Bullying and problematic Internet gaming (PIG) are two concerning phenomena among adolescents. Research suggests an association between them; however, longitudinal studies are scarce. Therefore, this study examined whether traditional and cybervictimization are prospective risk factors for PIG and how gender, school type, and age influence these relationships.Adolescents (grades 5-13; N = 4,390) answered two surveys one year apart which were linked by individual codes. They were classified as "victims" based on the Olweus Bullying Questionnaire-Revised. Changes in PIG (T2-T1) were computed based on nine items reflecting the diagnostic criteria for DSM-5 Internet Gaming Disorder.Traditional and cybervictimization independently predicted changes in PIG. The emergence of traditional victimization only, cybervictimization only, and particularly, both forms of victimization simultaneously, was associated with an increase in PIG. A decrease in PIG was only found if victimization terminated in both contexts. Further, an additive effect was found if traditional victimization newly extended to cyberspace. For boys and B-level students, the emergence of traditional victimization was associated with a larger increase in PIG than for girls and A-level students, when compared to the absence of traditional victimization. For boys, this also applied for cybervictimization.The emergence of bullying victimization in either an offline or online context appears to be a risk factor for PIG. Importantly, victimization must be stopped in both contexts for a decrease in PIG. Therefore, prevention programs need to focus on bullying offline as well as online to counter PIG. Efforts should especially focus on boys and B-level students.

Sexual ramifications of physical disease are well-documented in adult populations, but are scarcely investigated among adolescents and young adults (AYA). This study compared measures of sexuality and sexual health among 8,696 15-year-old to 24-year-old Danes with and without a history of treatment for long-lasting or severe physical disease. Using baseline data from Project SEXUS, a nationally representative cohort study on sexual health in the Danish population, differences in various domains of sexual behaviors and sexual health between AYA who have and AYA who have not been treated for long-lasting or severe physical disease were investigated. Logistic regression analyses yielded demographically weighted age-adjusted odds ratios (ORs) for associations between physical diseases and sexual outcomes. AYA treated for long-lasting or severe physical disease resembled their healthy peers on fundamental aspects of sexual interest, activity and satisfaction. However, significantly increased odds ratios of various sexual difficulties and dysfunctions, early sexual debut, high sex partner numbers, discontentment with body or genital appearance, gender nonconformity, nonheterosexuality, and exposure to sexual assaults were observed, overall or within specific disease categories. The overall similarity in sexual profiles between AYA treated for physical disease and healthy peers indicates that clinicians should routinely address questions related to sexuality and relationships when encountering AYA with chronic health conditions. Moreover, the observed excess of certain adversities, including sexual assaults, among physically ill AYA highlights the need for preventive measures and counseling services specifically targeted at AYA afflicted by physical disease.

Depressive symptoms and suicidality of adolescents during the COVID-19 pandemic are emerging public health issues. However, there is a lack of representative studies on adolescents' mental health that considers the preceding secular trends. This descriptive study used nationally representative cross-sectional data of Korean adolescents from the Korea Youth Risk Behavior Survey from 2005 to 2020 (N= 1,035,382). We utilized joinpoint regression analysis to explore the temporal prevalence trends of depressive symptoms, suicidal ideation, and suicide attempts. Based on the annual percentage change until 2019, the expected and actual prevalence in 2020 (N= 54,948) was compared to describe departures of prevalence from the trend line. These trends between sex, school level, ethnic status, and socioeconomic status were also compared. Considering the recent increase in secular trends until 2019, the actual observed values in 2020 were lower than expected by 13% in depressive symptoms, 20% in suicidal ideation, and 40% in suicide attempts. The gap between sexes, school levels, ethnic status, and socioeconomic groups was similar or narrowed in 2020 compared to previous trends. We observed a lower prevalence of depressive symptoms and suicidality among Korean adolescents than expected about 9 months from the beginning of the COVID-19 pandemic despite the recent increase in secular trends.

Substance use is common among adolescents, and among those with substance use disorders; use often persists into middle age, underlying the importance of early detection and treatment. The goal of this quality improvement project was to increase the electronic substance use screening rate of adolescents presenting for preventative health visits from 0% to 50% between March 2021 and September2021. This is an ongoing quality improvement project. Participants included patients ≥12 who presented to the Adolescent Medicine Clinic for preventative health visits. We incorporated the Screening to Brief Intervention into the existing Car, Relax, Alone, Forget, Friends, Trouble tool within the electronic health record. We completed a Plan-Do-Study-Act cycle by reviewing every patient's chart who did not receive screening and identified that a common reason for missed screening was designating the visit as "establishing care" rather than preventative health visit. We modified our eligible patient criteria to include all adolescents presenting to establish primary care. We achieved a statistically significant center-line shift with a p value (<.001) from approximately 0% at baseline to a new baseline of 85% from June 2021 to June 2022. After broadening our eligibility criteria, our electronic screening rate improved from 78% in November 2021, to 83% in December2021. Electronic health record integration of the Screening to Brief Intervention/Car, Relax, Alone, Forget, Friends, Trouble is an effective method to systematically and electronically screen adolescents for SUD at preventative health visits. Integration using similar approaches may benefit other institutions interested in providing standardized SUD screening.

Within the United States, human papillomavirus (HPV) vaccination rates remain low. We examined HPV vaccine recommendation practices among Florida clinicians by assessing variability in: (1) recommendation priorities by patient characteristics and (2) concordance with best practices. In 2018 and 2019, we conducted a cross-sectional survey incorporating a discrete choice experiment among primary care clinicians (MD/DO, APRN, and PA). We used linear mixed-effects models to determine the importance of patient characteristics (age, sex, time in practice, and chronic condition) and parental concerns. We compared clinician endorsement of predetermined constructs with reported vaccine recommendation statements. Among 540 surveys distributed, 272 were returned and 105 reported providing preventive care to 11- to 12-year-olds (43% response rate). Among completing clinicians, 21/99 (21%) did not offer the HPV vaccine. Among clinicians offering the vaccine (n= 78), 35%-37% of each decision to recommend the vaccine was based on the child's age (15 vs. 11years). For closed-ended questions, most clinicians endorsed best practices including emphasizing cancer prevention (94% for girls and 85% for boys; p= .06), vaccine efficacy (60% both sexes), safety (58% girls and 56% boys), importance at 11-12years (64% both sexes), and bundling vaccines (35% girls and 31% boys). When clinicians reported their typical recommendation, fewer clinicians incorporated best practices (59% cancer prevention, 5% safety, 8% the importance at 11-12years, and 8% bundling vaccines). HPV vaccination recommendation strategies among Florida clinicians somewhat aligned with best practices. Alignment was higher when clinicians were explicitly asked to endorse constructs versus provide recommendations.

Teen dating violence (TDV) must be addressed as a public health issue due to its prevalence and association with negative health outcomes among victims. To prevent TDV, it is essential to examine the risk factors of dating violence perpetration's applicability to younger samples. Using a population health approach, this study explored the associations among variables that affect emotion regulation and TDV perpetration of multiple types among a diverse sample of high school students. Latent profile analysis of four self-reported variables related to emotion regulation (anger regulation, depressive symptoms, impulsivity, and alcohol use) was conducted among a sample of 1,508 students. Next, regression analyses were used to test the relation between latent profile membership and self-reported TDV perpetration across two time points. A three-profile solution was found to be the solution of best fit (profile 1: n= 1,023, profile 2: n= 43, and profile 3: n= 442). Profile one had low means across all indicators; profile two had a high mean of recent alcohol use; and profile three had low to moderate means across all indicators. Profile two was associated with the most frequent lifetime perpetration and perpetration one year later. However, all three profiles were only associated with infrequent perpetration. This study found that an emotional regulatory framework was applicable to assess some risks of TDV. These findings justify further research on the relation between emotion regulation and TDV perpetration; however, risk factors at other socio-ecological levels should be incorporated to strengthen existing theories.

Urine drug testing (UDT) is an important feature of outpatient treatment for opioid use disorder, but associations with patient characteristics among adolescent and young adult patients are unknown. This study assessed UDT results in office-based opioid treatment and characteristics associated with treatment compliance. This was a retrospective study of adolescent and young adult patients enrolled in office-based opioid treatment between January 1, 2009, and December 31, 2020. UDT results were described as positive results or expected and unexpected results. Expected results were negative UDTs for opioids, marijuana (THC [tetrahydrocannabinol]), or cocaine/methamphetamine, or a positive UDT for buprenorphine. Unexpected results were positive UDTs for opioids, THC, or cocaine/methamphetamine, or a negative UDT for buprenorphine. Treatment compliance was defined as ≥75% of UDTs provided being expected results. Counts and percentages described UDT results. Regressions evaluated associations between patient characteristics (retention time, age, sex, race/ethnicity, insurance, and comorbid mental health diagnoses) with treatment compliance, and assessed change of positivity rates for UDTs over time. A total of 407 patients were included. Overall, 305 patients (74.9%) demonstrated treatment compliance. Rates of expected UDT results increased with longer retention time (p <.001), except for methamphetamine. Buprenorphine expected results ranged from 77.0% to 96.5%. Diagnosis of stimulant use disorder was associated with decreased compliance (p= .04), while diagnoses of depression, anxiety, nicotine use disorder, and post-traumatic stress disorder were associated with increased compliance (p ≤.04). Proportion of expected UDT results increased with retention time. Diagnosis of specific mental health conditions affected treatment compliance. Further research regarding long-term health outcomes is needed.

When my family moved to Lakeway, Texas, our relatives said we might as well have moved to a medieval village. There was no nearby Dunkin’ Donuts or Krispy Kreme. For that matter, there wasn't a movie theater or a McDonald's either. Although you would barely recognize it today, Lakeway before 2010 was a sleepy town intended for Longhorns fans to weekend at before returning to their urban estates. However, what the town's restaurants lacked in quantity they made up for in homeliness. Even if we lacked a processed confectionery chain, we still had a quirky donut shop my parents could take me to if they sensed I ever needed a celebratory treat or 20 minutes of quiet chewing. Since this was one of the only businesses in the area, it felt like our lives revolved around buttery fritters and the baker who made them. My school field trip? Donut shop. Snacks for church? Donut shop. The monkey poster lining the entrance and the silky sweet smell wafting from the back danced around my dreams. To avoid my requests that we go there every morning, Wednesdays during kindergarten became family donut day. We would wake up early, pack into the car, get our fill of donuts, and miraculously still manage to get to school by 7:30 a.m. Maybe something about this donut shop augmented time, because for me, Wednesday mornings seemed to last joyous hours. If our relatives viewed Lakeway as a medieval village, then this donut shop was my portal to a fantasy land. However, to enter this sacred space, I would first have to cross the threshold of adventure and reach the doorknobs; this was often achieved with assistance from my parental entourage. As I waddled through the doors, I beheld a model of small-town America in the 2000s. Every free space on the wall was taken by either a picture of the high-school soccer team from three years ago, a humorous newspaper comic, or a thank-you letter from a charity. The voice of James Taylor crooned from an undefinable source, and a claw machine beckoned me to visit in a few years once my dexterity was more advanced. These were all, however, mere distractions from what I really came to find. In the center of the room, I peered through a clear case of donuts with a multitude of different magically concocted colors and attempted to soak in the creatures of this new realm. Deciding between the different donuts, toppings, and sprinkles felt like choosing a lifelong pet. The cashier would always snicker at the arrested vacillation of a child with bedhead, but played along anyways, advising me as Merlin would to King Arthur. Eventually, I'd proudly point to a chocolate sprinkle or cinnamon twist and declare it my companion for the morning. Then I'd silently laugh at my grown-ups for choosing a spinach kolache (a type of savory turnover) and black coffee. We all knew who would have the better Instagram shot in 10 years. With a ding of the register, we were off to start the real festivities. The store itself had three tables in total, which were situated down a skinny side hallway only I could walk through with ease. For three people to sit around a table, we would have to keep elbows in and treats up. The main challenge I often encountered in my quest was the sheer height of this donut in comparison to how tall my six-year-old mouth could stretch. To go straight in would be to allow the frosting to glide over my upper lip. At the same time, asking for the donut to be cut into chips with a plastic fork would be both embarrassing to myself and to my new companion's pride. I always picked the former option. Anticipating my decision, my mom always asked for a water bottle and napkins with our order. No sojourner would leave a feast without entertainment, and unfortunately the mechanical claw still proved too difficult for my chubby hands to master. All the diversion I needed came from clinking coins and folding bills. In a timid voice, I would ask the cashier if I could fulfill my usual duty as a temporary change-counter. My parents had met the owners a while back, and a onetime gig playing “helper” soon evolved into my regular commitment. Luckily, the community was too intimate and the business too local to raise any alarms about a fetus counting change on Wednesday mornings. My life and the life of my town slowly got more hectic. We got a movie theater, a mall, and an H-E-B. My family's weekly outings to our beloved donut shop became monthly ideas, which eventually morphed into rare and spontaneous morning dates that would continue with my parents when I visited home from college. Even as the doorknobs, donuts, and claw machine became less mystical, I still always left the shop feeling refreshed. Frankly, I don't think it was the donuts (even though they are delicious). Too often, our family time is relegated to evening hours, and the TV families who can sit at a round table and eat breakfast together seem creepy and unrealistic. However, I believe there is an innate duality contained within breakfast time. On the one hand, the events of yesterday have muted but not yet dissipated. For example, novelist Henry Green described one of life's greatest pleasures as “Lying in bed on a summer morning… eating buttered toast” with the scent of last night's lover still fresh on the fingers. Even with the newfound perspective on yesterday, mornings are also times to look forward to the future. In The Odyssey, for example, Odysseus reunites with his son and plans an attack on the suitors invading his household all in a morning meal. To sit with the people, I love in the limbo between yesterday and today is to give myself a chance to talk about life through a new lens, a hopeful lens. It gives me a kind of peace that, even if my day falls apart, I will have a home to return to in the evening. Last year when back in town, I decided to pay it forward and take my younger cousins to the same donut shop before dropping them off at preschool. I helped them cross the threshold of tall doorknobs, waited patiently while they wavered between lemon and strawberry frosting, and remembered to ask for extra napkins. It had been over 10 years since I was in their young shoes, rubbing my eyes and looking into the glass for the best way to start the day. Although the joy of eating together almost overshadowed the realization, I was surprised to crave what I finally realized was delicious spinach and feta kolache. Desperate to avoid becoming a boring grown-up, I went to the claw machine and won some donut holes to nibble on as well. Hopefully, the kids would be too busy slipping frosting onto their noses to ask when they could try the claw machine. That time would come soon enough.