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Schools are ideal settings to promote adolescent physical activity (PA), yet school-based interventions have shown limited long-term impact. This position paper presents key issues surrounding school-based PA interventions. Collaborative conceptual thinking drawing on multi-author expertise and available evidence advanced our understanding and opinion. Key arguments: 1) the adoption of a systems approach, which maximizes partnership action and leverages policy, is crucial for understanding the complexities of implementing whole-school programs; 2) a reorientation to an assets perspective optimizes existing strengths and resources allowing greater emphasis on the full range of physical, cognitive, emotional and social benefits that PA provides, and 3) a move beyond traditional positivist research designs to advance our knowledge of what works better, for whom and in what context is needed for greater progress We provide suggestions, specifically advocating for systems approaches, as a realistic way to improve how we support PA in schools in the future. [ABSTRACT FROM AUTHOR]

To estimate the effect of neighborhood-level modification on the efficacy of the MyPEEPS Mobile intervention on the reduction of condomless anal sex acts among same-sex attracted adolescent men. A series of generalized linear mixed model was used to examine if the effect of the MyPEEPS Mobile intervention on condomless anal sex acts was moderated by neighborhood-level factors using data from the 2019 American Community Survey US Census Bureau. The magnitudes of intervention were significantly smaller at both 6- and 9-month follow-up among adolescents living in neighborhood with high proportions of Hispanic or Latino residents (IRR6M = 1.02, 95 % CI: 1.01, 1.02; IRR9M = 1.03, 95 % CI: 1.01, 1.05) and high proportions of families with income below the poverty level (IRR6M = 1.07, 95 % CI: 1.01, 1.12; IRR9M = 1.05, 95 % CI: 1.01, 1.10), which indicated that living in communities with a higher concentration of residents living under poverty or of Hispanic/and Latino ethnicity significantly modified the effective of program intervention on condomless sex among adolescent MSM. Understanding how neighborhood characteristics modify the effect of HIV prevention interventions may be useful in better targeting delivery and tailoring content of interventions based on neighborhood level characteristics such as the ones identified in this study.

PurposeEmerging research evidence suggests positive relationships between higher screen time and eating disorders. However, few studies have examined the prospective associations between screen use and eating disorder symptoms in early adolescents and how problematic screen use may contribute to symptom development.MethodsWe analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,246, 2016-2020, ages 9-14). Logistic regression analyses were used to estimate the longitudinal associations between baseline self-reported screen time and eating disorder symptoms in year two. Logistic regression analyses were also used to estimate cross-sectional associations between problematic screen use in year two (either problematic social media or mobile phone use) and eating disorder symptoms in year two. Eating disorder symptoms based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) included fear of weight gain, self-worth tied to weight, engaging in compensatory behaviors, binge eating, and distress with binge eating.ResultsEach additional hour of total screen time and social media use was associated with higher odds of fear of weight gain, self-worth tied to weight, compensatory behaviors to prevent weight gain, binge eating, and distress with binge eating two years later (odds ratio [OR] 1.05-1.55). Both problematic social media and mobile phone use were associated with higher odds of all eating disorder symptoms (OR 1.26-1.82).ConclusionsFindings suggest greater total screen time, social media use, and problematic screen use are associated with more eating disorder symptoms in early adolescence. Clinicians should consider assessing for problem screen use and, when high, screen for disordered eating.Level of evidenceLevel III: Evidence obtained from well-designed cohort or case-control analytic studies.

PURPOSE: The aim of this study is to expand the current knowledge on the relationship between poverty, family functioning, and the mental health of adolescent girls in families affected by poverty and HIV/AIDS in southern Uganda. The study investigates the association between family functioning and mental health and examines whether family functioning moderates the intervention effect on adolescent mental health. METHODS: Longitudinal data were collected over the course of 24 months in a cluster randomized controlled trial conducted among N=1,260 girls aged 14-17 years in Uganda. Participants were randomized into control group (n=408 girls from n=16 schools), matched youth development accounts treatment, YDA (n=471 girls from n=16 schools), and integrated intervention combining YDA with multiple family group component (n=381 girls from n=15 schools). RESULTS: We found a significant positive association between family functioning and mental health of adolescent girls in our sample. Moderator analyses suggests that effect of the intervention on Beck Hopelessness Scale was significantly moderated by family cohesion (χ2 (4) =21.43; p = .000), frequency of family communication (χ2 (4) =9.65; p = .047), and quality of child-caregiver relationship (χ2 (4) =11.12; p = .025). Additionally, the intervention effect on depression was moderated by the comfort of family communication (χ2 (4) =10.2; p = .037). DISCUSSION: The study findings highlight the importance of family functioning when examining the link from poverty to adolescent mental health. The study contributes to the scarce evidence suggesting that asset-accumulation opportunities combined with a family strengthening component may improve parenting practices and adolescent mental health in poor households.

BackgroundAdolescent girls and young woman (AGYW) comprise a significant proportion of new HIV infections and unintended pregnancies in sub-Saharan Africa yet face many barriers to accessing family planning and reproductive health (FPRH) information and services. Developed via human-centered design, the Malkia Klabu ("Queen Club") program aimed to facilitate access to HIV self-testing (HIVST) and FPRH information and products at privately-owned drug shops. We sought to understand barriers and facilitators to program implementation in a 4-month pilot in Tanzania.MethodsForty semi-structured interviews were conducted with participants in a cluster randomized trial of the Malkia Klabu program from November 2019 through March 2020, including 11 with AGYW, 26 with drug shopkeepers, and three with counselors at health facilities to whom AGYW were referred. Interviews were audio-recorded, transcribed, coded, and analyzed to identify key themes. The Consolidated Framework for Implementation Research (CFIR) was used to assess barriers and facilitators to program implementation at multiple levels. CFIR considers the outer setting (e.g., culture and systemic conditions), the inner setting where the intervention is implemented (e.g., incentives, relationships, and available resources), the individuals involved, the innovation as it relates to stakeholder needs, and the implementation process.ResultsThe Malkia Klabu program reshaped and directed the role of drug shopkeepers as providers of information and resources rather than FPRH gatekeepers. Key implementation facilitators included the program's adaptability to a wide range of needs and stages of readiness among AGYW, ability to capitalize on AGYW social networks for driving membership, responsiveness to AGYW's need for privacy, and positive contributions to the income and community standing of drug shopkeepers. Components such as HIVST were highly acceptable to both AGYW and shopkeepers, and the introduction of the loyalty program and HIVST kits in shops opened doors to the provision of FPRH products and information, which was further facilitated by program tools such as videos, product displays, and symbol cards. Although some shopkeepers maintained beliefs that certain contraceptive methods were inappropriate for AGYW, most appeared to provide the products as part of the program.ConclusionsThe Malkia Klabu intervention's success was due in part to its ability to address key motivations of both AGYW and drug shopkeepers, such as maintaining privacy and increasing access to FPRH products for AGYW and increasing business for shops. Better understanding these implementation barriers and facilitators can inform the program's future adaptation and scale-up.Trial registrationclinicaltrials.gov #NCT04045912.

ABSTRACT Background Aim Design Methods Results Conclusion Implications for the Profession and/or Patient Care Impact Patient or Public Contribution Adolescent parents are at an increased risk for loneliness and mental health challenges compared to childless peers. Nature‐based interventions are shown to promote social connectedness.To identify elements of a nature‐based intervention to reduce loneliness and foster nature connection among pregnant and parenting adolescents.Sequential exploratory mixed methods.In 2020 and 2021, we piloted the 8‐week MINT program at a school for pregnant and parenting teens. Our qualitative approach (n = 17) included online and in‐person group meetings with nature‐based educational content, discussion, park excursions, mindfulness activities, journaling and nature photography. Subsequently, we recruited 131 young mothers at a children's hospital for a cross‐sectional survey based on qualitative school findings.Qualitative results from the school‐based intervention showed a preference for meditative and contemplative activities and for spending time in nature with extended family. Participants typically accessed nature close to home. Our clinic‐based teen parent survey illustrated that participants' access to nature were most limited by lack of time (25% of responses), company (18%) and energy (28%). While participants showed a close nature connection (mean NR‐6 score = 3.9 (SD = 0.84)), they also showed moderate levels of loneliness (mean UCLA Loneliness score = 4.78 (SD = 1.60)). Walking, hiking and/or running were the most preferred nature activity.These findings provide key details to define nature‐based activities to address loneliness and psychological well‐being among teen mothers.Nature‐based health interventions can address loneliness and nature disconnection by building community resilience, improving provider and patient well‐being and motivating environmental stewardship.We identify key features of a nature‐based intervention for adolescent mothers. These findings support teen mothers in the US and abroad and may serve as a foundation for using nature‐based solutions for vulnerable mothers and for adolescents facing loneliness and mental health challenges.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Menstrual hygiene management is a critical aspect of adolescent health. However, access to adequate menstrual hygiene products and sanitation facilities is severely restricted during times of war. There is a dearth of information about the menstrual hygiene needs of adolescent girls during humanitarian crises. This study investigated the menstrual hygiene management needs of the internally displaced adolescent girls in the war-torn region of Tigray, Ethiopia. Methods: A qualitative study was conducted in three centers for internally displaced people in Mekelle, Tigray Region. Four focus-group discussions and six in-depth interviews were conducted using the local language among 39 adolescent girls aged 13–19 years. The collected data were recorded, transcribed, translated, and analyzed using the ATLAS.ti-7.5.18 software through a qualitative thematic analysis approach. Results: Six primary themes were identified: 1) shortage of menstrual pads; 2) poor accommodation of latrine facilities; 3) silence around menstruation; 4) exchange of menstrual pads for life-saving commodities, 5) lack of privacy; 6) menstruation is a "curse" for adolescent girls living in displaced people's camps. The study highlights the significant challenges faced by internally displaced adolescent girls in managing their menstrual hygiene while living in camps for internally displaced people. Lack of access to adequate menstrual hygiene management supplies often leads them to use rags or worn-out clothing instead of menstrual pads. Conclusion: Access to adequate menstrual hygiene products and sanitation facilities is severely limited among displaced adolescent girls in Tigray. The findings emphasize the urgent need to address menstrual hygiene issues during emergencies. Supplying essential items such as sanitary pads, soap, water, sanitation infrastructure, and improved information on menstrual hygiene management should be prioritized. [ABSTRACT FROM AUTHOR]

ABSTRACT Eating disorders encompass a spectrum of mental health conditions that are characterised by a preoccupation with eating, exercise, body weight or shape. The trajectory of eating disorders can result in hospitalisation for medical complications, such as electrolyte imbalance, extremely low weight and other medical issues that require urgent inpatient attention. Typically, care for adolescents with medically compromised eating disorders occurs in general medical settings, with most care provided by nurses who may or may not have the training and experience to provide quality care for this complex mental health condition. The aim of this scoping review is to examine literature surrounding the experience of nurses caring for adolescents admitted to general medical wards (non‐mental health settings) with medically compromised eating disorders. We used Arksey and O'Malley's (2005) five‐step scoping review process to conduct this review. A systematic search of the literature located 476 relevant papers, and after screening, 10 were included in the final review. Most included papers were qualitative in methodology, with one using a mixed‐methods design. The papers examined in this scoping review found common themes among nurses who were providing care for adolescents with medically compromised eating disorders being cared for in medical wards (non‐mental health settings): a lack of preparation to care for individuals with eating disorders, a high emotional and psychological toll on nurses providing care and a degree of stigma towards adolescents with eating disorders, including a belief that eating disorders were a ‘choice.’ This review indicates that to provide quality and safe care for adolescents with eating disorders admitted to general medical wards, nurses require specialised training. In addition, the care of adolescents with medically compromised eating disorders requires the support of trained mental health nurses, especially where nurses on general medical wards are novice or have limited mental health training. We recommend further research into support structures to prevent burnout and turnover that is prevalent when providing care to individuals with eating disorders. [ABSTRACT FROM AUTHOR]

Objective: This study aims to identify the most recommended components of creative art therapy (CAT) to improve the mental health of refugee adolescents. Design: A three-round Delphi design is proposed. The first round will include semi-structured interviews with a panel of 12 CAT professionals worldwide and 12 refugee adolescents aged 10–24 in Jordan with a history of participating in creative arts interventions. The hybrid approach of coding and thematic analysis will be conducted to develop statements on recommended CAT components from the interview narratives. In the second round, the same and newly enrolled 24 professionals and 24 refugee adolescents will be asked to rate the statements according to their importance, propose new statements, and add comments. A similar procedure will be followed in the third round, where panellists will rate new and old statements after perusing the feedback from the second round. Main outcome measure: A statement will gain consensus and indicate essential components when rated 'essential' or 'very important' by > = 80% of panellists. Very important components are those with the same ratings by 60–79.9% of panellists. Results: A list of essential and very important components, perspectives and suggestions will be provided to guide practice and intervention development. [ABSTRACT FROM AUTHOR]

Mobile Phone Addiction represents an emergent addictive disorder that gravely jeopardizes the physical and mental health of adolescents worldwide, necessitating exhaustive research. Current reviews of MPA are in dire need of updates and enhancements. Therefore, this review aggregates the extant research spanning the past two decades on the prevalence, pathogenesis, comorbidities, assessment, and treatment of MPA, aiming to furnish a reference for future investigations into this condition. [ABSTRACT FROM AUTHOR]

Aim: Although sexual and reproductive health for adolescents is a recognized fundamental human right and a critical component of health policy, it is poorly addressed and seldom researched in pastoral communities. The study aimed to determine the status of sexual and reproductive health knowledge, attitudes, and practice among pastoral school adolescents in Ethiopia. Study design: An Institution-based comparative study was conducted from Nov. 2020 to Jan. 2021. Methods: We conducted a comparative cross-sectional study at four randomly selected high schools. Seven hundred seventy-three adolescent students participated, with 384 from Gorodola and 389 from Wadara districts, Guji zone Ethiopia. The data was collected using 34 self-administered questions and analyzed using descriptive, t-test, and linear regression models. Results: The study found that only 44.2% of all the participants had good knowledge, 46.1% had good attitudes and 35.4% had good utilization of Sexual and Reproductive Health Services. Respondents from Wadara High School had significantly higher mean knowledge scores (49.3% vs. 44.2%, p < 0.01) than those of Gorodola High School. There was no significant difference in mean utilization scores between case and compare (45.08% vs. 37%, p > 0.01). Adolescents who were not communicated on SRH matters, previously utilized FHS, and visited Friendly Health facilities were associated with poor utilization of sexual and reproductive health services. Conclusion and public health contributions: Wadera High School adolescents have better Sexual and reproductive health knowledge and utilization than Gorodola high schools. Community public health care providers in Wadara District explain the outcome through their contributions. Within the context of inherent disadvantage in the school environment setting, there is a need to improve sexual and reproductive health education with a greater emphasis on school girls. [ABSTRACT FROM AUTHOR]

Background: Up to 1.9 million youth in the USA sustain a concussion each year, and up to 30% experience persistent post-concussive symptoms (PPCS) lasting 1 month or more. PPCS can substantially interfere with social, emotional, and academic functioning. Despite these concerns, few evidence-based treatments are available for youth with PPCS. We previously found effectiveness in treating youth with concussion using a collaborative care intervention that integrates mental health care into a medical model, with improvements in concussive symptoms and quality of life at 1 year. Using the multiphase optimization strategy (MOST) framework, we now aim to assess the contribution of each of the three components that were part of collaborative care: concussion-focused cognitive behavioral therapy (cf-CBT), parenting skills training (PST), and care management (CM). Methods: The MOST factorial design examines all three intervention components with two levels of each (present or absent), resulting in 8 possible treatment combinations. We will recruit 368 youth with PPCS from 2 geographic locations (Seattle and Dallas), randomizing them to 1 of 8 treatment groups. Youth and/or parents will attend treatment sessions via video conferencing software over 3 months, and complete surveys regarding primary outcomes (concussive symptoms and health-related quality of life) and secondary outcomes (sleep, pain, mood, and parental distress) at 6 weeks and 3, 6, and 12 months. We will also assess potential mediators and moderators to allow for future tailoring and refinement. Discussion: The overarching goal of this investigation is to determine which collaborative care components (delivered individually or in combination) are most effective in treating PPCS in concussion-exposed youth. The investigation will inform mental health screening, intervention, and referral procedures for youth and families following concussion. At the completion of this study, we will have an optimized and refined intervention for youth with PPCS ready for large-scale implementation and dissemination. Trial registration: ClinicalTrials.gov NCT06036147. Registered on September 13, 2023. [ABSTRACT FROM AUTHOR]

Instruments used to assess the mental well-being of young athletes in Brazil are scarce. Therefore, the present study aimed to translate, cross-culturally adapt for young athletes, and gather evidence of validity for the Sport Mental Health—Short Form (S-MHC) for use in Brazilian Portuguese. The research was conducted in five stages: translation, synthesis, back-translation, expert review, and validation of the psychometric properties. For validation, 246 young athletes of both genders (88 females, 35.8%), aged between 12 and 18 years (14.5 ± 1.9 years), were recruited. Psychometric methods were employed to confirm and validate the translated and adapted versions of the S-MHC for young athletes, including internal consistency using Cronbach's alpha and McDonald's omega, composite reliability, Item Characteristic Curve (ICC) using Item Response Theory (IRT), and Confirmatory Factor Analysis (CFA). Two structures were tested, with Model 1 loading the 14 items of the translated version of the S-MHC into a single latent factor and Model 2 loading the items into three factors related to emotional, social, and psychological sport well-being. Both models showed good validity, consistency, and reliability measures and can be used to investigate the sport well-being of young athletes. It was concluded that the translated version of the S-MHC in Brazilian Portuguese can be used to assess the sport well-being of young athletes in Brazil. Model 2 structure is recommended to observe the different nuances of emotional, social, and psychological well-being. [ABSTRACT FROM AUTHOR]

Objectives Design Methods Results Conclusions To explore adult stakeholders' perspectives on what supports or undermines the mental health of sexual and gender minoritised adolescents (SGMA) in everyday life in order to better understand how to foster supportive psychosocial environments for SGMA.Descriptive qualitative study design, using framework analysis.Semi‐structured interviews were conducted remotely with 16 UK‐based adult stakeholders which included parents of SGMA, health and social care professionals, community‐based professionals, and professionals who commission services related to adolescent health and well‐being.Nine themes were identified that represented barriers and enablers of fostering psychosocial environments that are supportive of SGMA mental health. Example barrier themes include SGMA ‘facing chronic and acute safety threats and stress’, ‘psychological responses to social connection losses and navigating alienation’, ‘digital exposure and online risk and vulnerability’ and ‘conflicting messages, resulting divisions and adult distancing’. Example enablers include ‘exploring, owning, and changing (personal) identities’, ‘advocating alongside adolescents whilst containing oneself as the adult in the situation’ and ‘personally fostering adolescents’ psychological safety and inclusion’.Adult stakeholders report that SGMA are often exposed to environments hostile to key aspects of their identity which then by extension undermines their mental health. These experiences can threaten their sense of safety and evolving identity. Practitioners in particular should be aware of the stressors relating to SGMA identity and minoritisation experiences in order to develop the psychological safety and sense of inclusion needed for SGMA to trust in the relationship and the support offered. [ABSTRACT FROM AUTHOR]

Our team developed Conversation Cards for Adolescents© (CCAs), a tool to help adolescents and health care providers (HCPs) communicate and collaboratively set behavior change goals. The objectives of this pilot randomized controlled trial were to test the feasibility, user experience, and preliminary effect of using CCAs with adolescents in primary care, focusing on behavior change and collaborative goal setting among adolescents. From March 2019 to September 2022, adolescents were recruited from the Northeast Community Health Centre (Edmonton, AB). Adolescents were randomized (1:1) to one of two groups: CCA + goal setting (experimental group) or goal setting alone (control group). Data were collected from both groups at baseline and at 3-weeks post-baseline. In total, 31 adolescents completed the trial (terminated early due to COVID-19). The study demonstrated high practicality. Adolescents reported positive user experiences with CCAs, citing attractiveness, clarity, efficiency, and dependability. No group differences were detected for behavior changes at 3-weeks post-baseline (p >.05), although adolescents in the experimental group qualitatively described improved rapport and communication with HCPs. CCAs can be used practically in a primary health care setting to facilitate communication and rapport with adolescents; however, their effect in enabling behavior change should be investigated in a multi-site, larger-scale trial. [ABSTRACT FROM AUTHOR]

This scoping review mapped the academic literature focused on the therapeutic itinerary of children who seek care in health services and proposed an explanatory model to expand the concept and classification of these health itineraries. A total of 789 articles were reviewed, of which 28 were eligible for inclusion. In these 28 it was possible to observe that the child's therapeutic itinerary is more than a physical path, but also encompasses all choices within a specific social and cultural environment in which the child is inserted. Our proposal is to expand the concept beyond the therapeutic, classifying the itinerary also according to the objective, the decision‐making agent, respect for the presence of company, the health subsystem used, according to the physical continuity of the itinerary, the perception of efficacy of the patient, the nature of the illness, the administration of healthcare, the means of transport used, the person providing information about the itinerary, the planning of the itinerary and its completeness. Knowing the child's itineraries toward healthcare allows the development of innovative discourses and practices for future public policies, through which the principles of comprehensiveness and resoluteness in children's health would be strengthened. There is still a need to deepen knowledge about the meanings and feelings regarding their interpretations of the events suffered in childhood. [ABSTRACT FROM AUTHOR]

Background: The relationship between physical activity and low back pain (LBP) in adolescents is complex, with conflicting evidence on whether activity is protective or a risk factor. The COVID-19 pandemic has introduced new challenges, increasing sedentary behaviors among adolescents. This systematic review updates the evidence on the association between physical activity and LBP in this population, focusing on the impact of the pandemic. Methods: A systematic search of PubMed, Cochrane Library, Web of Science, Medline, and SCOPUS identified observational studies published between January 2011 and December 2023. This review focused on adolescents aged 10 to 19 years, examining the effects of various physical activity levels and types on LBP incidence. Quality assessment was conducted using the ROBINS-I tool. Results: Twelve studies were included, with a total of 78,850 adolescents. The findings suggest a U-shaped relationship between physical activity and LBP, where low and high activity levels increase LBP risk, while moderate activity appears protective. The pandemic exacerbated LBP prevalence, likely due to increased sedentary behavior. Gender differences were noted, with females more likely to report LBP, particularly related to sports participation. Conclusions: Moderate physical activity may protect against LBP in adolescents, whereas both inactivity and excessive activity heighten risk. The pandemic's impact highlights the need for balanced physical activity to prevent LBP. Further research should explore the long-term effects of these changes. [ABSTRACT FROM AUTHOR]

Adolescents faced with chronic stressors (e.g., financial instability, interpersonal violence) are at heightened risk for developing mental health problems, likely due in part to stressors that interfere with effective emotion regulation. Although mindfulness may help to act as a buffer against the deleterious effects of life stressors, a relatively untested assumption is that adolescents can maintain mindfulness during periods of stress. This paper explores this assumption by investigating the real‐time, dynamic relationships among life stressors, mindfulness, and emotion regulation difficulties among adolescents exposed to chronic stressors. Eighty‐one participants who were 10–18 years old (M = 14.33; SD = 2.20; 56% male; 57% Non‐Hispanic White) completed ecological momentary assessments (EMA) three times a day for 7 days and contributed a total of 1186 EMA reports. Multilevel structural equation modelling revealed that the presence (vs. absence) of stressors was associated with lower momentary mindfulness and greater momentary emotion regulation difficulties concurrently and prospectively. Stressors with greater severity were also concurrently, but not prospectively, associated with lower momentary mindfulness and greater momentary emotion regulation difficulties. Findings highlight that exposure to life stressors may degrade momentary mindfulness and emotion regulation. Given that mindfulness and emotion regulation are closely associated with mental health, these results also demonstrate one way that stressors may contribute to health disparities at the micro‐level. Going forward, it will be important to investigate methods of helping adolescents learn to maintain mindfulness and adaptive emotion regulation in the face of stressful events. This study was preregistered (NCT04927286). [ABSTRACT FROM AUTHOR]

Aims: To consolidate adolescents' perspectives regarding various aspects of sleep and offer insights to promote healthier sleep habits during their critical developmental years. Methods/Data Sources: Six electronic databases (PubMed, CINAHL, Embase, Scopus, PsycINFO and Web of Science) were searched from their inception dates to June 2023. Data were extracted and meta‐summarised using Sandelowski and Barroso's approach and synthesised using Thomas and Harden's thematic analysis framework. Results: Meta‐synthesis from 11 peer‐reviewed published studies identified four main themes: (1) Awareness and understanding of sleep's significance, (2) The shadows and radiance of slumber, (3) Traversing the sleepscape: trouble bubbles and (4) Illuminating the path: Guiding lights to enhanced sleep. Conclusion/Implications: Our review findings suggest a lack of awareness and guidance regarding the significance of sleep and the cultivation of good sleep habits among adolescents. Identified barriers to adequate sleep encompass various factors, including overthinking, poor habits, family/environmental influences, extensive technology use, peer pressure, the fear of missing out, academic demands and involvement in extracurricular activities. Strategies to improve adolescents' sleep health involve multiple sleep strategies, including sleep education, workshops/seminars, parental involvement, incorporating digital well‐being practices, the promotion of relaxation techniques and the provision of essential resources. Prioritising sleep health and implementing targeted interventions are key steps to empower adolescents, create supportive environments and shape a healthier future generation. Future research endeavours should focus on evaluating the effectiveness of interventions and exploring the influence of cultural factors. Impact: There exists a notable lack of awareness and guidance regarding the significance of sleep and the cultivation of good sleep habits among adolescents.Barriers to achieving adequate sleep among adolescents include overthinking, poor habits, family/environmental influences, extensive technology use, peer pressure, the fear of missing out, academic demands and involvement in extracurricular activities.The collaboration between healthcare institutions, professionals and educational institutions is crucial to facilitate (1) the implementation of sleep education workshops/seminars targeting adolescents, (2) increased parental involvement and role‐modelling to instil good sleep practices among adolescents and (3) enhanced integration of digital well‐being practices, the promotion of relaxation techniques and accessibility to essential sleep hygiene resources. Reporting Method: Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Patient or Public Contribution: No patient or public contribution. Trial and Protocol Registration: This review was registered on the Prospective Register of Systematic Reviews (CRD42023403775). [ABSTRACT FROM AUTHOR]

Introduction: We test the effects of positive affect and its arousal subscale components of calm, wellbeing, and vigor on asthma control and symptom severity in adolescents with moderate to severe asthma. Additionally, we test whether positive affect (and its arousal components) moderate how stress impacts asthma control and symptom severity. Methods: Adolescents with asthma (N = 66, ages 12–17) completed brief surveys 4 times a day for 7 days reporting on their positive affect, stress, and asthma symptom severity and conducted a morning peak expiratory flow assessment each day. Asthma control and psychological asthma triggers were assessed at the end of the 7 days. Results: Positive affect moderated the association between stress and asthma control (b = −0.33, p = 0.009) as well as the association between psychological triggers and asthma control (b = −0.74, p = 0.007). When assessing the positive affect arousal components, calm and wellbeing seemed to be driving these effects. Additionally, calm moderated the association between stress and asthma symptom severity (b = −0.33, p = 0.036) as well as the association between psychological triggers and asthma symptom severity (b = −0.75, p = 0.021). Conclusions: When considering patient stress (e.g., general stress, psychological asthma triggers), positive affect and its arousal components of calm and wellbeing may be helpful for patients with higher levels of stress and/or for patients experiencing greater numbers of psychological triggers. [ABSTRACT FROM AUTHOR]

Background: Adolescent smoking is associated with significant health and social risks. Previous research has demonstrated the effectiveness of interventions based on behavior change theories in preventing adolescent smoking uptake. However, evidence from the theory-based perspective of evaluation is limited, especially for how such complex interventions work, and how they work when implemented in different contextual settings. Method: A comparative qualitative analysis was conducted to explore various influences on behavior change among participants taking part in two smoking prevention interventions in Northern Ireland and Bogotá. Twenty-seven focus groups were conducted in 12 schools (6 in Northern Ireland and 6 in Bogota, n = 195 pupils participated; aged 11–15 years). The Theoretical Domains Framework guided a content analysis of the data. Results: We found similarities across settings in terms of knowledge, skills, and beliefs related to smoking or vaping behavior change, as well as differences in contextual resources and social influence. Different environmental resources included availability to purchase tobacco products in the neighborhoods and previous information about tobacco risk. Participants in both interventions perceived behavioral change outcomes related to personal skills and intention to not smoke or vape. Conclusion: These findings have highlighted how both individual factors and contextual resources influence behavior change for smoking prevention in practice. Local contextual factors and social influences affecting pupils should be taken into account in the implementation and evaluation of health behavior change interventions. In particular, this study supports using social and contextual influence strategies in interventions to reduce the onset of adolescent smoking and vaping. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Few studies have explored the relationship between social drivers of health and pediatric low-value care (LVC). We assessed the relationship between Childhood Opportunity Index (COI) 2.0 and LVC in children's hospitals. METHODS: We applied the Pediatric Health Information System LVC Calculator to emergency and inpatient encounters from July 2021 through June 2022. Proportions with LVC in highest (greatest opportunity) and lowest COI quintiles were compared. Generalized estimating equation logistic regression models were used to analyze LVC trends across COI quintiles. RESULTS: 842 463 encounters were eligible for 20 LVC measures. Across all measures, odds of LVC increased across increasing COI quintiles (adjusted odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03-1.08). For 12 measures, LVC was proportionally more common in highest versus lowest COI quintile, whereas the reverse was true for 4. Regression modeling revealed increasing LVC as COI increased across all quintiles for 10 measures; gastric acid suppression for infants had the strongest association (OR 1.22, 95% CI 1.17-1.27). Three measures revealed decreasing LVC across increasing COI quintiles; Group A streptococcal testing among children <3 years revealed the lowest OR (0.85, 95% CI 0.73-0.99). The absolute volume of LVC delivered was greatest among low COI quintiles for most measures. CONCLUSIONS: Likelihood of LVC increased across COI quintiles for 10 of 20 measures, whereas 3 measures revealed reverse trends. High volumes of LVC across quintiles support a need for broad de-implementation efforts; measures with greater impact on children with lower opportunity warrant prioritized efforts. [ABSTRACT FROM AUTHOR]

This study was conducted to quantify the association of adverse childhood experiences (ACEs) and the academic performance of children and adolescents. The literature was systematically searched in six electronic databases, and a meta-analysis was conducted. Twenty studies with a total of 1,196,631 children and adolescents from five countries were included. Meta-analysis showed that ACE score was positively associated with poor academic achievement, grade repetition, and special education support. Compared with children and adolescents without any ACE, those with one or more ACE had a significantly higher risk of poor academic achievement (pooled odds ratio [OR]: 1.45, 95% confidence interval [CI] [1.13, 1.85], I 2 = 82.6%) and grade repetition (pooled OR: 1.36, 95% CI [1.29, 1.43], I 2 = 71.0%). Moreover, all types of ACEs were positively associated with poor academic achievement and grade repetition. In addition, there was a significant dose-response relationship between the ACE score and the risk of poor academic achievement. This study supported that ACE had a significant impact on the academic performance of children and adolescents. Based on these findings, we recommend that early screening of ACEs for children and adolescent is critical and appropriate support and prevention in education should be developed for those with ACEs. Further studies are needed to further explore the long-term effect of ACEs on education and its gender differences. [ABSTRACT FROM AUTHOR]

Peer victimization during adolescence has a detrimental impact on the mental health of victims throughout their lives. However, it remains unclear whether these effects are gender-specific. The present study conducted a systematic review to examine the effects of peer victimization on depression status, explore potential sources of heterogeneity, and investigate gender differences in these effects. We systematically searched four electronic databases (Web of Science, PubMed, Embase, and CNKI) for relevant articles that published as far as July 2022. We then extracted odds ratios (OR) and 95% confidence intervals (CI) to assess the association between peer victimization during adolescence and depression, and potential gender differences in the relation. Meta-analysis was performed, using fixed effects models and random effects models, to evaluate the association between each exposure and the outcome. A meta-analysis of 27 studies revealed that peer victimization during adolescence was significantly associated with higher risks of depression (OR = 2.79, 95% CI [2.43, 3.21], p <.001). This finding was consistent across subgroup analyses. In particular, the effect of peer victimization during adolescence on depression was found to be more pronounced in studies conducted in Asia (OR = 3.06, 95% CI [2.38, 3.92], p <.001). Furthermore, five studies focused on gender differences demonstrated that peer victimization has a stronger association with the risk of depression in women (OR = 2.84, 95% CI [2.49, 3.26], p <.001). Peer victimization during adolescence is a significant risk factor for depression, with a greater impact on women and individuals residing in Asia. Further prospective studies are needed to investigate the relationship between peer victimization and depression. [ABSTRACT FROM AUTHOR]

Online appearance preoccupation may put adolescents at risk of developing mental health challenges, perhaps especially during early-to-middle adolescence. A random intercept cross-lagged panel model assessed within-person associations between appearance-related social media consciousness and depressive symptoms over three time-points with three months between waves. The sample (n = 1594) included U.S. adolescents aged 11–15 (Mage = 13; 47% girls, 46% boys, 7% another gender; 37% Latine, 33% White, 18% Black, 7% Asian). Within-person increases in appearance-related social media consciousness were associated with subsequent increases in depressive symptoms, but not vice versa. There was no evidence of gender differences and results were robust to controlling for both time on social media and offline self-objectification. Thus, online appearance concerns precede mental health challenges during early and middle adolescence. [ABSTRACT FROM AUTHOR]

Purpose: Adolescence is a period of growing independence and maturity, within the period of legal minority. As parents or guardians are socially and legally responsible for adolescents' medical decisions, shared decision-making in adolescent healthcare could be ethically challenging. This review aims to identify and map the ethical tensions in shared decision-making in adolescent healthcare. Methods: We systematically searched the literature following the PRISMA guidelines to identify relevant articles, which were analyzed using the review of reasons methodology Strech and Sofaer (J Med Ethics 38(2):121-6, 2012). Results: We included 38 articles which involved adolescents, healthcare professionals and parents as being the main stakeholders. Shared decision-making was influenced not only by individual stakeholders' characteristics, but by tensions between stakeholder dyads. Most studies supported the involvement of the adolescent in decision-making, depending on their life experience, decision-making capacity and clinical condition. Conclusions: Shared decision-making in adolescent health is receiving increasing attention. However, questions remain on what this concept entails, the roles and involvement of stakeholders and its practical implementation. What is known: • Although adolescents wish to be involved in health decisions, shared decision-making in adolescents is underexplored • Adolescent shared decision-making is different from pediatric and adult shared decision-making, and is ethically complex due to the adolescent's growing autonomy What is new: • Adolescent SDM involves three-way interactions between the adolescent, healthcare professional and parents • In adolescent shared decision-making, involving or excluding a stakeholder and sharing or withholding information are ethically value-laden steps • Research is needed to further understand the roles of adolescents' personal value systems, extended or reconstituted families and decision aids in shared decision-making [ABSTRACT FROM AUTHOR]

A Community Health Assessment (CHA) was conducted among community members in a rural Western Kentucky county in 2022–2023 identified mental health as one of the top health issues in the county. The purpose of a CHA is to identify key health needs and issues through data and develop strategies for action. One of the objectives was to identify barriers to accessing mental health care, especially among youth. Secondary data analyses were performed from survey results conducted by the local health department and local public schools. Quantitative data were analyzed using SPSS software. Qualitative data were analyzed using a two-cycle coding process. Access to mental healthcare is an area of great need in this rural Western Kentucky county. Recommendations include working with healthcare providers, especially specialists, to accept Medicaid and it is recommended to cross-train other professionals to address mental health needs in this region. [ABSTRACT FROM AUTHOR]

Background: American Indian (AI) adolescents report earlier initiation and higher rates of cannabis and alcohol use compared to their non-AI peers. Simultaneous cannabis and alcohol (SCA) use is increasingly common. A primary goal of our research was to identify profiles of cannabis and alcohol use, including SCA use, among AI adolescents using latent class analysis (LCA). Method: Data from 1,673 7th–12th grade students attending 45 reservation-area schools throughout the United States who reported using alcohol and/or cannabis in the past year were used to identify the latent classes. Multinomial logistic regression analysis determined associations of sex, grade, and multiethnicity to class membership. Results: A four-class solution was found: (1) SCA-Heavier Use (16.1%); (2) SCA-Lighter Use (25.2%); (3) Primarily Cannabis Use (33.3%); and (4) Primarily Alcohol Use (25.4%). Multinomial regression showed higher grade, identifying as multiethnic, and being female were associated with higher likelihood of membership in the SCA class. Conclusion: AI adolescents were more likely to be classified in the Primarily Cannabis Use class as compared to all other classes. Characterizing profiles of use may help identify those engaging in risky or co-use and help researchers and clinicians better understand how AI adolescents engage with alcohol and marijuana. [ABSTRACT FROM AUTHOR]

Substance use is a significant risk factor for HIV infection among adolescent men who have sex with men (AMSM). Substance use may reduce the use of HIV prevention measures or increase the likelihood of engaging in activities with a higher risk of HIV transmission, but there is a lack of studies dedicated to analyzing these mechanisms in adolescents and young MSM. This study aimed to explore the impact of substance use on condomless anal sex (CAS) in a large, racially diverse sample of AMSM. Additionally, we investigated how an individual's general level of substance use moderated the association between substance use before sex and CAS at the partnership level. Baseline data for an HIV prevention intervention were collected through online surveys from April 2018 to June 2020. The sample consisted of 1624 AMSM (M age, 16.69 years) who reported at least one sexual partner in the previous 3 months. Participants provided information about their three most recent sexual partners, including their relationship to the partner, PrEP use, frequency of alcohol, marijuana, and non-prescription drug use before sex, and the number of CAS acts. Participants also completed measures of their substance use frequency. Multilevel modeling in Mplus was used for data analysis, accounting for sexual partnerships nested within participants. All models controlled for PrEP use and relationship status. Results revealed a significant positive association between the frequency of non-prescription drug use before sex and CAS at the partnership level. This indicates that higher non-prescription drug use frequency before sex was associated with a greater number of CAS acts with partners. Moreover, the cross-level interaction between alcohol frequency and non-prescription drug use before sex was statistically significant. Specifically, for participants with high alcohol frequency scores, there was a significant positive association between non-prescription drug use before sex and CAS at the partnership level. AMSM with higher average alcohol consumption were more likely to engage in CAS when using non-prescription drugs prior to sex with a partner, compared to those with lower alcohol consumption. This study's use of multilevel data analysis contributes innovatively to the field by shedding light on how substance use operates within sexual relationships and different partnership dynamics. Tailored interventions targeting substance use should be developed to reduce HIV risk among AMSM. [ABSTRACT FROM AUTHOR]

Less than two-thirds of US adolescents are up-to-date with HPV vaccination. While mothers engaged in preventive care are more likely to seek preventive care for their children, current studies on associations between maternal cervical cancer screening (CCS) and adolescent HPV vaccination are needed. We assessed associations between maternal preventive service utilization and adolescent HPV vaccination using electronic health record data from a healthcare system in Washington State. We included adolescents (11–17 years) and their mothers with ≥ 1 primary care visit between 2018 and 2020. Outcomes were HPV vaccine initiation and completion. The primary exposure was maternal adherence to guideline-recommended CCS. Secondary exposures were maternal breast cancer screening adherence (for mothers ≥ 52 years) and ≥ 1 wellness visit ≤ 2 years. We used Generalized Estimating Equations to estimate prevalence ratios, and explore effect modification by adolescent sex, adolescent provider characteristics, and maternal language interpreter use. Of 4121 adolescents, 66% had a CCS-adherent mother, 82% initiated HPV vaccination, and 49% completed the series. CCS adherence was associated with higher initiation (adjusted prevalence ratio (APR):1.10, 95%CI:1.06–1.13) and completion (APR:1.16, 95%CI:1.08–1.23). Associations were stronger for male vs. female adolescents, adolescents who had a primary care provider in family practice vs. pediatrics, and adolescents who had the same primary care provider as their mother vs. not. Recent maternal wellness visit was also associated with higher initiation (APR:1.04, 95%CI:1.01–1.07) and completion (APR:1.12, 95%CI:1.05–1.20). Results suggest that delivering healthcare through a family-centered approach and engaging mothers in broad preventive care could increase adolescent HPV vaccination coverage. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore Adverse Childhood Experiences (ACEs) as a moderator between sleep duration/irregularity and overweight/obesity in U.S. adolescents. Using the National Survey of Children's Health 2017–2018 cross-sectional dataset, we included adolescents with available sleep and Body Mass Index (BMI) data. In a sample of 24,100 adolescents (mean age = 13.56 years, 49.35% female; 51% White), parents reported adolescent's sleep duration/irregularity, and number of ACEs. Logistic regression estimated the interaction between sleep duration/irregularity and the number of ACEs on overweight/obesity risk (BMI ≥ 85th percentile-for-age) using a stepwise approach and accounting for complex survey design. In the 24,100 adolescents, 33% were overweight/obese, 50% had ≥ 1 ACE, 37% slept < 8–10 h/night, and 14% had irregular sleep. Accounting for covariates and ACEs, every hour increase in sleep duration was associated with 6% decrease in overweight/obesity odds. There was a significant interaction between sleep duration and ACEs; the association between increasing sleep duration and decreasing odds of overweight/obesity was significant only in adolescents without ACEs (OR = 0.87, 95% CI [0.80, 0.95], p < 0.001). Increasing sleep duration is a recognized intervention target to decrease obesity risk, yet in adolescents experiencing ≥ 1 ACE, this protective role may be dampened. Future work may explore mechanisms for overweight/obesity development to inform interventions for adolescents facing adversity. [ABSTRACT FROM AUTHOR]

Background: Racism is a public health crisis impacting the health and wellbeing of adolescents. Finding valid tools to measure race-based discrimination, a form of racism, is necessary to accurately assess the effectiveness of programs aimed to reduce those experiences. Objectives: Our objective was to evaluate measurement invariance of a race-based discrimination scale by gender among a sample of youth (ages 13–19) from historically marginalized groups and to assess associations of race-based discrimination with sexual violence victimization and perpetration. Methods: We used pooled cross-sectional baseline data from two sexual violence prevention programs from 2015 to 2019. Male and female participants were from Manhood 2.0 (a cluster randomized trial) and Sisterhood 2.0 (a quasi-experimental study), respectively. All participants were recruited through community organizations from the same neighborhoods. In this study, we included all non-white youth with completed responses to the 10-item Perceptions of Racism in Children and Youth (PRaCY) Scale. This study was approved by the University of Pittsburgh IRB. Results: We conducted confirmatory factor analysis (N = 749) and measurement invariance among male-identifying (n = 560) and female-identifying (n = 189) participants resulting in a unidimensional factor structure with weak factorial invariance by gender. Lifetime discriminatory experiences were common among all participants. Mean discrimination scores were associated with a significant increase in the odds of lifetime sexual violence victimization in males (OR = 3.03, 95%CI 1.43–6.42) and females (OR = 10.80, 95% CI 2.23–52.33), respectively. Conclusion: We confirmed construct validity of the PRaCY Scale among youth experiencing marginalization and found associations between experiences of discrimination and sexual violence victimization in both boys and girls. [ABSTRACT FROM AUTHOR]

To review the published literature on what has been reported on risk and protective factors for early adolescent sexual and reproductive health (SRH) in the recent decade. A scoping review of English language, peer-reviewed literature on risk and protective factors for early adolescent (aged 10–14 years) SRH published between January 2010 and January 2023 using Medline, Web of Science, PsycInfo, CINAHL, and Google Scholar. Articles reporting only on nonmodifiable demographic factors, or on the effect of interventions, were beyond the scope of this review. Of 11,956 screened records, 118 were included of which half (49.2%) were published since 2018. Most articles (44.9%) presented research conducted in North America, followed by sub-Saharan Africa (20.3%) and East Asia and Pacific (16.1%). Five percent were based on multicountry studies or reported on pooled global data. Two-thirds (61.0%) reported on quantitative cross-sectional research designs, and 78.8% included both females and males. The most common SRH outcomes were sexual behaviors (34.7%); sexual and dating violence (28.8%); and sexual attitudes, beliefs, and intentions (19.5%). Most (83.0%) articles reported on risk/protective factors at the individual level, followed by interpersonal (family 58.5%, peers 33.0%, partners 11.9%), school (21.2%), and community (15.2%) factors. None of the included articles reported on macro/structural-level factors. While there has been growing attention to risk/protective factors for early adolescent SRH, gaps remain with regards to study contexts (mainly North America), focus (mostly individual factors), and conceptualizations (generally risk-oriented). We offer recommendations for research priorities over the coming decade. [ABSTRACT FROM AUTHOR]

Sibling support for transgender and nonbinary (TNB) youth has the potential to improve TNB youths' mental health. A scoping review was conducted to map the knowledge of TNB youths' sibling relationships to create a foundation for the development of sibling-based support interventions for TNB youth. Nine included articles covered two areas: TNB youths' perceptions of sibling support (n = 5) and cisgender siblings' lived experience with a TNB sibling (n = 4). Siblings were perceived to support TNB youth, and their support was associated with less depression, suicidal ideation, and externalizing problems. Siblings of TNB youth lacked knowledge of TNB identities and support for their own understanding and acceptance. Siblings may experience unique stressors around their TNB sibling's changing gender identity. Overall, having a TNB sibling was perceived as a positive experience. None of the studies included intervention with or for siblings of TNB youth. Sibling support can be helpful for TNB youths' mental health. However, cisgender siblings' unique needs are rarely addressed. Providing cisgender siblings with knowledge of TNB identity, a place to process fears and concerns, and skills to navigate situations that may arise in relation to their sibling's gender, has the potential to benefit both siblings. [ABSTRACT FROM AUTHOR]

Few studies have investigated both the positive and negative impacts of perceived changes related to the COVID-19 pandemic on adolescents' wellbeing. This study aimed to comprehensively identify the factors associated with the overall wellbeing of the youth population. A cross-sectional study design was employed using data from the 2020 Korean Survey of Children and Youth. Data were collected from N = 7,170 adolescents (aged 9–24 years) during the implementation of social distancing measures in response to the COVID-19 pandemic. Participants provided self-reported data about their COVID-19–induced perceived changes, wellbeing, parental support, and self-esteem between November 2020 and February 2021. The effect of COVID-19–induced perceived changes on adolescents' wellbeing during the pandemic was assessed by evaluating the mediating roles of parental support and self-esteem. The findings highlighted a serial mediating effect of parental support and self-esteem on the relationship between adolescents' COVID-19–related perceived changes and wellbeing. This study deepens the understanding of the intricate interplay between pandemic-related perceived changes, mediating factors, and wellbeing among adolescents. The findings imply that a comprehensive approach combining interventions aimed at enhancing self-esteem at the individual level with parental support may be most effective in improving adolescents' wellbeing. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prevalence of problematic internet use (PIU) among adolescents and determine the associated factors contributing to PIU. Methods: In April/May 2023, a cross-sectional study was conducted among adolescents studying in grades 9 to 12 in government and private non-residential schools in Western Tamil Nadu, India. Participants completed a semi-structured questionnaire assessing demographic characteristics, behavioral patterns, and internet usage. The Problematic and Risky Internet Use Screening Scale (PRIUSS) was employed to quantify PIU. Results: Out of 1795 participants, 398 (24.5%) were identified with PIU. Prevalence rates of PIU were similar between adolescents studying in English (n = 189; 25.4%) and Tamil medium (n = 209; 23.7%), with no significant differences based on gender [boys (n = 270, 25.4%) and girls (n = 121, 22.2%)]. Students possessing personal gadgets showed higher PIU [n = 287 (27%) vs n = 111 (20%)]. Specific risk factors for PIU identified students in English medium and scoring below 80% [OR (95% CI) 1.5 (1.1, 2.3); P = 0.029] and those with multiple gadgets at home [1.3 (1.01, 1.7); P = 0.04]. Conclusion: Adolescents have a high prevalence of PIU. Implementing school-based educational programs will mitigate excessive internet usage. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the effectiveness of 8-week exercise programs (aerobic, stretching, and aerobic plus stretching) in improving menstrual characteristics in female adolescents in Saudi Arabia. Methods: In this quasi-experimental study, seventy-eight healthy female adolescents aged 12–18 from secondary and high schools in Riyadh participated. Participants were divided into three groups and subjected to different types of exercises (aerobic, stretching, and aerobic plus stretching) for 20–30 min, three times a week. Menstrual pain, stress, and attitudes were assessed using the Numerical Rating Scale, Adolescent Stress Questionnaire Short Version, and Adolescent Menstrual Attitude Questionnaire, respectively. Assessments were conducted before the intervention and after the third menstrual period post-intervention. Results: The aerobic exercise group experienced a significant reduction in the mean length of the menstrual cycle (p = 0.025). The aerobic plus stretching group had the most significant reduction in mean menstrual pain scores (p < 0.0001). Stress scores were significantly reduced in the stretching group (p < 0.0001). Conclusion: We conclude that combining aerobic and stretching exercises significantly reduces menstrual pain, while aerobic exercise decreases menstrual cycle length and pain. [ABSTRACT FROM AUTHOR]

Background: The objectives of this work were as follows: (1) to develop holistic recommendations for physical activity, sleep, sedentary behaviours and eating habits adapted to children and adolescent life stage (5–17 years) and targeting optimal metabolic cycle and achieving energy balance; (2) to provide evidence-based information that can be used by the government, policy makers, healthcare professionals, community, schools as well as families to endorse active, healthy, living in apparently healthy children and youth aged 5–17 years, and as a base for monitoring the activities, particularly the physical ones, on the people level. The Egyptian Academy of Bone and Muscle Health followed an established guideline development process to create the Egyptian 24-h movement clinical guideline for children and adolescents. Online databases (PubMed, Embase and Cochrane Library) were searched for relevant peer-reviewed studies that met the a priori inclusion criteria. Results: A total of 41 studies met the inclusion criteria. Leveraging evidence from the review of the literature led to the development of 11 key questions covering 8 domains. Fifteen statements focus on the overall identified targets through integration of the movement activities and eating behaviour. Results revealed a major change in the previous basic understandings as it shifts away from segregated into integrated movement behaviour and dietary habit paradigm. Based on this, the final guideline was developed providing evidence-based recommendations for a "Healthy 24-h day", for Egyptian children and adolescents. Conclusion: The 24-h composition of movement behaviours has principal implications for health at all ages. The developed guideline provides an up-to-date evidence-based recommendation towards a holistic approach for favourable daily life activities and adopts a feasible perspective by outlining these activities within a 24-h period. In addition, eating and dietary elements have been included to complete the energy cycle. Children and adolescents who meet the 24-h movement guidelines generally report more favourable health indicators than those who do not. [ABSTRACT FROM AUTHOR]

Physical activity (PA) and its contributions to wellbeing are understudied among incarcerated youth. We used 2019 Minnesota Student Survey data to describe PA rates and test PA's associations with indicators of psychological, social, and perceived health for adolescents in juvenile corrections facilities (JCFs). Participants (n = 265, 29% female, mage = 15.4 years) self-reported days of $ \ge $ ≥ 60 min of PA in the previous week. They also reported how often they experienced joy and energy and built trusting peer relationships, as well as how they perceived their overall health and symptoms of anxiety and depression. We calculated descriptive statistics and tested PA's associations with psychological, social, and perceived health variables among the full sample, then stratified by sex, with unadjusted and age-adjusted models. Female and male youth averaged over 5 days of $ \ge $ ≥ 60 min of PA. PA was positively, significantly associated with experiencing joy and energy, building trusting peer relationships, and having better perceived health, though sex-related differences emerged. PA was unassociated with anxiety and depression. Results suggest PA rates are high in JCFs, though quality remains unclear. While PA is positively associated with certain developmental outcomes for incarcerated youth, PA alone seems insufficient for mitigating their mental health concerns. [ABSTRACT FROM AUTHOR]

There are over 1.4 million adolescents living with HIV in sub-Saharan Africa, the majority of whom acquired the virus through perinatal transmission (PHIV). HIV stigma is particularly high among adolescents living with HIV and is associated with several outcomes that worsen health and increase the risk of onward HIV transmission. We tested associations between internalized HIV stigma and four of these outcomes over a one-year period among a sample of adolescent boys living with PHIV in Soweto, South Africa. Participants (N = 241) answered questions about internalized HIV stigma at baseline. They completed weekly mobile surveys over the following year to answer questions about their experiences with depression, binge drinking, medication adherence, and violence victimization. Using generalized linear mixed models, we found that baseline internalized HIV stigma was associated with increased odds of depression (OR 1.74), alcohol misuse (OR 2.09), and violence victimization (OR 1.44) and decreased odds of medication adherence (OR 0.60) over the course of a year. These outcomes negatively impact the health and wellbeing of adolescents living with PHIV and increase their risk of transmitting HIV to their partners in the future. Our findings provide novel, longitudinal evidence for the deleterious effects of HIV stigma. To improve health outcomes for adolescents with PHIV, it will be crucial to develop effective HIV stigma reduction interventions that address specific developmental, gendered, and cultural experiences. [ABSTRACT FROM AUTHOR]

Issue Addressed Methods Results Conclusions So What? Little is currently known about the relationships between body composition and the social determinants of health among Aboriginal and Torres Strait Islander youth in Australia, which could help inform policy responses to address health inequities.This study aimed to explore the relationship between various social factors and healthy body mass index (BMI) and waist/height ratio (WHtR) among Aboriginal and Torres Strait Islander youth aged 16–24 years. Baseline survey data from 531 participants of the ‘Next Generation: Youth Well‐being study’ were used. Robust Poisson regression quantified associations between healthy body composition and self‐reported individual social factors (education, employment and income, government income support, food insecurity, home environment, relationship status, racism), family factors (caregiver education and employment) and area‐level factors (remoteness, socioeconomic status).Healthy body composition was less common among those living in a crowded home (healthy WHtR aPR 0.67 [0.47–0.96]) and those receiving government income support (healthy BMI aPR 0.74 [0.57–0.95]). It was more common among those with tertiary educated caregivers (healthy BMI aPR 1.84 [1.30–2.61]; healthy WHtR aPR 1.41 [1.05–1.91]) and those in a serious relationship (healthy BMI aPR 1.33 [1.02–1.75]).Social factors at the individual and family level are associated with healthy body composition among Aboriginal and Torres Strait Islander youth.The findings of this study highlight the potential for health benefits for youth from policies and programs that address social inequities experienced by Aboriginal and Torres Strait Islander people in Australia. [ABSTRACT FROM AUTHOR]

Background: The intensive use of social media among adolescents has caused concern about its impact on their mental health, but studies show that social media use is linked to both better and worse mental health. These seemingly contradictory findings may result from the diverse motivations, interactions, and experiences related to social media use, and studies investigating specific facets of social media use in relation to mental health and well-being, beyond general usage metrics, have been called for. Aspects of self-presentation on social media, such as feedback-seeking and upwards social comparison have been linked to worse mental health, however, there is a need for more studies exploring the relationship between self-presentation on social media and adolescent mental health over time. Aim: The aim of this study was to explore the cross-sectional and longitudinal relationship between aspects of self-presentation and depression, anxiety, and well-being among adolescents. Methods: This study utilised both cross-sectional and longitudinal datasets from the LifeOnSoMe-study, comprising 3,424 and 439 participants, respectively (OSF preregistration https://doi.org/10.17605/OSF.IO/BVPS8). Latent Class Analysis (LCA) was used to identify similar response patterns within the Self-Presentation and Upwards Social Comparison Inclination Scale (SPAUSCIS). Regression models and first differencing methods were applied to evaluate the cross-sectional and longitudinal associations between focus on self-presentation and mental health and well-being among adolescents. Results: A strong emphasis on self-presentation was linked to increased levels of depression and anxiety in both males and females, and reduced well-being in females when compared to those with lower or intermediate self-presentation focus. The effect sizes ranged from small to medium. Furthermore, an escalation in self-presentation focus over time was associated with a slight increase in symptoms of anxiety and depression; however, the association with well-being did not reach statistical significance. Conclusion: The results of the present study suggest that a heightened focus on self-presentation, which includes behaviours such as seeking feedback, employing strategic self-presentation tactics, and engaging in upward social comparisons, is associated with an elevated risk of reduced mental health. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Design Sample Measurements Results Conclusion To explore public health nurses’ (PHN) perceptions and experiences of supporting siblings of children with complex care needs (CCNs) by using reading groups as a health promotion intervention in upper secondary schools.An action research approach using a qualitative design.Interviews with 10 PHNs.Thematic analysis.The analysis resulted in the overarching theme “A much needed health promotion intervention in upper secondary schools,” presented in terms of the following three themes: (1) supporting siblings is important, but resources and established procedures are lacking. (2) Reading groups using fiction have potential as a health‐promoting intervention in upper secondary schools. (3) A realistic collaborative approach is necessary for reading groups to be implemented.PHNs have no established procedures to support siblings of children with CCNs in upper secondary schools. Reading groups can enable PHNs to reach out and support these siblings. Providing the intervention can be a way of reaching all pupils and thus creating an understanding of the plight of siblings who have a brother or sister with CCNs. [ABSTRACT FROM AUTHOR]

Future orientation is considered as a significant antecedent of adolescents' health and positive psychosocial outcomes across adolescence and adulthood. While extensive research has explored the influence of culture on predicting future orientation, individual differences within the same country remain under-examined, particularly in China. Following the construal level theory and self-regulation theory, this study explores intra-cultural variations in future orientation by examining the association between future orientation and self-construal, and the moderating effect of self-esteem on this relationship. Using a sample of 683 Chinese adolescents (48.61% girls; Mage = 15.04), this study shows that individuals with independent self-construal have a lower future orientation score than those with interdependent self-construal. Self-esteem positively predicts future orientation and moderates the relationship between self-construal and future orientation, even after controlling for individual and family- level covariates. These findings enrich our understanding of the intricate interplay between cultural influences and temporality development and underscore the potential for targeted intervention programs. [ABSTRACT FROM AUTHOR]

AbstractQueerphobia is defined as society’s negative attitude towards LGBTQIA + people, translating into structures that marginalise LGBTQIA + people and contribute to health inequities that cause real harm and can be understood as structural violence. The purpose of this article is to explore what historically marginalised youth in a youth participatory action research (YPAR) project characterise as the big picture issues affecting the lives of LGBTQIA + youth. We used participatory arts-based methods to conduct community and identity building, define research questions and photo prompts, conduct data collection, engage in group thematic analysis, and make recommendations at the state policy level. We also conducted individual semi-structured interviews with participants. Our findings can be grouped into three main themes: LGBTQIA + youth may feel it is safer to remain closeted; queerphobia perpetuates housing instability; and queerphobia functions as a structural barrier to social services. Youth also developed state level policy recommendations to address the structural issues causing harm to LGBTQIA + youth health. Recommendations included increasing access to affordable housing and LGBTQIA + inclusive foster and group homes, and advocating for government-funded LGBTQIA + specific healthcare practices for LGBTQIA + youth. More youth-driven data are needed that centre those directly impacted by structural violence and associated health outcomes. [ABSTRACT FROM AUTHOR]

Background: Proactive health behaviours are crucial for enhancing adolescent health. However, there is limited evidence on the potential pathways through which social support influences adolescents' proactive health behaviours. This cross-sectional study aimed to examine the relationships between social support, self-efficacy, peer relationships and proactive health behaviours in Chinese adolescents. Methods: From October to December 2023, we recruited 6075 adolescents from Shandong Province, China. They completed self-report questionnaires on social support, self-efficacy, peer relationships and proactive health behaviours. Results: Linear regression analysis indicated that social support was positively associated with proactive health behaviours among adolescents (β = 0.571, 95% CI = 0.542, 0.600). Further mediation analyses revealed that self-efficacy (β = 0.085, 95% CI = 0.069,0.101) and peer relationships (β = 0.156, 95% CI = 0.136,0.177) mediated this relationship. Conclusions: Increased social support was associated with better proactive health behaviours in Chinese adolescents. Additionally, higher self-efficacy and positive peer relationships enhanced this association. Our findings emphasised the significance of providing supportive environments at home and at school to promote proactive health behaviours in adolescents. [ABSTRACT FROM AUTHOR]

Background: The importance of evidence-informed health policymaking is widely recognized. However, many low- and middle-income countries lack evidence-informed mental health policies due to insufficient data, stigma or lack of resources. Various policies address adolescent mental health in India, but published knowledge on their evidence-informed nature is limited. In this paper, we report results of our analysis of the role of evidence in adolescent mental health policymaking in India. Methods: This paper reports findings from the document analysis of key policy documentation (n = 10) and in-depth interviews with policy actors including policymakers, researchers, practitioners and intermediaries (n = 13). Framework analysis was used, informed by the components of a conceptual framework adapted from the literature: actors, policy and evidence processes, nature of evidence itself and contextual influences. Results: Results show that adolescent mental health policies in India were generally evidence-informed, with more key evidence becoming generally available from 2010 onwards. Both formal and informal evidence informed mental health policies, particularly agenda-setting and policy development. Mental health policymaking in India is deemed important yet relatively neglected due to competing policy priorities and structural barriers such as stigma. Use of evidence in mental health policymaking reflected differing values, interests, relative powers and ideologies of policy actors. Involvement of government officials in evidence generation often resulted in successful evidence uptake in policy decisions. Policy actors often favoured formal and quantitative evidence, with a tendency to accept global evidence that aligns with personal values. Conclusions: There is a need to ensure a balanced and complementary combination of formal and informal evidence for policy decisions. Evidence generation, dissemination and use for policy processes should recognize evidence preferences by key stakeholders, while prioritizing locally available evidence where possible. To help this, a balanced involvement of policy actors can ensure complementary perspectives in evidence production and policy agendas. This continued generation and promotion of evidence can also help reduce societal stigma around mental health and promote mental health as a key policy priority. [ABSTRACT FROM AUTHOR]

ABSTRACT Concerns related to school are consistently ranked as among the greatest stressors in the lives of adolescents. Research from varying contexts report rising rates of school‐related stress among students, but we currently lack knowledge on what drives these trends. The aim of this study is to investigate the predictors of temporal trends in school‐related stress in Swedish students between 2003 and 2020. To this end, repeated surveys of 9807 Swedish students aged 16 years are analysed using Blinder‐Oaxaca decomposition techniques. The results show that the rise in school‐related stress was primarily due to growing schoolwork difficulties and social exclusion among students, indicating possibly adverse consequences of a large‐scale educational reform as well as of the COVID‐19 pandemic. In addition, rising academic aspirations contributed to the increase, in line with arguments concerning the increasing weight attached to educational success among adolescents in the ‘schooled society’. [ABSTRACT FROM AUTHOR]

Physical fitness is considered an important indicator of health in adolescents. Despite the recognized benefits of regular physical activity, recent studies indicate a decline in physical fitness among adolescents, including agility, a key component of fitness often overlooked in research. This study aimed to investigate trends in agility among urban Catalan adolescents over two decades. A total of 1439 students, aged 13–15 years, participated in the 8 × 10 m shuttle run test between 2002 and 2022. The results revealed a significant decline in agility performance across both boys (F(3,839) = 392, p < 0.001, ηp2 = 0.584) and girls (F(3,593) = 414, p < 0.001, ηp2 = 0.677) over time, with notable differences observed between consecutive five-year periods. The findings underscore the urgency of addressing declining physical fitness among adolescents and advocate for enhanced physical education programs and community-based interventions to promote regular physical activity. Recognizing the importance of agility and other aspects of physical fitness in adolescent health, policymakers, educators, and healthcare professionals are urged to collaborate on initiatives to mitigate the risk of future health issues. Further research is recommended to explore the multifaceted influences on adolescent physical fitness and develop targeted interventions to improve overall health outcomes in this population. [ABSTRACT FROM AUTHOR]