MyVoice National Text Message Survey of Youth Aged 14 to 24 Years: Study Protocol

The perceived impact of a post-Dobbs landscape on U.S. adolescents and young adults

OBJECTIVE(S)

To capture the perspectives and knowledge of adolescents and young adults on abortion-related topics following the Dobbs decision.

STUDY DESIGN

Qualitative content analysis of an open-ended, five-question survey fielded on October 28, 2022 via the MyVoice project, a nationwide weekly text message poll of 14-24-year-olds.

RESULTS

We found the respondents (N = 565, response rate 71%) had a mean age of 20.0 years and resided in 47 states. Many described pro- or anti-abortion changes to abortion access in their state, though expressed mixed emotions about the changes (negative, positive, or mixed/neutral). Most often, they had conversations about abortion with peers (28%), followed by parents or family (20%); nearly 20% stated they have never had a conversation about abortion. The majority of respondents (55%) believed they and their peers should have access to abortion care without required parental consent/notification, frequently citing individual rights/autonomy (31%) followed by harms of parental involvement (12%). Most (79%) provided a technique for how to determine if online information about abortion was trustworthy.

CONCLUSION(S)

Four months after the Dobbs decision, this national sample of adolescents and young adults were aware of changes to abortion access, had conversations about abortion, shared diverse opinions on parental consent or notification laws, and could determine trustworthiness of online abortion resources. Abortion-related policy and practice can be improved by understanding adolescents' and young adults' needs and preferences, trusting and supporting their autonomy, and reducing barriers to care.

IMPLICATIONS

This study highlights the timely perspectives and experiences of a diverse, nationwide sample of adolescents and young adults on abortion-related topics. Findings can support centering adolescents and young adults in practice and policy changes to improve their knowledge about abortion and streamline access to essential reproductive health services post-Dobbs.

"Be more positive and more kind to your own bodies": Adolescent and young adult preferences for how parents can support their children with weight-related pressures

Body dissatisfaction is a key factor contributing to the development of disordered eating, and body dissatisfaction is often influenced by media, peer, and parental pressures during adolescence. Little research has explored ways in which parents can help their children manage pressures from social media and their peers. The present study used the MyVoice National Poll of Youth, a large text-message cohort of young people (14-24 years old) in the United States, to collect and examine qualitative data about their experiences with parental weight-related communication and how they think parents can best support their children regarding messages they see/hear surrounding weight, body shape and size by their peers and media sources. 801 participants responsed to at least one question. Results from the present study suggest that young people want their parents to model healthy relationships with food and their body, teach body neutrality/acceptance, and normalize all body types. Findings suggest that there are many proactive, practical approaches parents can adopt to help support their children and offset weight-related pressures from other sources.

Perspectives of adolescents and young adults on cannabis use during pregnancy

PURPOSE

Rates of cannabis use during pregnancy are highest for adolescents and young adults (AYAs). This study aims to understand AYA perspectives regarding the medical and legal consequences of prenatal and parental cannabis use.

METHODS

This study delivered five open-ended survey questions regarding prenatal cannabis use in May/June 2022 via a text message polling platform to the MyVoice cohort, a cohort of AYA aged 14-24 throughout the United States recruited from social media to target national benchmarks set by the American Community Survey. We used qualitative content analysis to analyze open-ended responses and summarized code frequency and demographic data with descriptive statistics.

RESULTS

Of 826 AYAs, 666 responded to at least one question (response rate = 80.6 %) and the mean age of respondents was 19.9 years (SD = 2.3). We identified four themes from responses: (1) AYA believe cannabis is harmful during pregnancy, (2) they are divided on whether prenatal cannabis exposure should be considered child abuse or neglect, (3) they have mixed attitudes about safe parenting and regular cannabis use, and (4) they support counseling from health care professionals about prenatal cannabis use.

CONCLUSIONS

AYAs were concerned about potential risks of prenatal cannabis exposure and want clinicians to counsel about cannabis use during pregnancy. More than one in three AYAs surveyed felt prenatal cannabis use should be classified as child abuse or neglect, in contrast to the declining perception of risk among pregnant people.

US youth perspectives on eye trauma and eye protection

Eye injuries from sports, activities, and work are a leading cause of vision loss in youth. Most eye injuries can be prevented with protective eyewear. An open-ended survey on youth perspectives on eye trauma and protection was administered to the MyVoice Text Message Cohort of US youth ages 14-24 years. Qualitative, text message responses were coded using thematic analysis. The survey was distributed to 798 recipients; 641 (80.3%) responded. Many youth were concerned about the impact of excessive screen use (n = 278 [43.8%]) and sunlight or UV exposure (n = 239 [37.6%]) on their eye health. Fewer were concerned about injury from sports and activities (n = 115 [18.1%]) or job-related eye risks (n = 77 [12.1%]). The most common actions that youth took to protect their eyes included sun protection (eg, sunglasses; n = 300 [47.2%]), refractive correction (eg, glasses, contacts; n = 195 [30.7%]) and screen protection (eg, blue light blocking glasses; n = 159 [25.0%]). Fewer wore eye protection for sports or activities (n = 54 [8.5%]) or work (n = 41 [6.5%]). Youth concerns about eye injury from screens and sunlight are misaligned with the main causes of vision loss in this population, suggesting that public health education is needed to promote optimal eye safety.

Youth Perspectives and Experiences With Menstruation and Period Poverty

PURPOSE

Period poverty is the lack of accessible menstrual education or menstrual tools. Millions of women and girls around the world experience period poverty, which can contribute to disparities in school and work performance, as well as overall quality of life. However, not much is known about youth experiences and perceptions of period poverty. This study aims to understand the personal experiences and opinions of American youth regarding knowledge about menstruation and period poverty, as well as to gauge youth attitudes of existing and future period poverty initiatives.

METHODS

The MyVoice nationwide text message poll was used to ask five open-ended questions to over 1,000 youth across the United States aged 14-24 years. Responses were analyzed using content analysis by two independent researchers, and differences in coding were reviewed and resolved by discussion.

RESULTS

Overall, 963 youth (80%) responded, and the sample was 54.7% self-reported male with an average age of 20.1 years (standard deviation = 2.3). Three main themes emerged: 1. Most youth, regardless of self-reported gender, have had conversations about periods but comfort discussing the topic varies, 2. Youths' knowledge of menstruation varies with personal experience, or lack thereof, and 3. Some youth have experience with period poverty, and most are overwhelmingly supportive of policies to improve access to period products.

DISCUSSION

These findings suggest that normalization of discussions of menstruation, increasing awareness of the prevalence and impacts of period poverty, and greater implementation of programs to mitigate period poverty are supported by youth, and may reduce period poverty in the United States.

Engaging the Next Generation in Communication to Address Information Quality

Information disorder can have adverse consequences on health. While there has been growing attention to health information quality among the general population, there has been less focus on the young adult age group and how their insights and ideas can help to explore the effects and potential interventions to address information quality. Since certain information consumption habits and effects vary among young people, their perspective can provide valuable insights for tackling the increasing issue of misinformation. This Perspective examines past youth involvement efforts to suggest ways to incorporate the youth perspective into improving the quality of health information, particularly through engagement strategies aimed at combating misinformation traits. We then propose a set of five recommendations to advance research to address information disorder, researchers can consider the following steps to engage youth.

Perceptions of Breastfeeding Among Adolescents and Young Adults

Purpose: We aimed to understand adolescents' and young adults' perceptions and the extent of their knowledge about breastfeeding. Methods: Participants (adolescents and young adults in the United States, 14-24 years of age) were texted five open-ended questions about their perceptions of various aspects of breastfeeding including their initial reaction to breastfeeding, the impact on the infant and parent, how it compares with formula, and whether they were breastfed. The responses were analyzed for themes using an inductive content analysis approach. Responses were compared using χ2 tests to assess if knowledge and education about breastfeeding differed according to gender identity and age. Results: Among 1,283 participants, 829 responded (response rate = 64.4%). The average age was 18.8 (standard deviation [SD] = 2.9), with 53% female and 10% Black. Most adolescents and young adults understand there are health benefits of breastfeeding for the breastfeeding dyad (n = 589; 78.8%), yet also indicate an awareness of negative aspects (n = 256; 36.1%). Participants who identified as female or gender-variant and those who were older were more likely to refer to the emotional and bonding connections breastfeeding creates (p = 0.0011 and p = 0.0002). Males were more likely to have less knowledge about breastfeeding effects on the breastfeeding person but have more negative attitudes toward formula (p = 0.0298 and p = 0.0543). Younger respondents tended to indicate that formula was better than breast milk (p = 0.0534). Conclusion: We found a mix of positive and negative perceptions of breastfeeding among adolescents and young adults. Understanding how youth view breastfeeding can inform targeted education for this population that includes all genders and can begin before pregnancy.

Youth preferences for healthcare providers and healthcare interactions: a qualitative study

BACKGROUND

Patient-physician relationships in healthcare can influence healthcare provision, patient engagement, and health outcomes. Little is known about youth preferences on types and characteristics of their healthcare providers. The aim of this study was to assess youth perspectives on preferences for and interactions with their healthcare providers.

METHODS

We posed 5 open-ended questions to 1,163 MyVoice participants, a nationwide text message cohort of United States youth aged 14-24, on April 10, 2020 related to youth preferences for healthcare providers. Content analysis was used to develop a codebook. Responses were independently coded by two reviewers with discrepancies discussed to reach consensus. Descriptive statistics were calculated for demographics and frequency of codes.

RESULTS

944 (81%) participants responded to at least one question. Respondents had a mean age of 18.9 years (SD: 2.8) and were a majority female (53.6%) and White (56.3%). Youth reported "kindness" or other personality traits (31%) and education (30%) as important in choosing their doctor. Patient-physician concordance was not important to many youths (44%) and among those who reported concordance as important (55%), having the same gender was the most noted (68%). Youth suggested respect, open conversation, and addressing issues directly to help alleviate uncomfortable situations, though some would simply switch providers.

CONCLUSION

Personality and empathy are important provider characteristics valued by youth. Female respondents preferred gender concordant providers, particularly for sexual health-related issues, and non-white respondents were more likely to prefer racial concordance. Strengthening professional and interpersonal skills among youth-serving providers may improve healthcare engagement and satisfaction among youth.

A Nationwide Sample of Adolescents and Young Adults Share Where They Would Go Online for Abortion Information After Dobbs v. Jackson

PURPOSE

Given the changing landscape of abortion access, we sought to understand where adolescents and young adults retrieve information about abortion online.

METHODS

A nationwide sample (n = 638) of 14- to 24-year-olds responded to a qualitative text message survey in July 2022 regarding websites or social media they would use for abortion-related information. Open-ended responses were coded and analyzed for themes.

RESULTS

Forty-six percent of respondents (n = 234) named specific websites or accounts of known organizations or individuals; 14% named general clinical or governmental resources; and 13% named social media platforms. Eight percent expressed skeptical sentiments about online abortion information. 17% (n = 99) said they were not sure or did not have an opinion.

DISCUSSION

Many adolescents and young adults could name an online resource for abortion information, but some are not aware of specific resources, underscoring a need to elevate reputable sources and provide guidance on how and where to look for accurate online abortion-related information.

Youth experiences with and perspectives on long covid

BACKGROUND

Research on the long-term effects of COVID-19 infection is ongoing, and the psychological and physical impacts of Long Covid on youth is poorly understood. To assess these impacts, we surveyed youth regarding their experiences with, and perspectives on, the long-term effects of COVID-19.

METHODS

We conducted a nationwide text message survey of youth ages 14-24 years in the United States. The survey asked four open ended questions regarding their experiences and perceptions regarding the long-term effects of COVID-19. Qualitative data was analyzed independently by three investigators using thematic analysis. Prevalence of codes were summarized using descriptive statistics.

RESULTS

Among 1150 participants, 991 responded to at least one survey question (response rate 86.1%). The vast majority of our sample had COVID-19 or knew someone who did (75%), and approximately one third (32%) of youth indicated that they knew someone who had experienced symptoms consistent with Long Covid. Many youth (50%) reported worry and concern about Long Covid even if they, or someone they knew, did not have Long Covid. Among youth who were not concerned about Long Covid, the most commonly reported reasons were having received the vaccine (29%) and not having a prior COVID-19 infection (24%).

CONCLUSIONS

Our findings suggest that among younger populations, there is significant concern regarding the long-term effects of COVID-19. Vaccination campaigns and youth-centered public health communication about Long Covid may not only reduce COVID-19 transmission, but also alleviate worries and concerns about Long Covid among youth.

"Time and money and support": Adolescents and young adults' perceived social and logistical support needs for safe abortion care

OBJECTIVE

To understand what support adolescents and young adults need to access abortion amidst the changing legal landscape.

STUDY DESIGN

A diverse nationwide sample (N = 638, response rate 78%) of individuals aged 14-24 responded to a text message survey in July 2022 about the social and logistical support they would need for safe abortion access. Responses were coded and analyzed thematically.

RESULTS

Respondents described parents and friends as primary sources of social support for potential abortion decisions. They frequently cited money and transportation as logistical support needs for out-of-state abortion care.

CONCLUSIONS

Adolescents and young adults report needing social support and specific resources to ensure access to abortion.

IMPLICATIONS

This study highlights the perspectives and experiences of a diverse, nationwide sample of adolescents and young adults on their perceived abortion-related social and logistical support needs. These findings can support centering adolescents and young adults in practice and policy change to minimize barriers, improve social support, tailor resources and information about abortion, and streamline access to essential reproductive health services in a post-Dobbs landscape.

Increasing representation and diversity in health research: A protocol of the MYHealth research training program for high school students

BACKGROUND

Despite decades of calls for increased diversity in the health research workforce, disparities exist for many populations, including Black, Indigenous, and People of Color individuals, those from low-income families, and first-generation college students. To increase representation of historically marginalized populations, there is a critical need to develop programs that strengthen their path toward health research careers. High school is a critically important time to catalyze interest and rebuild engagement among youth who may have previously felt excluded from science, technology, engineering, and mathematics (STEM) and health research careers.

METHODS

The overall objective of the MYHealth program is to engage high school students in a community-based participatory research program focused on adolescent health. Investigators will work alongside community partners to recruit 9th through 12th graders who self-identify as a member of a group underrepresented in STEM or health research careers (e.g., based on race and ethnicity, socioeconomic status, first generation college student, disability, etc.). MYHealth students are trained to be co-researchers who work alongside academic researchers, which will help them to envision themselves as scientists capable of positively impacting their communities through research. Implemented in three phases, the MYHealth program aims to foster a continuing interest in health research careers by developing: 1) researcher identities, 2) scientific literacy, 3) scientific self-efficacy, and 4) teamwork and leadership self-efficacy. In each phase, students will build knowledge and skills in research, ethics, data collection, data analysis, and dissemination. Students will directly collaborate with and be mentored by a team that includes investigators, community advisors, scientific advisors, and youth peers.

DISCUSSION

Each year, a new cohort of up to 70 high school students will be enrolled in MYHealth. We anticipate the MYHealth program will increase interest and persistence in STEM and health research among groups that have been historically excluded in health research careers.

Youths' perceptions and behaviors on COVID-19 testing

BACKGROUND

Social gatherings are frequent sources of COVID-19 infections, especially among youth. However, little is known about youth testing behaviors before and after gatherings. Our aim was to assess behaviors and perceptions of youth related to testing for COVID-19 before or after social gatherings in order to inform efforts to reduce disease spread.

METHODS

Five open-ended questions were texted to participants aged 14-24 throughout the United States via MyVoice. Using a content analysis approach, two investigators reviewed responses by question, developed a codebook, and independently applied codes. Discrepancies were resolved via discussion. Code frequency and demographic data were summarized using descriptive statistics.

RESULTS

Of 1204 participants, 989 responded to at least one question (RR = 94.1%). The mean age was 20.2 years (SD: 2.4 years). Most participants (80.7%) reported testing for COVID-19 at least once. Most (70.6%) were likely to test following an event, especially "[i]f someone at the gathering tested positive," while a smaller number (50.9%) endorsed testing prior to a gathering. Of youth who would not get tested, being vaccinated was the highest reported.

CONCLUSION

Youth in our nationwide sample are likely to test for COVID-19 after an event, though less likely if they are vaccinated. Their desire to test is primarily driven by symptoms, exposures, and requirements. Youth are interested in increased access to home testing. Youth-centered communications regarding testing recommendations and increased test availability for youth may reduce COVID-19 spread among young people and inform future pandemic recommendations.

Adolescent Awareness of the Changing Legal Landscape of Abortion in the United States and Its Implications

PURPOSE

Restrictions on abortion in the United States will have disproportionate and negative impacts on adolescents. Prior to the Supreme Court ruling to overturn federal protection of abortion, we sought to examine adolescents' awareness and knowledge about the legal landscape of abortion and how changes might affect them.

METHODS

We fielded a 5-question open-ended survey via text message to a nationwide sample of adolescents aged 14-24 years on May 20, 2022. We coded the responses using inductive consensus coding. Summary statistics were calculated for code frequencies and demographic data, and analyzed qualitatively using visual inspection of results overall and by subgroups (e.g., age, race and ethnicity, gender, and restrictiveness of state of residence).

RESULTS

A total of 654 responded (79% response rate), of which 11% were under 18 years. Most adolescents were aware of potential changes to abortion access. Most adolescents reported using the internet and social media for information about abortions. Overall, negative emotions about the changing legal landscape predominated, including anger, fear, and sadness. When considering factors for abortion decisions, adolescents most often discussed finances and life circumstances including their future, age, education, maturity, and emotional stability. Themes were relatively, uniformly distributed across subgroups.

DISCUSSION

Our study suggests that many adolescents are aware of and concerned about potential impacts of abortion restrictions, across a diversity of ages, gender, racial/ethnic, and geographic perspectives. Understanding and amplifying the voices of adolescents during this critical time is necessary to inform novel access solutions and policy initiatives that center the needs of youth.

Adolescent and Young Adult Perspectives on Quality and Value in Health Care

OBJECTIVE

To describe adolescent and young adult (AYA) perspectives on defining quality and value in health care and to gain understanding of their knowledge of value-based payment.

METHODS

A text message-based survey was sent to a convenience sample of AYAs aged 14 to 24 in 2019. Participants were asked 4 open-ended questions: 1) how they would define "good health care," 2) what factors to consider in rating doctors, 3) whose opinions should matter most when rating doctors, and 4) the best ways to collect AYA opinions on doctors, and one yes/no question on their awareness of value-based payment. Analyses included descriptive demographic statistics and an inductive thematic approach with multivariable models comparing adolescent (14-18) and young adult (19-24) responses.

RESULTS

Response rate was 61.0% (782/1283). Most participants were White (63.3%), female (53.3%), and adolescents (55.6%). Common themes from the first 2 questions included accessibility (specifically affordability), coverage benefits, and care experience (including compassion, respect, and clinical competence). Young adults more commonly mentioned affordability than adolescents (54.4% vs 43.3%, P = .001) and more commonly felt their opinion should matter more than their parents when rating doctors (80.6% vs 62.0%, P < .001). Only 21.0% of AYAs were familiar with the potential value-based link between physician payment and care quality.

CONCLUSIONS

When considering quality and value in health care, AYAs expressed their desired agency in rating the quality of their care and clinicians. AYAs' perspectives on health care quality, including the importance of care accessibility and affordability, should be considered when designing youth-centered care delivery and value-based payment models.

Perspectives of US Youths on Participation of Transgender Individuals in Competitive Sports: A Qualitative Study

Importance

Rights and access for transgender individuals, including the participation of transgender athletes in sports, have long been debated. These discussions often center around fairness and mental health impacts on youths associated with identity-based inclusion in sports.

Objective

To assess the experiences and perspectives of adolescents and young adults on the inclusion of transgender individuals in competitive sports.

Design, Setting, and Participants

In this qualitative study, 5 open-ended survey questions were sent to the MyVoice cohort from December 10 to 17, 2021. MyVoice is a nationwide text-message polling platform of US youths aged 14 to 24 years. All coding and subsequent analysis was completed between January 10 and December 11, 2022.

Main Outcomes and Measures

Qualitative perspectives of youths regarding transgender athlete participation in sports as measured by survey responses. Responses were reviewed using an inductive approach to qualitative thematic analysis to develop a codebook. The codes were independently applied to all responses by 2 investigators; discrepancies were resolved with discussion. Summary statistics were calculated for demographic characteristics and code frequencies, and χ2 tests (α = .05, 2-tailed) were used to evaluate differences in opinion based on gender identity and participation in competitive sports.

Results

A total of 905 of 1199 youths (75%) responded to the survey. Respondents had a mean (SD) age of 20 (2) years; 482 (53%) identified as male, 29 (3%) identified as transgender, and 306 (34%) reported having participated in high school and/or collegiate athletics. Three themes emerged: (1) youths differed regarding the inclusion of transgender athletes based on gender identity vs sex assigned at birth, (2) many youths did not have personal experience related to the inclusion of transgender athletes, and (3) youths were uncertain about the impacts of gender identity-based participation on cisgender individuals but perceived positive impacts for transgender individuals. Nearly half of respondents (327 of 691 [47%]) thought that transgender athletes should participate based on their gender identity or personal preference, whereas 240 (35%) favored participation based on sex assigned at birth or in a transgender-only category. Respondents mentioned concern about the fairness of identity-based participation, specifically for cisgender women, but many (410 of 697 [59%]) also reported that it would be affirming for transgender athletes to participate based on gender identity.

Conclusions and Relevance

The youths in our study differed in their opinions regarding sports participation of transgender youths, but many felt that inclusive policies would affirm and support the mental health of transgender individuals. Negative impacts on fairness were noted by some respondents. These findings suggest that nuanced policies are needed to address the participation of transgender athletes in competitive sports and should consider the impacts on and perspectives of youths most affected.

Perspectives on dental health and oral hygiene practice from US adolescents and young adults during the COVID-19 pandemic

BACKGROUND

Adolescence is a critical time for adopting health behaviors which continue through adulthood. There is a lack of data regarding perspectives of US adolescents and young adults on their dental health and oral hygiene practice.

METHODS

Adolescents and young adults, age 14-24, from MyVoice, a nationwide text message poll of youth. were asked five open-ended questions on the importance of dental health and impact of the COVID-19 pandemic. Responses were qualitatively analyzed using thematic analysis. Chi-square test was used to examine differences in experiences by demographics.

RESULTS

Of 1,148 participants, 932 responded to at least one question. The mean age was 19 years. Respondents were largely male (49.5%) and non-Hispanic white (62.4%). Most (92%) respondents perceived dental health as important or somewhat important and emphasized overall dental health and hygiene (38.6%) and aesthetics (18.3%). About half (49.2%) of respondents stated they have had at least one cavity since middle school. Just over half (54.8%) reported brushing and flossing to care for their dentition. 58% visited a dentist at least every 6 months, while 38% visited a dentist less frequently or not at all. Being non-cisgender, non-Hispanic black, Hispanic, and receipt of free or reduced lunch was associated with less frequent dental visits. 44% stated COVID-19 impacted their dental health, with many mentioning scheduling difficulties or worsened dental hygiene.

CONCLUSIONS

Most youth in our study consider dental health important, though their oral hygiene practice may not follow ADA guidelines and self-reported dental caries are high. Dental healthcare among youth has been affected by the COVID-19 pandemic with interruption in regular dental visits and changes in hygiene habits. Re-engagement of adolescents and young adults by dental care providers via greater access to appointments and youth-centered messaging reinforcing hygiene recommendations may help youth improve dental health now and in the future.

Youth Perspectives on the Recommended Age of Mobile Phone Adoption: Survey Study

BACKGROUND

Despite increasing prevalence of phone ownership in early adolescence, there is a deficit of evidence-based guidance on the appropriate time to provide youth their first phone.

OBJECTIVE

This survey study explored age recommendations for phone ownership among a diverse panel of youths, as their experiences are an important contribution to the development of ownership guidelines.

METHODS

Participants were recruited from MyVoice, a national panel of over 765 youth (14 to 24 years old) who respond to weekly SMS text message-based surveys. Questions were distributed between January 24 2018, and March 20, 2018. Inductive qualitative analysis was used to identify major themes among youths' open-ended responses.

RESULTS

In all, 469 youth (mean age 18.8 years; female: 299/469, 63.8%; White race: 332/468, 70.8%) responded. On average, respondents obtained their first phone at 12.2 years of age. Most participants (325/459, 71.1%) stated they received their first phone out of necessity rather than for entertainment or social reasons. Youth recommended that early adolescents receive their first phone between 12 and 13 years of age primarily for reasons of necessity (146/448, 32.6%).

CONCLUSIONS

According to the participants, phones supported safety and independence by allowing communication with parents and participation in activities. Youth-serving professionals and parents can incorporate these youth perspectives into shared decision-making about phone ownership among families. This can include discussions about essential features, safety, or phone use, as well as maturity and responsibility milestones, which were all key considerations reported by participants in the survey.

Adolescent and emerging adult perceptions of eating disorder severity and stigma

OBJECTIVE

Eating disorders are one of the deadliest mental health conditions, yet most individuals with eating disorders never receive treatment. Previous research has explored barriers to treatment among individuals diagnosed with eating disorders, but little is known about general adolescent and emerging adult perceptions of eating disorders, as compared to other mental health illnesses, a population at greatest risk for developing an eating disorder, and a population that may be important sources of information or support for peers.

METHOD

A sample of adolescents and emerging adults aged 14-24 years (mean age 19 years) from MyVoice, a national text-message-based cohort (53% female, 38% male, 9% other, race/ethnicity 63% White, 10% Black or African American, 13% Asian, 9% Mixed Race, and 5% Other) provided open-ended responses to questions on the severity of eating disorders as compared to other mental health diagnoses, others' perceptions of eating disorders and potential treatment barriers. Responses were collected using a secure online platform and analyzed using content analysis.

RESULTS

Among respondents (n = 792/1283), 91% felt that eating disorders were a mental health condition and 65% felt that eating disorders were as serious as other mental health conditions, while 21% said they were more serious than other mental health conditions. Responses to questions related to perception and barriers illustrated that beliefs of eating disorders involve blame, stigma, and overall lack of understanding.

DISCUSSION

Findings from this study illustrate that there is a lack of understanding around eating disorders that could be addressed in youth-focused initiatives.

PUBLIC SIGNIFICANCE

Adolescents and emerging adults understand that eating disorders are severe mental illnesses that are not taken seriously by others, especially in comparison with other mental health diagnoses. Adolescents and emerging adults report that individuals with eating disorders are blamed for their condition and face shame and stigma. The lack of understanding around eating disorders should be addressed in youth-focused prevention initiatives.

Youth Insight About Social Media Effects on Well/Ill-Being and Self-Modulating Efforts

PURPOSE

We aim to investigate youth insight about how their social media use affects them. We hope to understand if and how they self-modulate their use.

METHODS

Using a text message-based platform, codable survey responses were returned by a minimum of 871 of 1,144 youth aged 14-24 in November, 2020. Youth were asked the following three questions: (1) What advice would you give to young people who are new to social media? (2) Have you ever felt like you need to change your social media use (what you view, time spent, etc.)? Why? (3) Have you ever deleted or thought about deleting your social media account(s)? Why? A codebook was created from the data and two coders independently coded the entirety of the data set using the 18-code codebook. Coders resolved discrepancies in coding patterns together and the frequency of each code was recorded.

RESULTS

Youth showed insight about negative impacts of social media and were especially concerned about safety on social media. A majority of respondents deleted or thought about deleting their social media account or app. Youth were more likely to report wanting to change the amount of time spent on their social media compared to the content they view.

DISCUSSION

Youth are aware of ways in which social media could be negatively impacting them and they have employed methods to modulate their use because of this awareness.

Youth Perspectives on Their Medical Team's Role in Screening for and Addressing Social Determinants of Health

PURPOSE

Little is known about adolescents' and young adults' desires and preferences surrounding healthcare-based social determinants of health (SDOHs) interventions. To assess these preferences, we surveyed youth regarding their perspectives on their medical team's role in addressing SDOHs.

METHODS

We conducted a national text message survey of youth aged 14-24 years. The survey asked five open-ended questions about SDOHs and SDOH interventions. Qualitative data were analyzed independently by two investigators using thematic analysis. Prevalence of codes was summarized using descriptive statistics.

RESULTS

Among 1,156 participants, 1,038 responded to at least one survey question (response rate = 89.8%). Respondents were 19.2 (standard deviation: 2.4) years old on average, 48.9% male, 62.1% non-Hispanic white, and 38.9% qualified for free or reduced lunch. A large majority of our sample (81%) indicated that they think it is important for their doctor or medical team to ask about SDOHs. The most commonly reported barrier to seeking or receiving SDOH assistance was embarrassment (30%). Youth wanted their providers to help with SDOHs not only by providing information about resources (25%) and referrals (13%) but also by offering general advice (22%) and listening (11%). Approximately half (51%) of our sample preferred to receive information about SDOH assistance in person.

DISCUSSION

Most youth believe it is important for their medical teams to ask about and address SDOHs. Implementation of healthcare-based SDOH interventions for youth should optimize opportunities for face-to-face discussions about assistance during clinical encounters.

Perceptions of COVID-19 Vaccine Incentives Among Adolescents and Young Adults

Importance

Vaccine incentives have been used across the US to encourage COVID-19 vaccine uptake and include programs targeted to adolescents and young adults. However, little is known about youths' views regarding these initiatives.

Objective

To assess experiences and perceptions of COVID-19 vaccine incentives in a nationwide sample of US youth.

Design, Setting, and Participants

A qualitative survey study was conducted using the MyVoice text message-based polling platform from October 22 to October 29, 2021. Participants were US adolescents and young adults aged 14 to 24 years, who were sent 5 open-ended questions to assess their experiences and perceptions of COVID-19 vaccine incentives. Qualitative responses were analyzed thematically. Descriptive statistical analysis was performed in January 2022.

Main Outcomes and Measures

Experiences, perceptions, and opinions related to COVID-19 vaccine incentives as measured by survey response.

Results

A total of 1125 of 1206 youth (93%) responded to the survey and had a mean (SD) age of 20 (2) years, 664 (59%) identified as male, and 769 (68%) identified as non-Hispanic White. Of respondents, 871 (79%) reported having heard of vaccine incentives, and 892 (82%) believed they were a good idea or had positive attributes. Notably, 305 youth (28%) expressed concerns about vaccine incentives, citing uncertainty about their effectiveness (86 [28%]), their ethical use (63 [21%]), the impact on vaccine motivations (51 [17%]), and confidence (39 [13%]), and lack of fairness (35 [11%]). Only 73 youth (7%) reported that an incentive influenced their decision to get a COVID-19 vaccine. When asked what they thought would motivate others to get a COVID-19 vaccine, youth with an opinion (536 of 1032 [52%]) most commonly reported incentives (112 [21%]) and additional COVID-19 vaccine testing, safety, or regulation (115 [21%]).

Conclusions and Relevance

COVID-19 vaccine incentives are well known to youth but not a significant self-reported motivator for vaccination. Although generally viewed favorably, more than a quarter of youth expressed concerns regarding vaccine incentives, including but not limited to their ethics, effectiveness, fairness, and impacts on vaccine motivation and confidence. Policymakers considering targeted use of COVID-19 vaccine incentives should weigh youths' perspectives on these initiatives alongside objective effectiveness and cost-effectiveness data.

Mobile phone access, willingness, and usage for HIV-related services among young adults living in informal urban settlements in Kenya: A cross-sectional analysis

BACKGROUND

Mobile phone-based health (mHealth) interventions have the potential to improve HIV outcomes for high-risk young adults living in informal urban settlements in Kenya. However, less is known regarding young adults' differential access to mobile phones and their willingness and use of mobile phone technologies to access HIV prevention, care, and treatment services. This is important as young adults make up the largest demographic segment of impoverished, informal urban settlements and are disproportionately impacted by HIV.

METHODS

This study used observational survey data from 350 young adults, aged 18-22, who were living informal urban settlements in Nairobi, Kenya. Respondent driven sampling methods were used to recruit and enroll eligible youth. Using descriptive statistics and logistical regressions, we examined the prevalence of mobile phone access, willingness, and use for HIV services. We also assessed associated demographic characteristics in the odds of access, willingness, and use.

RESULTS

The mean age of participants was 19 years (±1.3). 56% were male. Mobile phone coverage, including text messaging and mobile internet, was high (>80%), but only 15% of young adults had ever used mobile phones to access HIV services. Willingness was high (65%), especially among those who had individual phone access (77%) compared to lower willingness (18%) among those who shared a phone. More educated (OR = 1.84, 95 %CI:1.14-2.97) and employed (OR = 1.70, 95 %CI:1.02 = 2.83) young adults were also more willing to use phones for HIV services. In contrast, participants living in large households (OR = 0.47, 95 %CI:0.24-0.921), were religious minorities (OR = 0.56, 95 %CI:0.32-0.99), partnered/married (OR = 0.30, 95 %CI:0.10-0.91), or female (OR = 0.29, 95 %CI:0.16-0.55) were significantly less likely to have mobile phone access or usage, limiting their potential participation in HIV-related mHealth interventions. Given the low usage of mobile phones currently for HIV services, no differences in demographic characteristics were observed.

CONCLUSION

Mobile health technologies may be under-utilized in HIV services for at-risk youth. Our findings highlight the importance of preliminary, formative research regarding population differences in access, willingness, and use of mobile phones for HIV services. More efforts are needed to ensure that mHealth interventions account for potential differences in preferences for mobile phone-based HIV interventions by gender, age, religion, education, and/or employment status.

Youth Knowledge and Perspectives on Expedited Partner Therapy

PURPOSE

Expedited partner therapy (EPT) is an effective sexually transmitted infection (STI) treatment and prevention practice that allows clinicians to provide treatment to the sexual partner(s) of individuals diagnosed with chlamydia and/or gonorrhea infections without a clinical evaluation. Due to the high incidence of STIs among youth, we sought to understand youth awareness and beliefs about EPT use.

METHODS

MyVoice, a national text message survey of youth aged 14-24 years, posed 5 questions on EPT knowledge and perceptions to 1,115 youth in August 2018. Responses were reviewed to identify themes and iteratively develop a codebook. Two reviewers independently coded each question, and a third reviewer resolved discrepancies. Summary statistics were calculated for demographic and thematic analysis.

RESULTS

A total of 835 participants responded to at least 1 question (74.9% response rate). Majority of youth (91.9%, n = 730/794) felt that it would be important to help their partners get treatment if they tested positive for chlamydia or gonorrhea. Although most participants were unaware of EPT (86.4%, n = 657/760), 81.3% (n = 624/768) supported the policy stating that it is "pretty darn convenient." Youth also noted they would be interested in asking their provider for EPT. Participants opposing EPT (6.9%, n = 53/768) noted that "they [sexual partner] are responsible for their own health" and preferred to "tell my partner to go to [their] doctor."

CONCLUSIONS

Most youth in the MyVoice cohort felt that EPT was a good way to get treatment for their partners, even though the majority were not aware that EPT was available as an STI treatment option.

The future of STI screening and treatment for youth: a National Survey of youth perspectives and intentions

Background

Sexually transmitted infection (STI) rates continue to rise in the U.S., with disproportionately high rates among those aged 15–24 years. Effective programs and policies are necessary to address this growing public health problem. The purpose of this study is to assess the perspectives of a national sample of youth on access to STI care and behaviors regarding STIs.

Methods

MyVoice, a national text message survey of youth, was used to pose four open-ended questions on STI screening and treatment to 1115 youth aged 14–24 in August 2018. A mixed-methods strategy was employed for the study. Qualitative data was analyzed using a modified grounded theory approach. Summary statistics were calculated for demographic data and prevalence of themes.

Results

Of the 800 participants who responded to at least one question (72% response rate), mean age was 19 years (SD = 3.1), 55% identified as female, 61% identified as non-Hispanic white, and 33% qualified for free/reduced lunch. A majority felt it would be easy to get screened (69%) or treated (68%) for an STI. Nearly all respondents (95%) stated they would share an STI diagnosis with their sexual partners.

Conclusions

Despite high rates of STIs among youth, most respondents reported that STI screening and treatment is accessible, and they would share an STI diagnosis with their partner.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12091-y.

Assessment of Sun Protection Knowledge and Behaviors of US Youth

This survey study examines sun protection knowledge and behaviors among US youth aged 14 to 24 years.

"If It Needs to be Done, It Needs to be Done": National Survey of Youth Experiences and Perspectives on Caregiving

PURPOSE

The purpose of this study was to explore youth experiences and perspectives on family caregiving to improve programs and policies that impact the well-being of youth.

METHODS

In August 2020, we asked three open-ended questions about current and anticipated caregiving responsibilities, impact, and needs using MyVoice, a national text message poll of youth. Content and thematic analysis was conducted to evaluate qualitative responses.

RESULTS

In our sample (n = 1,076), 35% of respondents reported previously or currently providing care for an adult relative either independently or by helping another relative. Participants believed caregiving had or would hinder their educational or career goals and that specific training would better prepare them to be a caregiver.

CONCLUSIONS

The prevalence of youth caregiving may be higher than previous estimates. Healthcare professionals should evaluate youth for caregiving responsibilities and support them in identifying resources or interventions to reduce potential impacts of caregiving burden on health outcomes.

COVID-19 mitigation policies and psychological distress in young adults

The COVID-19 pandemic has seen an unusually high proportion of the population suffering from mental health difficulties, but of particular concern is the disproportionate increase in psychological distress among younger adults. In this article, we exploit an explanatory sequential mixed-methods design to examine which aspects of the COVID-19 pandemic 18-25-year-olds found most challenging. We report analyses of American Voices Project (AVP) qualitative in-depth interview data, a MyVoice text-message open-ended survey, and Census Bureau Household Pulse Survey (HPS) data, all collected in 2020. Our interview and text-message results show that young adults were distressed about the effects of COVID-19 on the health of loved ones and older Americans. Young adults expressed concerns that the pandemic was not being treated sufficiently seriously by some politicians and the general public. The policy response was seen to be inadequate to the task of containing the disease, and some feared that the pandemic would never end. Statistical analyses of the HPS confirm that young adults' scores on the HPS's anxiety scale were significantly negatively associated with state-level policy responses. Overall, our results show that young adults found virus mitigation strategies challenging, but that a strong policy response was associated with reduced levels of psychological distress. Our results suggest that public health policy might have also operated as mental health policy during the COVID-19 pandemic.

Exploring the beliefs and perceptions of spending time in nature among U.S. youth

Purpose

The prevalence of poor mental health continues to rise among youth; however, large-scale interventions to improve mental and physical health remain a public health challenge. Time spent in nature is associated with improved health among youth. This study aimed to assess youth experiences with nature and the self-perceived impact on their mental and physical health among a nationwide sample of US youth.

Methods

In September 2020, five open-ended questions that aimed to assess perceptions regarding nature were posed to 1174 MyVoice youth, aged 14–24 years. Qualitative responses were analyzed using thematic analysis, and data were summarized using descriptive statistics.

Results

The mean (SD) age of the 994 respondents (RR = 84.7%) was 18.9 (2.7) years; 47.4% were female, and 57.4% Non-Hispanic White. Among youth, many felt that spending time in nature positively impacted their mental health, with 51.6% mentioning that it made them “feel calm when I am out in nature”; 22.1% said that it relieved stress or “reduces my anxiety,” and 17.1% felt that being in nature positively impacted their physical health and “makes me feel more active and in shape.” However, 7.0% said it negatively impacted their health, such as “It makes me feel isolated.” Most youth (87.8%) want to spend more time in nature, with 22% mentioning barriers (i.e., busy schedules, built environment, and COVID-19) impeding them from doing so.

Conclusions

Youth in our sample generally report feeling physically and mentally better when spending time in nature and want to spend more time in nature. Public health policies and practices that eliminate barriers and actively support time spent outside may be a feasible and acceptable practice to promote overall well-being among youth.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11622-x.

Perspectives on Telemedicine from a National Study of Youth in the United States

Introduction: Telemedicine is increasingly popular with the recent surge in use due to the COVID-19 pandemic. Despite youth status as "tech natives," limited data are available on their perspectives on telemedicine. Our study seeks to understand youth telemedicine knowledge, prior experiences, preferences for use, and the impact of COVID-19 on these perspectives. Methods: Participants in MyVoice, a national text message cohort of U.S. youth age 14-24, were sent five open-ended questions in October 2019 and October 2020. A codebook was iteratively developed by using inductive analysis. Responses were independently coded by two investigators, with discrepancies resolved by discussion or a third investigator. Results: Sixty-five percent (836/1,283) and 77% (887/1,129) of participants responded to at least 1 question in 2019 and 2020, respectively. Most youth reported awareness of telemedicine and although many have not used it, COVID-19 has increased use. Further, many are willing to try telemedicine services. Most youth noted a preference for video rather than phone visits, but they believe both to be less effective than in person. Youth also reported varied preferences on services best suited for telemedicine, with COVID-19 positively impacting their views. Discussion: Youth are aware of and willing to use telemedicine services, with many reporting use during the COVID-19 pandemic. Youth are willing to accept a wide variety of telemedicine services, though they still desire in-person options. Health systems and clinics should offer a wide range of services via telemedicine to fit the varying needs of youth both during and after the COVID-19 pandemic.

National Study of Youth Opinions on Vaccination for COVID-19 in the U.S

PURPOSE

This study aimed to understand the potential barriers and facilitators to COVID-19 vaccination among youth.

METHODS

Open-ended questions regarding COVID-19 vaccination were posed to a national cohort of 14- to 24-year-olds (October 30, 2020). Responses were coded through qualitative thematic analysis. Multivariable logistic regression tested the association of demographic characteristics with vaccination unwillingness.

RESULTS

Among 911 respondents (response rate = 79.4%), 75.9% reported willingness to receive a COVID-19 vaccine, 42.7% had unconditional willingness, and 33.3% were conditionally willing, of which the majority (80.7%) were willing if experts deemed vaccination safe and recommended. Preferred vaccine information sources were medical organizations (42.3%; CDC, WHO) and health care professionals (31.7%). Frequent concerns with vaccination included side effects (36.2%) and efficacy (20.1%). Race predicted vaccination unwillingness (Black: odds ratio = 3.31; and Asian: odds ratio = .46, compared with white, p < .001).

CONCLUSION

Most youth in our national sample were willing to receive a COVID-19 vaccine when they believe it is safe and recommended. Public health experts and organizations must generate youth-centered materials that directly address their vaccination concerns.

Views on COVID-19 and Use of Face Coverings Among U.S. Youth

PURPOSE

Little is known about the views of U.S. youth on COVID-19 or their use of face coverings. Closing this gap could facilitate messaging to promote COVID-19 risk mitigation behaviors.

METHODS

In July 2020, a five-question text message survey was sent to 1,087 youth aged 14-24 years. Questions assessed youths' perceptions regarding the likelihood of contracting COVID-19, the potential impact of contracting COVID-19 on their lives, the possibility of spreading COVID-19 to others, and their use of face coverings around others with whom they do not live. Coding was conducted to assign responses to discrete categories and to identify common themes.

RESULTS

Of 1,087 eligible participants, 797 (73.3%) were included in analyses. Of these participants, 27.3% believed they would likely contract COVID-19 in the next few months, 90.3% believed contracting COVID-19 would have a moderate or significant impact on their lives, 86.0% were moderately or very concerned about spreading COVID-19, and 89.2% reported wearing face coverings all or most of the time. Factors affecting face covering use included the desire to avoid contracting and spreading COVID-19, peer influence, and policy mandates.

CONCLUSIONS

Youths' perceptions regarding the risk of contracting COVID-19 varied, but most believed their lives would be adversely impacted if this occurred. Most youth were concerned about spreading COVID-19 and wore face coverings, but many made exceptions to face covering use when around close contacts. Public health campaigns may be most effective if they leverage positive peer influence and appeal to youths' desire not to spread COVID-19 to others.

"Stay home so this can be over:" A national study of youth perspectives on social distancing during the COVID-19 pandemic

Social distancing is an important public health recommendation that has been implemented to reduce the spread of COVID-19. Infections are rising among younger populations, but relatively little is known about youth social distancing behavior. Our qualitative study aims to examine youth engagement with social distancing and elucidate the reasons why guidelines are followed and broken. Members of the national MyVoice Text Message Cohort (aged 14–24) were surveyed from April 24 to April 30, 2020, through an open-ended text message poll. Responses were inductively coded and analyzed with descriptive statistics. Of the 944 youth who responded (response rate = 81.2%), 95% self-reported social distancing. However, 62% recalled instances of themselves or others breaking the guidelines and 19% expressed misconceptions about the rules. Notably, 14% of youth said they would encourage their friends to social distance by telling them it will accelerate a return to normal life. Feelings of social isolation were the most frequently cited (55%) negative impact of social distancing. Overall, responses from youth indicate significant variation in the interpretation of social distancing guidelines. Public health communications may need to address several critical misconceptions which impact the social distancing behaviors of youth. Further, safe methods for youth to interact with peers during periods of social distancing are necessary to prevent mental health impacts and to ensure adherence to social distancing guidelines.

Perspectives of US Youth During Initial Month of the COVID-19 Pandemic

PURPOSE

Asymptomatic youth in the United States acting as "silent spreaders" during the coronavirus disease 2019 (COVID-19) pandemic are an ongoing public health concern, particularly given their depiction as unengaged with recommendations. Our goal was to understand the knowledge, beliefs, and experiences of US youth at the onset of the COVID-19 pandemic.

METHODS

We posed 2 open-ended surveys to the national MyVoice text message cohort of youth, aged 14-24 years. On March 6, 2020, 4 questions were asked regarding knowledge and experiences during the COVID-19 pandemic with 3 questions repeated on March 20, 2020. Qualitative responses were coded using thematic analysis and summarized with descriptive statistics.

RESULTS

Of 1,174 youth, 1,087 responded to at least 1 question (response rate of 88%). The average age of respondents was 19 (SD 2.8) years with 52% female and 56% non-Hispanic White respondents. On March 6, 2020, most (70%) respondents reported knowing about COVID-19 and primarily cited the news (46%) as their source of information. Nearly all (95%) respondents reported impact by March 20, 2020, and respondents expressing worry increased from 25% to 51%. In both surveys, worried youth primarily cited concern for others (26% and 34%). Regarding preparation, respondents primarily reported doing nothing (36%) on March 6, 2020, and practicing social distancing (50%) on March 20, 2020.

CONCLUSIONS

Many youths in our sample are engaged with the COVID-19 pandemic and most are feeling knowledgeable, are concerned about its impacts on others, and are practicing social distancing. Sustained public health efforts should focus on maintaining youth engagement with accurate public information and youth-centered messaging promoting prevention measures to protect the health and well-being of youth and their friends and family.

Youth Perspectives regarding the Regulating of Bathroom Use by Transgender Individuals

Regulations regarding bathroom use by transgender people affect youth across the United States. This study examines youth opinions on bathroom use regulations. Data were obtained from MyVoice, a weekly text messaging survey of youth aged 14-24 years. Youth were recruited nationally at community events and online; Southeast Michigan was overrepresented. Mixed methods analysis was performed using grounded theory methodology. The majority of respondents (n = 683) were white (71.4%) and had education beyond high school (56.5%). Most (79%) stated that bathroom use by transgender people should not be restricted, rationalizing: 1) bathroom use is private and should be a personal decision; 2) choosing bathrooms is a matter of equality, freedom, and human rights; 3) transgender people are not sexual perpetrators; and 4) forcing transgender people to use particular bathrooms puts them at risk. Contrary to the current policy in many schools, respondents do not support restrictions on bathroom use by transgender people.

Results of a National Text Message Poll of Youth: Perspectives on Primary Care

PURPOSE

There is a significant interest in improving adolescent access to primary care, yet limited attempts to incorporate youth feedback within these efforts. The purpose of this study was to describe the experiences related to primary care among a large national sample of adolescents to improve patient-centered care.

METHODS

Youth were sent open-ended text message prompts via an ongoing study of 14- to 24-year-olds in the U.S. Text responses were analyzed using qualitative thematic analysis, including descriptive coding, consensus building, and theme development. Secondary quantitative analyses were conducted to determine differences by demographics.

RESULTS

Of 1,123 eligible participants, 789 (70.2%) responded to at least one prompt. Four themes were developed: (1) youth recognized the importance of primary care, but barriers exist that limited their utilization; (2) youth felt that improving convenience would increase the use of primary care; (3) youth were unsure how to transition between primary care settings; and (4) feeling respected was essential to youth having positive experiences in a primary care health care setting. Older youth and those identifying as female, nonbinary, or transgender were more likely to report previous bad experiences with primary care.

CONCLUSIONS

Our findings describe barriers and possible solutions to primary care among youth. Because attitudes toward health and health care are established during adolescence, a transformation is needed to create more patient-centered care that aligns with young people's values and experiences. Thus, primary care providers have the opportunity to positively impact the health of young people today and the adults of the future.

Needs and Coping Behaviors of Youth in the U.S. During COVID-19

PURPOSE

This study aimed to determine the needs, emotions, and coping behaviors of U.S. youth during COVID-19.

METHODS

Two open-ended questions were posed to 1,174 MyVoice youth, aged 14-24 years, on March 20, 2020, regarding their needs and coping strategies during COVID-19. Qualitative responses were coded using thematic analysis and data were summarized with descriptive statistics.

RESULTS

The average age of the 950 respondents (RR = 80.9%) was 18.9 ± 2.8 years with 52.1% female and 63.8% white. While 32.6% of participants felt resources were readily available, 35.2% felt resources were difficult to access or unavailable. Participants also described both emotional responses (27.4%) and coping strategies (69.8%). Most emotional responses were negative, including symptoms of anxiety or depression. Commonly reported coping strategies included staying connected and maintaining positivity.

CONCLUSIONS

A significant portion of U.S. youth are experiencing unmet needs and negative emotions due to COVID-19 suggesting additional youth outreach is necessary to ensure basic needs, including socialization, are met.

Youth opinions about Title X funding and policy in the United States: A mixed methods text message survey

OBJECTIVE

We aim to assess youth awareness of and opinions about Title X policy changes in 2019.

STUDY DESIGN

We analyzed data from four open-ended questions and demographic items collected through MyVoice, a national text message survey of youth aged 14-24. We calculated descriptive statistics to summarize awareness of and opinions about Title X. We integrated the quantitative findings with qualitative themes to achieve deeper understanding of the beliefs that inform youth opinions.

RESULTS

Seven hundred and fifty youth responded to the text message survey (58.0% response rate). The majority (74.9%) was unaware of recent Title X changes. Most (79.3%) were unsupportive of these changes, and a sizable portion (40%) worried these changes could impact them. Opposition to Title X changes was based upon five themes: (1) youth need to be aware of their health options, including abortion; (2) the policy will undermine reproductive rights; (3) the policy is unfair; (4) the policy is unconstitutional; (5) the policy will threaten public health and health services, including affordable and safe abortion. Those who supported Title X changes (13.8%) described moral objections to abortion and beliefs that the government should not be responsible for abortion care.

CONCLUSIONS

Most youth in this sample were unsupportive of Title X changes. Limited youth awareness of Title X changes suggests that better youth outreach is needed regarding sexual and reproductive health (SRH) policies.

IMPLICATIONS

Although youth represent 40% of clients who receive SRH services through Title X, more efforts are needed to inform and engage them in salient policy changes that may directly affect their SRH health and health care access.

Youth Preferences for Weight-Related Conversations

Little guidance is available to clinicians on how to talk about weight with their patients. The aim of this study is to explore youth preferences for weight-related conversations. Participants came from the National MyVoice Text Message Cohort. Between 7/2017 and 01/2018, 952 MyVoice participants provided open-ended responses via text message to three questions about weight-related conversations ("Has your doctor ever talked to you about weight?", "What did he or she say?", and "What should a doctor NOT say when talking about weight?"). The presence of themes was coded using standard qualitative methods. Of the 952 respondents, 568 (60%) reported that their doctor had talked with them about weight. Of these, 85% indicated that their doctor had notified them of their weight, BMI, or weight status and/or the need to change their body weight and 16% had doctors who provided advice about weight control. Eight themes emerged from the analysis of responses to the question "What should a doctor NOT say when talking about weight?". The two most common themes were: (1): Avoid stigmatizing terms/language (32%); and (2) Do not shame patient for their weight (25%). Findings suggest that weight-related conversations do not reflect the preferences of the youth they are designed to benefit. Youth recommended that clinicians focus on health and sustainable behavioral solutions, avoid stigmatizing language and comparing them to others, and be aware of the potential harm associated with making assumptions that conflate weight with health behaviors, morality, or appearance.

Active Shooter Drills in the United States: A National Study of Youth Experiences and Perceptions

PURPOSE

The purpose of this study was to understand youth experience and opinion surrounding active shooter drills.

METHODS

MyVoice is a national text message poll of the youth ages 14-24 years that collects youth opinion on salient policy issues. Participants are recruited to meet national benchmarks. Five open-ended probes were posed to participants on August 2, 2019. Qualitative data were analyzed using thematic analysis; quantitative data were summarized using descriptive statistics.

RESULTS

Among respondents (815 of 1283; 63.5%), the average age was 18.7 years (SD = 2.9). Most were girls (52.9%), non-white (42.8%), and with < high school diploma (56.9%). Responses centered around three themes: drill methods vary, active shooter drills cause emotional distress, and youth perceive drills to have questionable benefit. The majority (60.2%) mentioned that drills make them feel "scared and hopeless," but many (56.1%) also noted drills "teach kids on what to do." Others (24%) stated drills do not improve safety because they inform potential shooters or are ineffective because "people will likely panic, forgetting their drill."

CONCLUSIONS

Many youth report that active shooter drills have a negative effect on their emotional health and are conflicted on their effectiveness.

Youth Perceptions of Juul in the United States

This mixed-methods cohort study uses responses to text-messaged, open-ended questions to examine US youths’ perceptions of Juul e-cigarettes.

Feasibility of Assessing Economic and Sexual Risk Behaviors Using Text Message Surveys in African-American Young Adults Experiencing Homelessness and Unemployment: Single-Group Study

Background

Text messages offer the potential to better evaluate HIV behavioral interventions using repeated longitudinal measures at a lower cost and research burden. However, they have been underused in US minority settings.

Objective

This study aims to examine the feasibility of assessing economic and sexual risk behaviors using text message surveys.

Methods

We conducted a single-group study with 17 African-American young adults, aged 18-24 years, who were economically disadvantaged and reported prior unprotected sex. Participants received a text message survey once each week for 5 weeks. The survey contained 14 questions with yes-no and numeric responses on sexual risk behaviors (ie, condomless sex, sex while high or drunk, and sex exchange) and economic behaviors (ie, income, employment, and money spent on HIV services or products). Feasibility measures were the number of participants who responded to the survey in a given week, the number of questions to which a participant responded in each survey, and the number of hours spent from sending a survey to participants to receiving their response in a given week. One discussion group was used to obtain feedback.

Results

Overall, 65% (n=11/17) of the participants responded to at least one text message survey compared with 35% (n=6/17) of the participants who did not respond. The majority (n=7/11, 64%) of the responders were women. The majority (n=4/6, 67%) of nonresponders were men. An average of 7.6 participants (69%) responded in a given week. Response rates among ever responders ranged from 64% to 82% across the study period. The mean number of questions answered each week was 12.6 (SD 2.7; 90% of all questions), ranging from 72% to 100%. An average of 6.4 participants (84%) answered all 14 text message questions in a given week, ranging from 57% to 100%. Participants responded approximately 8.7 hours (SD 10.3) after receiving the survey. Participants were more likely to answer questions related to employment, condomless sex, and discussions with sex partners. Nonresponse or skip was more often used for questions at the end of the survey relating to sex exchange and money spent on HIV prevention services or products. Strengths of the text message survey were convenience, readability, short completion time, having repeated measures over time, and having incentives.

Conclusions

Longitudinal text message surveys may be a valuable tool for assessing HIV-related economic and sexual risk behaviors.

Trial Registration

ClinicalTrials.gov NCT03237871; https://clinicaltrials.gov/ct2/show/NCT03237871

Community-based Youth Participatory Action Research studies with a focus on youth health and well-being: A systematic review

On the basis of the systematic literature review, we investigate the characteristics of community-based Youth Participatory Action Research (YPAR) programs with a focus on health and well-being and their recommendations for future programs. The study was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram. Most included a case study design, mixed or qualitative methodology, interview as data collection, and YPAR youth in data reporting. The sample differs between studies, and most of the work took place in the United States. The stages (raise awareness, capacitation, design, motivation, implementation, evaluation, dissemination, and replication) are evident as a fundamental strategy in these programs.

"It's Healthy Because It's Natural." Perceptions of "Clean" Eating among U.S. Adolescents and Emerging Adults

Definitions for the culturally trendy "clean" eating phenomenon vary: whereas some characterize it as natural and healthy, others adopt more restrictive, moralizing, and affectively-laden definitions that may reflect disordered eating. We examined levels of familiarity with "clean" eating, sources of information, and perceptions of this dietary trend among a large, diverse sample of U.S. adolescents and emerging adults recruited from the National MyVoice Text Message Cohort (n = 1266; ages 14-24 years). Participants answered five questions assessing knowledge of "clean" eating, definitions, perceived healthiness vs. harm, and willingness to adopt "clean" eating, and responses were coded by three trained researchers. Results indicate that 55% of respondents had previously heard of "clean" eating, most commonly through social media, other online sources, and peers. Definitions were heterogeneous, with 40% offering "non-processed" or "whole foods" and 13% noting "non-GMO" or "organic" components. Few respondents (0.6%) expressed outright skepticism about "clean" eating, but many (30%) identified dietary avoidance and restriction as part of the definition. Overall, 71% characterized "clean" eating as a healthy approach, whereas 6% flagged it as "unhealthy", and 18% noted elements of both healthfulness and harm. Notably, 41% reported they "probably would" try "clean" eating themselves, with greater willingness to try "clean" eating among cisgender women. Present findings highlight high levels of awareness and positive attitudes toward "clean" eating among young people in the U.S., with little recognition of the potential risks of dietary restriction. Further research should examine actual dietary behaviors to clarify potential risks of "clean" eating and related trends and thus inform strategies for eating disorder prevention.

Youth Perspectives of Prescription Pain Medication in the Opioid Crisis

OBJECTIVE

To characterize current youth perspectives of prescription pain medication.

STUDY DESIGN

In total, 1047 youths aged 14-24 years were recruited by targeted social media advertisements to match national demographic benchmarks. Youths were queried by open-ended text message prompts about exposure and access to prescription pain medication, perceived safety of prescribed and nonprescribed medication, and associations with the word "opioid." Responses were analyzed inductively for emerging themes and frequencies.

RESULTS

Among 745 respondents (71.2% response rate), 439 identified as female (59.3%), 561 as white (75.8%), and mean age was 18.3 ± 3.2 years. Previous exposure to prescription pain medication was reported by 377 respondents (52.0%), most commonly related to dentistry (32.8%), surgery (19.2%), and injury (12.0%). Nonmedical sources of access to prescription pain medication were identified by 256 respondents (36.9%) and medical sources other than their doctor by an additional 111 respondents (16.0%). Three additional themes emerged from youth responses: (1) prescribed medication was thought to be safer than nonprescribed medication, based on trust in doctors; (2) risks of addiction and overdose were thought to be greater for nonprescribed medication; (3) respondents had a widely ranging understanding of the word "opioid," from historical to current events, medical to illicit substances, and personal to public associations.

CONCLUSIONS

Although youths are aware of the opioid crisis, they perceive less risk of prescription pain medication prescribed by a doctor, than from other sources. Policies should target education to youth in clinical and nonclinical settings, highlighting the risks of addiction and overdose with all opioids.

Self-Management of Health Care Among Youth: Implications for Policies on Transitions of Care

PURPOSE

Transitions from pediatric to adult health care are important milestones for youth. In surveys, providers report that youth lack the motivation or skills to manage their care independently, a prerequisite for successful transitions. To assess the validity of this belief, we surveyed youth regarding their current and desired level of involvement in their care.

METHODS

In 2017-2018, we conducted a national text message survey of youth aged 14-24 years. The survey included three open-ended questions assessing participants' independence on three health care tasks (scheduling appointments, attending appointments, and picking up prescriptions) and one open-ended question assessing their desire to be more, less, or equally involved in their care as they are now. We qualitatively analyzed free-text responses to identify themes.

RESULTS

Among 1,214 eligible participants, 805 (66.3%) completed all four questions and were included in the sample. Forty-one percent of youth reported wanting to be more involved in their care. Among young adults aged 18-24 years, 22% were not fully independent on the three health care tasks and reported wanting to be less involved or equally as involved as they are currently.

CONCLUSION

Many youth should be viewed as partners in health care transitions instead of as barriers, but some youth are at high risk for failed transitions. Policymakers and providers should promote routine screening of youth for their current levels of engagement in care and desire to be more involved.