Dietary Changes of Youth during the COVID-19 Pandemic: A Systematic Review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has taken the lives of millions and disrupted countless more worldwide. Simply living through the pandemic has had drastic effects on the health of citizens. Diet, an important aspect of health, has been uniquely affected by the pandemic, although these changes have not been sufficiently studied among youth.

OBJECTIVES

The objective of this systematic review was to investigate dietary changes of youth during COVID-19.

METHODS

A prespecified literature review was conducted using MEDLINE, EMBASE, Scopus, and CINAHL to identify studies from January 2020 to May 2023 that assessed dietary changes among youth aged ≤20 y compared with before the pandemic. Only quantitative observational studies that were published in English were included. Two authors completed all screening/study selection independently, with disagreements being resolved via discussion. Data extraction was completed by 1 author. Dietary changes were categorized into food groups and habits for analysis purposes.

RESULTS

In total, 67 studies met inclusion criteria. Most studies used recall to assess changes (48/67; 71.6%). Most studies found an increase in fruits and vegetables (24/46; 52.2%), grain products (6/11; 54.5%), meat, poultry, and eggs (4/8, 50.0%), diet quality indices and/or overall dietary assessments (7/13, 53.8%), and the frequency of snacking (9/12; 75.0%), whereas generally finding a decrease in ultraprocessed foods (32/53; 60.4%), compared with before the COVID-19 pandemic. Mixed findings or primarily no changes were found for fish and aquatic products, legumes, beans, seeds and nuts, milk and milk products, breakfast consumption, and nutrient intake.

CONCLUSIONS

Mostly favorable dietary changes appear to have occurred among youth during COVID-19, although there were several mixed findings and unclear takeaways among the foods and habits under study. The heterogeneity of defining food groups was a noted limitation in the current review.

"It Seems Like a Bad Thing": US South Asian Youths' Perspectives About the Use of Hospice Care

BACKGROUND

South Asians are one of the fastest growing populations in the US. Family based decision making is common among this population. Little is known about their knowledge and attitudes towards hospice use.

OBJECTIVE

This study explored US South Asian youths' knowledge of, and attitudes towards hospice care.

DESIGN

Qualitative study, using focus group discussions.

METHODS

Thirty-six university students of South Asian heritage participated in ten focus group discussions. Data were coded inductively and deductively. Thematic analysis was performed. Disagreements were resolved through discussion.

RESULTS

Participants were in consensus that if patients had an incurable, fatal condition, keeping them comfortable was important. Several participants were unaware of the terms 'hospice' and 'palliative care'. After these terms were explained, most opposed hospice care for reasons of 'desire for a normal life', 'cultural incompatibility', 'concerns about the hospice environment' and 'preference for home as the place of death'. Some were opposed to even home hospice fearing that it would continuously remind the family and patient about impending death. Concerns were also expressed about having a 'stranger' in the home to provide hospice care. One participant said she would support hospice use if it aligned with the patient's values. Others cited financial reasons and quality of life as considerations in choosing hospice care.

CONCLUSIONS

Research is needed on culturally-appropriate modes of palliative care education and advocacy for South Asian populations in the US, especially youth, that are often the decision makers for the care of older family members.

Cumulative risk factors for injuries and poisoning requiring hospital care in youth with prenatal substance exposure: A longitudinal controlled cohort study

Aim: To investigate whether the youth with prenatal substance exposure (PSE) (aged 15-24 years, n = 615) had been in hospital care more often due to injuries and poisoning in comparison with unexposed matched controls (n = 1787). Methods: Data from medical records (exposure) and national health and social welfare registers (outcome and confounders) were combined and youths were monitored from birth until either outpatient or inpatient hospital care for injury or poisoning, death or the end of the study period (December 2016). Cox regression models were used in the analyses accounting for associated child and maternal risk factors. Results: Half (50.4%) of the exposed group and 40.6% of controls had been in hospital care due to injury or poisoning during the follow-up (p < 0.001). The difference between groups was diminished after controlling for postnatal child and maternal risk factors (hazard ratio [HR] = 0.88, 95% confidence interval [CI] 0.72-1.07, p > 0.05). Cumulative adversity, especially out-of-home care in combination with a diagnosed attention or behavioural dysregulation problem, posed the highest risk in both groups (exposed: HR = 1.65, 95% CI 1.24-2.19, p < 0.001; controls: HR = 1.84, 95% CI 1.33-2.56, p < 0.001). Conclusion: Hospital care for injury and poisoning is more common in youth with PSE, but this is largely explained by the related postnatal child and maternal factors. Long-term support to families with maternal substance abuse problems could prevent injury and poisoning among youth with PSE.

Household Income and Subsequent Youth Tobacco Initiation: Minorities' Diminished Returns

Introduction

Household income, a prominent socioeconomic status (SES) indicator, is known to mitigate youth engagement in various health risk behaviors, including tobacco use. Nevertheless, the Minorities' Diminished Returns theory suggests that this protective effect may be less pronounced for racial and ethnic minorities compared to majority groups. This study aimed to investigate the protective role of high household income against tobacco use among youth and explore potential variations across different racial and ethnic groups.

Methods

Conducted as a longitudinal analysis, this study utilized data from the initial three years of the Adolescent Brain Cognitive Development (ABCD) Study spanning 2016-2022. The cohort consisted of 11,875 American youth aged 9-10 years, tracked over a three-year period. The dependent variable was tobacco initiation, irrespective of the product, while household income served as the independent variable. Covariates included youth age, gender, family education, structure, and employment, with race/ethnicity acting as the moderating variable.

Results

Out of the 8,754 American youth who were non-smokers at baseline, 3.1% (n = 269) initiated tobacco use during the 30-month follow-up, while 96.9% (n = 8,485) remained non-smokers. A family income exceeding $100,000 per year was associated with a lower hazard ratio for tobacco initiation (transitioning to ever-use) over the follow-up period (HR = 0.620, p = 0.022). However, household income of $50-100k exhibited significant interactions with race/ethnicity on tobacco initiation, indicating weaker protective effects for Black (HR for interaction = 7.860, p < 0.001) and Latino (HR for interaction = 3.461, p = 0.001) youth compared to non-Latino White youth.

Conclusions

Within the United States, the racialization and minoritization of youth diminish the protective effects of economic resources, such as high household income, against the transition to tobacco use. Non-Latino White youth, the most socially privileged group, experience greater protection from their elevated household income regarding tobacco initiation compared to Black and Latino youth, who face minoritization and racialization. Policymakers should address not only the SES gap but also the mechanisms contributing to the heightened risk of tobacco use among racialized and minoritized youth from affluent backgrounds.

Barriers to the uptake of oral pre-exposure prophylaxis among young key populations in Nigeria

BACKGROUND

Young key populations (YKP) contribute to the burden of HIV in Nigeria and are a priority population for oral pre-exposure prophylaxis (PrEP). However, their uptake of PrEP remains low. We assessed the main barriers to PrEP uptake and the variation among YKP (15-24 years) in Nigeria.

METHODS

This study was a secondary data analysis of the 2020 Integrated Biological & Behavioural Surveillance Survey conducted among key populations (KP), including female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender people (TG), in 12 states in Nigeria. A closed-ended question asking the main reason for not taking PrEP among KP who had never taken PrEP was included in the surveillance questionnaire. We collapsed the responses into six barrier themes. Using multinomial logistic regression analysis, we examined the association between the barriers (dependent variable) and KP group (independent variable), controlling for age, educational attainment, religion, marital status, employment status, and geopolitical zone.

RESULTS

A total of 1776 YKP were included in this study. The most cited barriers by KP group were: lack of access (28.3%) and fear of side effects (28.3%) by FSW; lack of interest (37.1%) by MSM; low risk perception (65.5%) by PWID; and lack of access (34.4%) by TG. The odds of reporting fear of side effects, lack of access, lack of interest, and nonspecific/others reasons were significantly different by KP group.

CONCLUSIONS

The barriers limiting the uptake of PrEP among YKP vary by KP group. Our results highlight the need for KP-specific interventions to improve the uptake of PrEP among YKP in Nigeria.

Does Participating in a Variety of Activities at a Variety of Locations or With Different People Predict Physical Activity Behavior Among Adolescents? The Mediating Role of Perceived Variety

We examine whether adolescents' participating in a variety of physical activities, locations, and/or with a variety of people relates to physical activity 16 months later and whether perceptions of variety mediate these relationships. Adolescents (N = 369) completed measures indicating various physical activities they participated in, where they primarily participated, and with whom they primarily participated, at three time points over a year (averaged for baseline measures). Perceptions of variety was measured 8 months later. Physical activity was measured 16 months after baseline. Mediation analyses tested perceptions of variety as a mediator of variety support and physical activity. Results indicated that variety of activities and variety of locations were indirectly associated with physical activity through perceptions of variety. Participating in a breadth of physical activities in a variety of locations during adolescence is positively associated with perceptions of variety, which relates to physical activity 16 months later.

Differentiating anorexia nervosa and atypical anorexia nervosa with absolute weight cut-offs results in a skewed distribution for premorbid weight among youth

OBJECTIVE

Anorexia nervosa (AN) and atypical AN are conceptualized as distinct illnesses, despite similar characteristics and sequelae. Whereas DSM-5 differentiates youth with AN and atypical AN by the presence of clinical 'underweight' (i.e., 5th BMI percentile for age-and-sex (BMI%)), we hypothesized that using this weight cut-off to discern diagnoses creates a skewed distribution for premorbid weight.

METHOD

Participants included hospitalized youth with AN (n = 165, 43.1%) and atypical AN (n = 218, 56.9%). Frequency analyses and chi-square tests assessed the distribution of premorbid BMI z-scores (BMIz) for diagnosis. Non-parametric Spearman correlations and Stepwise Linear regressions examined relationships between premorbid BMIz, admission BMIz, and weight loss in kg.

RESULTS

Premorbid BMIz distributions differed significantly for diagnosis (p < .001), with an underrepresentation of 'overweight/obesity' (i.e., BMI% ≥ 85th) in AN. Despite commensurate weight loss in AN and atypical AN, patients with premorbid 'overweight/obesity' were 8.31 times more likely to have atypical AN than patients with premorbid BMI% < 85th. Premorbid BMIz explained 57% and 39% of the variance in admission BMIz and weight loss, respectively.

DISCUSSION

Findings support a homogenous model of AN and atypical AN, with weight loss predicted by premorbid BMI in both illnesses. Accordingly, premorbid BMI and weight loss (versus presenting BMI) may better denote the presence of an AN-like phenotype across the weight spectrum. Findings also suggest that differentiating diagnoses with BMI% < 5th requires that youth with higher BMIs lose disproportionately more weight for an AN diagnosis. This is problematic given unique treatment barriers experienced in atypical AN.

PUBLIC SIGNIFICANCE

Anorexia nervosa (AN) and atypical AN are considered distinct conditions in youth, with differential diagnosis hinging upon a presenting weight status of 'underweight' (i.e., BMI percentile for age-and-sex (BMI%) < 5th). In our study, youth with premorbid 'overweight/obesity' (BMI% ≥ 85th) disproportionately remained above this threshold, despite similar weight loss. Coupled with prior evidence for commensurate characteristics and sequelae in both diagnoses, we propose that DSM-5 differentiation of AN and atypical AN inadvertently reinforces weight stigma and may contribute to treatment disparities in atypical AN.

Sexual Identity Disclosure and Alcohol Experiences Among LGBTQ+ Adolescents

Sexual and gender minority youth (SGMY) report greater alcohol use in comparison to their heterosexual counterparts. Prior research has found that elevated alcohol use among SGMY can be explained by minority stress experiences. Sexual identity outness may be another factor that drives alcohol use among SGMY, given that outness is associated with alcohol use among older sexual and gender minority samples. We examined how patterns of sexual identity outness were associated with lifetime alcohol use, past-30-day alcohol use, and past-30-day heavy episodic drinking. Data were drawn from the LGBTQ National Teen Survey (N = 8884). Participants were SGMY aged 13 to 17 (mean age = 15.59) years living in the US. Latent class analysis was used to identify sexual identity outness patterns. Multinomial regressions were used to examine the probability of class membership by alcohol use. Six outness classes were identified: out to all but teachers (n = 1033), out to siblings and peers (n = 1808), out to siblings and LGBTQ+ peers (n = 1707), out to LGBTQ+ peers (n = 1376), mostly not out (n = 1653), and very much not out (n = 1307). SGMY in classes characterized by greater outness to peers, friends, and family had greater odds of lifetime alcohol use compared with SGMY in classes characterized by lower outness. These findings suggest that SGMY with greater sexual identity outness may be a target for alcohol use prevention programming. Differences in sexual identity outness may be explained by minority stress factors.

Medically Attended Suicidality in Youth Who Live on Farms

Suicides are increasing in U.S. youth, particularly in rural areas. The influence of farming, however, is unclear, as suicide rates are higher in individual adult farm workers, but lower in farming-reliant counties. Early recognition of suicidality (suicidal ideation, intent, or attempt) is a key element of prevention, but there are no prior studies comparing suicidality in farm vs. non-farm youth. The purpose of this study was to examine associations between farm/rural residence and suicidality. Medical records were reused from an existing cohort of child and adolescent patients under surveillance for agricultural injuries in a Wisconsin healthcare system. The sample included 2,010 youth who lived on farms and 51,900 youth who did not live on farms (57% rural). The outcome was medically attended suicidality in 2017-2022 per a composite of diagnoses for suicidal ideation, attempt, or intentional self-harm that presented to ambulatory, emergency, or inpatient care settings. Suicidality was observed in 0.8% of farm, 1.8% of non-farm rural, and 1.6% of non-farm non-rural youth. After covariate adjustment, farm youth had significantly lower odds of suicidality (adjusted odds ratio [aOR] [95% confidence interval; CI] = 0.55 [0.33, 0.91], P = .019), while non-farm rural youth had significantly greater odds of suicidality (aOR [CI] = 1.21 [1.05, 1.40], P = .007), relative to non-farm non-rural youth. Children and adolescents who live on farms are about half as likely to (medically) present for suicidality as compared to their non-farm counterparts, both rural and non-rural. Future research should identify causal suicide protection factors in farm youth.

Firearm carrying and adolescent suicide risk outcomes between 2015 and 2021 across nationally representative samples

INTRODUCTION

Firearms are the most frequent means of youth suicide for the 14-18-year-old age group, and adolescent firearm access confers substantial increases in the risk of suicidal behaviors. There have been significant increases in firearm purchases and firearm violence in the United States since the onset of the COVID-19 pandemic.

METHODS

This study uses four time points of nationally representative data from the Youth Risk Behavior Survey (YRBS) from 2015 to 2021 to examine the differential associations of reporting having carried a firearm and suicide-related outcomes, after controlling for relevant demographic factors. As a sensitivity analysis, we examined whether a similar risk pattern was seen for the probability of reporting depressed mood.

RESULTS

Results reveal significant increases in suicide-related outcomes among students who reported carrying a firearm and no significant increases among those who did not. Unlike the suicide-related outcomes, increases in depressed mood overtime were not limited to students who carried firearms, suggesting that the risk associated with firearms may be specific to suicide-related outcomes.

CONCLUSIONS

Carrying a firearm is associated with significant increases in the risk of suicidal ideation and behaviors among youth and this risk has increased between 2015 and 2021. Implications for youth suicide prevention and directions for future research are discussed.

A necessary conversation to develop chatbots for HIV studies: qualitative findings from research staff, community advisory board members, and study participants

Chatbots increase business productivity by handling customer conversations instead of human agents. Similar rationale applies to use chatbots in the healthcare sector, especially for health coaches who converse with clients. Chatbots are nascent in healthcare. Study findings have been mixed in terms of engagement and their impact on outcomes. Questions remain as to chatbot acceptability with coaches and other providers; studies have focused on clients.To clarify perceived benefits of chatbots in HIV interventions we conducted virtual focus groups with 13 research staff, eight community advisory board members, and seven young adults who were HIV intervention trial participants (clients). Our HIV healthcare context is important. Clients represent a promising age demographic for chatbot uptake. They are a marginalized population warranting consideration to avoid technology that limits healthcare access.Focus group participants expressed the value of chatbots for HIV research staff and clients. Staff discussed how chatbot functions, such as automated appointment scheduling and service referrals, could reduce workloads while clients discussed the after-hours convenience of these functions. Participants also emphasized that chatbots should provide relatable conversation, reliable functionality, and would not be appropriate for all clients. Our findings underscore the need to further examine appropriate chatbot functionality in HIV interventions.

Associations Between Intersecting Sociodemographic Characteristics and Device-Measured Physical Activity Among Children and Adolescents Living in the United States

BACKGROUND

Despite robust evidence demonstrating sociodemographic characteristics may underly some of the disparities in physical activity observed among children and adolescents, the often-overlooked nexus of potential interactions between these characteristics warrants further exploration. This study explored the intersectionality of gender, race/ethnicity, parental education, and household income in relation to device-measured physical activity volume and intensity in a nationally representative sample of US children and adolescents.

METHODS

Cross-sectional data from 3 cycles of the US National Health and Nutrition Survey (2011-2012; 2012 National Youth Fitness Survey; and 2013-2014) were used. A total of 6116 participants (49% female) between 3 and 17 years of age wore an accelerometer on their nondominant wrist for 7 days. Monitor-independent movement summary units were used to represent physical activity volume and intensity. A Social Jeopardy Index was created to represent increasing levels of intersecting social disadvantages based on combinations of gender, race/ethnicity, parental education, and household income-to-poverty ratio tertiles. Generalized linear regression models were computed.

RESULTS

The results showed social disadvantages become increasingly evident among children and adolescents during the most intense 60 minutes of daily physical activity (B = -48.69 [9.94] SE, P < .001), but disparities in total volume were not observed (B = 34.01 [44.96] SE, P = .45).

CONCLUSIONS

Findings suggest that patterns of physical activity behavior may differ based on intersecting sociodemographic characteristics-more socially disadvantaged children and adolescents appear to accumulate activity at lighter intensities. Collecting contextual information about device-measured physical activity represents an important next step for gaining insight into these sociodemographic differences.

Exploring the Dynamics of Athletes' Enjoyment and Self-Determined Motivation, and of the Motivational Climate in Youth Football: A Longitudinal Perspective

We aimed to explore a short period longitudinal interplay between athletes' enjoyment and their self-determined motivation and motivational climate in youth football. We recruited 109 youth football athletes (79 males, 30 females) through a convenient sampling method. We included individuals within the 12-17-year-old age range, with a mean age of 14.31 (SD = 1.46) years. To examine these proposed associations, we performed hierarchical multiple regression analyses and found that enjoyment at pre-season assessment (T1) and self-determined motivation and a task-involving sport climate at mid-season (T2) were significant predictors of mid-season enjoyment (at T2). However, self-determined motivation and task-involving climate at T1 did not significantly contribute to the model. These findings emphasize the importance of initial enjoyment and an evolved self-determined motivation, and task-involving climate in understanding later enjoyment in sport. Coaches, practitioners, and policymakers should prioritize strategies that enhance intrinsic motivation, provide opportunities for autonomy, and cultivate a supportive and growth-oriented environment.

Non-Fatal Work-Related Farm Injuries Occurring to Michigan Adults and Youths

Farming is one of the top industries in Michigan and has the highest fatality rate. National sources of non-fatal farm injuries underestimate the burden, especially among children. In this paper, we provide a more accurate estimate of non-fatal farm injuries in Michigan by using an ongoing multi-source surveillance system. Michigan's farm-injury surveillance system includes abstractions of hospital-based medical records, poison control center calls, ambulance runs, and workers' compensation claims for individuals with a farm-related injury. For this analysis, injury onset occurred in 2015 to 2021 and included all injuries regardless of age or occupation. We identified 4,306 injuries in adults and 336 injuries in youth. For those 0-13 years of age all but two were family members. For those 14-15 and 16-17 years of age, 19% and 45%, respectively were hired hands. For adults, 51% were owner/operators, 43% were hired hands, and 5% were family members. For all ages, the most frequent injury source was cattle. Lacerations/cuts/punctures were the most common type of injury for those < 14 years of age while for older individuals it was contusions/bruises. The plurality of injuries occurred in the summer months. Children working on a farm are in unique situation and tracking injuries and identifying injury sources provide necessary information to protect their health and well-being. Michigan's farm-injury surveillance system will continue to provide a comprehensive count of work-related injuries among Michigan's farming population. The information is used to direct public health intervention both at the individual and population level.

Physical activity interventions among youth living in rural and remote areas: A systematic review

OBJECTIVES

Physical activity (PA) interventions have potential to improve health and social outcomes among youth. The aim of this study was to collate the evidence on the effectiveness of PA and sports-based interventions among youth living in rural and remote areas.

METHODS

We searched five databases and grey literature (HealthInfoNet). Search terms included PA, rural status, adolescents, and outcome measures. Studies were included if published in English, recruited 10- to 18-year olds, and were based in rural or remote communities (Modified Monash Model [MMM] area classification range of MMM 3-7). Quasi-experimental and pre-experimental and post-experimental PA interventions were included. Two authors evaluated the articles independently following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, and relevant data were extracted. International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020199001).

RESULTS

Of the 11802 studies identified, 6 were included in the review. Most studies were excluded for not meeting MMM 3-7 criteria. Four of the included studies had sports-related interventions, and 2 had walking-based interventions. Outcomes included self-efficacy, mental health, and academic performance. One study reported a positive effect of PA on self-efficacy (β = 0.26, p=0.018, odds ratio = 1.43 [95% confidence interval: 1.07-1.92]).

CONCLUSION

Few community-based PA interventions have been evaluated in rural areas. There is a need for future evaluations in rural areas and include PA as an outcome measure.

IMPLICATIONS FOR PUBLIC HEALTH

The findings highlight the need for measurement of PA outcomes in PA interventions in rural and remote areas. The findings also highlight the need for research to utilise a standardised measure of rurality.

Factors promoting and hindering resilience in youth with inflammatory bowel disease: A descriptive qualitative study

AIM

To explore factors promoting and hindering resilience in youth with inflammatory bowel disease (IBD) based on Kumpfer's resilience framework.

DESIGN

A descriptive qualitative study design with an interpretative approach was used.

METHODS

Participants consisted of 10 youths with IBD from a tertiary hospital in Beijing (China) recruited using the purposive sampling method. Data were collected by semi-structured interviews from December 2020 to March 2021. The directed content analysis was performed for data analysis.

RESULTS

Both promoting factors and hindering factors could be divided into personal factors and environmental factors. Thirteen themes were identified. The promoting factors included acceptance of illness, strict self-management, previous treatment experience, life goals, family support, medical support and peer encouragement. Stigma, lack of communication, negative cognition, societal incomprehension, economic pressure and academic and employment pressure were hindering factors.

CONCLUSION

Health care professionals need to develop greater awareness of factors, stemming from both the individual and the outside world, that hinder or promote resilience in order to aid young patients with IBD. Building targeted nursing measures to excavate the internal positive quality of patients, provide external support and promote the development of resilience.

Online Educational Resources for Youth Living With Type 1 Diabetes Transitioning to Adult Care: An Environmental Scan of Canadian Content

OBJECTIVES

There are many educational resources for adolescents and young adults living with type 1 diabetes; however, it is unknown whether they address the breadth of topics related to transition to adult care. Our aim in this study was to collect educational resources relevant to Canadian youth and assess their quality and comprehensiveness in addressing the knowledge necessary for youth to prepare for interdependent management of their diabetes.

METHODS

We conducted an environmental scan, a systematic assessment and analysis, of online education resources in English and French relevant to Canadian youth living with type 1 diabetes. Resources were screened using an open education resource evaluation grid and relevant resources were mapped to the Readiness for Emerging Adults with Diabetes Diagnosed in Youth, a validated diabetes transition readiness assessment tool.

RESULTS

From 44 different sources, 1,245 resources were identified and, of these, 760 were retained for analysis. The majority were webpages (50.1%) and downloadable PDFs (42.4%), and 12.1% were interactive. Most resources covered Diabetes Knowledge (46.0%), Health Behaviour (23.8%), Insulin and Insulin Pump Management (11.8% and 8.6%, respectively), and Health-care System Navigation (9.7%). Topic areas with the fewest resources were disability accommodations (n=5), sexual health/function (n=4), and locating trustworthy diabetes resources (n=3).

CONCLUSIONS

There are many resources available for those living with type 1 diabetes preparing to transition to adult care, with the majority pertaining to diabetes knowledge and the least for navigation of the health system. Few resources were available on the topics of substance use, sexual health, and reproductive health. An interactive presentation of these resources, as well as a central repository to house these resources, would improve access for youth and diabetes care providers during transition preparation.

Impaired coronary microvascular reactivity in youth with bipolar disorder

BACKGROUND

Cardiovascular disease (CVD) is excessively prevalent and premature in bipolar disorder (BD), even after controlling for traditional cardiovascular risk factors. The increased risk of CVD in BD may be subserved by microvascular dysfunction. We examined coronary microvascular function in relation to youth BD.

METHODS

Participants were 86 youth, ages 13-20 years (n = 39 BD, n = 47 controls). Coronary microvascular reactivity (CMVR) was assessed using quantitative T2 magnetic resonance imaging during a validated breathing-paradigm. Quantitative T2 maps were acquired at baseline, following 60-s of hyperventilation, and every 10-s thereafter during a 40-s breath-hold. Left ventricular structure and function were evaluated based on 12-15 short- and long-axis cardiac-gated cine images. A linear mixed-effects model that controlled for age, sex, and body mass index assessed for between-group differences in CMVR (time-by-group interaction).

RESULTS

The breathing-paradigm induced a significant time-related increase in T2 relaxation time for all participants (i.e. CMVR; β = 0.36, p < 0.001). CMVR was significantly lower in BD v. controls (β = -0.11, p = 0.002). Post-hoc analyses found lower T2 relaxation time in BD youth after 20-, 30-, and 40 s of breath-holding (d = 0.48, d = 0.72, d = 0.91, respectively; all pFDR < 0.01). Gross left ventricular structure and function (e.g. mass, ejection fraction) were within normal ranges and did not differ between groups.

CONCLUSION

Youth with BD showed evidence of subclinically impaired coronary microvascular function, despite normal gross cardiac structure and function. These results converge with prior findings in adults with major depressive disorder and post-traumatic stress disorder. Future studies integrating larger samples, prospective follow-up, and blood-based biomarkers are warranted.

Examining Teacher Concerns and Anxiety on the Implementation of a Universal Body Image Program

In the past 30 years, there have been numerous positive body image and eating disorder prevention programs targeting youth developed for school-based settings. Frequently, teachers are used as interventionists to increase dissemination, decrease costs relative to researchers, and increase scalability. However, little is known about teacher concerns and barriers that may hinder successful uptake and implementation. The current study recruited a total of 269 teachers who consented to implement a universal body image and appearance-related bullying and teasing prevention program in their classrooms as part of a randomized controlled trial. Teachers expressed some worry that they may say the wrong thing, and concern about feeling uncomfortable teaching the program due to their own body dissatisfaction. Teacher's ethnicity, gender, years teaching, dieting behaviors and other weight control behaviors, and self-efficacy were not associated with concerns related to teaching the curriculum. Teachers with lower body esteem reported higher concerns and anxiety related to teaching a body image curriculum. In free response items, teachers worried about handling student comments that were beyond the scope of the curriculum. Teacher self-efficacy was the only variable associated with the number of program sessions implemented. Findings suggest avenues to increase implementation.

Investigation of Underlying Association between Anthropometric and Cardiorespiratory Fitness Markers among Overweight and Obese Adolescents in Canada

BACKGROUND

Adolescents who experience overweight or obesity commonly persist in these conditions into adulthood, thereby elevating their vulnerability to health issues. The focus of this study is on health risk markers such as body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), body surface area (BSA), and cardiorespiratory fitness (CRF). The objectives include updating normative values for BMI, WC, WHtR, and BSA in Canadian adolescents, establishing cardiometabolic risk zones, and developing a composite score considering both anthropometric and CRF markers.

METHODS

Involving 1864 adolescents, the study used the LMS method to generate percentile norms, stratified by age and sex. Cardiometabolic risk zones were established for each marker based on Z-scores, and a composite score was created.

RESULTS

An increase in WC of 5.8 and 7.4 cm for boys and girls, respectively, was observed since 1981. Forward multiple regression analyses were conducted to assess the robustness and validity of the proposed model. The results indicated that the model explained nearly 90% (R2 = 0.890) of the common variance between the composite score and the retained independent variables. Moreover, the model demonstrated a mean absolute error (MAE) of approximately 6 percentiles, confirming its high precision. Furthermore, these analyses yielded key thresholds for identifying adolescents at risk: the 70th percentile for high cardiometabolic risk and the 85th percentile for very-high risk.

CONCLUSIONS

Individually, WC or WHtR seem to be better markers for evaluating cardiometabolic risk than BMI during adolescence. However, CRF showed comparable importance to anthropometric markers in determining cardiometabolic risk. The simultaneous inclusion of anthropometric and CRF markers provides a better picture of the global cardiometabolic risk in adolescents.

Considerations of gender-affirming care for transgender and gender-diverse youth

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Family Meals and Social Eating Behavior and Their Association with Disordered Eating among Spanish Adolescents: The EHDLA Study

PURPOSE

The aim of this study was to examine the association of family meals and social eating behavior with disordered eating behavior in Spanish adolescents.

METHODS

This was a cross-sectional study that included 706 adolescents (43.9% boys) from the Eating Habits and Daily Life Activities (EHDLA) study (aged 12 to 17) from Valle de Ricote, Region of Murcia, Spain. The frequency of family meals was assessed by asking participants to report how often their family, or most household members, had shared meals in the past week. Social eating behavior was evaluated using three statements: "I enjoy sitting down with family or friends for a meal", "Having at least one meal a day with others (family or friends) is important to me", and "I usually have dinner with others". To evaluate disordered eating, two psychologists administered the Sick, Control, One, Fat and Food (SCOFF) questionnaire.

RESULTS

After adjusting for several covariates, for each additional family meal, the likelihood of having disordered eating behavior was lower (odds ratio (OR) = 0.96; 95% confidence interval (CI) 0.93 to 0.9997, p = 0.049). On the other hand, a lower likelihood of having disordered eating behavior was observed for each additional point in the social eating behavior scale (OR = 0.85; 95% CI 0.77 to 0.93, p = 0.001). The likelihood of having disordered eating behavior was 0.7% lower for each additional family meal (95% CI 0.01% to 1.4%, p = 0.046). Furthermore, for each additional point in the social eating behavior scale, a lower probability of having disordered eating behavior was observed (3.2%; 95% CI 1.4% to 5.0%, p < 0.001).

CONCLUSIONS

While disordered eating behavior is complex and can be shaped by various factors, both family meals and social eating behavior emerge as significant factors inversely associated with this condition among adolescents. Promoting regular engagement in family meals and fostering positive social eating experiences could serve as effective strategies in public health initiatives aimed at mitigating the incidence of disordered eating behavior among the young population.

The Urgent Need for an Evidence-Based Digital Mental Health Practice Model of Care for Youth

Australian providers of mental health services and support for young people include private and public allied health providers, government initiatives (eg, headspace), nongovernment organizations (eg, Kids Helpline), general practitioners (GPs), and the hospital system. Over 20 years of research has established that many young people prefer to seek mental health support online; however, clear client pathways within and between online and offline mental health services are currently lacking. The authors propose a Digital Mental Health Practice model of care for youth to assist with digital mental health service mapping. The proposed model offers accessible pathways for a client to engage with digital mental health services, provides clear navigation to access support for individual needs, and facilitates a seamless connection with offline mental health services using a transferable electronic health records system. This future-looking model also includes emerging technologies, such as artificial intelligence and the metaverse, which must be accounted for as potential tools to be leveraged for digital therapies and support systems. The urgent need for a user-centered Digital Mental Health Practice model of care for youth in Australia is discussed, highlighting the shortcomings of traditional and existing online triage models evident during the COVID-19 pandemic, and the complex challenges that must be overcome, such as the integration of diverse mental health care providers and establishment of a robust electronic health records system. Potential benefits of such a model include reduced pressure on emergency rooms, improved identification of immediate needs, enhanced referral practices, and the establishment of a cost-efficient national digital mental health care model with global applicability. The authors conclude by stressing the consequences of inaction, warning that delays may lead to more complex challenges as new technologies emerge and exacerbate the long-term negative consequences of poor mental health management on the economic and biopsychosocial well-being of young Australians.

Predictors of U.S. Adults' Opinion Toward an R-Rating Policy for Movies With Cigarette Smoking

Recently, multiple health organizations and advocacy groups have pushed for giving an R-rating for movies depicting tobacco imagery. This study examined several predictors of U.S. adults' opinion toward an R-rating policy for movies depicting cigarette smoking. We used data from the Health Information National Trends Survey (2020 cycle), for a nationally representative sample of 3,865 US adults (aged ≥ 18). The outcome variable was opinion toward an R-rating policy (support, neutral, and oppose) for movies depicting cigarette smoking. A weighted adjusted multinomial logistic regression analysis with comparisons of support versus oppose, support versus neutral, and neutral versus oppose was performed. About 48.2% of respondents were supportive of, 31.1% were neutral toward, and 20.7% were opposed to an R-rating policy. Adults aged 50 to 64 years (adjusted odds ratio [aOR] = 2.28, p = .008) and ≥65 years (aOR = 4.54, p <.001) (vs. 18-34 years) were more likely to support the R-rating policy than oppose it. Non-Hispanic Black respondents (vs. non-Hispanic Whites) were 1.74 times more likely to support than oppose the policy (aOR = 1.74, p = .04), whereas adults with a household annual income of US$75,000 or more (vs. <$20,000) and those with moderate (vs. liberal) political viewpoints were more likely to be neutral than oppose the policy. Former and current e-cigarette users (vs. never users) were less likely to support than oppose the policy. Tailored messaging addressing the rationale behind R-rating policy should be directed towards communities based on age, race/ethnicity, household income, e-cigarette usage, and political ideologies.

Use of 'Elf Bar' among youth and young adults who currently vape in England: cross-sectional associations with demographics, dependence indicators and reasons for use

BACKGROUND AND AIMS

Elf Bar is currently the leading e-cigarette (vape) brand in Great Britain. This study examined youth and young adults' use of Elf Bar, socio-demographic characteristics and dependence indicators and reasons for use over other brands.

DESIGN

Cross-sectional survey.

SETTING AND PARTICIPANTS

Online 2022 International Tobacco Control Project Youth Tobacco and Vaping Survey (N = 1355 16-29-year-olds in England who had vaped in the past 30 days).

MEASUREMENTS

Currently using Elf Bar most often (versus other brands) and associations with: socio-demographics, owning a vaping device, dependence indicators and reasons for brand choice. Logistic regressions were used.

FINDINGS

Among 16-29-year-olds who vaped in the past 30 days, 48.4% (n = 732) reported Elf Bar as the brand they used most often. Among 16-17-year-olds, 40.7% used Elf Bar over other brands; this was lower than among 18-19-year-olds (60.1%) and 20-29-year-olds (47.4%) (P ≤ 0.002). Using Elf Bar over other brands was higher among those who were female (55.2 versus 41.5% male), identified as White (53.1 versus 30.9% other/mixed), a student (54.5 versus 44.3% not), did not own a vape (66.7 versus 44.4% who did) and typically vaped 5-8 hours after waking (62.7 versus 36.8% within 5 min) (P ≤ 0.044). Most who vaped but had never smoked used Elf Bar (64.3%), although use did not significantly differ from those who currently (45.4%), formerly (42.3%) or experimentally (48.7%) smoked (all P ≥ 0.060). Popular reasons for choosing Elf Bar over other brands were better flavour/taste (47.5%), less expensive (28.7%), easier to get (26.1%), smoother to inhale (24.0%) and popularity (23.1%). 'Better for quitting smoking' (10.1%) was least frequently selected reason for choosing Elf Bar over other brands.

CONCLUSIONS

Elf Bar brand e-cigarettes were used by approximately half of 16-29-year-olds who vaped in England in 2022 and was mainly chosen over other brands for subjective responses (e.g. flavour/taste), rather than for quitting smoking.

Topical Review: Getting into the head of youth with chronic pain: how theory of mind deficits may relate to the development and maintenance of pediatric pain

OBJECTIVE

Theory of mind (ToM) is the ability to understand the thoughts, feelings, and mental states of others and is critical for effective social and psychological functioning. ToM deficits have been associated with various psychological disorders and identified in adult pain populations. For youth with chronic pain, ToM deficits may underlie the biological, psychological, and social factors that contribute to their experience of pain, but this remains poorly understood.

METHODS

This topical review explored the extant literature in the areas of ToM and chronic pain, particularly for pediatric populations, with respect to biological, psychological, and social elements of the biopsychosocial model of pain.

RESULTS

ToM deficits may be present alongside previously identified biological, psychological, and social correlates of pediatric pain, as a vulnerability, mechanism, and/or consequence. Biologically, ToM deficits may relate to cortisol abnormalities and neurobiological substrates of pain processing. Psychologically, ToM deficits may stem from pain-focused cognitions, thus impacting relationships and fueling impairment. Socially, chronic pain may preclude normative development of ToM abilities through social withdrawal, thereby exacerbating the experience of pain.

CONCLUSION

Taken together, ToM deficits may be associated with increased risk for the development and/or maintenance of pediatric chronic pain, and pediatric chronic pain may similarly confer risk for ToM deficits. Future research should investigate the nature of ToM abilities in youth with chronic pain to test these hypotheses and ultimately inform ToM-focused and pain-based interventions, as this ability has been demonstrated to be modifiable.

How frequently is alcohol advertised on television in Canada?: A cross-sectional study

AIMS

Alcohol marketing is a commercial driver of alcohol use, including among youth. This study sought to quantify and characterize alcohol advertising on broadcast television in Canada.

METHODS

Open-source television program logs for January to December 2018 submitted to the Canadian Radio-television and Telecommunications Commission by 147 stations with alcohol advertisements were analyzed.

RESULTS

Overall, 501 628 alcohol advertisements were broadcast. Four companies accounted for 83% of advertisements, namely, Anheuser-Busch in Bev (33.7%), Molson Coors (22.7%), Diageo (16.1%), and Arterra Wines Canada (10.8%). On conventional stations, advertising was highest on French-language stations [Median (Mdn) = 3224; interquartile range (IQR) = 2262] followed by those with programming in foreign/mixed languages (Mdn = 2679; IQR = 219) and English-language stations (Mdn = 1955; IQR = 1563). On speciality stations, advertising was most frequent on those primarily focused on sports programming (Mdn = 8036; IQR = 7393), movies and scripted shows (Mdn = 7463; IQR = 5937), and cooking (Mdn = 5498; IQR = 4032). On weekdays, 33% of alcohol ads aired from 6 to 9 a.m. and 3 to 9 p.m. and on weekends, 52% aired from 6 a.m. to 9 p.m. when children or adolescents are more likely to be watching television. On youth-oriented stations (n = 4), 7937 alcohol advertisements were broadcast with most airing from 9 p.m. to midnight (44-45%) or 12-6 a.m. (50%) on both weekdays and weekends.

CONCLUSIONS

While few alcohol advertisements were broadcast on youth-oriented stations, young people in Canada are likely exposed to such advertising on programming intended for older or general audiences (e.g. sports). More research is needed to ascertain the extent to which broadcast television constitutes a source of alcohol advertising exposure among youth and to inform policies aimed at protecting them from the influence of such exposure.

Factors influencing the utilisation of Youth Friendly Health Services in Blantyre, Malawi

Background

Usage of Youth Friendly Health Services (YFHSs) remains unsatisfactory in sub-Saharan Africa despite global agreements on the utilisation of these services among the youths.

Aim

The aim of the study was to identify factors that influence the utilisation of YFHSs in Blantyre, Malawi.

Setting

Four health centres in Blantyre, Malawi.

Methods

A descriptive quantitative research design using multistage sampling was used to randomly sample (N = 293) unmarried youths and collect data using a structured questionnaire. Data were analysed using a computerised statistical package for social sciences (SPSS) version 26. Chi-square (χ²) was used to test the significance of the association between variables, and the p-value (p < 0.05) was considered significant. Regression analysis was used to examine the influence of independent variables on the utilisation of the services.

Results

Less than half of the respondents have ever accessed YFHSs (43%). The Chi-square test showed that the following variables had a significant association with utilisation of the services (p < 0.05): gender, age, knowledge, signage, printed health education materials, provider attitudes and being shy or fear of being seen at the services.

Conclusion

Age, knowledge, signpost, printed health education materials, provider attitudes and being shy or fear of being seen at the YFHSs are factors that influenced the utilisation of the services. Working on these factors would help to increase utilisation.

Contribution

The study findings will help to fill the gap in the provision of YFHSs and thus increase utilisation of the services.

A Systematic Review of the Impacts of Media Mental Health Awareness Campaigns on Young People

Mental health issues are prevalent among young people. An estimated 10% of children and adolescents worldwide experience a mental disorder, yet most do not seek or receive care. Media mental health awareness campaigns, defined as marketing efforts to raise awareness of mental health issues through mass media, are an effort to address this concern. While previous research has evaluated the outcomes of specific media mental health awareness campaigns, there is limited data synthesizing their overall effects. This study addresses the knowledge gap by reviewing the existing literature on the impact of media mental health awareness campaigns on young people. A search was conducted on MEDLINE, EMBASE, PsychINFO, Web of Science, and Google Scholar for studies published between 2004 and 2022 with results specific to people aged 10 to 24. Out of 20,902 total studies identified and screened, 18 studies were included in the review. The following data were extracted from each study: characteristics and descriptions of the campaign, evaluation design and sampling, and summary of impact. The review identified evaluations of 15 campaigns from eight different countries. Outcome evaluation methods commonly comprised of surveys and quantitative data. The campaigns were generally associated with positive changes in the attitudes, beliefs, and intentions of young people (e.g., reduced stigma) and positive changes in behaviors (e.g., increased help-seeking behaviors). The inclusion of few studies in the review indicates a need for ongoing evaluations of media mental health awareness campaigns for young people to inform good practices in their development and distribution.

Do Flavour Descriptions Influence Subjective Ratings of Flavoured and Unflavoured E-Liquids among Non-Smoking and Non-Vaping UK Adolescents?

INTRODUCTION

Youth use of electronic cigarettes (e-cigarettes) is rising globally and is associated with health harms. Flavour descriptions on e-liquid packaging may contribute to the appeal of e-cigarettes among youth. This study compared subjective ratings of e-liquid packaging flavour descriptions among non-smoking and non-vaping UK adolescents.

METHODS

This was an online observational study in a UK sample of non-smoking and non-vaping adolescents aged 11-17 years. The primary analyses compared flavoured versus unflavoured descriptions and the secondary analyses compared candy/sweet flavour versus fruit flavour descriptions. Outcomes were packaging appraisal, packaging receptivity, perceived harm, and perceived audience.

RESULTS

The survey was completed by 120 participants (74% female). Packaging appraisal ratings were higher for e-liquids with flavoured descriptions than unflavoured descriptions (mean difference 5.9, 95% CI 4.2 to 7.6, p<.001). Similarly, packaging receptivity ratings were higher for e-liquids with flavoured descriptions than unflavoured descriptions (mean difference 4.2, 95% CI 2.8 to 5.6, p<.001). Participants also perceived e-liquids with flavoured (versus unflavoured) descriptions as less 'grown-up' (mean difference -5.2, 95% CI -7.3 to -3.1, p<.001). However, ratings of perceived harm were similar for flavoured and unflavoured descriptions (mean difference -1.0, 95% CI -2.6 to 0.5, p=.189).

CONCLUSIONS

Although this study found differences in subjective ratings of e-liquids with flavoured and unflavoured descriptions, non-smoking and non-vaping UK adolescents generally had low appraisal and receptivity for e-liquids and they perceived them as being 'grown-up' and harmful.

IMPLICATIONS

Youth use of electronic cigarettes (e-cigarettes) is increasing globally, leading to concerns about health harms. This study compared adolescents' ratings of e-liquids with flavoured versus unflavoured descriptions and e-liquids with candy/sweet flavour versus fruit flavour descriptions. This study adds to previous studies that have compared adolescents' ratings of e-liquids with tobacco flavour versus non-tobacco flavour descriptions. Although packaging appraisal and receptivity ratings were higher (more positive) for e-liquids with flavoured versus unflavoured descriptions, overall, adolescents who do not smoke or vape had low appraisal and receptivity for e-liquids, and they perceived them as being 'grown-up' and harmful.

Guiding Principles for Adolescent Web-Based Portal Access Policies: Interviews With Informatics Administrators

BACKGROUND

Web-based patient portals are tools that could support adolescents in managing their health and developing autonomy. However, informatics administrators must navigate competing interests when developing portal access policies for adolescents and their parents.

OBJECTIVE

We aimed to assess the perspectives of informatics administrators on guiding principles for the development of web-based health care portal access policies in adolescent health care.

METHODS

We interviewed informatics administrators from US hospitals with ≥50 dedicated pediatric beds. We performed a thematic analysis of guiding principles for developing and implementing adolescent portal access policies.

RESULTS

We interviewed 65 informatics leaders who represented 63 pediatric hospitals, 58 health care systems, 29 states, and 14,379 pediatric hospital beds. Participants described 9 guiding principles related to three overarching themes: (1) balancing confidentiality and other care needs, (2) balancing simplicity and granularity, and (3) collaborating and advocating. Participants described the central importance of prioritizing the health and safety of the adolescent while also complying with state and federal laws. However, there were differing beliefs about how to prioritize health and safety and what role parents should play in supporting the adolescent's health care. Participants also identified areas where clinicians and institutions can advocate for adolescents, especially with electronic health record vendors and legislators.

CONCLUSIONS

Informatics administrators provided guiding principles for adolescent portal access policies that aimed to balance the competing needs of adolescent confidentiality and the usefulness of the portal. Portal access policies must prioritize the adolescent's health and safety while complying with state and federal laws. However, institutions must determine how to best enact these principles. Institutions and clinicians should strive for consensus on principles to strengthen advocacy efforts with institutional leadership, electronic health record vendors, and lawmakers.

Literacy and attitude of Asian youths on dengue and its prevention in an endemic developed community

Background

Over the past few decades, the incidence of dengue fever has considerably increased. Effective vector control strategies and specific protection using dengue vaccine are thought to be the key elements to combat dengue. The dengue incidence among the Singapore youths (15-24 years) was second only to that of adults (25-44 years). This study evaluated the knowledge and attitude of Singapore youths on dengue and its preventive measures.

Methods

A cross-sectional study using online-based questionnaire survey was conducted among Singapore youths from September to November 2022. Data were analyzed for descriptive statistics whereas Chi-squared test, linear regression analysis and Pearson correlation were used to determine the association between demographic factors and youth's attitude on dengue prevention using Rstudio.

Results

A total of 624 respondents completed the survey out of 1822 surveys distributed nation-wide, with a response rate of 34.2% (mean age 17.4 years ± 1.84; 59.3% female; 89.9% Chinese). The mean dengue knowledge scores of participants were 14.1 ± 2.8. Univariate analysis showed that teenagers (15-19 years) had significantly higher knowledge score than the young adults (20-24 years) (β =0.82,95%CI = 0.13-1.51, p = 0.021). Majority of them were aware of the Mozzie Wipeout campaign (90.2%) followed by the release of Wolbachia mosquitos (69.1%). Two-thirds of the youths who were aware of Wolbachia and Gravitrap considered that it was effective in reducing dengue infection rates. Participants suggested information about the current dengue infection rate (71.9%) as the most effective of the five proposed strategies to improve uptake of dengue preventive measures. In comparison to young adults, teenagers were more likely to uptake dengue preventive measures if widespread mosquito control practices were implemented (69.1% vs. 42.3%).

Conclusion

The overall knowledge of the youths on dengue and its prevention was satisfactory. Future health promotion campaigns targeting the youths should focus on transforming the knowledge into practice.

The Cost-Effectiveness of a Novel Online Social Therapy to Maintain Treatment Effects From First-Episode Psychosis Services: Results From the Horyzons Randomized Controlled Trial

BACKGROUND

Digital interventions have potential applications in promoting long-term recovery and improving outcomes in first-episode psychosis (FEP). This study aimed to evaluate the cost-effectiveness of Horyzons, a novel online social therapy to support young people aged 16-27 years following discharge from FEP services, compared with treatment as usual (TAU) from a healthcare sector and a societal perspective.

STUDY DESIGN

A cost-effectiveness analysis (CEA), based on the change in social functioning, and a cost-utility analysis (CUA) using quality-adjusted life years were undertaken alongside a randomized controlled trial. Intervention costs were determined from study records; resources used by patients were collected from a resource-use questionnaire and administrative data. Mean costs and outcomes were compared at 18 months and incremental cost-effectiveness ratios were calculated. Uncertainty analysis using bootstrapping and sensitivity analyses was conducted.

STUDY RESULTS

The sample included 170 participants: Horyzons intervention group (n = 86) and TAU (n = 84). Total costs were significantly lower in the Horyzons group compared with TAU from both the healthcare sector (-AU$4789.59; P < .001) and the societal perspective (-AU$5131.14; P < .001). In the CEA, Horyzons was dominant, meaning it was less costly and resulted in better social functioning. In the CUA, the Horyzons intervention resulted in fewer costs but also yielded fewer QALYs. However, group differences in outcomes were not statistically significant. When young people engaged more with the platform, costs were shown to decrease and outcomes improved.

CONCLUSIONS

The Horyzons intervention offers a cost-effective approach for improving social functioning in young people with FEP after discharge from early intervention services.

Need for Culturally Competent and Responsive Cancer Education for African Immigrant Families and Youth Living in the United States

Cancer prevalence data for Black Americans is monolithic and fails to consider the diverse cultures and backgrounds within that community. For instance, African immigrants constitute a meaningful proportion of the foreign-born Black immigrants in the United States (42%), but the prevalence of cancer in the African immigrant community itself is unknown. Therefore, without accurate cancer prevalence data, it is impossible to identify trends and other key factors that are needed to support the health of African immigrants and their children. Moreover, it is impossible to understand how the culture and language of subgroups influence their cancer-related health behavior. While research in this area is limited, the existing literature articulates the need for culturally responsive and culturally tailored cancer education for African immigrants and their adolescent children, which is what we advocate for in this viewpoint paper. Existing projects demonstrate the feasibility of culturally responsive programming for adults; however, few projects include or focus on adolescents or children born to African immigrants. To best meet the needs of this understudied community, researchers must use culturally competent interventions alongside familiar, usable media. For adolescents, technology is ubiquitous thus, the creation of a culturally tailored digital intervention has immense potential to improve cancer awareness and prevention for youth and their community. More research is needed to address many of the existing research gaps and develop a rich understanding of the unique experience of cancer among African immigrant families that can be used to inform intervention development. Through this viewpoint, we review the current state of cancer-related research among African immigrant families in the United States. In this paper, we acknowledge the current knowledge gaps and issues surrounding measurement and then discuss the factors relevant to designing an educational intervention targeted at African immigrants and the role of African immigrant youth.

Changes in real-world dispensing of ADHD stimulants in youth from 2019 to 2021 in California

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common pediatric neurobehavioral disorders in the U.S. Stimulants, classified as controlled substances, are commonly used for ADHD management. We conducted an analysis of real-world stimulants dispensing data to evaluate the pandemic's impact on young patients (≤ 26 years) in California.

Methods

Annual prevalence of patients on stimulants per capita across various California counties from 2019 and 2021 were analyzed and further compared across different years, sexes, and age groups. New patients initiating simulants therapy were also examined. A case study was conducted to determine the impact of socioeconomic status on patient prevalence within different quintiles in Los Angeles County using patient zip codes. Logistic regression analysis using R Project was employed to determine demographic factors associated with concurrent use of stimulants with other controlled substances.

Results

There was a notable reduction in prevalence of patients ≤26 years old on stimulants during and after the pandemic per 100,000 people (777 in 2019; 743 in 2020; 751 in 2021). These decreases were more evident among the elementary and adolescent age groups. The most prevalent age group on stimulants were adolescents (12-17 years) irrespective of the pandemic. A significant rise in the number of female patients using stimulants was observed, increasing from 107,957 (35.2%) in 2019 to 121,241 (41.1%) in 2021. New patients initiating stimulants rose from 102,754 in 2020 to 106,660 in 2021, with 33.2% being young adults. In Los Angeles County, there was an increasing trend in patient prevalence from Q1 to Q5 income quintiles among patients ≥6 years. Consistently each year, the highest average income quintile exhibited the highest per capita prevalence. Age was associated with higher risk of concurrent use of benzodiazepines (OR, 1.198 [95% CI, 1.195-1.201], p < 0.0001) and opioids (OR, 1.132 [95% CI, 1.130-1.134], p < 0.0001) with stimulants.

Discussion

Our study provides real-world information on dispensing of ADHD stimulants in California youth from 2019 to 2021. The results underscore the importance of optimizing evidence-based ADHD management in pediatric patients and young adults to mitigate disparities in the use of stimulants.

E-Cigarette Brand Trends in the United States: An Investigation of Data From a Youth and Young Adult Sample and the E-Cigarette Retail Market (2022)

Background

Electronic cigarettes (e-cigarettes) remain the most used tobacco product among young people in the United States (US). Given the need for current data on popular e-cigarette products, the current study leverages data from a rapid surveillance survey of young people and examines whether the top e-cigarette brands identified from this source align with US market data.

Methodology

Data were obtained from current e-cigarette users (N = 4145) participating in the Truth Continuous Tracker Online (CTO; a cross-sectional tracking survey of 15-24 year-olds sourced from the national Dynata panel) and NielsenIQ retail scanner data, collected in 2022 and aggregated by quarter (Q1, Q2, and Q3). The top 15 e-cigarette brands were determined from respondents' endorsement in the Truth CTO and ranked total sales in NielsenIQ in nominal dollars.

Results

Overall, 58% of e-cigarette brands overlapped across the Truth CTO and NielsenIQ data (60% for Q1, 47% for Q2 and 67% for Q3). Pod-based (JUUL; VUSE) and disposable (Hyde; Breeze Smoke) brands appeared as top brands in both datasets. Top brands were fairly consistent within and across quarters; though, more variability was found in the Truth CTO, relative to NielsenIQ. Many top brands were disposable.

Conclusions

Results suggest that data from rapid surveillance and retail data can be used complementarily to characterize the popular e-cigarette brands currently on the US market. Many of these popular e-cigarette brands have yet to receive marketing granted orders under the US Food and Drug Administration, suggesting the need to continue monitoring e-cigarette brands among young people.

Empathy rules, maps and paths: A qualitative exploration of the factors that facilitate or inhibit empathy and prosocial responding among youth

The aim of this study is to explore young people's perspectives on the factors that facilitate or inhibit empathy and prosocial responding among youth. Qualitative focus groups (n = 29) were undertaken with Irish young people aged 13-17 years relating to their views on the factors that facilitate or inhibit the expression of empathy. Parents, friends, and social media were found to be key influences, whereas barriers identified included societal norms, gender norms, lack of skill, or knowledge and target characteristics. This research provides important insights into adolescents' perceptions of the social correlates of empathy. Concepts from the sociology of empathy, such as empathy maps and paths, are helpful in drawing out the implications for future research and practice.

Have there been changes in daily smoking and cigarette consumption among adolescents? Investigation between 1999 and 2019 among Finnish adolescents

BACKGROUND AND AIMS

It is postulated that due to decreased smoking rates and increased denormalisation of smoking, those who start and maintain smoking have more socially disadvantaged characteristics and are more dependent on nicotine than those who do not (the so-called 'hardening' hypothesis). The aim of this study was to measure changes in daily smoking and cigarette consumption among Finnish adolescents according to background factors.

DESIGN AND SETTING

A repeated cross-sectional study using data from European School Survey Project on Alcohol and other Drugs (ESPAD) on six representative cross-sections of 15- to 16-year-old students between 1999 and 2019 in Finland.

PARTICIPANTS

A total of 11 377 males and 12 247 females.

MEASUREMENTS

The outcome measures included the proportion of daily smokers among current smokers, daily smoking and the estimated mean number of smoked cigarettes per day (CPD). Substance use, parental monitoring and school performance were used as independent variables. All measures were self-reported.

FINDINGS

Daily smoking decreased over time and daily smokers constituted a smaller part of current smokers in 2019 compared with 1999 (the ratio among boys 0.68 and 0.43, respectively; among girls 0.59 and 0.43). Boys using cannabis (interaction between cannabis*survey year: P = 0.020; in 2019 odds ratio [OR]: 3.68, 95% confidence interval [CI] 2.23-6.08) and girls with heavy episodic drinking (interaction between heavy episodic drinking*survey year: P = 0.006, in 2019 OR: 9.00, 95% CI 5.61-14.42) had elevated adjusted odds for daily smoking over time. The estimated mean number of CPD decreased among daily smokers from 9.0 in 1999 to 7.2 in 2019 (P = 0.0002) and the differences diminished between groups based on gender, snus/alcohol use and parental monitoring. The between-group differences remained with regard to cannabis use (P = 0.0233 in 2019) and school performance (P = 0.0111 in 2019).

CONCLUSIONS

Among currently smoking Finnish adolescents, the proportion of daily smokers decreased between 1999 and 2019, as did the number of cigarettes smoked per day (CPD) among daily smokers, suggesting an absence of 'hardening' in this group. However, differences were observed related to the odds of daily smoking and the mean number of CPD, indicating the change has been less favorable among some adolescent groups than others.

Being a sibling of a youth with a neurodisability: A qualitative study about the roles and responsibilities during the transition to adulthood

BACKGROUND

During the transition to adulthood, a common challenge that youth with a neurodisability may experience is learning how to navigate services in the adult care system. During this transition youth may rely on their families, including siblings, for support. However, delineation of sibling roles and responsibilities during this transition period are unclear. This study aims to identify the roles and responsibilities that siblings perceive to have with their sibling with a neurodisability during the transition to adulthood, and describe the decision-making process of how siblings chose these roles.

METHODS

In this descriptive qualitative case study, siblings were eligible to participate if they were between 14 to 40 years old, had a sibling between 14 to 21 years with a childhood-onset neurodisability and spoke English. Semi-structured interviews augmented by techniques of photo elicitation and relational maps were conducted. Reflexive thematic analysis was applied to identify sibling roles, as well as the emotional and decision-making process associated with these roles. Our team partnered with siblings with lived experience in all study phases.

RESULTS

Nineteen participants (median age = 19 years, range = 14 to 33 years) from 16 unique families were interviewed. Six unique roles were described: friend, role model/mentor, protector, advocate, supporter, or caregiver. The emotions that siblings experienced with each role, also known as emotional responsibility, were categorized into levels of low, medium or high. Siblings also described a four-phase decision-making process for their roles: (1) acquiring knowledge; (2) preparing plans; (3) making adjustments; and (4) seeking support. Intrapersonal characteristics, including personal identity, values and experiences, influenced roles assumed by siblings.

CONCLUSIONS

Siblings identified needing support as they process their decisions and emotional responsibility in their roles when their sibling with a neurodisability is transitioning to adulthood. Resources should be developed or further enhanced to support siblings.

Identifying Risk Factors for Preexisting or Developing Low Back Pain in Youth, High School, and Collegiate Lacrosse Players Using 3-Dimensional Motion Analysis

Background

Low back pain (LBP) is a common condition that can affect athletes of all ages. The risk factors for LBP onset and worsening associated with the lacrosse shooting motion are not yet known.

Purpose

To identify training and biomechanical factors associated with preexisting LBP and development of LBP over 6 months in youth, high school, and collegiate lacrosse players.

Study Design

Case-control study; Level of evidence, 3.

Methods

A total of 128 lacrosse players were enrolled in this study between January 2016 and January 2019. Player characteristics, lacrosse experience, and participation in other sports were self-reported. At baseline and 2-, 4-, and 6-month follow-ups, the players self-rated the presence and severity of LBP using a numeric pain rating scale (0-10 points). Participants were grouped according to LBP symptoms: no LBP at any time point (n = 102), preexisting LBP (n = 17), or developed LBP within the 6-month period (n = 9). The lacrosse shooting motion was captured via 3-dimensional motion analysis, and kinematic and kinetic variables were recorded. A Low Back Stress Index was used to estimate lumbar stress as a function of pelvic acceleration at the time of maximum lateral trunk lean during the shot. Univariate analyses of covariance and logistic regression models were used to address study aims.

Results

Compared with the no-LBP group, the preexisting LBP group demonstrated 13.9% to 22.9% lower maximum angular velocities at the pelvis, trunk, and shoulders in the transverse plane (P < .05), 19.3% less collective pelvis-shoulder rotation in the transverse plane (P = .015), and 4.5% more knee flexion excursion (P = .063). The developed-LBP group produced 2.3% to 11.1% higher angular velocities in the pelvis, trunk, and shoulder and generated maximum pelvic acceleration values 36% to 42% higher than the remaining groups (P < .05 for both). Mean Low Back Stress Index values were not statistically significant among the groups (no LBP: 12,504 ± 13,076 deg2/s2; preexisting LBP: 8808 ± 10,174 deg2/s2; developed LBP: 19,389 ± 13,590 deg2/s2; P = .157).

Conclusion

Preexisting LBP was associated with significantly restricted motion of the pelvis, trunk, and shoulders during a lacrosse shot. Excessive pelvic acceleration may be related to the development of LBP in lacrosse players.

Behavior Change Techniques That Prevent or Decrease Obesity in Youth With a Low Socioeconomic Status: A Systematic Review and Meta-Analysis

Background: Interventions, targeting youth, are necessary to prevent obesity later in life. Especially youth with low socioeconomic status (SES) are vulnerable to develop obesity. This meta-analysis examines the effectiveness of behavioral change techniques (BCTs) to prevent or reduce obesity among 0 to 18-year-olds with a low SES in developed countries. Method: Intervention studies were identified from systematic reviews or meta-analyses published between 2010 and 2020 and retrieved from PsycInfo, Cochrane systematic review, and PubMed. The main outcome was body mass index (BMI), and we coded the BCTs. Results: Data from 30 studies were included in the meta-analysis. The pooled postintervention effects of these studies indicated a nonsignificant decrease in BMI for the intervention group. Longer follow-up (≥12 months) showed favorable differences for intervention studies, although that BMI change was small. Subgroup analyses showed larger effects for studies with six or more BCTs. Furthermore, subgroup analyses showed a significant pooled effect in favor of the intervention for the presence of a specific BCT (problem-solving, social support, instruction on how to perform the behavior, identification of self as role model, and demonstration of the behavior), or absence of a specific BCT (information about health consequences). The intervention program duration and age group of the study population did not significantly influence the studies' effect sizes. Conclusions: Generally, the effects of interventions on BMI change among youth with low SES are small to neglectable. Studies with more than six BCTs and/or specific BCTs had a higher likelihood of decreasing BMI of youth with low SES.

Mind the gap! Gender differences in alcohol consumption among Swedish ninth graders 1989-2021

INTRODUCTION

To examine gender differences in drinking habits among Swedish ninth graders over the period 1989-2021.

METHODS

Annual school surveys with nationally representative samples of ninth-grade students in Sweden covering the period 1989-2021, total sample of 180,538 students. Drinking habits were measured with self-reports of frequency and quantity of use and frequency of heavy episodic drinking. Differences between genders were compared annually and differences were tested using logistic and ordinary least square regression models with cluster robust standard errors.

RESULTS

Small gender differences in the prevalence of alcohol use during the first part of the study period were followed by an increasing gap over the past decade with girls being more likely to drink alcohol than boys. Boys consumed larger amounts of alcohol than girls during the first three decades of the studied period but no gender differences were found in later years. Binge drinking was more prevalent among boys during 1989 to 2000 but no systematic gender difference was found during the past 15 years.

DISCUSSION AND CONCLUSIONS

There used to be clear gender differences in drinking habits among ninth graders in Sweden with boys drinking more than girls. This gap has narrowed over the past three decades and among contemporary adolescents, no gender differences are found neither in binge drinking nor volume of drinking and the prevalence of drinking is even higher among girls.

Have the personality and socio-demographic profiles of Australian adolescent drinkers changed?

INTRODUCTION

Adolescent alcohol consumption has been declining across many countries, with rates of abstinence also increasing among younger cohorts. A range of socio-demographic variables and personality traits are associated with alcohol use; however, no study has examined whether the relationship between personality and drinking has changed over time as adolescent drinking has declined.

METHODS

Data from 15- to 17-year-old respondents were extracted from four waves (2004/2005, 2008/2009, 2012/2013, 2016/2017) of a long running Australian cohort study. Logistic regression analyses with interaction terms were used to determine whether personality traits (openness, conscientiousness, extraversion, agreeableness and emotional stability) and socio-demographic variables (age, gender, equivalised income, family structure, cultural background, school attendance and regionality) significantly differed between drinkers and abstainers and whether these relationships changed across cohorts.

RESULTS

The prevalence of drinking for 15- to 17-year-olds significantly declined over each survey wave from 54% in 2004/2005 to 24% in 2016/2017. Conscientiousness (odds ratio [OR] 0.82, confidence interval [CI] = 0.73, 0.93), extraversion ([OR] 1.25, [CI] = 1.11, 1.40) and emotional stability ([OR] 0.73, [CI] = 0.64, 0.83) were all significant predictors of alcohol consumption. No significant interactions between cohort and personality traits or socio-demographic variables were found.

DISCUSSION AND CONCLUSIONS

The study found no evidence to indicate that the relationship between adolescent alcohol consumption and personality has changed. Similarly, socio-demographic relationships with drinking were stable as drinking prevalence dropped by more than half. This adds to the evidence that drinking declines among adolescents are spread broadly across the population and not concentrated within identifiable sub-groups of young people.

The Characteristics of Youth With Missed HIV Visits in Alabama

Gaps in knowledge remain related to understanding missed human immunodeficiency virus (HIV) visits and youth with HIV (YWH). This study examined data from an Alabama academic HIV clinic with clients aged 16 to 24 years old and found that non virally suppressed and older YWH were associated with missed visits among YWH.

Disordered eating in transgender and gender non-conforming youth: A comparison to community-based and clinical samples

OBJECTIVE

This study investigates eating pathology in transgender and gender non-conforming (TGNC) youth compared to a community-based sample and individuals with eating disorders (EDs).

METHOD

Participants (ages 13-21 years) included TGNC youth from a paediatric gender clinic (N = 97), a demographically matched community-based sample of cisgender males (N = 97) and cisgender females (N = 97), and treatment-seeking patients with EDs (N = 112). The Eating Disorder Examination Questionnaire (EDE-Q) was used to assess ED cognitions and behaviours.

RESULTS

Transgender and gender non-conforming participants reported significantly higher EDE-Q global scores compared to the cisgender samples, but significantly lower than the ED sample. Transgender and gender non-conforming individuals reported a higher likelihood of objective binge episodes (OBEs) than the cisgender groups, albeit lower than youth with EDs. A substantial proportion of TGNC participants scored in elevated ranges on the EDE-Q global score (35% ≥ score of 3, 17% ≥ score of 4), significantly higher than cisgender males (0% ≥ score of 3, 0% ≥ score of 4) and females (9% ≥ score of 3, 3% ≥ score of 4).

CONCLUSIONS

Findings indicate that TGNC youth exhibit increased ED cognitions and OBEs compared to cisgender samples, highlighting the need for screening and addressing ED symptoms in this population.

Trajectories of Daily Postconcussion Symptoms in Children

OBJECTIVES

To identify trajectories of daily postconcussion symptoms (PCS) from the acute postinjury period to symptom resolution among concussed children and examine demographic factors and acute PCS associated with the identified symptom trajectories.

SETTING AND PARTICIPANTS

Seventy-nine participants with a concussion were enrolled within 72 hours of injury and completed a daily survey that assessed PCS from enrollment until symptom resolution.

DESIGN

This was a prospective cohort study among concussed children aged 11-17 years.

MAIN MEASURES

Children rated their concussion symptoms daily using the Post-Concussion Symptom Scale. Symptom duration was assessed using participants' date of symptom resolution and coded as a dichotomous variable: (1) PCS duration 14 days or less or (2) PCS duration longer than 14 days.

RESULTS

Of the 79 participants, most were male ( n = 53, 67%), injured during a sporting activity ( n = 67, 85%), or had PCS that persisted for more than 14 days post-injury ( n = 41, 52%). Group-based trajectory modeling yielded 4 trajectory groups: (1) low acute/resolved PCS ( n = 39, 49%), (2) moderate/persistent PCS ( n = 19, 24%), (3) high acute/persistent PCS ( n = 13, 16%), and (4) high acute/resolved PCS ( n = 8, 10%). No significant associations were found between demographic factors and the trajectory group. A higher symptom burden at injury was associated with an increased odds of being in the high acute/resolved or high acute/persistent recovery groups than being in the low acute/resolved group (odds ratio [OR] 1.39, 95% CI = 1.11-1.74; OR = 1.33, 95% CI = 1.11-1.60, respectively), as was a higher symptom severity at injury (OR = 1.09, 95% CI = 1.03-1.15; OR = 1.06, 95% CI = 1.02-1.11, respectively).

CONCLUSION

Our findings may help clinicians identify concussed children on slower recovery trajectories, and implement early, individualized treatment plans that foster optimal recovery for concussed children.

Orphanhood vulnerabilities for violence and HIV by education, sex, and orphan type among 18-24-year-old youth: findings from the 2018 Lesotho violence against children and youth survey

HIV and violence among orphans are key measures of vulnerability in low-resource settings. Although Lesotho has the second highest HIV adult prevalence rate (21.1%) in the world, and the prevalence of orphanhood (44.2%) and violence exposure (67.0%) is high, little research exist on orphanhood vulnerabilities for violence and HIV in Lesotho. Using data from 4,408 youth (18-24 years old) from Lesotho's 2018 Violence Against Children and Youth survey, a nationally representative cross-sectional household survey, the study examined associations among orphan status, violence, and HIV and assessed how associations differed by education, sex, and orphan type, using logistic regression. Orphans had higher odds of violence (aOR, 1.21; 95% CI, 1.01-1.46) and HIV (aOR, 1.69; 95% CI, 1.24-2.29). Having primary education or less (aOR, 1.43; 95% CI, 1.02-2.02), male sex (aOR, 1.74; 95% CI, 1.27-2.36), and being a paternal orphan (aOR, 1.43; 95% CI, 1.14-1.80) were significant interaction terms for violence. Orphans who completed primary school or less (aOR, 1.61; 95% CI, 1.09-2.39), female (aOR, 3.08; 95% CI, 2.14-4.42) and double orphans (aOR, 2.54; 95% CI, 1.56-4.13) had higher odds of HIV. These relationships highlight the importance of comprehensive strategies to support education and family strengthening for orphans as core violence and HIV prevention efforts.

The Ratio between Weekly Training and Match External Physical Loads in U17 Elite Youth Soccer Players: Implications for the Training Process

Research on the external physical load on elite youth soccer players during the weekly training microcycle in competitive periods and official matches is limited. The aims of this study were twofold: a) investigate possible differences in external physical load (PL) across player positions in U17 elite youth soccer players during official matches; b) determine the weekly training to match physical load ratio (WTMLr) across player positions. The sample included 20 outfield players from an elite soccer academy (mean age 15.94 ± 0.25 years) playing in four positions: central defender (CD), full-back (FB), central midfielder (CM) and Striker (S). Data were collected during the spring in-season period for 17 official matches played in a 4-3-3 game format. Indicators of external physical load monitored were: total distance (TD); total distance in high-speed running (HSR; > 16.1 km.h-1); total distance in sprint running (SPR; > 21.6 km.h-1); and relative physical load intensity (%HSR). The WTMLr was calculated for TD, HSR, SPR and %HSR as the ratio of the average weekly sum of training PL to the average sum of PL in an official match for a given players' position. Collectively, the training intensity during a one-week microcycle (%HSR in WTMLr) achieved only 76 % of match demands. CD performed significantly lower in all measured indicators of external PL during the official match than all other positions (p < 0.05; g > 0.80) except for TD in S. S achieved significantly higher SPR during official matches compared to CD (p < 0.05; g > 0.80), CM, and FB (g > 0.80). In contrast, CD reported higher WTMLr (medium-large effect size) in HSR and SPR indicators than all other positions. CM performed significantly higher %HSR in WTMLr than S and FB (p < 0.05; g > 0.80). Results revealed insufficient training intensity relative to match demands and, at the same time, weekly training PL did not meet match demands (especially in HSR and SPR) for players across the different positions. Therefore, practitioners should select appropriate training methods (drills and games) to ensure sufficient training intensity (HSR and SR metrics) and consider using the WTMLr, which can be used to help optimise and individualise training PL for different player positions.

Cross-sectional and longitudinal relationships between cardiorespiratory fitness and health-related quality of life in primary school children in England: the mediating role of psychological correlates of physical activity

AIMS

The aims were (1) to analyse the cross-sectional and longitudinal associations between children's cardiorespiratory fitness (CRF) and health-related quality of life (HRQoL) and (2) to examine whether these associations were mediated by physical activity self-efficacy and physical activity enjoyment.

METHODS

This study involved 383 children (10.0 ± 0.5 years) recruited from 20 primary schools in northwest England. Data were collected on two occasions 12 weeks apart. The number of laps completed in the 20-m Shuttle Run Test was used as the CRF indicator. HRQoL was assessed using the KIDSCREEN-10 questionnaire. Physical activity self-efficacy and enjoyment were assessed with the social-cognitive and Physical Activity Enjoyment Scale questionnaires, respectively. Linear mixed models with random intercepts (schools) assessed associations between CRF and HRQoL cross-sectionally, and longitudinally. Boot-strapped mediation procedures were performed, and indirect effects (IE) with 95% confidence intervals (CI) not including zero considered as statistically significant. Analyses were adjusted for sex, time of the year, socioeconomic status, waist-to-height ratio, maturation, and physical activity.

RESULTS

CRF was cross-sectionally associated with HRQoL (β = 0.09, 95% CI = 0.02, 0.16; p = .015). In the longitudinal analysis, CRF at baseline was associated with HRQoL at 12 weeks after additionally controlling for baseline HRQoL (β = 0.08, 95% CI = 0.002; p = .15, p = .045). Cross-sectionally, physical activity self-efficacy and enjoyment acted individually as mediators in the relationship between CRF and HRQoL (IE = 0.069, 95% CI = 0.038; p = .105 and IE = 0.045, 95% CI = 0.016; p = .080, respectively). In the longitudinal analysis, physical activity self-efficacy showed a significant mediating effect (IE = 0.025, 95% CI = 0.004; p = .054).

CONCLUSION

Our findings highlight the influence of CRF on children's psychological correlates of physical activity and their overall HRQoL.

Improving Social Climate In Youth Detention

Ongoing concerns have been expressed about the poor rehabilitative climate of youth detention centers, with a number of government inquiries examining the nature of the centers and how to improve their rehabilitative culture. Emerging research points to staff training and support as mechanisms to improve institutional climate. This study examines the impact on institutional climate of training and coaching staff in effective practice skills. Staff and young people, across three Australian detention centers, were administered a validated social climate measure prior to and 3 to 6 months following training and coaching. The social climate improved at a statistically significant level for staff. For young people the social climate improved but the improvement was not statistically significant. The measure was also administered at two control sites for staff where minimal changes in social climate were seen, suggesting that the staff improvements flowed from the training and coaching rather than from other organizational factors. It is concluded that training and coaching improved detention center social climate for staff although the study does not provide evidence that it improved significantly for young people.