SD] = 44.11[5.08]). Parental enhancing and dampening were measured using a dyadic ESM procedure at baseline and 12-months. Youth completed monthtly questionnaires assessing depressive symptoms and trait positive and negative affect across 12 months. Parents reported on depressive symptoms and anhedonia at baseline and 12-months. Results showed that parental anhedonia negatively related to parental daily-life enhancing, and youths' perceptions of their parents' enhancing and dampening reciprocally related to youth emotional development across one year, with downstream implications for parents' own symptoms of depression.

Childhood Physical Fitness as a Predictor of Cognition and Mental Health in Adolescence: The PANIC Study

BACKGROUND

Cognitive and mental health problems are highly prevalent in adolescence. While higher levels of physical fitness may mitigate these problems, there is a lack of long-term follow-up studies on the associations of physical fitness from childhood with cognition and mental health in adolescence.

OBJECTIVE

We investigated the associations of physical fitness from childhood to adolescence over an 8-year follow-up with cognition and mental health in adolescence.

METHODS

The participants were 241 adolescents (112 girls), who were 6-9 years at baseline and 15-17 years at 8-year follow-up. Average and change scores for cardiorespiratory fitness (maximal power output [Wmax]; peak oxygen uptake [VO2peak]), motor fitness (10 × 5-m shuttle run), and muscular fitness (standing long jump; hand grip strength) were calculated. Global cognition score was computed from six individual cognitive tasks, and perceived stress and depressive symptoms were assessed at the 8-year follow-up. The data were analysed using linear regression models adjusted for age, sex, and parental education.

RESULTS

Average motor fitness was positively associated with global cognition score (standardised regression coefficient [β] - 0.164, 95% confidence interval [CI] - 0.318 to - 0.010) and inversely with perceived stress (β = 0.182, 95% CI 0.032-0.333) and depressive symptoms (β = 0.181, 95% CI 0.028-0.333). Average cardiorespiratory fitness was inversely associated with perceived stress (Wmax: β =  - 0.166, 95% CI - 0.296 to - 0.036; VO2peak: β =  - 0.149, 95% CI - 0.295 to - 0.002) and depressive symptoms (Wmax: β =  - 0.276, 95% CI - 0.405 to - 0.147; VO2peak: β =  - 0.247, 95% CI - 0.393 to - 0.102). A larger increase in cardiorespiratory fitness was associated with lower perceived stress (Wmax: β =  - 0.158, 95% CI - 0.312 to - 0.003; VO2peak: β =  - 0.220, 95% CI - 0.395 to - 0.044) and depressive symptoms (Wmax: β =  - 0.216, 95% CI - 0.371 to - 0.061; VO2peak: β =  - 0.257, 95% CI - 0.433 to - 0.080).

CONCLUSIONS

Higher levels of motor fitness in childhood and adolescence were associated with better cognition in adolescence. Higher levels of and larger increases in cardiorespiratory fitness from childhood to adolescence were associated with better mental health in adolescence.

Validity and Reliability Assessment of a Food and Physical Activity Questionnaire for Adolescents From Low-Income Communities

OBJECTIVE

Develop and validate an evaluation questionnaire for sixth-12th grade Expanded Food and Nutrition Education Program (EFNEP) participants.

DESIGN

Five-step process: domain concept prioritization, question generation, question pretesting, reliability testing, and criterion validity testing.

SETTING

Community sites in 4 states and New Jersey EFNEP secondary program data.

PARTICIPANTS

Nineteen sixth-12th graders were interviewed; secondary data included 164 ninth-12th graders.

VARIABLES MEASURED

Content, face, and criterion validity; internal reliability.

ANALYSIS

Iterative template analysis to gauge conceptual understanding; exploratory factor analysis with orthogonal Varimax rotation, interitem correlations, and Cronbach α; Spearman correlations and Bland-Altman plots against the Physical Activity Questionnaire for Adolescents and Youth Risk Behavior Survey questions.

RESULTS

Fourteen questions with acceptable face validity were developed. One item (handwashing) had a ceiling effect and was removed. Eleven of the remaining 13 items were loaded onto 4 factors. The remaining 2 items were kept because of conceptual relevance. The questionnaire demonstrated acceptable reliability and validity overall, but subscale Cronbach α values ranged from 0.53-0.75.

CONCLUSIONS AND IMPLICATIONS

This 13-item questionnaire was presented to national EFNEP program leaders and was implemented by EFNEP in October 2023. Further research could establish temporal reliability and gold standard criterion validity estimates with a multistate sample of sixth through 12th graders.

The Value of an Informal Before-School Exercise Opportunity for Adolescent Girls Living in a Low-Socioeconomic Community

BACKGROUND

Physical activity is beneficial to physical, social, and emotional well-being, and schools are required to provide opportunities to engage in physical activity. While physical education and school sport have been extensively researched, little is known about the value of informal, unstructured, exercise opportunities.

METHODS

This study involved interviews with 19 adolescent girls who attended "extra" exercise opportunities provided by their school. The 3 opportunities were: (1) informal before-school exercise sessions at school, (2) before-school sport training, and (3) externally provided exercise sessions in a community setting during school hours.

RESULTS

Students perceived all opportunities as valuable with benefits to confidence, social well-being, and emotional well-being. The informal exercise sessions held greater benefits to confidence as confidence transferred from the physical activity context into the academic classroom more so than for those participating in sport. Social benefits were greater for those exercising before school as this opportunity created new relationships with teachers and with students from other classes and year groups.

CONCLUSIONS

The opportunity to engage in informal exercise with peers before school widened social networks, increased confidence, changed the overall school climate, and increased attendance.

Managing Challenging Behaviour in the Adolescent Inpatient Environment

Frontline clinical staff, typically nurses, are routinely faced with the dilemma of managing challenging, defiant and sometimes unsafe behaviours. Structures of ward rules, regulations and 'behavioural expectations' are often employed in hospital environments in service of regulating these behaviours and ensuring collective well-being. Adolescent inpatient populations, however, pose unique and particularly complex challenges for managing behavioural expectations, given the unique needs and inherent tempestuousness of this developmental period. This article presents a critical review of the existing literature on behavioural expectations for inpatient units, which is largely bereft of adolescent-specific guidelines. Relevant theoretical perspectives are examined that lend understanding to the management of adolescent behaviour. Finally, drawing from neurodevelopmental, attachment and socio-evolutionary theory, guiding clinical principles and recommendations are derived for best practice in managing challenging adolescent behaviour in hospital settings.

Personality traits and co-occurrence of depressive symptoms and high BMI: a prospective cohort study

We assess the associations between personality traits and co-occurrence of depressive symptoms and high BMI from adolescence to early adulthood. We employed a nationally representative cohort in China from 2010 to 2020 year. We included adolescents aged 10-19 years without depressive symptoms and unhealthy weight status (obesity, overweight, or thinness) at baseline and excluded those without any measurement of depressive symptoms or BMI at follow-ups. We assessed baseline personality traits in 7 dimensions of conscientiousness, openness, neuroticism, agreeableness, extraversion, self-esteem, and responsibility. We also assessed the combined effects of these 7 dimensions of personality traits by generating individual-level personality trait risk scores based on the weighted sum of all these 7 dimensions of personality traits. We measured the co-occurrence of depressive symptoms and high BMI using both a single measurement of depressive symptoms and BMI at the last follow-up and repeated measurements of them over 10 years. We used the multinomial logistic regression models to examine the exposure-outcome associations. At baseline, we included 1778 individuals (mean age: 14.4 year; female: 853 (48.0%)). At follow-ups, we observed increased risk of co-occurrence of depressive symptoms and high BMI per 1-SD increase in neuroticism score (1.95-2.38 odds ratio) or 1-SD decrease in self-esteem and conscientiousness (0.63-0.80 odds ratio; all P values < 0.05); we observed no evidence of associations between openness, agreeableness, extraversion, or responsibility and the risk of co-occurrence of depressive symptoms and high BMI (all P values > 0.05). For the combined effects of the 7 dimensions of personality traits, we found an elevated risk of co-occurrence of depressive symptoms and high BMI per 1-SD increase in the personality trait risk scores (OR (95% CI), single measurement at the last follow-up: 2.01, 1.66 to 2.43; trajectory classification using the repeated measurements 2.30, 1.55 to 3.42; average level using the repeated measurements: 2.27, 1.93 to 2.67). In this national cohort in China, personality traits were found to be associated with the co-occurrence of depressive symptoms and high BMI from adolescence to early adulthood. These findings highlight the importance of stratifying individuals based on their personality traits and providing targeted interventions for those at risk of comorbid depression and obesity.

Association between physical activity, smartphone usage, and obesity risk among Korean adolescents: A cross-sectional study based on 2021 Korean adolescent health behavior survey

BACKGROUND

With adolescent obesity rates steadily rising, it has become crucial to identify modifiable risk factors to develop effective interventions. This study explores the associations between physical activity (PA) levels, smartphone usage, and obesity risk among Korean adolescents, aiming to inform the design of targeted health promotion programs to mitigate obesity rates in this demographic.

METHODS

This cross-sectional analysis used data from 50,407 Korean adolescents who participated in the 2021 Adolescent Health Behavior Online Survey. Descriptive statistics and chi-square tests compared PA patterns, sedentary behavior, and smartphone usage between adolescents with obesity and those without obesity. To examine the impact of key exposure factors-including PA, muscle strengthening exercises (MSE), sedentary behavior, and smartphone usage-on obesity risk, binary logistic regression models were used, adjusting for grade level, economic status, and other potential confounders.

RESULTS

Male adolescents exercising "3-4 times/week" had a significantly higher obesity risk compared to those with no PA (OR = 1.144, 95 % CI: 1.032-1.267, p < 0.01). Similarly, females exercising "3-4 times/week" (OR = 1.208, 95 % CI: 1.048-1.393, p < 0.01) or "≥ 5 times/week" (OR = 1.333, 95 % CI: 1.087-1.636, p < 0.01) also showed increased risk. Both males and females participating in high-intensity PA (HIPA) "1-2 times/week" were at higher risk (males: OR = 1.110, 95 % CI: 1.011-1.219, p < 0.01; females: OR = 1.427, 95 % CI: 1.283-1.587, p < 0.001). Conversely, MSE was linked to a significant reduction in obesity risk across most frequency groups, especially in males (OR = 0.450, 95 % CI: 0.399-0.508, p < 0.001). For sedentary behavior, females with ≥6 h of weekday non-learning sedentary time (SWD-N) had increased obesity risk (OR = 1.210, 95 % CI: 1.002-1.462, p < 0.01), as did males with ≥6 h of weekend sedentary time (SWK-N) (OR = 1.334, 95 % CI: 1.154-1.542, p < 0.001) and females with ≥6 h of weekend smartphone usage (SPWK_TM) (OR = 1.567, 95 % CI: 1.066-2.303, p < 0.01).

CONCLUSIONS

The findings reveal complex relationships between PA, MSE, sedentary behavior, and smartphone usage in the context of adolescent obesity. Certain PA levels, particularly 3-4 times/week and ≥ 5 times/week for females, and HIPA frequency were associated with increased obesity risk. In contrast, MSE significantly reduced obesity risk across genders, with the most substantial effects observed in males engaging in MSE ≥ 5 times/week. Only associations meeting the p < 0.01 threshold were interpreted in this study to ensure robust conclusions. These results emphasize the importance of promoting MSE and balanced sedentary behavior patterns to reduce adolescent obesity risk, suggesting health policies should address these factors with a focus on gender-specific and age-specific strategies. However, limitations such as the lack of nutrition data, unassessed PA intensity, and HIPA duration should be addressed in future research.

The association between self-acceptance, emotion regulation, and treatment adherence self-efficacy among adolescents with HIV in Liangshan prefecture, China: a cross-sectional study

BACKGROUND

Achieving viral suppression through effective treatment adherence is critical for adolescents with HIV; however, the role of treatment adherence self-efficacy-an individual's confidence in their ability to consistently follow antiretroviral therapy (ART) regimens-remains under-explored among Chinese adolescents. This gap is particularly concerning given the United Nations' "95-95-95" targets to end the AIDS epidemic by 2030.

OBJECTIVE

The aim of this study is to investigate the treatment adherence self-efficacy levels of Yi ethnic adolescents with HIV in a county in Liangshan Prefecture, and to explore the association between self-acceptance, emotion regulation, and treatment adherence self-efficacy.

METHODS

A cross-sectional study was conducted in a county of Liangshan Prefecture from November 2023 to March 2024. A convenience sampling method was used to select 205 participants. Multiple linear regression models were employed to examine the relationships between demographic variables, self-acceptance, emotion regulation and treatment adherence self-efficacy. A p-value < 0.05 was considered statistically significant.

RESULTS

The study involved 205 participants (response rate: 96%) with an average age of 14.08 years. The mean ± standard deviation (SD) treatment adherence self-efficacy score of the study participants was 73.09 (± 16.37). Treatment adherence self-efficacy was significantly associated with factors such as residence [β = -0.174, 95% CI = (-13.841, -2.260)], occupation [β = 3.234, 95% CI = (7.061, 29.137)], and age [β = 0.312, 95% CI =(0.742, 2.502)]. In addition, self-acceptance and emotion regulation were positively correlated with treatment adherence self-efficacy. For each unit increase in self-acceptance, treatment adherence self-efficacy improved [β = 0.157; 95% CI =(0.081, 0.892)], and for each unit increase in emotion regulation, treatment adherence self-efficacy also improved [β = 0.314; 95% CI = (0.288, 0.724)].

CONCLUSIONS

This study highlighted that several factors, including place of residence, occupation, age, self-acceptance, and emotion regulation, were significantly associated with treatment adherence self-efficacy among adolescents with HIV. Notably, self-acceptance and emotion regulation were positively correlated with treatment adherence self-efficacy. Enhancing treatment adherence self-efficacy in this population could be achieved by focusing on improving self-acceptance and emotion regulation. Furthermore, interventions aimed at increasing treatment adherence self-efficacy should prioritize rural areas, non-student populations, and younger adolescents, as these groups tend to exhibit lower adherence self-efficacy. Tailored interventions that address the specific needs of these subgroups could contribute to improved health outcomes and more effective HIV management among adolescents.

Maternal Incarceration and Health Risk Behaviors Among Adolescents: A Latent Class Analysis

Most studies on the impact of maternal incarceration on adolescent health risk behaviors have focused on singular, separated behaviors, even though these behaviors often cluster and co-occur. This study used the FFCWS dataset to examine the association between maternal incarceration and the aggregation of health risk behaviors among adolescents. Latent class analysis suggested the four-class model had the optimal model fit. Multinomial logistic regression revealed that the odds of adolescents with maternal incarceration histories being classified into the "high dietary risk behavior," "high insomnia risk behavior," and "high health risk behavior" groups, compared to the "low health risk behavior" group, were 4.02 times, 3.12 times, and 7.80 times those of adolescents without such experience, respectively. Findings contributed to our knowledge of maternal incarceration's collateral consequences and suggested it be considered in bundled interventions targeting adolescents. Future research that disentangles these relationships' underlying explanatory factors and sociodemographic moderators is needed.

Impact of digital exposure on premarital sex and contraception use among unmarried Indian youth

BACKGROUND

Premarital sex in India is hugely stigmatized. With the widespread use of mobile phones and the internet, attitudes and behaviors towards premarital sexual activities are inevitably shifting. This study investigates the impact of digital exposure, specifically mobile phones and the internet on premarital sex and contraception use among unmarried Indian youths.

METHODOLOGY

Utilizing data from the 5th National Family Health Survey, the analysis includes 172,568 women and 33,397 men aged 15-29 years. The study applies univariate, bivariate, and multivariate statistical methods, such as Chi-square tests and Multiple Logistic Regression. Propensity Score matching addresses selection bias, estimating the impact of digital exposure on premarital sexual activities and condom use.

RESULTS

The findings show that youth exposed to mobile phones and the internet are more likely to engage in premarital sex and use condoms during their first sexual encounter. Specifically, 13.46% of men and 2.83% of women reported premarital sex, with 60.84% of men using condoms at first sex. These behaviors are significantly associated with age, education, urban residence, and mass media exposure.

CONCLUSION

Digital exposure significantly influences premarital sexual behaviors and contraception use among unmarried Indian youth. Adoption of mobile devices and internet usage in India should be accompanied by the implementation of holistic and culturally appropriate technology-driven interventions to provide sex education in India.

The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up Study

BACKGROUND

Mental health problems among adolescents are increasing, and internet-delivered acceptance and commitment therapy (iACT) constitutes a possible way to improve access to care while reducing costs. Nevertheless, few studies have investigated iACT for adolescents in regular primary care nor the role of parental support.

OBJECTIVE

This is an exploratory evaluation investigating iACT, with or without parental support, for adolescents. The aims were to examine treatment adherence, symptoms of anxiety and depression, psychological flexibility, and overall functioning.

METHODS

Adolescents with anxiety were recruited within the regular primary care patient flow during the implementation phase of therapist-assisted iACT for adolescents. Assessment and inclusion were executed face-to-face. Due to organizational reasons, the assignment of treatment methods could not be randomized. Adherence was investigated by measuring the number of completed modules. Outcome measures were collected by self-assessment questionnaires including the Revised Children's Anxiety and Depression Scale and Avoidance and Fusion Questionnaire for Youth, as well as interviews using the Children's Global Assessment Scale. The analysis was performed as an exploratory evaluation using descriptive data for treatment adherence and nonparametric within-group analysis with the Wilcoxon signed rank test for related samples and treatment outcomes. This evaluation is naturalistic, and the results are preliminary and of a hypothesis-generating character and should be handled with caution.

RESULTS

The iACT group without parental support (n=9) exhibited a gradual dropout throughout the treatment period (n=5), whereas the iACT group with parental support (n=15) exhibited the lowest number of dropouts from treatment before completion (n=2), of which all occurred during the second half of treatment. The within-group, per-protocol analyses for the Revised Children's Anxiety and Depression Scale indicated reduced symptoms of anxiety and depression at the 12-month follow-up (z score: -2.94; P=.003; r=-0.6). The within-group, per-protocol analyses for the Avoidance and Fusion Questionnaire for Youth indicated increased psychological flexibility at the 12-month follow-up (z score: -2.54; P=.01; r=0.55). Nevertheless, no differences in overall functioning measured by the Children's Global Assessment Scale were found.

CONCLUSIONS

The results indicate that parental support might play a role in treatment adherence in iACT for adolescents with anxiety. Moreover, the outcome measures suggest that iACT for adolescents in primary care could constitute an effective treatment for both anxiety and depression, as indicated by the symptom reduction and increased psychological flexibility, maintained at the 12-month follow-up. Nevertheless, due to a small and gender-biased sample size with a large proportion of dropouts and missing data, a nonrandomized assignment of intervention, and an analysis limited to within group, this study should be considered an explorative evaluation rather than an outcome study.

Perceived racial discrimination, resilience, and oral health behaviours of adolescents with immigrant backgrounds

INTRODUCTION

Unmet oral health needs remain a significant issue among immigrant adolescents, often exacerbated by experiences of racial discrimination. This study aimed to examine the associations between perceived discrimination and oral health behaviours in adolescents with immigrant backgrounds and explore the potential moderating role of resilience on this association.

METHODS

Ethical approval for this cross-sectional study was obtained from the University of Alberta Research Ethics Board. Participants were 12 to 18-year-old adolescents from immigrant backgrounds. Participants were recruited through nine community organizations using a snowball sampling technique. After obtaining active parental consent and assent from the adolescent, the participants completed a questionnaire covering demographics, oral health behaviours, and perceived racial discrimination and resilience. Perceived racial discrimination and resilience were measured using validated scales. Descriptive statistics summarized variables. Logistic regression assessed associations, controlling for confounding factors. Resilience's moderating impact was analyzed via the interaction model of regression analysis.

RESULTS

In this cross-sectional study of 316 participants, average age of 15.3 (SD = 1.9) years, and a median age of 15 years (Inter Quartile Range-12-18), 76% reported discrimination experiences. Adjusted analysis showed that an increase of one unit in the total discrimination distress score was associated with 51% less likelihood of categorizing self-rated oral health as good (OR = 0.49, 95% CI: 0.29-0.81). The odds of brushing teeth more than twice a day, as opposed to once a day, decreased by 58% with one unit increase in the total discrimination distress score (OR = 0.42, 95% CI: 0.25-0.71). The odds of visiting the dentist for an urgent procedure instead of a regular check-up were 2.3 times higher with a unit increase in the total discrimination distress score (OR = 2.3: 95% CI:1.3-4.0) Resilience did not moderate the observed association.

CONCLUSION

Perceived racial discrimination was associated with the pattern for dental attendance, tooth brushing frequency, and self-rated oral health. Resilience did not moderate the observed association.

Association between depressive symptom trajectories and unhealthy lifestyle factors among adolescents based on the China family panel studies

BACKGROUND

The prevalence of depressive symptom in adolescents has sharply increased over the past decade. Depressive symptom during adolescence could hinder the development of social, cognitive, and psychological competencies, potentially influencing young adults' lifestyle factors. This study aimed to identify trajectories of depressive symptom from adolescence to early adulthood and evaluated their association with lifestyle factors in early adulthood.

METHODS

Data was collected from the China Family Panel Studies (CFPS). The Center for Epidemiological Studies Depression Scale (CES-D) was assessed during the 2016, 2018, and 2020. Group - based trajectory modeling was used to identify trajectories of depressive symptom over a 5 - year follow - up. We used binary logistic regression analyze to explore the relationship between depressive symptom trajectories and lifestyle factors.

RESULTS

We identified four trajectories of depressive symptom, characterized by maintained low scores (non - symptom); moderately high scores (moderately high symptom); consistently high scores (persistently high symptom); and low starting scores that steadily increased (increasing symptom). After adjusting for potential confounding factors, the ORs for smoking were 2.95 (1.47, 5.97) for the "persistently high symptom" trajectory comparing to the "non - symptom" trajectory.

CONCLUSION

The depressive symptom trajectories was associated with unhealthy lifestyle factors. Future studies are needed to determine whether depressive symptom might serve as early indicators prompting adolescents to make psychological changes that could reduce the risk of unhealthy lifestyle factors in the later life.

The effects of acute exercise on emotional pattern separation in adolescents and young adults

Acute exercise has been associated with cognitive improvements, particularly in memory processes linked to the hippocampus, such as the ability to discriminate between similar stimuli, called hippocampal pattern separation. This can be assessed behaviorally with a mnemonic discrimination task and neurally with functional magnetic resonance imaging (fMRI). Additionally, previous research has shown an emotional modulatory effect on pattern separation, involving the amygdala. In this randomized between-subject study, we investigated whether a 10-minute bout of moderate-intensity exercise, compared to rest, could enhance pattern separation of neutral and emotional images in a group of healthy adolescents and young adults (n=53). Our results showed no significant effects of exercise on either mnemonic discrimination performance or neural activity in the hippocampus and amygdala. Additionally, arterial spin labeling (ASL) confirmed that there were no significant differences in cerebral blood flow between exercise and rest. We did observe worse discrimination for images with a higher similarity level and worse discrimination for highly similar positive images compared to negative and neutral images. However, there were no significant correlations between behavioral outcomes and neural activity. Exploratory analysis revealed a neural signal consistent with pattern completion in the bilateral CA1 and left CA3, but no evidence of pattern separation. Future studies should optimize the exercise characteristics necessary to robustly enhance pattern separation.