Adolescence and Gender Equality in Health

Knowledge, attitude, and practices of adolescents and peer educators in relation to the components of the National Adolescent Health Program in India: findings from a cross-sectional survey

Background

Adolescence is a critical period of growth and development. Many adverse health outcomes in adulthood begin during adolescence, often due to insufficient knowledge and attitudes resulting from a lack of education. Therefore, appropriate knowledge, attitudes, and practices (KAP) regarding various aspects of health are essential for holistic adolescent and lifelong health. In India, the Rashtriya Kishore Swasthya Karyakram (RKSK or National Adolescent Health Strategy) has utilized an innovative peer-education approach to engage with adolescents and improve their KAPs. Amid limited evidence, we aimed to assess the KAP of adolescents regarding the six themes of the RKSK, with a particular focus on the status of peer educators (PEs). Our objective was to evaluate these aspects disaggregated by sex and to examine how engagement with the RKSK peer-education program influenced their KAP.

Methods

A cross-sectional survey of 238 peer educators and 2885 adolescents enrolled under peer educators was conducted in two localities; Madhya Pradesh and Maharashtra states. KAPs were estimated using descriptive statistics then disaggregated by gender. Practice scores of nutrition and non-communicable disease (NCD) were modelled upon engagement with RKSK (graded as 0, 1, 2, 3).

Results

Knowledge was highest regarding substance misuse and lowest in the domains of sexual and reproductive health, and violence and injury. PEs possessed greater knowledge in most domains as compared to adolescents enrolled under them. Attitudes toward abstention from substance misuse were positive, whereas attitudes toward injury and violence, and sexual health, were suboptimal. Boys exhibited better practices related to NCDs, while their nutritional practices were comparatively worse than girls. The RKSK engagement was associated with better nutritional practices: adjusted relative risks (RRs) being 1.04 (95% confidence interval [CI]: 0.94-1.15), 1.12 (1.04-1.21), and 1.21 (1.13-1.31), respectively, for engagement scores 1, 2, and 3 with reference to score 0. The relationship between RKSK engagement and NCD-related practices was restricted to the top engagement group.

Conclusion

The knowledge regarding sexual health, and injury and violence, was grossly deficient in adolescents. These components must be prioritized in the program because they are critical for health not only across the life course of individuals but also across generations. However, the RKSK engagement was associated with better practices in a variety of domains, which should be leveraged in the future.

Effect of Gender Attitudes of Young Adults on Levels of Perceived Social Support in Health Behaviors

The current cross-sectional descriptive study was performed to determine the effect of young adults' attitudes regarding social gender roles on perceived social support level in health behaviors. Participants comprised 209 young adults aged 18 to 21 years. Data collection tools included a sociodemographic characteristics form, the Gender Roles Attitude Scale, and Child and Adolescent Social Support Scale for Healthy Behaviors (CASSS-HB). Data were analyzed using percentile, correlation, and regression analysis. A significant positive correlation was found between total CASSS-HB score and the egalitarian gender role subdimension of the Gender Roles Attitude Scale. It was determined that participants with an egalitarian perspective toward gender roles had increased levels of social support in health behaviors. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 17-23.].

Gender differences in Russian adolescent mental health from 1999 to 2021

This study examined secular trends in Russian adolescent mental health, the specific effects of the COVID-19 pandemic, and associations with country-level indicators. A cross-sectional survey of 12,882 adolescents aged 11-18 years was carried out between 1999 and 2021 using the Strengths and Difficulties Questionnaire. The results showed an incline in girls' internalizing problems with a two-fold increase in the gender gap. There was a decline in girls' prosocial behavior and an incline in peer problems, with decreasing gender differences. Conduct problems showed a reversal of gender differences. Changes during the pandemic were not greater than over-time changes, with the exception of inclines in hyperactivity-inattention in both genders. Time trends in adolescent mental health were associated with over-time changes in national indicators of wealth and gender equality. The findings provide a strong basis for further research into the determinants of gender differences in adolescent mental health and for gender-specific interventions.

Gender and sexual identity-based inequalities in adolescent wellbeing: findings from the #BeeWell Study

BACKGROUND

Gender and sexual minority adolescents experience greater symptoms of psychological distress than their peers, but little is known about broader aspects of their wellbeing. This study examines wellbeing inequalities relating to gender and sexual identity among adolescents from Greater Manchester in the United Kingdom.

METHOD

37,978 adolescents (aged 12-15, attending 165 secondary schools) completed surveys of life satisfaction, positive and negative affect (hedonic framework); autonomy, self-esteem, optimism, and positive relationships (eudaimonic framework); and, symptoms of distress and mental wellbeing (complete state framework). Structural correlated factors models were used to assess gender and sexual identity wellbeing inequalities.

RESULTS

The magnitude of wellbeing inequalities pertaining to gender and sexual identity were routinely substantially greater than those concerning other characteristics (e.g., socio-economic disadvantage). Gender identity wellbeing inequalities followed a consistent pattern, with the largest disparities evident between gender diverse adolescents and boys. Sexual identity wellbeing inequalities also followed a consistent pattern, with the largest disparities evident between sexual minority youth (both gay/lesbian and bi/pansexual) and their heterosexual peers. Finally, variation was evident across wellbeing domains. For example, observed gender identity (boys vs. girls) and sexual identity (heterosexual vs. sexual minority) disparities were substantially greater for symptoms of distress than for mental wellbeing in the complete state model.

CONCLUSIONS

LGBTQ + adolescents experience lower wellbeing than their peers, and this is evident across a range of wellbeing domains. Accordingly, there is an urgent need for the prioritisation of improved prevention and intervention efforts that can better meet the needs of gender diverse and sexual minority youth, and future research should be conducted to improve understanding of the mechanisms underpinning the wellbeing inequalities observed.

Adolescents' developing awareness of inequality: Racial and ethnic differences in trajectories

To advance knowledge of critical consciousness development, this study examined age-related change in awareness of inequality by race and ethnicity, gender, parent education, generation status, and their interactions. With longitudinal data (2013-2017) from 5019 adolescents in grades 6-12 (55.0% female) from California, Minnesota, and West Virginia, multigroup second-order latent growth curves were estimated for Black (13.7%), Latinx (37.0%), Asian (8.1%), and white (41.3%) youth. Black, Latinx, and Asian adolescents increased awareness of inequality longitudinally; white youth showed no change. Multiracial youth accelerated awareness of inequality in mid-adolescence; changes in race and ethnicity predicted decline, followed by increases. Girls with more educated, immigrant-origin parents started out more aware of inequality. Results signal the need for race-specific and intersectional approaches to studying critical consciousness development.

Accelerating UN Sustainable Development Goals with AI-Driven Technologies: A Systematic Literature Review of Women's Healthcare

In this paper, we critically examine if the contributions of artificial intelligence (AI) in healthcare adequately represent the realm of women's healthcare. This would be relevant for achieving and accelerating the gender equality and health sustainability goals (SDGs) defined by the United Nations. Following a systematic literature review (SLR), we examine if AI applications in health and biomedicine adequately represent women's health in the larger scheme of healthcare provision. Our findings are divided into clusters based on thematic markers for women's health that are commensurate with the hypotheses that AI-driven technologies in women's health still remain underrepresented, but that emphasis on its future deployment can increase efficiency in informed health choices and be particularly accessible to women in small or underrepresented communities. Contemporaneously, these findings can assist and influence the shape of governmental policies, accessibility, and the regulatory environment in achieving the SDGs. On a larger scale, in the near future, we will extend the extant literature on applications of AI-driven technologies in health SDGs and set the agenda for future research.

Exploring caregivers' gender attitudes' influence on adolescent health in the eastern Democratic Republic of Congo: A mixed methods study

Adolescence is a developmentally important phase in one's life. However, restrictive gender attitudes that gain increased importance during adolescence prevent many from reaching their health and development potential. The objective of this study is to explore associations between caregiver gender attitudes and adolescent psychosocial health, school attendance, and food security in a sample living in the eastern Democratic Republic of Congo, a region that has experienced persistent poverty and nearly thirty years of insecurity. A mixed methods design was selected for this research. Quantitative results were combined with qualitative focus group discussion results to provide new insight into how caregiver gender attitudes might influence adolescent health and development. Findings from the research suggest that more gender equitable caregiver attitudes are associated with fewer reports of internalising behaviour and greater food security in adolescent girls. No significant associations were found between caregiver gender equality attitudes and adolescent prosocial behaviour or school attendance. Focus group discussions supported some quantitative findings while refuting others. Participants suggested that adolescent girls with caregivers who endorse more equitable gender attitudes experience less psychological control and witness less conflict and violence between caregivers in their home.

The civic engagement community participation thriving model: A multi-faceted thriving model to promote socially excluded young adult women

Social policies to promote socially excluded young adult women generally concentrate on education, employment, and residence but tend to neglect thriving. The current article puts forward a Civic Engagement Community Participation Thriving Model (CECP-TM) that views thriving as a social policy goal in and of itself. It posits that civic engagement, beyond its contribution to social justice, serves as a vehicle for thriving through self-exploration and identity formation. Both are considered key components of successful maturation and thriving. Nonetheless, civic engagement and self-exploration tend not to be nurtured in socially excluded young adult women, a unique group experiencing intersecting discrimination. The model shows how active civic engagement in the context of a community of peers contributes to developing a sense of belonging and connectedness and promotes new self-reflection, identity formation, and agency capabilities. When situated within the context of intersectionality, these encourage the development of critical consciousness and new understandings of “who I am and how I fit into the social world in which we live.” These can provide a sense of meaning, contribute to identity formation, and promote the thriving of the self and the community. Several examples illustrate the model.

Civic Engagement in Socially Excluded Young Adults Promotes Well-Being: The Mediation of Self-Efficacy, Meaning in Life, and Identity Exploration

Civic engagement is thought to contribute to well-being among young adults. However, less is known about the ways in which civic engagement promotes well-being in general and in particular in socially excluded populations. This study investigated whether civic engagement contributes to life satisfaction and hope in a sample of 127 socially excluded young Israeli women who participated in social activism programs for a period of eight months. A mediation model incorporating self-efficacy, meaning in life, and identity exploration was used to examine the contribution of positive attitudes toward civic engagement, civic engagement skills, and political awareness to the participants' life satisfaction and hope. Indirect effects were found between positive attitudes toward civic engagement, civic engagement skills, and political awareness and the participants' life satisfaction and hope via self-efficacy. Positive attitudes toward civic engagement and political awareness also predicted the participants' life satisfaction via meaning in life. A positive direct effect was found between political awareness and hope. However, contrary to the hypothesis, a negative direct effect was found between positive attitudes toward civic engagement and life satisfaction. Civic engagement skills and political awareness also predicted identity exploration. These findings underscore the need for clinicians to be aware of the potential benefits of civic engagement for the well-being of socially excluded populations.

A safe place - Adolescents' and young adults' perceptions of youth clinics in northern Sweden

BACKGROUND/OBJECTIVE

Adolescents and young adults are a diverse group with varied health needs. In Sweden, youth clinics are critical for improving their sexual, reproductive, mental, and general health. The aim of this qualitative study was to gain a deeper understanding of key conditions needed for youth friendliness, and to better understand youth-friendly health services from the perspective of adolescents and young adults in northern Sweden.

METHODS

Information was collected through focus group discussions and interviews with 23 adolescents and young adults (aged 16 to 25) at youth clinics in each of the four northernmost regions of Sweden. Interviews were analysed inductively using Braun and Clarke's thematic analysis.

RESULTS

Three themes and six sub-themes emerged. A safe, empowering and holistic space, outlines how youth-friendly physical spaces and staff contributed to a sense of safety in contrast to other healthcare facilities. The theme Youth clinics are accessible - but reaching out is challenging, refers to low thresholds for visiting youth clinics and perceived barriers to access. The third theme "You feel a bit vulnerable" - the importance of privacy, highlights privacy dimensions and young people's vulnerability when their privacy is compromised.

CONCLUSION

Adolescents and young adults perceived youth clinics as being youth-friendly. Key conditions for youth friendliness were safety, respect, a holistic and empowering approach, accessibility, and privacy. Youth-friendly opening hours and outreach to specifically target groups with access barriers are needed. Young people should be involved in the development of equitable youth-friendly health services.

Age at first exposure to violence and later mental health outcomes: A sex-disaggregated, multi-country analysis in sub-Saharan Africa

BACKGROUND

A growing body of research has begun examining the relationship between a child's age at first exposure to violence and outcomes of mental wellbeing, though no studies have assessed these relationships in the sub-Saharan African (SSA) region.

OBJECTIVE

Given known gender and sex differences in violence exposure and mental health symptomology, this study conducts a multi-country, gender-stratified analysis of the relationship between age at first incident of physical violence and outcomes of wellbeing in SSA.

PARTICIPANTS AND SETTING

This study uses data from the Violence Against Children Surveys on 13-24-year-old males and females in five SSA countries (Kenya (2010), Malawi (2013), Nigeria (2014), Tanzania (2009), and Uganda (2015)).

METHODS

The predictor of interest is a categorical variable indicating whether a respondent's first exposure to physical violence took place from 0 to 5, 6-11, 12 and older, or never. Outcomes of interest include: sadness, anxiety, suicide ideation, smoking, drug use, and alcohol use. Employing both country-specific and pooled data, gender-stratified, multiple logistic regressions are used to estimate the effect of age at first exposure to physical violence on the six outcomes of interest.

RESULTS

Findings show significant variation across countries in age at first exposure to physical violence. For females, findings reveal no association between age at first exposure and outcomes of wellbeing; all periods were equally associated with poor outcomes. For males, results show increased likelihood of anxiety, suicide ideation, and alcohol use when the first violence exposure occurred from 0 to 5 years.

CONCLUSIONS

This study advances the literature on gender and sex differences in mental health symptomology, suggesting that boys and girls may exhibit different symptomology in response to comparable exposures to violence.

Self-Reported School Difficulties and the Use of the School Nurse Services by Adolescent Students

Adolescents are increasingly finding school difficult and physical, mental and social problems increase the risk of exclusion. School health services help to identify problems and prevent them from escalating and the school nurse should be consulted when children are struggling academically. This study explored associations between school difficulties and the use of school health nurse services by 73,680 comprehensive school students with median age of 15.3. The study was based on nationally representative data from the 2017 Finnish School Health Promotion study and analyzed by gender. Difficulties in schooling were common and ranged from 9.9–32.7%. Girls reported difficulties more frequently than boys. Having self-reported difficulties was associated with greater use of school health nurse services, with girls seeking help more often than boys with similar issues and more boys saying they had no need for services. In addition, more self-reported difficulties with schooling were associated with unmet need for school health nurse services. School difficulties were associated with greater use of the school health nurse service use when the data were controlled for background factors. This study highlights shortcomings in access to school health nurse services by children with self-reported school difficulties and that girls were more likely report problems and seek help.

The gender gap in adolescent mental health: A cross-national investigation of 566,829 adolescents across 73 countries

Mental ill-health is a leading cause of disease burden worldwide. While women suffer from greater levels of mental health disorders, it remains unclear whether this gender gap differs systematically across regions and/or countries, or across the different dimensions of mental health. We analysed 2018 data from 566,829 adolescents across 73 countries for 4 mental health outcomes: psychological distress, life satisfaction, eudaemonia, and hedonia. We examine average gender differences and distributions for each of these outcomes as well as country-level associations between each outcome and purported determinants at the country level: wealth (GDP per capita), inequality (Gini index), and societal indicators of gender inequality (GII, GGGI, and GSNI). We report four main results: 1) The gender gap in mental health in adolescence is largely ubiquitous cross-culturally, with girls having worse average mental health; 2) There is considerable cross-national heterogeneity in the size of the gender gap, with the direction reversed in a minority of countries; 3) Higher GDP per capita is associated with worse average mental health and a larger gender gap across all mental health outcomes; and 4) more gender equal countries have larger gender gaps across all mental health outcomes. Taken together, our findings suggest that while the gender gap appears largely ubiquitous, its size differs considerably by region, country, and dimension of mental health. Findings point to the hitherto unrealised complex nature of gender disparities in mental health and possible incongruence between expectations and reality in high gender equal countries.

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Girls have worse average mental health than boys across 4 measures of mental health.

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There is large heterogeneity in the size of the mental health gender gap across countries.

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The gap is most pronounced for psychological distress and life satisfaction.

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More gender equal countries have larger gender gaps in mental health.

A Sex/Gender Perspective on Interventions to Reduce Sedentary Behaviour in Girls and Boys: Results of the genEffects Systematic Review

This systematic review aims to evaluate the extent of sex/gender consideration and effectiveness of interventions designed to reduce sedentary behaviour (SB). We searched for randomised or non-randomised controlled trials with the outcome SB and a sex/gender analysis in eleven electronic databases. Sixty-seven studies were included. Sex/gender considerations were qualitatively rated. Sex/gender was reported separately in 44.8% of studies, 14.9% of studies conducted a sex/gender interaction analysis, and 19.4% enrolled either girls or boys. SB was significantly reduced for girls in 16.4%, for boys in 11.9% and for both in 13.4%. No sex/gender intervention effect was found in 38.8%. According to the qualitative rating, studies without significant sex/gender effects reached "detailed" rating twice as often as studies finding a significant intervention effect for either girls or boys, or both. Overall, no clear pattern according to the qualitative rating and in terms of intervention effectiveness can be drawn. The results reveal a lack of sufficient sex/gender information in intervention planning and delivery. Further research should consider analysing sex/gender intervention effects as well as consider sex/gender inclusive intervention planning and delivery.

Socioeconomic Effects in Cyberbullying: Global Research Trends in the Educational Context

Nowadays, cyberbullying has become a problem of social harassment in numerous educational centres worldwide. New communication technologies have provided the perfect support for the development of this type of harassment in peer relationships, in addition to being linked to broad social and economic circumstances. In this study, the global trends of the socioeconomic implications of cyberbullying in the educational context have been analysed, from 2004 to 2019. Thus, a bibliometric analysis has been applied to 1128 articles, obtaining results of the evolution of scientific activity in this period. The articles are mainly associated with the thematic areas of Social Sciences, Psychology, Medicine and Computer Science. Seven main thematic axes have been detected, highlighting those related to the psychological aspect, adolescence, and the school environment. Likewise, the link of the main authors, institutions, and countries to these lines of research has been detected. The evidence has shown the interest and relevance of this topic at the international level. Future research lines propose different analyses about how certain socioeconomic factors influence this psychological harassment inside and outside the classroom.