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Jones P, Yala JA, Knight KN, Song JM, Adkins SML, Battaglia-Hoffman G, Trapl ES. Unifying Public Health Surveillance: A Scoping Review of Global Use of the Youth Risk Behavior Survey. J Adolesc Health 2024; 75:383-391. [PMID: 38752965 DOI: 10.1016/j.jadohealth.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/27/2024] [Accepted: 03/02/2024] [Indexed: 08/18/2024]
Abstract
PURPOSE The Youth Risk Behavior Survey (YRBS) is a well-established surveillance tool designed to document the health risk behaviors of youth. However, there is limited insight into the use of the survey outside of the United States. The aim of this scoping review was to assess the global presence and utilization of the YRBS. METHODS A structured electronic search of all publication years (through February 2020) was conducted to identify articles in PubMed and EBSCOhost. The search identified 128 articles that used the YRBS beyond the United States. RESULTS More than one-third of all countries, territories, and dependencies were represented in the articles, with the greatest use among upper-middle and high-income economies and those in the East Asia and Pacific geographic region. Priority health-risk behaviors identified were alcohol and other drug use (51%), tobacco use (48%), and unintentional and intentional injuries (44%). The articles predominantly suggested that the survey data be used to influence programs, policies, and practices (57%). DISCUSSION The development and proliferation of surveillance systems has allowed for important contributions to public health. Extensive use of the YRBS is notable; however, greater efforts are needed to support more systematic and collaborative approaches for evaluating youth behaviors around the world.
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Affiliation(s)
- P'Ashe Jones
- Kent State University, College of Public Health, Kent, Ohio.
| | - Joy Atieno Yala
- Department of Psychiatry, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Kristina N Knight
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Jessica M Song
- Kent State University, College of Public Health, Kent, Ohio
| | | | | | - Erika S Trapl
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, Ohio
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Abduvahobov P, Guthold R, Moller AB, Friedman HS, Carvajal-Velez L, Bendaud V, Damji N, Marsh AD, Castle C, Banerjee A. A United Approach to Enhance Adolescent Health Measurement. J Adolesc Health 2024; 74:S3-S5. [PMID: 38762260 PMCID: PMC11099294 DOI: 10.1016/j.jadohealth.2023.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/01/2023] [Indexed: 05/20/2024]
Affiliation(s)
- Parviz Abduvahobov
- Division for Peace and Sustainable Development, Health and Education Section, Education Sector, UNESCO, Paris, France.
| | - Regina Guthold
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
| | - Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Howard S Friedman
- Technical Division, United Nations Population Fund, New York, New York
| | - Liliana Carvajal-Velez
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York
| | | | - Nazneen Damji
- Governance and Participation Section, Gender equality, HIV and Health, UN Women, New York, New York
| | - Andrew D Marsh
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
| | - Christopher Castle
- Division for Peace and Sustainable Development, Education Sector, UNESCO, Paris, France
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
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3
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Berg TD, Ford CA. To Improve Adolescent Health Globally, We Need Globally Applicable Standardized Health Measures. J Adolesc Health 2024; 74:1064-1065. [PMID: 38762248 DOI: 10.1016/j.jadohealth.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Tor D Berg
- Managing Editor, San Francisco, California
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4
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Keogh SC, Guthold R, Newby H, Storey S, Ahmed T, Azzopardi P, Fagan L, Ferguson BJ, Friedman HS, Tang K, Marsh AD. Filling Gaps in Adolescent Health Measurement: Taking Stock of Progress and Priorities Ahead. J Adolesc Health 2024; 74:S17-S21. [PMID: 38762255 DOI: 10.1016/j.jadohealth.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/28/2023] [Accepted: 01/21/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Sarah C Keogh
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland.
| | - Regina Guthold
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Holly Newby
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Simone Storey
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Tashrik Ahmed
- Division of Data, Analytics, Planning and Monitoring, United Nations Children's Fund, New York, New York
| | - Peter Azzopardi
- Department of Paediatrics, Centre for Adolescent Health, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia; Adolescent Health and Wellbeing Program, Telethon Kids Institute, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Lucy Fagan
- UN Major Group for Children and Youth, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Howard S Friedman
- Technical Division, United Nations Population Fund, New York, New York
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Andrew D Marsh
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
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Ekman C, Bose K, Marsh AD, Giyava CR, Adebayo E, Wickremarathne D, Fagan L, Gueye Ba M, Guthold R. "Nothing About Us Without Us": Engagement of Young People in the Selection of Priority Indicators for Adolescent Health Measurement. J Adolesc Health 2024; 74:S9-S11. [PMID: 38762267 DOI: 10.1016/j.jadohealth.2024.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Carolin Ekman
- Independent Consultancy, Sexual and Reproductive Health and Rights, Adolescent Health, Geneva, Switzerland.
| | - Krishna Bose
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrew D Marsh
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | | | - Emmanuel Adebayo
- Adolescent Health Unit, Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | | | - Lucy Fagan
- UN Major Group for Children and Youth, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mariame Gueye Ba
- Faculty of Medicine, Pharmacy and Odontology, University Cheikh Anta Diop of Dakar, Dakar, Sénégal; Gynecology and Obstetrics Clinic, University Teaching Hospital A. Le Dantec, Dakar, Sénégal
| | - Regina Guthold
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
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Marsh AD, Newby H, Storey S, Yeung D, Diaz T, Baltag V, Banerjee A, Abduvahobov P, Adebayo E, Azzopardi PS, Ba MG, Bose K, Cardona M, Carvajal-Velez L, Dastgiri S, Fagan L, Ferguson BJ, Friedman HS, Hagell A, Inchley J, Kågesten AE, Keogh SC, Moller AB, Saewyc EM, Tang K, Guthold R. Indicators to Measure Adolescent Health at the Country, Regional, and Global Levels: Results of a Five-Year Selection Process by the Global Action for the Measurement of Adolescent Health. J Adolesc Health 2024; 74:S31-S46. [PMID: 38762261 DOI: 10.1016/j.jadohealth.2024.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE To improve adolescent health measurement, the Global Action for the Measurement of Adolescent health (GAMA) Advisory Group was formed in 2018 and published a draft list of 52 indicators across six adolescent health domains in 2022. We describe the process and results of selecting the adolescent health indicators recommended by GAMA (hereafter, "GAMA-recommended indicators"). METHODS Each indicator in the draft list was assessed using the following inputs: (1) availability of data and stakeholders' perceptions on their relevance, acceptability, and feasibility across selected countries; (2) alignment with current measurement recommendations and practices; and (3) data in global databases. Topic-specific working groups comprised of GAMA experts and representatives of United Nations partner agencies reviewed results and provided preliminary recommendations, which were appraised by all GAMA members and finalized. RESULTS There are 47 GAMA-recommended indicators (36 core and 11 additional) for adolescent health measurement across six domains: policies, programs, and laws (4 indicators); systems performance and interventions (4); health determinants (7); health behaviors and risks (20); subjective well-being (2); and health outcomes and conditions (10). DISCUSSION These indicators are the result of a robust and structured five-year process to identify a priority set of indicators with relevance to adolescent health globally. This inclusive and participatory approach incorporated inputs from a broad range of stakeholders, including adolescents and young people themselves. The GAMA-recommended indicators are now ready to be used to measure adolescent health at the country, regional, and global levels.
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Affiliation(s)
- Andrew D Marsh
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland.
| | - Holly Newby
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Simone Storey
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Diana Yeung
- Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Theresa Diaz
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Valentina Baltag
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Parviz Abduvahobov
- Health and Education Section, Division for Peace and Sustainable Development, Education Sector, UNESCO, Paris, France
| | - Emmanuel Adebayo
- Adolescent Health Unit, Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Peter S Azzopardi
- Department of Paediatrics, Centre for Adolescent Health, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia; Adolescent Health and Wellbeing Program, Telethon Kids Institute, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Mariame Gueye Ba
- Faculty of Medicine, Pharmacy and Odontology/Gynecology, University Cheikh Anta Diop of Dakar, Dakar, Senegal; Obstetrics Clinic, University Teaching Hospital A. Le Dantec, Dakar, Senegal
| | - Krishna Bose
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore
| | - Marcelo Cardona
- Center for Eating and feeding Disorders Research, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services, Copenhagen, Denmark
| | - Liliana Carvajal-Velez
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York
| | - Saeed Dastgiri
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Lucy Fagan
- UN Major Group for Children and Youth, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Howard S Friedman
- Technical Division, United Nations Population Fund, New York, New York
| | - Ann Hagell
- Independent Consultant, London, United Kingdom
| | - Jo Inchley
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Anna E Kågesten
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Sarah C Keogh
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Ann-Beth Moller
- Department of Sexual and Reproductive Health and Research World Health Organization includes the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | | | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Regina Guthold
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
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Newby H, Massaquoi L, Guthold R, Saewyc E, Abduvahobov P, Adebayo E, Azzopardi PS, Dastgiri S, Ferguson BJ, Friedman HS, Giyava CR, Kågesten AE, Keogh SC, Moller AB, Saha KK, Marsh AD. Towards Harmonized Adolescent Health Measurement: Assessing Alignment Between Current Recommendations and the Global Action for Measurement of Adolescent Health-Recommended Indicators. J Adolesc Health 2024; 74:S56-S65. [PMID: 38762263 DOI: 10.1016/j.jadohealth.2024.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE This study identified alignment of indicators across different initiatives and data collection instruments as a foundation for future harmonization of adolescent health measurement. METHODS Using the Global Action for Measurement of Adolescent health (GAMA) recommended indicators as the basis for comparison, we conducted a desk review of 14 global-level initiatives, such as the Sustainable Development Goals and the Global Strategy for Women's, Children's and Adolescents' Health, and five multicountry survey programs, such as the Multiple Indicator Cluster Surveys and the Global school-based Student Health Survey. We identified initiative and survey indicators similar to a GAMA indicator, deconstructed indicators into standard elements to facilitate comparison, and assessed alignment to the corresponding GAMA indicator across each of the elements. RESULTS A total of 144 initiative indicators and 90 survey indicators were identified. Twenty-four initiative indicators (17%) and 14 survey indicators (16%) matched the corresponding GAMA indicators across all elements. Population of interest was the most commonly discrepant element; whereas GAMA indicators mostly refer to ages 10-19, many survey and initiative indicators encompass only part of this age range, for example, 15-19-year-olds as a subset of adults ages 15-49 years. An additional 53 initiative indicators (39%) and 44 survey indicators (49%) matched on all elements except the population of interest. DISCUSSION The current adolescent measurement landscape is inconsistent, with differing recommendations on what and how to measure. Findings from this study support efforts to promote indicator alignment and harmonization across adolescent health measurement stakeholders at the global, regional, and country levels.
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Affiliation(s)
- Holly Newby
- Maternal, Newborn, Child and Adolescent health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Lamin Massaquoi
- Maternal, Newborn, Child and Adolescent health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Regina Guthold
- Maternal, Newborn, Child and Adolescent health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Elizabeth Saewyc
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Parviz Abduvahobov
- Health and Education Section, Division for Peace and Sustainable Development, Education Sector, UNESCO, Paris, France
| | - Emmanuel Adebayo
- Adolescent Health Unit, Institute of Child health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Peter S Azzopardi
- Department of Paediatrics, Centre for Adolescent Health, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia; Adolescent Health and Wellbeing Program, Telethon Kids Institute, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Saeed Dastgiri
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Howard S Friedman
- Technical Division, United Nations Population Fund, New York, New York
| | | | - Anna E Kågesten
- Maternal, Newborn, Child and Adolescent health and Ageing Department, World Health Organization, Geneva, Switzerland; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Sarah C Keogh
- Maternal, Newborn, Child and Adolescent health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Ann-Beth Moller
- Department of Sexual and Reproductive Health and Research World Health Organization includes the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Kuntal Kumar Saha
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Andrew D Marsh
- Maternal, Newborn, Child and Adolescent health and Ageing Department, World Health Organization, Geneva, Switzerland.
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Kågesten AE, Marsh AD, Storey S, Abduvahobov P, Adebayo E, Amezquita Velásquez AI, Azzopardi PS, Ba MG, Bose K, Camara MK, Cardona M, da Cruz J, Dastgiri S, Fagan L, Ferguson BJ, Giyava CR, Karna P, Keogh SC, Melkumova M, Moller AB, Newby H, Swai E, Tchandana M, Uzma Q, Yoffo GJ, Zainal Abidin Z, Zbelo M, Guthold R. Exploring a Preliminary Set of Indicators to Measure Adolescent Health: Results From a 12-Country Feasibility Study. J Adolesc Health 2024; 74:S66-S79. [PMID: 38762265 DOI: 10.1016/j.jadohealth.2024.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE To explore data availability, perceived relevance, acceptability and feasibility of implementing 52 draft indicators for adolescent health measurement in different countries globally. METHODS A mixed-methods, sequential explanatory study was conducted in 12 countries. An online spreadsheet was used to assess data availability and a stakeholder survey to assess perceived relevance, acceptability, and feasibility of implementing each draft indicator proposed by the Global Action for Measurement of Adolescent health (GAMA). The assessments were discussed in virtual meetings with all countries and in deep dives with three countries. Findings were synthesized using descriptive statistics and qualitative thematic analysis. RESULTS Data availability varied across the 52 draft GAMA indicators and across countries. Nine countries reported measuring over half of the indicators. Most indicators were rated relevant by stakeholders, while some were considered less acceptable and feasible. The ten lowest-ranking indicators were related to mental health, sexual health and substance use; the highest-ranking indicators centered on broader adolescent health issues, like use of health services. Indicators with higher data availability and alignment with national priorities were generally considered most relevant, acceptable and feasible. Barriers to measurement included legal, ethical and sensitivity issues, challenges with multi-sectoral coordination and data systems flexibility. DISCUSSION Most of the draft GAMA indicators were deemed relevant and feasible, but contextual priorities and perceived acceptability influenced their implementation in countries. To increase their use for a more comprehensive understanding of adolescent health, better multi-sectoral coordination and tailored capacity building to accommodate the diverse data systems in countries will be required.
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Affiliation(s)
- Anna E Kågesten
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Andrew D Marsh
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Simone Storey
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Parviz Abduvahobov
- Health and Education Section, Division for Peace and Sustainable Development, Education Sector, UNESCO, Paris, France
| | - Emmanuel Adebayo
- Adolescent Health Unit, Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Peter S Azzopardi
- Department of Paediatrics, Centre for Adolescent Health, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia; Adolescent Health and Wellbeing Program, Telethon Kids Institute, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Mariame Gueye Ba
- University Cheikh Anta Diop of Dakar, Faculty of Medicine, Pharmacy and Odontology/Gynecology and Obstetrics Clinic, University Teaching Hospital, Dakar, Senegal
| | - Krishna Bose
- Bill and Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Marcelo Cardona
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland; Center for Eating and feeding Disorders Research, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services, Copenhagen, Denmark
| | | | - Saeed Dastgiri
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Lucy Fagan
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | | | - Priya Karna
- WHO Country Office for India, New Delhi, India
| | - Sarah C Keogh
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Marina Melkumova
- Arabkir Medical Centre, Institute of Child and Adolescent Health, Yerevan, Armenia
| | - Ann-Beth Moller
- Department of Sexual and Reproductive Health and Research World Health Organization includes the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Holly Newby
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Edwin Swai
- Universal Health Cluster- Live Course, WHO Country Office for the United Republic of Tanzania, Dar-es-Salaam, United Republic of Tanzania
| | - Makilioubè Tchandana
- Division Santé Maternelle Infantile et Planification Familiale, Ministère de la Santé de l'hygiène publique et de l'accès universel aux soins, Lomé, Togo
| | - Qudsia Uzma
- Reproductive, Maternal, Newborn, Child and Adolescent Health Programme, WHO Country Office for Pakistan, Islamabad, Pakistan
| | - Gboboto Jérôme Yoffo
- Programme National de la Santé Scolaire et Universitaire Santé Adolescents et Jeunes, Ministère de la Santé de l'Hygiène Publique et de la Couverture Maladie Universelle, Abidjan, Côte d'Ivoire
| | - Zamzaireen Zainal Abidin
- Adolescent Health Sector, Family Health Development Division, Ministry of Health, Putrajaya, Malaysia
| | - Mesfin Zbelo
- Health Services and Policies, WHO Country Office for Lesotho, Maseru, Lesotho
| | - Regina Guthold
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland.
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Wallengren E, Guthold R, Newby H, Moller AB, Marsh AD, Fagan L, Azzopardi P, Ba MG, Kågesten AE. Relevance of the Sustainable Development Goals (SDGs) to Adolescent Health Measurement: A Systematic Mapping of the SDG Framework and Global Adolescent Health Indicators. J Adolesc Health 2024; 74:S47-S55. [PMID: 38762262 DOI: 10.1016/j.jadohealth.2024.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE To assess the relevance of the Sustainable Development Goals (SDGs) framework for adolescent health measurement, both in terms of age disaggregation and different health domains captured, and how the adolescent health indicators recommended by the Global Action for Measurement of Adolescent Health (GAMA) can complement the SDG framework. METHODS We conducted a desk review to systematically map all 248 SDG indicators using the UN metadata repository in three steps: 1) age-related mandates for SDG reporting; 2) linkages between the SDG indicators and priority areas for adolescent health measurement; 3) comparison between the GAMA indicators and the SDG framework. RESULTS Of the 248 SDG indicators, 35 (14%) targeted an age range overlapping with adolescence (10-19 years) and 33 (13%) called for age disaggregation. Only one indicator (3.7.2 "adolescent birth rate") covered the entire 10-19 age range. Almost half (41%) of the SDG indicators were directly related to adolescent health, but only 33 of those (13% of all SDG indicators) overlapped with the ages 10-19, and 15 (6% of all SDG indicators) explicitly mandated age disaggregation. Among the 47 GAMA indicators, five corresponded to existing SDG indicators, and eight were adolescent-specific age adaptations. Several GAMA indicators shed light on aspects not tracked in the SDG framework, such as obesity, mental health, physical activity, and bullying among 10-19-year-olds. DISCUSSION Adolescent health cannot be monitored comprehensively with the SDG framework alone. The GAMA indicators complement this framework via age-disaggregated adaptations and by tracking aspects of adolescent health currently absent from the SDGs.
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Affiliation(s)
- Emma Wallengren
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Regina Guthold
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Holly Newby
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Ann-Beth Moller
- Department of Sexual and Reproductive Health and Research World Health Organization includes the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Andrew D Marsh
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Lucy Fagan
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Peter Azzopardi
- Global Adolescent Health Group, Burnet Institute, Melbourne, Victoria, Australia; Adolescent Health and Well-being Program, Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Department of Paediatrics, Centre for Adolescent Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Mariame Guèye Ba
- Faculty of Medicine, Pharmacy and Odontology/Gynecology, University Cheikh Anta Diop of Dakar, Dakar, Senegal; Obstetrics Clinic, University Teaching Hospital A. Le Dantec, Dakar, Senegal
| | - Anna E Kågesten
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
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10
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Adeomi AA, Lawal NOO. Overweight and obesity among female adolescents in Nigeria; an emerging, but under-reported epidemic. BMC Womens Health 2024; 24:302. [PMID: 38773434 PMCID: PMC11106934 DOI: 10.1186/s12905-024-03146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/15/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Overweight and obesity are increasing at epidemic levels in all ages globally, but there is little nationally representative data on female adolescents in Nigeria. The focus on female adolescents is important because of the negative implications of overweight and obesity on their health and survival, and that of their unborn children. AIM To estimate the prevalence and identify the determinants of overweight and obesity among female adolescents in Nigeria. METHODS Cross-sectional study using data from the Nigeria demographic and health survey, 2018. A total of 2,721 female adolescents aged 15-19 years were selected using cluster sampling technique. Overweight and obesity were determined using BMI-for-age reference values of World Health Organization and different explanatory variables at the individual, household and community levels were included. Binary logistic regression analysis was used to identify the determinants of overweight/obesity using five models. RESULTS The mean age of the respondents was 16.8 ± 1.4 years. The prevalence rate of overweight/obesity was 10.2%, but with a large variation in the geographical and socio-economic distribution. At the crude/unadjusted rate, nearly all the explanatory variables showed a statistically significant association with overweight and obesity, but at the full model which controlled for all the explanatory variables, only the household wealth index retained its statistically significant association, such that female adolescents who were from richer and richest households had about 3 times higher odds of being obese compared to those from the poorest households. (OR: 2.7; p = 0.018; CI: 1.18-6.18), (OR: 2.8; p = 0.027; CI: 1.13-7.06) respectively. CONCLUSION The prevalence of overweight/obesity among female adolescents in Nigeria was 10.2%. The household wealth index remained the only factor with a statistically significant association with overweight and obesity after controlling for confounders. Efforts at addressing overweight and obesity among female adolescents in Nigeria should target those from the richer/richest households.
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Affiliation(s)
- Adeleye Abiodun Adeomi
- Department of Community Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.
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11
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Karumazondo JJ, Ross DA, Mangombe A, Zvoushe LK, Jani K, Mugarapanyama D, Gumbo JT, Nyanungo KRL, Nyamayaro W, Murinda E, Mhloyi MM, Ferrand RA, Mackworth-Young CRS. Innovative Professional Development for Multisectoral Policy Making and Programming for Adolescent Wellbeing. J Adolesc Health 2024; 74:637-643. [PMID: 38323967 DOI: 10.1016/j.jadohealth.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 02/08/2024]
Affiliation(s)
- JayJay J Karumazondo
- The Health Research Unit, Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe; Department of Demography Settlement and Development, University of Zimbabwe, Harare, Zimbabwe
| | - David A Ross
- Adolescent Well-being, Child Health Initiative, FIA Foundation, Stellenbosch, South Africa; Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Aveneni Mangombe
- The Health Research Unit, Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe; Department of Demography Settlement and Development, University of Zimbabwe, Harare, Zimbabwe; Ministry of Health and Childcare, Government of Zimbabwe, Harare, Zimbabwe
| | - Linnet K Zvoushe
- The Health Research Unit, Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe; Department of Demography Settlement and Development, University of Zimbabwe, Harare, Zimbabwe
| | - Kelvin Jani
- The Health Research Unit, Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe; Department of Demography Settlement and Development, University of Zimbabwe, Harare, Zimbabwe
| | - Debrain Mugarapanyama
- The Health Research Unit, Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe; Young Peoples Network on Sexual and Reproductive Health HIV/AIDS (YPNSRHHA), National AIDS Council, Harare, Zimbabwe
| | - Jacquiline T Gumbo
- Ministry of Health and Childcare, Government of Zimbabwe, Harare, Zimbabwe
| | | | | | - Ellias Murinda
- Ministry of Youth Empowerment, Development and Vocational Training, Government of Zimbabwe, Harare, Zimbabwe
| | - Marvellous M Mhloyi
- Department of Demography Settlement and Development, University of Zimbabwe, Harare, Zimbabwe
| | - Rashida A Ferrand
- The Health Research Unit, Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Constance R S Mackworth-Young
- The Health Research Unit, Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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12
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Currie C, Alemán Díaz AY, Bosáková L, de Looze M. The international Family Affluence Scale (FAS): Charting 25 years of indicator development, evidence produced, and policy impact on adolescent health inequalities. SSM Popul Health 2024; 25:101599. [PMID: 38313871 PMCID: PMC10835442 DOI: 10.1016/j.ssmph.2023.101599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 12/05/2023] [Accepted: 12/30/2023] [Indexed: 02/06/2024] Open
Abstract
In the absence of suitable indicators of adolescent socioeconomic status, the Family Affluence Scale (FAS) was first developed in Scotland 25 years ago. Since then, it has been adapted for use in the Health Behaviour in School-Aged Children (HBSC) Study to research inequalities in adolescent health in Europe and North America. FAS has also been used as an indicator of adolescent socioeconomic status in research studies outside of HBSC, worldwide. There has been a need for FAS to evolve and change its component items over time in order to take into account social and technological changes influencing the families of adolescents. This paper uniquely charts the development of FAS describing the methodological work carried out to validate the measure internationally and over time. It also presents an overview of the body of evidence on adolescent health inequalities produced over years from the HBSC Study and other research studies. Interviews conducted with policy stakeholders reveal that the evidence from FAS-related HBSC work has influenced their strategic work to raise awareness of inequalities and make the case for action to address these. Finally, the future of FAS is discussed with respect to its continual evolution in the context of technological, environmental and social change.
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Affiliation(s)
- Candace Currie
- Glasgow Caledonian University London, 40 Fashion Street, London, E1 6PX, UK
| | | | - Lucia Bosáková
- Department of Health Psychology and Methodology of Research, Medical Faculty, PJ Safarik University, Trieda SNP 1, 040 01, Kosice, Slovak Republic
- Olomouc University Social Health Institute, Palacky University in Olomouc, Univerzitni 22, 771 11, Olomouc, Czech Republic
| | - Margreet de Looze
- Department of Interdisciplinary Science, Faculty of Social and Behavioural Sciences, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands
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13
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The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019. Lancet 2023; 402:313-335. [PMID: 37393924 PMCID: PMC10375221 DOI: 10.1016/s0140-6736(23)00860-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/22/2023] [Accepted: 04/26/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. METHODS In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. FINDINGS In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. INTERPRETATION Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world. FUNDING The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation.
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14
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Shinde S, Harling G, Assefa N, Bärnighausen T, Bukenya J, Chukwu A, Darling AM, Manu A, Millogo O, Mwanyika-Sando M, Ncayiyana J, Nurhussien L, Patil R, Tang K, Fawzi W. Counting adolescents in: the development of an adolescent health indicator framework for population-based settings. EClinicalMedicine 2023; 61:102067. [PMID: 37448809 PMCID: PMC10336247 DOI: 10.1016/j.eclinm.2023.102067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Changing realities in low- and middle-income countries (LMICs) in terms of inequalities, urbanization, globalization, migration, and economic adversity shape adolescent development and health, as well as successful transitions between adolescence and young adulthood. It is estimated that 90% of adolescents live in LMICs in 2019, but inadequate data exist to inform evidence-based and concerted policies and programs tailored to address the distinctive developmental and health needs of adolescents. Population-based data surveillance such as Health and Demographic Surveillance Systems (HDSS) and school-based surveys provide access to a well-defined population and provide cost-effective opportunities to fill in data gaps about adolescent health and well-being by collecting population-representative longitudinal data. The Africa Research Implementation Science and Education (ARISE) Network, therefore, systematically developed adolescent health and well-being indicators and a questionnaire for measuring these indicators that can be used in population-based LMIC settings. We conducted a multistage collaborative and iterative process led by network members alongside consultation with health-domain and adolescent health experts globally. Seven key domains emerged from this process: socio-demographics, health awareness and behaviors; nutrition; mental health; sexual and reproductive health; substance use; and healthcare utilization. For each domain, we generated a clear definition; rationale for inclusion; sub-domain descriptions, and a set of questions for measurement. The ARISE Network will implement the questionnaire longitudinally (i.e., at two time-points one year apart) at ten sites in seven countries in sub-Saharan Africa and two countries in Asia. Integrating the questionnaire within established population-based data collection platforms such as HDSS and school settings can provide measured experiences of young people to inform policy and program planning and evaluation in LMICs and improve adolescent health and well-being.
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Affiliation(s)
- Sachin Shinde
- Department of Global Health and Population, T. H. Chan School of Public Health, Harvard University, USA
| | - Guy Harling
- Institute of Global Health, University College of London, United Kingdom
- Africa Health Research Institute, South Africa
- Department of Epidemiology, T. H. Chan School of Public Health, Harvard University, USA
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, South Africa
| | - Nega Assefa
- College of Health and Medical Sciences, Harmaya University, Ethiopia
| | - Till Bärnighausen
- Department of Global Health and Population, T. H. Chan School of Public Health, Harvard University, USA
- Africa Health Research Institute, South Africa
- Heidelberg Institute of Global Health, Heidelberg University, Germany
| | | | - Angela Chukwu
- Department of Statistics, University of Ibadan, Nigeria
| | - Anne Marie Darling
- Department of Global Health and Population, T. H. Chan School of Public Health, Harvard University, USA
| | - Adom Manu
- Department of Population, Family, and Reproductive Health, University of Ghana, Ghana
| | | | | | - Jabulani Ncayiyana
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Lina Nurhussien
- Department of Global Health and Population, T. H. Chan School of Public Health, Harvard University, USA
| | | | - Kun Tang
- Vanke School of Public Health, Tsinghua University, China
| | - Wafaie Fawzi
- Department of Global Health and Population, T. H. Chan School of Public Health, Harvard University, USA
- Department of Epidemiology, T. H. Chan School of Public Health, Harvard University, USA
- Department of Nutrition, T. H. Chan School of Public Health, Harvard University, USA
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15
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Vakili M, Mirzadeh M, Mirzaei M, Modarresi M, Raei R, Karimi R, Aghakoochak A, Imani AA. Sex differences in high-risk health behaviors among school-going adolescents in Yazd, Iran; a cross-sectional study. Heliyon 2023; 9:e16404. [PMID: 37303572 PMCID: PMC10250580 DOI: 10.1016/j.heliyon.2023.e16404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Objective Adolescents are exposed to a wide range of high-risk health behaviors. This study aimed to investigate the high-risk health behaviors of adolescents in an Iranian adolescent population and gender differences. Method This cross-sectional descriptive study recruited high school students in Yazd city in center of Iran. Schools were randomly selected. In each school, all selected classes were included. Sampling in each class was census. The study investigated self-reported high-risk health behaviors. Students completed the Global School-based Student Health Survey (GSHS), an anonymous, validated questionnaire. Results 2420 students participated in this study (52.5% male). The age range was 12-19 years. Daily consumption of ≥1 serving of fruit and vegetables per day was reported by 77.4% and 49.5% of respondents, respectively. Adequate physical activity was reported by only 18.4% of adolescents, and significantly less frequently by girls than boys (p < 0.001). 11.8% were current smokers (M/F ratio: 2.6), and 20.5% (M/F ratio: 1.5) were ever used hookah. The prevalence of ever alcohol and substance abuse was 15.5% and 8.8%, respectively. The prevalence of tobacco and substance use was significantly higher in participants' boys than in girls (p < 0.001). Males were over twice more likely to report frequent fighting in the past 12 months than girls. Overall, girls reported more parental supervision than boys (82.1% vs. 73.4%) and parental monitoring (90.6% vs. 86.8%), while boys reported higher levels of awareness over leisure activities than girls (65.8% vs. 58.4%). Conclusions High-risk health behaviors are more common in boys than girls. Health policymakers should use these results in prioritizing and designing health interventions to promote youth health. Further studies are recommended to identify the factors influencing the prevalence of these behaviors.
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Affiliation(s)
- Mahmood Vakili
- Health Monitoring Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahboobahsadat Mirzadeh
- Department of Internal Medicine, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohsen Mirzaei
- Accident Prevention and Crisis Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mozhgan Modarresi
- Yazd Cardiovascular Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reihaneh Raei
- Health Monitoring Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reihaneh Karimi
- Health Monitoring Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Arezoo Aghakoochak
- Health Monitoring Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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16
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Guthold R, Carvajal-Velez L, Adebayo E, Azzopardi P, Baltag V, Dastgiri S, Dua T, Fagan L, Ferguson BJ, Inchley JC, Mekuria ML, Moller AB, Servili C, Requejo J. The Importance of Mental Health Measurement to Improve Global Adolescent Health. J Adolesc Health 2023; 72:S3-S6. [PMID: 36229397 DOI: 10.1016/j.jadohealth.2021.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Regina Guthold
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland.
| | - Liliana Carvajal-Velez
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Emmanuel Adebayo
- Adolescent Health Unit, Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Peter Azzopardi
- Global Adolescent Health Group, Burnet Institute, Melbourne, Victoria, Australia
| | - Valentina Baltag
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Saeed Dastgiri
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Lucy Fagan
- UN Major Group for Children and Youth, London, United Kingdom
| | | | - Joanna C Inchley
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Million L Mekuria
- Technical Division, Sexual and Reproductive Health Branch, UNFPA, Geneva, Switzerland
| | - Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Jennifer Requejo
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York
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17
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Qiu Q, Dai S, Yan J. Health behaviors of late adolescents in China: Scale development and preliminary validation. Front Psychol 2022; 13:1004364. [PMID: 36438386 PMCID: PMC9692111 DOI: 10.3389/fpsyg.2022.1004364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/27/2022] [Indexed: 06/27/2024] Open
Abstract
Health behaviors influence health and well-being, improve quality of life, and provide economic benefits. It is important to take advantage of health-related opportunities during adolescence. Staying healthy during adolescence also promotes the future well-being of individuals and that of the next generation. We aimed to develop a reliable and valid scale based on the General Senior High School Physical Education and Health Curriculum Standards (2017 edition) to evaluate Chinese late adolescents' health behavior. The scale was to help physical education teachers measure the health behavior level of senior high school students, improve physical education and health teaching, and promote Chinese adolescent health. Participants were recruited by convenience sampling from September to October 2019. For the first survey, we recruited 526 senior high school students (318 boys, 208 girls; Mage = 16.5), and the data were subjected to item analysis and exploratory factor analysis. For the second survey, we recruited 542 senior high school students (249 boys, 293 girls; Mage = 15.5), and the data were subjected to confirmatory factor analysis and internal consistency reliability analysis. After exploratory factor analysis, we extracted four factors with 23 items: exercise awareness and habits (five items), mastering and applying healthy behavior knowledge (10 items), emotional regulation (four items), and environment adaptation (four items). The Cronbach's alpha values for these factors ranged from 0.863 to 0.937. After confirmatory factor analysis, we achieved a satisfactory goodness-of-fit model (CMIN/DF = 2.92, RMR = 0.03, GFI = 0.93, CFI = 0.91, TLI = 0.92, RMSEA = 0.06). Internal consistency, test-retest reliability, and construct validity were all satisfactory. These results suggest that the Chinese version of the Health Behavior Scale is a reliable and valid instrument for assessing the health behavior of senior high school students. The findings have important implications for increasing adolescents' health literacy, promoting adolescents' health, and enhancing the well-being of late adolescents.
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Affiliation(s)
- Qian Qiu
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China
- College of Physical Education and Health, East China Normal University, Shanghai, China
| | - Shengting Dai
- School of Sports Science and Engineering, East China University of Science and Technology, Shanghai, China
| | - Jingfei Yan
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China
- College of Physical Education and Health, East China Normal University, Shanghai, China
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18
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Marsh AD, Moller AB, Saewyc E, Adebayo E, Akwara E, Azzopardi P, Ba MG, Baltag V, Bose K, Burrows S, Carvajal L, Dastgiri S, Fagan L, Ferguson J, Friedman HS, Giyava C, Hagell A, Inchley J, Jackson D, Kågesten AE, Mangombe A, Morgan A, Newby H, Schultz L, Sommer M, Speizer I, Tang K, Guthold R. Priority Indicators for Adolescent Health Measurement - Recommendations From the Global Action for Measurement of Adolescent Health (GAMA) Advisory Group. J Adolesc Health 2022; 71:455-465. [PMID: 35779998 PMCID: PMC9477504 DOI: 10.1016/j.jadohealth.2022.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/25/2022] [Accepted: 04/23/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This article describes the selection of priority indicators for adolescent (10-19 years) health measurement proposed by the Global Action for Measurement of Adolescent health advisory group and partners, building on previous work identifying 33 core measurement areas and mapping 413 indicators across these areas. METHODS The indicator selection process considered inputs from a broad range of stakeholders through a structured four-step approach: (1) definition of selection criteria and indicator scoring; (2) development of a draft list of indicators with metadata; (3) collection of public feedback through a survey; and (4) review of the feedback and finalization of the indicator list. As a part of the process, measurement gaps were also identified. RESULTS Fifty-two priority indicators were identified, including 36 core indicators considered to be most important for measuring the health of all adolescents, one alternative indicator for settings where measuring the core indicator is not feasible, and 15 additional indicators for settings where further detail on a topic would add value. Of these indicators, 17 (33%) measure health behaviors and risks, 16 (31%) health outcomes and conditions, eight (15%) health determinants, five (10%) systems performance and interventions, four (8%) policies, programmes, laws, and two (4%) subjective well-being. DISCUSSION A consensus list of priority indicators with metadata covering the most important health issues for adolescents was developed with structured inputs from a broad range of stakeholders. This list will now be pilot tested to assess the feasibility of indicator data collection to inform global, regional, national, and sub-national monitoring.
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Affiliation(s)
- Andrew D. Marsh
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland,Address correspondence to: Andrew D. Marsh, Ph.D., Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, 20, Avenue Appia, CH-1211, Geneva, Switzerland.
| | - Ann-Beth Moller
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Elizabeth Saewyc
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emmanuel Adebayo
- Adolescent Health Unit, Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Peter Azzopardi
- Global Adolescent Health group, Burnet Institute, Melbourne, Victoria, Australia,Adolescent Health and wellbeing program, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Mariame Guèye Ba
- University Cheikh Anta Diop of Dakar, Faculty of Medicine, Pharmacy and Odontology/Gynecology, Dakar, Senegal,Obstetrics Clinic, University Teaching Hospital A. Le Dantec, Dakar, Senegal
| | - Valentina Baltag
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
| | - Krishna Bose
- Bill and Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Liliana Carvajal
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Saeed Dastgiri
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Lucy Fagan
- UN Major Group for Children and Youth, London, United Kingdom,Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jane Ferguson
- Independent Consultant, Adolescent Health, Tannay, Switzerland
| | | | | | - Ann Hagell
- Association for Young People's Health, London, United Kingdom
| | - Jo Inchley
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Debra Jackson
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom,School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Anna E. Kågesten
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Aveneni Mangombe
- Zimbabwe LSHTM Research Partnership, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Alison Morgan
- Global Financing Facility, The World Bank Group, Washington, District of Columbia,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Holly Newby
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
| | - Linda Schultz
- Global Financing Facility, The World Bank Group, Washington, District of Columbia
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Ilene Speizer
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Regina Guthold
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
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Sexual and reproductive health services during outbreaks, epidemics, and pandemics in sub-Saharan Africa: a literature scoping review. Syst Rev 2022; 11:161. [PMID: 35945580 PMCID: PMC9361234 DOI: 10.1186/s13643-022-02035-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic could worsen adolescent sexual and reproductive health (ASRH). We sought evidence on the indirect impacts of previous infectious disease epidemics and the current COVID-19 pandemic on the uptake of ASRH in sub-Saharan Africa (SSA) to design relevant digital solutions. METHODS We undertook a literature scoping review to synthesize evidence on the indirect impacts of COVID-19 on ASRH in SSA per the Arksey and O'Malley framework and PRISMA reporting guidelines. We conducted the search on PubMed, Embase, Google Scholar, and ResearchGate in June and November 2020. We included all peer-reviewed, English-language primary studies on the indirect impacts of infectious disease epidemics on the uptake of sexual and reproductive health (SRH) in SSA. RESULTS We included 21 of 42 identified studies. Sixteen studies (76.2%) quantitatively assessed utilization and access to SRH during epidemics. Five studies (2 [9.6%] qualitative and 3 [14.3%] mixed methods) explored factors affecting SRH services. All studies focused on adult populations, most often on labor and delivery (n = 13 [61.9%]) and family planning (n = 8 [38.1%]) outcomes. Although we sought out to assess all outbreaks, epidemics, and pandemics, the only relevant studies took place during the West African Ebola pandemic (n = 17 [80.9%]) and COVID-19 pandemic (n = 4 [19.0%]). One study (4.8%) highlighted adolescent-specific outcomes and condom use. Most studies found declined access to and utilization of facility delivery, antenatal care, family planning, and HIV care. One study noted an increase in adolescent pregnancies. However, other studies noted similar, or even increasing trends in access to and utilization of other SRH services (family planning visits; HIV diagnosis; ART initiation) during epidemics. Barriers to SRH uptake included factors such as a reduced ability to pay for care due to lost income, travel restrictions, and fear of infection. Supply-side barriers included lack of open facilities, workers, commodities, and services. Community-based peer delivery systems, telemedicine, and transport services improved SRH uptake. CONCLUSION Access to SRH services during epidemics among adolescents and young people in SSA is understudied. We found that no studies focused on SRH outcomes of abortion, emergency contraception, sexually transmitted infections, or cervical cancer. To improve access to and utilization of SRH during pandemics, we recommend the following; in terms of research, key standardized SRH indicators should be included in routine data collection, routine data should be disaggregated by age, gender, and geography to understand gaps in ASRH service delivery, and additional rigorous epidemiological and social-behavioral studies should be conducted. On implementation, community-based peer delivery systems and telemedicine, internet-based, and other technological solutions may better reach adolescent and young people in SSA.
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Amuthavalli Thiyagarajan J, Mikton C, Harwood RH, Gichu M, Gaigbe-Togbe V, Jhamba T, Pokorna D, Stoevska V, Hada R, Steffan GS, Liena A, Rocard E, Diaz T. The UN Decade of healthy ageing: strengthening measurement for monitoring health and wellbeing of older people. Age Ageing 2022; 51:6625700. [PMID: 35776669 PMCID: PMC9249069 DOI: 10.1093/ageing/afac147] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/03/2022] [Indexed: 11/22/2022] Open
Abstract
Over the past 100 years, life expectancy has increased dramatically in nearly all nations. Yet, these extra years of life gained have not all been healthy, particularly for older people aged 60 years and over. In 2020, the World Health Organisation (WHO) and United Nations (UN) member states embraced a sweeping 10-year global plan of action to ensure all older people can live long and healthy lives, formally known as the UN Decade of Healthy Ageing (2021–2030). With the adoption of the UN Decade of Healthy Ageing resolution, countries are committed to implementing collaborative actions to improve the lives of older people, their families and the communities in which they reside. The Decade addresses four interconnected areas of action. Adopting the UN's resolution on the Decade of Healthy Ageing has caused excitement, but a question that has weighed on everyone's mind is how governments will be held accountable? Besides, there have been no goals or targets set for the UN Decade of Healthy Ageing from a programmatic perspective for the action areas, and guidance on measures, data collection, analysis and reporting are urgently needed to support global, regional and national monitoring of the national strategies, programmes and policies. To this end, WHO in collaboration with UN agencies and international agencies established a Technical Advisory Group for Measurement of Healthy Ageing (TAG4MHA) to provide advice on the measurement, monitoring and evaluation of the UN Decade of Healthy Ageing at the global, regional and national levels.
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Affiliation(s)
| | - Christopher Mikton
- Demographic Change and Healthy Aging Unit, Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Rowan H Harwood
- Faculty of Medicine and Health Sciences, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Muthoni Gichu
- Division of Geriatric Medicine at the Ministry of Health, Nairobi, Kenya
| | - Victor Gaigbe-Togbe
- Demographic Analysis Section, Population Division, Department of Economic and Social Affairs United Nations, New York, NY, USA
| | - Tapiwa Jhamba
- Population and Development Branch, Technical Division United Nations Population Fund, New York, USA
| | - Daniela Pokorna
- International Telecommunication Union (ITU), ICT Data and Analytics Division, Geneva, Switzerland
| | - Valentina Stoevska
- Department of Statistics, The International Labour Organization, Geneva, Switzerland
| | - Rio Hada
- Economic, Social and Cultural Rights Section, Office of the United Nations High Commissioner for Human Rights (OHCHR), Geneva, Switzerland
| | - Grace Sanico Steffan
- Economic, Social and Cultural Rights Section, Office of the United Nations High Commissioner for Human Rights (OHCHR), Geneva, Switzerland
| | - Ana Liena
- Directorate for Employment, Labour and Social Affairs, Organization for Economic Co-operation and Development, Paris, France
| | - Eileen Rocard
- Directorate for Employment, Labour and Social Affairs, Organization for Economic Co-operation and Development, Paris, France
| | - Theresa Diaz
- Epidemiology, Monitoring and Evaluation Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO HQ, Geneva, Switzerland
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21
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Thiongo M, Gichangi P, Macho PK, Byrne ME, Kimani P, Waithaka M, Radloff S, Anglewicz P, Decker MR. Implementation of respondent driven sampling in Nairobi, Kenya, for tracking key family planning indicators among adolescents and youth: lessons learnt. BMC Res Notes 2022; 15:200. [PMID: 35672785 PMCID: PMC9171948 DOI: 10.1186/s13104-022-06038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Adolescents and youth constitute a significant proportion of the population in developing nations. Conventional survey methods risk missing adolescents/youth because their family planning/contraception (FP/C) behavior is hidden. Respondent-driven sampling (RDS), a modified chain-referral recruitment sampling approach, was used to reach unmarried adolescents/youth aged 15-24 in Nairobi, Kenya to measure key FP/C indicators. Seeds were selected and issued with three coupons which they used to invite their peers, male or female, to participate in the study. Referred participants were also given coupons to invite others till sample size was achieved. We report on key implementation parameters following standard RDS reporting recommendations. RESULTS A total of 1674 coupons were issued to generate a sample size of 1354. Coupon return rate was 82.7%. Study participants self-administered most survey questions and missing data was low. Differential enrolment by gender was seen with 56.0% of females recruiting females while 44.0% of males recruited males. In about two months, it was possible to reach the desired sample size using RDS methodology. Implementation challenges included presentation of expired coupons, recruitment of ineligible participants and difficulty recruiting seeds and recruits from affluent neighborhoods. Challenges were consistent with RDS implementation in other settings and populations. RDS can complement standard surveillance/survey approaches, particularly for mobile populations like adolescents/youth.
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Affiliation(s)
- Mary Thiongo
- International Centre for Reproductive Health, Mombasa, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health, Mombasa, Kenya
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Present Address: P.O. Box, Nairobi, 2631-00202 Kenya
| | - Patrick K. Macho
- School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Meagan E. Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Peter Kimani
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Michael Waithaka
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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22
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Orth Z, van Wyk B. Rethinking mental wellness among adolescents: an integrative review protocol of mental health components. Syst Rev 2022; 11:83. [PMID: 35501908 PMCID: PMC9063294 DOI: 10.1186/s13643-022-01961-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents have been overlooked in global public health initiatives as this period is generally considered to be the healthiest in an individual's life course. However, the growth of the global adolescent population and their changing health profiles have called attention to the diverse health needs of adolescents. The increased attention toward adolescent health has accentuated existing gaps as global health reports have emphasised that there is a continued need for valid and reliable health data. In this context, evidence has shown that mental health issues constitute one of the greatest burdens of disease for adolescents. This integrative review aims to unpack the meaning of mental wellness among adolescents and its associated constructs by analysing and synthesising empirical and theoretical research on adolescent mental wellness. In doing this, we will develop a working definition of adolescent mental wellness that can be used to develop an instrument aimed at measuring adolescent mental wellness. METHODS The integrative review is guided by the five steps described by Whittemore and Knafl. A comprehensive search strategy which will include carefully selected terms that correspond to the domains of interest (positive mental health/mental wellness) will be used to search for relevant literature on electronic databases, grey literature and government or non-governmental organisations (NGO) websites. Studies will be included if they describe and/or define general mental wellness in adolescent populations aged 10-19. The screening and reporting of the review will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data from the integrative review will be analysed using narrative framework synthesis for qualitative and quantitative studies. DISCUSSION This integrative review aims to search for and synthesise current research regarding adolescent mental wellness to identify how wellness is being described and conceptualised. We aim to identify gaps and to contribute to a more comprehensive definition of mental wellness which can aid in the development of an age- and culturally appropriate measure of adolescent mental wellness.
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Affiliation(s)
- Zaida Orth
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa.
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa
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23
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Requejo J, Strong K, Agweyu A, Billah SM, Boschi-Pinto C, Horiuchi S, Jamaluddine Z, Lazzerini M, Maiga A, McKerrow N, Munos M, Park L, Schellenberg J, Weigel R. Measuring and monitoring child health and wellbeing: recommendations for tracking progress with a core set of indicators in the Sustainable Development Goals era. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:345-352. [PMID: 35429452 PMCID: PMC9764429 DOI: 10.1016/s2352-4642(22)00039-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
Although great improvements in child survival were achieved in the past two decades, progress has been uneven within and across countries, and the COVID-19 pandemic threatens to reverse previous advances. Demographic and epidemiological transitions around the world have resulted in shifts in the causes and distribution of child death and diseases, and many children are living with short-term and long-term chronic illnesses and disabilities. These changes, plus global threats such as pandemics, transnational and national security issues, and climate change, mean that regular monitoring of child health and wellbeing is essential if we are to achieve the Sustainable Development Goals. This Health Policy describes the three-phased process undertaken by the Child Health Accountability Tracking technical advisory group (CHAT) to develop a core set of indicators on child health and wellbeing for global monitoring purposes, and presents CHAT's research recommendations to address data gaps. CHAT reached consensus on 20 core indicators specific to the health sector, which include 11 impact-level indicators and nine outcome-level indicators that cover the topics of: acute conditions and prevention; health promotion and child development; and chronic conditions, disabilities, injuries, and violence against children. An additional six indicators (three impact and three outcome) that capture information on child health issues such as malaria and HIV are recommended; however, these indicators are only relevant to high-burden regions. CHAT's four research priorities will require investments in health information systems and measurement activities. These investments will help to increase data on children aged 5-9 years; develop standard metadata and data collection processes to enable cross-country comparisons and progress assessments over time; reach a global consensus on essential interventions and associated indicators for monitoring emerging priority areas such as child development, chronic conditions, disabilities, and injuries; and implement strategies to increase the uptake of data on child health to improve evidence-based planning, programming, and advocacy efforts.
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Affiliation(s)
- Jennifer Requejo
- Division of Data, Analytics, Planning and Monitoring, United Nations Children's Fund, New York, NY, USA.
| | - Kathleen Strong
- Maternal, Newborn, Child and Adolescent Health and Aging Department, World Health Organization, Geneva, Switzerland
| | - Ambrose Agweyu
- Epidemiology and Demography Department, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Sk Masum Billah
- Maternal and Child Health Division, International Centre of Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Cynthia Boschi-Pinto
- Departamento de Epidemiologia e Bioestatistica, Instituto de Saude Coletiva, University Federal Fluminense, Rio de Janeiro, Brazil
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, University of Yamanashi, Chuo-shi, Japan
| | | | - Marzia Lazzerini
- World Health Organization Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Trieste, Italy
| | - Abdoulaye Maiga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neil McKerrow
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Melinda Munos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lois Park
- University of Southern California, Los Angeles, CA, USA
| | | | - Ralf Weigel
- School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Hennegan J, Swe ZY, Than KK, Smith C, Sol L, Alberda H, Bukenya JN, Kibira SPS, Makumbi FE, Schwab KJ, Azzopardi PS. Monitoring Menstrual Health Knowledge: Awareness of Menstruation at Menarche as an Indicator. Front Glob Womens Health 2022; 3:832549. [PMID: 35400130 PMCID: PMC8988033 DOI: 10.3389/fgwh.2022.832549] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/28/2022] [Indexed: 11/21/2022] Open
Abstract
As initiatives to support menstrual health are implemented globally, monitoring progress through a set of comprehensive indicators provides important feedback to direct policies and programs. One proposed core indicator is awareness of menstruation at menarche. That is, at the time of menarche an adolescent girl knowing that menstrual bleeding is something she will experience. In this investigation, we undertook secondary analysis of data collected across four studies to support interpretation of this indicator. We (1) describe the proportion of each sample aware of menstruation at menarche, (2) test variations in awareness according to sociodemographic characteristics, and (3) describe the associations between this indicator and self-reported experience at menarche, social support, and confidence to manage menstruation. Studies included cross-sectional survey data from 421 schoolgirls in Magway, Myanmar, 537 schoolgirls in Soroti, Uganda, 1,359 schoolgirls in Netrokona, Bangladesh, and 599 adult women working in Mukono, Uganda. Awareness of menstruation at menarche varied from 84% in Myanmar to 34% in Bangladesh. Older age at menarche was associated with awareness. Awareness at menarche was not associated with household poverty in the adolescent samples, but greater poverty was associated with lower levels of awareness among adult women. In Myanmar, girls aware of menstruation had significantly higher odds of reporting that they felt prepared (2.85 95% CI 1.34–6.08), happy (OR = 3.81 95% CI 1.74–8.37) and knew what was happening at menarche (OR = 2.37 95% CI 1.34–4.19). However, they also reported higher levels of embarrassment (OR = 1.76 95% CI 1.04–2.97) and did not report significantly less fear (OR = 1.24 95% CI 0.82–1.85). Awareness of menstruation at menarche was associated with higher scores on a menstrual knowledge quiz in both Myanmar (b = 9.51 95% CI 3.99–15.04) and Bangladesh (b = 4.78 95% CI 1.70–7.87). In these studies girls aware of menstruation at menarche also had higher odds of reporting they felt confident discussing menstruation with support sources and managing menstruation at school, while these differences were not significant among schoolgirls in Uganda. Findings support the usefulness of awareness of menstruation at menarche as an indicator to describe minimal knowledge of menstruation and suggest that awareness may signal greater knowledge, social support, and confidence in some settings.
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Affiliation(s)
- Julie Hennegan
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Julie Hennegan
| | - Zay Yar Swe
- Myanmar Country Program, International Development Discipline, Burnet Institute, Yangon, Myanmar
| | - Kyu Kyu Than
- Myanmar Country Program, International Development Discipline, Burnet Institute, Yangon, Myanmar
| | - Calum Smith
- Irise International, Sheffield, United Kingdom
| | - Lidwien Sol
- School of Business and Economics, Maastricht University, Maastricht, Netherlands
| | | | - Justine N. Bukenya
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Simon P. S. Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fredrick E. Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kellogg J. Schwab
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Peter S. Azzopardi
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Adolescent Health and Wellbeing Program, Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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25
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Orth Z, Moosajee F, Van Wyk B. Measuring Mental Wellness of Adolescents: A Systematic Review of Instruments. Front Psychol 2022; 13:835601. [PMID: 35356328 PMCID: PMC8959676 DOI: 10.3389/fpsyg.2022.835601] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/08/2022] [Indexed: 12/26/2022] Open
Abstract
Objective Mental health is critical to the healthy development of adolescents. However, mental health encompasses more than the absence of mental illness; and should include indicators of mental wellness. A critical review of available mental wellness instruments for adolescents were conducted to identify operational definitions of mental wellness concepts for this population group. Method A systematic review of literature published between 2000 and 2020 was done to identify mental wellness instruments for adolescent populations. The review followed the PRISMA operational steps. Results We identified 2,543 articles from the search strategy and screened titles and abstracts for eligibility. After appraisal, 97 studies were included in the qualitative synthesis; of which, 79 mental wellness instruments were identified. Most studies did not provide a definition for mental wellness. We identified thirteen mental wellness concepts from 97 studies, namely: life satisfaction, mental wellbeing [general], resilience, self-efficacy, self- esteem, connectedness, coping, self-control, mindfulness/spiritual, hope, sense of coherence, happiness, and life purpose. Conclusion The review reflected previous research identifying a lack of consensus around the definitions of mental health, mental wellness, and mental wellbeing. This has implications for developing instruments for adolescents that adequately measure these constructs. Most of the instruments identified in the review were predominantly English and from developed countries. This indicates a need for instrument that are explicitly conceptualised and operationalised for adolescents in all their varied contexts.
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Affiliation(s)
- Zaida Orth
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Faranha Moosajee
- Division for Postgraduate Studies, University of the Western Cape, Bellville, South Africa
| | - Brian Van Wyk
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
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26
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Chen L, Su B, Zhang Y, Ma T, Liu J, Yang Z, Li Y, Gao D, Chen M, Ma Y, Wang X, Wen B, Jiang J, Dong Y, Song Y, Ma J. Association between height growth patterns in puberty and stature in late adolescence: A longitudinal analysis in chinese children and adolescents from 2006 to 2016. Front Endocrinol (Lausanne) 2022; 13:882840. [PMID: 35937794 PMCID: PMC9354934 DOI: 10.3389/fendo.2022.882840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The relationship between the characteristics of puberty growth and the stature (height and overweight and obesity) in late adolescence was not clear. We aimed to explore the effects of puberty growth patterns on the stature in late adolescence. METHODS A total of 13,143 children from a longitudinal cohort from 2006 to 2016 in Zhongshan city of China were included. The Preece-Baines growth curve was fitted for each individual child, and the age at peak height velocity (APHV), peak height velocity (PHV), and age at take-off (TOA) were obtained from the Preece-Baines model. To compare the difference in height in late adolescence (at 18 years old) at different pubertal height growth patterns (height spurt timing, intensity, and duration), the height at baseline was matched by using the propensity score matching. The log-binomial model was applied to assess the association between the three pubertal height growth patterns (timing, intensity, and duration) and overweight and obesity status in late adolescence, controlling the urbanity and body mass index (BMI) at baseline. RESULTS After matching the baseline height, boys and girls in three pubertal patterns with early timing (P < 0.01), small intensity (P < 0.01), and short duration (P < 0.01) of height spurt had the lowest final height in the late adolescence. A 16% increase and 45% increase of risk for overweight and obesity were significantly associated with the early APHV in boys and girls, respectively, relative risk (RR) in boys, 1.16(95% confidence interval, CI: 1.03-1.30), P = 0.011; RR in girls, 1.45(1.21-1.75), P < 0.001. A 21% increase and 59% increase of risk for overweight and obesity were significantly associated with small PHV in boys and girls, respectively, RR in boys, 1.21(1.07-1.36), P < 0.001; RR in girls, 1.59(1.30-1.95), P < 0.001; and an 80% increase of risk for overweight and obesity with small spurt duration in girls (RR = 1.80; 95% CI: 1.49, 2.18; P < 0.001). CONCLUSION Pubertal growth patterns, including earlier puberty onset timing, smaller puberty intensity, and shorter puberty spurt duration, had a positive association with lower height risks and higher overweight and obesity risks in late adolescence.
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Affiliation(s)
- Li Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Binbin Su
- Institute of Population Research, Peking University Asia-Pacific Economic Cooperation (APEC) Health Science Academy, Beijing, China
| | - Yi Zhang
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Tao Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Jieyu Liu
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Zhaogeng Yang
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yanhui Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Di Gao
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Manman Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Ying Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Xijie Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Bo Wen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jun Jiang
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, United States
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
- *Correspondence: Yi Song, ; Yanhui Dong,
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
- *Correspondence: Yi Song, ; Yanhui Dong,
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
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Rocco I, Tamburis O, Pecoraro F, Luzi D, Corso B, Minicuci N. Quality of child healthcare in European countries: common measures across international databases and national agencies. Eur J Public Health 2021; 31:679-687. [PMID: 34480552 PMCID: PMC8504999 DOI: 10.1093/eurpub/ckab086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The evaluation of child healthcare is not yet widely explored, especially from a cross-country comparison perspective. The routine adoption of measures by national assessment agencies is under-investigated. Though the guiding principles developed at international level call for a child-centric multi-dimensional evaluation of child care, its feasibility is hampered by the availability of robust and harmonized data. METHODS To explore the data availability, international databases (IDBs) were scrutinized and measures dealing with child health-related issues were collated. In parallel, an ad hoc questionnaire was administrated to 30 Country Agents (CAs) to gather measures routinely adopted at local level. To facilitate the comparison of measures, a three-level conceptual map was developed. RESULTS The IDBs yielded at 207 measures that pertained mainly to non-health determinants of health, whereas the 352 measures obtained from CAs focused on process and outcome. A set of 33 common measures that related to immunization, morbidity and mortality were identified. CONCLUSIONS A limited set of measures used both in IDBs and at national level identify common areas of concerns that certainly capture crucial issues with child prevention and health outcomes. However, they are far from satisfying a child-centric multi-dimensional approach to the evaluation of child well-being and well-becoming. There is room for improvement at both international and national levels. IDBs should include and harmonize measures that concern the provision of child-centric services and encompass physical, social and mental development. At the national level, efforts towards the inclusion of measures that concern non-health determinants of health should be pursued.
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Affiliation(s)
- Ilaria Rocco
- Departement of Biomedical sciences, Neuroscience Institute, National Research Council, Padova, Italy
| | - Oscar Tamburis
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
| | - Fabrizio Pecoraro
- Departement of Social sciences and humanities, cultural heritage, Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Daniela Luzi
- Departement of Social sciences and humanities, cultural heritage, Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Barbara Corso
- Departement of Biomedical sciences, Neuroscience Institute, National Research Council, Padova, Italy
| | - Nadia Minicuci
- Departement of Biomedical sciences, Neuroscience Institute, National Research Council, Padova, Italy
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Klein JD. Adolescent Health - Indicators for Measurement and Accountability-A Necessary Step Towards Achieving Global Goals. J Adolesc Health 2021; 69:357-358. [PMID: 34452724 DOI: 10.1016/j.jadohealth.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
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Newby H, Marsh AD, Moller AB, Adebayo E, Azzopardi PS, Carvajal L, Fagan L, Friedman HS, Ba MG, Hagell A, Morgan A, Saewyc E, Guthold R. A Scoping Review of Adolescent Health Indicators. J Adolesc Health 2021; 69:365-374. [PMID: 34272169 PMCID: PMC8405182 DOI: 10.1016/j.jadohealth.2021.04.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE A host of recent initiatives relating to adolescent health have been accompanied by varying indicator recommendations, with little stakeholder coordination. We assessed currently included adolescent health-related indicators for their measurement focus, identified overlap across initiatives, and determined measurement gaps. METHODS We conducted a scoping review to map the existing indicator landscape as depicted by major measurement initiatives. We classified indicators as per 33 previously identified core adolescent health measurement areas across five domains and by age groups. We also identified indicators common across measurement initiatives even if differing in details. RESULTS We identified 413 indicators across 16 measurement initiatives, with most measuring health outcomes and conditions (162 [39%]) and health behaviors and risks (136 [33%]); followed by policies, programs, and laws (49 [12%]); health determinants (44 [11%]); and system performance and interventions (22 [5%]). Age specification was available for 221 (54%) indicators, with 51 (23%) focusing on the full adolescent age range (10-19 years), 1 (<1%) on 10-14 years, 27 (12%) on 15-19 years, and 142 (64%) on a broader age range including adolescents. No definitional information, such as numerator and denominator, was available for 138 indicators. We identified 236 distinct indicators after accounting for overlap. CONCLUSION The adolescent health measurement landscape is vast and includes substantial variation among indicators purportedly assessing the same concept. Gaps persist in measuring systems performance and interventions; policies, programs, and laws; and younger adolescents' health. Addressing these gaps and harmonizing measurement is fundamental to improve program implementation and accountability for adolescent health globally.
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Affiliation(s)
- Holly Newby
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
| | - Andrew D. Marsh
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland,Address correspondence to: Andrew D. Marsh, Ph.D., Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, 20, avenue Appia, CH-1211 Geneva, Switzerland.
| | - Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Emmanuel Adebayo
- Adolescent Health Unit, Institute of Child Health, University of Ibadan, Ibadan, Nigeria
| | - Peter S. Azzopardi
- Global Adolescent Health Group, Burnet Institute, Melbourne, Victoria, Australia,Adolescent Health and Well-being Program, Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia,Centre for Adolescent Health, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Liliana Carvajal
- Division of Data Analytics Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Lucy Fagan
- UN Major Group for Children and Youth, London, United Kingdom,Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Mariame Guèye Ba
- University Cheikh Anta Diop of Dakar, Faculty of Medicine, Pharmacy and Odontology/Gynecology, Dakar, Senegal,Obstetrics Clinic, University Teaching Hospital A. Le Dantec, Dakar, Senegal
| | - Ann Hagell
- Association for Young People's Health, London, United Kingdom
| | - Alison Morgan
- Global Financing Facility, World Bank Group, Washington, District of Columbia,Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Saewyc
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Regina Guthold
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
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30
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Schultz L, Ruel-Bergeron J. Considerations for Monitoring School Health and Nutrition Programs. Front Public Health 2021; 9:645711. [PMID: 34336757 PMCID: PMC8322578 DOI: 10.3389/fpubh.2021.645711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/22/2021] [Indexed: 11/29/2022] Open
Abstract
School health and nutrition (SHN) interventions are among the most ubiquitous public health investments and comprise a key mechanism for reaching populations that are otherwise difficult to reach through the health system. Despite the critical role of monitoring these multisectoral programs to enable data-informed adaptive programming, information to guide program implementers is scant. This manuscript provides an overview of how monitoring indicators can be selected across a SHN program's logical framework, with specific examples across five SHN implementation models. Adaptation of SHN programs in times of school closures, such as those currently being experienced globally due to the emergence of COVID-19, is also addressed. Key aspects of SHN program monitoring are explored, including: (1) why monitor; (2) what to measure; (3) how to measure; and (4) who measures. In situations of school closures, strategies to shift both program activities and corresponding monitoring mechanisms are critical to understanding the rapidly evolving situation and subsequently guiding policy actions to protect vulnerable populations.
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Affiliation(s)
- Linda Schultz
- Global Financing Facility, Health, Nutrition and Population Global Practice, World Bank, Washington, DC, United States
| | - Julie Ruel-Bergeron
- Global Financing Facility, Health, Nutrition and Population Global Practice, World Bank, Washington, DC, United States
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31
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Klein JD. Adolescent Health Measurement-A Necessary Step Toward Achieving Global Goals. J Adolesc Health 2021; 68:836-839. [PMID: 33896549 DOI: 10.1016/j.jadohealth.2021.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
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32
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Guthold R, Moller AB, Adebayo E, Carvajal L, Ekman C, Fagan L, Ferguson J, Friedman HS, Ba MG, Hagell A, Kohl K, Azzopardi PS. Priority Areas for Adolescent Health Measurement. J Adolesc Health 2021; 68:888-898. [PMID: 33632644 PMCID: PMC8083105 DOI: 10.1016/j.jadohealth.2020.12.127] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE We establish priority areas for adolescent health measurement and identify current gaps, aiming to focus resources on the most relevant data to improve adolescent health. METHODS We collected four critical inputs to inform priority setting: perspectives of youth representatives, country priorities, disease burden, and existing measurement efforts. Health areas identified from the inputs were grouped, mapped, and summarized according to their frequency in the inputs. Using a Delphi-like approach, international experts then selected core, expanded, and context-specific priority areas for adolescent health measurement from all health areas identified. RESULTS Across the four inputs, we identified 99 measurement areas relevant to adolescent health and grouped them under six domains: policies, programs, laws; systems performance and interventions; health determinants; health behaviors and risks; subjective well-being; and health outcomes and conditions. Areas most frequently occurring were mental health and weight status in youth representatives' opinions; sexual and reproductive health and HIV/AIDS in country policies and perspectives; road injury, self-harm, skin diseases, and mental disorders in the disease burden analysis; and adolescent fertility in measurement initiatives. Considering all four inputs, experts selected 33 core, 19 expanded, and 6 context-specific adolescent health measurement areas. CONCLUSION The adolescent health measurement landscape is vast, covering a large variety of topics. The foci of the measurement initiatives we reviewed do not reflect the most important health areas according to youth representatives' or country-level perspectives, or the adolescent disease burden. Based on these inputs, we propose a set of priority areas to focus national and global adolescent health measurement.
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Affiliation(s)
- Regina Guthold
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland.
| | - Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Emmanuel Adebayo
- Adolescent Health Unit, Institute of Child Health, University of Ibadan, Ibadan, Nigeria
| | - Liliana Carvajal
- Division of Data Analytics Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York
| | - Carolin Ekman
- Independent Consultant, Sexual and Heproductive Health and Rights, Geneva, Switzerland
| | - Lucy Fagan
- UN Major Group for Children and Youth, London, United Kingdom
| | - Jane Ferguson
- Independent Consultant, Adolescent Health, Geneva, Switzerland
| | - Howard S Friedman
- Technical Division, United Nations Population Fund, New York, New York
| | - Mariame Guèye Ba
- University Cheikh Anta Diop of Dakar, Faculty of Medicine, Pharmacy and Odontology/Gynecology and Obstetrics Clinic, University Teaching Hospital A. Le Dantec, Dakar, Senegal
| | - Ann Hagell
- Association for Young People's Health, London, United Kingdom
| | - Kid Kohl
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
| | - Peter S Azzopardi
- Global Adolescent Health Group, Burnet Institute, Melbourne, Australia; South Australian Health and Medical Research Institute, Aboriginal Health Equity theme, Adelaide, Australia; Centre for Adolescent Health, Department of Paediatrics, University of Melbourne, Melbourne, Australia
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33
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Kumar S, Khanduri A, Sidibe A, Morgan C, Torode J, Basu P, Bhatla N, Schocken C, Bloem P. Acting on the call: A framework for action for rapid acceleration of access to the HPV vaccination in low- and lower-middle-income countries. Int J Gynaecol Obstet 2021; 152:32-39. [PMID: 33185283 PMCID: PMC7898307 DOI: 10.1002/ijgo.13482] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/18/2020] [Accepted: 11/27/2020] [Indexed: 12/12/2022]
Abstract
Cervical cancer, caused by HPV infection, is responsible for more than 311 000 preventable deaths every year. A global call to accelerate efforts to eliminate this disease has generated a new global strategy proposing ambitious, but achievable, targets for HPV vaccination of girls, and screening and treatment of women. The present paper addresses the suboptimal access to HPV vaccination in low-income and lower-middle-income countries (LICs/LMICs), where the burden of disease weighs most heavily, in part through co-infection with HIV. A proposed framework for action was formulated by first reviewing the reasons underlying gaps in HPV vaccine coverage. Good practices from recent introductions of HPV vaccine at scale in LICs/LMICs were then assessed based on targeted literature reviews and the experience and views of the authors. Difficulties in uptake and coverage of the HPV vaccine relate to the costs of the vaccine and service delivery, lack of prioritization, the challenges of vaccinating adolescents, and shortage of vaccines as the supply failed to keep pace with the rapid expansion in global demand, including from LICs/LMICs. The framework for action calls for new strategic thinking to consolidate global learning and invigorate operationalization at a country level.
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Affiliation(s)
- Somesh Kumar
- Jhpiego, a Johns Hopkins University affiliate, Baltimore, MD, USA
| | - Arunima Khanduri
- HPV Vaccine, Vaccine Implementation, Gavi, the Vaccine Alliance, Geneva, Switzerland
| | - Anissa Sidibe
- HPV Vaccine, Vaccine Implementation, Gavi, the Vaccine Alliance, Geneva, Switzerland
| | - Christopher Morgan
- Jhpiego, a Johns Hopkins University affiliate, Baltimore, MD, USA.,School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Burnet Institute, Melbourne, VIC, Australia
| | - Julie Torode
- Union for International Cancer Control, Geneva, Switzerland
| | - Partha Basu
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Neerja Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Paul Bloem
- Life Course and Integration/EPI, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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Ross DA, Hinton R, Melles-Brewer M, Engel D, Zeck W, Fagan L, Herat J, Phaladi G, Imbago-Jácome D, Anyona P, Sanchez A, Damji N, Terki F, Baltag V, Patton G, Silverman A, Fogstad H, Banerjee A, Mohan A. Adolescent Well-Being: A Definition and Conceptual Framework. J Adolesc Health 2020; 67:472-476. [PMID: 32800426 PMCID: PMC7423586 DOI: 10.1016/j.jadohealth.2020.06.042] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/19/2022]
Affiliation(s)
- David A Ross
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland.
| | - Rachael Hinton
- Partnership for Maternal, Newborn & Child Health, Geneva, Switzerland
| | | | - Danielle Engel
- Adolescent and Youth Team, Technical Division, United Nations Population Fund (UNFPA), New York, New York
| | - Willibald Zeck
- Global Maternal, Newborn and Adolescent Health Program, UNICEF, New York, New York
| | - Lucy Fagan
- Global Focal Point, UN Major Group for Children and Youth, London, UK
| | - Joanna Herat
- Section of Health and Education, United Nations Educational, Scientific and Cultural Organization (UNESCO), Paris, France
| | | | | | | | | | - Nazneen Damji
- Gender Equality, HIV and Health, UN Women, New York, New York
| | - Fatiha Terki
- Nutrition Division, World Food Programme, Rome, Italy
| | - Valentina Baltag
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - George Patton
- Centre for Adolescent Health, University of Melbourne, Melbourne, Australia
| | | | - Helga Fogstad
- Partnership for Maternal, Newborn & Child Health, Geneva, Switzerland
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Anshu Mohan
- Partnership for Maternal, Newborn & Child Health, Geneva, Switzerland
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Strong K, Requejo J, Agweyu A, McKerrow N, Schellenberg J, Agbere DA, Billah SM, Boschi-Pinto C, Horiuchi S, Lazzerini M, Maiga A, Munos M, Weigel R, Banerjee A, Hereward M, Diaz T. Child Health Accountability Tracking-extending child health measurement. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:259-261. [PMID: 32059788 DOI: 10.1016/s2352-4642(19)30426-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Kathleen Strong
- Department of Maternal, Child, Adolescent Health and Ageing, WHO, Geneva, Switzerland.
| | | | - Ambrose Agweyu
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Neil McKerrow
- Maternal, Child and Women's Health Dept of Health Kwazulu-Natal, Pietermaritzburg, South Africa
| | | | | | - Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Sayaka Horiuchi
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Marzia Lazzerini
- Institute for Maternal and Child Health, Mother and Child Referral Hospital and Research Institute Burlo Garofolo, Trieste, Italy
| | - Abdoulaye Maiga
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melinda Munos
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Anshu Banerjee
- Department of Maternal, Child, Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | | | - Theresa Diaz
- Department of Maternal, Child, Adolescent Health and Ageing, WHO, Geneva, Switzerland
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36
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Requejo J, Diaz T, Park L, Chou D, Choudhury A, Guthold R, Jackson D, Moller AB, Monet JP, Moran AC, Say L, Strong KL, Banerjee A. Assessing coverage of interventions for reproductive, maternal, newborn, child, and adolescent health and nutrition. BMJ 2020; 368:l6915. [PMID: 31983681 PMCID: PMC7461908 DOI: 10.1136/bmj.l6915] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Progress has been made in priority interventions, but we need new measurement systems that include the whole life course and give better assessment of equity of coverage, argue Jennifer Requejo and colleagues
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Affiliation(s)
| | | | - Lois Park
- Johns Hopkins University, Baltimore, USA
- University of Southern California, Los Angeles, USA
| | - Doris Chou
- World Health Organization, Geneva, Switzerland
| | | | | | - Debra Jackson
- Unicef, New York, USA
- University of Western Cape, Cape Town, South Africa
| | | | | | | | - Lale Say
- World Health Organization, Geneva, Switzerland
| | | | - Anshu Banerjee
- World Health Organization, Geneva, Switzerland
- United Nations H6+ Technical Group, New York, USA
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Ivanovitch K, Keolangsy S, Homkham N. Overweight and Obesity Coexist with Thinness among Lao's Urban Area Adolescents. J Obes 2020; 2020:5610834. [PMID: 32864170 PMCID: PMC7444367 DOI: 10.1155/2020/5610834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/09/2020] [Accepted: 07/23/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION In recent decades, the developing countries of Southeast Asia, including the Lao People's Democratic Republic (Lao PDR), have experienced a rapid growth of their urban population. Partly as a result of that, issues of undernutrition and overnutrition became a significant public health problem. OBJECTIVE To examine the prevalence of overweight and obesity and their related factors, among the school-attending adolescents in the Lao capital of Vientiane. METHODS A cross-sectional data on 300 adolescents aged 15-19 were collected during the months of March, April, and May 2018 by means of a self-administrated questionnaire. Anthropometric measurements were used to obtain data on height and weight. Pearson's chi-squared test, Fisher exact tests, and univariable and multivariable logistic regressions were applied in the course of the statistical analysis. RESULTS The study found a high prevalence of overweight/obesity (23.3%) and thinness (10.3%). Poor eating habits were noted in 67.0% of adolescents, even though 78.0% of them had a good knowledge of nutrition. Factors significantly associated with the overweight/obesity were low physical activities (aOR = 18.3; 95% CI: 5.51-60.66) and adolescents living with their guardians (aOR = 0.25; 95% CI: 0.08-0.79). Results also indicated that, in 47.3% of the cases, teachers, acting as a source of health and nutrition information, can prevent the risk of adolescents' overweight/obesity (aOR = 2.05, 95% CI = 1.11-3.80) but not their thinness (aOR = 0.4, 95% CI = 0.17-0.88). CONCLUSIONS Laotian adolescents are facing the spectrum of malnutrition in urban areas. To improve adolescents' nutritional status, there is a need for a collaborative approach of public health agencies that would address the issues of an effective food and nutrition policy. The school curricula should also include programs on nutrition and physical education.
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Affiliation(s)
- Katiya Ivanovitch
- Faculty of Public Health, Thammasat University (Rangsit Campus), Klong Luang District, Patumthani 12120, Thailand
| | - Sonemany Keolangsy
- Faculty of Public Health, Thammasat University (Rangsit Campus), Klong Luang District, Patumthani 12120, Thailand
| | - Nontiya Homkham
- Faculty of Public Health, Thammasat University (Rangsit Campus), Klong Luang District, Patumthani 12120, Thailand
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Plesons M, Cole CB, Hainsworth G, Avila R, Va Eceéce Biaukula K, Husain S, Janušonytė E, Mukherji A, Nergiz AI, Phaladi G, Ferguson BJ, Philipose A, Dick B, Lane C, Herat J, Engel DMC, Beadle S, Hayes B, Chandra-Mouli V. Forward, Together: A Collaborative Path to Comprehensive Adolescent Sexual and Reproductive Health and Rights in Our Time. J Adolesc Health 2019; 65:S51-S62. [PMID: 31761004 DOI: 10.1016/j.jadohealth.2019.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 11/25/2022]
Abstract
The 1994 International Conference on Population and Development established a basis for the advancement of adolescent sexual and reproductive health and rights (ASRHR) that endures today. Twenty-five years later, our vision for the future warrants reflection based on a clear understanding of the opportunities and challenges before us. Inclusion of adolescents on global, regional, and national agendas; increased investment in ASRHR policies and programs; renewed commitments to universal health coverage; increased school enrollment; and advances in technology are all critical opportunities we can and must leverage to catalyze progress for adolescents. At the same time, a range of significant challenges remain, have newly emerged, or can be seen on the horizon, including persistent denial of adolescent sexuality; entrenched gender inequality; resistance to meaningfully engaging adolescents and young people in political and programmatic processes; weak systems, integration, and multisectoral coordination; changes in population dynamics; humanitarian and climate crises; and changes in family and community structures. To achieve as much progress toward our vision for ASRHR as possible, the global ASRHR community must take strategic and specific steps in the next 10 years within five areas for action: (1) mobilize and make full use of political and social support for ASRHR policies and programs; (2) increase and make effective use of external and domestic funding for ASRHR; (3) develop, communicate, apply, and monitor enabling and protective laws and policies for ASRHR; (4) use and improve available ASRHR data and evidence to strengthen advocacy, policies, and programs; and (5) manage the implementation of ASRHR strategies at scale with quality and equity.
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Affiliation(s)
- Marina Plesons
- World Health Organization, Department of Reproductive Health and Research and the Human Reproduction Programme, Geneva, Switzerland
| | - Claire B Cole
- Population Services International, Sexual and Reproductive Health Department, Washington, DC
| | - Gwyn Hainsworth
- Bill and Melinda Gates Foundation, Family Planning Team, Seattle, Washington
| | - Ruben Avila
- International Youth Alliance for Family Planning, Monterrey, Mexico
| | | | | | - Eglė Janušonytė
- International Federation of Medical Students' Associations, Vilnius, Lithuania
| | | | | | | | - B Jane Ferguson
- Independent Consultant, Adolescent Health and Development, Geneva, Switzerland
| | - Anandita Philipose
- UNFPA, East and Southern Africa Regional Office, Johannesburg, South Africa
| | - Bruce Dick
- Independent Consultant, Adolescent Health and Development, Geneva, Switzerland
| | - Cate Lane
- Family Planning 2020, Washington, DC
| | - Joanna Herat
- Section on Health and Education, UNESCO, Paris, France
| | | | - Sally Beadle
- Section on Health and Education, UNESCO, Paris, France
| | - Brendan Hayes
- Global Financing Facility World Bank, Washington, DC
| | - Venkatraman Chandra-Mouli
- World Health Organization, Department of Reproductive Health and Research and the Human Reproduction Programme, Geneva, Switzerland.
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39
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Guthold R, Stevens GA, Riley LM, Bull FC. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 4:23-35. [PMID: 31761562 PMCID: PMC6919336 DOI: 10.1016/s2352-4642(19)30323-2] [Citation(s) in RCA: 1315] [Impact Index Per Article: 263.0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Physical activity has many health benefits for young people. In 2018, WHO launched More Active People for a Healthier World, a new global action on physical activity, including new targets of a 15% relative reduction of global prevalence of insufficient physical activity by 2030 among adolescents and adults. We describe current prevalence and trends of insufficient physical activity among school-going adolescents aged 11-17 years by country, region, and globally. METHODS We did a pooled analysis of cross-sectional survey data that were collected through random sampling with a sample size of at least 100 individuals, were representative of a national or defined subnational population, and reported prevalence of of insufficient physical activity by sex in adolescents. Prevalence had to be reported for at least three of the years of age within the 10-19-year age range. We estimated the prevalence of insufficient physical activity in school-going adolescents aged 11-17 years (combined and by sex) for individual countries, for four World Bank income groups, nine regions, and globally for the years 2001-16. To derive a standard definition of insufficient physical activity and to adjust for urban-only survey coverage, we used regression models. We estimated time trends using multilevel mixed-effects modelling. FINDINGS We used data from 298 school-based surveys from 146 countries, territories, and areas including 1·6 million students aged 11-17 years. Globally, in 2016, 81·0% (95% uncertainty interval 77·8-87·7) of students aged 11-17 years were insufficiently physically active (77·6% [76·1-80·4] of boys and 84·7% [83·0-88·2] of girls). Although prevalence of insufficient physical activity significantly decreased between 2001 and 2016 for boys (from 80·1% [78·3-81·6] in 2001), there was no significant change for girls (from 85·1% [83·1-88·0] in 2001). There was no clear pattern according to country income group: insufficient activity prevalence in 2016 was 84·9% (82·6-88·2) in low-income countries, 79·3% (77·2-87·5) in lower-middle-income countries, 83·9% (79·5-89·2) in upper-middle-income countries, and 79·4% (74·0-86·2) in high-income countries. The region with the highest prevalence of insufficient activity in 2016 was high-income Asia Pacific for both boys (89·0%, 62·8-92·2) and girls (95·6%, 73·7-97·9). The regions with the lowest prevalence were high-income western countries for boys (72·1%, 71·1-73·6), and south Asia for girls (77·5%, 72·8-89·3). In 2016, 27 countries had a prevalence of insufficient activity of 90% or more for girls, whereas this was the case for two countries for boys. INTERPRETATION The majority of adolescents do not meet current physical activity guidelines. Urgent scaling up of implementation of known effective policies and programmes is needed to increase activity in adolescents. Investment and leadership at all levels to intervene on the multiple causes and inequities that might perpetuate the low participation in physical activity and sex differences, as well as engagement of youth themselves, will be vital to strengthen the opportunities for physical activity in all communities. Such action will improve the health of this and future young generations and support achieving the 2030 Sustainable Development Goals. FUNDING WHO.
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Affiliation(s)
- Regina Guthold
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland.
| | - Gretchen A Stevens
- Independent Researcher, Los Angeles, CA, USA; School of Public Health, Imperial College London, UK
| | - Leanne M Riley
- Department of Non-communicable Diseases, WHO, Geneva, Switzerland
| | - Fiona C Bull
- Health Promotion Department, WHO, Geneva, Switzerland; Department of Sport and Exercise Science, University of Western Australia, Perth, WA, Australia
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