Adolescent Adherence Research Articles

The Role of Food Security in Mediterranean Diet Adherence Among Adolescents: Findings from the EHDLA Study

Food insecurity is a growing public health concern, particularly among vulnerable groups such as adolescents, and it has been linked to poor nutritional outcomes and increased risk of chronic diseases. The Mediterranean diet (MedDiet) is recognized for its numerous health benefits, yet few studies have explored the association between food insecurity and adherence to the MedDiet among adolescents, especially in Mediterranean regions. Objective: This study aimed to investigate the association between food insecurity and adherence to the MedDiet in a sample of adolescents from Spain. Methods: Data were acquired from 2021–2022 school years from adolescents aged 12–17 years enrolled in different secondary schools in Valle de Ricote, Region of Murcia, Spain. Food security was assessed via the Spanish Child Food Security Survey Module (CFSSM-S), and adherence to the MedDiet was assessed via the Mediterranean Diet Quality Index for Children and Adolescents (KIDMED). A total of 836 participants were involved, and statistical analyses were conducted via linear regression models adjusted for lifestyle, anthropometric, and sociodemographic covariates. Results: After adjusting for potential confounders, the mean KIDMED score was 7.0 (95% confidence interval [CI] 6.7 to 7.2) in the food-security group, 6.8 (95% CI 6.3 to 7.3) in the low-security group, and 5.9 (95% CI 4.9 to 6.9) in the very-low-security group. Notable differences were observed between participants with food security and their counterparts with very low food security (p = 0.040). Compared with those with food security (57.2%, 95% CI 51.5% to 62.8%), a significantly greater likelihood of having nonoptimal adherence to the MedDiet was identified in adolescents with low food security (61.6%, 95% CI 50.4% to 71.8%) and in those with very low food security (77.4%, 95% CI 54.5% to 90.7%). We identified a significant difference only between adolescents with food security and their peers with very low food security (p = 0.036). Conclusions: The findings suggest that very low food security negatively impacts MedDiet adherence in adolescents. Compared with their food-secure peers, adolescents with very low food security showed significantly poorer diet quality. These results highlight the importance of addressing food insecurity through low-cost, high-nutrition programs aimed at improving healthy eating habits, particularly for children and adolescents living in low-food-security households.

Healthcare Experiences of Mothers of Children and Adolescents With Acute Lymphoblastic Leukemia in Mexico

Background: In Mexico, acute lymphoblastic leukemia (ALL) is the second leading cause of death in children and adolescents aged 4–15. It is also the most frequent type of cancer in this age group. Cancer diagnosis is commonly associated with mortality and generates fear and anxiety in Mexican parents. Objective: To analyze the experiences of mothers in the care, accompaniment, and treatment adherence of children and adolescents diagnosed with ALL, including changes in their daily life and how they deal with them. Results: Health professionals at the first level of care delay to identify the symptoms of leukemia in children. ALL affects both the patient as well as the whole family and there are several changes in daily life, especially for mothers. Due to gender roles, women (mothers) are the main caregivers of sick children. Mothers often blame themselves for believing that they did not attend to their children on time or that they made some errors in children rearing. They experience fear, doubts, and confusion; these feelings diminish over the course of the disease process due to interaction with other mothers and health professionals, as well as the evolution of the disease. Conclusion: It is critical to achieve early-stage diagnosis of ALL and ensure timely treatment in children and adolescents, as well as to provide effective emotional support for mothers and foster the development of peer support networks.

Charting the Path: Psychological Factors and Diet Adherence in Adolescents With Celiac Disease.

Introduction Adolescence is a pivotal time for individuals with celiac disease (CD), presenting a host of psychosocial challenges. Managing a strict gluten-free diet (GFD) while forming self-identity, striving for autonomy, and navigating social relationships significantly impacts adolescents with CD.The present pilot study investigates the impact of psychological factors on behavioral and dietary responses in adolescents with CD, utilizing repeated measures over time. Methods Thirty-one adolescents aged 11-18 from a pediatric outpatient CD department were recruited. Participants completed the Resilience Youth Development Module (RYDM), the Child and Adolescent Mindfulness Measure (CAMM), the Strengths and Difficulties Questionnaire (SDQ), and Celiac Dietary Adherence Test (CDAT) over four phases spanning four months. Twenty-seven parents also agreed to participate in completing the SDQ parents' version. Results The results revealed moderate levels of mindfulness and resilience, accompanied by inadequate adherence to a GFD. Baseline assessments revealed difficulties in peer relationships and psychosocial functioning, which parents corroborated. Over time, reductions in mindfulness and resilience were observed, along with modest improvements in dietary adherence and decreases in psychosocial difficulties. Discussion This study underscores the importance of psychological traits, suggesting that enhancing mindfulness and resilience may improve both dietary adherence and overall well-being. However, given the dynamic nature of adolescents' coping strategies through developmental changes and social environments, tailored interventions are essential for effective disease management and social integration.

<i>Helicobacter pylori</i> Infection and Its Association with Mediterranean Diet Adherence in Lebanese Children and Adolescents: A Cross-sectional Study

Background: Lebanon, a middle-income country in the Eastern Mediterranean, has been experiencing a socioeconomic and humanitarian crisis since at least 2019, which has severely impacted the population’s well-being. As a result, the country has faced unprecedented deprivation of basic survival needs including food, clean water, hygiene, and healthcare. Objectives: This cross-sectional study aimed to evaluate the association between adherence to the Mediterranean diet (MD) and Helicobacter pylori (H. pylori) infection among children and adolescents during the economic crisis. A total of 198 children and adolescents, visiting the pediatric gastroenterology departments of two hospitals in a suburban area of Northern Lebanon, were enrolled in this study. Methods: Data collection involved a structured questionnaire that included anthropometric measurements, sociodemographic and behavioral characteristics, and adherence to the MD. H. pylori infection was determined using the H. pylori CHECK stool antigen test. Multiple binary logistic regression was conducted to identify the association between H. pylori infection and patient characteristics, including adherence to the MD. Results: Helicobacter pylori was detected in 12.1% of the tested children and adolescents. Factors associated with H. pylori infection included washing fruits and vegetables before consumption, use of olive oil, and consumption of dairy products. Additionally, multiple binary logistic regression analysis indicated that children and adolescents who consumed olive oil or dairy products were more likely to have H. pylori infection. Conclusions: The consumption of olive oil and dairy products was associated with H. pylori infection. Further studies are required to confirm the effect of diet on H. pylori infection, with a detailed assessment of macronutrient and micronutrient intake.

Knowledge, Attitudes, Eating Practices, and Iron (Fe) Consumption among Adolescent Girls (Aged 10-18 Years) in Central Java, Indonesia

Background The Iron (Fe) supplementation program was initiated in 2016 by the Indonesian government. The program included administering iron tablets once a week to female students in schools, although it was not effectively implemented. Objective This study aimed to examine knowledge, attitudes, and eating practices as well as iron intake among adolescent girls (Aged 10-18 Years) in Central Java, Indonesia. Methods and Materials A cross-sectional study was conducted with 484 respondents. The data obtained were analyzed using univariate as the descriptive method, bivariate with Chi-square, and multivariate through logistic regression. Results This study found that knowledge and positive attitudes toward iron tablet consumption were prevalent among respondents, but actual adherence was low, with only 14.7% adhering to the recommended intake. Although adolescent girls showed better eating practices, adherence to consumption did not differ significantly across age groups. A healthy lifestyle significantly improved iron tablet consumption (OR = 14.684) and eating practices (OR = 30.298). The source of information played a crucial role, with health providers being more effective in promoting behaviors (OR = 2.615 for iron tablet consumption and OR = 1.713 for healthy eating practices) compared to non-health attendants (OR = 0.332 for poor eating practices). These results suggested that targeted interventions focusing on lifestyle and information sources could enhance health behaviors in this population. Conclusion A significant influence of knowledge related to anemia, the benefits of iron tablets, healthy eating patterns, and sources of information was observed on the adherence to iron tablet consumption. However, this study recommended that to improve adolescent adherence to iron tablet consumption and eating practices, comprehensive knowledge related to anemia should be provided through various sources, particularly from health professionals.

VACINAÇÃO CONTRA O HPV EM ADOLESCENTES: BENEFÍCIOS, DESAFIOS E PERSPECTIVAS - UMA REVISÃO SISTEMÁTICA

Introduction: Vaccination against the Human Papillomavirus (HPV) is a fundamental intervention for the prevention of cancers related to the virus, especially cervical cancer. Although recommended by the World Health Organization (WHO) and included in several national immunization programs, adolescent vaccination adherence still faces barriers. This systematic review aims to evaluate the benefits, challenges and prospects of HPV vaccination in adolescents, focusing on studies that address both clinical efficacy and factors influencing vaccine acceptance and coverage. Methodology: A search was conducted in the databases Latin American and Caribbean Literature in Health Sciences (LILACS) and Virtual Library in Health (VHL) to identify studies published between 2018 and 2024. Scientific studies were included that evaluated the effectiveness of vaccination, the perception of parents and adolescents, and public policies to encourage vaccination. Results and discussion: HPV vaccination shows up to 90% effectiveness in preventing infections by oncogenic strains of the virus. However, factors such as misinformation, fear of side effects and cultural resistance were identified as the main challenges for vaccine adherence. The implementation of educational campaigns and the strengthening of public policies aimed at immunization were highlighted as effective strategies to increase vaccination coverage. Conclusion: HPV vaccination in adolescents offers clear benefits in the prevention of virus-related diseases, such as cervical cancer. However, challenges such as low acceptance and misinformation about vaccine safety need to be overcome in order to maximize its effectiveness at the population scale. Coordinated actions between governments, health professionals and communities are needed to increase uptake and ensure broad and effective vaccination coverage.

Feasibility and Acceptability of a REDCap-Embedded HIPAA-Compliant Text Messaging Application to Track Medication Adherence in Adolescents With Lupus.

Despite advances in clinical care and treatment options, adolescents with lupus continue to experience adverse health outcomes. Poor adherence to medication regimens is a major contributor to these negative outcomes. The utility of short message service (SMS) in tracking barriers to adherence prospectively remains untested for adolescents with lupus. Our objectives were (1) feasibility of incorporating a Health Insurance Portability and Accountability Act (HIPAA)-compliant SMS text messaging application into REDCap and (2) acceptability of using SMS text messaging to track barriers to medication adherence in adolescents with lupus. This study is a 12-week pilot cohort study of adolescents with SLE per the 1997 revised American College of Rheumatology. A REDCap-embedded HIPAA-compliant text messaging application was used to send biweekly messages with survey link to track medication adherence. Measures were completed. Descriptive statistics were used to summarize demographics, medical, and acceptability data. Response to text messages and survey completion rates were reported as a measure of feasibility. Most eligible adolescents approached agreed to participate (n = 17, 71% enrollment rate). The cellphone ownership rate among adolescents eligible for participation was 92%. Nine subjects responded to all text messages sent (53% response and completion rate). Eleven subjects (65%) responded to two thirds of the text messages. Overall, 77% of enrolled subjects completed at least half of the surveys sent. Reminders to complete surveys were sent to 30% of enrolled adolescents. This study shows that embedding a HIPAA-compliant SMS text message application in REDCap is feasible and can be used to engage adolescents with chronic conditions in monitoring between clinic visits.

The association between family physical activity environment and exercise adherence in adolescents: a chain mediation model.

The family plays an immensely crucial role in the development of adolescents, significantly influencing their behavioral patterns. To explore the impact mechanism of the family physical activity environment on adolescents' exercise adherence, and analyze the chain-mediating role of exercise self-efficacy and exercise satisfaction. A questionnaire was administered to 500 adolescents and their parents using the Family Physical Activity Environment Scale, Exercise Adherence Scale, Exercise Self-Efficacy Scale and Satisfaction Scale. The direct impact value of the family physical activity environment on adolescents' exercise adherence is 0.148, with an effect size of 32.81%. The impact values of exercise self-efficacy and satisfaction between the family physical activity environment and adolescents' exercise adherence are 0.113 and 0.092 respectively, with effect sizes of 25.05% and 20.39%. The chain-mediating effect of exercise self-efficacy and satisfaction is significant, with an effect value of 0.097 and an effect size of 21.50%. Family physical activity environment can directly and positively predict adolescents' exercise adherence, positively predict adolescents' exercise adherence through the independent mediating role of exercise self-efficacy and satisfaction, and also positively predict adolescents' exercise adherence through the chain mediating role of exercise self-efficacy and satisfaction. This provides a theoretical reference for enhancing adolescents' exercise adherence and improving their levels of physical health.

Barriers to Type 1 Diabetes Adherence in Adolescents.

Background: Adolescence is a particularly crucial period of physical, emotional, and social development and adaptation, rendering these formative years rather challenging for individuals with chronic conditions like type 1 diabetes (T1D). Despite rapid improvement in diabetes therapies, adolescents with T1D are characterized by poorer adherence to treatment regimens compared with other pediatric age groups. Insufficient adherence is strongly related to low diabetes control, increasing morbidity, and risk for premature mortality. This study aimed to provide a comprehensive overview of adolescents' most common barriers to T1D adherence, stressing the need for a deep and comprehensive understanding of these barriers. The complexity of these barriers is underscored by the diverse factors contributing to poor T1D adherence in adolescents. Methods: A narrative review was conducted, surveying four databases (PubMed, Scopus, EMBASE, and Web of Science) for full-text articles in the English language published up to June 2024. All studies related to barriers to T1D adherence in adolescents were considered. The literature was selected using selection and exclusion criteria and extracted and organized using Mendeley. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. This review revealed that adolescents face numerous obstacles to T1D adherence related to psychological factors, flux in family dynamics, perceived social pressures, therapy-related factors, transitioning responsibility, risk-taking behaviors, and pubertal changes. Conclusions: Navigating the adaptations to the different aspects of T1D, from treatment to complications and adolescents' personal growth, effectively requires a thorough understanding of the barriers of a treatment regimen that patients at this critical age face.

Executive Function and Adherence in Children and Adolescents Living with HIV: Evidence from the HIV-associated Neurocognitive Disorders in Zambia (HANDZ) Study.

Executive function (EF) may be impaired in people with human immunodeficiency virus (HIV) infection, and poor EF may affect medication adherence. However, there is little data on EF in children with HIV in sub-Saharan Africa. 208 children/adolescents with perinatally acquired HIV and 208 HIV-exposed uninfected controls were recruited in Zambia for this prospective cohort study. EF was measured using performance-based, self-report, and parental report measures. Adherence over one year of follow-up was assessed through questionnaires and viral load measurement. Children with HIV performed significantly worse on all three measures of EF. Lower parental rating of EF was associated with poorer antiretroviral therapy adherence (OR: 1.5, 95% CI = 1.02 - 2.2, p = 0.04). Children with HIV have EF impairments which may lead to consequences like poor medication adherence and treatment failure. Interventions to improve EF or compensate for impaired EF may be necessary in this population.

Motivational Enhancement System for Adherence for Adolescents and Young Adults Newly Recommended to Start Antiretroviral Therapy.

Adolescents and young adults (AYAs) (age 13-24 years) accounted for 20% of HIV diagnoses in the United States and 6 dependent areas in 2020. Optimal treatment adherence during adolescence and young adulthood decreases the pool of infectious individuals during the risky sexual activity commonly reported among AYAs living with HIV. Adolescents and young adults newly recommended to start antiretroviral therapy (ART) were recruited, nationally, from 7 clinical sites. At each clinical site, participants were randomized to receive a 2-session (baseline and 1 month) online intervention. For the Motivational Enhancement System for Health (MESA) intervention condition, based on the principles of motivational interviewing, participants received ART information and personalized feedback + ART standard of care (n = 86), while for the System for Health (SH) control condition, participants received information on healthy eating and physical activity + ART standard of care (n = 66). Adherence was 21% greater in the MESA intervention group compared with the SH control group at 6 months. In addition, the MESA intervention group was significantly more adherent during the postintervention, and was more likely to maintain viral suppression up to 12 months after initiating ART if both doses of the intervention were received compared with the SH control group. A brief, scalable online computer-delivered intervention shows promise for achieving long-term health outcomes because of improved adherence when intervention occurs early in the course of treatment. NCT02761746.

Challenges of asthma therapy adherence in adolescents and solutions (literature review)

Introduction. Asthma is a globally significant non-communicable disease with serious public health implications, affecting both children and adults. It includes high morbidity and mortality rates in severe cases. Understanding the reasons for decreased adherence to asthma therapy in adolescents remains a pressing issue for physicians across various specialties. It is important to analyze the challenges faced by young people that lead to ineffective asthma control.Aim. To review the latest literature to understand the driving factors behind non-adherence to treatment regimens in adolescents with asthma, their consequences, and potential solutions to ensure better disease control.Materials and methods. A systematic search was conducted in electronic databases including PubMed, Cochrane Library, Elsevier, Embase, Wiley, and CyberLeninka. The planned search depth was 2019-2024, using keywords: adherence to therapy in adolescents, asthma, therapy control.Results. The literature review discusses the unique aspects of adherence to asthma therapy in adolescence, along with programs and methods successfully used to optimize medical care for adolescents with asthma.Conclusion. The course of asthma during adolescence changes due to various factors: hormonal changes, the child's desire for separation from parents, fear of being different from peers, increased societal and school demands, stress, and psychological characteristics. Consequently, researchers from various countries are developing methods to improve therapy adherence and asthma control, such as educational programs in schools, the use of digital health technologies, and even financial incentives for adolescents. Implementing modern methods to enhance medical care for young people with asthma may help reduce mortality rates in this age group.

Development and Validation of a Questionnaire to Measure Adherence to a Mediterranean-Type Diet in Youth.

Proper nutrition during childhood is crucial for preventing chronic diseases and ensuring optimal growth. This study aimed to develop and validate the Korean version of the KIDMED (K-KIDMED) questionnaire to accurately measure Mediterranean diet (MD) adherence among Korean children and adolescents. A total of 226 parents, representing their children and adolescents, completed the K-KIDMED, a 112-item food frequency questionnaire (FFQ), and a 24-h dietary recall method through an anonymous online survey. The K-KIDMED comprised 11 questions, with five excluded from the original scoring as they did not apply to the FFQ. Scores were categorized into three levels of adherence to the MD: low (1 or less), average (2-4), and good (5 or more). The agreement between total MD scores from the Korean version of the Mediterranean diet adherence screener and the FFQ was moderate (intraclass correlation coefficient = 0.455, 95% confidence interval: 0.346, 0.553). Among the 226 children and adolescents, 36.7% had low adherence to the KIDMED, 43.3% had intermediate adherence, and 19.9% had good adherence. Higher K-KIDMED scores were correlated with greater intakes of fiber, vitamin K, vitamin B6, and potassium (all p < 0.05). We developed the K-KIDMED as a valid tool to assess MD adherence in Korean children and adolescents.

Medication adherence and persistence in children and adolescents with attention deficit hyperactivity disorder (ADHD): a systematic review and qualitative update.

Low medication-adherence and persistence may reduce the effectiveness of ADHD-medication. This preregistered systematic review (PROSPERO CRD42020218654) on medication-adherence and persistence in children and adolescents with ADHD focuses on clinically relevant questions and extends previous reviews by including additional studies. We included a total of n = 66 studies. There was a lack of consistency in the measurement of adherence/persistence between studies. Pooling the medication possession ratios (MPR) and using the most common adherence definition (MPR ≥ 80%) indicated that only 22.9% of participants had good adherence at 12-month follow-up. Treatment persistence on medication measured by treatment duration during a 12-month follow-up averaged 170days (5.6months). Our findings indicate that medication-adherence and persistence among youth with ADHD are generally poor and have not changed in recent years. Clinicians need to be aware that various factors may contribute to poor adherence/persistence and that long-acting stimulants and psychoeducational programs may help to improve adherence/persistence. However, the evidence to whether better adherence/persistence contributes to better long-term outcomes is limited and requires further research.

Disparities in adolescent controller medication adherence, treatment barriers, and asthma control.

Disparities in asthma persist despite advances in interventions. Adherence and self-management behaviors are critical yet challenging during adolescence. Treatment barriers include individual factors as well as structural and social determinants of health. To determine differences in controller medication adherence, asthma control, and treatment barriers by race, income, and insurance and whether racial disparities persist when controlling for income and insurance. Associations between adherence, barriers, and control were also examined. Adolescents completed measures of treatment barriers and asthma control. Controller medication adherence was measured electronically. Descriptive statistics, means comparisons, and analyses of covariance were conducted. One hundred twenty-five adolescents participated (Mage = 14.55, SD = 2.01, 37.6% Black or African American, 55.2% White). Black or African American adolescents had significantly lower adherence than White adolescents, t(105) = 2.79, p = .006, Cohen's d = .55. This difference was not significant when controlling for income and insurance (p > .05). There was a significant difference in asthma control, F(1,86) = 4.07, p = .047, ηp 2 = .045, where Black or African American adolescents had better asthma control scores than White adolescents. Feeling tired of living with asthma was the most common barrier among all adolescents (62.4%). More Black or African American adolescents endorsed difficulty getting to the pharmacy than White adolescents, X2 (1, N = 116) = 4.86, p = .027. Racial disparities in asthma may be partially driven by income, insurance, and pharmacy access. Asthma burnout may be important to address for all adolescents with asthma.

Nutrition Literacy, Mediterranean Diet adherence and lifestyle of Adolescents, Giza, Egypt.

Nutrition Literacy, Mediterranean Diet adherence and lifestyle of Adolescents, Giza, Egypt.

Development of the medical adherence scale in adolescents using psychotropic medication and evaluation of validity and reliability in Turkish population

PurposeAlthough treatment non-adherence is relatively high among adolescents, there is a need for standardized measurement tools that measure adherence to treatment in adolescents. This study aimed to develop a new measurement tool to assess the adherence to treatment of adolescents with mental disorders who use psychotropic medication. MethodsThe data of this methodologically designed study were collected between 01.04.2022 and 01.07.2023 in the Department of Child and Adolescent Psychiatry of a university hospital in the Aegean Region of Turkey. The Medication Adherence Reporting Scale and Adolescent Medical Adherence Scale draft form were used for data collection. The scale items were formed from the themes, sub-themes, and statements in the qualitative study that the researchers had conducted with adolescents with mental disorders and their parents, clinicians' experiences, and systematic reviews and meta-synthesis in the literature. The study sample consisted of 95 adolescents with mental disorders. Exploratory factor analysis was performed with Varimax rotation to determine the factorial construct validity of the scale. Internal consistency analyses were performed in reliability analyses, and Cronbach's alpha coefficient was used. ResultsThe mean age of the adolescents was 14.18 years (1.81); 50.5% were male, and 96.8% were attending school. When the mental disorder diagnoses were analyzed, 65.3% of the adolescents were being followed up with Attention Deficit and Hyperactivity Disorder diagnoses, and 58.8% were using stimulants. The 12-item form of the Adolescent Medical Adherence Scale was found to have a three-factor structure with item-total correlation values ranging between 0.26 and 0.66, and these factors were named functionality, responsibility in treatment, and medication adherence. Factor loadings ranged between 0.44 and 0.86, and the items explained 62.98% of the total variance. The internal consistency coefficients of the scale were between 0.69 and 0.83 for the subscales and 0.82 for the total scale. ConclusionBased on the analysis and results used in this study, the Adolescent Medical Adherence Scale is a valid and reliable new measurement tool. Practice implicationsThis tool can be used in clinical settings to evaluate adolescents' treatment adherence and prognosis. Clinical studies conducted with adolescents can also determine adherence to treatment and affecting factors.

A Scoping Review on Strategies that Enhance Medication Adherence in Children and Adolescents with Attention Deficit Hyperactivity Disorder and Associated Outcomes

A Scoping Review on Strategies that Enhance Medication Adherence in Children and Adolescents with Attention Deficit Hyperactivity Disorder and Associated Outcomes

Giving adolescents with cystic fibrosis a voice: Predicting cystic fibrosis nutritional adherence from their decision-making involvement.

Suboptimal nutritional adherence in adolescents with cystic fibrosis (awCF) has been associated with lower lung function. AwCF often have more independence in dietary decisions than younger children, yet little research has examined how adolescent decision-making relates to nutritional adherence. This study explored whether components of adolescent decision-making involvement facilitate enzyme and caloric adherence in awCF. 37 families participated and completed study procedures. AwCF and caregivers completed electronic surveys, including the Decision-Making Involvement Scale (DMIS). The DMIS evaluated awCF behaviors during nutrition-related decision-making/discussions with caregivers using DMIS subscales: Child Seek (asking for help/advice from caregivers), Child Express (awCF stating opinions) and Joint/Options (awCF participating in joint decision-making or caregiver providing options). AwCF completed 2, 24-hr diet recalls via videoconferencing/phone to estimate adherence. Chart reviews collected medical information. DMIS subscales were regressed onto enzyme and caloric adherence. 43% of awCF met calorie recommendations; 48.6% took all enzymes as prescribed. Caloric adherence was positively correlated with adolescent- and parent-reported Child Seek (r = 0.53; r = 0.36) and adolescent-reported Joint/Options (r = 0.41). Per adolescent-report, the caloric adherence regression model was significant, with Child Seek contributing unique variance in caloric adherence (β = .62, p = .03). Parent-reported adolescent-decision-making involvement significantly predicted caloric adherence, but none of the subscales contributed unique variance. No other regressions were significant. When awCF participated in nutrition-related discussions with a caregiver, especially with questions, caloric adherence was better. Future research should examine whether family factors influence these results. AwCF are encouraged to ask questions in nutrition discussions.

Trends in adherence to the 24-h movement guidelines among US adolescents from 2011 to 2019: Evidence from repeated cross-sectional cycles of the Youth Risk Behavior Surveillance System.

Adherence to the 24-h movement guidelines is associated with various health benefits, but given the novelty of these integrative recommendations, little is known about year-to-year trends in guideline adherence in adolescents. This study investigated trends of adherence to the 24-h movement guidelines among US adolescents. Data from 2011 to 2019 cycles of the Youth Risk Behavior Surveillance System were used, which included 62 589 US adolescents aged 14-17 years (female: unweighted sample size = 31 876, 51%; weighted% = 50.1%). Participants self-reported their demographic information (i.e., sex, age, race/ethnicity), physical activity, screen time and sleep duration. Meeting the 24-h movement guidelines was operationalized as simultaneously engaging in 60 min or more of moderate-to-vigorous physical activity, no more than 2 h of screen time, and 8-10 h of sleep per day. Trend analysis was used to examine the secular changes in adherence to the integrated guidelines from 2011 to 2019. Downward trends in adherence to the 24-h movement guidelines were observed among adolescents from 2011 (3.6%) to 2019 (2.6%). After stratification by sex, age, and race/ethnicity, similar downward trends in the guideline adherence were observed in females and Black/African American adolescents. The lowest prevalence of meeting the individual guidelines was for the PA guidelines (25.6%). Movement guideline adherence was consistently lowest among females, older adolescents, and those who identified as Black/African American. Adherence to the 24-h movement guidelines has declined among US adolescents over the past decade. Interventions should prioritize an integrative approach that could increase concurrent adherence to each of the 24-h movement guideline, particularly among female, older and minority adolescents.