Adolescent Health Outcomes Research Articles

Investigating Affective Responding to Daily Positive Events Among Adolescents Using Ecological Momentary Assessment

The experience of positive events is associated with increased positive affect, which can beneficially impact the physical and mental health outcomes of adolescents. Despite an increase in important life events during adolescence, little research has examined the influence of positive events on affect in this population. This study used Ecological Momentary Assessment to investigate individual differences in the effects of daily positive events on momentary positive and negative affect and event-specific positive affect among 136 adolescents ( M age = 13.03 years). Results indicated that interpersonal and independent events elicited greater event-specific positive affect than non-interpersonal and dependent events. Dependent interpersonal events were associated with the greatest positive affect compared to other combinations of event types. Gender did not moderate these effects. These findings may address the gap in the literature regarding the types of daily positive events that elicit the most positive affect in adolescents, and in turn, may enhance well-being.

Social capital and oral health in children and adolescents: Asystematic review and meta-analysis.

To systematically evaluate the association of individual and contextual social capital with oral health outcomes in children and adolescents. Electronic searches were performed in PubMed/Medline, Embase, Web of Science and Scopus databases for articles published from 1966 up to June 2021. Two calibrated reviewers screened and critically appraised the identified papers. Observational studies that evaluated the relationship of individual or/and contextual social capital or their proxies with oral health outcomes in children and adolescents using validated methods were included. Quality assessment was conducted using the Newcastle-Ottawa Scale. Data were extracted for narrative synthesis and meta-analysis followed by a meta-regression model. Meta-analysis using random effects method was used to estimate pooled prevalence ratio (PR) and 95% confidence intervals (CI). Of the 3060 studies initially retrieved, 31 were included in the systematic review and 21 in the meta-analysis, totalling 81241 individuals. The clinical outcomes included dental caries and gingival bleeding and subjective outcomes were oral health-related quality of life (OHRQoL) and self-rated oral health (SROH). Individuals with lower levels of individual social capital had a higher prevalence of poor clinical (PR 1.11; 95%CI 1.02-1.22) and subjective (PR 1.25; 95%CI 1.09-1.45) oral health conditions. The prevalence of worse clinical (PR 1.34; 95%CI 1.11-1.61) and subjective (PR 1.56; 95%CI 1.13-2.16) oral health outcomes were also associated with lower levels of contextual social capital. In general, the contextual level of social capital exerted more impact, and the subjective oral health outcomes were the more affected. Contextual and individual social capital were positively related to oral health outcomes, such as dental caries, gingival bleeding, SROH and OHRQoL in children and adolescents.

A systematic review protocol of quantitative instruments of income inequality in studies of children and adolescents

Background: Income inequality is an important indicator of socioeconomic position which is a determinant of social, psychological, and physical health outcomes from childhood to adulthood. Different income inequality instruments (metrics) are used to investigate associations between income inequality and health outcomes (e.g. Gini coefficient, Theil Index). Income inequality instruments provide unique information on the construct of socioeconomic inequality. Albeit there is variation in studies as to the type and rationale for using a particular quantitative instrument of income inequality. The aim of this systematic review will investigate and identify the most used quantitative income inequality instrument in studies of children and adolescents Methods: The PRISMA-P framework will be applied to identify high quality articles (PROSPERO: CRD42021259114). A search will be conducted in PubMed, Embase, and PsycINFO. The search will include studies concerned with income inequality and/or socioeconomic inequality in children and adolescents. All articles will be independently reviewed, data extracted, and quality appraised by two reviewers and a third to arbitrate disputes. Articles will be initially reviewed by title and abstract using inclusion criteria. A data extraction form will be used. Three questions will be answered on the quality of the rationale for using a particular income inequality instrument and the Newcastle-Ottawa Scale will be used to assess bias and quality. The primary outcome of interest is the type and frequency of quantitative income inequality instrument used and the study outcome associated with that income inequality instrument. Conclusions: This systematic review will aim to explore and provide a summary of the different types of quantitative income inequality instruments used in studies of child and adolescent populations. This will help to guide researchers and policy makers on the inclusion and use of income inequality metrics in future studies aimed at understanding associations with health and social outcomes in children and adolescents.

Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design.

BackgroundTreating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined.ObjectiveThis study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns.MethodsAdolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality.ResultsParticipants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language.ConclusionsThe novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes.

Understanding the association between spirituality and mental health outcomes in adolescents in two non-Western countries: Exploring self-control as a potential mediator.

Empirical knowledge on what specific aspects of mental health are associated with spirituality is limited, and explanations for the mechanisms underlying this association is scarce. Furthermore, there is limited research on this association among individuals from non-Christian religious backgrounds and non-Western countries. The current study examined relations between spirituality and aspects of mental health in 1,544 adolescents from diverse religious backgrounds in two Eastern countries, India and the United Arab Emirates (UAE). Additionally, we examined mediating and moderating factors. Adolescents (58% female) ages 11-15 years completed a questionnaire on aspects of their mental health, spirituality, and self-control abilities. Results showed that spirituality had a significant positive association with life satisfaction and a significant negative association with internalizing problems, but a non-significant relation with externalizing problems, controlling for age, gender, and socioeconomic status. Self-control completely mediated the association between spirituality and life satisfaction, and this mediational relation was only present for adolescents from the UAE. Results support prior research suggesting positive associations between spirituality and adaptive mental health outcomes and extend these findings to adolescents from diverse religious backgrounds in non-Western countries. These findings have important clinical and policy implications for supporting the role of spirituality in an adolescent's life.

Health System Strategies and Adolescent Sexual Health: A Systematic Review of the Literature using Rodgers Concept Analysis Framework

Background: Health Systems Strategies play a key role in determining Adolescent Sexual Health outcomes. This study aims to review the literature on the relationship between Health Systems Strategies and Adolescent Sexual Health issues guided by Rodger's evolutionary concept analysis framework. The study further develops a Conceptual Framework that would guide a study that seeks to “Develop strategies to facilitate safe sexual practices in adolescents through Integrated Health Systems in selected Districts in Zimbabwe.” Methods: Adolescents, Health Systems, Sexual Health, and Strategies were used to search for published literature (in English) on Google Scholar, PUBMED, EBSCO, Cochran Library, and Science Direct. A total of 142 Articles and 11 reports were obtained, and the content was screened for relevance. This led to 42 articles and 03 reports being found suitable and relevant, and thus, the content was reviewed. Thematic analysis was done to identify attributes, antecedents, and consequences of Health Systems Strategies on Adolescent Sexual Health. These findings were then used to inform the development of the Conceptual Framework. Results: Key attributes, antecedents and consequences of Health System Strategies on Adolescent Sexual Health were identified. Strategies to Improve Adolescent Sexual Health outcomes were also identified. Conclusions: Different contextual factors influence policy changes and the consequences are mixed, with both positive and negative outcomes.

Effects of telehealth interventions for adolescent sexual health: A systematic review and meta-analysis of randomized controlled studies

Introduction Telehealth interventions to advance adolescent sexual health have evolved and are being used to promote adolescent sexual health knowledge and healthy sexual behaviors. However, as this area of intervention modality expands, there is a need to pause and examine the effects of telehealth interventions on adolescent sexual health outcomes. Addressing this knowledge gap will inform researchers and practitioners on the current state of evidence of telehealth interventions and inform further intervention development and testing. This study aimed to explore the meta-effects of telehealth interventions on self-efficacy of using condoms, condom use practices, and sexually transmitted infection testing behaviors among adolescents. Methods A systematic review and meta-analysis of randomized controlled trials were conducted. Seven databases (Academic Search Complete, CINAHL, EMBASE, MEDLINE, PubMed, OVID (UpToDate), and Web of Science) were searched for relevant full-text articles from the inception to May 2021. The revised Cochrane risk-of-bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random effects model to calculate the pooled effects of telehealth interventions for adolescents. Stata 16.0 was used for statistical analysis. Results A total of 15 studies (N = 5499) that used telehealth interventions with adolescents were included in the analysis. Telehealth interventions were found to increase self-efficacy for condom use (standardized mean difference: 0.22; 95% confidence interval: 0.08–0.36), practice for condom use (standardized mean difference: 0.35; 95% confidence interval: 0.23–0.47), and being screened/tested for sexual transmitted infections (standardized mean difference: 0.61; 95% confidence interval: 0.31–0.92). Discussion Telehealth interventions show promise as effective intervention delivery solutions for improving self-efficacy and certain sexual health behaviors among adolescents. These telehealth strategies could be important alternatives to in-person visits to accessing sexual health information or services near where they live. Future research should consider testing telehealth strategies where there is evidence of impact to move the field forward.

Innovative methods to analyse the impact of gender norms on adolescent health using global health survey data

BackgroundUnderstanding how gender norms affect health is an important entry point into designing programs and policies to change norms and improve gender equality and health. However, it is rare for global health datasets to include questions on gender norms, especially questions that go beyond measuring gender-related attitudes, thus limiting gender analysis. MethodsWe developed five case studies using health survey data from six countries to demonstrate approaches to defining and operationalising proxy measures and analytic approaches to investigating how gender norms can affect health. Key findings, strengths and limitations of our norms proxies and methodological choices are summarised. FindingsCase studies revealed links between gender norms and multiple adolescent health outcomes. Proxys for norms were derived from data on attitudes, beliefs, and behaviours, as well as differences between attitudes and behaviours. Data were cross-sectional, longitudinal, census- and social network-based. Analytic methods were diverse. We found that gender norms affect: 1) Intimate partner violence in Nigeria; 2) Unhealthy weight control behaviours in Brazil and South Africa; 3) HIV status in Zambia; 4) Health and social mobility in the US; and 5) Childbirth in Honduras. InterpretationResearchers can use existing global health survey data to examine pathways through which gender norms affect health by generating proxies for gender norms. While direct measures of gender norms can greatly improve the understanding of how gender affects health, proxy measures for norms can be designed for the specific health-related outcome and normative context, for instance by either aggregating behaviours or attitudes or quantifying the difference (dissonance) between them. These norm proxies enable evaluations of the influence of gender norms on health and insights into possible reference groups and sanctions for non-compliers, thus informing programmes and policies to shape norms and improve health.

Variability in Sexual History Documentation in a Primary Care Electronic Health Record System

PurposeWe sought to evaluate sexual history documentation and corresponding Chlamydia trachomatis screening practices across a large pediatric primary care network in the context of patient and clinic characteristics. MethodsDemographic, chlamydia screening, and provider note data were collected via electronic health record and manual chart audit for females aged 15-19 years attending annual well-adolescent visits, from February 1 to 28, 2019. Inductive qualitative textual analysis evaluated sexual history documentation as informative (containing clear indication of patient as sexually active or not) or noninformative and identified documentation subtypes. We examined patient and clinic characteristics by sexual history documentation type (informative or noninformative) and chlamydia screening status and documentation subtypes across clinic types using chi-square and Fisher’s exact tests. A multilevel logistic regression model considering clinic-specific random effects evaluated predictors of informative sexual history documentation. ResultsChart notes were examined for 1,062 patients across 31 unique clinics. Only 34.7% of chart notes were found to have informative sexual history documentation. Older patients (odds ratio: 1.51, 95% confidence interval: 0.99-2.31) and patients seen at clinics receiving U.S. Department of Health and Human Services Title-X funding (odds ratio: 11.05, 95% confidence interval: 1.34-90.86) had higher rates of informative documentation. The overall Chlamydia screening rate was 13.1%. ConclusionSexual history documentation varied widely across clinics, and the majority of chart notes were found to have noninformative documentation. Understanding and addressing barriers to informative sexual history documentation and comprehensive sexual health care is fundamental to improve adolescent sexual health outcomes, particularly given recently enacted federal electronic health record transparency policies.

"There's Nothing Wrong With You": Pain-Related Stigma in Adolescents With Chronic Pain.

Adolescents with chronic pain often experience symptom disbelief and social rejection by others secondary to "medically unexplained" symptoms. Although chronic pain is common in adolescents, limited research has conceptualized these social experiences as pain-related stigma in this population. The purpose of this study was to identify and describe pain-related stigma among adolescents with chronic pain and their parents using focus group methodology. Five adolescent focus groups (N = 18; Age M = 15.33 years, SD = 1.28) and three parent focus groups (N = 9) were conducted. Directed content analysis was used to analyze focus group transcripts. Stigma categories were developed a priori (Felt Stigma, Anticipated Stigma, Internalized Stigma, Concealment, and Controllability) and new categories emerged during analysis. Two coders reached 87.16% agreement for all groups (adolescent group: 90.34%; Parent group: 79.55%) and consensus was achieved for discordant codes. Adolescents and their parents endorsed pain-related stigma across all social domains. Analyses revealed four main categories for both groups (a) Felt Stigma (subcategories: pain dismissal, faking or exaggerating, and mental health stigma), (b) Anticipated Stigma and Concealment, (c) Internalized Stigma, and (d) Sources of Pain-Related Stigma (subcategories: pain invisibility, lack of chronic pain knowledge, lack of understanding, and controllability). Adolescents with chronic pain experience pain-related stigma from medical providers, school personnel, family members, and peers, which may have negative social and health implications. More research is needed to evaluate the link between pain-related stigma and health outcomes for adolescents with chronic pain. Clinical approaches targeting pain-related stigma are discussed.

Advancing Pediatrics During Turbulent Times.

Advancing Pediatrics During Turbulent Times.

Decade of research into the acceptability of interventions aimed at improving adolescent and youth health and social outcomes in Africa: a systematic review and evidence map

ObjectiveInterventions aimed at improving adolescent health and social outcomes are more likely to be successful if the young people they target find them acceptable. However, no standard definitions or indicators...

Discrimination and the Role of the Clinician.

Discrimination and the Role of the Clinician.

Improve in-depth immunological risk assessment to optimize genetic-compatibility and clinical outcomes in child and adolescent recipients of parental donor kidney transplants: protocol for the INCEPTION study

BackgroundParental donor kidney transplantation is the most common treatment option for children and adolescents with kidney failure. Emerging data from observational studies have reported improved short- and medium-term allograft outcomes in recipients of paternal compared to maternal donors. The INCEPTION study aims to identify potential differences in immunological compatibility between maternal and paternal donor kidneys and ascertain how this affects kidney allograft outcomes in children and adolescents with kidney failure.MethodsThis longitudinal observational study will recruit kidney transplant recipients aged ≤18 years who have received a parental donor kidney transplant across 4 countries (Australia, New Zealand, United Kingdom and the Netherlands) between 1990 and 2020. High resolution human leukocyte antigen (HLA) typing of both recipients and corresponding parental donors will be undertaken, to provide an in-depth assessment of immunological compatibility. The primary outcome is a composite of de novo donor-specific anti-HLA antibody (DSA), biopsy-proven acute rejection or allograft loss up to 60-months post-transplantation. Secondary outcomes are de novo DSA, biopsy-proven acute rejection, acute or chronic antibody mediated rejection or Chronic Allograft Damage Index (CADI) score of > 1 on allograft biopsy post-transplant, allograft function, proteinuria and allograft loss. Using principal component analysis and Cox proportional hazards regression modelling, we will determine the associations between defined sets of immunological and clinical parameters that may identify risk stratification for the primary and secondary outcome measures among young people accepting a parental donor kidney for transplantation. This study design will allow us to specifically investigate the relative importance of accepting a maternal compared to paternal donor, for families deciding on the best option for donation.DiscussionThe INCEPTION study findings will explore potentially differential immunological risks of maternal and paternal donor kidneys for transplantation among children and adolescents. Our study will provide the evidence base underpinning the selection of parental donor in order to achieve the best projected long-term kidney transplant and overall health outcomes for children and adolescents, a recognized vulnerable population.Trial registrationThe INCEPTION study has been registered with the Australian New Zealand Clinical Trials Registry, with the trial registration number of ACTRN12620000911998 (14th September 2020).

The effect of attending schools with higher ability peers on memory and language abilities in later‐life

AbstractBackgroundPeers influence adolescent behavior, educational, and health outcomes. Evaluating the influence of school‐mates’ cognitive aptitude on later‐life cognition is important for understanding the role of school segregation and tracking in establishing inequality. Yet, few studies have the data to study this. We used a national high‐school based study followed up 58 years later to examine if attending schools with more skilled peers predicts individual later‐life cognition.MethodIn 1960, about 5% of US high schools participated in Project Talent (n=377,000), where students reported demographics and completed aptitude tests. Some of these students were enrolled in 2018/2019 (mean age=74.6) in the Project Talent Aging Study (PTAS). For each PTAS participant, we calculated peer cognitive aptitude as the average of cognitive aptitudes of all other students who were in the same high school. The outcome, later‐life cognition, was operationalized as z‐score composites for language (semantic and phonemic fluency) and memory (CERAD learning list and delayed recall). For each outcome we estimated multilevel linear models to account for school clustering. All models were adjusted for age, sex/gender, parental education; secondary models were also adjusted for the participant’s own adolescent cognitive aptitude. To examine heterogeneity of the association, we evaluated interactions of peer ability with sex/gender, and the participant’s own adolescent cognitive aptitude.ResultParticipants were predominantly non‐Hispanic White (80.4%) and women (52.6%). Attending schools with peers who averaged 1 standard deviation higher on cognitive aptitude predicted better later‐life cognition prior to adjustment for own aptitude (language: β=0.162, 95% CI: 0.120, 0.205; memory: β=0.084, 95% CI: 0.041, 0.126), but not after adjustment. However, for women (β=0.045, 95% CI: ‐0.012, 0.101) and those with below mean adolescent cognitive aptitude (β=0.091; 95% CI: 0.016, 0.166), attending schools with higher ability peers predicted better later‐life language scores even after own ability was considered. There was no moderation of these relationships by race/ethnicity.ConclusionPeople with below average cognitive aptitude in adolescence had better language function 58 years later if they attended high schools with high aptitude peers. Future work will examine the plausible life‐course mechanisms to address why certain groups benefit more from schooling contextual factors.

Enhancing Early Engagement (E3) in mental health services training for children\u2019s advocacy center\u2019s victim advocates: feasibility protocol for a randomized controlled trial

BackgroundChild maltreatment is a major public issue in the United States, yet most children affected by abuse or neglect never engage in evidence-based practices (EBP) for child mental health. Children’s Advocacy Centers (CACs’) are uniquely situated to serve as Family Navigators who connect children impacted by maltreatment to appropriate EBPs. In fact, the CAC position of Victim Advocate mirrors the Mental Health Family Navigator national initiative.MethodsThe feasibility study protocol is to develop, implement, and evaluate web-based and consultative training for Victim Advocates to enhance early engagement in services (E3 training). The interactive web-based training embeds key targets of knowledge and skills related to family engagement, trauma, and EBP services. Participating CACs were randomized to E3 webinar-based training, E3 webinar plus consultation, or delayed training. The project will test the E3 training’s impact on key mechanisms of change (e.g., knowledge, skills) to improve rates of screening, referral, and access to EBP services. The feasibility of implementing the training program and differential impact and costs by level of training will be examined.DiscussionThe overarching goal of this project is to test the feasibility of training that is readily implemented through CACs and examine the mechanisms for improving early engagement and, ultimately, child, and adolescent mental health outcomes. Results and cost findings will be used to plan a large-scale comprehensive, mixed-methods hybrid type II effectiveness-implementation and cost-effectiveness trial of family navigator E3 training. If outcomes are positive, considerable infrastructure exists to support the scale-up and sustainability of E3 training nationwide, by embedding the training in national CAC training protocols.Trial registrationNCT04221633Date and version identifierMarch 25, 2021; Vers. 1.0 (original); September 11, 2021; Vers 2.0 (revision); October 29, 2021; Vers. 3.0 (revision)

Exploring the Interaction Effects of Gender Contentedness and Pubertal Timing on Adolescent Longitudinal Psychological and Behavioral Health Outcomes.

Background: Off-time pubertal timing (PT) and non-conforming gender identity have been reported to predict adverse health and well-being in adolescents. However, the joint effects of these two factors are less addressed. We aimed to investigate the main and interaction effects of gender identity, proxied by perceived gender contentedness (GC), and PT on longitudinal adolescent psychological and behavioral outcomes.Methods: Data (N = 1806, Mage = 13.3 ± 0.5 years) come from the Taiwan Youth Project, which prospectively followed a longitudinal cohort of Taiwanese junior high school students from 2000 (wave 1) to 2009 (wave 9). GC was self-reported at waves 1 and 9 in a binary response, and thus 4 GC trajectories were created. PT was defined using the Pubertal Developmental Scale, which mainly measured physical changes in puberty. Multiple linear regression analyses with gender stratification were applied to examine the effects of the GC trajectory and its interaction with PT on the outcomes.Results: A total of 1,562 subjects (86.5%) remained consistently satisfied with their gender, while the GC of 226 subjects (12.6%) changed at some point. Regression analyses found that males with gender dissatisfaction at wave 9 were likely to engage in delinquent behavior, and females in this group were more likely to have lower self-esteem, as compared to those with consistent GC. The interaction effect between the GC trajectory and PT appeared to be associated with smoking and drinking only at wave 1.Conclusions: These findings indicate that healthcare professionals should concentrate on gender non-conforming individuals at early adolescence, navigating them toward a healthy adulthood.

Abstract 14404: Developing a Frailty Score for Use in Children and Adolescents With Congenital Heart Disease

Introduction: Frailty is a complex syndrome that is associated with morbidity and decreased quality of life. It consists of 5 constructs: slowness, weakness, fatigue, energy expenditure, and body composition. Although frailty has been investigated in geriatrics, there is little describing the association of a frailty score on health outcomes in children and adolescents with chronic disease. The purpose of the study is to create a frailty score for use in children and adolescents and evaluate its usefulness in predicting morbidity in those with congenital heart disease (CHD). Hypothesis: We hypothesize that a higher composite frailty score is associated with an increased incidence in poor clinical status. Methods: Participants (Fig 1A) were enrolled in a cross-sectional study comparing the 5 components of frailty to age and sex matched controls. Frailty measures were modified for children and adolescents (Fig 1B). Constructs were combined to form a composite frailty score, which was correlated to clinical status, characterized as number of hospitalizations, emergency room (ER) visits, number of heart failure medications, at 23-31 month follow up. Results: The association between composite frailty scores, individual frailty measures, and outcomes was evaluated using Pearson correlation coefficient (Fig 1B). A higher frailty score was not found to be significantly correlated with outcomes. However, all individual frailty measures excluding body composition were inversely associated with the outcomes, indicating worse outcomes with poor functional status. Conclusions: Although composite frailty score was not associated with clinical outcomes, individual constructs were associated with worse clinical status. Our study was limited by a small and heterogenous sample, and future studies should be done to validate a frailty score for use in the CHD population. A frailty tool can identify at risk patients in this vulnerable population prior to sentinel events.

Weight Stigma and Mental Health in Youth: A Systematic Review and Meta-Analysis.

Over the past two decades, there has been a steady increase in research focused on the association between weight-based stigma and mental health outcomes in children and adolescents. The present study is a systematic review and meta-analysis of the associations between weight stigma and mental health in youth. A systematic search of PubMed, PsychInfo, and Embase databases was conducted in January 2020. Inclusion criteria included the following: (a) examined an association between weight stigma and a mental health outcome, (b) mean sample age <18 (+1 standard deviation) years, (c) written in English, and (d) peer reviewed. Forty eligible articles were identified. The moderating effects of age, sex (percent female), weight status (percent with overweight/obesity), and study quality were examined. Overall, meta-analytic findings using a random-effects model indicated a statistically significant moderate association between weight stigma and poorer mental health outcomes (r = .32, 95% confidence interval [0.292, 0.347], p < .001). Age and study quality each moderated the association between weight stigma and mental health. Generally, the study quality was fair to poor, with many studies lacking validated measurement of weight stigma. Although there was a significant association between weight stigma and mental health in youth, study quality hinders the current body of literature. Furthermore, findings highlight the lack of consideration of internalized weight stigma in child populations, the importance of using validated measures of weight stigma, and the need for increased awareness of how these associations affect populations of diverse backgrounds.

The association of parental involvement with adolescents\u2019 well-being in Oman: evidence from the 2015 Global School Health Survey

BackgroundThe parent-adolescent relationship plays a key role in adolescent development, including behaviour, physical health, and mental health outcomes. Studies on the parental factors that contribute to an adolescent’s dietary habits, exercise, mental health, physical harm and substance use are limited in the Middle East and North Africa region, with none in Oman. This study aims to investigate the association between parental involvement and adolescent well-being in Oman.MethodsCross-sectional data from the 2015 Global School Health Survey for Oman was analysed. The dataset consisted of 3468 adolescents. Adolescents reported on their parental involvement (checking to see if they did their homework, understanding their problems, knowing what they are doing in their free time and not going through their things without permission). Parental involvement was scored on a 20-point scale. Associations with the following dependent variables: nutrition, exercise, hygiene, physical harm, bullying, substance use, tobacco use and mental health well-being were done using Spearman’s correlations, linear and logistic regressions.ResultsThe surveyed population was 48% male, 65% aged 15 to 17 years old and 5% reported that they “most of the time or always” went hungry. Parental involvement was positively correlated with each of the dependent variables. Adolescents with higher parental involvement had significantly higher odds of good nutrition (1.391), hygiene (1.823) and exercise (1.531) and lower odds of physical harm (0.648), being bullied (0.628), poor mental health (0.415), tobacco use (0.496) and substance use (0.229).ConclusionsParental involvement plays a positive role in all aspects of adolescents’ well-being in Oman. Awareness campaigns and interventions aimed to help improve the well-being of adolescents should incorporate such positive role in their designs.