Adolescent Engagement Research Articles

Social media use and adolescent engagement in health risk behaviours: a systematic review and meta-analysis

BackgroundSocial media might influence adolescents' perceived social norms and subsequent engagement in behaviours with potentially negative effects on health (health-risk behaviours). We systematically reviewed studies investigating the relationship between social media and health-risk behaviours in adolescents (age 10–19 years). MethodsWe searched five databases (CINAHL, Embase, MEDLINE, APA PsycINFO, and SocINDEX), four preprint repositories (SSRN, SocArXic, PsyArXiv, and MedRxiv), and Google Scholar from Jan 1, 1997, to April 30, 2020, for studies reporting social media use (time spent, frequency, and exposure to health-risk behaviour content) and engagement in health-risk behaviours (PROSPERO: CRD42020179766). No geographical or language limits were applied, but only English-language studies were included, due to translation issues. Risk of bias was assessed using a modified Newcastle Ottawa Scale. We used random-effects meta-analysis; potential effect modification was explored with meta-regression and stratified analyses. FindingsOf 13 142 hits, 84 studies (n=571 175 participants) were included (79% [66 studies] cross-sectional): 55% (46 studies) with high risk of bias, 20% (17 studies) moderate, and 25% (21 studies) low. The most commonly investigated exposure was frequency of social media use (43 studies). Binary exposure meta-analyses showed that frequent social media use (versus infrequent) was associated with increased tobacco use (OR 1·8, 95% CI 1·4–2·3; n=236 300; four studies), alcohol use (1·5, 1·4–1·6; n=208 318; six studies), drug use (1·2, 1·0–1·5; n=59 823; three studies), gambling (2·8, 2·0–4·0; n=26 537; five studies), sexual risk (1·7, 1·4–2·1; n=46 483; eight studies), anti-social behaviour (1·7, 1·4–2·0; n=53 539; four studies), and multiple risk behaviours (1·8, 1·3–2·4; n=43 571; two studies). Increased time (2·3, 1·6–3·4; n=10 831; three studies) and exposure to health-risk behaviour content (2·4, 1·3–4·7; n=14 731; five studies) was associated with increased harmful alcohol use. Heterogeneity varied across different outcomes (I2 16–98%). Sensitivity analyses showed that effect sizes were generally larger for cross-sectional studies than cohort studies. For alcohol use, anti-social, and sexual risk behaviours, effects were mostly larger in studies adjusted for pre-specified critical confounders (age, sex, and socioeconomic position) and those at low or moderate risk of bias, while for gambling and tobacco use, larger effects were found in unadjusted studies, and those with higher risk of bias. InterpretationSocial media use is adversely associated with unhealthy adolescent behaviours, with exposure to harmful content potentially linked to increased risk. However, more robust longitudinal studies are needed. Given increasing use of social media by adolescents and targeting of social media by unhealthy commodity industries, action to mitigate risks is needed. FundingMedical Research Council, Chief Scientist Office, NHS Research Scotland, and Wellcome Trust.

School Engagement and Context: A Multilevel Analysis of Adolescents in 31 Provincial-Level Regions in China.

According to ecological system theory, both the microsystem environment (home environment) and the more macrolevel environment (provincial environment) influence school engagement in adolescents. This study tests an ecological model of adolescents’ school engagement with 19,084 middle school students across 31 provincial-level regions in China. Multilevel modeling is used to predict adolescents’ school engagement (behavior, emotion, and cognition) at two levels, individual [gender and family socioeconomic status (SES)] and provincial (economy, public cultural facilities, technological industry and education). The school engagement of students varies significantly across provincial-level regions. SES positively affects the school engagement of students. Students benefit from the provincial environment when the economy is booming, public cultural facilities are adequate and education is flourishing. The development of the technology industry fails to boost students’ school engagement. Limitations and future directions are discussed.

Self-reported experience of orofacial injury, preventive practice, and knowledge of Iranian adolescent martial art athletes towards sports-related orofacial injuries

BackgroundIncreased engagement of adolescents in martial arts exposes them to a relatively high risk of experiencing orofacial injuries. We evaluated self-reported experience of orofacial injuries, preventive practice, and knowledge of management of sport-related orofacial injuries and related factors in adolescent Karate and Taekwondo athletes in Iran.MethodsThis cross-sectional study was conducted on Iranian martial arts athletes including Karate and Taekwondo aged 11–17-year-old in 2020 via an online questionnaire. The anonymous self-administrated questionnaire had four parts: background (age, gender, duration of sports activity, training sessions per week, and previous education on orofacial injury); self-reported experience of orofacial injury; preventive practice including mouthguard and helmet use; and knowledge of emergency management of orofacial injuries. Preventive practice and knowledge scores were calculated by summing up the scores of corresponding questions (possibly range 0–7). A linear regression model and the Pearson correlation served for statistical analysis.ResultsTotally, 295 athletes with a mean age of 14.56 ± 1.91 years participated in the study. A quarter (n = 74, 25.1%) of athletes stated that they had received training on prevention of orofacial injuries. Only 3.7% (n = 11) of the participants reported the use of custom-made mouthguards, and 62% (n = 183) reported a positive history of orofacial injuries. A significant relationship existed between self-reported orofacial injury and age (β = − 0.32, p < 0.001), hours of training per week (β = 0.12, p = 0.037), type of sport (β = 0.11, p = 0.049), and previous training on orofacial injuries (β = − 0.14, p = 0.010). No difference existed in the history of orofacial injury between females (n = 114) and males (n = 69) (p = 0.374). The mean score of self-reported preventive practice and knowledge of management of orofacial injuries was 3.53 ± 1.82 (out of 7) and 1.67 ± 1.10 (out of 7), respectively. Age (β = 0.19, p = 0.002) and history of orofacial injury (β = − 0.15, p = 0.010) were associated with the score of self-reported preventive practice. Female athletes (β = 0.11, p = 0.048) and athletes who exercised more per week (β = 0.15, p = 0.012) had significantly more knowledge on management of orofacial injuries.ConclusionAdolescent athletes had relatively undesirable preventive practices and a distinct lack of knowledge. The high occurrence of self-reported orofacial injuries indicates the importance of more education and stricter rules for the athlete population.

The impact of childhood adversity on addictive behaviours through impulsivity among adolescents

Abstract Background Little is known about the mechanism by which Adverse childhood experience (ACE) affects adolescent's engagement in addictive behaviours in the African context. We investigated the role of impulsivity in the link between ACE and behavioural addiction among schooled youth in Tunisia. Methods We performed a cross sectional study among 1940 schooled adolescents in the region of Mahdia (Tunisia) from January to February 2020. We used the validated Arabic version of the World Health Organization ACE questionnaire. The Barratt Impulsivity Scale as well as the Internet Addiction Test were used as screening tools for impulsivity and internet addiction. Results A total of 1940 adolescents returned the questionnaires. About 97.5% reported experiencing at least one ACE. We found that ACEs score predict addictive behaviours through impulsiveness (p &amp;lt; 0.001; % mediated = 16.7%). Particularly, intra-familial ACEs (p &amp;lt; 0.001; % mediation = 27.8%) demonstrated the most mediation by impulsivity followed by exposure to extra-familial ACEs (p &amp;lt; 0.001; % mediation = 10.5%). There were interactions between ACE and impulsivity in terms of their impact on internet addiction (p &amp;lt; 0.001; % mediation = 37.5%). Conclusions The mediation part of impulsivity in the association between ACE and cyberaddiction is alarming. Key messages Impulsive behaviors mediates the effect of childhood adversity on addictive behaviors. Great mediation part of impulsivity (37.5%) for internet addiction among Tunisian youth.

Quality of adolescent and youth-friendly health services in Dehana district public health facilities, northeast Ethiopia: Using the Donabedian quality framework.

Adolescents and youths who need exceptional healthcare are the shapers and leaders of our global future. However, many of them are died prematurely, while others suffer from diseases partly because of the poor quality of health services. Thus, this study aimed to assess the quality of Adolescent and Youth-friendly Health Services (AYFHS) and associated factors in the public health facilities of Dehana district, Northeast Ethiopia. A facility-based quantitative cross-sectional study supported with a qualitative component was conducted from February 24 to March 30, 2020. The quality of AYFHS was measured using the Donbidean framework (structure, process and output component). Accordingly, a total of 431 adolescents and youths, five health facilities, twenty-five client-provider interaction observations, and nine key informant interviews were conducted. Binary logistic regression analysis was done, and variables with a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with its 95% Confidence Interval (CI) were used to measure the association. The qualitative data were audio-recorded and transcribed verbatim. Then, Open Code 4.03 software was used to manage and analyze the data. The quality of adolescent and youth-friendly health services was 58.8, 46.4, and 47.2% for structural, process, and output quality dimensions, respectively. The predictor variables for output quality were, being a student (AOR: 2.07, 95%CI: 1.07-3.40), farmers (AOR: 2.59, 95%CI: 1.25-5.39), own income sources (AOR: 1.99, 95%CI: 1.03-3.85), exempted services (AOR: 2.30, 95%CI: 1.43-3.71) and long waiting time (AOR: 3.8495%CI: 1.80-8.23). The overall quality of adolescent and youth-friendly health services was still lower than the WHO good quality standards. The structural quality dimension was affected by the unavailability of adequate and trained health service providers, poor engagement of adolescents and youths in the facility governance structure, unavailability of guidelines, protocols and procedures. In contrast, the process quality dimension was also compromised due to the provider's poor compliance with the national AYFHS guidelines. Therefore, health facilities need to engage adolescents and youths in the health facility governance structure, and providers should comply with the national guideline.

The Association between Externalizing and Internalizing Problems with Bullying Engagement in Adolescents: The Mediating Role of Social Skills.

Bullying has severe public health consequences, due to its high prevalence worldwide and devastating effects on physical and mental health. Therefore, it is relevant to further understand the factors that contribute to the emergence and maintenance of bullying. This study aimed to examine the differential mediating role of social skills in the relationship between (i) externalizing problems and engagement in aggressive bullying behaviors, and (ii) internalizing problems and the engagement in victimization bullying behaviors. Participants were 669 Portuguese adolescents aged between 12 and 19 years. The Social Skills Improvement System-Rating Scales and the Scale of Interpersonal Behavior at School were used to assess social skills and the engagement in bullying behaviors, respectively. Boys scored higher on aggressive behaviors and externalizing problems. Girls reported higher scores on internalizing problems, communication, cooperation and empathy. Social skills differently mediated the association between behavior problems and engagement in bullying. While empathy negatively mediated the association between externalizing problems and aggressive bullying behaviors, assertiveness negatively mediated the relationship between internalizing problems and victimization bullying behaviors. The risk factors for engaging in bullying are discussed, and so are the protective ones, which may help to prevent bullying behaviors and reduce their negative impact.

Adolescents' perceptions of barriers and facilitators to engaging in mental health treatment: A qualitative meta-synthesis.

One in seven children, aged 3-17, have a mental health diagnosis with suicide being the second leading cause of death in the United States in persons aged 10-24. Adolescents are at high risk for mental health disorders, substance use, and risky behaviors, yet most adolescents never receive treatment. Research is needed to answer the question, "What are adolescents' perceived barriers and facilitators to engaging in mental health treatment?" A four-step qualitative meta-synthesis design included: A structured research question and search strategy, data immersion through quality appraisal, thematic synthesis of primary research studies, and reciprocal translation of derived themes. Eight studies met inclusion criteria. Autonomy was the primary theme that emerged. Meta-synthesis produced five subthemes: (a) choice as integral to engagement, (b) stigma as barrier to engagement, (c) quality of the therapeutic relationship as integral to engagement, (d) systemic influences as both barrier and facilitator to engagement, and (e) mental health literacy as crucial factor in decision to engage. Adolescents require autonomy to engage in mental health treatment. Improving treatment engagement in adolescents requires interventions that address their ability to be autonomous.

70.2 WE SBIRE (SCREENING, BRIEF INTERVENTION, AND REFERRAL TO EVALUATION FOR SUBSTANCE USE) TO MAKE SBIRT (SUBSTANCE SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT) WORK

Less than 10% of adolescents who could benefit from substance treatment receive it. In an effort to address this gap in 2011, the AAP recommended universal adoption of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in pediatric primary care settings. Unfortunately, despite widespread implementation of SBIRT, service utilization figures have remained stubbornly persistent over the past decade, leading us to conclude that SBIRT, in its current form, is not working. To overcome the limitations of SBIRT, Paula Riggs, MD, has partnered with pediatric primary care providers to develop “warm handoff” procedures to enhance adolescent substance treatment engagement in which pediatric clinicians screen and refer substance-involved adolescents for brief consultative evaluation (SBIRE), not treatment (SBIRT). Pediatric primary care providers are trained to administer Screening to Brief Intervention (S2BI)—a brief, well-validated substance screening measure—at annual adolescent well-visits. Youth who report at least monthly drug/alcohol use are asked for their consent to share screening results and be contacted by an expert in adolescent substance use for a brief consultative evaluation. During a brief telephone consultation/evaluation lasting 15 to 20 minutes, youth are provided with psychoeducation relevant to their screening results, along with information about treatment and motivational enhancement approaches, to facilitate treatment engagement. Since implementation (September 2020), 27 adolescents have screened positive on the S2BI and consented to referral and brief expert consultation/evaluation. Among these adolescents, 1 out of 27 lived in a different state and 2 out of 27 could not be reached by phone despite multiple attempts. Among the 24 who participated in brief telephone consultation/evaluation, 18 (75%) engaged in substance treatment (5 inpatient detox or residential; 13 outpatient substance treatment). These preliminary findings suggest that the SBIRE approach may significantly enhance adolescent substance treatment engagement compared to conventional SBIRT protocols.

Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study.

BackgroundEffective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic.ObjectiveThis study aims to assess the effectiveness of and adolescent engagement with a mobile app–based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program.MethodsThis prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo’s health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up.ResultsOf the 73 adolescents who were approached for enrollment, 40 (55%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83% (33/40) of participants completing at least 7 coaching sessions. In total, 78% (18/23) of participants rated the app as good to excellent and 70% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months.ConclusionsThe use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake.

Adolescent Self-Perceived Social Engagement following Inter-professional Community Adolescent Group in Inpatient Rehab

<h3>Research Objectives</h3> To investigate adolescents perceived effectiveness of group therapy in relation to social engagementTo investigate the effectiveness of adolescent groups in the inpatient rehab setting <h3>Design</h3> Pre-post administration of PROMIS Peer Relations Questionnaire. <h3>Setting</h3> Adolescents (12y/o+) in inpatient rehab at the Children's Hospital of Philadelphia presenting with cognitive, physical and/or psychosocial impairments secondary to illness or injury. Patient must be deemed medically stable by the physician. <h3>Participants</h3> 24 subjects total. 9 incomplete data (either missing pre- or post-questionnaire). 14 complete data. Diagnoses varying from oncologic in nature to neuro-based impairments. <h3>Interventions</h3> Monday-Thursday 60 minutes/day group. Days consist of: introduction/planning, gross motor/sport activity, cooking task, outing. Group is facilitated by CLS, OT, and/or SLP/PT depending on the day. Group dynamics follow Cole's 7 Stages. <h3>Main Outcome Measures</h3> PROMIS Peer Relations. <h3>Results</h3> 10 adolescents showed improvements in their overall score. The average score improved by 8.8. 4 adolescents showed a decrease in scores with the average score decrease being 7.5. <h3>Conclusions</h3> Peer-related outcomes measures are helpful to determining a patient's self-perceived emotions/skills, however, some patients require assist with filling out questionnaires due to visual, motor, or cognitive concerns. The majority of participants showed an improvement in their self-perceived peer relations following group therapy in inpatient rehab. Subjective data was not able to be gathered based on particular parts of the group that they felt were beneficial or less beneficial. An additional study would be warranted to see how having a questionnaire being presented in a standard fashion by a consistent provider would impact the overall scores for the adolescent population, especially in relation to adolescent development with regards to emotions/mood fluctuation day-to-day. <h3>Author(s) Disclosures</h3> No disclosures to discuss.

Be ACTive! mindfulness and acceptance-based interventions for physical activity engagement in adolescents.

Be ACTive! mindfulness and acceptance-based interventions for physical activity engagement in adolescents.

“The music gets through”: Experiences of classical composers and observations of hospitalized adolescents in a music-based intervention

Music is a valuable aid for hospitalized adolescents as they navigate normative and non-normative stressors. Music-based interventions link these adolescents with composers who write music designed to facilitate emotional well-being; yet little is known about how each engage and find meaning in these interventions. This study examines the motivations and musical choices of composers of music for mental health, as well as how hospitalized adolescents engage in and benefit from the creative process. Ten adolescents with extensive hospital experiences, six composers, two hospital staff, and one program coordinator were observed and/or interviewed in a music-based intervention. Interpretative phenomenological analysis (IPA) of interviews with composers, coordinators, and hospital staff was performed to gain deep understanding of psychosocial benefits for all groups. This was supplemented by ethnographic observation of the program. Qualitative themes of Composer Reasoning, Listener Influence, and Adolescent Engagement revealed interplay of challenges and rewards for composers and adolescents. Composers reported positive change in adolescent mood and engagement and reflected on this within the context of meaning-making and social connection. This study demonstrates the potential value of music as a tool to promote positive identity and contributes to the body of research forging a connection between the arts and health care.

Patterns of Engagement With an Incentivized Text Messaging Intervention (MyDiaText) in Teens With Type 1 Diabetes in Suboptimal Control.

Adolescents with type 1 diabetes are vulnerable to suboptimal glycemic control, generally due to insufficient self-care behaviors (1,2). Because they have some of the highest rates of mobile communication technology use (3), this modality may hold promise for providing reminders or encouragement to adolescents to engage in self-care. However, the effects of text messaging interventions on self-care and glycemic outcomes are mixed, with some reports favoring improvements in teen self-care behaviors such blood glucose monitoring frequency or medication adherence (4–7). In an alternative attempt to reach this high-risk age-group, researchers have explored the use of financial incentives to promote self-care behaviors, which yielded some glycemic benefit in the short term (8,9). However, there is limited research on the combination of a financial incentive and a mobile health intervention (10,11) and the potential benefits that could accrue from blending these approaches. Nonetheless, use of either a unimodal or a bimodal intervention requires that adolescent recipients remain engaged with the program. In this report, we describe adolescent engagement during a 6-month study of a psychoeducational text messaging intervention that incorporated financial incentives. The primary study included adolescents with type 1 diabetes in suboptimal control and showed a potential increase in self-reported self-care in those receiving the intervention as intended (10). This analysis of the primary study’s intervention group described patterns of adolescent engagement with the intervention and identified factors associated with responsiveness. We also evaluated the potential impact of engagement on glycemic outcomes and self-care. This study analyzed 6 months of data from teenagers with type 1 diabetes receiving an incentivized text messaging intervention aimed at increasing education and support for diabetes self-care. Youths were eligible for inclusion if they were 12–18 years of age, had a duration of type 1 diabetes of …

Core Elements of Family Therapy for Adolescent Behavioral Health Problems: Validity Generalization in Community Settings

ABSTRACT Objective The core elements of family therapy for adolescent mental health and substance use problems, originally distilled from high-fidelity sessions conducted by expert clinicians, were tested for validity generalization when delivered by community therapists in routine settings. Method The study sampled recorded sessions from 161 cases participating in one of three treatment pools: implementation trial of Functional Family Therapy (98 sessions/50 cases/22 therapists), adaptation trial of Multisystemic Therapy (115 sessions/59 cases/2 therapists), and naturalistic trial of non-manualized family therapy in usual care (107 sessions/52 cases/21 therapists). Adolescents were identified as 60% male and 40% female with an average age of 15.4 years; 49% were Latinx, 27% White Non-Latinx, 15% African American, 3% another race/ethnicity, 6% race/ethnicity unknown. Session recordings (n = 320) were randomly selected for each case and coded for 21 discrete family therapy techniques. Archived data of one-year clinical outcomes were gathered. Results Confirmatory factor analyses replicated the factor structure from the original distillation study, retaining all four clinically coherent treatment modules comprised of all 21 techniques: Interactional Change (ICC = .77, Cronbach’s α = .81); Relational Reframe (ICC = .75, α = .81); Adolescent Engagement (ICC = .72, α = .78); Relational Emphasis (ICC = .76, α = .80). Exploratory analyses found that greater use of core techniques predicted symptom improvements in one treatment pool. Conclusions Core techniques of family therapy distilled from manualized treatments for adolescent behavioral health problems showed strong evidence of validity generalization, and initial evidence of links to client outcomes, in community settings.

A Six-Step Process to Reduce Bullying in Schools; The Content of a Health Promotion Intervention to Reduce Bullying Among Early Adolescents in a Rural School in Sri Lanka

Bullying is a form of aggression which has negative impacts on health. Bullying acts are reported to be common among early adolescents in rural schools in Sri Lanka. It is timely to design and implement interventions aiming to reduce bullying in schools in Sri Lanka. In this article, we aim to describe the process and the content of a health promotion intervention carried out aiming to reduce bullying among early adolescents in a rural school in Sri Lanka. The intervention is comprised of a six-step process. A logical framework developed based on Samarasinghe et al (2011) was used to guide the intervention. The content of the intervention was designed following health promotion principles. Health promotion aims for empowering people- to take collective community actions aiming to achieve desired health outcomes. The intervention for bullying was designed aiming for empowering early adolescents -to generate collective actions to reduce bullying in their school. In the intervention, adolescents not merely participated but also engaged and involved in modifying the planned intervention. Different activities, brainstorming sessions, facilitated discussions, role plays, etc. were carried out in the process. In this intervention, the health promotion approach we employed enabled engagement and involvement of adolescents beyond mere participation in the intervention.

Collecting Social Media Information in a Substance Use Intervention Trial With Adolescent Girls With Lifetime Substance Use History: Observational Study.

BackgroundAdolescents with juvenile legal system contact face numerous barriers to participation in behavioral health intervention research, including housing disruption, legal privacy concerns, and systems mistrust. Technology, such as social media, may be a novel and developmentally appropriate adolescent research study engagement and retention tool.ObjectiveWe examined data on social media information collected for study retention purposes from adolescents participating in a substance use intervention trial.MethodsData were collected as part of a randomized controlled trial determining efficacy of a group-based substance use intervention for girls and young women (12-24 years) with substance use histories referred from legal and school systems in the United States. Baseline demographic and social media information was analyzed from the subset of 114 adolescent girls (mean age 15.7 years; range 13-18 years), of whom 31.6% (36/114) were legally involved, 87.7% (100/114) belonged to minoritized racial/ethnic groups, and 32.5% (37/114) received public assistance.ResultsMost girls (74/114, 64.9%) provided at least one social media account (Instagram, 95% [70/74]; Facebook, 27% [20/74]; and Twitter, 11% [8/74]) during study enrollment. Legally involved girls were significantly less likely to provide social media information than school-referred girls (44% [16/36] versus 74% [58/78]; χ21 [N=114]=9.68, P=.002).ConclusionsObtaining social media information for study retention purposes from adolescent girls with lifetime substance use appears possible; however, particular subgroups (ie, legally involved girls) may be less likely to provide accounts. Factors shaping legally involved girls’ willingness to provide social media information, including mistrust and privacy concerns, and the impact of researcher’s access to social media information on study retention are critical directions for future research.Trial RegistrationClinicalTrials.gov NCT02293057; https://clinicaltrials.gov/ct2/show/NCT02293057

“It’s about making adolescents in charge of their health”: policy-makers’ perspectives on optimizing the health care transition among adolescents living with HIV in Kenya

ABSTRACT The health care transition (HCT) from pediatric to adult care is a potential contributor to poor clinical outcomes among adolescents living with HIV (ALHIV). In sub-Saharan Africa (SSA), there is limited information on effective tools and processes to prepare and support ALHIV through this transition. This study elicited perspectives of policy-makers regarding barriers and facilitators to successful HCT among ALHIV in Kenya. Twenty in-depth interviews (IDIs) were conducted with policy-makers using a semi-structured guide. Using the socio-ecological model (SEM) as an organizing framework, directed content and thematic network analyses methods were used to characterize themes related to key influences on HCT processes and to describe actionable recommendations for improved tools and resources. Policy-makers identified multilevel support, including the development of a triadic relationship between the caregiver, healthcare worker (HCW) and adolescent, as an essential strategy for improved HCT success. Across the SEM, policy-makers described the importance of actively engaging adolescents in their care to promote increased ownership and autonomy over health decisions. At the structural level, the need for more comprehensive HCT guidelines and improved HCW training was highlighted. Expanded HCT tools and guidelines, that emphasize supportive relationships and intensified adolescent engagement, may improve HCT processes and outcomes.

Family Socioeconomic Status and Learning Engagement in Chinese Adolescents: The Multiple Mediating Roles of Resilience and Future Orientation.

This study explored the mediating effects of resilience and future orientation on the relationship between family socioeconomic status (SES) and learning engagement within the context of Chinese culture based on the cognitive theory of social class. A total of 1,245 junior high school students were recruited to complete anonymous questionnaires regarding the objective and subjective SES of their families, resilience, future orientation, and learning engagement. The mediating effects were tested by stepped multiple linear regression. Results indicated the following: (1) the relationships between objective and subjective SES, resilience, future orientation, and learning engagement was significantly positive; (2) resilience only mediated the relationship between subjective SES and learning engagement, whereas future orientation mediated the relationships between objective/subjective SES and learning engagement; (3) resilience and future orientation sequentially mediated the relationship between subjective SES and learning engagement. The current study contributes to a better understanding of how family SES influences adolescent academic performance from the perspective of adolescent cognitive abilities. In addition, this study provides implications for the prevention and intervention of academic performance of poor adolescents due to low SES.

Young and invisible: a qualitative study of service engagement by people who inject drugs in India

ObjectivesThe HIV epidemic in India is concentrated in key populations such as people who inject drugs (PWID). New HIV infections are high among young PWID (≤30 years of age), who...

Between two worlds: Exploring esports betting in relation to problem gambling, gaming, and mental health problems.

Background and aimsEsports betting is an emerging gambling activity where individuals place bets on an organized video gaming competition. It represents only one of several gambling activities commonly endorsed by adolescents. To date, limited research has explored the relationship between esports betting and mental health among adolescents and its convergence with both problem gambling (PG) and problem video gaming (PVG). The present study examined the relation between esports betting, PG and PVG, and both externalizing and internalizing problems among adolescents while accounting for adolescents' video gaming intensity (i.e., how often they play 2 h or more in a day) and engagement in other gambling activities.MethodsData was collected from 6,810 adolescents in Wood County, Ohio schools. A subset of 1,348 adolescents (M age = 14.67 years, SD = 1.73, 64% male) who had gambled and played video games during the past year were included in the analyses.ResultsApproximately 20% (n = 263) of the included sample had bet on esports during the past year. Esports betting was positively correlated with other forms of gambling, both PG and PVG, and externalizing behaviors. Mediation analyses revealed esports betting was associated to both internalizing and externalizing problems through PVG and not PG.ConclusionsEsports betting may be particularly appealing to adolescents who are enthusiastic video gamers. As such, regulators must be vigilant to ensure codes of best practices are applied to esports betting operators specifically for underaged individuals.