A Scoping Review of Adolescent Health Indicators

Unifying Public Health Surveillance: A Scoping Review of Global Use of the Youth Risk Behavior Survey

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.

Economic Indicators, Quantity and Quality of Health Care Resources Affecting Post-surgical Mortality

OBJECTIVE

to identify correlations between quality and quantity of health care resources, national economic indicators, and postoperative in-hospital mortality as reported in the EUSOS study.

METHODS

Different variables were identified from a series of publicly available database. Postoperative in-hospital mortality was identified as reported by EUSOS study. Spearman non-parametric and Coefficients of non-linear regression were calculated.

RESULTS

Quality of health care resources was strongly and negatively correlated to postoperative in-hospital mortality. Quantity of health care resources were negatively and moderately correlated to postoperative in-hospital mortality. National economic indicators were moderately and negatively correlated to postoperative in-hospital mortality. General mortality, as reported by WHO, was positively but very moderately correlated with postoperative in-hospital mortality.

CONCLUSIONS

Postoperative in-hospital mortality is strongly determined by quality of health care instead of quantity of health resources and health expenditures. We suggest that improving the quality of health care system might reduce postoperative in-hospital mortality.

Trends in Adolescent Sexual and Reproductive Health Outcomes Before and Into the COVID-19 Pandemic in Burkina Faso and Kenya: Evidence From Panel Data

PURPOSE

Many predicted that COVID-19 would have a substantial impact on the sexual and reproductive health (SRH) trajectories of adolescents in sub-Saharan Africa. The lack of longitudinal data with information collected before and into the pandemic has limited investigation into this topic.

METHODS

We performed a secondary analysis using nationally representative longitudinal data from Kenya and Burkina Faso, collected at three time points (pre-COVID-19 in late 2019, and during COVID-19 in 2020 and 2021), to determine the extent to which SRH outcomes and behaviors, including pregnancy, contraceptive use, partnership status, and sexual activity, changed during the pandemic among adolescent women.

RESULTS

Among adolescents aged 15-19 years (Kenya n = 1,893, Burkina Faso n = 1,422), there was a reduction in both partnership and pregnancy in 2021 as compared to pre-COVID 2019. Contraception use significantly increased between 2019 and 2021 in Kenya only (adjusted odds ratio [aOR]: 1.42, 95% confidence interval [CI] 1.03-1.97). COVID-19-related household income loss was associated with a decline in sexual activity among unmarried Kenyan girls (aOR: 0.47, 95% CI 0.25-0.87) and lower odds of pregnancy in Burkina Faso (aOR: 0.13, 95% CI 0.02-0.91). We did not find a relationship between COVID-19 measures and initiation of partnership or marriage in either setting.

DISCUSSION

Contrary to expectations, our results suggest that COVID-19 did not have a consistent or sustaining impact on adolescent SRH and behaviors in Burkina Faso and Kenya. Further research is needed to assess the longer-term implications of the pandemic on adolescent social and health outcomes.

State-level population estimates of sexual minority adolescents in the United States: A predictive modeling study

PURPOSE

The Youth Risk Behavior Survey (YRBS) among high school students includes standard questions about sexual identity and sex of sexual contacts, but these questions are not consistently included in every state that conducts the survey. This study aimed to develop and apply a method to predict state-level proportions of high school students identifying as lesbian, gay, or bisexual (LGB) or reporting any same-sex sexual contacts in those states that did not include these questions in their 2017 YRBS.

METHODS

We used state-level high school YRBS data from 2013, 2015, and 2017. We defined two primary outcomes relating to self-reported LGB identity and reported same-sex sexual contacts. We developed machine learning models to predict the two outcomes based on other YRBS variables, and comparing different modeling approaches. We used a leave-one-out cross-validation approach and report results from best-performing models.

RESULTS

Modern ensemble models outperformed traditional linear models at predicting state-level proportions for the two outcomes, and we identified prediction methods that performed well across different years and prediction tasks. Predicted proportions of respondents reporting LGB identity in states that did not include direct measurement ranged between 9.4% and 12.9%. Predicted proportions of respondents reporting any same-sex contacts, where not directly observed, ranged between 7.0% and 10.4%.

CONCLUSION

Comparable population estimates of sexual minority adolescents can raise awareness among state policy makers and the public about what proportion of youth may be exposed to disparate health risks and outcomes associated with sexual minority status. This information can help decision makers in public health and education agencies design, implement and evaluate community and school interventions to improve the health of LGB youth.

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

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.

Towards Harmonized Adolescent Health Measurement: Assessing Alignment Between Current Recommendations and the Global Action for Measurement of Adolescent Health-Recommended Indicators

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.

Exploring a Preliminary Set of Indicators to Measure Adolescent Health: Results From a 12-Country Feasibility Study

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.

Relevance of the Sustainable Development Goals (SDGs) to Adolescent Health Measurement: A Systematic Mapping of the SDG Framework and Global Adolescent Health Indicators

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.

The international Family Affluence Scale (FAS): Charting 25 years of indicator development, evidence produced, and policy impact on adolescent health inequalities

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.

Priority strategic directions in adolescent health in Iran based on the WHO's Global Accelerated Action for the Health of Adolescents

OBJECTIVES

In line with the World Health Organization's Global Accelerated Action for the Health of Adolescents (AA-HA!) guidance, the goal of the current research was to identify critical strategies for adolescents' health and to determine the role and distribution of responsibilities among the leading players in the field of adolescent health in Iran.

METHODS

The current qualitative and applied study is part of the Ministry of Health and Medical Education's "Adolescent, Youth and School Health" plan to develop the "National Adolescent Health Plan Document" in 2020. First, stakeholder analysis was done, then a pool of nationally appropriate strategies was selected from the list of priority strategies recommended by the WHO in the AA-HA! through several group sessions. After that, the experts selected priority strategies based on the criteria of feasibility, acceptability, effectiveness, guaranteed resources, coordination with other plans and temporal priority, scoring, and executive priorities. Eventually, the priority strategies were assigned to different players/stakeholders in the field over several sessions bearing in mind the methods of implementation and the target groups.

RESULTS

The experts identified 58 priority strategies/actions for adolescent health under the seven priority areas of positive development, sexual protection, reproductive health, mental health, substance abuse, self-harm, violence, unintentional injury, communicable and non-communicable diseases, nutrition, and physical activity.

CONCLUSIONS

The highest identified priority areas were in the areas of vaccination; special health care package for service providers; training and education to promote health literacy and self-care, life skills, sexual awareness, and prevention/protection against violence; community-based mental health services, planning for adolescents' spare time, substance use prevention.

Counting adolescents in: the development of an adolescent health indicator framework for population-based settings

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.

An overview of the main messages from key data on young people's health in the UK

Having access to good data on the health of 10-24 year olds is essential for targeting services and improving health outcomes for this age group. We identify the main UK population level data compendiums that include young people, outline some clear messages those data tell us about the state of youth health and suggest what this means for setting priorities for policy and practice.Although 10-24 year olds in the UK are generally in good health, the data reveal some trends that suggest the need for more prevention and early intervention during adolescence and early adulthood to protect their health now, their future health and the health of their own families later down the line. Particular concerns include preventable mortality, mental health trends, rates of obesity and the need to promote self-management of long-term conditions arising in the transition to adulthood.

Opportunities to advance measurement of adolescent wellbeing: building on a new conceptual framework

Available data are insufficient and inconsistent, but increasing focus on adolescent wellbeing provides the impetus to advance measurement, argue Holly Newby and colleagues

Priority Indicators for Adolescent Health Measurement - Recommendations From the Global Action for Measurement of Adolescent Health (GAMA) Advisory Group

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.

Exhausted due to the pandemic: Validation of Coronavirus Stress Measure and COVID-19 Burnout Scale in a Polish sample

This study validated Polish versions of the Coronavirus Stress Measure (CSM) and the COVID-19 Burnout Scale (COVID-19-BS) to measure stress and burnout associated with COVID-19. Participants were 431 Polish young adults (72.6% female; Meanage = 26.61 ± 12.63). Confirmatory factor analysis verified a one-factor solution for both the CSM and the COVID-19-BS. Both scales had high internal consistency reliability. Coronavirus stress and COVID-19 burnout were positively related to depression, anxiety, and stress and negatively related to resilience. The coronavirus stress and COVID-19 burnout were correlated with elevated levels of depression, anxiety, and stress over and beyond resilience, age, and gender. Findings suggest that the Polish versions of the CSM and the COVID-19-BS are valid scales to measure stress and burnout related to COVID-19. Findings also demonstrated that the coronavirus stress and COVID-19 burnout experienced during the later stages of the pandemic might be a permanent risk factor for mental health problems.