The global school-based student health survey as a tool to guide adolescent health interventions in rural Guatemala

Dietary Knowledge, Attitude, Practice Survey and Nutritional Knowledge-Based Intervention: A Cross-Sectional and Randomized Controlled Trial Study among College Undergraduates in China

BACKGROUND

Understanding undergraduates' dietary literacy, including dietary knowledge, attitude and practice (KAP), is important for future health promotion policies. Therefore, this study aimed to investigate the current status and influencing factors of dietary literacy in Chinese college undergraduates and explore whether a nutritional lecture could improve their dietary literacy.

METHODS

This study included two parts: a cross-sectional study (n = 1026) conducted by a dietary literacy questionnaire, and a randomized controlled trail (RCT) that enrolled 99 college undergraduates who were randomized to a control group or a nutritional lecture group. Data from the questionnaire and 72 h food records were obtained on day 0, day 3 and day 100 before and after intervention.

RESULTS

This cross-sectional study showed that the mean scores of dietary KAP were respectively 100.0 (33.3), 59.1 (13.6) and 71.7 (11.7), with an excellent rate of 36.6%, 1.9% and 3.4%. Female upper-grade undergraduates and those with medicine-related majors illustrated higher dietary knowledge scores (p < 0.001). Dietary attitude rather than dietary knowledge had a significant impact on dietary practice (p < 0.001). This finding was in line with the results in the RCT study. Compared with the control group, dietary knowledge was significantly improved in the nutritional lecture group on both day 3 (p = 0.002) and day 100 (p = 0.023) after intervention. However, dietary behavior was improved only on day 3 post nutritional lecture (p = 0.029) but decreased to the original level 100 days later (p < 0.001).

CONCLUSIONS

This study discovered the unsatisfying status and discrepancy between dietary literacy among college undergraduates of different sex, majors and college years. Dietary attitude instead of dietary knowledge was discovered as a determining role in dietary practice. One nutritional lecture could improve undergraduates' dietary literacy but the effect was not long-lasting. Further studies with more reinforced and durable interventions are warranted.

"We don't know how to talk": Adolescent meaning making and experiences of participating in research on violence in Romania, South Africa, and the Philippines

BACKGROUND

Current evidence on adolescent participation in violence research has primarily measured distress, harm or upset using quantitative methods. There are relatively few studies which have employed qualitative methods to understand adolescent emotional experiences, and to articulate the experiences of participation from their own perspective.

OBJECTIVE

This study aimed to assess adolescents' experiences of participating in research on violence in different contexts, namely Romania, South Africa, and the Philippines.

METHODS

A purposive sample of adolescents (N = 53, 51 % female) were recruited from rural, urban, and peri-urban areas in Romania, the Eastern Cape Province of South Africa, and Metro Manila, Philippines. Semi-structured one-on-one in-depth interviews and drawings sought adolescent perspectives on their experiences of participation, including the emotions they felt, and their perceptions of research on violence.

RESULTS

Drawing on analysis of interviews and drawings, adolescents reported a layered emotional experience, ranging from sadness, anger, apprehension, and upset, to joy, relief, and laughter. Their emotional experiences were driven by participation as a relational encounter, both with the researchers involved, as well as with other children and young people they encountered. Adolescents emphasized participation as enabling disclosure of difficult experiences, and the creation of awareness of violence.

CONCLUSIONS

Adolescent perspectives of participation in research on violence are nuanced and encompass their lived experience as well as the fundamentally relational nature of participation. Adolescents experienced increased awareness of topics in violence and perceived research participation as enabling disclosure and possible help-seeking. Measures of participation impact developed along with adolescents, which reflect this complexity, are needed.

Characteristics of Global Data on Adolescent's Dietary Intake: A Systematic Scoping Review

Data on adolescents' dietary intake are essential to improve their diets and nutrition. However, the availability of (high-quality) data on adolescents' dietary intake is scarce with great global differences. We conducted a systematic scoping review to investigate the availability, characteristics, and gaps in global adolescent dietary data, following the Preferred Reporting Items for Systematic Reviews and Meta Analyses-Extension for Scoping Reviews checklist and guidelines (registered under PROSPERO no. 171170 https://www.crd.york.ac.uk/PROSPERO/). We included peer-reviewed and grey literature articles (2010 onwards) on the dietary intake of male and female adolescents (10-24 y). Studies from all countries and languages and including any information related to types of food consumed, diet composition, dietary diversity, or meal patterns were considered. We excluded studies with insufficient methodological information, unclear description of population, samples sizes <25, school-based data sets containing <6 schools, and studies that focused on pregnant or unhealthy study populations. Data, including year(s) of data collection, age, gender, sample size, dietary assessment methods, number of food items/groups, study design, location, and representativeness, were extracted. A total of 52,889 titles were identified and 722 articles, describing 1,322 data sets, were retained for analysis. Nationally representative, detailed dietary data for adolescents aged 10-24 y are still lacking, particularly in sub-Saharan Africa, South Asia, and low-income countries. Data quality and representativeness remain limited, highlighting the need for data disaggregation by age, gender, locality, comprehensive dietary information, and broader geographic coverage. A notable amount of data was available through grey literature, especially in data-scarce countries. The study underscores the importance of addressing adolescent nutrition, emphasizing the urgent need for more robust, accessible, and representative data on adolescents' dietary intake to support effective nutritional efforts.

The prevalence of suicidal behaviour and its associated risk factors among school-going adolescents resident in the United Arab Emirates

Suicidal behaviour which includes suicidal ideation, having a plan to commit suicide and suicide attempts remains a global public health issue as it substantially impacts adolescent health and wellbeing. Suicidal behaviour, however, remains understudied in Middle Eastern contexts. This study analysed data from the 2016 Global School-based Student Health Survey collected in the United Arab Emirates (UAE). A sample of 5826 adolescents aged between 11 and 18 years were sampled. Potential risk factors associated with an elevated risk for engagement in suicidal behaviour were examined. These factors were stratified into categories for analysis (demographics, psychosocial, risky health, and socio-environmental). The age-adjusted prevalence of suicidal behaviour amongst the school-going adolescent population in the UAE was 54%. Analyses indicated that elevated risk was significantly associated with anxiety difficulties, the experience of loneliness, and amongst those who smoked tobacco. None of the socio-environmental factors emerged as significant. A dose-dependent relationship was evident in that the degree of risk that was evident appeared to compound as the number of adverse risk factors increased. The data suggest that suicidal behaviour may be highly prevalent in this location. Findings highlight the immense need to develop preventative interventions, some of which may be school-delivered and targeted at parents. Our findings provide initial indications as to which risk factors could be targeted for remediation in developing these interventions.

Community perceptions of vaccine advocacy for children under five in rural Guatemala

Historically, partnerships with community leaders (e.g., religious leaders, teachers) have been critical to building vaccination confidence, but leaders may be increasingly vaccine hesitant. In rural Guatemala, the extent of vaccine hesitancy among community leaders is unclear, as are their perceptions of advocacy for childhood vaccines. We sought to: (i) compare Guatemalan religious leaders' and community leaders' attitudes toward childhood vaccines, (ii) describe leaders' experiences and comfort with vaccination advocacy, and (iii) describe community members' trust in them as vaccination advocates. In 2019, we surveyed religious leaders, other community leaders, and parents of children under five in rural Guatemala. We recorded participant demographic information and assessed participant vaccine hesitancy regarding childhood vaccines. We analyzed data descriptively and via adjusted regression modeling. Our sample included 50 religious leaders, 50 community leaders, and 150 community members (response rate: 99%); 14% of religious leaders and community leaders were vaccine hesitant, similar to community members (P = 0.71). In the prior year, 47% of leaders had spoken about vaccines in their formal role; 85% felt responsible to do so. Only 28% of parents trusted politicians "a lot" for vaccine advice, versus doctors (72%; P < 0.01), nurses (62%; P < 0.01), religious leaders (49%; P < 0.01), and teachers (48%; P < 0.01). In this study, religious leaders and community leaders were willing but incompletely engaged vaccination advocates. Most community members trusted doctors and nurses a lot for vaccination advice; half trusted teachers and religious leaders similarly. Public health officials in rural Guatemala can complement efforts by doctors and nurses through partnerships with teachers and religious leaders to increase vaccination confidence and delivery.

Factors Influencing Undernutrition among Female Adolescent Students in Darchula District, Nepal

Failure to understand and address the problem of malnutrition and its associated factors among female adolescents could lead to a vicious cycle of intergenerational malnutrition. A cross-sectional study was conducted in six secondary schools of four rural municipalities in Darchula District, Nepal. Data collection for the study was conducted from November 2021 to February 2022. Four hundred female adolescent students aged 15 to 19 years old were selected using quota sampling. The study aims to examine the prevalence of malnutrition by assessing different levels of body mass index (BMI) that is thinness (BMI less than 18.5 kg/m2), normal (18.5 kg/m2 to 24.9 kg/m2), overweight (25 kg/m2 to 29.9 kg/m2) and obese (BMI more than or equal to 30 kg/m2). Along with BMI, factors associated with undernutrition, here identified as thinness, are assessed using a structured questionnaire. Additionally, key informant interviews and review of interventions was performed to understand the gaps in nutrition-related policies and programs of school going adolescents in the study district. Quantitative data analysis included a prevalence study and chi-square test along with simple and multiple logistic regression to obtain crude and adjusted odds ratio at 95% confidence interval for the significant factors with p < 0.05 identified in the chi-square test. Thematic analysis and reviews were used for the synthesis of qualitative data. The results show a 24.7% prevalence of thinness in the study participants. Pre-mensuration status (OR = 5.015, CI = 1.257–20.011, p < 0.022), father having a monthly paying job (OR = 4.384, CI = 1.135–16.928, p < 0.032), father’s foreign employment (OR = 6.96, CI = 1.649–29.377, p < 0.008), household (HH) food insecurity status (OR = 2.079, CI = 1.182–3.658, p < 0.011) and grain/roots/tuber as most commonly bought food (OR = 9.487, CI = 1.182–76.138, p < 0.034) were found to be significantly associated with thinness. Information from the qualitative part identified gaps in existing interventions for an improved nutritional outcome among school going adolescent females. Further studies to understand the nutritional practices and its contributory factors in relation to thinness is encouraged. Stakeholders are urged to effectively address the shortcomings in existing interventions and adopt a more adolescent-centered approach to enhance the nutritional status of female adolescents.

Epidemiology of suicidal behaviors among junior and senior high school adolescents: Exploring the interactions between bullying victimization, substance use, and physical inactivity

Suicide is a pandemic among global youths and adolescents. Still, there is insufficient evidence to show whether the interactions between bullying victimization, physical inactivity, substance use, and mental health illness aggravate suicidal behaviors among high school students. Based on the Global School-Based Student Health Survey, we analyzed the individual and interaction impacts of bullying victimization, physical inactivity, substance use, and suicidal behaviors among 3,632 adolescents. The 12-month prevalence of suicidal thoughts and plans among senior high school students was over fifty percent. Junior high school students had higher rates of suicide attempts and bullying victimization than senior high school students. Multivariate results indicate that bullying victimization, substance use, and physical inactivity were significantly associated with suicidal thoughts, plans, and attempts among high school students. The interaction of physical inactivity and alcohol was significantly associated with suicidal thoughts in junior high school. In contrast, the interaction of bullying and alcohol was associated with suicidal plans among senior high school adolescents. We hope the findings from this study will generate interventions toward reducing the suicide epidemic in Ghana.

Effects of brief training on mental health provider's knowledge of working with youth at risk of suicide in Guatemala

BACKGROUND

Resources for mental healthcare are lacking in Guatemala, yet rates of mental illness and suicide are quite high. Mental healthcare providers often lack the knowledge needed to effectively work with young at-risk of suicide. To address this gap, we developed a training program for mental health professionals focused on increasing knowledge and understanding of engaging and working with youth at risk of suicide and present its acceptability and preliminary effectiveness.

METHODS

Mental health providers (N = 17) from a low SES community participated in the training, Formacion CUIDAR (Comunidades Unidos para Individuales De Alto Riesgo; CARE Training; Communities United for Individuals at High Risk). Mixed methods were used to explore outcomes including, self-reported knowledge and understanding of warning signs; risk and protective factors; effective risk assessment; and, techniques for working with at-risk youth.

RESULTS

Findings indicate that the training was effective at increasing all targeted domains of knowledge (t = 2.46, p < .05, Cohen's d = .56). Acceptability was also rated as high.

CONCLUSION

Scarcity of mental health specialists and lack of training on suicide assessment and management have resulted in inadequate resources for at-risk youth in need of mental health services in Guatemala. Results of our study demonstrate that our training is an acceptable, effective program for practicing mental health providers to address their lack of specialized training on how to work with individuals at risk of suicide. Further examination of the training in a larger RCT is required to attain more robust indictors of effectiveness and to assess long-term impact.

Prevalence and Determinants of Underweight, Overweight, and Obesity: A Cross-Sectional Study of Sociodemographic, Dietary, and Lifestyle Factors Among Adolescent Girls in Jutiapa, Guatemala

BACKGROUND

As the incidence of overweight continues to increase among children and adolescents in Guatemala, underweight remains a prominent health problem. However, the prevalence of overweight or underweight and associated risk factors has not been investigated among adolescent girls.

OBJECTIVE

To determine the prevalence of underweight and overweight/obesity and associated sociodemographic, dietary, and lifestyle factors among adolescent girls in Jutiapa, Guatemala.

METHODS

A cross-sectional study of a subsample of 392 girls aged 12 to 17 years from an agriculture-nutrition trial was conducted. Anthropometric data were obtained using standard methods. Sociodemographic, dietary, and lifestyle data were collected using a structured questionnaire. Multivariable logistic regression was conducted using underweight (body mass index [BMI] for age < 5th percentile) and overweight/obesity (BMI for age ≥ 85th percentile) as outcome variables.

RESULTS

The prevalence of underweight and overweight/obesity was 9.9% and 15.6%, respectively. Age (15-17 years), high waist circumference, high blood pressure, father being a farmer, large family (> 5 persons), hours spent watching TV, and high red meat consumption were significantly associated with underweight. Whereas being in school, high waist circumference, high blood pressure, overweight/obese mother, unemployed father, watching TV for more than 2 hours, having soft drinks at home, and meeting fruit recommendations were significantly associated with overweight/obesity.

CONCLUSIONS

Our findings highlight the importance of concurrently addressing underweight and overweight/obesity among adolescent girls in rural Guatemala. Studies in various parts of the country are needed to confirm the results of the present study and for appropriate strategies to be implemented to reduce both underweight and overweight.

The association of sleep problem, dietary habits and physical activity with weight status of adolescents in Nepal

BACKGROUND

Overweight/obesity among adolescents is an emerging public health issue worldwide. However, the evidence on the determinants of body weight status and lifestyle behaviors among Nepalese adolescents is limited. This study aims to explore the sleep characteristics, dietary habits, and physical activity and its association with body mass index (BMI) among Nepalese adolescents.

METHODS

A cross-sectional study was conducted between July and November 2019 among 627 randomly selected adolescents from eight schools located in Kathmandu Metropolitan City, Nepal. A self-administrated structure questionnaire was used to collect the data. Anthropometric measurements (adolescent's BMI), sleep characteristics, dietary habits, and physical activity were assessed using validated tools. Multinomial logistic regression analyses assessed the association between covariates and BMI categories. The statistical significance was considered at p-value < 0.05 and 95% confidence intervals (CIs).

RESULTS

The overall prevalence of underweight and overweight/obesity among adolescents was 9.1% (95% CI: 7.1-11.6) and 23.7% (95% CI: 20.6-27.7) respectively. In multinomial logistic regression, adolescents who reported sleep problem compared to those with no such problem (Relative risk ratio (RRR) = 13.37, 95% CI: 7.14-25.05), adolescents who had obstructive sleep apnea (OSA) symptoms (RRR = 3.21, 95% CI:1.31-7.86), who consumed soft drink ≥1 time/day in past 1 months (RRR = 5.44, 95% CI: 2.93-10.10), consumed high-fat dietary ≥2 times/day (RRR = 2.17, 95% CI: 1.18-3.99), and had a habit of junk food consumptions (RRR = 5.71, 95% CI:2.55-12.82), adolescents who had 5-6 h/day sedentary behavior (RRR = 3.21, 95% CI: 1.14-9.09), adolescents from Terai/Madhesi castes (RRR = 2.81, 95% CI: 1.19-6.64) and adolescents whose father was employed (RRR = 2.04, 95% CI: 1.04-3.98) were at increased risk of being overweight/obesity. In contrast, adolescents aged 14-16 years had 71% lower (RRR = 0.29, 95% CI: 0.16-0.52), and adolescents who consumed less than five food groups had 45% lower (RRR = 0.55, 95% CI: 0.31-0.97) risk of being overweight/obesity compared to 12-14 years age groups and consumed more than five food groups respectively.

CONCLUSIONS

The findings of this study warrant immediate interventions to improve the lifestyle to reduce overweight/obesity among Nepalese adolescents. Creating a conducive environment, both at school and home is essential to encourage adolescents for the adoption of healthy lifestyle behaviors.

Dietary behavior of school-going adolescents in Bhutan: Findings from the global school-based student health survey in 2016

OBJECTIVES

Bhutan is experiencing a dual burden of undernutrition and overnutrition among adolescents. Understanding dietary behavior is vital to designing evidence-based interventions to improve adolescent nutrition and prevent non-communicable diseases in adults. The aim of this study was to assess the pattern of dietary behavior and associated sociodemographic, behavioral, and metabolic risk factors among school-going adolescents in Bhutan.

METHODS

The Bhutan Global School-based Student Health Survey 2016 studied students in grades 7 to 11 (N = 7576), sampled from 50 schools, randomly selected based on probability proportional to enrollment size, using a standardized self-administered questionnaire. Consumption of adequate fruits and vegetables (each at least twice daily, or a combination of at least five times daily), high-protein food at least twice weekly) in the past 30 d, no fast food in the past week, and no carbonated/sweetened drinks in the past 30 d were studied. Weighted prevalence of dietary behaviors and adjusted prevalence ratio (95% confidence interval) for factors associated with them were calculated.

RESULTS

Of 5809 students from 13 to 17 y of age comprising 3255 (56%) girls and 3184 (54.8%) day students, 1166 (20.1%) were underweight, 1655 (28.5%) were tobacco users, and 1349 (23.2%) were alcohol users. Adequate fruit and vegetable intake, high protein consumption, not consuming fast foods and carbonated beverages were reported by 29.6%, 31.8%, 9.6%, and 14.9%, respectively. Being a day student, sex, and not reporting health risk behaviors were significantly associated with any healthy dietary behavior.

CONCLUSION

Healthy eating behavior was low among Bhutanese adolescents. Policies influencing availability, affordability, and acceptability of healthy diets through peer-led, school- and community-based interventions are required to promote adolescent health and prevent non-communicable diseases.

Depressive symptoms and suicidal ideation among Vietnamese students aged 13-17: Results from a cross-sectional study throughout four geographical regions of Vietnam

We conducted a cross-sectional study in four provinces located in four different geographical areas in Vietnam to examine the prevalence and associated factors of depression and suicide ideation among school students aged 13-17. A sample of 6407 students from secondary school and high school participated in our survey to complete self-reported questionnaires. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression scale (CES-D). Suicidal ideation and associated factors were measured by the Global School Student Health Survey (GSHS) questionnaire. We found that 31.7% of students had depressive symptoms, and 11% reported suicidal ideation during the last year. Female students and older students were more at risk of experiencing depressive symptoms and suicidal ideation than male students and younger students. Bullying, violence, smoking, and alcohol consumption appear as risk factors, while a good relationship with parents/guardians may protect school students from having depressive symptoms and suicidal ideation.

Prevalence and correlates of past 12-month suicide attempt among in-school adolescents in Guatemala

Background

The aim of this investigation was to estimate the prevalence of past 12-month suicide attempts and associated factors among in-school adolescents in Guatemala.

Methods

Cross-sectional data from the 2014 "Global School-based Health Survey (GSHS)" included 4,274 students (median age 14 years, interquartile range=2 years) that were representative of all middle school students in Guatemala.

Results

The prevalence of past 12-month suicide attempt was 16.6%, 12.2% among boys and 20.2% among girls. Among students with a suicide attempt in the past year, 52.8% had a suicide plan in the past year. In adjusted logistic regression analysis, male sex and loneliness were associated with past 12-month suicide attempt, and among boys, none of the variables, and among girls, loneliness and current alcohol use were associated with past 12-month suicide attempt.

Conclusion

A high prevalence and several specific factors associated with suicide attempt were identified which can help in guiding preventive strategies.