Studying adolescence

Long-lasting effects of disturbing the circadian rhythm or sleep in adolescence

Circadian rhythms are endogenous, near 24-hour rhythms that regulate a multitude of biological and behavioral processes across the diurnal cycle in most organisms. Over the lifespan, a bell curve pattern emerges in circadian phase preference (i.e. chronotype), with children and adults generally preferring to wake earlier and fall asleep earlier, and adolescents and young adults preferring to wake later and fall asleep later than their adult counterparts. This well-defined shift speaks to the variability of circadian rhythmicity over the lifespan and the changing needs and demands of the brain as an organism develops, particularly in the adolescent period. Indeed, adolescence is known to be a critical period of development during which dramatic neuroanatomical changes are occurring to allow for improved decision-making. Due to the large amount of re-structuring occurring in the adolescent brain, circadian disruptions during this period could have adverse consequences that persist across the lifespan. While the detrimental effects of circadian disruptions in adults have been characterized in depth, few studies have longitudinally assessed the potential long-term impacts of circadian disruptions during adolescence. Here, we will review the evidence that disruptions in circadian rhythmicity during adolescence have effects that persist into adulthood. As biological and social time often conflict in modern society, with school start times misaligned with adolescents' endogenous rhythms, it is critical to understand the long-term impacts of disrupted circadian rhythmicity in adolescence.

Caries clusters at lesion-severity thresholds: A Sierra Leone case study

OBJECTIVES

Despite being almost entirely preventable, globally, dental caries is extremely prevalent. Moreover, dental caries will continue to present an even larger challenge for lower income countries, particularly those in the African context, as they transition to a more Western diet. Hence, epidemiological data providing insight into disease patterns and trends is critical to inform public health action. The purpose of this study was to examine dental caries clusters by caries detection threshold among 15-year-old adolescents in Sierra Leone, using data from the latest national survey, and to explore associated sociodemographic factors.

METHODS

This paper presents a secondary analysis of oral health data on 490 15-year-olds from the Sierra Leone national oral health survey of schoolchildren. Hierarchical cluster analysis of dental caries experience was conducted across all surfaces at four decay detection thresholds using the International Caries Detection and Assessment System (ICDAS) (clinical: ICDAS 2-6, cavitated: ICDAS 3-6, obvious: ICDAS 4-6 and extensive obvious: ICDAS 5-6 decay) across the four regions of Sierra Leone. Ordered logistic regression was used to estimate the association of sociodemographic factors with generated clusters relating to clinical and obvious decay experience. These are of both clinical and epidemiological relevance.

RESULTS

A 3-cluster decay pattern representing a 'low' to 'high' decay experience distribution was observed under each decay detection threshold across surfaces. For clinical decay (including visual enamel caries), 28.8% had low, 55.1% medium and 15.9% high caries status. In the adjusted model, the only significant risk factor across obvious and clinical decay thresholds was region, with adolescents outside the Western region more likely to experience decay.

CONCLUSION

This study suggests that adolescents in Sierra Leone fall into three distinct caries clusters: low, medium to high decay experience distribution, regardless of decay threshold. It reinforces the importance of recognizing dental caries detection thresholds and the use of contemporary epidemiological methodology. This suggests that adolescents outside the Western region are likely to have higher caries experience. The data also provides insight to the nature of adolescents in each cluster and should help to inform policy and planning of the integration of oral health into primary care and school systems.

The patterns, trends and major risk factors of suicide among Indian adolescents-A scoping review protocol

INTRODUCTION

Suicide is one of the serious health problems among Indian adolescents. Adolescence helps with the transition of an individual into an adult, so it is important to understand the suicidal behavior of adolescents. Several studies have been carried out in different states in India on the suicidal behavior of adolescents, but there is no review that studied the national patterns, trends, and major risk factors. Therefore, this review aims to study the patterns, trends, and major risk factors of suicidal behavior among Indian adolescents.

METHODS

The study will be conducted as per the Arksey and O'Malley scoping review framework and the Joanna Briggs institute Reviewers' manual. The Population, Concept and Context strategy (PCC) will ensure the review questions, eligibility criteria and search strategy. The Systematic Review and Meta-analysis: Extension for Scoping Review (PRISMA-ScR) will be used for the findings of the study of Scoping Review. The literature search will be done using electronic databases: PubMed, Google Scholar, SCOPUS, EMBASE, Psycinfo, Web of Science, Google, and Cochrane library by specific keywords such as "patterns"; "suicide"; "trends"; "risk factors"; "depression"; "anxiety"; "mental health"; "adolescent"; "teenager"; and "youth";" India" etc. Additional studies will be considered using cross-references.

ETHICS AND DISSEMINATION

This study does not involve the collection of primary data; there is no requirement of any ethical approval.

STRENGTHS AND LIMITATIONS OF THE STUDY

The proposed scoping review is the first study on patterns, trends, and major risk factors of adolescent suicide in India as per the information available on the online platforms.This proposed scoping review will bring together all the previously available data into one place for better study.This evidence-based study will be highly helpful for healthcare professionals and policymakers. This study will be limited to English language and electronically available evidence.

Parental divorce and smoking dependence in Lebanese adolescents: the mediating effect of mental health problems

BACKGROUND

Lebanon has the highest prevalence estimates among Middle Eastern countries and Arab women regarding cigarette smoking, with 43% of men and 28% of women involved in such trends. Marital disruption is a tremendous source of irritability and discomfort that may hinder a child's healthy development, creating perturbing distress and increasing disobedience that may exacerbate smoking addiction. Additionally, Lebanese adolescents are inflicted by high emotional and economic instability levels, rendering increased susceptibility to distress and propensity to engage in addictive behavior. This study aims to investigate the association between parental divorce and smoking dependence among Lebanese adolescents, along with exploring the potential mediating effect of mental health disorders of such correlation.

METHODS

A total of 1810 adolescents (14 and 17 years) enrolled in this cross-sectional survey-based study (January-May 2019). Linear regressions were conducted to check for variables associated with cigarette and waterpipe dependence. PROCESS v3.4 model 4 was used to check for the mediating effect of mental health disorders between parental divorce and smoking dependence.

RESULTS

Higher suicidal ideation and having divorced parents vs living together were significantly associated with more cigarette and waterpipe dependence. Higher anxiety was significantly associated with more waterpipe dependence. Insomnia and suicidal ideation played a mediating role between parental divorce and cigarette/waterpipe dependence.

CONCLUSION

Our results consolidate the results found in the literature about the association between parental divorce and smoking addiction and the mediating effect of mental health issues. We do not know still in the divorce itself or factors related to it are incriminated in the higher amount of smoking in those adolescents. Those results should be used to inspire parents about the deleterious effect of divorce on their children to lower their risk of smoking addiction. Further longitudinal studies are needed to better understand the complexity of such associations and to see whether the divorce experience by itself or the factors that accompany it are involved in the increased smoking addiction among adolescents.

How Ethnic Minority Context Alters the Risk for Developing Mental Health Disorders and Psychological Distress for Latinx Young Adults

Policy Points In low-income communities in the South Bronx and Puerto Rico, Puerto Rican youth are exposed to many of the same risk and protective factors for developing depression, anxiety, or psychological distress; yet it is unclear how the ethnic minority context of the South Bronx and ethnic majority context of Puerto Rico influence risk. Results from our quasi-experimental, longitudinal study demonstrate the importance of addressing social factors (parent-child relationships, youth peer relationships) for youth living in the majority context, and neighborhood and cultural factors (residential mobility, perceived discrimination, perceived social position in the neighborhood) for youth living in the minority context. Our findings support the need for tailoring programs specific to the needs of youth who reside in an ethnic majority or a minority context, since some of the risk factors might operate differently depending on context. Housing and neighborhood environment policies that address discrimination and eliminate structural inequities for ethnic minority groups may protect against the harm of minoritization on young people's mental health.

CONTEXT

Puerto Rican youth growing up in low-income communities in the South Bronx and Puerto Rico are exposed to many of the same risk factors for major depressive disorder, generalized anxiety disorder, and psychological distress. One potentially powerful factor differs: Puerto Ricans have been socially marginalized as an ethnic minority group in the South Bronx, but are the ethnic majority of the population in Puerto Rico. A growing body of literature demonstrates the influence of neighborhood, cultural, and social factors and parental psychopathology in the development of mental health problems. An important unanswered question is whether these risk and protective factors have the same impact for youth raised as members of an ethnic majority versus minority group.

METHODS

Using a population-based cohort study, with four waves of assessment from early childhood into young adulthood, we investigated whether ethnic minority context alters risk and protective factors for depression, anxiety, and psychological distress. Our longitudinal data set includes 2,491 young children at baseline (82.8% retained at wave 4). Using a quasi-experimental design, we examine how ethnic minority context can alter the development of mental health disorders as Latinx children transition to late adolescence and young adulthood.

FINDINGS

Some risk and protective factors operated differently across minority and majority contexts. Higher discrimination and social position were more powerful risk and protective factors, respectively, in the minority context, whereas positive peer relationships mattered more in the majority context. Children of mothers with depression were significantly more likely to develop anxiety in late adolescence and young adulthood in the majority context (60.0%) compared to the minority context (4.5%).

CONCLUSIONS

Preventing depression and anxiety disorders in Latinx young adults may require targeting different childhood factors depending on whether they reside within the ethnic majority or minority context. People in the ethnic minority context may benefit more from policies aimed at reducing discrimination and improving economic opportunity, while people in the majority context may benefit more from opportunities for strengthening family and peer relationships.

Adolescents' Self-Esteem and Life Satisfaction: Communication with Peers as a Mediator

The main goal of this study was to verify whether the relationship between adolescents’ self-esteem and life satisfaction is mediated by peer communication. The rationale behind this choice was the fact that while we know a lot about the association between self-esteem and life satisfaction in adolescents, we know far less about the mechanisms that may regulate this direct relationship. The research was conducted among high school students in one of the Polish provincial capitals (N = 429). The Rosenberg Self-Esteem Scale, the Satisfaction with Life Scale, and the Scale of Communication of Adolescents with Peers were used. In line with the hypotheses, self-esteem correlated positively with life satisfaction and openness, and negatively with difficulty in communication with peers. Open peer communication was positively associated with life satisfaction, and difficult peer communication was negatively correlated with life satisfaction. Moreover, the association between self-esteem and life satisfaction was mediated by openness and difficulty in peer communication. The mediatory effect of peer communication suggests that the simple bivariate relationship between adolescents’ evaluation of the self and a subjective assessment of their overall quality of life may be more complex.

Clustering of multiple lifestyle behaviors among migrant, left-behind and local adolescents in China: a cross-sectional study

BACKGROUND

Influence of migration on externalized behavioral problems (e.g., aggressive) among adolescents has been well assessed, yet lifestyle behaviors of migrant, left-behind and local adolescents have been largely overlooked by researchers and policy-makers. Therefore, this study aimed to identify clustering of multiple lifestyle behaviors and their associations with migrant status among Chinese adolescents.

METHODS

A cross-sectional survey was conducted in 2015 in Beijing, and Wuhu city (Anhui province). Adolescents self-reported age, gender, family economic status, migrant situation, and lifestyle behaviors (i.e., physical activity, screen time, sleep, smoke, soft-drink, alcohol, fruit and vegetable consumption) via a battery of validated questionnaires. Latent class analysis was conducted to identify behavioral clusters using Mplus 7.1. ANOVA, and multivariable logistic regression were used to examine associations between migrant situations and behavioral clusters using SPSS 22.

RESULTS

Three distinct behavioral clusters were exhibited among 1364 students (mean age: 13.41 ± 0.84 years): "low risk" (N = 847), "moderate risk" (N = 412) and "high risk" (N = 105). The "high-risk" cluster had the highest prevalence of adolescents not meeting healthy behavioral recommendations. There were no significant differences in the prevalence of high-risk lifestyle among migrant, left-behind, rural local and urban local adolescents. But migrant adolescents had the lowest prevalence of low-risk lifestyle, followed by left-behind, rural and urban local adolescents. Moreover, compared with urban local, migrant (OR = 2.72, 95%CI: 1.88,3.94), left-behind (OR = 2.28, 95%CI: 1.46, 3.55), and rural local (OR = 1.76, 95%CI:1.03,3.01) adolescents had a higher risk of moderate-risk lifestyle.

CONCLUSIONS

Clustering of assessed lifestyle behaviors differed by the migrant status. Particularly, migrant and left-behind adolescents were more likely to have moderate-risk lifestyle compared with their counterparts. Interventions that promote moderate to vigorous physical activity and consumption of fruits and vegetables simultaneously are needed among them.

Factors associated with current tobacco use among adolescents and young students

OBJECTIVES

To determine the prevalence of current tobacco use and its association with sociodemographic factors and risk behaviors among adolescents and young students, according to gender.

METHODS

The sample consisted of students from the state public school network aged between 12 and 24 years, who answered the Brazilian version of the Youth Risk Behavior Survey questionnaire. The data were analyzed in SPSS software (v. 20.0), using Poisson regression to evaluate the prevalence ratio (PR) of the independent variables in relation to the outcome. p<0.05 was established as the significance level.

RESULTS

The final analysis consisted of 1275 adolescents, of whom 716 (56.2%) were girls and 559 (43.8%) were boys. The prevalence of current tobacco use was 6.6% among girls and 9.7% among boys. In females, consuming alcohol in the last 30 days (3.91 [1.54-9.94]) and being 14 years old or younger (0.50 [0.26-0.96]) influenced current tobacco use. In the male gender, tobacco use in the last 30 days was influenced by current alcohol consumption (2.92 [1.21-7.08]) and involvement in physical fighting in the last 12 months (2.32 [1.32-4.09]).

CONCLUSION

Although the prevalence of current tobacco use was low in both genders, the assessed population still presents a risk, since male involvement in physical fighting and current consumption of alcohol in both genders increased the probability of this population becoming regular tobacco users.

Association between parental separation and addictions in adolescents: results of a National Lebanese Study

Background

Since divorce rates are on the rise in Lebanon (an increase of 101% between 2006 and 2017) and since previous international studies have shown a relationship between divorced parents and adolescents’ addiction to smoking, alcohol, and the internet, assessing the background of the Lebanese situation was deemed necessary. The study objective was to investigate the association between the divorce of parents and smoking, alcohol, and internet addiction among a representative sample of Lebanese adolescents.

Methods

This study was a cross-sectional, conducted between January and May 2019 using a proportionate random sample of schools from all Lebanese Mohafazat. Out of 2000 questionnaires distributed; 1810 (90.5%) were completed and collected back.

Results

The mean age was 15.42 ± 1.14 years, with 53.3% females and 74.1% smokers. In addition, 11.9% [95% CI 0.104–0.134] of the adolescents had separated/divorced parents. Divorce in parents was significantly associated with higher alcohol use disorder (Beta = 8.035), higher cigarette dependence (Beta = 2.767) and a higher waterpipe dependence (Beta = 5.263) in adolescents. However, divorce in parents was not associated with internet addiction in adolescents.

Conclusion

Parental divorce is correlated to higher alcohol and smoking, but not internet addiction among adolescents. Children whose parents are divorced should be subject to continuous follow-up by their parents and by a psychiatrist/psychologist in order not to develop an addiction that could potentially harm them.

The Mediating Role of the Self-Concept Between the Relationship of the Body Satisfaction and the Intention to Be Physically Active in Primary School Students

The aim was to analyze the extent to which anthropometric values, in line with body image and physical ability, predict physical self-concept, and the latter, in turn, predicts the practice and intention to pursue physical activity. A total of 302 participants, 150 males and 152 females were recruited from different primary schools in Extremadura (Spain). The age of the participants ranges from 10 to 13 years old (M = 11.74; SD = 0.86). The indirect effects of the model showed significant relationship between physical condition (p = 0.001) and PA levels, according to the perception of self-concept [β = 0.231, 95% BcCI = (0.055, 0.212)]. However, anthropometric variables proved not to be related to any significant extent (p < 0.05). The second level covered the indirect effects between the intention to be physically active and self-concept, which showed a significant relationship between the perception of self-concept (p = 0.000) and the intention to be physically active. Last, the third level showed significant relationships between physical condition (p = 0.001) and the intention to pursue physical activity. The present investigation concluded that physical condition, anthropometric variables, and body image predict the perception of physical self-concept in adolescents. Finally, this article highlights the importance of body image perception, anthropometric values, and physical condition in the intention of being physically active. In addition, it highlights the mediating role of physical self-concept to develop physical activity.

Parenting perspective on the psychosocial correlates of adolescent sexual and reproductive health behavior among high school adolescents in Ethiopia

BACKGROUND

While parents are a crucial part of the social environment in which adolescents live, learn and earn, they could play important roles in efforts to prevent adolescent sexual and reproductive health (SRH) risk behaviors and promote healthy development. Involving parents in prevention programs to risky SRH practices in adolescents requires understanding of the effect of different parenting practices and styles on these behaviors. The purpose of this study was to investigate the relationships between various aspects of perceived parenting and self-reported engagement in sexual risk behavior among adolescents.

METHODS

A cross-sectional study was employed among 406 randomly selected 14-19 years old high school adolescents in Legehida district, Northeast Ethiopia from 15 February to 15 March/ 2016. Structured and pre-tested self-administered questionnaire adapted from the Youth Risk Behavior Surveillance questionnaire was used for the data collection. Bivariate and multivariate logistic regression analysis with odds ratio along with the confidence interval of 95% were used. P-value < 0.05 were considered for statistical significance.

RESULTS

About two-third (64.5%) of the participants reported that they had ever had sex. Nearly half (48.6%) of the participants who were currently sexually active reported that they engaged in at least one type of risky sexual behavior. Specifically, 42.7% reported starting sexual life earlier, 32.2% having more sexual partners in the past 12 months and 23.8% never used condom during the most recent sexual intercourse. High quality parent─adolescent relationships (AOR = 0.53; 95% CI (0.45-0.63) and authoritative form of parenting (AOR = 0.74; 95% CI (0.61-0.92) were associated with lower odds of engaging in risky sexual behaviors in adolescents. The odds of risky sexual behaviors were about three-fold higher in adolescents who perceived parental knowledge as poor (AOR = 2.97; 95% CI (1.51-4.25) and to some extent (AOR = 3.00; 95% CI (1.43-5.55) toward SRH than those whose parents were very knowledgeable. Adolescents with poor behavioral beliefs on SRH issues had a 37% increased odds of engaging in risky sexual behaviors.

CONCLUSIONS

Therefore, to engage the parents within preventive interventions design to support healthy SRH behaviors among adolescents, the role of authoritative parenting style, and improved quality of parent-adolescent relationship, as well as improving adolescents' behavioral beliefs and parental knowledge towards SRH are essential.

Knowledge and quality of adolescents reproductive health communication between parents and their adolescents children in Ibadan, Nigeria

Communication between parents and adolescents on Adolescent Reproductive Health (ARH) issues are emerging public health concerns in Nigeria; yet they can be tackled through parents’ intervention. This study was designed to document the parents’ knowledge and quality of communication relating to ARH between parents and their adolescents in Ibadan, Oyo State, Nigeria.A descriptive cross-sectional study was conducted in two Local Government Areas in the state. Interviewer-administered instruments were used to collect data from the parents and adolescents pair. Both instruments included a 28-point knowledge scale and questions on ARH practices. The instrument for adolescents contained an additional 15-point Perceived Quality of ARH Communication (PQARHC). Knowledge scores ≤9, ≤10-18 and ≥20 were categorized as poor, fair and good, respectively for both parents and adolescents. Data were analyzed using descriptive statistics and Chisquare tests at P=0.05. Ages of adolescents were 13.9±2.4 years while parents’ ages was 42.6±8.5 years. Parent’s and adolescents knowledge scores 22.6±3.4 and 19.4±5.9, respectively with no significant difference. Adolescents whose parents ever discussed ARH issues with them were 20.9% as against 72.1% by the parents. The proportion of parents and adolescents with good knowledge of ARH were 89.4% and 64.7% with no significant difference while the proportion of Adolescents’ PQARHC with their parents was adjudged to be of good quality communication was 82.2% with P&gt;0.05. Both the parents and adolescents had good knowledge of adolescent reproductive health but practice and quality of communication was poor. Therefore, training intervention to improve the adolescent- parent communication is recommended for the parents.

Intracerebroventricular injection of RFRP-3 delays puberty onset and stimulates growth hormone secretion in female rats

BACKGROUND

Puberty onset is a complex, organized biological process with multilevel regulation, and its physiopathological mechanisms are yet to be elucidated. RFRP-3, the mammalian ortholog to gonadotropin-inhibitory hormone, is implicated in inhibiting the synthesis and release of gonadotropin in mammals. However, it is unclear whether RFRP-3 participates in regulating pubertal development.

METHODS

This study investigated the functional significance and regulatory mechanism of hypothalamic RFRP-3 neuropeptide in the onset of puberty in young female rats. On postnatal day 22, we implanted cannulas into the lateral ventricles of female rat pups. From postnatal day 28 to postnatal day 36, the intracerebroventricular injection of RFRP-3, or vehicle, was conducted twice a day. To investigate whether puberty onset was affected, we examined the body weight, age of vaginal opening, serum hormone levels, uterus and ovary development, and hypothalamic Kiss-1 mRNA expression.

RESULTS

Intracerebroventricular injection of RFRP-3 significantly decreased the serum concentrations of luteinizing hormone and estradiol, delayed uterine maturation, and postponed the time of vaginal opening. This study suggests that RFRP-3 can delay the onset of puberty in young female rats; the expression of Kiss-1 mRNA is potently inhibited in the RFRP-3 group. Moreover, our data show that RFRP-3 elevates serum growth hormone levels.

CONCLUSIONS

These data suggest that intracerebroventricular injection of RFRP-3 significantly delays the onset of puberty in female rats. Additionally, RFRP-3 may be associated with prepubertal rise in the secretion of growth hormone.

Parent-Adolescent Sexual and Reproductive Health Communication Is Very Limited and Associated with Adolescent Poor Behavioral Beliefs and Subjective Norms: Evidence from a Community Based Cross-Sectional Study in Eastern Ethiopia

Introduction

While parent-adolescent sexual and reproductive health (SRH) communication is one potential source of SRH information for adolescents, it appears to be inadequately practiced in Ethiopia. This study was designed to investigate the factors that limit or improve parent-adolescent SRH communication in Harar, Eastern Ethiopia.

Methods

A community based cross-sectional study was done on 4,559 adolescents of age 13–18. SRH communication was measured using a nine-item scale whose response ranged from “not at all” to “always.” Summated composite score ranging from 0–36 was generated; higher score indicates high SRH communication. A median value of the composite score was 4 out of the possible 36 with an Interquartile Range (IQR) of 7. Respondents were ranked as very poor, poor and satisfactory communicators based on 33rd and 67th percentiles values. Generalized ordered logit model was applied to investigate the factors associated with SRH communication.

Results

Results showed that the adolescents who were more likely to practice poor-very poor/very poor SRH communication were those who had poor behavioral beliefs on and poor subjective norms of communicating sexual issues with parents and those who perceived their parents’ reproductive health (RH) knowledge as poor. Nonetheless, the probability of poor-very poor/very poor SRH communication was less with high adolescent-parent communication quality, television co-viewing and discussions, and self-disclosure.

Conclusions

Curtailing the adolescents’ underlying poor beliefs and norms, and improving adolescent-parent communication quality, self-disclosure, and television co-viewing and discussions are essential to engage the parents in sexual and reproductive health education of the adolescents.

Daily successive changes in reproductive gene expression and neuronal activation in the brains of pubertal female mice

Puberty is governed by the secretion of gonadotropin releasing hormone (GnRH), but the roles and identities of upstream neuropeptides that control and time puberty remain poorly understood. Indeed, how various reproductive neural gene systems change before and during puberty, and in relation to one another, is not well-characterized. We detailed the daily pubertal profile (from postnatal day [PND] 15 to PND 30) of neural Kiss1 (encoding kisspeptin), Kiss1r (kisspeptin receptor), Tac2 (neurokinin B), and Rfrp (RFRP-3, mammalian GnIH) gene expression and day-to-day c-fos induction in each of these cell types in developing female mice. Kiss1 expression in the AVPV/PeN increased substantially over the pubertal transition, reaching adult levels around vaginal opening (PND 27.5), a pubertal marker. However, AVPV/PeN Kiss1 neurons were not highly activated, as measured by c-fos co-expression, at any pubertal age. In the ARC, Kiss1 and Tac2 cell numbers showed moderate increases across the pubertal period, and neuronal activation of Tac2/Kiss1 cells was moderately elevated at all pubertal ages. Additionally, Kiss1r expression specifically in GnRH neurons was already maximal by PND 15 and did not change with puberty. Conversely, both Rfrp expression and Rfrp/c-fos co-expression in the DMN decreased markedly in the early pre-pubertal stage. This robust decrease of the inhibitory RFRP-3 population may diminish inhibition of GnRH neurons during early puberty. Collectively, our data identify the precise timing of important developmental changes - and in some cases, lack thereof - in gene expression and neuronal activation of key reproductive neuropeptides during puberty, with several changes occurring well before vaginal opening.

Caregivers' intentions to disclose HIV diagnosis to children living with HIV in South Africa: a theory-based approach

When children know their HIV serostatus, they are more likely to cooperate with steps to manage their health and the risk of transmitting HIV to others. Mounting evidence indicates that caregivers often do not disclose to HIV-positive children that the children are living with HIV, but little is known about the modifiable determinants of pediatric HIV disclosure. The present study examined theory-of-planned-behavior predictors of the intention to disclose to children their HIV diagnosis. The participants were 100 caregivers of HIV-positive children in Eastern Cape Province, South Africa. Proportional-odds logistic regression analysis revealed that normative support for disclosure and caregiver-child communication predicted the intention to disclose, whereas behavioral beliefs regarding the consequences of disclosing and self-efficacy to disclose did not. The results suggest that interventions to increase pediatric HIV disclosure in South Africa should help caregivers enlist support for disclosure among important referents and improve communication with their HIV-infected children.

The study design and methodology for the ARCHER study--adolescent rural cohort study of hormones, health, education, environments and relationships

Background

Adolescence is characterized by marked psychosocial, behavioural and biological changes and represents a critical life transition through which adult health and well-being are established. Substantial research confirms the role of psycho-social and environmental influences on this transition, but objective research examining the role of puberty hormones, testosterone in males and oestradiol in females (as biomarkers of puberty) on adolescent events is lacking. Neither has the tempo of puberty, the time from onset to completion of puberty within an individual been studied, nor the interaction between age of onset and tempo. This study has been designed to provide evidence on the relationship between reproductive hormones and the tempo of their rise to adult levels, and adolescent behaviour, health and wellbeing.

Methods/Design

The ARCHER study is a multidisciplinary, prospective, longitudinal cohort study in 400 adolescents to be conducted in two centres in regional Australia in the State of New South Wales. The overall aim is to determine how changes over time in puberty hormones independently affect the study endpoints which describe universal and risk behaviours, mental health and physical status in adolescents. Recruitment will commence in school grades 5, 6 and 7 (10–12 years of age). Data collection includes participant and parent questionnaires, anthropometry, blood and urine collection and geocoding. Data analysis will include testing the reliability and validity of the chosen measures of puberty for subsequent statistical modeling to assess the impact over time of tempo and onset of puberty (and their interaction) and mean-level repeated measures analyses to explore for significant upward and downward shifts on target outcomes as a function of main effects.

Discussion

The strengths of this study include enrollment starting in the earliest stages of puberty, the use of frequent urine samples in addition to annual blood samples to measure puberty hormones, and the simultaneous use of parental questionnaires.

Concepções de saúde mental a partir da análise do desenho de adolescentes

Neste estudo buscou-se conhecer a percepção de saúde mental de adolescentes advindos de contextos socioeconômicos diferentes. Participaram da pesquisa 252 jovens do Distrito Federal, do Ensino Médio, sendo 129 de escola particular situada em região com alto Índice de Desenvolvimento Humano - IDH (54,3% do sexo feminino, 34,1% do 3º ano e 48,8% com idades acima de 16 anos) e 123 de escola pública situada em região de baixo IDH (52,8% sexo feminino, 82,9% do 1º ano e 32,8% com 16 anos). Solicitou-se aos jovens que completassem, por meio de desenhos, a frase: "para mim, estar saudável mentalmente/emocionalmente é...". A análise dos desenhos resultou em 312 representações de saúde mental classificadas em 11 categorias temáticas. De forma geral, as representações de saúde mental estavam pautadas por uma visão ecológica, sendo representada principalmente por figuras humanas com conteúdos ligados a bem estar pessoal, representações de vínculos inter-relacionais e intrafamiliares e contextos sociais.

Disclosure of HIV Diagnosis to HIV-Infected Children in South Africa: Focus Groups for Intervention Development

Worldwide about 2.5 million children younger than 15 years of age are living with HIV, and more than 2.3 million of them live in sub-Saharan Africa. Antiretroviral therapy has reduced mortality among HIV-infected children, and as they survive into adolescence, disclosing to them their diagnosis has emerged as a difficult issue, with many adolescents unaware of their diagnosis. There is a need to build an empirical foundation for strategies to appropriately inform infected children of their diagnosis, particularly in South Africa, which has the largest number of HIV-positive people in the world. As a step toward developing such strategies, we conducted a study in Eastern Cape Province, South Africa to identify beliefs about disclosing HIV diagnosis to HIV-infected children among caregivers, health-care providers, and HIV-positive children who knew their diagnosis. We implemented 7 focus groups with 80 participants: 51 caregivers in 4 groups, 24 health-care providers in 2 groups, and 5 HIV-positive children in 1 group. We found that although the participants believed that children from age 5 years should begin to learn about their illness, with full disclosure by age 12, they suggested that many caregivers fail to fully inform their children. The participants said that the primary caregiver was the best person to disclose. The main reasons cited for failing to disclose were (a) lack of knowledge about HIV and its treatment, (b) the concern that the children might react negatively, and (c) the fear that the children might inappropriately disclose to others, which would occasion gossip, stigmatization, and discrimination towards them and the family. We discuss the implications for developing interventions to help caregivers appropriately disclose HIV status to HIV-infected children and, more generally, communicate effectively with the children to improve their health outcomes.

Smoking of parents and best friend--independent and combined effects on adolescent smoking and intention to initiate and quit smoking

INTRODUCTION

This study investigates the independent and combined effects of smoking of parents and best friend on smoking and the intention to initiate or quit smoking in adolescents.

METHODS

In this school-based survey, 6,553 Hong Kong students aged 13-18 reported their demographic characteristics, smoking status of themselves, parents, and best friend; and intention to smoke (initiation among never-smokers and reinitiation among ex-smokers) or quit smoking among current smokers. Logistic regression yielded adjusted odds ratios (AORs) of student smoking (current/ever) and intention to smoke or quit smoking for parental (paternal/maternal/both parents vs. none) and best friend (yes vs. no) smoking.

RESULTS

Parental smoking and having a smoking best friend were associated with adolescent current smoking, ever smoking, and intention to initiate smoking. Having a smoking best friend was also associated with reinitiating and quitting smoking. The AORs (95% CI) of current smoking for having a smoking best friend, in addition to smoking father, mother, or both were 19.14 (14.36-25.51), 20.38 (12.42-33.43), and 24.18 (15.89-36.77). The respective AORs of ever smoking were 8.30 (6.74-10.22), 8.92 (5.63-14.12), and 11.99 (8.05-17.87).

CONCLUSIONS

Parental smoking and best friend smoking have independent effects on adolescent smoking behaviors. Their combined effects on current and ever smoking were particularly large. Smoking prevention programs should pay special attention to adolescents with both best friend and parents who smoke.

Exposição ao tabagismo entre escolares no Brasil

O objetivo deste trabalho é descrever a exposição ao tabagismo de participantes da Pesquisa Nacional de Saúde do Escolar (PeNSE) e identificar fatores associados a ele. Para se apresentar o perfil de tabagismo regular, era preciso ter fumado cigarro pelo menos um dia nos 30 dias anteriores à pesquisa. As características estudadas foram idade, sexo, raça/cor, escolaridade da mãe, índice de bens do domicílio e dependência administrativa da escola. Os comportamentos de risco e proteção incluídos foram experimentar álcool ou drogas, ter relação sexual, consumo de > 1 copo de bebida alcoólica nos últimos 30 dias e realizar/ter interesse em realizar atividade física na maioria dos dias da semana. A prevalência de fumante regular foi 6,3% (IC95%:5,87-6,74), sendo estatisticamente maior nos mais velhos, de cor parda, cujas mães têm menor escolaridade, estudantes em escolas públicas e apresentando os comportamentos estudados. Na análise multivariável, o tabagismo permaneceu associado à idade e a comportamentos de risco. A chance de fumar também foi menor em quem não faz nem gostaria de fazer atividade física. CONCLUSÃO: comportamentos de risco para a saúde coexistem também na adolescência, sugerindo que políticas de promoção da saúde na adolescência provavelmente terão impacto amplo, incluindo o problema do tabagismo.

School-based randomized controlled trial of an HIV/STD risk-reduction intervention for South African adolescents

OBJECTIVE

To test the efficacy of a school-based human immunodeficiency virus/sexually transmitted disease (HIV/STD) risk-reduction intervention for South African adolescents.

DESIGN

A cluster-randomized, controlled design with assessments of self-reported sexual behavior collected before intervention and 3, 6, and 12 months after intervention.

SETTING

Primary schools in a large, black township and a neighboring rural settlement in Eastern Cape Province, South Africa.

PARTICIPANTS

Nine of 17 matched pairs of schools were randomly selected. Sixth-grade students with parent or guardian consent were eligible.

INTERVENTIONS

Two 6-session interventions based on behavior-change theories and qualitative research. The HIV/STD risk-reduction intervention targeted sexual risk behaviors; the attention-matched health promotion control intervention targeted health issues unrelated to sexual behavior.

OUTCOME MEASURES

The primary outcome was self report of unprotected vaginal intercourse in the previous 3 months averaged over the 3 follow-ups. Secondary outcomes were other sexual behaviors.

RESULTS

A total of 1057 (94.5%) of 1118 eligible students (mean age, 12.4 years) participated, with 96.7% retained at the 12-month follow-up. Generalized estimating equation analyses adjusted for clustering from 18 schools revealed that, averaged over the 3 follow-ups, a significantly smaller percentage of HIV/STD risk-reduction intervention participants reported having unprotected vaginal intercourse (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.30-0.85), vaginal intercourse (OR, 0.62; 95% CI, 0.42-0.94), and multiple sexual partners (OR, 0.50; 95% CI, 0.28-0.89), when adjusted for baseline prevalences, compared with health-promotion control participants.

CONCLUSION

This is the first large-scale, community-level, randomized intervention trial to show significant effects on the HIV/STD sexual risk behavior of South African adolescents in the earliest stages of entry into sexual activity.

Family structure, parent-child conversation time and substance use among Chinese adolescents

BACKGROUND

The family plays a vital role in shaping adolescent behaviours. The present study investigated the associations between family structure and substance use among Hong Kong Chinese adolescents.

METHODS

A total of 32,961 Form 1 to 5 (grade 7-12 in the US) Hong Kong students participated in the Youth Smoking Survey in 2003-4. An anonymous questionnaire was used to obtain information about family structure, daily duration of parent-child conversation, smoking, alcohol drinking and drug use. Logistic regression was used to calculate the adjusted odds ratios (OR) for each substance use by family structure.

RESULTS

Adjusting for sex, age, type of housing, parental smoking and school, adolescents from non-intact families were significantly more likely to be current smokers (OR = 1.62), weekly drinkers (OR = 1.72) and ever drug users (OR = 1.72), with significant linear increases in ORs from maternal, paternal to no-parent families compared with intact families. Furthermore, current smoking (OR = 1.41) and weekly drinking (OR = 1.46) were significantly more common among adolescents from paternal than maternal families. After adjusting for parent-child conversation time, the ORs for non-intact families remained significant compared with intact families, but the paternal-maternal differences were no longer significant.

CONCLUSIONS

Non-intact families were associated with substance use among Hong Kong Chinese adolescents. The apparently stronger associations with substance use in paternal than maternal families were probably mediated by the poorer communication with the father.

Coming of age in the kisspeptin era: sex differences, development, and puberty

The status of the neuroendocrine reproductive axis differs dramatically during various stages of development, and also differs in several critical ways between the sexes, including its earlier pubertal activation in females than males and the presence of neural circuitry that generates preovulatory hormone surges in females but not males. The reproductive axis is controlled by various hormonal and neural pathways that converge upon forebrain gonadotropin-releasing hormone (GnRH) neurons, and many of the critical age and sex differences in the reproductive axis likely reflect differences in the "upstream" circuits and factors that regulate the GnRH system. Recently, the neural kisspeptin system has been implicated as an important regulator of GnRH neurons. Here I discuss the evidence supporting a critical role of kisspeptin signaling at different stages of life, including early postnatal and pubertal development, as well as in adulthood, focusing primarily on information gleaned from mammalian studies. I also evaluate key aspects of sexual differentiation and development of the brain as it relates to the Kiss1 system, with special emphasis on rodents. In addition to discussing recent advances in the field of kisspeptin biology, this paper will highlight a number of unanswered questions and future challenges for kisspeptin investigators, and will stress the importance of studying the kisspeptin system in both males and females, as well as in multiple species.

Mental health promotion initiatives for children and youth in contexts of poverty: the case of South Africa

In order to achieve sustainable development and a consequent reduction in levels of poverty, a multisectoral response to development incorporating pro-poor economic policies in low- to middle-income countries (LMICs) is required. An important aspect is strengthening the human capital asset base of vulnerable populations. This should include the promotion of mental health, which can play an important role in breaking the intergenerational cycle of poverty and mental ill-health through promoting positive mental health outcomes within the context of risk. For each developmental phase of early childhood, middle childhood and adolescence, this article provides: (i) an overview of the critical risk influences and evidence of the role of mental health promotion initiatives in mediating these influences; (ii) a background to these risk influences in South Africa; and (iii) a review of mental health promotion initiatives addressing distal upstream influences at a macro-policy level in South Africa, as well as evidence-based micro- and community-level interventions that have the potential to be scaled up. From this review, strengths and gaps in existing micro- and community-level evidence-based mental health promotion interventions as well as macro-policy-level initiatives are identified, and recommendations made for South Africa that may also have applicability for other LMICs.

Age at menarche and weight concerns in relation to smoking trajectory and dependence among adolescent girls enrolled in a smoking cessation trial

Many girls adopt dieting and other practices (i.e. cigarette smoking) to control weight during puberty. This analysis explored the relationship between age at menarche and onset of daily smoking, and whether this relationship was influenced by weight concerns among treatment seeking female adolescents. The sample consisted of 71 participants enrolled in a smoking cessation trial (age 15.2+/-1.3 years; 74.7% European American, baseline BMI 24.7+/-5.4, age at menarche 11.7+/-1.3 years, Fagerström Test for Nicotine Dependence score 7.0+/-1.2). Over 60% of participants reported weight concerns at baseline, based on responses to the Eating Disorders module from the Diagnostic Interview for Children and Adolescents. Linear regression analyses revealed a significant association between age at menarche and age of onset of daily smoking (beta=0.18+/-0.09, p=0.038). Having weight concerns did not modify the relationships between age at menarche and smoking trajectory/severity or abstinence. Findings support previous research showing that early maturation represents a risk factor for substance use. Further study in larger samples that include non-treatment-seeking adolescent female smokers is warranted.

Emerging ideas about kisspeptin- GPR54 signaling in the neuroendocrine regulation of reproduction

Neurons that produce gonadotropin-releasing hormone (GnRH) drive the reproductive axis, but the molecular and cellular mechanisms by which hormonal and environmental signals regulate GnRH secretion remain poorly understood. Kisspeptins are products of the Kiss1 gene, and the interaction of kisspeptin and its receptor GPR54 plays a crucial role in governing the onset of puberty and adult reproductive function. This review discusses the latest ideas about kisspeptin-GPR54 signaling in the neuroendocrine regulation of reproduction, with special emphasis on the role of Kiss1 and kisspeptin in the negative and positive feedback control of gonadotropin secretion by sex steroids, timing of puberty onset, sexual differentiation of the brain and photoperiodic regulation of seasonal reproduction.

Mental health of young people: a global public-health challenge

Mental disorders account for a large proportion of the disease burden in young people in all societies. Most mental disorders begin during youth (12-24 years of age), although they are often first detected later in life. Poor mental health is strongly related to other health and development concerns in young people, notably lower educational achievements, substance abuse, violence, and poor reproductive and sexual health. The effectiveness of some interventions for some mental disorders in this age-group have been established, although more research is urgently needed to improve the range of affordable and feasible interventions, since most mental-health needs in young people are unmet, even in high-income countries. Key challenges to addressing mental-health needs include the shortage of mental-health professionals, the fairly low capacity and motivation of non-specialist health workers to provide quality mental-health services to young people, and the stigma associated with mental disorder. We propose a population-based, youth focused model, explicitly integrating mental health with other youth health and welfare expertise. Addressing young people's mental-health needs is crucial if they are to fulfil their potential and contribute fully to the development of their communities.