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The impact of childhood exposure to parental smoking on epigenetic age acceleration (EAA) in later life has not been thoroughly investigated. This study investigates the relationship while considering genetic susceptibility to smoking. We analyzed data from 3102 participants in the Health and Retirement Study (HRS) who also participated in the 2016 Venous Blood Study and the 2015–2017 Life History Mail Survey. Self-reported measures included childhood parental smoking exposure and smoking status in late adulthood. We utilized five epigenetic clocks—HorvathAA, HannumAA, GrimAA, PhenoAA, and DunedinAA—and assessed genetic susceptibility with a polygenic risk score (PRS) for smoking initiation, categorized into tertiles. We regressed the clocks against chronological age to derive EAA residuals. Associations between childhood exposure and EAA were examined in the overall sample and by PRS tertiles, stratified by race. The model controlled for age, sex, education, smoking, alcohol consumption, body mass index, and CESD scores. Significant associations were found between childhood exposure to parental smoking and the EAA measured by GrimAA (β = 0.98; p < 0.001) and DunedinAA (β = 0.01; p = 0.002) among White participants, with stronger effects in those with a high PRS. Similar patterns were observed in Black participants, highlighting the importance of preventing secondhand smoke exposure in children. Full article

During the COVID-19 pandemic, the New Jersey Safe Schools Program (NJSS) surveyed a subset of newer NJ high school (HS) teachers who completed NJSS work-based learning supervisory trainings from October 2021 to June 2023. The purpose of this study was to gain insight on NJ HS teacher perceptions of school provided mental health services, and well-being supports received during the COVID-19 pandemic. Via online surveys, teachers anonymously identified who should be responsible for supporting mental well-being in schools, satisfaction with existing mental health services, and self-care practices implemented during the COVID-19 pandemic. Of the 114 HS teachers surveyed, nearly 70% would recommend existing school mental health services to colleagues, 53% would like an increase in mental health and counseling services available at their school, and 44% would like their schools to improve mental health literacy. This study presents insight into the needs teachers expressed for appropriate school mental health support and services. Data will inform guidance for how to better address identified needs, including employee wellness, and creating positive social and emotional school environments. School districts should prioritize the implementation of suitable and equitable school-based mental health services to teachers and students alike to promote healthy and productive school environments. Full article

Background: While both high birth weight and childhood overweight/obesity have been associated with a heightened risk of high blood pressure (BP) during childhood, the association between weight status change from birth to childhood and the risk of high BP has not been fully explored. This study aimed to investigate how changes in weight status from birth to childhood influence the development of high BP in childhood. Methods: The data for this study were obtained from the baseline survey of the Huantai Childhood Cardiovascular Health Cohort Study, which included 1237 children aged 6 to 11. Children with a birth weight under 2500 g or a body mass index (BMI) below the fifth percentile for their age and sex during childhood were excluded. Based on birth weight (high birth weight [>4000 g] vs. healthy [≤4000 g]) and childhood weight status (overweight [including obesity] vs. healthy weight), participants were categorized into four groups: consistently healthy weight, weight decrease, weight increase, and consistently excess weight. Results: Compared to children who maintained a healthy weight from birth to childhood, higher odds of childhood high BP was observed among those with consistently excess weight (odds ratio [OR] = 2.73, 95% confidence interval [CI] = 1.46–5.12) and those with a weight increase (OR = 2.77, 95% CI = 1.91–4.02). In contrast, children with a weight decrease did not exhibit significantly higher odds of childhood high BP (OR = 0.94, 95% CI = 0.36–2.45). Conclusion: Children who become overweight in childhood or who consistently had excess weight from birth were at higher risk of childhood high BP. However, the risk of high BP in childhood may be mitigated or eliminated in individuals with high birth weight who achieve a healthy weight by childhood. Full article

Background: Previous studies reported screen time in association with unhealthy dietary behaviors, such as excessive intake of sugar-sweetened beverages leading to dental caries. Thus, we aimed to explore the association between screen time on mobile devices and dental caries experience in adolescents, as well as whether sugar-sweetened beverages would mediate the association. Methods: We analyzed 24,374 junior and senior high school students of age 12 to 17 years from the 2021 “Surveillance for common diseases and health risk factors among students” Project in Jiangsu Province of China. Dental caries experience was determined by the designated dentists. Screen time and consumption of sugar-sweetened beverages were self-reported and treated as a priori risk. We employed an instrumental variable (IV) approach for the current cross-sectional setting. We used the lasso technique to shortlist covariates from a range of confounding factors. Binary logistic regression or ordered logistic regression was performed where appropriate to explore the associations of screen time on mobile devices with dental caries and sugar-sweetened beverages. Results: The prevalence rate of dental caries was 38.4% in the study population. In comparison with <2 h/d screen time on mobile devices, extended screen time (≥2 h/d) was associated with higher dental caries risk (coefficient: 1.27, 95%; confidence interval: 0.80–1.75). Mediation analysis suggested that sugar-sweetened beverage intake might be an independent risk factor for dental caries, instead of the mediator between screen time on mobile devices and dental caries. None of the interaction terms under investigation was statistically significant. Conclusions: Exposure to mobile device screens and sugar-sweetened beverages was associated with dental caries in adolescents. These findings highlighted the importance of increasing awareness of potential risks owing to mobile device usage and sugar-sweetened beverages and the necessity to develop appropriate intervention strategies for school-aged adolescents. Full article

Research demonstrates that overcoming school violence is crucial for ensuring a safe environment and quality education for all students. The scientific literature shows that educators can significantly impact school violence, but their effectiveness hinges on the quality of their training. Therefore, identifying the most effective training types is essential. This literature review aims to identify and synthesize the characteristics of teacher-training programs that have effectively reduced school violence. Inclusion criteria were studies focusing on interventions to reduce school violence, with either quantitative or qualitative outcomes. Exclusion criteria were studies not specifically addressing school violence or lacking evaluative measures. Data sources included Web of Science, EBSCO Host, Medline, Scielo, and Scopus, with searches conducted in December 2023. From an initial pool of 2128 articles, 13 studies were included. The results, synthesized through narrative analysis, reveal the key features of teacher-training programs that effectively address school violence, including the nature of the training, the content covered, and the social impact achieved. Full article

Obstetric trauma refers to injuries that occur to the newborn during the birth process and can occur despite proper perinatal care. Limiting risk factors could reduce its incidence and avoid significant morbidity and mortality to the infant. The aim of our study was to determine the incidence of birth injury in our setting and to discover its associated risks factors. For this case–control study, all births that took place in our center during the year 2021 were systematically reviewed. A total of 231 full-term newborns, with 77 cases and 154 controls, were included. For each case, two controls of similar sex and gestational age, born during the same shift before and after the case were selected. Preterm infants, outborn patients, twins, and infants with major congenital anomalies were excluded. The incidence of birth injury was 22.8‰ of singleton births. The most frequent injuries were cephalohematoma, peripheral facial paralysis, and clavicle fracture. After the adjusted logistic regression analysis, the variables that were independently associated with obstetric trauma were (aOR; 95% CI) breech presentation: 10.6 (1.2, 92.6), p = 0.032; dystocia: 7.8 (3.8, 16.2), p < 0.001; forceps instrumentation: 3.1 (1.0, 9.1), p = 0.043; induced labor: 3.0 (1.6, 5.5), p < 0.001; and newborn birthweight (per each 100 g): 1.1 (1.0, 1.2), p = 0.004. In conclusion, the incidence of birth trauma in our setting was 22.8‰ of singletons. The most frequent injuries were cephalohematoma, peripheral facial paralysis, and clavicle fracture. There was an independent association between birth trauma and breech presentation, dystocia, forceps instrumentation, labor induction, and infant birthweight. Full article

Background: Puberty is a life milestone that marks the transition from childhood to adulthood. An ambispective Chongqing Pubertal Timing (CQPT) cohort was started in 2014 to understand pubertal timing and identify environmental risk factors. Methods: A total of 1429 children and adolescents were recruited and have been followed up once every 6 months for 8 years in a district of Chongqing, China. Data were collected via questionnaires for social and family environment, health conditions, gestational and maternal information, and in-person physical examinations by trained medical school graduate students in follow-ups. Environmental exposures of polycyclic aromatic hydrocarbons (PAHs), neonicotinoids, and heavy metals in urine samples were measured at different time points. Results: The mean ages at pubertal onset were 10.20 for thelarche, 11.62 for pubic hair development, and 11.84 for menarche in girls, and 11.16 for genital development, 11.66 for testicular enlargement, and 12.71 for first spermatorrhea in boys. Four OH-PAHs were associated with delayed timing of menarche, thelarche, pubic hair, and axillary hair development in girls, and thiacloprid was found to potentially impact genital stages in boys and axillary hair development in girls. Conclusions: We built a cohort to provide evidence of regional pubertal timing of boys and girls and the significant environmental factors. Further health outcomes, especially mental health and women’s health and its long-term health implications, will be followed. Full article

The characteristics of the school environment can influence students’ participation. Therefore, exploring the existing barriers to school participation and academic success of students with chronic conditions (CCs) is essential since they are a population at an increased risk for impairments and difficulties in these areas. This specific study aimed to explore the personal and school-environment variables associated with the school participation of students with CCs. Additionally, it aimed to analyze the differences between (1) male and female adolescents concerning the impact of CCs on school participation and the personal and school-environment variables; and (2) adolescents with and without school participation affected by the existing CCs regarding personal and school-environment variables. This work included 1442 adolescents with CCs, 56.3% female (n = 769), with a mean age of 15.17 years (SD = 2.33), participating in the Health Behavior in School-Aged Children (HBSC) 2022 study. The results showed that girls and students with school participation affected by CCs are at greater risk regarding the personal and school-environment variables under study. In the multivariable logistic regression analysis of the association between these variables and the school participation of students with CCs, a greater weight of personal variables was observed, followed by those of the school environment related to interpersonal relationships and, finally, the physical environment and safety-at-school variables. The study highlights the relevance of considering the existing barriers to school participation and academic success of students with CCs. The results also underline the importance of aligning the intervention of health and education professionals and policymakers. All of these professionals must make a joint effort to overcome existing barriers in the school context and move towards an increasingly balanced environment that promotes and protects the equal participation of all students. Full article

Background: In Portugal, teachers have constantly sought better working conditions in order to improve their mental health, which can result in demotivation and personal and professional exhaustion. Methods: A total of 1454 national public school teachers participated in this study, 17.4% (n = 253) male, aged between 22 and 66 years old (M = 51.4, SD = 7.5). The instrument used included questions concerning sociodemographic data (gender, years of teaching experience, age, length of service), a life satisfaction scale, WHO-5/quality of life perception, the physical and psychological symptoms scale-HBSC, depression, stress, and the anxiety scale-DASS-21. It also included questions about the school environment: relationship with the principal, and school atmosphere. Results: Four groups of teachers were created for the statistical analyses: No Life Satisfied/No Symptoms; Life Satisfied/No Symptoms; No Life Satisfied/With Symptoms; and Life Satisfied/With Symptoms. The results revealed that male teachers showed higher percentages for the following groups: No Life Satisfied/No Symptoms (χ² = 17.223(3), p ≤ 0.001, 20.2%), Life Satisfied/No Symptoms (χ² = 17.223(3), p ≤ 0.001, 43.3%) and No Life Satisfied/With Symptoms (χ² = 17.223(3), p ≤ 0.001, 23.9%). Conclusions: The results made it possible to identify a profile of teachers who are more likely to develop mental health problems and psychological distress: those who have lower perceived life satisfaction and more psychological symptoms, which are associated with a low perception of quality of life, a worse relationship with principals and a worse perception of the quality of the school environment; this situation seems to be even worse among female teachers. Full article

School violence is a social problem that has an impact on the psychological well-being of adolescents. One of the least identified roles within school violence is that of bystander, which refers to students who witness acts of violence perpetrated by their peers in the school environment. Current scientific evidence determines that young people with high self-esteem and resilience tend to have better mental health. The aim of this research is to identify the role of being a bystander of school violence on self-esteem and resilience in this crucial developmental stage of adolescence. The sample is composed of a total of 730 adolescents aged between 14 and 19 years. The results obtained indicate that young people who perceive themselves as non-bystanders of school violence show higher levels of self-esteem. As for the differences according to sex, it was found that non-bystander boys have greater resilience and self-esteem compared to girls. There are negative correlations between a healthy lifestyle and stress, but positive correlations between healthy lifestyle and self-esteem. In addition, we wanted to investigate the likelihood that observant adolescents intervene to help their peers. The results show that resilience acts as a protective factor that encourages such intervention, while self-esteem would be a risk factor. These findings highlight the importance of promoting resilience and self-esteem in school settings to improve peer relationships and foster healthy youth development. Full article

Clinical trials of chronic kidney disease (CKD) in children have important implications for the early identification and management of CKD. The selection of clinical trial outcomes is critical for assessing the effectiveness of interventions in pediatric CKD clinical trials. This review systematically examines the spectrum of outcome measures deployed in pediatric CKD clinical trials, which includes clinical and alternative outcomes, patient-reported outcome measures (PROMs), and safety indicators. Alternative outcome measures were stratified into four levels of evidence strength: convincing, probable, suggestive, and inconclusive. Consequently, the selection of outcome measures for pediatric CKD clinical trials mandates careful consideration of both their methodological feasibility and the robustness of their evidence base. Moreover, the burgeoning field of PROMs warrants integration into the design of future pediatric clinical trials to enrich the relevance and impact of research findings. Full article

Children with spinal muscular atrophy (SMA) are now living longer as a result of advancements in pharmaceutical and medical interventions. There is a paucity of research regarding therapeutic interventions to support this population to be independent and participate in life activities that are most important to them. The aim of this case report is to explore the use of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach to support a child with SMA type 1 to achieve their functional and participation goals. This is a retrospective case study. A 7-year-old girl with SMA type 1 received ten 1 h sessions of CO-OP, weekly in the home and community settings with a physiotherapist. Clinically meaningful improvements were found in goal performance and satisfaction on the Canadian Occupational Performance Measure (COPM) and Performance Quality Rating Scale (PQRS). Despite the progressive nature of SMA, the CO-OP approach was able to support goal attainment. Given medical advances are leading to a longer life span for children with neuromuscular conditions, further research is needed to investigate the efficacy of functional and participation-based interventions, including impact on quality of life and self-efficacy. Full article

This study explores the feasibility of large language models (LLMs) like ChatGPT and Bard as virtual participants in health-related research interviews. The goal is to assess whether these models can function as a “collective knowledge platform” by processing extensive datasets. Framed as a “proof of concept”, the research involved 20 interviews with both ChatGPT and Bard, portraying personas based on parents of adolescents. The interviews focused on physician–patient–parent confidentiality issues across fictional cases covering alcohol intoxication, STDs, ultrasound without parental knowledge, and mental health. Conducted in Dutch, the interviews underwent independent coding and comparison with human responses. The analysis identified four primary themes—privacy, trust, responsibility, and etiology—from both AI models and human-based interviews. While the main concepts aligned, nuanced differences in emphasis and interpretation were observed. Bard exhibited less interpersonal variation compared to ChatGPT and human respondents. Notably, AI personas prioritized privacy and age more than human parents. Recognizing disparities between AI and human interviews, researchers must adapt methodologies and refine AI models for improved accuracy and consistency. This research initiates discussions on the evolving role of generative AI in research, opening avenues for further exploration. Full article

Knee and foot deformities refer to structural abnormalities in the knee and foot bones, joints, ligaments, or muscles. Various factors, including genetics, injury, disease, or excessive use, can cause these deformities. These musculoskeletal conditions can significantly impact individuals’ quality of life. This study examined foot and knee deformities in 231 young healthy adults (165 men, 66 women) aged 22.6 ± 4.9 years and their association with physical activity and body composition. The postural assessment was performed by two Physiotherapists, with the subject standing in three views: side, anterior, and posterior. Physical activity (Baecke’s Habitual Physical Activity Questionnaire) and body composition (InBody 770) were assessed. Results showed that the most common foot deformity was pes planus, while the genu recurvatum was the most common knee deformity among the individuals. Physical activity level was negatively associated with knee and foot deformities. Conversely, body composition differed with the presence of genu recurvatum. These findings present a starting point to understand the occurrence of knee and foot postural alterations according to the individuals’ body composition and physical activity profiles, which could support the deployment of tailored interventions among healthy adults. In addition, early detection of postural changes is crucial in mitigating their negative long-term impact on physical well-being. Full article

Background: School bullying is a global problem. Although previous studies showed rural adolescents were at higher risk of being bullied compared to their urban counterparts, the rural–urban differences in the risk of bullying or poly-bullying victimization in relation with different characteristics and the joint association of internet addiction and depressive symptoms with the observed urban–rural disparities are unclear. Objective: We aim to investigate the rural–urban differences in bullying or poly-bullying victimization among adolescents and whether the observed rural–urban differences are associated specifically with internet addiction or depression. Methods: This cross-sectional study considered a total of 25,377 Grade 7 to 12 adolescents from the ‘Surveillance for Common Disease and Health Risk Factors among Students’ project implemented in Jiangsu Province in 2019. Rurality of residence was ascertained via the Regulation of Statistical Classification. We used Poisson regression to estimate the age–sex adjusted rate ratios (RRs) and 95% confidence interval (CI) for bullying and poly-bullying victimization. Results: Approximately 20.26% (95%CI: 16.11–25.47%) and 7.67% (5.48–10.74%) rural adolescents experienced bullying and poly-bullying, in comparison with 16.50% (12.65–21.52%) and 5.81% (4.34–7.78%) urban adolescents, respectively. Rural adolescents had 14% and 23% higher rates of bullying victimization (RR: 1.14, 95%CI: 1.03–1.26) and poly-victimization (RR: 1.23, 95%CI: 1.05–1.44) than their urban counterparts. When further controlled for internet addiction, the observed rural–urban disparities increased among adolescents with depressive symptoms, whereas diminished among those without depressive symptoms. Full article

Many studies have identified that adverse childhood experiences (ACEs) are associated with non-suicidal self-injury (NSSI) and suicidality. However, most studies have been restricted to a few types of ACEs. This study aims to investigate the association of 13 common types of ACEs with NSSI, suicidal ideation (SI), and suicide attempts (SA), as well as the mediation of depressive and anxiety symptoms therein. A total of 1771 (994 male, 777 female) students aged 11–16 (12.9 ± 0.6) years who participated in the baseline survey of the Chinese Adolescent Health Growth Cohort study were included in the analysis. ACEs, including childhood maltreatment, other common forms of ACEs, and smoking, were measured via the Chinese version of the Child Trauma Questionnaire (CTQ) and a series of valid questionnaires that were derived from previous studies. NSSI was measured using the Chinese version of the Functional Assessment of Self-mutilation. SI and SA were measured using questions derived from the Global School Based Student Health Survey. Depressive symptoms were measured via the Chinese version of the Center for Epidemiologic Studies Depression Scale, and anxiety symptoms were measured via the General Anxiety Disorder-7. Of the included participants, 92.0% reported one or more category of ACEs. Smoking, parent–child separation, emotional abuse, physical abuse, and being bullied were positively associated with NSSI; smoking, parent–child separation, emotional abuse, physical abuse, emotional neglect, and being bullied were positively associated with SI; smoking, emotional abuse, and being bullied were positively associated with SA. The associations of ACEs with NSSI, SI, and SA were each partially or completely mediated through depressive and anxiety symptoms. Children and adolescents who had experiences of smoking, physical abuse, and being bullied during childhood are consistently and independently associated with NSSI and suicidality, and these associations may be largely mediated through depressive and anxiety symptoms. In conclusion, not all the types of ACEs are independently associated with NSSI, and suicidality and other associations may mediate through depressive and anxiety symptoms. Target interventions for adolescents’ NSSI and suicidality should focus on those who have a history of ACEs and depressive and anxiety symptoms. Full article

Objective: To describe the secular trends of cause-specific mortality among adolescents aged 10 to 24 years from 2004 to 2019 and explore the association between mortality and economic status, education level as well as health investment. Methods: Mortality data of adolescents aged 10 to 24 years were obtained from the national disease surveillance points system. The age-standardized mortality rate (ASMR) was calculated by using the population data from the sixth national population census in 2010. GDP per capita, urbanization rate, illiteracy rate of the population over 15 years old, government education expenditure per capita, number of health service providers per 1000 people, and number of health beds per 1000 people were collected from China’s Economic and Social Big Data Research Platform. Age-period-cohort analysis was used to analyse the net age, period, and cohort effects of mortality among adolescents, while panel data regression was used to explore the association between mortality and economic status, education level as well as health investment. Results: Overall, the ASMR was 28.84 per 100,000 and the top five causes of mortality were road injuries, drowning, intentional self-harm and sequelae, leukaemia, and falls among adolescents aged 10 to 24 years in China in 2019. All-cause mortality declined with an annual percentage change of 4.02% (95% Confidence interval: 3.74% to 4.30%) from 2004 to 2019 yet with persistent differences across different demographic (gender and age) and geographical (urban-rural, and regional) subgroups. Notably, the ASMR for HIV/AIDS in males, lower respiratory infections in urban adolescents, and iron deficiency anaemia as well as cervical cancer in adolescents aged 20 to 24 years showed an increase over time. The multivariate panel data regression showed that the ASMR decreased by 5.18 (3.27, 7.08) per 100,000 for every increase in the number of health beds per 1000 population, but with insignificant association with GDP per capita and illiteracy rate in the total sample. Health beds investment was positively associated with ASMR at almost all subgroups except for adolescents aged 10 to 14 years; GDP per capita increase was helpful to males and rural adolescents while an increasing literacy rate was beneficial for females and adolescents aged 15 to 19 years. Conclusion: Given the persistent differences between subgroups, further investments including improving health services, especially increasing health bed investment, GDP per capita, and reducing the illiteracy rate and concern for adolescents in males, rural areas, the western regions, and aged 15 to 24 years are needed. Additionally, the increased burden of some diseases, such as HIV/AIDS, must be of further concern. Full article

(1) Background: Previous studies have shown that stress increases the risk of bullying (including perpetration and victimization) in adolescents, and depressive symptoms are associated with both stress and bullying. However, the relationship between stress, depressive symptoms, and bullying has not been fully elucidated. In addition, previous studies have focused only on stressors but have ignored the role of resilience in evaluating individual’s stress. This study aimed to incorporate resilience into the assessment of an individual’s stress, which we named comprehensive stress; to examine the relationship between comprehensive stress and bullying; and then to investigate the potential role of depressive symptoms in this relationship. (2) Methods: We recruited 6353 middle and high school students from the 2021 Shanghai CDC Youth Risk Behavior Surveillance Project. After signing informed consent, participants provided demographic information and completed effective measures of stressors, resilience, depressive symptoms, and bullying. (3) Results: Latent profile analysis revealed four profiles of comprehensive stress, labeled as Low stressor–High resilience (37.57%, n = 2216), Moderate high stressor–Average resilience (14.38%, n = 848), Average stressor–Moderate low resilience (33.33%, n = 1966), and High stressor–Low resilience (14.72%, n = 868). In comparison to students in the Low stressor–High resilience profile, students in other profiles demonstrated higher likelihoods of engaging in bullying victimization and perpetration, as well as higher levels of depressive symptoms. Specifically, students in the High stressor–Low resilience profile had the highest odds of bullying victimization (OR = 6.74, 95% CI: 4.92–9.22) and perpetration (OR = 5.15, 95% CI: 3.56–7.46), along with the highest level of depressive symptoms (β = 11.35, Se(β) = 0.17). Students in the Average stressor–Moderate low resilience profile had a moderate increase in the odds of bullying victimization (OR = 2.21, 95% CI: 1.63–3.00) and perpetration (OR = 2.69, 95% CI: 1.91–3.80), as well as a moderate level of depressive symptoms (β = 5.03, Se(β) = 0.13). Students in the Moderate high stressor–Average resilience profile also showed increased odds of bullying victimization (OR = 2.99, 95% CI: 2.12–4.20) and perpetration (OR = 2.80, 95% CI: 1.88–4.20), as well as a moderate level of depressive symptoms (β = 4.44, Se(β) = 0.16). Depressive symptoms were positively correlated with both perpetration and victimization. Furthermore, the mediating role of depressive symptoms between comprehensive stress and bullying was observed. (4) Conclusions: Combining stressors and resilience is crucial when evaluating an individual’s stress. Comprehensive stress is associated with bullying, and depressive symptoms may partially mediate this relationship. Full article

The sexual health of young people during the youth age period is of utmost importance, as it sets the stage for sexual well-being over the life course. In addition to the existing challenges that youth face concerning their sexual health, electronic cigarettes may also negatively impact their sexual well-being. Specifically, through issues such as stuttering priapism, reduced sperm quality and quantity, and erectile dysfunction. Electronic cigarette use among youth is prevalent. Therefore, given the negative sexual health impacts associated with electronic cigarette use, coupled with the prevalent use of electronic cigarettes, it is necessary for youth to receive adequate support and guidance, so they understand the potential impacts that electronic cigarette use can have on their sexual well-being. Urologists are uniquely situated to play an important role in supporting the sexual health of youth, given their medical and surgical knowledge, however, it appears that they do not receive adequate training to carry out discussions about sexual health with youth. This paper aims to support urologists to have discussions with youth patients on the impact that electronic cigarettes have on their sexual health through a proposed four-step framework. This four-step framework involves: (i) establishing the relationship, (ii) assessing current electronic cigarette use, (iii) sharing research examining the impact of electronic cigarettes on sexual health, and (iv) discussing strategies to prevent/reduce or stop electronic cigarette use. It is necessary to acknowledge that this framework is only a small component of efforts to educate youth on the impacts that electronic cigarettes have on their sexual health. Moving forward, implementation and evaluation of this framework is needed. Full article