Adolescents

The aim of the current study was to investigate the relationship between school bullying and inter-peer group status among Japanese middle-school students. A total of 2294, 7th–9th grade Japanese middle-school students participated in this study. Using a self-report questionnaire, we measured their inter- and intra-peer group status, bullying behavior, victimization, coping strategy, and current victimization status. The results showed that, compared to those in the higher-status groups, students in lower-status peer groups tended to be bullied and experienced prolonged victimization. These findings suggest that a lower peer-group status predisposes students to victimization. Full article

Cyberbullying victimization (CV), a widespread experience in adolescence, is associated with increased depression and suicidality. However, few studies have taken a gender approach when investigating the association between CV and suicidality, despite research that indicates disparate experiences by gender for both CV and mental health. We conducted a secondary data analysis of the 2019 Youth Risk Behavior Survey (N = 10,309; 50.1% girls), a cross-sectional survey drawn from a representative sample of US high school students. We found that CV remained significantly associated with suicidality after controlling for emotional and behavioral risk factors, for both boys and girls. CV increased the odds of suicidality directly and indirectly by increasing risk for depression, for both boys and girls. Boys contending with both CV and sexual violence were particularly vulnerable to suicidality, and binge drinking was positively associated with CV for girls but negatively associated with CV for boys. Findings confirmed that CV is a pervasive issue among U.S. adolescents. A gendered approach is necessary in order to understand and address the effects of CV. Full article

Scoliosis is an abnormal curvature of the spine, which generally develops during childhood or adolescence. It affects 2–4 percent of the global population and is more prevalent among girls. Scoliosis is classified by its etiology: idiopathic, congenital, or neuromuscular. Among these, the former is the most common. Treatment options for scoliosis vary depending on the severity of the curve. Most scoliosis diagnoses tend to be mild and only require monitoring. However, curves between 20 and 40 degrees require bracing, while 40 degrees and above require surgery. There are various bracings available, such as Boston, Charleston, and Milwaukee. In severe cases of scoliosis, either fusion or fusionless surgery may be required. This review aims to discuss etiologies and different treatment interventions for scoliosis. Full article

Adolescence is a period between childhood and adulthood with eating habits often against the nutritional needs of adolescents. The present study used a socio-ecological approach to investigate personal and environmental factors influencing the eating habits of 15- to 19-years old Beninese urban schoolgirls. Eleven focus groups (n = 77) and seven individual interviews were conducted with adolescent girls attending school in Cotonou, Benin. Focus groups were as homogeneous as possible regarding age group and school character. Transcripts were analyzed using an inductive-deductive thematic method using the socio-ecological model. Taste preference for sweet foods, insufficient dietary knowledge and low personal income were factors explaining unhealthy food choices, while higher self-efficacy and healthy outcome expectations mainly characterized their healthy eating habits at the intrapersonal level. Family influence was beneficial for healthy eating while friends’ pressure led to an unhealthy diet at the interpersonal level. At the organizational level, adolescents reported unhealthy school food environments and urban areas increased their unhealthy eating habits. It appears that one factor alone is not enough to influence adolescent girls’ eating habits. Therefore, this study presents the need of elaborating interventions in a school context to improve eating habits in adolescents focusing on different factors in Beninese adolescent schoolgirls. Full article

Background. This study examined the effects of post-traumatic stress symptoms and child–primary caregiver relationships on the ethnic identity of Yi ethnic minority adolescents (n = 550; aged 13–18) in rural China over one school year. The moderating effect of caregivers’ relationships over time and ethnic identity, and post-traumatic stress and ethnic identity, were investigated. Methods. Participants completed two waves of the survey. Longitudinal multilevel modeling was used. Results. (1) Ethnic identity exploration increased over time, while ethnic identity commitment remained stable. (2) Post-traumatic stress symptoms led to high levels of ethnic identity exploration and commitment. (3) Participants with distinct caregivers’ relationship patterns, i.e., secured, optimal, deprived, and disengaged, differed in their ethnic identity exploration scores, but not in ethnic identity commitment. (4) While the secured group scored highest in their ethnic identity development over time, youths who felt disengaged with their caregivers showed the fastest rate of positive change in their ethnic identity exploration. (5) Having a secured caregivers’ relationship weakened the effect of post-traumatic stress on ethnic identity exploration. Conclusion. Practical implications for the meaning of ethnic identity exploration, the promoting effect of caregivers’ relationships, and the negative impact of post-traumatic stress among ethnic minority youths were discussed. Future research directions were also proposed. Full article

Background: During puberty and emerging sexuality, adolescents experience important physical, mental, and social transformations. In the process of dealing with these changes, adolescents can become potentially vulnerable to mental health problems. Aim: The aim is to identify and synthesize published research evidence on sexuality-related mental health stressors among adolescent girls and boys, identify gaps (if any) in the current knowledge, and contribute to the knowledge about the experiences of emerging sexuality and health among adolescents, to further inform research, practice, and policy initiatives in sexual health. Design: A scoping literature review of peer-reviewed articles published between 1990 and 2021. MEDLINE, CINAHL, EMBASE, PsycINFO, Global health, ERIC, and Sociological Abstracts databases were searched for research studies that reported experiences of sexuality-related mental health issues and symptomatology of adolescents. We targeted studies conducted with adolescent populations between ages 10–19 years living in LMICs. Results: Data from 12 published research papers, including 8 qualitative studies, 3 quantitative studies, and 1 mixed method study, were systematically analyzed. Four major themes and four sub-themes were identified regarding the sexual and mental health of adolescents: (1) Relationship of sexuality and mental health; (2) Social and cultural influences; (3) Challenges in seeking sexuality information and services among adolescents; and (4) Educational needs among adolescents related to sexuality. Conclusions: Lack of social support, unmet needs for accessible adolescent-friendly sexual health services, counseling, and age-appropriate information may be associated with several mental health stressors and symptoms, such as sadness, depressive and anxiety symptomatology, regret, fear, embarrassment, low self-esteem, guilt, shame, and anger. Therefore, tackling sexuality-related stressors could play an important role in addressing the overall well-being of young people. Future studies need to generate a deeper understanding of the concept of sexual health and its relation to mental health in diverse contexts. Implications for Practice: Health care professionals need to be aware of sexuality-related experiences of adolescent girls and boys by offering effective youth-friendly sexual and reproductive health education to support overall mental health and improve the experiences of emerging sexuality in adolescents. Full article

Young people (YP), defined as individuals aged between 10 and 24 years, are a vulnerable population. Leveraging digital platforms to reach YP is essential in identifying protective and risk behaviors among this population. The objectives of this study were to (1) examine the user-inclusive development process of a theory-based digital platform to reach YP, (2) describe aspects of the digital application prototype, and (3) provide preliminary findings from the utilization of the app. We present the five-step design process for building the app. The app, known as the REACH-AYA survey, consisted of 98 closed-ended questions with built-in skip-logic algorithms and took approximately 7 min to complete. The survey questions centered on behavioral, lifestyle, and psychosocial factors, which were adopted from different validated instruments, thereby addressing 10 different domains. During the pilot phase, participants utilized the app, critiqued its features, and provided iterative feedback. We used respondent-driven sampling to recruit participants in Nairobi, Kenya, the leading county in high-speed data connectivity. Once recruited, each participant completed the survey and later sent it to their peers until the desired sample size was achieved. The REACH-AYA app prototype was guided and developed by the design thinking approach with an initial pilot sample of 33 YP for pre-testing. The end-user pre-testing assessed for functionality, time, and adaptability. The app was then launched initially through social media, reaching 1101 YP, with approximately eighty percent (n = 887) having completed the survey by the close of the study. The majority of the participants were male (59%), and approximately (69%) of the participants were aged between 15 and 24 years. This is one of the few studies that demonstrate user-centric methodologies of app development and real-life application in identifying protective and risk factors for the wellbeing of YP. Methodologies and lessons learned from this research may benefit other disciplines using digital technology to reach YP or other difficult-to-reach populations. Full article

We assessed whether the coronavirus disease 2019 (COVID-19) pandemic-related disruptions impacted the physical fitness of adolescent athletes. We reviewed the age-, sex-, and sports category-matched data of 78 adolescent athletes (divided into two groups: 2019 group = 37; 2020 group = 41) from the clinical database and investigated their height, weight, body composition, flexibility muscle strength, and jump height. We also provided questionnaires to the teams’ coaches to collect data on the duration of practice suspension due to the COVID-19 pandemic; the practice hours per week in August 2019, immediately after the suspension ended, and in August 2020; and the guidelines for the players after resuming their practice. For data analyses, we considered p ≤ 0.05 as statistically significant. The strength of knee flexion and extension was significantly lower in the 2020 group than in the 2019 group; there was no difference in the other physical fitness parameters. The practice duration in August 2019 and August 2020 was the same. COVID-19-related interruptions did not alter the athletes’ jump height, upper-limb strength, and flexibility but reduced lower-limb muscle strength. We recommend that basic strength training protocols be followed to prevent sports-related injuries after such unexpected practice interruptions. Full article

The literature about the relationship between extreme BMI and at-risk behaviors is quite inconsistent, and few articles focus on the underweight male population. This study aimed to analyze BMI level and its association with risky behavior, such as psychoactive substances use, gaming, and gambling, in a representative sample of the male adolescent population. Psychosocial variables were considered to better describe the possible at-risk profiles. This study used data from the 2018 ESPAD^®Italia cross-sectional study, a survey using a self-administered anonymous questionnaire. For the purpose of the paper, males only were included in the analysis, with a total sample of 6938 students aged 15–19 years. Multinomial logistic regression showed that being overweight is positively associated with the gambler profile, the perception of a low financial family situation, and dissatisfaction with health conditions. Furthermore, being underweight was positively associated with gaming. Both extremes of BMI were associated with a frequent alcohol consumption and a sedentary lifestyle. This study provides important information regarding both extremes of BMI conditions, underling the presence of at-risk behavior and self-related perceptions with shared factors between underweight and overweight. Full article

Measures taken to contain the COVID-19 pandemic are particularly stressful for families. Limited data is available regarding the effects of a mandatory quarantine on the psychological stress of children, adolescents and their parents. Quarantined individuals participating in the online-based CoCo-Fakt study had at least one child <3, 3 to <6, 6 to <10, 10 to <14 and 14 to <16 years old (n = 2153). Parents were asked about how often their children felt nervous, anxious, or tense, down or depressed, lonely or physical reactions occur. A relative sum score characterizing psychosocial stress was determined and related to parents’ socio-demographic factors, psychosocial distress, coping strategies and resilience. Parents reported significantly higher psychological stress if at least one child was quarantined. Parents’ relative psychological stress sum score had the strongest influence on the psychological state of the children across all age groups (β = 0.315–0.457) besides male sex of the reporting parent, no partnership, low to medium socioeconomic status, lower resilience and coping scores, and parents quarantined as close contacts. The variance in the linear regression models was between 17.8% and 31.4%. These findings highlight that the entire family system must be considered during official mandatory quarantines. Full article

Background: In the U.S., research to identify the risk factors explaining high rates of adolescent pregnancy disproportionately affecting racial/ethnic minorities, including Latinas, have largely focused on social and cultural factors that influence girls’ pregnancy intentions and decisions regarding the use of contraception, as well as girls’ sexual and reproductive decision-making control in relationships. However, economic factors may play a role in increasing girls’ risk for adolescent pregnancy as well. Disproportionately high rates of adolescent pregnancy occur in areas of concentrated poverty, with higher rates among ethnic minorities. This qualitative study used a descriptive, exploratory design with a content analysis approach (1) to describe economic vulnerability in girls’ lives and (2) to identify potential ways in which economic vulnerability may influence risk factors for adolescent pregnancy among adolescent females at high risk for pregnancy recruited from a health clinic by the U.S.–Mexico border in California. Methods: Qualitative in-depth interviews were conducted among 21 girls reporting risk factors for pregnancy (including a previous pregnancy, experiences of dating violence, or having ever been diagnosed with an STI) and who were seeking sexual/reproductive health services at a clinic near the U.S.–Mexico border in California. Participants were asked about their family life, economic stressors, characteristics of intimate partner relationships, and future education/career aspirations. Interviews were analyzed using content analysis to identify common themes related to economic vulnerability and risk for pregnancy. Results: Female participants were 17 years of age on average, most (72%) were Latina, and over half (60%) were in a relationship. Participants reported a high level of economic vulnerability at home, which they felt compromised their welfare, negatively affected expectations for future educational goals, and promoted financial dependence for basic needs (e.g., food) on male partners. The latter often compromised girls’ decision-making control with relationship partners over contraceptive use and pregnancy timing. Conclusions: Study findings suggest that economic vulnerability: (a) supports economic reliance on male partners, with implications for male partner control over pregnancy decisions and (b) hinders girls’ expectations for future educational opportunities, which may reduce girls’ prioritization to delay pregnancy. Full article

Adolescents who break the law or deviate from social norms are often criminalized as their behavior is perceived as resulting from conscious choices. However, it is likely that such choices result from their circumstances, namely the failure of their proximal environment to safeguard their wellbeing. The purpose of this study was to gain an in-depth understanding of the background variables and choices that led these institutionalized adolescents down the road of deviance. We conducted a qualitative study using semi-structured in-depth interviews, conducted between March and May 2018, with 18 participants aged between 15 to 19 years. Participants were purposefully sampled from various welfare institutions in the states of Kuala Lumpur and Selangor, Malaysia. Audio recordings of interviews were transcribed verbatim and analyzed thematically. We found three core themes, (i) Sources of Distress, (ii) Drivers of Deviance, and (iii) Adjustment Strategies for Coping with Distress, which appeared to have influenced participants’ life trajectories and eventual institutionalization. The findings showed that participants were disadvantaged by backgrounds of risk and vulnerability, characterized by a lack of social support and opportunities for personal development, negative schooling experiences, and negative peer interactions. Substance abuse, which provided a coping strategy for the participants, may have further contributed to their delinquency. Drawing upon the socio ecological model (SEM), we systematically identify interventional opportunities at the individual, community, and policy levels to safeguard the wellbeing of at-risk adolescents. We make recommendations aimed at improving the family dynamics, promoting a healthy schooling experience, and transforming neighborhoods into a safe and nurturing environment. Full article

Although socioeconomic status (SES) may affect children’s urinary electrolytic excretion and dietary intakes, few studies have reported the association between SES and urinary sodium (Na)-to-potassium (K) ratio in Japanese adolescents and children. Therefore, this study aimed to investigate the association between SES and urinary Na/K ratio (Analysis 1) and between dietary intake and urinary Na/K ratio to determine the SES effects in children and adolescents (Analysis 2). This cross-sectional study included 168 Japanese male adolescent and child football players. The urinary Na/K ratio was calculated from three spot urinary electrolyte values. Multiple regression analysis was performed in both first and second analyses to assess the associations between SES and the urinary Na/K ratio and between dietary intake and the urinary Na/K ratio for ages 9–12 and 13–15 years separately. The mean urinary Na/K ratio was 4.8, with higher SES associated with a lower urinary Na/K ratio. Our results suggested that urinary Na/K ratios in Japanese child football players were high due to poor childhood diets, and higher SES was associated with lower urinary Na/K ratios. Further, milk and dairy products are associated with the urinary Na/K ratio, independent of SES in children and adolescents. Full article

Background: Bearing in mind that the characteristics of the family system have a significant influence on the positive development of adolescents and considering that there are different measuring instruments, the main objective of this work is to review studies on the instruments for evaluating the family context, to determine which instruments are validated or adapted by researchers between 2010 and 2020 and which variables in the family context are valued during the adolescent stage. Methods: The academic search engines consulted have been Scopus, Redalyc and Web of Science. Following the criteria contemplated in the PRISMA Declaration, once duplicates were eliminated, a total of 101 studies were identified. A critical reading of the titles, summaries and a large part of the complete articles was carried out, and 56 studies were excluded. Finally, a systematic review of 45 studies that contrasted the psychometric properties of self-report measures (questionnaires, inventories, scales), between original papers and adaptations was carried out. Results: The results obtained reveal that the instruments measure different aspects of the family system: the family dynamics (variables such as parental competence, resilience, social support, parenting style and practices of leisure and free time); family functioning (variables such as problem solving, communication, roles, affective response capacity, affective participation, behavior control, cohesion, adaptability and family satisfaction); family adjustment (variables referring to parental stress, parental conflict, family health and family protection; and the parent–child relationships (variables such as quality, family effectiveness, family atmosphere and attachment). Conclusions: The most used psychological tests are: Parental Bonding Instrument, Family Assessment Resources, Social Support Scale, Parental Stress Index and Scale of Adaptation, Participation, Gain, Affection and Resources. Parental Bonding Instrument shows excellent psychometric properties. The rest of the self-report measures present acceptable reliability indices. The psychometric properties of some Family Assessment Resources, Social Systems Assessment Scale and Protective Factors Survey scales are more questionable, so new validation studies of these instruments are required. Affect (quality of relationships, manifestation, attachment bond), communication between members of the family group and parental control (behavioral and psychological) have been the main dimensions of the family context studied in adolescence. Along with these variables, others have been incorporated, such as parental resilience, family leisure and free time routines, family health or family strengths and weaknesses. The related instruments used in different psychological and cultural environments may help us to better understand the educational and parenting practices based on family dynamics, functioning, adjustment and parent–child relationships. Full article

Background: Medically ill youth are at increased suicide risk, necessitating early detection. This study aimed to assess the feasibility of administering the Death Implicit Association Test (Death IAT) to pediatric medical inpatients. Methods: Participants completed measures including the Ask Suicide-Screening Questions (ASQ) and the Death IAT. Results: Over 90% of participants found the Death IAT to be acceptable and more than 75% of participants were comfortable completing the task. There was a small, but statistically significant, improvement from pre-survey to post-survey reports of mood (t(174) = 3.02, p = 0.003, d = 0.15). Participants who endorsed a past suicide attempt on the ASQ had significantly higher “suicide” trial D-scores than those without a past suicide attempt (Wilcoxon W = 1312; p = 0.048; d = 0.61). Conclusions: Implementing an IAT measure among pediatric medical inpatients was feasible and acceptable. In exploratory analyses, “suicide” trial IAT D-scores were associated with past suicide attempts, suggesting future studies should examine whether implicit measures may be useful in hospital settings to augment detection of youth suicide risk. Full article

Social capital, namely civic engagement, adult support, and community support, shapes behaviors in meaningful ways, yet the literature examining the relationship between social capital and sexual risk behaviors and HIV testing among youth remains limited. This study examined the influence of social capital on sexual risk behaviors (i.e., unprotected sex, multiple sex partners, and being drunk or high prior to sex) and HIV testing among youth. A total of 200 primarily ethnic minority youth (mean age of 17.4 years) in Denver, Colorado were included in the study. Structural equation modeling findings indicate that higher levels of social capital were associated with unprotected sex and less HIV testing. Additionally, the association between social capital and sex with multiple partners was mediated by sex refusal self-efficacy. Youth may benefit from social capital, but it may not have the same protective or health-promotive value for youth as for adults. Full article

Background: Adolescent inpatients with substance use disorder (SUD) and a history of child maltreatment (CM) present a vulnerable population at considerable risk of poor health and social outcomes. The aims of this study were to explore the proportion of adolescent inpatients with SUD and a history of CM and to compare these patients to inpatients with SUD and no history of CM. Methods: In this retrospective chart review, we explored adolescent patients who were consecutively admitted to a regional child and adolescent inpatient unit for psychiatric care and met DSM (5th ed) criteria for SUD. A standardized form was created and used to extract clinical information and psychosocial histories. Results: From 1 September 2019 to 28 February 2020, 126 adolescents were admitted with SUD, and for 80 (63.3%) patients, a history of CM was recorded in the medical charts. Patients with a history of CM were significantly more likely to be female (p = 0.02), have longer lengths of stay (p = 0.04), to be readmitted (p = 0.03), be diagnosed with trauma/stress-related (p = 0.04) and eating disorders (p = 0.05), to have a parent with a mental illness (p = 0.01), experienced physical (p < 0.01) and sexual (p < 0.01) assaults and homelessness (p < 0.01), and to engage in self-harming behaviors (p < 0.01) than inpatients with SUD but no history of CM. Conclusions: Almost two-thirds of adolescent inpatients with an SUD reported a history of CM. Addressing their specific clinical and psychosocial vulnerabilities through comprehensive treatment and discharge plans may reduce readmission and improve quality of life. Full article

Teen dating violence is a serious problem and intervention programs aimed at reducing this violence and helping adolescents to develop healthier romantic relationships are needed. The objective of this study was to assess the effects of the DARSI program on the development of a more adequate perception of love, the reduction of tolerance toward abuse in romantic relationships, and the reduction of the perpetration of dating violence in adolescents. The sample consisted of 129 adolescents, aged 12 to 17 years (M = 14.05, SD = 1.08). A repeated measures (pre-test and post-test) quasi-experimental design with an intervention group and a control group was used to assess the effects of the program. The results showed significant decreases in unhealthy perceptions of love (linking love with control and dependence), tolerance toward abuse in romantic relationships, and dating violence perpetration in the intervention group. Healthier perceptions of love (linking love with respect and communication) were observed in the intervention group after the implementation of this program. These findings support the implementation in educational contexts of programs focused on the development of non-violent and healthy romantic relationships in adolescents. Full article