Search Results (1,081)

Background/Objectives: The rising prevalence of mental health disorders among adolescents underscores the need for early intervention. Of concern is the increasing consumption of sugar-sweetened beverages (SSBs) and high-caffeine drinks, which may adversely affect adolescent mental health. This study examined their association with stress perception, depressive symptoms, suicidal ideation, and loneliness among Korean adolescents. Methods: Data were derived from the 2022 Korea Youth Risk Behavior Survey, a nationally representative dataset comprising 51,850 Korean adolescents aged 12–18 years. Beverage consumption frequency was categorized into three groups: none, 1–4 times per week, and ≥5–6 times per week. Logistic regression models were employed to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for mental health conditions, adjusting for potential confounders. Results: Compared with non-consumers, adolescents who consumed SSBs ≥5–6 times per week exhibited significantly higher odds of stress perception (AOR 1.35, 95% CI 1.24–1.46), depressive symptoms (AOR 1.32, 95% CI 1.19–1.46), suicidal ideation (AOR 1.23, 95% CI 1.09–1.39), and loneliness (AOR 1.44, 95% CI 1.28–1.61). Similarly, frequent consumption of high-caffeine drinks (≥5–6 times per week) was associated with increased odds of stress perception (AOR 2.13, 95% CI 1.99–2.29), depressive symptoms (AOR 1.75, 95% CI 1.62–1.88), suicidal ideation (AOR 2.04, 95% CI 1.86–2.24), and loneliness (AOR 1.72, 95% CI 1.59–1.87). Conclusions: Frequent consumption of SSBs and high-caffeine drinks is significantly associated with adverse mental health outcomes among Korean adolescents. Given the increasing intake of these beverages, targeted public health interventions are warranted to mitigate their potential negative impact on adolescent mental well-being. Full article

Psychological distress remains a significant public health concern, particularly among youth. With the growing integration of mobile and wearable technologies into daily life, digital phenotyping has emerged as a promising approach for early self-detection and intervention in psychological distress. Objectives: The study aims to determine how behavioral and device-derived data can be used to identify early signs of emotional distress and to develop and evaluate a prototype system that enables users to self-detect these early warning signs, ultimately supporting early intervention and improved mental health outcomes. Method: To achieve this, this study involved a multi-phase, mixed-method approach, combining literature review, system design, and user evaluation. It started with a scoping review to guide system design, followed by the design and development of a prototype system (ESFY) and a mixed-method evaluation to assess its feasibility and utility in detecting early signs of psychological distress through digital phenotyping. Results: The results demonstrate the potential of digital phenotyping to support early self-detection for psychological distress while highlighting practical considerations for future deployment. Conclusions: The findings highlight the value of integrating active and passive data streams, prioritizing transparency and user empowerment, and designing adaptable systems that respond to the diverse needs and concerns of end users. The recommendations outlined in this study serve as a foundation for the continued development of scalable, trustworthy, and effective digital mental health solutions. Full article

Background: Chronic illness affects children’s health and disrupts the spatial and temporal aspects of schooling by complicating attendance, interrupting learning routines, and exposing institutional rigidity. While many educational systems treat chronicity as an exception to be managed, this review reconceptualizes it as a pedagogical and symbolic challenge to normative assumptions about inclusion, care, and participation. Objective: To systematically examine how school-based behavioral and psychosocial interventions support children and adolescents with chronic health conditions (CHCs) in inclusive educational settings and to analyze what these interventions reveal about institutional practices of care and recognition. Methods: Following PRISMA 2020 guidelines, we conducted a systematic search across five databases, PubMed, ERIC, PsycINFO, Scopus, and Web of Science, for studies published between January 2010 and April 2025. Of 420 records screened, 28 studies met inclusion criteria. Eligible studies reported on school-based interventions for students aged 5–18 with chronic conditions. Methodological quality was appraised using the Cochrane Risk of Bias 2 tool (for RCTs) and the Joanna Briggs Institute checklist (for quasi-experimental designs). Findings were synthesized narratively and thematically. Results: The included studies addressed asthma, attention-deficit/hyperactivity disorder (ADHD), diabetes, epilepsy, autism, cancer, and food allergies. Interventions ranged from nurse-led management and teacher training to peer education and executive function coaching. Most reported improvements in symptom control, school attendance, academic performance, and psychosocial wellbeing. Several studies also demonstrated how interventions reshaped institutional routines and distributed responsibility for care, challenging rampant assumptions about autonomy, ability, and normativity. Conclusions: School-based interventions for chronic illness operate as health strategies and as symbolic and structural enactments of inclusion. When designed relationally, they modulate schools into responsive institutions where care is integrated in everyday pedagogical and organizational practices. Future research prioritizes longitudinal studies, underrepresented contexts, and the active participation of youth in shaping interventions. Full article

Background: Exposure-based cognitive behavioral therapy (Ex-CBT) is widely seen as the gold-standard treatment for anxiety and obsessive-compulsive disorder (OCD). Yet, minoritized youth are underrepresented in efficacy studies, raising questions about the applicability of Ex-CBT to minoritized youth. Effectiveness data suggest systematic adaptation of Ex-CBT to address youth culture and context is likely needed, and many clinicians make adaptations and augmentations in practice. However, research on the specific strategies clinicians use to address their youth clients’ culture and context within anxiety and OCD treatment is lacking. In the current study, we assess practice-based adaptations, augmentations, and process-based approaches utilized when delivering treatment to youth for OCD and anxiety in public mental health clinics. Methods: We conducted qualitative interviews with 16 clinicians from both specialty anxiety and general mental health clinics serving youth with anxiety or OCD in the public mental health system. Participating clinicians had a mean age of 32.19 (SD = 5.87) and 69% of therapists identified as female; 69% identified as White, 25% identified as Asian, and 6% as Black or African American. In qualitative interviews, clinicians shared how they addressed clients’ culture and context (e.g., social identities, stressors and strengths related to social identities and lived environment). Thematic analysis identified the strategies clinicians employed to address culture and context. Results: Clinicians reported incorporating culture and context through process-based approaches (e.g., building trust gradually, considering clients’ social identity stressors, engaging in self-awareness to facilitate cultural responsiveness) and through culturally adapting and augmenting treatment to promote person-centered care. Core strategies included proactive and ongoing assessment of clients’ cultural and contextual factors, adapting exposures and augmenting Ex-CBT with strategies such as case management and discussion of cultural context, and taking a systems-informed approach to care. Conclusions: Examining practice-based adaptations, augmentations, and process-based approaches to treatment for minoritized youth with OCD or anxiety can inform efforts to understand what comprises person-centered culturally responsive Ex-CBT. Empirical testing of identified strategies is a needed area of future research. Full article

Objective: Irritability and reactive aggression are transdiagnostic features that are predictive of adverse long-term outcomes. This investigation examined whether intranasal oxytocin administration impacts the interaction between irritability and reactive aggression, and whether these effects can be detected at a neural level via a facial expression processing task during functional MRI (fMRI). Methods: In this study, 40 children and adolescents with severe irritability and psychiatric diagnoses of disruptive mood and behavioral disorders were assigned to either intranasal oxytocin or placebo administration over a 3-week period in a randomized, double-blind trial (ClinicalTrials, NCT02824627). Clinical measures and fMRI during a facial expression processing task were collected pre- and post-intervention. Brain regions sensitive to oxytocin administration were determined using whole-brain statistical analyses, with post hoc analyses to determine whether changes in the neural activity mediated the relationship between changes in irritability and reactive aggression across the intervention period. Results: Youth who received intranasal oxytocin administration exhibited significant decreases in irritability and reactive aggression compared to their counterparts in the placebo group. Further, oxytocin administration was associated with significant increases in neural activity in the right superior prefrontal cortex, which fully mediated the relationship between improvements in irritability and improvements in reactive aggression. Conclusions: Intranasal oxytocin significantly reduced irritability and reactive aggression in youth, as well as neural activity in the prefrontal cortex, such that increases in the cortical activity fully mediated the relationship between changes in irritability and reactive aggression. Taken together, these findings may reflect oxytocin-related enhancements in emotional regulation in youth with severe irritability, a potential therapeutic mechanism for mitigating reactive aggression. Full article

Background/Introduction: Psychological inflexibility, which includes experiential avoidance, is a transdiagnostic process associated with multiple mental health issues in adolescence. Physical fitness (PF) has shown benefits for mental well-being, yet its specific relationship with psychological inflexibility remains understudied, particularly among youth. Objectives: To examine the association between components of PF and psychological inflexibility, measured by the Acceptance and Action Questionnaire-II (AAQ-II), in a representative sample of Spanish adolescents. Methods: A cross-sectional analysis was conducted using data from 631 adolescents (aged 12–17) participating in the Eating Healthy and Daily Life Activities (EHDLA) study. PF was assessed by the Assessing the Levels of PHysical Activity and Fitness (ALPHA-Fit) Test Battery (cardiorespiratory fitness, muscular strength, agility, and flexibility). Psychological inflexibility was measured using the AAQ-II. Generalized linear models (GLMs) were used to evaluate associations, adjusting for age, sex, body mass index, socioeconomic status, physical activity, sedentary behavior, sleep duration, and energy intake. Results: Unadjusted analyses showed weak but significant associations between psychological inflexibility and performance in the 20 m shuttle run test (p = 0.002), the 4 × 10 shuttle run test (p = 0.005), and the sit-and-reach test (p < 0.001). However, after adjusting for covariates, none of the PF components maintained a statistically significant association with the AAQ-II scores. Conclusions: In this adolescent sample, PF components were not independently associated with psychological inflexibility after adjustment for key confounders. These findings suggest that, while PF may contribute to general well-being, it is not a primary determinant of psychological inflexibility. Further longitudinal and intervention studies are needed to clarify the mechanisms linking physical and psychological health in youth. Full article

Urban forests, as a form of green infrastructure, play a vital role in enhancing urban resilience, environmental health, and quality of life. However, users perceive and utilize these spaces in diverse ways. This study aims to identify latent perception types among urban forest visitors and analyze their behavioral, demographic, and policy-related characteristics in Incheon Metropolitan City (Republic of Korea). Using latent class analysis, four distinct visitor types were identified: multipurpose recreationists, balanced relaxation seekers, casual forest users, and passive forest visitors. Multipurpose recreationists preferred active physical use and sports facilities, while balanced relaxation seekers emphasized emotional well-being and cultural experiences. Casual users engaged lightly with forest settings, and passive forest visitors exhibited minimal recreational interest. Satisfaction with forest elements such as vegetation, facilities, and management conditions varied across visitor types and age groups, especially among older adults. These findings highlight the need for perception-based green infrastructure planning. Policy recommendations include expanding accessible neighborhood green spaces for aging populations, promoting community-oriented events, and offering participatory forest programs for youth engagement. By integrating user segmentation into urban forest planning and governance, this study contributes to more inclusive, adaptive, and sustainable management of urban green infrastructure. Full article

In an era where digitalization shapes economic and social landscapes, the intersection of digital skills, ethics, and integrity plays a crucial role in understanding the vulnerability of youth classified as NEET (Not in Education, Employment, or Training). This study explores how risky internet use and digital skill gaps contribute to socio-economic exclusion, integrating a multivariate and spatial approach to assess regional disparities in Europe. This study adopts a systems thinking perspective to explore digital exclusion as an emergent outcome of multiple interrelated subsystems. The research employs logistic regression, Principal Component Analysis (PCA) with Promax rotation, and Geographic Information Systems (GIS) to examine the impact of digital behaviors on NEET status. Using Eurostat data aggregated at the country level for the period (2000–2023) across 28 European countries, this study evaluates 24 digital indicators covering social media usage, instant messaging, daily internet access, data protection awareness, and digital literacy levels. The findings reveal that low digital skills significantly increase the likelihood of being NEET, while excessive social media and internet use show mixed effects depending on socio-economic context. A strong negative correlation between digital security practices and NEET status suggests that youths with a higher awareness of online risks are less prone to socio-economic exclusion. The GIS analysis highlights regional disparities, where countries with limited digital access and lower literacy levels exhibit higher NEET rates. Digital exclusion is not merely a technological issue but a multidimensional socio-economic challenge. To reduce the NEET rate, policies must focus on enhancing digital skills, fostering online security awareness, and addressing regional disparities. Integrating GIS methods allows for the identification of territorial clusters with heightened digital vulnerabilities, guiding targeted interventions for improving youth employability in the digital economy. Full article

Digital hoarding (DH) is an emerging behavior with potential implications for psychological well-being and daily functioning. While traditionally associated with physical hoarding disorder, DH presents unique challenges in digital environments, particularly among university students increasingly immersed in technology. This study examines the relationship between DH and academic performance, proposing a theoretical model in which academic engagement and academic burnout act as mediating mechanisms. Drawing on the Job Demands–Resources Theory, we provide evidence that DH contributes to a health impairment process that negatively affects student outcomes. Our findings reveal DH as a novel predictor of academic burnout, highlighting its detrimental impact on academic performance. These results carry significant theoretical and practical implications, offering new insights into the role of technology-related anxiety disorders in educational settings. From a practical perspective, our study underscores the need for higher education institutions to implement targeted interventions focused on emotional regulation and learning strategies to mitigate the negative effects of DH. Despite limitations related to sample specificity and cross-sectional data, this research opens avenues for future longitudinal studies and interventions aimed at addressing DH in both academic and professional contexts. By linking digital behaviors to mental health and performance, this work aligns with public health interests in understanding technology’s impact on youth well-being. Full article

Asthma is the leading chronic condition in children and adolescents, requiring continuous monitoring to effectively prevent and manage symptoms. Symptom monitoring can guide timely and effective self-management actions by children and their parents and inform treatment decisions by healthcare providers. This paper examines two conventional monitoring methods, including symptom-based and peak expiratory flow (PEF) monitoring, reviews early efforts to quantify respiratory symptoms, and introduces an emerging sensor-based mHealth approach. Although symptom-based monitoring is commonly used in clinical practice, its adequacy is a concern due to its subjective nature, as it primarily relies on individual perception. PEF monitoring, while objective, has shown weak correlations with actual asthma activity or lung function and suffers from suboptimal adherence among youth. To enhance objectivity in symptom monitoring, earlier efforts focused on quantifying respiratory symptoms by harnessing mechanical equipment. However, the practicality of these methods for daily use is limited due to the equipment’s bulkiness and the time- and labor-intensive nature of data processing and interpretation. As an innovative alternative, sensor-based mHealth devices have emerged to provide automatic, objective, and continuous monitoring of respiratory symptoms. These wearable technologies offer promising potential to overcome the issues of perceptual inaccuracy and poor adherence associated with conventional methods. However, many of these devices are still in developmental or testing phases, with limited data on their clinical efficacy, usability, and long-term impact on self-management behaviors. Future research and robust clinical trials are warranted to establish their role in asthma monitoring and management and improving asthma outcomes in children and adolescents. Full article

Background/Objectives: Hypoglycemia occurs when blood glucose levels drop significantly below the normal range leading to unpleasant symptoms and a greater risk of acute complications. Fear of hypoglycemia (FH) is a conditioned psychological response to hypoglycemia frequently experienced by people with type 1 diabetes (T1D) and their loved ones. The present study aimed to examine the psychometric properties of a Portuguese translation of the Hypoglycemia Fear Survey—Parents (HFS-P) for the parents of youths with T1D. Methods: The sample consisted of 102 parents (M = 44.58 years old; SD = 5.01; mothers = 92.2%) of youths with T1D (8 to 17 years of age; M = 12.67; SD = 2.58). Confirmatory Factor Analysis (CFA) and convergent validity were performed to examine the factor structure and the construct validity of the HFS-P. Results: CFA supports a refined two-factor 18-item version of the HFS-P. The results indicate good psychometric properties (χ² [129] = 220.47.; p ≤ 0.001; χ²/DF = 1.71; RMSEA = 0.08; SRMR = 0.07; CFI = 0.93; TLI = 0.91; GFI = 0.93) along with good to excellent internal consistency coefficients (behavior subscale: α = 0.81, total: α = 0.93, and worry: α = 0.94). Conclusions: Our Portuguese version of the HFS-P appears reliable for assessing FH in parents of youths with T1D, and is ready for use in clinical research and to evaluate psychological interventions targeting parental FH in the Portuguese context. Full article

The COVID-19 pandemic fundamentally disrupted assumptions about entrepreneurship, career planning, and professional development. This study explored how the pandemic influenced the entrepreneurial intentions of undergraduate business students in the United States. Using a qualitative methodology based on in-depth interviews with 31 students at a public Midwestern university, the research interpreted student narratives through the lenses of effectuation theory, resilience theory, and the theory of planned behavior. Findings revealed that many participants reframed entrepreneurship as a strategy for navigating economic uncertainty and enhancing personal agency. Students reported valuing adaptability, resourcefulness, and opportunity recognition, often experimenting with side hustles during the pandemic as a means of resilience. Their entrepreneurial thinking shifted from purely economic motivations toward aspirations for flexibility, self-fulfillment, and purposeful work. The study highlights the formative role of crisis contexts in shaping entrepreneurial identity among emerging professionals. It suggests that entrepreneurship education should move beyond traditional models, fostering skills for navigating complexity and building resilience. In doing so, the findings contribute to broader conversations about youth entrepreneurship, post-pandemic career development, and the evolving demands of the labor market in times of disruption. Full article

Background/Objective: A growing body of international research continues to show evidence of worsening youth mental health since the beginning of the COVID-19 global pandemic, yet very little research in this area has included young children under 6 years. Given the potential impact of early life stress during this critical period of development, it is crucial to better understand the effects on this age group. The objective of this study was to better understand the impact of the COVID-19 pandemic on the emotional health of very young children. Methods: This study utilized retrospective chart review of primary care records to compare the prevalence of markers of stress in two cohorts of children under the age of 6 years, comparing children presenting for care prior to the pandemic (1 April 2019–31 March 2020; control period) with those presenting for care during the first year of the pandemic (1 April 2020–31 March 2021; study period) in a large pediatric primary care clinic in Washington, DC, USA. Based on power calculations, charts of 200 patients from each cohort were reviewed and prevalence of stress markers were summarized using counts and percentages and compared between groups using chi-squared tests. Multivariable logistic regression models were also conducted for each domain adjusting for age, gender, and insurance type. Results: Overall, sleep difficulties were significantly more prevalent during the pandemic period compared to the control period (14% vs. 6.5%, p = 0.013). In addition, signs of stress presented differently across age groups. For example, during the pandemic period toddlers (13–35 months) were 13 times more likely (OR = 13, 95% CI [2.82, 60.4], p < 0.001) and preschool-aged children (36–71 months) were 18.5 times more likely (OR = 18.5, 95% CI [4.0, 86], p < 0.001) than infants to present with behavior problems, indicating substantially higher risk of externalizing symptoms in older children compared to infants. Toddlers were less likely than infants to present with mood changes (e.g., fussiness or crying) (OR = 0.15, 95% CI [0.03, 0.65], p = 0.011). In addition, toddlers (OR = 0.55, 95% CI [0.31, 0.97], p = 0.038) and preschool-aged children (OR = 0.15, 95% CI [0.06, 0.4], p < 0.001) were also less likely to present with feeding difficulties compared to infants. Conclusions: One of the very few studies of young children under 6 years (including infants) during the COVID-19 pandemic, this study found that even very young children experienced stress during the pandemic. Signs of emotional stress were identified in a primary care office during routine care, highlighting an important opportunity for early intervention and/or prevention, such as counseling and resources for caregivers, in settings where young children are already presenting for routine care. Full article

The development of stock markets is pivotal for economic growth, particularly through the mobilization of idle resources into productive investments. Despite recent reforms to enhance Uzbekistan’s capital market, public engagement remains limited. This study examines the behavioral determinants of stock market investment intention and participation among university students, employing the Theory of Planned Behavior (TPB) and Partial Least Squares Structural Equation Modeling (PLS-SEM). The model investigates the influence of digital literacy, financial literacy, social interaction, herding behavior, overconfidence bias, risk tolerance, and financial well-being on investment intention and behavior. A survey of 369 university students was conducted to assess the proposed relationships. The results reveal that risk tolerance, overconfidence bias, and herding behavior significantly and positively affect investment intention, while digital literacy demonstrates a notable negative effect, suggesting caution in assuming technology readiness automatically translates to investment readiness. Investment intention, in turn, strongly predicts actual participation and mediates several of these effects. Conversely, financial literacy, financial well-being, and social interaction showed no significant direct or mediating influence. Additionally, differences according to gender and academic background were observed in how intention translates into behavior. The findings underscore the need for integrated financial and behavioral education to enhance market participation and contribute to policy discourse on youth financial engagement in emerging economies. Full article

This study presents a systematic review regarding the use of augmented reality and virtual reality in exergaming by analyzing studies published during 2010–2025. This study focuses on providing an overview of the field and on examining and synthesizing the findings of related studies to identify the contexts, applications, and domains in which extended reality exergames are being used and the related implications, benefits, and challenges. Based on the results, augmented reality and virtual reality exergames offer immersive, enjoyable, engaging, and personalized experiences that support physical, cognitive, and emotional well-being, while enhancing physical performance, cognitive functioning, psychological outcomes, and mental health. They promote motivation, active lifestyles, and sustainable health behaviors across diverse populations, including older adults, individuals with disabilities, and neurological groups, as well as the general adult and youth populations. Although emphasis is placed on their use in physical and cognitive rehabilitation and treatment, they also show great potential to be effectively used in different domains, including education. Among the technologies examined, the significant majority of studies focused on virtual reality exergames, a limited number of studies involved augmented reality, and only a few studies examined mixed reality, extended reality, and the metaverse. Finally, nine main topics were identified through topic modeling, providing a clear representation of the core themes within the literature. Full article