Challenges and strategies for sustaining youth-friendly health services - a qualitative study from the perspective of professionals at youth clinics in northern Sweden

Background

Youth-friendly health-care services — those that are accessible, acceptable, equitable, appropriate and effective for different youth subpopulations – are beneficial for youth health, but not easy to implement and sustain. Sweden is among the few countries where youth-friendly health-care services have been integrated within the public health system and sustained for a long time.

This study explores the challenges and strategies in providing sustainable youth-friendly health-care services, from the perspective of professionals working in youth clinics in northern Sweden.

Methods

Eleven semi-structured interviews with various health-care professionals working in youth clinics in northern Sweden were conducted. The interviews were transcribed verbatim, and analysed using thematic analysis in relation to the World Health Organization domains of youth friendliness.

Results

Four themes emerged from the analysis of the data: 1) ‘Meeting youths on their own terms – the key to ensuring a holistic and youth-centred care’ was related to the acceptability and appropriateness of the services; 2) ‘Organizational challenges and strategies in keeping professionals’ expertise on youth updated’ referred to the domain of effectiveness; 3) ‘Youth clinics are accessible for those who know and can reach them’ was related to the domains of accessibility and equity, and 4) ‘The challenge of combining strong directions and flexibility in diverse local realities’ focused on the struggle to sustain the youth clinics organization and their goals within the broader health system.

Conclusions

Professionals working in youth clinics are perceived as motivated, interested and knowledgeable about youth, and the clinics ensure confidentiality and a youth-centred and holistic approach. Challenges remain, especially in terms of ensuring equitable access to different youth subpopulations, improving monitoring routines and ensuring training and competence for all professionals, independently of the location and characteristics of the clinic. Youth clinics are perceived as an indisputable part of the Swedish health system, but organizational challenges are also pointed out in terms of weak clear directives and leadership, heavy workload, local/regional diversity and unequitable distribution of resources.

Electronic supplementary material

The online version of this article (doi:10.1186/s12978-016-0261-6) contains supplementary material, which is available to authorized users.

Health promotion in schools: a multi-method evaluation of an Australian School Youth Health Nurse Program

Background

Health promotion provides a key opportunity to empower young people to make informed choices regarding key health-related behaviours such as tobacco and alcohol use, sexual practices, dietary choices and physical activity. This paper describes the evaluation of a pilot School Youth Health Nurse (SYHN) Program, which aims to integrate a Registered Nurse into school communities to deliver health promotion through group education and individual sessions.

Methods

The evaluation was guided by the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. The objectives were to explore: 1) whether the Program was accessible to the high school students; 2) the impacts of the Program on key stakeholders; 3) which factors affected adoption of the Program; 4) whether implementation was consistent with the Program intent; and 5) the long-term sustainability of the Program. Research included retrospective analysis of Program records, administration of a survey of student experiences and interviews with 38 stakeholders.

Results

This evaluation provided evidence that the SYHN Program is reaching students in need, is effective, has been adopted successfully in schools, is being implemented as intended and could be maintained with sustained funding. The nurses deliver an accessible and acceptable primary health care service, focused on health promotion, prevention and early intervention. After some initial uncertainty about the scope and nature of the role, the nurses are a respected source of health information in the schools, consulted on curriculum development and contributing to whole-of-school health activities.

Conclusions

Findings demonstrate that the SYHN model is feasible and acceptable to the students and schools involved in the pilot. The Program provides health promotion and accessible primary health care in the school setting, consistent with the Health Promoting Schools framework.

Electronic supplementary material

The online version of this article (doi:10.1186/s12912-015-0071-0) contains supplementary material, which is available to authorized users.

Evaluation of a multidimensional cystic fibrosis transition program: a quality improvement initiative

The adequate preparation of cystic fibrosis (CF) youth for the transfer from pediatric to adult-based health care services is essential to meet the needs of this changing population. This paper describes the evolution of a transition clinic for patients with CF into a multidimensional quality improvement transition initiative. Three transition interventions (a patient transition clinical pathway; collaboration with the adult clinic; and a tool to measure transfer readiness) were sequentially implemented and evaluated. Each was found to be a valuable addition to a comprehensive transition protocol and today are endorsed as part of transition best practices.

A Scoping Review of Adolescent Health Indicators

PURPOSE

A host of recent initiatives relating to adolescent health have been accompanied by varying indicator recommendations, with little stakeholder coordination. We assessed currently included adolescent health-related indicators for their measurement focus, identified overlap across initiatives, and determined measurement gaps.

METHODS

We conducted a scoping review to map the existing indicator landscape as depicted by major measurement initiatives. We classified indicators as per 33 previously identified core adolescent health measurement areas across five domains and by age groups. We also identified indicators common across measurement initiatives even if differing in details.

RESULTS

We identified 413 indicators across 16 measurement initiatives, with most measuring health outcomes and conditions (162 [39%]) and health behaviors and risks (136 [33%]); followed by policies, programs, and laws (49 [12%]); health determinants (44 [11%]); and system performance and interventions (22 [5%]). Age specification was available for 221 (54%) indicators, with 51 (23%) focusing on the full adolescent age range (10-19 years), 1 (<1%) on 10-14 years, 27 (12%) on 15-19 years, and 142 (64%) on a broader age range including adolescents. No definitional information, such as numerator and denominator, was available for 138 indicators. We identified 236 distinct indicators after accounting for overlap.

CONCLUSION

The adolescent health measurement landscape is vast and includes substantial variation among indicators purportedly assessing the same concept. Gaps persist in measuring systems performance and interventions; policies, programs, and laws; and younger adolescents' health. Addressing these gaps and harmonizing measurement is fundamental to improve program implementation and accountability for adolescent health globally.

Is excessive smartphone use associated with weight status and self-rated health among youth? A smart platform study

BACKGROUND

In Canada, it is recommended that youth limit screen time to less than two hours per day, yet, the majority of youth are reportedly spending a significantly higher amount of time in front of a screen. This is particularly concerning given that these recommendations do not take into account smartphone devices, which is the most common screen time technology of choice for the younger generations. This study implements an innovative approach to understanding screen time behavior and aims to investigate the unique relationship between smartphone specific screen time and physical health outcomes.

METHODS

This cross-sectional study is part of the Smart Platform, a digital epidemiological and citizen science initiative. 436 youth citizen scientists, aged 13-21 years, provided all data via their own smartphones using a custom-built smartphone application. Participants completed a 124-item baseline questionnaire which included validated self-report surveys adapted to collect data specifically on smartphone use (internet use, gaming, and texting), demographic characteristics, and physical health outcomes such as weight status and self-rated health. Binary regression models determined the relationship between smartphone use and physical health outcomes.

RESULTS

Overall participants reported excessive smartphone use in all categories. 11.4% and 12% of the 436 youth participants reported using their smartphone excessively (greater than 2 h per day) during the week and weekend respectively for gaming and were over 2 times more likely than their peers to fall within an overweight/obese BMI status. Excessive weekend gaming was also associated with self-rated health where participants were over 2 times more likely than their peers to report poor self-rated health.

CONCLUSIONS

The results indicate that excessive screen time on smartphones does have complex associations with youth health. Further investigation with more robust study designs is needed to inform smartphone-specific screen time guidelines for youth.

A hand hygiene intervention to decrease hand, foot and mouth disease and absence due to sickness among kindergarteners in China: A cluster-randomized controlled trial

OBJECTIVES

To evaluate the effect of the "Clean Hands, Happy Life" intervention on the incidence of hand, food and mouth disease (HFMD) and on school absences due to sickness in kindergarten students.

METHODS

The intervention consisted of four hand hygiene (HH) promotion components and was evaluated in a cluster-randomized controlled trial among 8275 children and 18 kindergartens from May to October, 2015 in Shenzhen, China. We compared two intervention arms - received the intervention in kindergartens only and in both kindergartens and families, respectively - to the control arm in multilevel analyses.

RESULTS

During the follow-up, the incidence of HFMD in both intervention arms was significantly lower than in the control arm (IRR₁: 0.39, 95%CI: 0.26-0.59; IRR₂: 0.30, 95%CI: 0.19-0.49); the duration of absence due to sickness (in days) in both intervention arms was significantly shorter than in the control arm (β₁ = 0.58, 95%CI: 0.41-0.74; β₂ = 0.34, 95%CI: 0.17-0.50), controlling for the area type of kindergarten and grade level of children. Furthermore, during the follow-up we found that there were fewer episodes of absence due to respiratory, skin and eye infections (P < 0.05).

CONCLUSIONS

Our intervention is effective at reducing HFMD infections and absence due to sickness in children attending kindergartens in China.

Youth Sexual Health: Sexual Knowledge, Attitudes, and Behavior Among Students at a University in Turkey

INTRODUCTION

To determine sexual attitudes, behavior, and knowledge of Namik Kemal University (NKU) students about sexual health and sexually transmitted infections (STIs).

METHOD

A sample representing 10% of the undergraduate population of NKU in 2009-2010, was studied. Of 1,500 questionnaires distributed, 1,314 (87.6%) were filled out.

RESULTS

The mean age of the respondents (52.9% male) was 20.07±1.75 years. The rate of students who had received sexual health education was 32.0%, and 15.3% had previously used a sexual health service. Eleven percent of the female students and 50.3% of the male students had had sexual intercourse. The average age of initial sexual intercourse was 16.83±2.07 years. Of the students who had had sexual intercourse, 46.6% reported that they did not use any contraception method. The most preferred method was condoms (37.6%). The rate of contraceptive use was 58.7% in sexually educated students and 43.9% in those not educated (p=.004). The most well-known STI was AIDS (96.5%), with sexually educated students giving higher rates of correct answers about STIs (p<.05).

CONCLUSION

The students who had received sexual health education were more knowledgeable about vital consequences of STI's, even though it is not sufficient, than sexually active students. Awareness of safe sexual practices and changes in behavior, in particular, promoting condom use should be established in higher risk youths. Deficiencies in knowledge could be addressed by adding a sexual healthtraining component to the university curriculum, and unmet requirements could be met by reorganizing medico-social centers in universities.

Rural-urban inequities in deaths and cancer mortality amid rapid economic and environmental changes in China

OBJECTIVES

This paper examines rural-urban inequities in mortality and cancer mortality amid rapid economic growth and environmental degradation in China.

METHODS

SPSS and Joinpoint Regression were used to analyze the 2002-2015 datasets from all death registries in China and associated economic and environmental data.

RESULTS

Death and cancer mortality rates among rural residents were higher and increased faster than urban residents. In particular, rural men 30-34 years old were 44% more likely to die from cancer and over 67% more likely to die from all causes, compared to their urban counterparts. Among rural women 15-19 years old, the death rate was 47% higher and the cancer mortality rate was 44% higher than among urban women. Death and cancer mortality rates tended to be positively associated with economic growth and air pollution variables.

CONCLUSIONS

Rural-urban health inequities have widened in China, with rural youth at the greatest disadvantage. The anticipated health benefits from income growth may have been offset by the impact of air pollution, which calls for further investigation into the causes of rural-urban health inequities.

Impact of legislation on youth indoor tanning behaviour: A systematic review

Jurisdictions around the world have implemented indoor tanning legislations, which aim to protect all individuals, especially youth, from dangers of artificial ultraviolet radiation exposure. The objective of this study was to conduct a systematic review to synthesize the available peer-reviewed literature to determine whether indoor tanning legislation has impacted the prevalence of youth indoor tanning. Following PRISMA guidelines, six databases were searched in 2016. Reference lists from relevant articles were also searched. An updated literature search was conducted in 2018. Each article was critically appraised using a merged checklist created from two previously validated checklists. All articles meeting the inclusion criteria were retained after appraisal. Seven studies, all conducted in the U.S., met the inclusion criteria. All studies used an observational, cross-sectional design. There were small absolute decreases in youth indoor tanning prevalence after legislation vs before (n = 3, mean = 3% decrease, range = 1%-6% decrease). Prevalence of youth indoor tanning was significantly lower in states with indoor tanning legislation vs states without legislation (n = 4, mean = 5% lower, range = 1%-18% lower). Prevalence of youth indoor tanning was lower in states with longer standing indoor tanning legislation vs states with more recently implemented legislation (n = 2, mean = 9% lower, range = 2%-20% lower). Indoor tanning legislation is generally associated with lower indoor tanning prevalence among youth. The small percent differences equate to millions of youth at the population level. Longer time lapses from legislation implementation to evaluation, coupled with greater enforcement, compliance, legislative stringency, and public education may result in even more pronounced declines in youth indoor tanning prevalence.

Priority Indicators for Adolescent Health Measurement - Recommendations From the Global Action for Measurement of Adolescent Health (GAMA) Advisory Group

PURPOSE

This article describes the selection of priority indicators for adolescent (10-19 years) health measurement proposed by the Global Action for Measurement of Adolescent health advisory group and partners, building on previous work identifying 33 core measurement areas and mapping 413 indicators across these areas.

METHODS

The indicator selection process considered inputs from a broad range of stakeholders through a structured four-step approach: (1) definition of selection criteria and indicator scoring; (2) development of a draft list of indicators with metadata; (3) collection of public feedback through a survey; and (4) review of the feedback and finalization of the indicator list. As a part of the process, measurement gaps were also identified.

RESULTS

Fifty-two priority indicators were identified, including 36 core indicators considered to be most important for measuring the health of all adolescents, one alternative indicator for settings where measuring the core indicator is not feasible, and 15 additional indicators for settings where further detail on a topic would add value. Of these indicators, 17 (33%) measure health behaviors and risks, 16 (31%) health outcomes and conditions, eight (15%) health determinants, five (10%) systems performance and interventions, four (8%) policies, programmes, laws, and two (4%) subjective well-being.

DISCUSSION

A consensus list of priority indicators with metadata covering the most important health issues for adolescents was developed with structured inputs from a broad range of stakeholders. This list will now be pilot tested to assess the feasibility of indicator data collection to inform global, regional, national, and sub-national monitoring.

Patterns of Family, School, and Community Promotive Factors and Health Disparities Among Youth: Implications for Prevention Science

Increasing knowledge of factors that promote health among youth from diverse backgrounds is an important step towards addressing health disparities. Although many promotive factors have been identified individually, there is an overabundance of research on risk factors, and a comparable dearth of knowledge regarding the influence of combinations of promotive factors. The current study examined how promotive factors across family, school, and community contexts co-occur to promote health among youth of different race/ethnicity. Utilizing a nationally representative sample of Black (10%), Latinx (12%), and White (77%) youth ages 12-17 (N = 30,668), latent class analysis was employed to identify classes of youth who endorsed homogenous patterns of promotive factors. Associations between class membership and health were explored. Each subsample was best characterized by its own 4-class model, with significant differences in patterns of promotive factors experienced by Black, Latinx, and White youth. Youth health outcomes also varied significantly by class membership (p < .05). Greater access to more promotive factors was associated with better health, and low access to community and school promotive factors was associated with worse health. Results suggest that increasing promotive factors in school, family, and community settings may help to prevent poor health outcomes; however, jointly addressing discrimination against racial/ethnic minority youth through education, policy, and practice is also needed to address health disparities.

The Young Canadians Roundtable on Health: promising practices for youth and adults working in partnership

SETTING

Canadian youth (aged 15-29 years) are more diverse, educated, connected and socially engaged than ever before. However, many face health-related challenges, including mental health problems (10-20%), substance use concerns (14%) and obesity (45%).

INTERVENTION

The Young Canadians Roundtable on Health (YCRH) was created in 2013 to be Canada's youth voice on health. Supported by the Sandbox Project, this youth-led advisory works primarily virtually, leading advocacy projects and wide-ranging health initiatives.

OUTCOMES

Youth and adult allies engaged in a participatory research evaluation of the YCRH, which was identified as a living laboratory, where youth could experiment with ideas and provide new perspectives on health issues. Adult allies reported learning new skills from youth, and youth gained advocacy and leadership skills. Collaborative projects resulted in a sense of shared achievement. Further, youth increased their connections to health and youth-serving spaces across the country. Identified challenges included difficulties in coordinating a national roundtable and defining shared responsibilities.

IMPLICATIONS

The researchers generated the following evidence-based promising practices for youth engagement in health systems and program planning: (1) provide a consistent platform for youth input; (2) appreciate different forms of knowledge, expertise and communication methods; (3) invest in relationships and build mutual understanding among youth and adults; (4) for adult allies, be patient and comfortable with the ambiguity and unpredictability of working with youth; and (5) continually revisit and renegotiate structure and flexibility.

Adolescent Feelings on COVID-19 Distance Learning Support: Associations With Mental Health, Social-Emotional Health, Substance Use, and Delinquency

PURPOSE

School social support is associated with improved adolescent wellbeing. However, positive school relationships were potentially disrupted when schools transitioned to distance learning in 2020 to mitigate the spread of COVID-19. This study investigated associations among perceived distance learning school support, mental health, social-emotional wellbeing, substance use, and delinquency among low-income, public high school students.

METHODS

We analyzed longitudinal survey data, collected between June 2020 and June 2021, from 372 students attending five large urban public high schools. Mixed-effects regression models examined associations among changes in distance learning support and changes in mental health, social-emotional wellbeing, substance use, and delinquency, controlling for time, social-demographics, and baseline health.

RESULTS

In this predominantly Latinx (83%) sample, within-person increases in perceived distance learning support were associated with improved mental health, increased grit, increased self-efficacy, and decreased stress. Between-person differences in distance learning support indicated that students reporting greater support had improved mental and social-emotional outcomes. Although there were no within-person associations among distance learning support and hopelessness or delinquency, students with greater distance learning support (between-person) had lower levels of hopelessness and lower odds of engaging in any delinquent behavior. There were no associations between distance learning support and 30-day substance use.

DISCUSSION

School social support, even without students physically on campus, may be critical to adolescent health behaviors and social-emotional outcomes.

Examining the association between exposure to various screen time sedentary behaviours and cannabis use among youth in the COMPASS study

Background

Canadian youth are among the top users of cannabis globally. The Canadian federal government identified protecting youth from cannabis-related harms as a key public health objective aligned with the legalization and strict regulation of cannabis. While there are well-established associations between screen time sedentary behaviour (STSB) and alcohol and tobacco use, the association with cannabis use is understudied. The purpose of this study is to examine the association between various types of STSBs and cannabis use in a large sample of Canadian youth.

Methods

Using cross-sectional data from 46,957 grade 9 to 12 students participating in year 5 of the COMPASS host study (2016–2017), four gender-stratified ordinal logistic regression models were used to examine how total STSB and four different types of STSBs (watching/streaming TV shows/movies, playing video games, Internet use, emailing/messaging/texting) are associated with frequency of cannabis use.

Results

One-quarter of participants (24.9%) reported using cannabis in past 12 months; the largest proportion of this group (37.9%) reported rare/sporadic use. Overall, participants spent an average 7.45 ( ±5.26) hours/day on STSBs. Total STSB was positively associated with more frequent cannabis use, and when separated by type, internet use and messaging were significant. Playing video games and watching TV/movies were also significantly associated with more frequent cannabis use, but only for females.

Conclusions

The associations between frequency of cannabis use and various measures of STSBs suggest that screen time may be a risk factor for cannabis use among youth. This association may be mediated by youths’ mental wellbeing, given emerging evidence that STSB is a risk factor for poor mental health, and the tendency for individuals to use substances as a coping mechanism. Further, the ubiquity of pro-substance use content on the internet may also contribute to increased exposure to and normalization of cannabis, further promoting its use.

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Youth average of overall STSBs was 7.48 h per day.

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Greater hours of overall STSB increased likelihood of higher frequency cannabis use.

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Internet use and messaging STSBs were both positively associated with cannabis use.

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Gender differences present for TV watching and video gaming STSBs.

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Cyber-bullying victims show increased likelihood for higher frequency cannabis use.

Canadian after-school care providers' perceived role promoting healthy lifestyles: a focused ethnography

BACKGROUND

After-school care programs have garnered interest in recent years as the hours of 3:00-6:00 p.m. are an opportune time for children to engage in healthy behaviours, specifically healthy eating and physical activity. Care providers are major influencers within the after-school care setting, impacting health promoting opportunities for children. However, little is known regarding the role care providers play in health promotion interventions in the after-school care setting, specifically those using comprehensive approaches. The purpose of this research was to explore care providers' role and experience promoting healthy eating and physical activity through the after-school care health promotion intervention School's Out … Let's Move (SOLMo). SOLMo was guided by the evidence-based comprehensive school health framework. SOLMo had two main goals: [1] to serve a healthy snack with vegetable or fruit, and milk or water as the drink; [2] to include 30 min of moderate to vigorous physical activity. The intervention included resources and coaching for care providers to promote healthy eating and physical activity for children and took place in four after-school sites over a six-month period. Three of four sites were located in a school. The primary researcher was engaged with the sites over 22-months.

METHODS

This research was guided by the qualitative method focused ethnography. Semi-structured interviews with care providers (n = 13) taking part in SOLMo were conducted. Participant observation was included as part of data generation to further understand care provider roles. Latent content analysis was utilized iteratively and concurrently throughout data generation.

RESULTS

Overall, care providers were supportive of promoting health behaviours in the after-school setting. Through analysis, five themes and eight subthemes emerged related to care providers' role and experience promoting healthy eating and physical activity through SOLMo: 1) enhanced awareness; 2) improved programming; 3) strong relationships; 4) collaborative approach; and 5) role tension.

CONCLUSIONS

As major influencers, care providers play a crucial role in promoting healthy lifestyle behaviours for children. This research provides valuable insight into this role and the implementation of comprehensive health promotion approaches in the after-school setting. Findings contribute to the implementation knowledge base and help inform the promotion of healthy lifestyle behaviours for children.

Relevance of the Sustainable Development Goals (SDGs) to Adolescent Health Measurement: A Systematic Mapping of the SDG Framework and Global Adolescent Health Indicators

PURPOSE

To assess the relevance of the Sustainable Development Goals (SDGs) framework for adolescent health measurement, both in terms of age disaggregation and different health domains captured, and how the adolescent health indicators recommended by the Global Action for Measurement of Adolescent Health (GAMA) can complement the SDG framework.

METHODS

We conducted a desk review to systematically map all 248 SDG indicators using the UN metadata repository in three steps: 1) age-related mandates for SDG reporting; 2) linkages between the SDG indicators and priority areas for adolescent health measurement; 3) comparison between the GAMA indicators and the SDG framework.

RESULTS

Of the 248 SDG indicators, 35 (14%) targeted an age range overlapping with adolescence (10-19 years) and 33 (13%) called for age disaggregation. Only one indicator (3.7.2 "adolescent birth rate") covered the entire 10-19 age range. Almost half (41%) of the SDG indicators were directly related to adolescent health, but only 33 of those (13% of all SDG indicators) overlapped with the ages 10-19, and 15 (6% of all SDG indicators) explicitly mandated age disaggregation. Among the 47 GAMA indicators, five corresponded to existing SDG indicators, and eight were adolescent-specific age adaptations. Several GAMA indicators shed light on aspects not tracked in the SDG framework, such as obesity, mental health, physical activity, and bullying among 10-19-year-olds.

DISCUSSION

Adolescent health cannot be monitored comprehensively with the SDG framework alone. The GAMA indicators complement this framework via age-disaggregated adaptations and by tracking aspects of adolescent health currently absent from the SDGs.

Development and Preliminary Evaluation of a Food Literacy Measure for Use With Young People in Canada

BACKGROUND

This article presents the culmination of a multiyear research project aimed at creating a comprehensive food literacy framework and corresponding measure. Specifically, this article documents the development and validation of a food literacy measure for young people facing social inequities.

OBJECTIVES

This study aimed to identify items to measure 12 attributes of food literacy; test the measure with the identified target groups, considering attribute, face, and content validity, inter-rater reliability and test-retest reliability; and refine the measure.

DESIGN

The study's design consisted of a 5-phase approach that included drafting the food literacy measure, expert review, cognitive interviews, pilot testing, and validity and reliability testing.

PARTICIPANTS AND SETTING

Seven international experts provided feedback on the measure, and 25 individuals aged 16 to 25 years participated in cognitive interviews. Two hundred fifty-five young people completed the test survey, and 147 completed a retest survey 2 weeks later. These surveys identified food literacy factors. To further evaluate the validity of these factors, 193 participants completed a confirmatory test that was used for confirmatory factor analysis to assess the final model's fit. Interview participants were recruited from local programs and services from across Ontario, Canada, and survey participants were recruited from across Canada via social media. The research study was conducted between January 2018 and December 2019.

MAIN OUTCOME MEASURES

The main outcome measures were validity and reliability scores for a food literacy measurement tool that consisted of 50 questions across 10 attributes of food literacy.

STATISTICAL ANALYSES PERFORMED

Interview analyses were guided by the 4 stages of cognitive processing. Exploratory factor analysis was used to identify the factors that improved the Cronbach's alpha of the food literacy measure. Test-retest reliability was assessed using percent agreement, Cohen's kappa, and weighted kappa. Confirmatory factor analysis was used to produce an acceptable final model with a root mean square error of approximation estimate.

RESULTS

The final food literacy measure consisted of 50 questions addressing 10 food literacy attributes. Exploratory factor analysis showed an improvement in Cronbach's alpha when compared with the initial attribute construction. Test-retest reliability showed percent agreement ranging from 64% to 97%, with most items having fair (0.21 to 0.40) to moderate (0.41 to 0.60) kappa values. Confirmatory factor analysis produced an acceptable final model with a root mean square error of approximation estimate of 0.0437.

CONCLUSIONS

The food literacy measure is a comprehensive tool for assessing food literacy among young people. Additional research is needed to explore the measure's modularity, its use as an evaluation tool, and its suitability for use with diverse samples, including individuals from varied gender, geographic locations, ethnicities, and cultural backgrounds.

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.

Exploring barriers to accessing health care services by young women in rural settings: a qualitative study in Australia, Canada, and Sweden

BACKGROUND

The aim of this study is to explore young rural women's perceived barriers in accessing healthcare services with a focus on the interrelation between three marginalization criteria: age (youth), gender (female), and place of residence (rural areas) in Australia, Canada, and Sweden.

METHODS

Using a qualitative interpretive approach, we conducted semi-structured in-depth interviews with 31 young women aged 18 to 24 in selected rural communities. Data collection took place from May 2019 to January 2021, and the qualitative data were analyzed using NVivo software.

RESULTS

Self-perceived barriers for access to healthcare services among young women living in rural and remote areas encompass various challenges across individual, institutional, and structural levels. Individual barriers include limited knowledge about available health services, negative attitudes toward healthcare, psychological discomfort when seeking assistance, and economic affordability issues. Institutional challenges involve limited healthcare resources, gender insensitivity among providers, judgmental attitudes from healthcare staff, inadequate time management of services, and a lack of privacy and confidentiality within facilities. Structural barriers further compound these issues through socio-cultural and gender norms, insufficient coverage of universal health insurance, low budget allocations for health facilities in rural and small urban areas, and the geographic distance to healthcare providers. Addressing these multifaceted barriers is crucial to improving healthcare access for rural population.

CONCLUSIONS

Appropriate strategies and policies must be introduced to promote access to healthcare services in rural and remote areas even in most high-`income countries.

Screen Time Correlates of Bullying Perpetration and Victimization in Brazilian Adolescents

This study is an investigation of the associations of time spent in different screen time activities with bullying among Brazilian adolescents. In this cross-sectional study, adolescents answered questions related to bullying in the past 30 days and reported the weekly volume of screen time spent studying, working, watching videos, playing video games, and using social media applications. Multilevel logistic regression models were used. Our results indicate that higher social media use was associated with higher odds of bullying victimization among males but not females. Excessive use of screen time for work and social media purposes was associated with a higher likelihood of bullying victimization.

Do sociodemographic risk profiles for adolescents engaging in weekly e-cigarette, cigarette, and dual product use differ?

BACKGROUND

E-cigarette use represents a contemporary mode of nicotine product use that may be changing the risk profile of participating adolescents. Understanding differences in sociodemographic characteristics of adolescents engaging in contemporary e-cigarette use and traditional cigarette use is important for effectively developing and targeting public health intervention programs. The objective of this study was to identify and compare sociodemographic risk profiles for exclusive e-cigarette use and dual-product use among a large sample of Canadian youth.

METHODS

A survey of 46,666 secondary school students in the 2021-22 wave of the COMPASS study measured frequency of past month e-cigarette and cigarette use as well as age, sex, gender, racial or ethnic background, spending money, relative family affluence, and having one's own bedroom. Rates of cigarette-only, e-cigarette-only, and dual product use were calculated, and separate classification trees were run using the CART algorithm to identify sociodemographic risk profiles for weekly dual-product use and weekly e-cigarette-only use.

RESULTS

Over 13% of adolescents used only e-cigarettes at least weekly, 3% engaged in weekly dual e-cigarette and cigarette use, and less than 0.5% used only cigarettes. Available spending money was a common predictor of dual-product and e-cigarette-only use. Gender diverse youth and youth with lower perceived family affluence were at higher risk for dual-product use, while white and multiethnic adolescents were at greater risk of e-cigarette-only use. Two high-risk profiles were identified for e-cigarette-only use and four high-risk profiles were identified for dual product use.

CONCLUSIONS

This study used a novel modelling approach (CART) to identify combinations of sociodemographic characteristics that profile high-risk groups for exclusive e-cigarette and dual-product use. Unique risk profiles were identified, suggesting that e-cigarettes are attracting new demographics of adolescents who have not previously been considered as high-risk for traditional cigarette use.