Adolescent Health Research Articles

Screen time and social media exposure in children and adolescents - the landscape

Abstract Dr. Cecilia Elias is a Public Health Consultant, collaborating with the Infant, Youth, Sexual and Reproductive Health Division at the Health Directorate General, in Lisbon, Portugal. Following on from John’s introduction, Cecilia will dig deeper into the impacts of the omnipresence of social media and phones in modern society. She will provide an overview of the harms and benefits for today’s youth. She will highlight data for example on impaired development of language, cognitive and social skills from screen exposure at young ages, and increased rates of depression, anxiety, self-harm, and school refusal among adolescents with problematic social media usage, including examples of significant outcomes. Exposure to disturbing and harmful content on social media platforms like TikTok and Instagram will be covered also.

INSATISFAÇÃO CORPORAL EM ADOLESCENTES E A RELAÇÃO COM AS MÍDIAS SOCIAIS DIGITAIS

Body dissatisfaction and the use of social networks are current phenomena that mark female adolescence and therefore require evaluation. Objective: to analyze the relationship between the use of social media and body dissatisfaction in female adolescents. Methodology: This is a literature review consisting of nine scientific articles found in the databases: SciElo and PubMed. Results and Discussion: The articles selected for this study, through the analysis of their elements, allowed the understanding that social networks exert a strong influence on the development of body dissatisfaction (BD) in adolescent girls, because these networks present information about the so-called ideal body, which is equally unattainable for most women. It was also identified that body dissatisfaction causes serious consequences to the psychological and physical health of adolescents, such as: problems with self-esteem, distorted selfperceptions, hatred of one’s own body, depression, insomnia, social isolation, alcohol use, restrictive diets, eating disorders, among other complications. Therefore, actions aimed at resolving and/or alleviating this scenario were demonstrated, such as interventions aimed at periodically withdrawing from social networks, healthy diets and self-acceptance. Final considerations: Although the social pressure on women’s bodies is an old phenomenon, it currently has strong allies in the media and social networks. Therefore, the relevance of the topic discussed in this article for science and society is considered and it is suggested that further studies be developed on this subject.

5.Y.2. Alcohol intoxication among adolescents in Italy, Belgium and The Netherlands

Abstract Excessive drinking behavior poses a significant risk to the health of adolescents and contributes to high social and health costs. It is also well-documented that engaging in risky drinking behavior at a young age increases the likelihood of developing alcohol use disorders and other mental health disorders later in life. Therefore, the timely development of adequate interventions to prevent and reduce such behavior is an important public health task. The initial step here is to gather comprehensive data on the phenomenon. Studying alcohol intoxication data among adolescents is an important source in this context. In the Netherlands, data on alcohol intoxication in adolescents have been routinely collected for several years, leading to a successful transmural framework aimed at supporting these young individuals and their parents. As countries are at varying stages in addressing this issue, the objective of this workshop is to facilitate mutual learning about effective prevention initiatives targeting problematic alcohol use in young people. The workshop will feature presentations from four studies representing three countries: Italy, Belgium, and the Netherlands. Allegra Ferrari from Italy will discuss alcohol-related emergencies among adolescents admitted to an emergency department in Genoa, emphasizing the importance of urgent interventions to mitigate adolescent alcohol use. Hanna van Roozendaal from Belgium will present data from both retrospective and prospective studies on adolescents with acute alcohol intoxication in Antwerp hospitals, exploring the feasibility of follow-up interventions. Louise Pigeaud from the Netherlands will share data from a cohort of individuals under 18 years presented with acute alcohol intoxication symptoms at an emergency department between 2015-2023 to monitor trends in admission characteristics. Finally, Guido van Hal will focus more in depth on the differences and similarities in adolescents accessing emergency care for acute alcohol intoxication in Italy, Belgium and The Netherlands. The workshop will conclude with an open discussion on topics such as the necessary data to be registered for minors with acute alcohol intoxication, the most effective methods for preventing/reducing alcohol intoxication in these age groups, and the potential transferability of the successful Dutch transmural framework to other countries. Key messages • Acute alcohol intoxication and problematic alcohol use in minors can lead to significant alcohol-related issues in adulthood. • Collecting and analyzing high-quality data can facilitate the development of interventions aimed at reducing and preventing alcohol-related issues in adolescents.

Youth mental health and exposome

Abstract Mental health is a complex Public Health challenge, especially youth. A better understanding of factors that contribute to youth mental health and reduce the burden of youth mental health conditions such as executive and emotional functioning is needed to develop primary and secondary prevention interventions. One of the main challenges for better understanding mental health of youth is the complexity and diversity of exposures that individuals experience throughout their lifetime. There is a wide range of factors in the environment, and individuals are exposed to different combinations of external factors depending on their location, occupation, and lifestyles. These factors include physical (e.g., noise and indoor and outdoor air), chemical and social factors (e.g., neglect and abuse, relationship conflicts) based on the exposome framework. The exposome is a guiding framework for the multi-country study EARLY involving Albania, Belgium, Germany, Israel, Moldova, Portugal, Romania, Serbia, Spain, and Switzerland. EARLY is one of the first projects to theoretically explore and empirically investigate youth mental health in line with the exposome framework. We aim to identify factors influencing youth mental health with validated exposure measures. An exploratory list of measures was collected in Albania, Belgium, Germany, Israel, Moldova, Portugal, Romania, Serbia, Spain, and Switzerland. The measures vary widely. Besides the variation, there is still a lack of standardized methods for measuring environmental exposures. Limitations of measures affect reliability and validity. Therefore, an overview of available assessment methods and steps toward improving measures will be discussed in this talk. Speakers/Panelists Karin Boode GGD GHOR Nederland, Utrecht, Netherlands Peter Van Den Hazel INCHES, Ellecom, Netherlands

Public Health Challenges for 2050 in the Netherlands

Abstract Every 4 years, the National Institute for Public Health and the Environment (RIVM) carries out the Dutch Public Health Foresight Study, commissioned by the Ministry of Health. The ninth edition (PHFS-2024) compiles an outlook on future public health and the health care system in the Netherlands. It combines a business-as-usual Trend Scenario with literature study and a range of qualitative and mixed-methods approaches. The Trend Scenario comprises projections up to 2050 for a broad range of epidemiological indicators. Such as (healthy) life expectancy, disease burden, life style factors. The qualitative and mixed methods approaches supported an incremental intersubjective process. Methods were a focus groups study, stakeholder sessions and workshops. An important innovation in this study was the Citizen Council and Panel. The outcomes show that demographic development, in particular growth of the group people at high age with multimorbidity, will lead to high pressure on the formal and informal health care system but also on e.g. mental health. A life course approach applied shows that decreasing mental health of youth will have long term consequences. Also, overweight will deeply impact older people’s health in the future. Lastly, climate change in combination with e.g. energy transition will deeply affect our society and living environment. Next to these challenges, there will also be opportunities to improve health. Building a climate-proof living environment that also stimulates healthy life styles and social interaction is one of them. However, improving health has linkages with policy areas outside the traditional public health domain as well and requires, firstly, a Health in/for All Policies approach. Secondly a whole-of-society approach in which companies and civil organizations take action is needed. All these efforts can only be effective if people and communities are put at the core of all health policies.

Changes in anxiety among youth with and without disabilities before, during and after the pandemic

Abstract Background Disabled youth are a vulnerable group that have faced challenges during the pandemic. Research about mental health and its changes of disabled youth during and after the pandemic is limited. Thus, this study examined changes in anxiety symptoms among youth with disabilities compared to those without disabilities before, during, and after the pandemic. Methods We analyzed population-based cross-sectional data from the Finnish School Health Promotion study (SHP) of youths with an age range of 12-29 years obtained in before (2019; n = 155,166), during (2021; n = 160,796), and after (2023; n = 151,224) the pandemic. Disabled youth were identified based on the Child Functioning Module (CFM). Anxiety symptoms were measured using the Generalized Anxiety Disorder-7 (GAD-7). Logistic regression models were applied to investigate population-level changes in anxiety. Results Over the years, the prevalence of anxiety symptoms was higher among youth with disabilities (10.2%, CI95% 10.1-10.4) compared to youth without disabilities (40.1%, 39.9-40.4), females having more symptoms than males. Prevalence of anxiety increased significantly during the pandemic (Before: 31.7% 95%CI 31.2-32.3 & During: 41.8%, 41.4-42.3) and continued to increase slightly after (44.4%, 43.9-44.9) among disabled youth. The same trend was seen in non-disabled youth (Before: 7.5%, 7.4-7.7, During: 11.4%, 11.2-11.6 & After: 12.0%, 11.8-12.2). Conclusions The prevalence of anxiety among disabled youth increased during the pandemic and has continued to increase even afterward, highlighting the inequality among youth with disabilities. The results indicate that it is important for educators and stakeholders to target measures and resources to support the mental health of youth with disabilities during and after a crisis, improving their equality in schools and society. Key messages • Youth with disabilities experienced anxiety symptoms four times more often than non-disabled youth, and this difference has remained quite stable during the pandemic and afterwards. • Decision-makers should be aware of this weaker mental health condition of youth with disabilities while planning preventive actions and interventions.

An Overview of Knowledge and Attitude About Premenstrual Syndrome on 9th Grade Students at Junior High School Number 1 West Selemadeg

Adolescent health efforts are activities that aim to help adolscents become healthy adults. The change towards adolescence is marked by puberty, such as the occurrence of menstruation in teenage girls. Before expriencing the menstrual phase, woman will experience symptoms such as stomach ache, difficulty concentrating and sharp emotional changes called premenstrual syndrome. The aim of this research is to determine the description of knowledge and attitudes about premenstrual syndrome in class IX students at SMP Negeri 1 Selemadeg Barat. This research wa conducted from March to April 2024 at SMP Negeri 1 Selemadeg Barat. This type of research is descriptive research with design cross sectional. The number of respondents used was 64 female students. Data collection includes filling out knowledge and attitudequestionnaires. The results of the study showed that the majority of respondents ages 15 years, began to experience menarche at the age of 12, has no sisters and the majority obtains information from the surrounding environment. The assessment regarding female students’ knowledge obtained results, only a few got good marks, namely 10 female students (15,6%) and the majority of female students showed a positive attitude, namely 36 female students (56,25%). Female students are advised to learn more about premenstrual syndrome and local health center staff are advised to provide edication to female students to from an attitude of students who are ready to face the problem menarche and premenstrual syndrome.

Factors Influencing Tobacco Use in Chinese Teenagers

The Report on Chinese Adolescent Tobacco Use 2023 announces a year-on-year decline in the prevalence of smoking in Chinese teenagers. Nevertheless, the hazards of tobacco products to the physical and mental health of this population remain a concerning issue. This study is an encapsulation of factors influencing the smoking behavior of Chinese adolescents based on a review of relevant literature. Personal characteristics such as gender, age, psychological traits, lifestyle, and perceptions of tobacco use, along with environmental factors like the family environment, circle of friends, and school climate, can all potentially influence a teenager's smoking behavior. A thorough examination of these factors can provide implications for advancing the regulation of teenager tobacco use and improving the work on adolescent health protection.

11.K. Scientific session: Roots of public health: school health literacy to enhance population health outcomes in Europe

Abstract This workshop will present empirical results from three representative studies on health literacy and digital health literacy conducted in primary and secondary schools in Wales and Germany: (1) Digital Health Literacy in Schools, (2), HLCA HL-Kids, (3) WHO HBSC Wales. While research on child and adolescent health literacy has gained traction in the past decade, only a few studies focus on health literacy in schools. While the European Commission and WHO, as well as most European governments, highlight the importance of schools to support children’s health literacy, schools remain neglected as a research context. With only little evidence available, it is difficult to derive strategies and programs to promote health literacy in schools. We aim to provide practical novel knowledge and contribute to closing the school health literacy gap that is prevalent in Europe. In turn, this will also contribute to European public health development and population health outcomes. Levels of health literacy in child and adolescent populations across European countries and age groups are alarmingly low, making low health literacy a severe risk factor for health outcomes. Low health literacy is associated with worse health conditions and unhealthy behaviours, and in turn, impacts school attainment and educational outcomes. Evidence suggests that health literacy acts as a determinant of health and itself is influenced by other social determinants of health, such as education, intertwining health and education. All studies conducted so far provide evidence that low health literacy follows a social gradient, with children from less affluent families being more likely to have lower health literacy, widening preexisting health inequities observed in almost all health domains within Europe. While effective interventions on the individual and system levels are needed to enhance health literacy, implementation and evaluation research concerning children’s health literacy is rare. Workshop objectives The aim of this workshop is to present findings from three representative studies on health literacy and digital health literacy in primary and secondary schools: (i) The 1st speaker will introduce a study on health literacy and health behaviours of children aged 8-11 (ii) The 2nd speaker will discuss the influence of living environments on health literacy in 4th-grader school kids (iii) The 3rd presentation will have its focus on navigating the infodemic through digital health literacy in adolescent students (iv) The 4th speaker will show links between digital health literacy and health behaviour in adolescent students The format of this workshop will be 4x10-minute presentations followed by a 20-minute panel discussion with the audience, reflecting the relevance of the results to public health research, practice, and policy. The chairs will provide a brief introduction to the concept and moderate the presentations and panel discussion. Key messages • Our results show that health literacy should be addressed as early as in primary schools and that the places, households, and environments children grow up are critical social determinants of health. • Digital health literacy has proven to be a valid learning topic in secondary schools and is linked to digital and media literacy, allowing us to define it as a targeted curriculum item.

1.K. Scientific session: Health literacy of children and adolescents across Europe

Abstract Health literacy is developed throughout the life course. Enhancing health literacy at an early age is especially important since it may impact both current and future health skills and outcomes. Low health literacy in child and adolescent populations has been linked to worse health outcomes and health disparities in Europe, making health literacy of children and adolescents an important public health topic. Developing and delivering targeted interventions and services for these age groups requires insight and data on the development and state of health literacy in early age. However, child and adolescent health literacy is still an under-researched topic. This is partly due to a lack of appropriate measurement instruments and methods to involve children in research. In the past years, new studies on child and adolescent health literacy have emerged in several European countries. In this workshop, innovative studies from Germany, the Netherlands and the UK on HL in childhood and adolescence are introduced and discussed. Both methodological findings as well as empirical data will be presented. In Germany, an instrument to measure child health literacy was developed and validated for primary school children. This instrument, the HLS-Child-Q15, has been used both in Germany and in the Netherlands to study the relationship between children’s health literacy and their health behaviors and outcomes. In the UK, methods of involving primary school children in health literacy research were studied. Experiences with a Children’s Advisory Group will be shared. Another study in the Netherland focuses on the health literacy profiles and needs of adolescent patients with rheumatic diseases. The format of this workshop will be 4x10-minute presentations (including questions) followed by a 20-minute interactive discussion, reflecting on the relevance of these results to further research, health promotion and health services. which will be followed by Q&A and an open discussion with the audiences. This workshop offers a forum for researchers, health educators, practitioners and policy-makers interested in health literacy measurement and research in children and adolescents. Key messages • Child and adolescent health literacy is an important, yet under-researched public health topic. • Child health literacy is an important predictor of their health behavior and outcomes.

Tobacco and nicotine products use among adolescents in Serbia – Latent class analysis

Abstract Background In parallel with a decline in cigarette smoking in the previous decade, other tobacco and nicotine products (TNPs), that are often used concurrently, have gained popularity among adolescents. The purpose of this study was to identify patterns of tobacco and nicotine product use among Serbian adolescents. Methods Data for this study were obtained from Health Behavior in School-aged Children (HBSC), a WHO collaborative cross-national study of adolescent health and well-being, that was conducted in Serbia in 2022 on a sample of 3713 students 11,13 and 15 years old. Descriptive statistics was used as well as latent class analysis to classify students based on their past-month use of cigarettes, e-cigarettes, heated tobacco products, waterpipes, and oral tobacco/nicotine products. Results Among students 11,13 and 15 years old, 10.2% smoke cigarettes, 13% use e-cigarettes, 11.1% waterpipes, 3.7% oral tobacco/nicotine products, and 4.5% heated tobacco products with differences by age and sex. We found high percentages of dual use of TNPs among cigarette smokers. Among students who smoke cigarettes, 61.6% also use e-cigarettes, 36.2% smoke waterpipes, 30.2% heated tobacco products, and 24.1% oral tobacco/nicotine products. Latent class analysis identified three classes as optimal solution: (1) dual e-cigarette and cigarette users (6.9%); (2) minimal/non-users (83.2%) and (3) poly tobacco and nicotine products users (9.9%). Statistically significant differences between classes were found in age and sex. Conclusions Dual and poly-tobacco and nicotine use is common among Serbian adolescents and presents a challenge for monitoring and public health response. Findings contribute to a better understanding of patterns and heterogeneity of TNPs use among adolescents and might have implications for prevention and cessation interventions for youth. Key messages • Among students 11,13 and 15 years old, tobacco and nicotine products, other than cigarettes is gaining popularity and with the e-cigarettes being the most popular product. • Dual and poly tobacco and nicotine products use is new challenged that should be taken into account in tobacco and nicotine monitoring, cessation and prevention.

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.

Status Quo of E-Cigarettes in Adolescents: A Comprehensive Review

Although marketed as a safer alternative to traditional cigarettes, e-cigarettes still contain nicotine and other harmful chemicals that can negatively impact adolescent health. E-cigarette use by adolescents is associated with an increased risk of transitioning to smoking traditional cigarettes, as well as negative impacts on their overall wellbeing. Numerous factors contribute to the rise in e-cigarette use among adolescents. By acquiring a more profound comprehension of the concerns about e-cigarettes in young populations, researchers can formulate more efficacious preventative and intervention techniques to diminish e-cigarette consumption among adolescents and alleviate any health risks linked to their use.

4.N. Scientific session: Equity in Child Health: Leveraging Universal Health Promotion Services for Families Amid Uncertainty

Abstract This workshop addresses the urgent need to foster resilience and equity in child health within the context of an increasingly uncertain Europe. Rapid societal changes, exacerbated by events such as the COVID-19 pandemic and heightened risks of conflict, climate change and economic instability, underscore the importance of nurturing environments where children can thrive despite challenging circumstances. The workshop aims to explore strategies for promoting well-being and addressing social inequalities in child health within the context of universal health promotion services, such as school health services and child health clinics. Objectives are to 1) Elucidate the importance and impact of universal health promotion services in addressing social inequalities and promoting equitable opportunities for all children, regardless of background or circumstance; 2) Identify actionable steps for interventions mitigating social inequalities and promoting equitable opportunities focusing on health literacy among parents with immigrant backgrounds; 3) Showcase successful models and initiatives in universal healthcare and health promotion services for children and families, emphasizing early intervention and standardized evaluation tools; and 4) Facilitate dialogue and knowledge exchange among professionals, policymakers, and stakeholders involved in child and adolescent health promotion. This workshop’s added value lies in its multidisciplinary approach, fostering collaboration for innovative solutions in child health resilience and equity. The coherence between presentations lies in their joint focus on addressing social inequalities in the context of universal health promotion services for children and families. Each presentation offers a unique perspective on these themes, contributing to a comprehensive understanding of the challenges and opportunities in child health promotion. • Hanne Nissen Bjørnsen’s presentation on the role of universal services in public health and addressing social inequality sets the stage by examining the structural factors contributing to disparities in child health outcomes. • Kirsti Riiseŕs presentation conveys the importance of user, stakeholder, and community involvement in creating culturally sensitive strategies for effective health promotion services in the context of health literacy among parents with immigrant backgrounds • Kristin Haraldstad’s presentation on Starting Right, an evidence-based assessment of children in municipalities healthcare centers, highlights the importance of early intervention and targeted support in mitigating health inequalities and promoting well-being. Format of the workshop: Three 10-minute presentations followed by a 20-minute moderated discussion to delve into empowerment and equity in child health, encouraging rich idea exchanges. Key messages • Leveraging universal health promotion services effectively empowers children and families while addressing social inequalities amidst periods of uncertainty. • Collaborative, user-centered approaches and evidence-based working strategies are key to promoting equity and building resilience in child health.

A process evaluation of a LifeLab Dublin; an interactive health literacy intervention

Abstract The argument for targeting adolescent health has been made strongly, with poor lifestyle behaviours often emerging during this life stage. Furthermore, there is consistent evidence of a widening socioeconomic gap in health indicators. Developing health literacy (HL) in youth populations to improve lifelong health behaviours has garnered increased interest in recent years. This process evaluation examines the acceptability, fidelity and dose delivered of the pilot of LifeLab Dublin: a nine-week, school-based HL intervention for low socioeconomic adolescents. The intervention, which comprised of two out-of-school, interactive HL experiences in conjunction with seven school-based lessons, took place between September and December in 2021 and involved students aged 11 - 13. The health issues targeted were previously identified by the teachers and students of the target population, and the learning activities within the out-of-school experiences were co-designed by adolescents of a similar demographic. Overall, the intervention was perceived positively by the students and teachers, particularly the two interactive out-of-school experiences. The teachers, however, highlighted issues with the volume and content of the school-based lessons, resulting in a reduced number of lessons being delivered. The fidelity of the two LifeLab experiences was high, demonstrating that the students engaged well with the learning activities and that the experience aligned with LifeLab’s core principles and underpinning theoretical constructs. The findings from this study highlight the value in implementing experiential style learning in school-based HL education and the benefit of involving participants in the design of intervention. The evaluation provided valuable insight into the refinements required to enhance the efficacy of the intervention, as well as providing an evidence-base to inform future school-based HL interventions for low socioeconomic adolescents. Key messages • The benefit of adopting experiential style health literacy education with young people. • The benefit of including young people in the design of a health literacy intervention.

Data-driven prediction of early language delay at Youth Health Care Services in the Netherlands

Abstract Introduction Language development in early childhood significantly impacts future academic success, social interaction, and emotional well-being. This study aimed to develop and evaluate a prediction model using data on developmental milestones and parents’ socio-economic background known at age 2, and translate the results into an interactive digital dashboard and pilot it with Youth Health Care (YHC) professionals and parents. Methods A mixed-method study on retrospective cohort of children attending YHC at age 2, followed up until age 4. Data on language development, gender, parental education, and home language environment were obtained from YHC digital dossiers and linked to parental socio-economic status characteristics, and perinatal outcomes and healthcare costs using a secure remote access environment of Statistics Netherlands. Random forest and logistic regression models were computed with language development at age 4 as an outcome, initially using all available data at age 2 as predictors and then with a restricted model using variables readily available in YHC settings. Models performance was assessed using sensitivity, specificity, and AUC value. Results were visualized through an interactive dashboard and pilot-tested in simulated consultations. Results Among 9,148 children, 13.2% had language development delay at age 4. The full model had an AUC of 0.78, while the restricted model (gender, parental education, language environment, and language development), achieved an AUC of 0.77. YHC professionals and parents recognized the value of individualized, data-driven risk assessment for potential language delay to stimulate the discussion of preventive interventions. Conclusions A good quality prediction model for language development at age 4 can be derived from just a few background characteristics of the child and parents at age 2. The digital dashboard presents a practical approach of integrating prediction model results into daily YHC practice. Key messages • Language development at age of 4 can be predicted as early as age of 2 using just a few background characteristics of child and parents, which presents a window of opportunity for prevention. • The digital dashboard presents a practical approach of integrating prediction model results into preventive care practice.

Children eight to twelve years of age have clear opinions about Positive Health

Abstract Introduction Positive Health (PH) focuses on the ability to maintain control over one’s own health, also for children. This study explores how primary school children eight to twelve years of age think about the concept of PH and the dimensions of PH as described in the child tool. Methods A qualitative research method was applied, in which 25 semi-structured interviews consisting of eight questions were conducted. Results Children mainly think of nutrition, exercise and ‘feeling good’ when asked what PG means. More specifically on the different dimensions, for ‘My body’ they mainly think about sleeping, healthy eating and exercise. For ‘My feelings and thoughts’, they mainly mention being happy, sad or angry and also for ‘feeling good about yourself’ they mainly talk about emotions and feeling good where appearance is important. The dimension ‘Now and later’ is mainly about occupation later, according to the children. Friends and bullying are terms mentioned in the dimension ‘Participation’ and being able to do what they feel like is most important in the dimension ‘Daily life’. For children, the dimensions ‘Feeling good about yourself’ and ‘My feelings and thoughts’ are most important. In addition, ‘Participating’ is important where having fun with friends is particularly mentioned by all children. Conclusions Children aged eight to twelve years of age perceive PH more than just the physical component and recognise all the dimensions of PH be it in their own words. Where children of all ages value the dimensions ‘Feeling good about yourself’, ‘My feelings and thoughts’ and ‘Participating’ most, these dimensions become even more important with increasing age. For teachers, youth health professionals and parents/carers this might imply, first, that the concept of Positive Health could be used as a tool when talking about being and staying healthy. Second, interventions might be more effective when aligned to children’s perceptions and language. Key messages • The concept of Positive Health could be used as a tool when talking about being and staying healthy. • Interventions might be more effective when aligned to children’s perceptions and language.

Youth Health Trends in Northern Portugal: Analyzing Diet, Physical Activity, and Body Image

(1) Background: In the face of global concerns regarding unhealthy lifestyles among youths, understanding dietary habits, physical activity, and weight management strategies among third-cycle students in Portugal becomes essential. This study aims to evaluate the extent to which middle school students adhere to the Mediterranean diet and assess their physical activity habits and overall weight perceptions. (2) Methods: This study is a cross-sectional observational study. Using self-reported data from a sample of 232 students aged between 12 and 18, this study delved into their dietary patterns, engagement in physical activities, perceptions of weight, and weight management approaches, measured by the KIDMED and YRB questionnaires. (3) The results demonstrated that adolescents engaged in a varied diet, and 65.5% had recently engaged in physical activity. However, 25% reported exercise-related injuries, suggesting potential safety gaps. Extreme weight management practices were minimal, but a disparity in weight perception and weight loss desire emerged, hinting at underlying societal and media influences. Gender differences in certain habits were minimal. (4) Conclusions: While students were generally inclined towards healthy habits, there are evident areas of concern, particularly regarding safety in physical activities and weight perceptions. In the future, interventions should be implemented to increase students’ literacy and raise awareness of the Mediterranean diet and physical well-being.

Associations Between Adverse Childhood Experiences, Adolescent Behavioral Health Challenges, and High School Dropout.

Adverse childhood experiences (ACEs) are associated with behavioral health challenges and high school dropout, and behavioral health is associated with high school dropout. Less is known about the role of behavioral health challenges in the relationship between ACEs and high school dropout. Using data from the Panel Study of Income Dynamics (2013) and its 2014 Childhood Retrospective Circumstances Study supplement, the current study conducts mediational path analysis to examine the direct and indirect effects of cumulative ACEs on high school dropout via adolescent depression, anxiety, and substance use. Experiencing more ACEs was associated with depression, anxiety, and substance use. Only depression and substance use were associated with high school dropout. There was a significant direct effect between increased ACEs and high school dropout and significant indirect effects via depression and substance use, but not anxiety. Adolescent behavioral health interventions to address the long-term effects of ACEs may also support academic achievement. School-based interventions, particularly those aligned with trauma-sensitive school frameworks and engaging various school personnel, including school nurses, should be considered. Community- and policy-level interventions aimed at primary prevention of ACEs are also needed.

Identifying Levers for Change in Healthcare Coordination Between the Emergency Youth Shelter and Health Systems in Toronto, Canada Through Stakeholder Engagement: A Qualitative Study

Background: Healthcare coordination involves supporting youth experiencing homelessness (YEH) with accessing appropriate healthcare; synchronizing delivery of their healthcare across multiple systems; sharing healthcare and discharge plans with youth and providers who fall under their ‘circle of care;’ and coordinating post-care follow-up as necessary. Challenges with coordinating healthcare within and between the emergency youth shelter (EYS) and health systems include poor accountability for healthcare coordination across systems; information-sharing and privacy policies inhibiting communication between sectoral staff; inconsistencies in system-based and organizational norms, operations, and funding; and each system’s historically fragmented structure. Methods: We used a system thinking framework to identify levers for change in healthcare coordination within and between the EYS and health systems in Toronto, Canada. Six stakeholders who work at various levels of each system participated in online breakout room discussions as part of a two-hour forum facilitated by our research team. A series of four questions were asked to identify levers for change in system parts and system patterns in healthcare coordination within and between the EYS and health systems. Breakout room discussions were recorded, transcribed, and co-analyzed by the research team using reflexive thematic analysis for each question. Results: Organizational and system-wide goals discussed to strengthen healthcare coordination include clarifying accountability in staff roles, revisiting discharge policies to improve continuity of care, prioritizing funding for programs evaluated to be effective, establishing more opportunities for system cross over, enhancing accessibility for YEH, integrating social medicine into healthcare approaches, and streamlining health communication across both systems. When asked about what is realistically possible, stakeholders were optimistic about enhancing information-sharing through digital health platforms, adapting organizational policies to consider the holistic needs of YEH, and dispersing funds more intentionally to support coordination initiatives. Furthermore, poor staff-youth relations, harmful discharge policies and the Toronto housing crisis were noted as patterns impeding meaningful change in coordinating healthcare. Finally, stakeholders identified systems integration and alignment of well-defined healthcare coordination processes across systems to harmonize efforts in achieving healthcare coordination goals. Conclusions: Stakeholder forum participants discussed promising levers for change that are recommended to strengthen parts of the EYS and health systems along with patterns that influence healthcare coordination between them.