Adolescent Health Behaviors Research Articles

Addressing social norms for adolescent timing and spacing of pregnancy in low and middle-income countries: Developing a global research agenda.

Social norms shape adolescent sexual and reproductive health behaviours contributing to contraceptive and pregnancy outcomes. No global research agendas exist to guide research on adolescent social norms shifting in low- and middle-income countries (LMICs). We developed a social norms research agenda to improve adolescent healthy timing and spacing of pregnancy in LMICs. We adapted and applied the Child Health and Nutrition Research Initiative (CHNRI) method. A group of researchers guided the process, and consulted with diverse experts to develop a list of 21 research questions for global stakeholders to score via an online survey. Survey participants scored each research question according to four criteria (fills key gap, feasible, impactful, equitable). Research priority scores (RPS) and average expert agreement (AEA) statistics were calculated for each question and analysed overall and by stakeholder region and profession. We received 185 survey responses. Participants were, on average, 44 years old, 64% were women, 70% were from LMICs and 47% were implementers. The RPS ranged from 52 to 81% (74% median) and the AEA ranged from 49 to 70% (58% median). Nearly 70% of stakeholders gave the same score to each of the top five research questions. The top five research priorities focused on effective norm-shifting interventions (NSIs) strategies, processes and indicators to NSIs, and NSI adaptation and scale-up. Using a collaborative and rigorous process with diverse representation from LMICs and implementers, we reached consensus on five priority research questions to guide future adolescent social norms research to improve healthy timing and spacing of pregnancy in LMICs.

Insomnia severity and obesity mediated by health behaviors in adolescents.

Sleep difficulties in youth have been associated with numerous negative outcomes, such as higher risk of obesity. Though the relationship between sleep and obesity is not well clarified, past research has shown that modifiable health behaviors, such as diet, physical activity, and screen time, may explain this relationship. The purpose of this study was to simultaneously examine these health behaviors as mediators of the relationship between insomnia severity and obesity among a sample of adolescents aged 12-18years. English-speaking parents/legal guardians of adolescents were invited to participate in an online survey focused on pediatric sleep patterns, health behaviors, and weight. Parents/guardians (N = 599) reported on their adolescent's diet (i.e., consumption of fruits/vegetables, fast food, and breakfast), physical activity, screen time, and BMI. A multiple mediation analysis was run to test these health behaviors as mediators of the relationship between insomnia severity and BMI, after controlling for sex, age, race, and poverty. While insomnia was related to most health behaviors, screen time was the only significant mediator of the relationship between insomnia and BMI, after controlling for the effects of the other mediators and all covariates, ab = .04, 95% CrI [.01, .09]. Screen time has implications for both adolescents' sleep health and weight. Pediatric clinicians should systematically assess for, and provide, recommendations on ways to improve sleep and screen time use, in addition to providing traditional dietary and physical activity recommendations.

Unequal effects of adolescent health behaviors on adult cardiometabolic conditions: a cohort study

Abstract Background Health behaviors in adolescence could have a life-long effect on cardiometabolic health and differ by parental socioeconomic conditions. Adopting a life course perspective and a causal inference framework, we aimed to quantify the differential effect of adolescent unhealthy behaviors on adult cardiometabolic conditions by parental financial situation. Methods Using the National Longitudinal Study of Adolescent to Adult Health in the United States (n = 3,772), we estimated conditional causal effect by parental financial situation through inverse probability-weighted marginal structural models. Exposures were adolescent health behaviors (dietary habits, cigarette smoking, alcohol consumption and physical activity) and the effect modifier was parental financial situation (difficulty paying bills vs. no difficulty), both measured at ages 12-19 (1994-1995). Outcomes were cardiometabolic conditions (hypertension, stroke, cardiac failure, diabetes, chronic kidney disease), measured at ages 33 - 43 (2016-2018) using biomarkers and self-reports. Results There were 1,206 participants with cardiometabolic conditions after 20 years of follow-up. Alcohol consumption among adolescents with parental financial difficulty led to 325 more cardiometabolic cases (95% confidence interval: 2 - 647) compared to alcohol consumption by their peers without financial difficulty. This differential effect is driven more by cardiovascular conditions (hypertension, stroke, or cardiac failure) than by metabolic conditions (diabetes or chronic kidney disease). There were no differential effects of dietary habits, cigarette smoking and physical inactivity on the occurrence of adult cardiometabolic conditions. Conclusions Public health initiatives targeting alcohol consumption during adolescence could mitigate socioeconomic inequalities in adult cardiometabolic conditions. Key messages • Socioeconomically disadvantaged adolescents are more susceptible to the long-term detrimental health effects of alcohol consumption. • These susceptible groups may need targeted interventions to mitigate the cardiometabolic effect of alcohol consumption.

Income inequality and risky health behaviors of affluent adolescents in the post-Communist Europe

Abstract Background We aim to study the “golden youth” hypothesis and examine the risky behaviors of adolescents with high socioeconomic position (SEP) in post-Communist countries of Europe (PCCE) in relation to income inequality. Methods Adolescents aged 11-15 years from 14 PCCE participating in the Health Behavior in School-aged Children survey 2017/18 were included. A K-means cluster analysis was conducted to group adolescents based on tobacco smoking, alcohol use, binge drinking, and bullying perpetration. Generalized linear mixed models were fitted. Results Four clusters of adolescents were identified. The percentage of high-SEP adolescents in Cluster 1 (low risky behaviors) was slightly less compared to middle and low-SEP groups (70.9% vs 73.1% vs 73.9%, respectively). High-SEP adolescents were more likely to be in Cluster 2, characterized by frequent alcohol consumption but moderate binge drinking (14.3% vs 12.6% vs 10.7%). The prevalence of risky behaviors was similar between high and low-SEP adolescents in Cluster 3 (high smoking, frequent alcohol use, binge drinking, and moderate bullying) (8.0% vs 7.7% vs 8.2%) and Cluster 4 (high levels of bullying perpetration) (6.7% vs 6.5% vs 7.2%). Countries with higher Gini index were at a greater risk of reporting risky behaviors. High-SEP adolescents were more likely to engage in risky behaviors in countries with high income inequality. The odds ratios comparing high- vs. low-SEP adolescents ranged from 0.89 in the least unequal to 1.67 in the most unequal countries for multiple risky behaviors (Cluster 3: P-interaction = 0.042) and from 0.61 to 1.19 for bullying perpetration (Cluster 4: P-interaction = 0.030). Conclusions High-SEP adolescents in PCCE might be at an increased risk for unhealthy and vicious behaviors, especially in countries with high income inequality. This study highlights the need for policies that address income inequality to ensure the well-being of adolescents across socioeconomic strata in PCCE. Key messages • High-SEP adolescents might be at an increased risk for unhealthy behavior in PCCE. • Wide income inequality might contribute to risky behaviors among high-SEP adolescents.

The effect of educational intervention based on self-efficacy theory on promoting adolescent oral health behaviors through mobile application: a randomized controlled trial study

BackgroundOral health is so important for the adolescent age group that the World Health Organization has listed oral health as a lifelong prerequisite for maintaining public health; Therefore, this research was carried out with the aim of the effect of educational intervention based on self-efficacy theory on the promotion of behaviors related to oral health of adolescents through mobile application.MethodsIn this clinical trial, 80 adolescents aged 13–15 years from Shushtar city were selected using a random cluster sampling method and assigned to either the test or control group. The data collection tools included a standard questionnaire for measuring Oral health behavior (awareness, attitude, behavior) and a standard questionnaire for measuring self-efficacy (self-efficacy in brushing teeth, self-efficacy in using dental floss, and self-efficacy in visiting the dentist), as well as demographic characteristics. Training was provided to the test group via a mobile application for 3 weeks. During the intervention, the control group did not receive any training. Questionnaires were distributed in both groups immediately after the intervention, as well as one month and three months post-intervention, and data were collected. In accordance with research ethics, at the end of the study, the educational content was provided to the control group. Collected data were analyzed using SPSS 22 software and Mann-Whitney and Friedman non-parametric tests.ResultsThe findings showed that the educational intervention through the mobile application was effective in improving the average scores of awareness, attitude, self-efficacy in brushing teeth, flossing, visiting the dentist, and the behavior of adolescents regarding oral health behaviors, and this statistical difference was significant compared to before the educational intervention (P < 0.05), while no change was observed in the control group (p > 0.05).ConclusionConsidering that adolescents aged 13–15 years are the age of starting behavioral habits, including oral health behaviors, and on the other hand, their interest in using technology and virtual spaces is high, it is suggested that part of the education of this age group should be designed and implemented in the platform of mobile application.Clinical TrialRegistration in Iran Clinical Trial Center with ID code (IRCT20200120046204N1) Date of.Registration: 2018-02-25.

Mental health awareness intervention for junior high school students in Jakarta

Purpose: Adolescence is a time of significant physical, cognitive, emotional, and behavioral upheaval, making teenagers susceptible to experiencing difficulties. With a limited number of professionals available to address the escalating trend of mental health problems, there is growing interest in preventive measures. This study aims to evaluate the impact of a two-hour educational program aimed at promoting mental health awareness among junior high school students in Jakarta. Method: A one-group post-test only design was carried out in providing psychoeducational activities regarding adolescent development, mental health, and help-seeking behavior. Seventy-three students participated in this activity, selected purposively. Result: The findings from this research demonstrate that the students' comprehension of mental health and their willingness to seek help improved significantly after participating in a psychoeducation program. Conclusion: Understanding and promoting mental health awareness and literacy among adolescents has been shown to be effective through education on their world, mental health, and help-seeking behavior.

8256 Early Life Stress and Pubertal Predictors of Youth Substance Use Initiation: Does Sex Moderate the Relationship Between ELS, Puberty, and Substance Use Initiation?

Abstract Disclosure: A. Donovan: None. S. Assari: None. M. Shaheen: None. C. Grella: None. L. Richter: None. T.C. Friedman: None. Background: Early life stress (ELS) is a construct composed of children’s experiences of abuse, neglect, and conflict. Approximately 20% of adolescents in the United States have experienced ELS at some point, and these experiences influence adolescent and adult health behavior outcomes. Adults with a history of ELS display higher rates of substance use disorders (SUD) and report earlier initiation of substance use. Additionally, ELS has been associated with early puberty, which in turn is linked to earlier substance use initiation. Our study examines the roles of pubertal status, sex hormones (estradiol, testosterone, and DHEA) and ELS as predictors of the initiation of substance use among a nationally representative sample of male and female adolescents in NIDA’s Adolescent Brain Cognitive Development (ABCD) database. Methods: Baseline measures from the ABCD database release 5.0 were used to generate an ELS score (0-60), puberty assessed via parental report on the Pubertal Development Scale (PDS, 1-4), and sex hormones (estradiol, testosterone, and DHEA) were analyzed via salivary samples. The relationship between these scores and time to first use of alcohol, nicotine, and marijuana was determined via survival analysis utilizing a cox regression. Age was tested as a covariate in the interaction of ELS and time to first use of alcohol, nicotine, and marijuana. Data were analyzed overall and for biological boys and girls separately (N=11,866, 52%M 48%F. ages 9-11 at baseline). Results: We observed additive effects of PDS score, estradiol measure, age, and ELS on time to first use of any substance (alcohol, nicotine, or marijuana) and found age (Exp β= 1.029, p&amp;lt;0.001) and ELS (Exp β= 1.017, p&amp;lt;0.05) to be significant predictors of time to first use. After separating by sex, ELS was no longer a significant predictor for males (Exp β= 1.014, p=0.054), but remained a predictor for females (Exp β= 1.019, p&amp;lt;0.05) indicating the overall effect was driven by females. Additionally, salivary estradiol was a significant predictor of first use for females (Exp β= 1.208, p&amp;lt;0.05), while salivary DHEA and testosterone were not predictors for males or females. Conclusions: Our results indicate sex does moderate the relationship between ELS and substance use initiation within our population, with females showing increased risk of initiation with increases in estradiol. Further findings from our study will help to describe sex differences among the factors that increase the risk of substance use initiation among ELS-exposed youth and explore how these vary by substance. ABCD provides an unprecedented opportunity to explore the mechanisms behind complex effects of ELS by sex on risk factors for adolescent substance use initiation. Presentation: 6/1/2024

The Triple E project: a factorial randomised controlled trial to enhance engagement with eHealth approaches to improve health risk behaviours among adolescents

BackgroundDigital, or eHealth, interventions are highly promising approaches to help adolescents improve their health behaviours and reduce their risk of chronic disease. However, they often have low uptake and retention. There is also a paucity of high-quality research into the predictors of eHealth engagement, and a lack of studies that have systematically evaluated existing engagement strategies in adolescent populations. This paper describes the protocol for a randomised controlled trial which primarily aims to assess the effectiveness of different strategies in increasing engagement with a healthy lifestyles app, Health4Life. Associations between the engagement strategies and improvements in adolescent health behaviours (healthy eating, physical activity, sleep, recreational screen time, smoking, alcohol use) will also be examined, along with potential predictors of adolescents’ intentions to use health apps and their use of the Health4Life app.MethodsThe current study will aim to recruit 336 adolescent and parent/guardian dyads (total sample N = 672) primarily through Australia wide online advertising. All adolescent participants will have access to the Health4Life app (a multiple health behaviour change, self-monitoring mobile app). The trial will employ a 24 factorial design, where participants will be randomly allocated to receive 1 of 16 different combinations of the four engagement strategies to be evaluated: text messages, access to a health coach, access to additional gamified app content, and provision of parent/guardian information resources. Adolescents and parents/guardians will both complete consent processes, baseline assessments, and a follow-up assessment after 3 months. All participants will also be invited to complete a qualitative interview shortly after follow-up. The primary outcome, app engagement, will be assessed via an App Engagement Index (Ei) using data collected in the Health4Life app and the Mobile App Rating Scale – User version.DiscussionThis research will contribute significantly to building our understanding of the types of strategies that are most effective in increasing adolescents’ engagement with health apps and which factors may predict adolescents’ use of health apps.Trial registrationThe trial is registered at the Australian New Zealand Clinical Trials Registry (ACTRN12623000399695). Date registered: 19/04/2023.

Improving Parent–Adolescent Conversation to Promote Adolescent Sleep Health Behavior Change: An Open Trial of the Parent Behavior Change Intervention

The Parent Behavior Change Intervention (PBC-I) was developed to target parent–adolescent conversations that promote adolescent health behavior change. We report on an open trial of the PBC-I. Participants were 36 parent–adolescent dyads. Adolescents received the Transdiagnostic Sleep and Circadian Intervention (TranS-C) as parents received the PBC-I. Dyads were assessed at pre- and postintervention for parent use of behavior change techniques (BCT) and positive and negative conversational behaviors, parent–adolescent conflict, adolescent motivation for change, and adolescent sleep outcomes. From pre to post, parents used fewer total and types of BCTs, more positive communication behaviors, and less negative communication behaviors when discussing a sleep-related hot topic. From pre to post, parents reported decreased coercion and less anger intensity, while adolescents reported fewer parental conflict behaviors and less quantity and anger intensity during parent–adolescent disagreement. There was a pre-to-post increase in interest/enjoyment of sleep and a decrease in effort/importance to participate in TranS-C. More positive and less negative communication was associated with select adolescent sleep outcomes. Parents rated the PBC-I as highly acceptable and perceived it as useful. These results provide preliminary evidence that supports the PBC-I in improving the parent–adolescent interpersonal process, which is linked to improved adolescent sleep. The results may be relevant to conversations parents have with adolescents about a range of health behavior changes.

Health Education in the Bulgarian Schools

The following article focuses on health education in Bulgarian schools. A systematic health education was conducted during on school term among 71 children on current health issues directly related to the health and health behavior of adolescents. The following methods are used: traditional (lectures, conversations, discussions, individual tasks), non-traditional (debate) and interactive (role-playing games, sports activities, educational film and others) pedagogical methods aimed at developing skills in adolescents in order to recognize and avoid health risk factors. The application of non-traditional and interactive methods of health education in schools in accordance with children’s age and interests is effective, which was proved by a comparative analysis of the level of knowledge and point of view of the particular group before and after the education. It is necessary to introduce the methods during the education.

Associations between social support and proactive health behaviours among Chinese adolescents: the mediating role of self-efficacy and peer relationships

BackgroundProactive health behaviours are crucial for enhancing adolescent health. However, there is limited evidence on the potential pathways through which social support influences adolescents’ proactive health behaviours. This cross-sectional study aimed to examine the relationships between social support, self-efficacy, peer relationships and proactive health behaviours in Chinese adolescents.MethodsFrom October to December 2023, we recruited 6075 adolescents from Shandong Province, China. They completed self-report questionnaires on social support, self-efficacy, peer relationships and proactive health behaviours.ResultsLinear regression analysis indicated that social support was positively associated with proactive health behaviours among adolescents (β = 0.571, 95% CI = 0.542, 0.600). Further mediation analyses revealed that self-efficacy (β = 0.085, 95% CI = 0.069,0.101) and peer relationships (β = 0.156, 95% CI = 0.136,0.177) mediated this relationship.ConclusionsIncreased social support was associated with better proactive health behaviours in Chinese adolescents. Additionally, higher self-efficacy and positive peer relationships enhanced this association. Our findings emphasised the significance of providing supportive environments at home and at school to promote proactive health behaviours in adolescents.

Latent classes of adolescent health behaviour, social covariates and mental wellbeing: a longitudinal birth cohort study

BackgroundAdolescent mental wellbeing has been declining in the United Kingdom for over a decade. Expansion of services to support the mental wellbeing of young people is a public health priority and a core component of the National Health Service’s Long-Term Plan. In this paper, we leverage secondary analysis of a very large longitudinal dataset (#BeeWell) to generate insights regarding different patterns of health behaviour, their covariates, and consequences for mental wellbeing one year later.MethodsA Latent Class Analysis was conducted using data on physical activity, sleep, and eating habits collected in 2021 from 18,478 Year 8 pupils from Greater Manchester (United Kingdom) to (1) identify distinct latent classes of adolescent health behaviour; (2) establish factors likely to be associated with latent class membership; and (3) determine whether latent class membership contributes to variance in self-reported mental wellbeing one year later.ResultsA three-class solution was identified as an excellent fit to the data, discriminating between: the Wellness Weary (n = 2,717; 15%); the Balanced Bunch (n = 7,377; 40%); and the Green and Dream Team (n = 8,384; 45%). Several factors significantly influenced class membership. Most notably, socio-economic disadvantage and social media use were linked with less favourable health behaviour patterns, whilst cisgender heterosexual girls were likely to endorse healthier patterns. After adjusting for covariates, the Green and Dream Team reported significantly greater mental wellbeing than the Balanced Bunch one year later. However, there was no difference between the Balanced Bunch and the Wellness Weary, signalling that health behaviours may support mental wellbeing, but only among the healthiest young people.ConclusionsBeyond advancements in fundamental understanding, our findings yield significant translation opportunities through their use and application in health, education, and allied professional settings designed to support young people.

P036 INFLUENCE OF FOOD ENVIRONMENT IN AND AROUND SCHOOLS ON FOOD CHOICES AND PRACTICES OF STUDENTS: A MIXED METHODS STUDY – ANTICIPATORY FINDINGS

Background: The health behaviors of adolescents are significantly influenced by their living environments, with schools serving as crucial settings for promoting healthy behaviors. The school food environment, encompassing areas where food is provided and consumed within and around schools, plays a key role in shaping adolescents’ dietary choices. However, there is a notable scarcity of evidence regarding the school food environment in Pakistan. This study aims to examine the school food environment and associated factors, including the availability, accessibility, and affordability of foods within and around schools for adolescents, the facilitators and barriers school vendors face while offering healthy food options, and the perspective of policymakers on the role of food environments. Objectives: • To assess the school lunchtime food practice and sources of adolescents in schools in Karachi • To explore facilitators and barriers to offering healthier food options to adolescents through school vendors both within and outside school premises • To explore the perspectives of adolescents regarding the food choices available to them Methods: A mixed methods concurrent study design i.e. a cross-sectional study, interpretive descriptive qualitative study. Six schools, comprising three government and three private schools from District Central of Karachi, will be recruited. Students from grades 6 and 7 who provide consent and assent will be included, with an anticipated sample size of 430 participants. Descriptive statistics will be utilized to analyze quantitative data and a manual thematic analysis approach will be employed to analyze qualitative data. Results: The anticipated outcome of this study is to understand the school food environment holistically taking into consideration the practices and perspectives of key stakeholders i.e. school-going adolescents, vendors, and policymakers. Conclusion The groundwork done through this research project will help develop evidence-based healthy school food environment programs/interventions that can be feasibly deployed in government and private schools in Pakistan. The research outcomes will foster collaborative efforts among various stakeholders to co-create and implement viable solutions.

The health behaviors differences among male and female school-age adolescents in the Middle East and North Africa region countries: a meta-analysis of the Global School-based Student Health Survey data.

Understanding gender disparities in adolescent health behaviors is crucial for developing targeted health promotion strategies. This study uses data from the Global School-based Student Health Survey (GSHS) across 17 MENA countries to analyze gender differences in adolescent health behaviors, aiming to provide a comprehensive overview for both boys and girls. This meta-analysis incorporates data from recent years of the GSHS, covering 17 MENA countries. The objective was to assess and compare health behaviors between adolescent girls and boys. A random-effects model was employed to calculate odds ratios for gender comparisons in these behaviors. Statistical analyses and modeling were performed using JAMOVI software. In most MENA countries, boys consumed more vegetables compared to girls. Girls were less likely to frequent fast food establishments (OR = 0.82, 95% CI: 0.69-0.98) and generally exhibited better self-care behaviors. Boys reported a higher prevalence of physical altercations (OR = 2.18, 95% CI: 1.88-2.51) and were more involved in fights (OR = 3.00, 95% CI: 2.46-3.67). Girls were more likely to miss school without permission and were consistently described as kinder and more helpful across various income levels. However, in some countries such as Oman and Tunisia, boys missed school more frequently. There were no significant gender differences in parental oversight of homework or knowledge of students' activities, but girls were reported to have stronger parental relationships and better parental understanding of their problems and free time, with exceptions in Morocco and the Palestinian Territory-Gaza. Boys were more likely to engage in smoking (OR = 3.57, 95% CI: 2.69-4.76) and other substance use. Conversely, girls reported higher levels of physical inactivity and loneliness, but also demonstrated greater kindness and helpfulness in school settings and stronger parental relationships. Policymakers in the MENA region should develop and implement gender-specific interventions targeting key areas such as hygiene practices, physical activity, and substance use. By focusing on these targeted strategies, they can address the distinct health behaviors and needs of both boys and girls. Effective interventions in these areas are crucial for improving overall health outcomes and promoting healthier lifestyles, thereby enhancing adolescent health and well-being across the region.

Adverse Childhood Experiences and Police Contact in Canada.

A growing body of research has demonstrated that adverse childhood experiences (ACEs) are a risk factor for criminal justice system contact. However, much of this research is limited by (1) being conducted in the United States and (2) a lack of details on specific types of harmful experiences of criminal justice system contact, such as police contact characterized by intrusion or harassment. Using survey data from 940 individuals aged 16 to 30 in Canada from the Canadian Study of Adolescent Health Behaviors, this study investigates the relationship between ACEs and police contact, focusing on encounters involving intrusion or harassment. Results from logistic and multinomial logistic regression analyses reveal that individuals with high ACE exposure, particularly those with four or more ACEs, are more likely to have police contact, including experiences of intrusion and harassment. The results are significant in understanding the interplay between childhood trauma and later encounters with the criminal justice system, emphasizing the need for trauma-informed approaches in policing and healthcare. The study highlights the importance of early interventions to mitigate the effects of ACEs and prevent adverse outcomes in police interactions.

Creatine monohydrate use is prospectively associated with muscle dysmorphia symptomatology

This study aimed to determine the prospective association between creatine monohydrate use and muscle dysmorphia symptomatology among adolescents and young adults in Canada. Data from 912 adolescents and young adults from the Canadian Study of Adolescent Health Behaviors were analyzed. Creatine monohydrate use in the past 12 months was assessed at Wave 1, and muscle dysmorphia symptomatology was measured using the Muscle Dysmorphic Disorder Inventory (MDDI) at Wave 1 and Wave 2. The prospective associations between creatine monohydrate use and the MDDI total score and subscale scores were determined using linear regression analyses. Regression analyses controlled for relevant demographic identifiers, prior substance use, and the corresponding Wave 1 MDDI variable. Creatine monohydrate use at Wave 1 was prospectively associated with both total muscle dysmorphia symptomatology (B 1.34, 95 % CI 0.27, 2.42) and greater Appearance Intolerance (B 0.52, 95 % CI 0.02, 1.03) at Wave 2. Importantly, these findings were independent of prior muscle dysmorphia symptomatology, lifetime anabolic-androgenic steroid use, lifetime cigarette use, and frequency of alcohol use. Creatine monohydrate is commonly used among adolescents and young adults. Findings from this study are among the first to document that creatine monohydrate use may be a risk factor for the development of muscle dysmorphia symptomatology among adolescents and young adults. Health and mental health care professionals may consider assessing for both creatine monohydrate use and muscle dysmorphia symptomatology among adolescents and young adults.

Effects of an Online Health Management Program for South Korean Adolescents with Complex Congenital Heart Disease during Their Transition to Adulthood: A Randomized Controlled Trial.

Adolescents with complex congenital heart disease (CHD) are at risk of experiencing complications later in life. The purpose of this study was to develop an online health management program for adolescents with complex CHD and to evaluate its effects on self-efficacy, health behavior, and health-related quality of life. A randomized controlled trial design was used. A total of 29 adolescents with complex CHD were divided into an experimental group of 15 and a control group of 14. Participants in the intervention group took part in the 4-week online health management program (weekly online group sessions, 1:1 phone coaching, dietary diary feedback, and provision of health information) developed based on self-efficacy theory, while those in the control group received standard medical follow-up. Data were collected from August 2021 to March 2022 using a questionnaire-including the Korean Self-Rated Abilities for Health Practices: Health Self-Efficacy Measure (K-SRAHP) and Pediatric Cardiac Quality of Life Inventory (PCQLI)-and an ActiGraph accelerometer to track physical activity and sleep. The intervention group showed significant improvements in health self-efficacy (p = 0.003), psychosocial impact (p = 0.013), daily step counts (p = 0.011), and moderate to vigorous-intensity physical activity (p = 0.027). Additionally, a decrease in weekend leisure time sedentary behavior (p = 0.035) was observed. However, there were no significant differences in sleep behavior between two groups. The online health management program significantly enhanced self-efficacy, health behavior, and psychosocial impact in adolescents with complex CHD. These findings will inform the development of policies for transitional medical care tailored to adolescents with complex CHD.

Adolescent Mental Health and Suicidal Behaviors in the Context of Expanded Supplemental Nutrition Assistance Program Eligibility

PurposeFood insecurity is a risk factor for poor mental health and suicidal behaviors among adolescents. Prior research shows that states with policies that expand Supplemental Nutrition Assistance Program (SNAP) eligibility have a lower prevalence of food insecurity. The primary aim of this study was to compare the prevalence of feelings of sadness or hopelessness, suicidal ideation, and suicide attempts among adolescents in states that had the asset test eliminated and the income limit increased for SNAP eligibility to adolescents in states that did not have either policy. MethodsUsing 2013-2021 data from state Youth Risk Behavior Surveys (N = 855,119) and the SNAP Policy Database, we conducted log-binomial regression with generalized estimating equations and adjusted for confounders. ResultsThe prevalence of persistent feelings of sadness or hopelessness was similar among adolescents in states that had the asset test eliminated only and among adolescents in states that had both the asset test eliminated and the income limit increased (i.e., both policies) compared to adolescents in states that did not have either policy. While the prevalence of suicidal thoughts was similar among adolescents in states that had the asset test eliminated only compared to adolescents in states that did not have either policy, the prevalence of suicidal thoughts (prevalence ratio = 0.91, 95% CI 0.88, 0.94) and suicide attempts (prevalence ratio = 0.82, 95% CI 0.78, 0.86) was lower among adolescents in states that had both policies compared to adolescents in states that did not have either policy. DiscussionStates with policies that expand SNAP eligibility have a lower prevalence of suicidal behaviors among adolescents.

Just-in-time adaptive interventions for adolescent and young adult health and well-being: protocol for a systematic review

IntroductionHealth behaviours such as exercise and diet strongly influence well-being and disease risk, providing the opportunity for interventions tailored to diverse individual contexts. Precise behaviour interventions are critical during adolescence...

Mutans Streptococci and Oral Health Behavior in Children and Adolescents Having Primary and Permanent Caries: A Case–Control Study

Mutans Streptococci and Oral Health Behavior in Children and Adolescents Having Primary and Permanent Caries: A Case–Control Study