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Cherewick M, Dahl RE, Bertomen S, Hipp E, Shreedar P, Njau PF, Leiferman JA. Risk and protective factors for mental health and wellbeing among adolescent orphans. Health Psychol Behav Med 2023; 11:2219299. [PMID: 37274749 PMCID: PMC10234133 DOI: 10.1080/21642850.2023.2219299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
Background Research has demonstrated the importance of understanding risk factors for mental health and wellbeing. Less research has focused on protective factors that protect mental health and promote wellbeing in diverse contexts. Estimating structural paths from risk protective factors to psychopathology and wellbeing can inform prioritization of targeted investment in adolescent health programs that seek to modify factors that are most closely associated with mental wellbeing. Study objective The purpose of this study was to examine risk factors (e.g. emotional neglect, emotional abuse, physical neglect, stigma) and protective factors (e.g. community relationships, self-esteem, and autonomy) among adolescent orphans, protective associations with depression, anxiety and externalizing behaviors and promotive associations with hope, happiness, and health. Methods The analytic sample was collected between January and March of 2019 and included 350 adolescent orphans ages 10-15 from three districts in Tanzania. Participants completed survey interviews, 75-90 min in length, that measured risk and protective factors, psychological symptoms, and mental wellbeing measures. Results Results of the fitted structural equation model indicated that structural paths from protective factors to psychopathology (β = -0.53, p = 0.015) and mental wellbeing (β = 0.72, p = 0.014) outcomes were significant. Structural paths from risk factors to psychopathology (β = -0.34, p = 0.108) and mental wellbeing (β = -0.24, p = 0.405) were not significant. Conclusion In a sample of vulnerable youth, protective factors (e.g. community relationships, self-esteem, and autonomy) were significantly associated with reduced depression, anxiety and externalizing behaviors and increased hope, happiness, and health in a structural equation model that included risk factors (emotional neglect, emotional abuse, physical neglect). Results suggest that strong community relationships, self-esteem and autonomy may be important modifiable factors to target in intervention programs aimed at supporting adolescent mental wellbeing.
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Affiliation(s)
- Megan Cherewick
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Ronald E. Dahl
- Institute of Human Development, University of California Berkeley, Berkeley, CA, USA
| | - Samantha Bertomen
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Emily Hipp
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Priyanka Shreedar
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | | | - Jenn A. Leiferman
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
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Cherewick M, Dahl RE, Rubin D, Leiferman JA, Njau PF. Psychometric validation of the collective asset Utu: associations with coping strategies and resilience during adolescence. Glob Health Res Policy 2023; 8:15. [PMID: 37198701 DOI: 10.1186/s41256-023-00303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 05/07/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Utu is a Kiswahili term with a long history of cultural significance in Tanzania. It conveys a value system of shared, collective humanity. While variants of Utu have been studied in other contexts, a measure of Utu that captures this important collective asset has not been developed in Tanzania. The aims of this study were to (1) examine dimensional constructs that represent Utu, (2) validate a measurement scale of Utu for use with adolescents, (3) examine differences between orphan and non-orphan adolescents in self-reported Utu and, (4) examine structural paths between adverse life experiences, coping strategies, Utu, and resilience. METHODS: This study collected survey data from adolescents from three districts in peri-urban Tanzania in two samples: 189 orphan adolescents ages 10-17 in May 2020 and 333 non-orphan adolescents ages 10-14 in August 2020. Confirmatory factor analysis was used to validate the hypothesized factor structure of the developed Utu measure. Structural equation models were used to examine path associations with adverse life experiences, coping and resilience. RESULTS The five dimensional constructs comprising the Utu measure included Resource Sharing, Group Solidarity, Respect and Dignity, Collectivity, and Compassion. Confirmatory factor analysis of the Utu measure demonstrated excellent fit (CFI = 0.98; TLI = 0.97; SRMR = 0.024; RMSEA = 0.046) and internal consistency (α = 0.94) among adolescents in this study. Positive, significant associations were found between Utu and coping (β = 0.29, p < 0.001) and Utu and intra/interpersonal and collective resilience (β = 0.13, p < 0.014). Utu was not significantly associated with adverse life experiences, age or gender. CONCLUSIONS A five-dimensional measurement scale for Utu was validated in a sample of orphan and non-orphan adolescents in Tanzania. Utu is a collective asset associated with higher levels of reported resilience in both orphan and non-orphan adolescent populations in Tanzania. Promoting Utu may be an effective universal public health prevention approach. Implications for adolescent programming are discussed.
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Affiliation(s)
- Megan Cherewick
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, 13001 East 17th Place, Aurora, CO, 80045, USA.
| | - Ronald E Dahl
- Institute of Human Development, University of California Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720-1690, USA
| | - Daphna Rubin
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Jenn A Leiferman
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Prosper F Njau
- Health for a Prosperous Nation, P.O. Box 13650, Dar es Salaam, Tanzania
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Streatfield AJ, Rahman MM, Khan S, Haider MM, Rahman M, Nahar Q, Jamil K. What shapes attitudes on gender roles among adolescents in Bangladesh. Front Public Health 2023; 11:1121858. [PMID: 37056652 PMCID: PMC10088519 DOI: 10.3389/fpubh.2023.1121858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/20/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundIn Bangladesh, large gender differentials exist in outcomes in almost all spheres of life, stemming from conservative norms and attitudes around gender. Adolescence is a crucial period for social-emotional learning that can shape gender norms and attitudes.ObjectiveThe aim of the paper is to investigate the extent to which adolescents hold egalitarian attitudes toward gender roles, and to examine the factors that influence egalitarian gender attitudes.MethodsThe paper uses data from a nationally representative sample survey of 7,800 unmarried girls and 5,523 unmarried boys ages 15–19 years. Adolescents were considered to have egalitarian attitudes on gender role if they disagreed with all the following four unequal gender role statements with regards to socio-economic participation, while respondents who agreed with any one of the four statements were considered to have non-egalitarian attitudes: (1) It is important that sons have more education than daughters, (2) Outdoor games are only for boys, not girls, (3) Household chores are for women only, not for men, even if the woman works outside the home, and (4) Women should not be allowed to work outside the home. Multivariable linear probability regression analysis was implemented to identify the factors shaping attitudes on gender roles.ResultsUnmarried girls and boys differ hugely in their views on gender roles regarding socio economic participation-girls were much more egalitarian than boys (58 vs. 19%). The multivariate linear probability model results show girls and boys who completed at least grade 10 were 31% points and 15% points more likely to have egalitarian views on gender roles respectively, compared to girls and boys with primary or less education. Having strong connection with parents is associated with having egalitarian views on gender roles among girls but not boys. Adolescents' individual attitude on gender role is highly associated with the views of their community peers for both girls and boys. Girls and boys who had participated in adolescent programs were 6–7% points more likely to have egalitarian attitude than those who were not exposed to these programs. Egalitarian views were also significantly higher, by 5% points among girls and 6% points among boys, who were members of social organizations compared to those who were not. Watching television had positive influence on egalitarian attitudes among girls but not among boys. To create a more egalitarian society, both men and women need to hold progressive attitudes toward gender roles. The interventions must be multilevel, influencing adolescents at the personal, interpersonal, communal, and societal levels.
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Affiliation(s)
| | - Md Mahabubur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Data for Impact, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Shusmita Khan
- Data for Impact, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - M. Moinuddin Haider
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Data for Impact, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mizanur Rahman
- Data for Impact, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Quamrun Nahar
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Kanta Jamil
- Independent Consultant, Fitzroy North, VIC, Australia
- *Correspondence: Kanta Jamil
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Cherewick M, Hipp E, Njau P, Dahl RE. Growth mindset, persistence, and self-efficacy in early adolescents: Associations with depression, anxiety, and externalising behaviours. Glob Public Health 2023; 18:2213300. [PMID: 37196667 DOI: 10.1080/17441692.2023.2213300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
ABSTRACTGrowth mindset, persistence, and self-efficacy are important protective factors in understanding adolescent psychopathology, including depression, anxiety, and externalising behaviours. Previous studies have shown that dimensions of self-efficacy (academic, social, and emotional) have differential protective effects with mental health outcomes and these differences vary by sex. This study examines the dimensional mediation of self-efficacy from motivational mindsets on anxiety, depression, and externalising behaviours in a sample of early adolescents ages 10-11. Surveys were administered to participants to measure growth mindset and persistence on internalising and externalising symptoms. The Self-Efficacy Questionnaire for Children (SEQ-C) was used to measure domains of self-efficacy for mediation analysis. Multi-group structural equation modelling by sex indicated that structural paths were not invariant by sex. Significant direct effects were identified from persistence to externalising behaviours in boys, and significant direct effects were identified from growth mindset to depression in girls. In a sample of Tanzanian early adolescents, self-efficacy mediates the protective association between motivational mindsets on psychopathology. Higher academic self-efficacy was associated with reduced externalising problems in both boys and girls. Implications for adolescent programmes and future research are discussed.
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Affiliation(s)
- Megan Cherewick
- Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, CO, United States
| | - Emily Hipp
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Prosper Njau
- Health for a Prosperous Nation, Dar es Salaam, Tanzania
| | - Ronald E Dahl
- Institute of Human Development, University of California Berkeley, Berkeley, CA, United States
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Cherewick M, Dahl RE, Leiferman JA, Hipp E, Schmiege S. Psychometric properties of the empathy questionnaire for children and adolescents in a sample of Tanzanian adolescents. Front Psychol 2022; 13:981967. [PMID: 36275217 PMCID: PMC9583906 DOI: 10.3389/fpsyg.2022.981967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/22/2022] [Indexed: 12/19/2022] Open
Abstract
Construct definitions of empathy have sought to distinguish between different domains of empathetic capacity that are related to psychological distress or wellbeing. This study aims to validate the psychometric properties of the Empathy Questionnaire for Children and Adolescents (EmQue-CA) and to test for measurement invariance by gender in a sample of 579 very young adolescents (270 boys and 309 girls) ages 9-12 from Tanzania. Exploratory and confirmatory factor analysis were completed to assess the factor analytic structure of the EmQue-CA, indicating a three-factor model fit these data well. Concurrent validity was demonstrated through strong significant correlations with prosocial behavior and generosity measures. Convergent validity indicated the behavioral subdimension of empathy, intent to comfort, was significantly and negatively associated with externalizing behaviors. Measurement invariance by gender was not supported for these data due to configural invariance in covariance between cognitive empathy and intent to comfort latent constructs. These findings confirm the EmQue-CA is an important measure of three dimensions of empathy; affective empathy, cognitive empathy, and behavioral empathy (intent to comfort) in a sample of Tanzanian adolescents.
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Affiliation(s)
- Megan Cherewick
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, United States
- *Correspondence: Megan Cherewick,
| | - Ronald E. Dahl
- Institute of Human Development, University of California, Berkeley, Berkeley, CA, United States
| | - Jenn A. Leiferman
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, United States
| | - Emily Hipp
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Sarah Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
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Taba M, Allen TB, Caldwell PHY, Skinner SR, Kang M, McCaffery K, Scott KM. Adolescents' self-efficacy and digital health literacy: a cross-sectional mixed methods study. BMC Public Health 2022; 22:1223. [PMID: 35725389 PMCID: PMC9207829 DOI: 10.1186/s12889-022-13599-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The internet and social media are increasingly popular sources of health information for adolescents. Using online health information requires digital health literacy, consisting of literacy, analytical skills and personal capabilities such as self-efficacy. Appraising trustworthiness and relevance of online health information requires critical health literacy to discriminate between sources, critically analyse meaning and relevance, and use information for personal health. Adolescents with poor digital health literacy risk using misinformation, with potential negative health outcomes. We aimed to understand adolescents' contemporary digital health literacy and compared self-efficacy with capability. METHODS Adolescents (12-17 years) completed an eHEALS self-report digital health literacy measure, a practical search task using a think-aloud protocol and an interview to capture perceived and actual digital health literacy. eHEALS scores were generated using descriptive statistics, search tasks were analysed using an observation checklist and interviews were thematically analysed based on Social Cognitive Theory, focussing on self-efficacy. RESULTS Twenty-one participants generally had high self-efficacy using online health information but perceived their digital health literacy to be higher than demonstrated. They accessed online health information unintentionally on social media and intentionally via search engines. They appraised information medium, source and content using general internet searching heuristics taught at school. Information on social media was considered less trustworthy than websites, but participants used similar appraisal strategies for both; some search/appraisal heuristics were insufficiently nuanced for digital health information, sometimes resulting in misplaced trust or diminished self-efficacy. Participants felt anxious or relieved after finding online health information, depending on content, understanding and satisfaction. They did not act on information without parental and/or health professional advice. They rarely discussed findings with health professionals but would welcome discussions and learning how to find and appraise online health information. CONCLUSIONS Whilst adolescents possess many important digital health literacy skills and generally feel self-efficacious in using them, their critical health literacy needs improving. Adolescents desire increased digital health literacy so they can confidently appraise health information they find online and on social media. Co-designed educational interventions with adolescents and health providers are required.
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Affiliation(s)
- Melody Taba
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Tiffany B Allen
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Patrina H Y Caldwell
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - S Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Melissa Kang
- Specialty of General Practice, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Karen M Scott
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Cherewick M, Schmiege S, Hipp E, Leiferman J, Njau P, Dahl RE. A developmental analysis of dimensions of empathy during early adolescence: Behavioral empathy but not cognitive empathy is associated with lower psychopathology. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001231. [PMID: 36962683 PMCID: PMC10021927 DOI: 10.1371/journal.pgph.0001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/09/2022] [Indexed: 11/09/2022]
Abstract
Construct definitions of empathy have sought to distinguish between different dimensions of empathetic capacity that are significantly associated with psychological distress or wellbeing. Research has provided substantial evidence differentiating affective and cognitive empathy; however, more recent research has cited the importance of a third domain represented by empathetic behaviors and compassionate intent to comfort others. Examining developmental and maturational stage during the rapid transitional period of early adolescence is needed to model developmental trajectories, mechanisms of change and mental health outcomes. This study aims to assess relationships between pubertal developmental stage, dimensions of empathy, and depression, anxiety and externalizing behaviors among early adolescents. A cross-sectional survey among young adolescents ages 9-12 years was conducted in Dar es Salaam, Tanzania. The relationships between pubertal developmental stage, affective, cognitive, and behavioral empathy scores and internalizing and externalizing symptoms were evaluated using hierarchical regression modeling. Structural equation modeling was used to test a theoretical model of structural paths between these variables. A sample of 579 very young adolescents (270 boys and 309 girls) aged 9-12 years participated in the study. Pubertal development scale scores were associated with affective, cognitive, and behavioral empathy. Adolescents who had greater behavioral empathy scores reported lower internalizing and externalizing symptoms. Adolescents who had transitioned further through puberty and had higher cognitive empathy scores and reported higher internalizing symptoms. These findings support the importance of pubertal developmental stage in assessing risk and protective paths to mental health during adolescence. While empathetic capacity is widely perceived to be a positive trait, dimensional analysis of empathy among early adolescents indicates that behavioral skills and compassionate acts may be particularly protective and promote positive mental health outcomes.
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Affiliation(s)
- Megan Cherewick
- Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, CO, United States of America
| | - Sarah Schmiege
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, United States of America
| | - Emily Hipp
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, United States of America
| | - Jenn Leiferman
- Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, CO, United States of America
| | - Prosper Njau
- Health for a Prosperous Nation, Dar es Salaam, Tanzania
| | - Ronald E Dahl
- Institute of Human Development, University of California Berkeley, Berkeley, CA, United States of America
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