Health risk behaviours amongst school adolescents: protocol for a mixed methods study

Association of tobacco experimentation with anxiety and depression: findings from a representative sample of Tunisian adolescents

OBJECTIVES

Emerging evidence points to tobacco experimentation being associated with a vast array of mental disorders, particularly anxiety and depression. We aimed to assess the prevalence of tobacco experimentation, its predictive factors and its potential links with anxiety and depressive disorders among in school adolescents in a Tunisian delegation.

METHODS

We carried out a cross sectional study among adolescents schooling in middle and high schools in the delegation of Nfidha, Sousse, Tunisia, during the period from January to March of the 2019-2020 school year using an anonymous questionnaire self-administered to a representative sample of 1,353 randomly selected pupils. Data were collected using the Arabic versions of the Beck Depression Inventory short form (13 items) and the Screen for Child Anxiety Related Disorders (SCARED-C) and a socio-demographic questionnaire with reference to the literature.

RESULTS

Tobacco was experimented by (17.5 %; CI 95 %: 14.8-18.8 %) of pupils. Almost three out of four pupils (73.2 %; CI 95 %: 70.8-75.6 %) reported experiencing depressive symptoms and (65 %; CI 95 %: 62.5-67.5 %) anxiety symptoms. Pupils who exhibited depressive disorder indicators were significantly more prone to experiment with tobacco (20.2 vs. 9.9 %, p<0.001; crude OR=2.301 CI 95 %: 1.74-3.58). Similarly, the prevalence of tobacco experimentation was found to be higher among pupils who reported having experienced anxiety disorders (21.0 vs. 14.5 %, p<0.001; crude OR=1.56 CI 95 %: 1.06-2.27). Being a male pupil (AOR=5.48 95 % CI: 3.62-8.31), being be enrolled in a high school (AOR=2.86, 95 % CI: 1.92-4.26), tobacco use by father and siblings (respectively AOR=1.76, 95 % CI: 1.19-2.60; AOR=2.47, 95 % CI: 1.52-4.02) and experiencing depressive disorders (AOR=2.69, 95 % CI: 1.60-4.53) were the determinants of tobacco experimentation in the multivariate analysis.

CONCLUSIONS

Tobacco experimentation in adolescence has been shown to be significantly associated with anxiety and depression. National smoking prevention strategies should be reinforced with a focus on mental health disorders.

Prevalence and predictors of tobacco, alcohol and illicit drug experimentation among Tunisian middle and high school-adolescents

OBJECTIVES

Psychoactive substance experimentation among Tunisian adolescents remains one of the most threatening public health concerns. In spite of this, little is known about the prevalence and predictors of these behaviors in the Tunisian context. This study aims to assess the prevalence of tobacco, alcohol and illicit drug experimentation and its predictive factors among adolescents in the delegation of Nfidha, Sousse governorate, Tunisia.

METHODS

We conducted a cross sectional study in middle and high schools in the delegation of Nfidha, Sousse governorate, Tunisia, during the first trimester of the 2019-2020 school year using an anonymous questionnaire self-administered to a randomly drawn representative sample of 1,352 pupils. Data collected included socio-demographic characteristics, substance experimentation among school-adolescents, academic performance as well as family and peer' factors.

RESULTS

Tobacco was the most commonly experimented substance with a prevalence rate of 17.5 % (CI 95 %: 14.8-18.8 %). The prevalence of alcohol and illicit drugs use were 3.3 % [CI 95 %: (2.1-3.9 %)] and 2 % [CI 95 %: (1.1-2.6 %)] respectively. Being male (Adjusted (AOR)=4.09, p<0.001), being a high school pupil (AOR=2.81, p<0.001), having experiencing academic failure (AOR=1.60, p=0.007) and having a father and siblings who use tobacco (AOR=1.72, p=0.002; AOR=2.03, p=0.001 respectively) were the predictors of tobacco experimentation in the multivariate logistic regression analysis. Additionally, being male (AOR=8.40, p<0.001), having experienced academic failure (AOR=2.76, p=0.017) as well as having a father and siblings who use alcohol (AOR=5.90, p<0.001; AOR=3.03, p=0.045 respectively) and having experienced tobacco (AOR=4.28, p<0.001) were the determinants of alcohol experimentation. Similarly, having a history of academic failure (AOR=3.44, p=0.041), having peers who use illicit drugs (AOR=3.22, p=0.028), having a history of tobacco and alcohol experimentation (AOR=6.52, p<0.001; AOR=3.49, p=0.046 respectively) were the predictors of illicit drug experimentation among adolescents.

CONCLUSIONS

A substantial number of socio-demographic and environmental factors have been identified as being involved in experimentation with psychoactive substance during adolescence. Therefore, further prevention programs targeting not only adolescents, but also all risk factors are needed.

Assessment of food consumption, smoking, alcohol use, and physical activity by sex and major of study among a sample of college students in Jordan

This study aimed to assess the food frequency and health-related risk behaviors based on gender and major of study (health and non-health majors) in a sample of undergraduate university students. A cross-sectional study was conducted among 708 undergraduate university students (37.4% males; 62.6% females) with a mean age of 20.88(SD = 2.20), ranging from 18 to 37 years from five universities. A self-reported questionnaire was administered in the university classrooms to collect data. Results showed that 47.3% of students reported consuming fruits and vegetables (38.1%), and 54% reported consuming unhealthy foods at least once in the preceding 24 h. About 16% of the students were cigarette smokers, 17% were waterpipe smokers, and slightly more than 4% were alcohol consumers. Significant associations were found between the participants based on their sexes, and study majors (P < 0.001). Male students smoked and consumed alcohol at significantly higher rates than female students. As with regards to the physical activity in the preceding week, students had not carried out any stretching activities (52.8%), strengthening activities (62.4%), cycling (35%), or taken part in any physical activity classes (68.4%). The rates of physical activity were significantly higher among male students than female students (p < 0.001). The results showed that non-health major students differ from those in health majors in the consumption of cigarettes (p < 0.001) and waterpipe smoking (p = 0.027). Students in non-health majors were more likely than students in health majors to have carried out stretching activities (p = 0.021) and participated in physical activity classes (p = 0.02). Our findings highlighted the importance of identifying health-related risk behaviors among university students to develop a health-promoting intervention tailored to a specific group of students considering their sex and study majors.

Investigating the relationship between high-risk behaviors and mental health in adolescents in Rabor city, Iran

OBJECTIVES

High-risk behaviors (HRBs) represent significant health threats for adolescents and significantly affect adolescents' mental health. Adolescents often engage in risky behaviors. The present study was conducted to investigate the relationship between high-risk behaviors (HRBs) and mental health in adolescents in Rabor.

CONTENT

The present study was a cross-sectional analytical study that was performed on 334 girl and boy students aged 12-18 years in Rabor city in 2021. In this study, adolescents answered high risk behaviors and mental health questionnaires. Data were analyzed using SPSS-26 software and the spearman correlation coefficient and linear regression analysis (univariate and multivariate analysis) were used to analyze the data.

SUMMARY AND OUTLOOK

In this study, the mean age was 15.25 ± 1.78. The findings indicate that smoking and hookah use were higher in boys than girls. Among the demographic variables, age and level of education had a positive and significant relationship with HRBs and mental health (p<0.05). The mean score of total mental health for all subjects was 12.83 ± 10.82. The variables of age, sex, marital status of parents, the number of children in the family, educational level, smoking, hookah, and alcohol have been determined as influential and facilitating factors in HRBs of adolescents. Father's literacy was considered as a facilitator and age variables, alcohol consumption and parents' marital status were considered as deterrents to mental health. The present study showed that the male gender is one of the risk factors for alcohol, smoking and other substances, the tendency to high-risk sexual behaviors, depression, and suicide in adolescents. Among the determinants of the tendency to HRBs in adolescents, psychological variables are of particular importance at the individual, social, and family levels. Good mental health can improve quality of life, while poor mental health can make it worse.

Prevalence of self-medication and associated factors in adolescents aged 18-19 years: the 1997/1998 cohort in São Luís-MA, Brazil

This article aims to assess the prevalence and factors associated with self-medication in adolescents. Cross-sectional study, nested in cohort, with 2,515 adolescents aged 18-19 years born in São Luís-MA. The use of medication in the last 15 days without a medical prescription or by a qualified professional was considered self-medication. Factors associated with self-medication were evaluated using Poisson regression with robust variances and hierarchical selection of variables. Medicines were used in the last 15 days by 48.05% of adolescents. Among these, 70.09% use it without a prescription or indication from another health professional. The most used medications for self-medication were "over the counter" (93.68%). Self-medication was positively associated with female gender (PR: 1.41; 95%CI: 1.25-1.59), screen time ≥5h/day (PR: 1.32; 95%CI: 1.05-1.67) and self-reported diagnosis of allergic rhinitis (PR: 1.19; 95%CI: 1.02-1.39); however, negatively associated with self-satisfaction with health (PR: 0.79; 95%CI: 0.67-0.94) and hospitalization in the previous year (PR: 0.70; 95%CI: 0.50-0.97). Self-medication was common among adolescents and to reduce this practice, greater attention should be given to women, individuals with intense exposure to meshes and allergic diseases.

Cannabis Use and Emotional Intelligence in Adolescents during COVID-19 Confinement: A Social Network Analysis Approach

Confinement by COVID-19 had negative consequences on adolescent mental health, including increased cannabis use. Cannabis is related to variables that influence health and well-being. Emotional Intelligence is associated with adaptive coping styles, peer relationships, and social–emotional competencies. In adolescence, peer selection plays a unique role in the initiation of substance use. However, there are no studies during a confinement stage that analyse the relationships between networks, Emotional Intelligence, and cannabis use. The aim of this paper is to describe and analyse the consumption and friendship networks of an adolescent classroom and their relationship with Emotional Intelligence, cannabis use, and gender during COVID-19 confinement. Participants completed different questionnaires for Emotional Intelligence, cannabis use, and the consumption and friendship network. The sample consisted of 21 students from 10th grade, of which 47.6% were consumers. The friendship network correlates with the consumption network, and significant associations between emotional repair and being a cannabis user. The regression model points to the friendship network as a significant variable in predicting the classroom use network. This study highlights the role of the Social Network Analysis in predicting consumption networks during a COVID-19 confinement stage and serves as a tool for cannabis use prevention interventions in a specific population.

"Everything else is going to be ok if your spiritual wellness is well". A qualitative exploration of wellness amongst secondary school students in Fiji

Purpose

Adolescent wellness over the years has been a major public health concern. The adolescent period is stated to be a critical phase as developments occur in all areas of the individual. This study aims to explore secondary school students’ perceptions on knowledge of wellness, influences of wellness, prioritization of wellness dimensions and ideal adolescent wellness programmes in Fiji.

Method

This study qualitatively investigates adolescents in four purposively selected schools in Suva, Fiji. 31 students who enrolled into years 11 to 13 in the selected schools were interviewed in-depthly using a semi-structured, open-ended questionnaire. Data was transcribed and classified into categories, sub-themes and major themes.

Results

Participants’ responses indicated wellness perceived as multidimensional with no regard to dimensional balance. Family, peers and school support, social media, nutrition and physical activities are factors perceived to influence wellness. The availability of school counsellors, facilitation of effective school health programmes, and incorporation of wellness into the school curriculum were perceived as ideal ways to increase adolescent wellness.

Conclusions

This study provides important research findings of adolescent wellness for Fiji’s health sector, its policymakers and programme developers. Further studies are needed to understand the broad concept of wellness and its several dimensions.

Clustering Lifestyle Risk Behaviors among Vietnamese Adolescents and Roles of School: A Bayesian Multilevel Analysis of Global School-Based Student Health Survey 2019

BACKGROUND

Adolescence is a vulnerable period for many lifestyle risk behaviors. In this study, we aimed to 1) examine a clustering pattern of lifestyle risk behaviors; 2) investigate roles of the school health promotion programs on this pattern among adolescents in Vietnam.

METHODS

We analyzed data of 7,541 adolescents aged 13-17 years from the 2019 nationally representative Global School-based Student Health Survey, conducted in 20 provinces and cities in Vietnam. We applied the latent class analysis to identify groups of clustering and used Bayesian 2-level logistic regressions to evaluate the correlation of school health promotion programs on these clusters. We reassessed the school effect size by incorporating different informative priors to the Bayesian models.

FINDINGS

The most frequent lifestyle risk behavior among Vietnamese adolescents was physical inactivity, followed by unhealthy diet, and sedentary behavior. Most of students had a cluster of at least two risk factors and nearly a half with at least three risk factors. Latent class analysis detected 23% males and 18% females being at higher risk of lifestyle behaviors. Consistent through different priors, high quality of health promotion programs associated with lower the odds of lifestyle risk behaviors (highest quality schools vs. lowest quality schools; males: Odds ratio (OR) = 0·67, 95% Highest Density Interval (HDI): 0·46 - 0·93; females: OR = 0·69, 95% HDI: 0·47 - 0·98).

INTERPRETATION

Our findings demonstrated the clustering of specific lifestyle risk behaviors among Vietnamese in-school adolescents. School-based interventions separated for males and females might reduce multiple health risk behaviors in adolescence.

FUNDING

The 2019 Global School-based Student Health Survey was conducted with financial support from the World Health Organization. The authors received no funding for the data analysis, data interpretation, manuscript writing, authorship, and/or publication of this article.

Treatment outcomes of Gene Xpert positive tuberculosis patients in KwaMashu Community Health Centre, KwaZulu-Natal, South Africa: A retrospective review

Background

We sought to investigate the relationship between tuberculosis (TB) treatment outcomes and its predictors in the KwaMashu region in KwaZulu-Natal (KZN). This area is currently a hotbed for TB and human immunodeficiency virus (HIV) co-infection.

Method

A retrospective study design was adopted to characterise adult patients diagnosed with Gene Expert (GXP) positive pulmonary TB from 01 January 2016 to 31 December 2017. Tuberculosis treatment outcomes were assessed after two months and five months according to the standard World Health Organization (WHO) criteria. Multiple logistic regression analysis was used to calculate the odds ratio (OR) of the possible determinants associated with unsuccessful treatment outcomes.

Results

Amongst the 596 patients diagnosed, 57.4% (95% confidence interval [CI]: 53.3–61.4; 342 of 596) had successful treatment outcomes. Of these reported cases, 88.89% (85.1–92.0; 304 of 342) were cured. For the unsuccessful treatment outcomes, 52.4% (46.0–58.6; 133 of 254) patients were lost to follow-up, 20.9% (16.0–26.4; 53 of 254) failed treatment, 1.2% (0.2–3.4; 3 of 254) died and 25.6% (20.3–31.4; 65 of 254) of the patients could not be accounted for. Patients with unknown HIV status were more likely to have unsuccessful treatment outcomes (adjusted OR [aOR] = 4.94 [1.83–13.36]). Patients who had sputum conversion at 2 months (aOR = 1.94 [1.27–2.96]) were significantly more likely to exhibit unsuccessful treatment outcomes.

Conclusion

Treatment success rate was 57.4% which was below the target set by the WHO. This underscores the urgent need to strengthen treatment adherence strategies to improve outcomes, especially in high HIV burden settings.

Structural relationships among adolescents' peer attachment, career-related self-efficacy, parents' attitudes and health risk behaviours

Aim

This study aimed to determine whether the peer attachment of adolescents, mediated by career‐related self‐efficacy and having parents with positive attitudes, influences health risk behaviours.

Design

A cross‐sectional questionnaire survey.

Methods

This study adopted the secondary data analysis method, using the 2010 Korean Children and Youth Panel Survey (KCYPS). The 7th‐wave panel data of 1,932 first graders in high schools were analysed using structural equation modelling.

Results

The final model provided a good fit for the data. Having a close relationship with peers had a direct effect on adolescents’ health risk behaviours. High peer attachment also had an indirect effect on health risk behaviours, mediated by career‐related self‐efficacy and having parents with positive attitudes. Though adolescents with broad and intimate peer relationships may be exposed to more temptations towards health risk behaviours and tend to make riskier decisions, these influences are reduced by being exposed to positive parenting attitudes and having clear, conscious career goals.

Clustering effects of health risk behavior on mental health and physical activity in Chinese adolescents

PURPOSE

Risk behaviors are significantly impacting physical and psychological health among adolescents, resulting in a tremendous public health issue. The aim of this study is to examine the association of clustered risk behaviors with mental health and physical activity, and identify to what extent the clustering of various risk behaviors is associated with psychological health and physical activity in Chinese adolescents.

METHODS

Students aged 16-18 years, male 16.2 ± 1.03, female 16.3 ± 1.56, were recruited from 30 high schools to complete an online questionnaire in fall semester 2017. A structured questionnaire, 2017 state and local youth risk behavior survey was revised, modified, and translated into Chinese. Five questions were designed to assess physical activity times of the last 7 days. Symptom checklist 90 (SCL-90) was used to investigate the mental health status of the participants. Statistical analyses were done employing chi-square tests, two step cluster analysis, logistic regression.

RESULT

Results illustrate that girls report a significantly higher mean of being bullied in school, electronically bullied, feeling sad or hopeless, and trying cigarette smoking. Two-step cluster analysis and regression analysis find that alcohol use, smoking and sedentary behavior have significant effect on adolescent health. Logic regression demonstrated that risk behaviors have significantly associated with mental health and physical activity in specific cluster.

CONCLUSION

This study finds that a specific behavior cluster has significant impact on mental health and physical activity among adolescents. Integrating risk behaviors cluster with factors can be employed to target high-risk adolescents who have poor physical and psychosocial health. The research suggest that more effective and feasible school intervention programs can be designed to promote adolescent health-related behavior in terms of those pathways.

Social-ecological influences on unhealthy dietary behaviours among Moroccan adolescents: a mixed-methods study

OBJECTIVE

To identify the prevalence of unhealthy dietary behaviours and their social-ecological influences in adolescents.

DESIGN

The study used a sequential explanatory mixed-methods design, which begins with the collection of quantitative data, followed by the collection of qualitative data to explain and enrich the quantitative findings. Quantitative data were collected via a global school-based student health survey and were analysed using quantitative approaches. Qualitative data were obtained via focus group discussions and were analysed thematically.

SETTING

Middle and high secondary schools in Taza city, Morocco.

PARTICIPANTS

Our quantitative analyses included 764 students (14-19 years). For the qualitative part, seventeen focus group discussions were conducted with 100 participants (fifty-six adolescents, twenty-six parents and eighteen teachers).

RESULTS

Of total student participants, 46·1 % skipped breakfast, 60·6 % had inadequate intake of fruits and vegetables (F&V), 39·4 % consumed soft drinks and 28·0 % consumed fast foods. All of these dietary behaviours could coexist in the same person except for inadequate intake of F&V. Gender, academic performance, age, perceived family income and education level of mother were associated with unhealthy dietary behaviours. Qualitative findings identified seven themes regarding social-ecological influences on adolescents' dietary behaviours: cognitive, affective/biological, lifestyle, outcome expectation, social network, accessibility/availability and macro-level influences.

CONCLUSIONS

The prevalence of unhealthy dietary behaviours in our study group is a concern. Dietary behaviours are the result of inseparable interactions among social-ecological influences. Modifiable factors identified may be useful when designing a future intervention aimed at improving breakfast and F&V consumption and reducing fast/snack-food consumption among adolescents.

Saúde dos adolescentes da coorte de nascimentos de São Luís, Maranhão, Brasil, 1997/1998

Resumo: O objetivo foi estimar a prevalência de indicadores de saúde de adolescentes em São Luís, Maranhão, Brasil, em 2016. Foram estudadas condições sociodemográficas, hábitos de vida, composição corporal, qualidade do sono, atividade física, habilidade cognitiva e risco de suicídio de 2.515 adolescentes com 18 e 19 anos. Os adolescentes pertencem à coorte de nascimento 1997/1998 ou foram incluídos, retrospectivamente, utilizando-se o banco do SINASC (Sistema de Informações sobre Nascidos Vivos). Os adolescentes eram, principalmente, da classe econômica C (50,1%), 69,5% estudavam, 40,3% trabalhavam e 25,2% não estudavam nem trabalhavam; 60,3% já foram vítimas de assalto e 48,7% tinham pais separados. Apresentaram padrão de consumo nocivo, excessivo ou provável dependência de álcool 19,4%, 19,1% usaram ou estavam usando drogas ilícitas, 53,7% tinham qualidade de sono ruim, 40,8% referiram dor de cabeça frequente, 34,3% declararam tempo de tela por dia maior que cinco horas e 4,1% apresentaram alto risco para suicídio. A prevalência de hipertensão arterial foi de 12% e de obesidade, 6%. As meninas eram mais inativas (80,7%) e apresentaram maior percentual de gordura corporal alto (15,8%) e muito alto (21,5%), já os meninos tiveram maior prevalência de hipertensão arterial (21,2%) e menor prevalência de inatividade física (40,9%). As elevadas prevalências de fatores de risco à saúde aumentam a vulnerabilidade dos adolescentes, expondo estes indivíduos precocemente a fatores que levam ao acometimento cada vez mais cedo de doenças e agravos à saúde.

Perceptions and intervention preferences of Moroccan adolescents, parents, and teachers regarding risks and protective factors for risky sexual behaviors leading to sexually transmitted infections in adolescents: qualitative findings

BACKGROUND

Sexual choices and practices of adolescents living in conservative societies, including Morocco, can be influenced either positively or negatively by the prevailing contextual and social norms. These norms not only limit the access to reproductive health information and services but also lead to abstinence among devout adolescents. Thus, identifying contextual risks and protective factors of risky sexual behaviors leading to sexually transmitted infections (STIs) in adolescents, as well as exploring perceptions of adolescents, parents and teachers regarding effective intervention preferences could improve the sexual health of adolescents.

METHODS

We conducted a qualitative study using focus group discussions (FGDs) based on the socio-ecological model as a theoretical framework. Sample groups of adolescents, parents, and teachers were selected from two public middle schools (disadvantaged and advantaged according to socio-economic level) in Taza city, Morocco, from May to July 2016. Participants were polled on protective factors and perceived facilitators of risky sexual behaviors leading to sexually transmitted infections (STIs) in adolescents as well on their perception of intervention preferences to reduce the risks. Three sets of data were initially formed, coded, and analyzed using thematic analysis.

RESULTS

Seventeen FGDs were conducted, including 8 groups of adolescents (28 boys and 28 girls, 14-16 years old), 5 groups of parents (21 males and 5 females), and 4 groups of teachers (13 males and 5 females). Five overall themes seemed to influence risky sexual behaviors in adolescents: (1) risky sexual practices and STIs; (2) the adolescent's social domain; (3) the role of school; (4) media, including internet and social media; and (5) socio-cultural norms. Participants also suggested a number of possible interventions to improve the sexual health of adolescents and to reduce the risk of STIs, which could be applied at multiple levels.

CONCLUSIONS

Successful intervention programs should target the multifaceted factors affecting the adolescent's sexual behaviors, from the individual to the societal level. Allowing parents, teachers, and adolescents to work together could help reduce the socio-cultural and personal barriers that prevent effective communication about sexuality. Furthermore, schools can play a vital role in reducing risky sexual behaviors and STI acquisition rates in adolescents by promoting sex education in school curriculum and encouraging adolescents to engage in extracurricular activities and awareness campaigns.

Treatment outcomes among children, adolescents, and adults on treatment for tuberculosis in two metropolitan municipalities in Gauteng Province, South Africa

Background

Gauteng Province has the second lowest tuberculosis (TB) incidence rate in South Africa but the greatest proportion of TB/HIV co-infection, with 68% of TB patients estimated to have HIV. TB treatment outcomes are well documented at the national and provincial level; however, knowledge gaps remain on how outcomes differ across detailed age groups.

Methods

Using data from South Africa’s National Electronic TB Register (ETR), we assessed all-cause mortality and loss to follow-up (LTFU) among patients initiating treatment for TB between 01/2010 and 12/2015 in the metropolitan municipalities of Ekurhuleni Metropolitan Municipality and the City of Johannesburg in Gauteng Province. We excluded patients who were missing age, had known drug-resistance, or transferred into TB care from sites outside the two metropolitan municipalities. Among patients assigned a treatment outcome, we investigated the association between age group at treatment initiation and mortality or LTFU (treatment interruption of ≥2 months) within 10 months after treatment initiation using Cox proportional hazard models and present hazard ratios and Kaplan-Meier survival curves.

Results

We identified 182,890 children (<10 years), young adolescent (10–14), older adolescent (15–19), young adult (20–24), adult (25–49), and older adult (≥50) TB cases without known drug-resistance. ART coverage among HIV co-infected patients was highest for young adolescents (64.3%) and lowest for young adults (54.0%) compared to other age groups (all over 60%). Treatment success exceeded 80% in all age groups (n = 170,017). All-cause mortality increased with age. Compared to adults, young adults had an increased hazard of LTFU (20–24 vs 25–49 years; aHR 1.43 95% CI: 1.33, 1.54) while children, young adolescents, and older adults had lower hazard of LTFU. Patients with HIV on ART had a lower risk of LTFU, but greater risk of death when compared to patients without HIV.

Conclusions

Young adults in urban areas of Gauteng Province experience a disproportionate burden of LTFU and low coverage of ART among co-infected patients. This group should be targeted for interventions aimed at improving clinical outcomes and retention in both TB and HIV care.

Exposure to violence across multiple contexts and health risk behaviours in South African adolescents: the moderating role of emotion dysregulation

Objective: The association between violence exposure and health risk behaviours in South African adolescents, and the moderating role of emotion dysregulation were investigated. Design: A multi-ethnic sample of adolescents (N = 925: boy: 47.3%, girl: 52.7%, M age = 16 years, SD = 1.54) completed a survey. Main outcome measures: Violence exposure across different contexts (home-, school-, community-, political victimisation), emotion dysregulation (inability to regulate sadness and anger) and a composite measure of health risk behaviours (smoking, substance use, risky sexual behaviour) were examined. Results: Boys reported more risk behaviours than girls, t (844) = 5.25, p < 0.001. Direct community victimisation was a predictor for boys' risk behaviours, B = 0.22, p < 0.001. Indirect school victimisation and direct community victimisation were predictors for girls' risk behaviours, B's = 0.19, p's < 0.01. Girls reported higher emotion dysregulation than boys, t (748) = -2.95, p < 0.01. Only for girls, emotion dysregulation moderated the associations of indirect home victimisation, B = 16, p < 0.01, and direct community victimisation, B = 15, p < 0.05, with risk behaviours. Conclusion: Interventions may target emotion regulation skills, particularly for girls, to enhance resilience to the negative effects of violence on behaviours.

Perspectives of adolescents, parents, and teachers on barriers and facilitators of physical activity among school-age adolescents: a qualitative analysis

Background

Physical activity levels are low among adolescents in Morocco; however, the influences on physical activity behavior of adolescents have not yet been explored in a qualitative study. Here, we explored potential social-ecological barriers and facilitators of physical activity in Moroccan adolescents with the goal of developing a successful intervention program aimed at improving their physical activity level.

Methods

For this study, we conducted 17 focus group discussions (100 participants, composed of 56 adolescents, 26 parents, and 18 teachers from two middle schools in Taza city, Morocco). Discussions during focus groups were facilitated by a semi-structured interview guide. Guide questions were underpinned by the social-ecological model as a theoretical framework. Data analysis was carried out by two coders using thematic analysis.

Results

We found that barriers and facilitators of physical activity in adolescents are organized into six themes that belong to different levels of the social-ecological model. Three themes belonged to the intrapersonal level (perceived motivating and limiting factors, physical activity awareness, and time constraints), two themes were classified into the interpersonal/cultural level (social support and gender and cultural norms), and one theme belonged to the environmental level (access to opportunities). Most of the themes were at the individual level, with each theme including both barriers and facilitators.

Conclusions

Adolescent participation in physical activity can be facilitated or hampered by many factors. Results from the focus group discussions showed that these factors belonged to different levels of the social-ecological model, but most were at the individual level. Our findings have several implications. First, they may offer suggestions for a tailored intervention program aimed at improving adolescent physical activity. Second, they can improve quantitative research by enriching the battery of questions of physical activity instruments (e.g., a question related to physical disability). Third, the proposed thematic map can contribute to understanding interactions and causal pathways in the social-ecological model.

Adolescents, parents and teachers' perceptions of risk and protective factors of substance use in Moroccan adolescents: a qualitative study

Background

Substance use in adolescents is a global public health concern that continues to draw attention from academics, policy experts, and government officials. In Morocco, few studies have investigated the influencing factors of substance use in adolescents. Here, we aimed to fill this gap and to better understand factors that protect or influence substance use in adolescents.

Methods

We conducted a qualitative study using focus group discussions. The semi-structured interview guides were based on the socio-ecological model as a theoretical framework to explore perceptions of students, parents, and teachers regarding substance use risks and protective factors in adolescents. Data from each group were audio-recorded, transcribed, and analyzed using thematic analysis.

Results

From May to July 2016, 17 focus group discussions were conducted at two middle schools in Taza city, Morocco, which included 8 groups of 7 adolescents (28 boys and 28 girls) aged 14 to 16 years, 5 groups of parents (5 females and 21 males), and 4 groups of teachers (13 males and 5 females). Thematic analysis resulted in six common themes that represented the most salient perceived risk and protective factors regarding substance use among adolescents: perceived benefits of substance use, awareness and beliefs, family influence, peer influence, easy accessibility of substances, and social norms.

Conclusions

Our results demonstrate that multilevel prevention programs in adolescents should address influencing factors from the individual to the societal level, including social norms and the government’s policy toward substance use. Health education programs included as part of the school curriculum can contribute to promoting awareness and reducing risky behaviors of Moroccan adolescents.

Level and potential social-ecological factors associated with physical inactivity and sedentary behavior among Moroccan school-age adolescents: a cross-sectional study

BACKGROUND

Creating a successful intervention that supports an active lifestyle and prevents sedentary one requires a better understanding of the factors associated with physical inactivity (PI) and sedentary behavior (SB). However, these factors have not been assessed among Moroccan adolescents. This study aimed to determine prevalence of PI and SB and to explore their potential social-ecological associated factors in school-age adolescents.

METHODS

In this cross-sectional study, 764 students (age range, 14-19 years) were enrolled from six schools in Taza city, Morocco. The Global School-based Student Health Survey was used to collect data about variables. We used bivariate and multivariate analyses to assess relations between dependent and independent variables.

RESULTS

Overall, the prevalence of PI was 79.5% and SB was 36.5%. Among girls, these rates were higher (87.0 and 39.1%, respectively) than rates shown in boys (70.9 and 33.6%, respectively). In the multivariate logistic regression analysis, PI was associated with the following variables: illiterate father, hunger, suicidal ideation, inadequate vegetable consumption, and absence from physical education classes. Age, inadequate vegetable consumption, and absenteeism were associated with SB.

CONCLUSIONS

The prevalence of PI and SB is high, especially among girls. Thus, there is an urgent need to implement appropriate interventions to reduce PI and SB levels in secondary school-age adolescents and the associated factors identified can be useful.