搜索结果：International journal of adolescence and youth

While mental health and substance use challenges have been shown to most frequently emerge during adolescence and young adulthood, a significant portion of these youth experience barriers when attempting to access quality and timely care. The Integrated Youth Service (IYS) model of care aims to transform healthcare for youth by bringing together a broad array of service providers in low-barrier, accessible settings across Canada. Youth Wellness Hubs Ontario (YWHO) is the IYS network in Ontario and consists of Networks across the province that serve diverse youth aged 12-25. YWHO is founded on six core components that were developed based on youth-centred approaches to care, including integrated service delivery (ISD) and measurement-based care (MBC). Despite ample evidence promoting ISD and MBC, there remains a gap in identifying key implementation considerations and recommendations within IYS settings. This study will use the Quality Implementation Framework and a mixed methods approach to understand the perspectives of youth, caregivers/family and service providers' experiences of ISD and MBC. Focus groups will be conducted with all participant groups to identify their perspectives on these two IYS core components. Group concept mapping will identify youth-friendly, higher-level conceptualisations of ISD and MBC. Quantitative data will be collected using the Service Provider Adopter and Innovation Characteristics Questionnaire (SPAICQ) and a Social Network Analysis approach. The study will use a Convergence Parallel Design (triangulation) as the primary integration strategy, where qualitative and quantitative data are collected concurrently and brought together during the interpretation phase. This will be supplemented by embedded sequential mixing where the outputs of one method (eg, focus groups) inform the design or analysis of another (eg, SPAICQ scores). Youth and caregivers/family members will be recruited through YWHO networks and youth advisory councils, and service providers will be recruited from YWHO Networks across the province. This study has been approved by the Centre for Addiction and Mental Health's (CAMH) Research Ethics Board (REB # 2023/030). Ongoing ethical approval will be maintained annually. As the study procedures are not greater than minimal risk, adverse events and/or serious adverse events are not expected. Findings from this study will be disseminated via publications in peer-reviewed journals, national and international conferences, regular briefings to interested parties and youth and family-friendly briefs through our networks and social media.

Against the backdrop of increasing international calls for the development and implementation of integrated person-centered care that address both quality and access issues to improve adolescent and youth health services, this paper aims to develop a conceptual framework for integrating Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STIs) prevention into pregnancy prevention routine services in Vhembe District, to improve teenagers' health outcomes. A convergent triangulation mixed methods design was used for comparing and contrasting of quantitative and qualitative data to determine the extent of agreement between the two data types to generate contextual findings. In this study, employing both quantitative data were collected through questionnaires on a sample of healthcare workers (n = 112) providing Adolescent and Youth-Friendly Services to evaluate programme effectiveness on the high rate of teenage pregnancy and HIV infection among youth in Vhembe District. Qualitative data were collected using face-to-face interviews with nurses (n = 24) and teenagers aged 14-19 yrs (n = 28). For a richer understanding of dynamic family planning and HIV programs, face-to-face interview was conducted to explore more deeply the experiences and challenges of teenagers between the ages of 14-19 years. Nurses were interviewed on the barriers and facilitators of integrating HIV, STI and pregnancy prevention services in the rural facilities of Vhembe District. Quantitative data were analysed using frequencies and percentages, and qualitative data were analysed using thematic analysis. The findings of the study point out that the integrated HIV, STIs and pregnancy prevention service uptake among adolescents is likely to be influenced by social and institutional factors. It is also evident from this study that adolescents face challenges when it comes to obtaining PrEP, PEP and contraceptives in primary healthcare clinics. Provider competency reveals a disparity, with a majority 67.0% of healthcare providers trained in effective communication with adolescents with 95% Confidence Interval of [0.57-0.75] (n = 112), suggesting a high level of adoption in the population. In comparison, significantly fewer have received specific training in AYFS 16% with 95% Confidence Interval of [0.09-0.24] (n = 112) or on Pre-Exposure Prophylaxis (PrEP) 25.9% with 95% Confidence Interval of [0.18-0.35] (n = 112), underscoring the need for a more balanced approach to training focus. The empirical findings provide evidence on challenges unique to low-resource, rural settings, contributing to global discourse on HIV and Sexual Reproductive Health (SRH) integration. Consequently, 95% of the key stakeholders and experts approved the feasibility and applicability, while 92% approved the acceptability and sustainability of the proposed framework. It is recommended in this study that policy changes be implemented through an integrated health policy that recognizes the interconnectedness of HIV, STIs, and teenage pregnancy prevention to improve access to quality healthcare and education for youth.

Prospective data on the natural history of alcohol-use disorders (AUD) from adolescence into middle adulthood are scarce. This study aims to describe the prevalence, incidence, and remission of Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 AUD from adolescence into middle adulthood and thereafter characterise those who do and do not develop AUD symptoms or experience remission. In this prospective cohort study, data were drawn from the Australian 11-wave population-based Victorian Adolescent Health Cohort Study (N=1943; 1000 female and 943 male participants). Between wave 7 (1998) and wave 11 (2019-21), we assessed 12-month DSM-5 AUD symptoms at age 21 years and 24 years (late adolescence), age 29 years and 35 years (young adulthood), and age 42 years (early middle adulthood) using the Composite International Diagnostic Interview (CIDI). The CIDI was administered by a trained interviewer, with AUD symptoms scored to align with DSM-5 AUD clinical diagnosis. We estimated incidence and incidence rate using flexible parametric survival models, and symptom prevalence and remission from symptoms using proportions, with and without cessation of heavy drinking. We used risk ratios and relative risk ratios from univariable generalised linear regression models to describe participant characteristics associated with symptoms of AUD and remission. Multiple imputation was used to address missing data. At any wave between ages 21 years and 42 years, estimated cumulative incidence of AUD symptoms using multiply imputed data was 58·0% (95% CI 52·3-63·8), and highest in male individuals (71·6% [65·1-78·1]). Incidence and prevalence increased markedly from age 21 years to 24 years, peaking at age 24 years, then decreased and stabilised across the subsequent assessment waves at age 29 years, 35 years, and 42 years. By age 42 years, 25·0% (95% CI 21·2-28·8) of the population had either ongoing or middle-adulthood-onset AUD, 11-13% had persistent AUD symptoms from late adolescence (age 21-24 years), and most experienced remission from AUD (67·0% [61·1-73·0]), with a majority also reporting cessation from heavy drinking (63·6% [58·6-65·5]). Remission from AUD was most common between the assessment waves at age 29 years and age 35 years (43·9% [95% CI 34·5-53·3]), and in female individuals (55·3% [42·6-67·9]), with a distinct reduction in remission for male individuals between the assessment waves at age 35 years and age 42 years (32·4% [24·8-39·9]). In both male and female individuals, remission from AUD was more common in those with higher education, in stable relationships, or without long-term other substance use. Cumulative incidence of AUD from late adolescence to middle adulthood is high. Although most individuals with AUD remit by age 42 years, greater investment in public health prevention and health service responses is needed for those with persistent AUD, particularly in male individuals. National Health and Medical Research Council of Australia.

Research has consistently shown that early onset of drinking (EOD) is associated with alcohol-related problems in adulthood. However, recent reviews have identified several limitations in the early onset literature, including the use of retrospective reports, insufficient control for potential confounders, ambiguous definitions of the concept, and an assumption that early onset is independent of cultural norms and national alcohol policies. This study addresses these limitations by examining whether EOD, independent of early onset of excessive drinking (EOE), prospectively predicts hazardous drinking in late adolescence/young adulthood in Norway and Australia, two countries with different drinking cultures. Data were drawn from two population-based longitudinal studies; the Norwegian Tracking Opportunities and Problems Study (n = 329) and the Australian International Youth Development Study (n = 786). Data were collected prospectively from mid adolescence (14-16 years) to late adolescence/young adulthood (18-25 years) and a modified Poisson regression approach was used to estimate prevalence ratios. Adolescent self-reports included measures of EOD and EOE. Young adults completed the Alcohol Use Disorders Identification Test (AUDIT). The results were adjusted for adolescent factors; age, gender, impulsivity, hyperactivity, conduct problems, smoking, early sexual intercourse and friends' substance use, and family factors; alcohol and drug use in the family, maternal education, family management and monitoring. Hazardous drinking was identified in 46.8 and 38.9% of young adults in Norway and Australia, respectively. Both EOD and EOE in adolescence were significantly related to an increased risk of alcohol-related problems in late adolescence/young adulthood in both studies, even when adjusting for possible confounders. Our findings indicate that adolescent drinking behaviour is an indicator of alcohol-related problems in late adolescence/young adulthood, even when controlling for a variety of covariates. This finding is in contrast to previous research on older adults, where no association between adolescent drinking and later alcohol-related problems were found when controlling for covariates. The divergence in findings may suggest that the impact of EOD/EOE is limited to the late adolescent and young adult period. Preventing drinking in early adolescence may thus have some impact on the drinking patterns in late adolescence/young adulthood.

The youths in Zambia have limited access to information concerning Sexual Reproductive Health (SRH) and this puts them at risk of unwanted pregnancies. Talking about other methods of preventing pregnancy or sexually transmitted infections than abstinence is regarded as culturally unacceptable. The Research Initiative to Support the Empowerment of Girls (RISE) is a cluster randomised controlled trial testing the effectiveness of different support packages on teenage pregnancies, early marriages and school drop-out rates. One of the support packages included youth clubs focusing on Comprehensive Sexual and Reproductive Health Education (CSRHE). Although similar interventions have been implemented in other settings, their integration process has been complex and comprehensive assessments of factors shaping acceptability of CSRHE are lacking. This article qualitatively aimed at identifying factors that shaped the acceptability of CSRHE youth clubs in rural schools in Central Province. A qualitative case study was conducted after the youth clubs had been running for a year. Data were gathered through eight focus group discussions with grade eight pupils and eight individual interviews with teachers. Data were analysed using thematic analysis. The perceived advantage and simplicity of the clubs related to the use of participatory learning methods, films and role plays to communicate sensitive reproductive health information made the learners like the youth clubs. Further, the perceived compatibility of the content of the sessions with the science curriculum increased the learners' interest in the youth clubs as the meetings also helped them to prepare for the school examinations. However, cultural and religious beliefs among teachers and parents regarding the use of contraceptives complicated the delivery of reproductive health messages and the acceptability of youth clubs' information among the learners. The study indicated that CSRHE youth clubs may be acceptable in rural schools if participatory learning methods are used and head-teachers, teachers as well as parents appreciate and support the clubs.

This is the fourth and final study designed to develop International Classification of Functioning, Disability and Health (ICF, and children and youth version, ICF-CY) core sets for attention-deficit hyperactivity disorder (ADHD). To investigate aspects of functioning and environment of individuals with ADHD as documented by the ICF-CY in clinical practice settings. An international cross-sectional multi-centre study was applied, involving nine units from eight countries: Denmark, Germany, India, Italy, Portugal, Saudi Arabia, Sweden and Taiwan. Clinicians and clinical researchers rated the functioning level of 112 children, adolescents and adults with ADHD using the extended ICF-CY checklist version 2.1a. The ratings were based on a variety of information sources, such as medical records, medical history, clinical observations, clinical questionnaires, psychometric tests and structured interviews with participants and family members. In total, 113 ICF-CY categories were identified, of which 50 were related to the activities and participation, 33 to environmental factors and 30 to body functions. The clinical study also yielded strengths related to ADHD, which included temperament and personality functions and recreation and leisure. The study findings endorse the complex nature of ADHD, as evidenced by the many functional and contextual domains impacted in ADHD. ICF-CY based tools can serve as foundation for capturing various functional profiles and environmental facilitators and barriers. The international nature of the ICF-CY makes it possible to develop user-friendly tools that can be applied globally and in multiple settings, ranging from clinical services and policy-making to education and research.

Adolescent pregnancy is of public health concern due to high rates of pregnancy-related complications and lower antenatal attendance among adolescent girls and young women. Mobile health (mHealth) interventions have the potential to improve pregnancy health behaviors and thereby birth outcomes. This pilot randomized controlled trial with pre-post design evaluated user acceptability and preliminary efficacy of an mHealth intervention to improve antenatal appointment attendance and its determinants among pregnant adolescent girls and young women in South Africa. The "Teen MomConnect" intervention entailed both fixed and 2-way tailored SMS text messages about antenatal appointment keeping and pregnancy health behaviors. The intervention content and functionality were adapted from MomConnect, a national mHealth program that sends fixed SMS text messages to pregnant women in South Africa. Pregnant adolescent girls and young women aged 13-20 years were recruited from health facilities and community networks in Cape Town during May-December 2018. Simple 1:1 randomization was used to allocate participants into the control group that received the standard MomConnect maternal health messages or the experimental group that received the Teen MomConnect intervention. A subset of experimental group participants received an in-person motivational interviewing session. Questionnaires were administered at baseline and after the end of the participants' pregnancies. Appointment attendance data were obtained from clinic records. ANOVA, ANCOVA, and logistic regression models assessed the differences in appointments attended, awareness of HIV status, and the psychosocial determinants of antenatal attendance between the control and experimental groups. Overall, 412 adolescent girls and young women were enrolled, of which 254 (62%) completed the posttest survey (64% control, 59% intervention). Patient record data were obtained for 222 of the 412 (54%; in both control and intervention) participants. A total of 84% (63/75) and 72% (54/75) rated the intervention messages highly regarding their content value and their motivational nature for behavior change, respectively. Participants responded to an average of 20% of the 2-way messages they received. Mean appointment attendance did not differ significantly between the experimental (4.86, SD 1.76) and control (4.79, SD 1.74; P=.79) groups. Appointment attendance was higher among intervention participants who responded to ≥50% of messages ("high-responders"; 5.08, SD 1.66) than intervention participants who responded to fewer messages (4.82, SD 1.79) and control participants (4.79, SD 1.74; P=.86). The mean increase in knowledge scores was significantly higher among experimental group high-responders (2.1, SD 3.17) than the control group (0.7, SD 2.73; β=1.50; P=.045). Engagement with the intervention's 2-way messaging was low, which could have impacted the outcomes. However, the intervention content was deemed acceptable. Appointment attendance did not vary significantly between the intervention and control groups. More intensive intervention may be needed to impact appointment adherence. Pan African Clinical Trial Registry (PACTR) PACTR201912734889796; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9565. RR2-10.2196/43654.

Adequate sleep is essential for adolescents' physical, emotional, and cognitive well-being. However, accurately capturing the complex components of sleep in this demographic is challenging, especially with retrospective self-report measures. This study aims to compare sleep data obtained from youth reports, caregiver reports, and Fitbit devices among early adolescents. Data from 11 879 adolescents (11-14 years, 47.83% female), in year 2 of the Adolescent Brain Cognitive Development (ABCD) study, were analyzed. Adolescents self-reported their sleep characteristics using the Munich Chronotype Questionnaire, and caregivers provided data through the Children's Sleep Disturbance Scale. Additionally, a subset of participants (N = 3803) wore Fitbit Charge 2 devices for 21 days. We assessed the questionnaires' internal consistency and utilized Bland-Altman and interclass correlation analyses for comparing self-reported sleep characteristics with Fitbit measures. Youth-reported and caregiver-reported sleep questionnaires demonstrated acceptable internal consistency. Discrepancies between caregiver and adolescent reports were more pronounced when adolescents reported sleep periods of less than 7 hours. Compared to Fitbit measurements, adolescents' self-reports showed a reasonably high agreement on sleep period and bedtime, while agreement on the duration of wakefulness after sleep onset and sleep onset latency was poor. Results show reasonable agreement between adolescent self-reports and Fitbit measurements of sleep period and indicate their usefulness in assessing sleep behavior in adolescents. Caregivers provided valuable perspectives on the youth's sleep disturbances; however, they tended to overestimate sleep duration. These findings offer important methodological insights and highlight the necessity of adopting multi-dimensional approaches to assess sleep in adolescents.

Is well known that oral health and dental aesthetic have significant effects on the sociality of human beings. The aim of the present study was to assess some aspects of oral health with possible repercussions in adolescent and youth, with particular reference to gender differences. A total of 190 subjects with female prevalence (F = 62.6%, M = 37%) and ages between 14 and 29 years old (Mean = 23.8; SD = 3.27) participated. Evaluation was carried using standardized instruments to assess quality of oral life (PIDAQ), negative impact of oral conditions (OHIP-14), and self-esteem (Rosenberg Self Esteem Scale). Correlational and difference analyses and linear regressions were performed. Significant gender differences were found in terms of gender, in reference to variables such as self-confidence and convictions. Positive correlations emerged between psychological impact and social impact, aesthetic concern and social impact, convictions and self-confidence, oral health with psycho-social impact, and aesthetic concern, self-esteem with oral health. Inverse correlations emerged between psycho-social impact and self-confidence, aesthetic concern and self-confidence, oral health, and self-confidence. Multivariate linear regression indicated relations between age and psychological impact, sex and self-confidence, crooked teeth and conviction. The impact of oral health on the psychological well-being of young people is relevant. These factors, if considered within clinical practice, can improve the quality of life of the subject.

Background: Adolescence is a developmentally sensitive period for trauma-related psychopathology, yet posttraumatic stress disorder (PTSD) is defined differently across diagnostic systems. The DSM-5 conceptualises PTSD broadly, whereas the ICD-11 distinguishes PTSD from complex PTSD (CPTSD), raising questions about diagnostic alignment and clinical meaning in youth.Objective: This study examined the diagnostic concordance between DSM-5 PTSD and ICD-11 PTSD and the differentiation between DSM-5 PTSD and ICD-11 CPTSD in adolescents, further evaluating whether adverse childhood experiences (ACEs) differentially predicted diagnoses.Method: Participants included 585 adolescents aged 13-20 years from psychiatric outpatient clinics and 2146 control adolescents from schools. DSM-5 PTSD was assessed using the PTSD Checklist for DSM-5, ICD-11 PTSD and CPTSD were assessed with the International Trauma Questionnaire (ITQ), and ACEs were measured using the ACE International Questionnaire (ACE-IQ). Least absolute shrinkage and selection operator (LASSO) logistic regression and receiver operating characteristic (ROC) analyses were used to identify stable adversity-based predictors and evaluate model discrimination.Results: DSM-5 PTSD prevalence was substantially higher than ICD-11 PTSD prevalence in both samples. ACEs showed minimal predictive value for ICD-11 PTSD but strong associations with DSM-5 PTSD and ICD-11 CPTSD, particularly cumulative adversity and community violence. DSM-5 PTSD aligned more closely with ICD-11 CPTSD than with ICD-11 PTSD in adolescents, and ACEs predicted diagnostic differentiation primarily in samples with lower trauma exposure.Conclusions: By directly mapping diagnostic overlap and adversity-based differentiation within adolescent cohorts, this study addresses a critical gap in the literature regarding the age-specific validity and clinical meaning of DSM-5 and ICD-11 trauma diagnoses. DSM-5 PTSD and ICD-11 PTSD showed limited cross-system equivalence in adoles-cents.ICD-11 CPTSD shows closer alignment with DSM-5 PTSD, supporting CPTSD as a distinct subgroup within the broader DSM-5 PTSD.The diagnostic utility of ACE showed limited discrimination in the high-trauma-burden clinical sample but clearer differentiation in the low-trauma-burden cohort. Antecedentes: La adolescencia es un período de desarrollo sensible para la psicopatología relacionada con el trauma, sin embargo, el trastorno de estrés postraumático (TEPT) se define de manera diferente en los distintos sistemas diagnósticos. El DSM-5 conceptualiza el TEPT de forma amplia, mientras que la CIE-11 distingue el TEPT del TEPT complejo (TEPTc), lo que plantea interrogantes acerca de la coherencia diagnóstica y su significado clínico en jóvenes. Objetivo: Este estudio examinó la concordancia diagnóstica entre el TEPT del DSM-5 y el TEPT de la CIE-11 y la diferenciación entre el TEPT del DSM-5 y el TEPTc de la CIE-11 en adolescentes, además de evaluar si las experiencias adversas en la infancia (ACEs por sus siglas en inglés) predecían de manera diferente los diagnósticos. Métodos: Los participantes incluyeron 585 adolescentes, edades 13 a 20 años de centros psiquiátricos ambulatorios y 2.146 adolescentes de control de escuelas. El TEPT del DSM-5 se evaluó utilizando la lista de chequeo de TEPT para el DSM-5, el TEPT y TEPTc de la CIE-11 se evaluaron con el Cuestionario Internacional de Trauma (ITQ), y las ACEs se midieron utilizando el Cuestionario Internacional de ACE (ACE-IQ). Se utilizaron análisis de regresión logística LASSO (least absolute shrinkage and selection operator) y análisis de curvas ROC (characteristic) para identificar predictores estables basados en la adversidad y evaluar la capacidad de discriminación del modelo. Resultados: La prevalencia de TEPT según el DSM-5 fue sustancialmente mayor que la prevalencia de TEPT según la CIE-11 en ambas muestras. Las ACEs demostraron un valor predictivo mínimo para el TEPT según la CIE-11, pero fuertes asociaciones con el TEPT según el DSM-5 y TEPTc según la CIE-11, particularmente la adversidad acumulativa y la violencia comunitaria. El TEPT según el DSM-5 se alineó más estrechamente con el TEPTc según la CIE-11 que con el TEPT según la CIE-11 y las ACEs predijeron la diferenciación diagnóstica principalmente en muestras con menor exposición al trauma. Conclusiones: Al mapear directamente la superposición diagnóstica y la diferenciación basada en la adversidad en las cohortes de adolescentes, este estudio aborda una brecha crítica en la literatura relacionada con la validez específica por edad y el significado clínico de los diagnósticos de trauma según el DSM-5 y CIE-11.

Although essential for providing optimal adolescent patient support, knowledge of the impact of Marfan syndrome in adolescence is limited. To explore adolescents' perceived impact of Marfan syndrome on (physical) functioning (activities, participation), disability (limitations, restrictions), contextual factors and support needs, we interviewed 19 adolescents with Marfan syndrome. Audio-recordings were transcribed, coded and analysed using thematic analysis. Identified themes were "difficulties in keeping up with peers" and "being and feeling different from peers". Furthermore, an adolescent Marfan syndrome-specific International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) model derived from the data describing the adolescent perceived impact of Marfan syndrome on functioning, disability and its contextual factors. Adolescents perceived problems in keeping up with peers in school, sports, leisure and friendships/relationships, and they could not meet work requirements. Moreover, participants perceived to differ from peers due to their appearance and disability. Contextual factors: coping with Marfan syndrome, self-esteem/image, knowledge about Marfan syndrome, support from family/friends/teachers, ability to express needs and peer-group acceptation acted individually as barrier or facilitator for identified themes.Conclusion: Adolescents with Marfan syndrome perceived limitations and restrictions in (physical) functioning. They perceived problems in keeping up with peers and perceived to differ from peers due to their appearance and disability. This warrants awareness and tailored physical, psychosocial, educational and environmental support programmes to improve (physical) functioning and empowerment of adolescents with Marfan syndrome.What is known:• Marfan syndrome is a hereditary connective tissue disorder.• Marfan syndrome affects multiple systems.What is new:• Adolescents with Marfan syndrome perceive (1) problems in keeping up with peers in school, sports, leisure, friendships/relationships and work (2) to differ from peers due to their appearance and disability.• An adolescent Marfan syndrome-specific International Classification of Functioning, Disability and Health for Children and Youth model derived from the data describing the adolescent perceived impact of Marfan syndrome on functioning, disability and contextual factors.

The Adolescent Brain Cognitive DevelopmentSM (ABCD) Study is the largest longitudinal study on brain development and adolescent health in the United States. The study includes a sociodemographically diverse cohort of nearly 12,000 youth born 2005-2009, with an open science model of making data rapidly available to the scientific community. The ABCD Study® data has been used in over 1100 peer-reviewed publications since its first data release in 2018. The dataset contains a broad scope and comprehensive set of measures of youths' behavioral, health, and brain outcomes, as well as extensive contextual and environmental measures that map onto the social determinants of health (SDOH). Understanding the impact of SDOH on the developmental trajectories of youth will help to address early lifecourse health inequities that lead to disparities later in life. However, the open science model and extensive use of ABCD data highlight the need for guidance on appropriate, responsible, and equitable use of the data. Our conceptual framework integrates the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework with strength-based and data equity perspectives. We use this framework to articulate best practices and methods for investigations that aim to identify the multilevel pathways by which structural and systemic inequities impact adolescent health trajectories. Using our conceptual model, we provide recommendations for equitable health disparities research using ABCD Study data. We identify over fifty ABCD measures that can encompass SDOH across five levels of influence: individual, interpersonal, school, community, and societal. We expand the societal level to acknowledge structural discrimination as the root cause of systemic and structural inequities resulting in health disparities among marginalized youth. We apply the methodological recommendations in an example data analysis using a multi-level approach that integrates strength-based and data equity perspectives to elucidate pathways by which social and structural inequities may influence cognitive decision making in youth. We conclude with recommendations for strengthening the utility of ABCD data for health disparities research now and in the future. Adolescence is a critical period of development with subsequent ramifications for health outcomes across the lifespan. Thus, understanding SDOH among diverse youth can inform prevention interventions before the emergence of health disparities in adulthood.

The onus for educating and supporting young people in navigating romantic relationships often falls on professional youth work organizations; yet, evidence relating to healthy young adult relationship (HYAR) education programmes delivered within these settings remains limited. The present study sought to capture youth work professionals' views as part of a research programme focused on developing HYAR education resources for young people. Eleven youth work professionals in Northern Ireland participated in individual interviews or focus groups (5 interviews and 2 focus groups) between September and November 2024. Three master themes were identified using Reflexive Thematic Analysis: (1) defining and understanding coercive control; (2) barriers to communicating and reporting; and 3) training needs. The findings highlight professionals' perceptions of HYAR education and training needs of young people, parents and professionals. Participating professionals believed that youth work organizations should assume a key role in delivering HYAR education in a meaningful and accessible way.

Adolescent mothers in the Caribbean represent a high-need, under-served population facing overlapping reproductive, mental health, and social challenges. Despite the urgency of these needs, few randomized controlled trials (RCTs) target this group using culturally tailored, integrated care models. The Teen motHers' ReproductIve and behaVioral health intErvention (THRIVE) was conceptualized in Barbados in April 2024 as a randomized trial to evaluate such a model. However, as of today, THRIVE has not launched due to prolonged Institutional Review Board (IRB) delays and cultural sensitivities surrounding adolescent pregnancy-barriers that reflect broader systemic challenges common across low- and middle-income country (LMIC) contexts. In response, a parallel initiative-the Project Amai-was launched as a community-driven, service-based intervention outside the traditional RCT framework. Prioritizing cultural responsiveness, youth engagement and leadership, and low-barrier access, Amai reached a cohort of marginalized adolescent mothers and achieved high retention, program graduation, and improvements in agency and well-being within 8 months. This commentary contrasts the stalled progress of THRIVE with the rapid implementation of Amai to examine how institutional, infrastructural, and cultural factors shape the feasibility of equity-focused trials. We draw lessons for trialists working in under-resourced settings and suggest that advancing diversity, equity, and inclusion in trials requires adaptive strategies-including pragmatic designs, regional ethics collaboration, and broader outcome measures in the Caribbean. These insights contribute to emerging models of inclusive global health research and offer actionable guidance for designing trials and programs that are not only methodologically rigorous but also socially just and accessible to those most in need.

Obese Latino adolescents are disproportionately impacted by insulin resistance and type 2 diabetes. Prediabetes is an intermediate stage in the pathogenesis of type 2 diabetes and represents a critical opportunity for intervention. However, to date, no diabetes prevention studies have been conducted in obese Latino youth with prediabetes, a highly vulnerable and underserved group. Therefore, we propose a randomized-controlled trial to test the short-term (6-month) and long-term (12-month) efficacy of a culturally-grounded, lifestyle intervention, as compared to usual care, for improving glucose tolerance and reducing diabetes risk in 120 obese Latino adolescents with prediabetes. Participants will be randomized to a lifestyle intervention or usual care group. Participants in the intervention group will attend weekly nutrition and wellness sessions and physical activity sessions twice a week for six months, followed by three months of booster sessions. The overall approach of the intervention is framed within a multilevel Ecodevelopmental model that leverages community, family, peer, and individual factors during the critical transition period of adolescence. The intervention is also guided by Social Cognitive Theory and employs key behavioral modification strategies to enhance self-efficacy and foster social support for making and sustaining healthy behavior changes. We will test intervention effects on quality of life, explore the potential mediating effects of changes in body composition, total, regional, and organ fat on improving glucose tolerance and increasing insulin sensitivity, and estimate the initial incremental cost effectiveness of the intervention as compared with usual care for improving glucose tolerance. The proposed trial builds upon extant collaborations of a transdisciplinary team of investigators working in concert with local community agencies to address critical gaps in how diabetes prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution oriented programs to prevent type 2 diabetes in this and other populations of high-risk youth. NCT02615353, registered on June 8, 2016.

Classification systems like the DSM-5 and ICD-10 facilitate international comparative research on mental disorders. However, few studies have compared classification distributions in child and adolescent psychiatric settings across countries. This study explored similarities and differences in classification prevalence between German and Dutch children and adolescents referred to psychiatric facilities. Data were retrospectively collected from clinical samples of inpatients and outpatients who underwent diagnostic assessments in Germany (n = 7,089) and the Netherlands (n = 2,574), aged 0-18 years (M = 12.70; SD = 3.82). A multivariate analysis compared primary classifications between the two samples, which were further stratified into three age groups: early childhood (0-5 years), middle childhood (6-12 years), adolescence (13-18 years). The main factor influencing classification was the country. Age and sex showed moderate to low effect sizes, respectively. The impact varied across different age groups and sexes. Patients in the German sample were generally older and had a higher proportion of girls than those in the Dutch sample. Mood, anxiety, disruptive/impulsive-control and conduct, and trauma and stressor-related disorders were more prevalent in the German sample, while autism spectrum disorder and attention-deficit/hyperactivity disorder were more common in the Dutch sample. Our findings suggest that the primary classifications of mental disorders in Dutch and German children and adolescents largely depend on the country. This may have implications for cross-country comparisons and highlights the potential influence of national mental healthcare systems and cultural contexts on classification practices, which could impact policy decisions.

The International Classification of Functioning, Disability and Health (ICF) and subsequent ICF-CY (child and youth version) recognize the importance of personal and environmental factors in facilitating holistic transition planning and service delivery for youth with chronic health conditions (YCHC). The objective of this scoping review is to investigate the degree to which the ICF and ICF-CY have been used in transition research and practice since its initial publication. Arksey and O'Malley's five-stage methodological framework guided the scoping review using the following databases: AMED, CINAHL, EMBASE, HealthSTAR, MEDLINE, and PsycINFO. Keywords included: 'ICF', 'ICF-CY', and 'transition', which were adapted to each database. 25 articles met final inclusion. Two key themes emerged regarding use of the ICF: 1) the ICF enhances transdisciplinary processes to inform transition planning and interventions; and 2) the ICF facilitates comprehensive and developmentally appropriate transition services over a youth's lifecourse. The strengths and limitations of the ICF in guiding the planning and delivery of transition services are discussed. Some limitations include the large number of items inherent within the ICF and a lack of clarity between the components of activity and participation. Key recommendations include: i) further explanation and development of items for quality of life and well-being, personal factors, and psychological issues; and ii) additional research to advance knowledge towards developing empirically- based evidence for the application of the ICF in clinical practice to facilitate transition.

Eswatini has implemented national strategies to prevent child sexual abuse (CSA) since 2009, yet little is known about how prevalence patterns and help-seeking have evolved across subgroups. To assess changes in overall and type-specific CSA prevalence over 15 years, examine disparities by demographic and maltreatment history, and evaluate shifts in formal and informal help-seeking among young females. Females aged 13-24 years from the nationally representative Eswatini Violence Against Children and Youth Surveys conducted in 2007 (n = 1244) and 2022 (n = 6318) were included. Complex survey analyses and multivariable logistic regression were used to estimate CSA prevalence and temporal changes, examine subgroup differences, and identify correlates of formal and informal help-seeking. The overall CSA prevalence declined markedly over the 15-year period, from 33.6% in 2007 to 5.3% in 2022. The largest reduction was observed in the pressurized CSA, which decreased by 92.3%. The decline in the odds of CSA varied across subgroups, with the most pronounced reductions observed among females aged 18-24 years (OR = 0.15) and those with no history of emotional abuse (OR = 0.12). Physical CSA and multiple incidents predicted higher help-seeking, while intrafamilial abuse and adolescent encounter were associated with lower help-seeking. Despite substantial declines in CSA, marked disparities persist. Prevention and intervention strategies should prioritize youth abused in familial contexts and during adolescence, with efforts to expand accessible, survivor-centered formal services.

Youth depression can be prevented, yet few programs are offered. Decision makers lack cost information. This study evaluated the cost-effectiveness of a cognitive-behavioral prevention program (CBP) versus usual care. A cost-effectiveness analysis was conducted with data from a randomized controlled trial of 316 youths, ages 13-17, randomly assigned to CBP or usual care. Youths were at risk of depression because of a prior depressive disorder or subthreshold depressive symptoms, or both, and had parents with a prior or current depressive disorder. Outcomes included depression-free days (DFDs), quality-adjusted life years (QALYs), and costs. Nine months after baseline assessment, youths in CBP experienced 12 more DFDs (p=.020) and .018 more QALYs (p=.007), compared with youths in usual care, with an incremental cost-effectiveness ratio (ICER) of $24,558 per QALY. For youths whose parents were not depressed at baseline, CBP youths had 26 more DFDs (p=.001), compared with those in usual care (ICER=$10,498 per QALY). At 33 months postbaseline, youths in CBP had 40 more DFDs (p=.05) (ICER=$12,787 per QALY). At 33 months, CBP youths whose parents were not depressed at baseline had 91 more DFDs (p=.001) (ICER=$13,620 per QALY). For youths with a currently depressed parent at baseline, CBP was not significantly more effective than usual care at either 9 or 33 months, and costs were higher. CBP produced significantly better outcomes than usual care and was particularly cost-effective for youths whose parents were not depressed at baseline. Depression prevention programs could improve youths' health at a reasonable cost; services to treat depressed parents may also be warranted.