Health Outcomes For Young People Research Articles

Process and outcome of child psychotherapies offered in Kenya: a mixed methods study protocol on improving child mental health

BackgroundChild and adolescent mental health problems account for a significant proportion of the local and global burden of disease and is recognized as a growing public health concern in need of adequate services. Studies carried out in Kenya suggest a need for a robust service for the treatment, prevention, and promotion of child and adolescent mental health. Despite a few existing services to provide treatment and management of mental health disorders, we need more knowledge about their effectiveness in the management of these disorders. This paper describes a study protocol that aims to evaluate the process and outcomes of psychotherapies offered to children and adolescents seeking mental health services at the Kenyatta National Hospital in Kenya.MethodsThis study will use a prospective cohort approach that will follow adolescent patients (12–17 years of age) receiving mental health services in the youth clinics at the Kenyatta National Hospital for a period of 12 months. During this time a mixed methods research will be carried out, focusing on treatment outcomes, therapeutic relationship, understanding of psychotherapy, and other mental health interventions offered to the young patients. In this proposed study, we define outcome as the alleviation of symptoms, which will be assessed quantitatively using longitudinal patient data collected session-wise. Process refers to the mechanisms identified to promote change in the adolescent. For example, individual participant or clinician characteristics, therapeutic alliance will be assessed both quantitatively and qualitatively. In each session, assessments will be used to reduce problems due to attrition and to enable calculation of longitudinal change trajectories using growth curve modeling. For this study, these will be referred to as session-wise assessments. Qualitative work will include interviews with adolescent patients, their caregivers as well as feedback from the mental health care providers on existing services and their barriers to providing care.ConclusionThis study aims to understand the mechanisms through which change takes place beyond the context of psychotherapy. What are the moderators and through which mechanisms do they operate to improve mental health outcomes in young people?

Cyberbullying and Children and Young People's Mental Health: A Systematic Map of Systematic Reviews

Cyberbullying is associated with considerable negative mental and psychosocial consequences in children and young people, making it a serious public health concern. To review the highest level of available evidence, a systematic mapping review was conducted to identify systematic reviews that investigated the relationship between cyberbullying and mental and psychological outcomes in young people. Topic-relevant bibliographic databases and online resources were searched to identify reviews published since 2007. Data were extracted using a coding tool developed for this study. Methodological quality of included reviews was assessed using AMSTAR criteria. Nineteen systematic reviews satisfied the inclusion criteria and they reported a strong negative association between cyberbullying and mental health outcomes in young people. Meta-analysis was performed in 11 reviews and narrative synthesis in 8 reviews. Data were derived from predominantly cross-sectional studies and a clear causal relationship between cyberbullying and mental outcomes cannot be established. Two-third of the included reviews were classified to be of low or unclear quality, due to the lack of quality assessment of the primary studies included in individual reviews. This systematic map consolidates available evidence at review level and confirms the existing gaps in longitudinal and qualitative evidence synthesis. Closer examination of the moderating factors influencing cyberbullying behaviors in future research can advance our understanding and inform the development of tailored programs of intervention to mitigate the negative impact of this phenomenon.

The Impact of Cash Transfers on Mental Health in Children and Young People in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Background: Although cash transfer programme are not explicitly designed to improve mental health, by reducing poverty and improving the life chances of children and young people, they may also improve their mental health. This systematic review and meta-analysis assessed the evidence on the effectiveness of cash transfers to improve the mental health of children and young people in low- and middle-income countries. Methods: We searched Pubmed, EBSCOhost, SciELO, ISI Web of Science and Social Sciences Citation Index and grey literature (from Jan 2000 to the July 2020) for studies which quantitatively assessed the impact of cash transfer on mental health in young people (aged 0-24 years), using a design that incorporated a control group. No restrictions to language or article type were applied. We extracted Cohen’s d effects size and assessed the quality of studies using Cochrane Bias Tool. We used a random-effects model for the meta-analysis on studies that measured depressive symptoms, I2 statistic and assessment of study quality. This review is registered with PROSPERO (CRD42020168227). Findings: We identified 12,112 articles for screening, of which 12 were included in the systematic review (covering 13 interventions) and seven in the meta-analysis assessing impact on depressive symptoms specifically. There was high heterogeneity (I2=95·2) and a high risk of bias (0·38, 95% CIs: -5·08, 5·85, p=0·86) across studies. Eleven interventions (85%) showed a significant positive impact of cash transfers on at least one mental health outcome in children and young people. However, no study found a positive effect on all mental health outcomes examined, and the meta-analysis showed no impact of cash transfers on depressive symptoms (0·02, 95% CIs=-0·19, 0·23; p=0·85). Interpretation: Cash transfers may have positive effects on some mental health outcomes for young people, but there is high heterogeneity across studies, with some interventions showing no effects. Our review highlights how the effect of cash transfers may vary by social and economic context, culture, design, conditionality and mental health outcome. Registration: This review is registered with PROSPERO (CRD42020168227). Funding Statement: UKRI Global Challenges Research Fund (ES/S001050/1). Declaration of Interests: We declare no competing interests.

"If you don't speak from the heart, the young mob aren't going to listen at all": An invitation for youth mental health services to engage in new ways of working.

Aboriginal and Torres Strait Islander young people are more likely to experience mental health issues or end their life by suicide than non-Aboriginal youth, but are less likely to access mental health services for support. Systemic change is required if mainstream youth mental health services are to be relevant and culturally secure for Aboriginal and Torres Strait Islander young people. Building Bridges (2017-2019) is a three-year participatory action research project being conducted in partnership with the Nyoongar community and three mainstream youth mental health services in Perth, Western Australia. The project involves Nyoongar Elders and Aboriginal and Torres Strait Islander young people working directly with senior management and key staff of youth mental health services to co-design, implement and evaluate a framework for systems change. The aim of the project is to increase Aboriginal and Torres Strait Islander young people's engagement with services and improve mental health outcomes for young people and their families. This paper outlines the engagement process that underpinned the first phase of the project. Our research methods are premised by an investment in establishing safe spaces for the Elders, young people and service staff to engage in open, honest dialogue. We present two key activities that illustrate this process of building trust and deepening understanding, namely: spending time "On Country" and engaging in a "storying" process. Building Bridges demonstrates the centrality of trusting relationships for systemic change and the way in which meaningful engagement is at the core of both the process and the outcome.

Correction: Google for Sexual Relationships: Mixed-Methods Study on Digital Flirting and Online Dating Among Adolescent Youth and Young Adults

[This corrects the article DOI: 10.2196/10695.].

Google for Sexual Relationships: Mixed-Methods Study on Digital Flirting and Online Dating Among Adolescent Youth and Young Adults.

BackgroundAccording to a 2015 report from the Pew Research Center, nearly 24% of teens go online almost constantly and 92% of teens are accessing the internet daily; consequently, a large part of adolescent romantic exploration has moved online, where young people are turning to the Web for romantic relationship-building and sexual experience. This digital change in romantic behaviors among youth has implications for public health and sexual health programs, but little is known about the ways in which young people use online spaces for sexual exploration. An examination of youth sexual health and relationships online and the implications for adolescent health programs has yet to be fully explored.ObjectiveAlthough studies have documented increasing rates of sexually transmitted infections and HIV among young people, many programs continue to neglect online spaces as avenues for understanding sexual exploration. Little is known about the online sexual health practices of young people, including digital flirting and online dating. This study explores the current behaviors and opinions of youth throughout online sexual exploration, relationship-building, and online dating, further providing insights into youth behavior for intervention opportunities.MethodsFrom January through December 2016, an exploratory study titled TECHsex used a mixed-methods approach to document information-seeking behaviors and sexual health building behaviors of youth online in the United States. Data from a national quantitative survey of 1500 youth and 12 qualitative focus groups (66 youth) were triangulated to understand the experiences and desires of young people as they navigate their sexual relationships through social media, online chatting, and online dating.ResultsYoung people are using the internet to begin sexual relationships with others, including dating, online flirting, and hooking up. Despite the fact that dating sites have explicit rules against minor use, under 18 youth are using these products regardless in order to make friends and begin romantic relationships, albeit at a lower rate than their older peers (19.0% [64/336] vs 37.8% [440/1163], respectively). Nearly 70% of youth who have used online dating sites met up with someone in person (44.78% [30/67] under 18 vs 74.0% [324/438] over 18). Focus group respondents provided further context into online sexual exploration; many learned of sex through pornography, online dating profiles, or through flirting on social media. Social media played an important role in vetting potential partners and beginning romantic relationships. Youth also reported using online dating and flirting despite fears of violence or catfishing, in which online profiles are used to deceive others.ConclusionsYouth are turning to online spaces to build sexual relationships, particularly in areas where access to peers is limited. Although online dating site use is somewhat high, more youth turn to social media for online dating. Sexual relationship-building included online flirting and online dating websites and/or apps. These findings have implications for future sexual health programs interested in improving the sexual health outcomes of young people. Researchers may be neglecting to include social media as potential sources of youth hookup culture and dating. We implore researchers and organizations to consider the relationships young people have with technology in order to more strategically use these platforms to create successful and youth-centered programs to improve sexual health outcomes.

Resilience factors in young people’s mental health: The views of professionals working within specialist services

This qualitative study explored professional views of which (resilience) factors best promote positive mental health outcomes for young people in inpatient care.

Parents’ Perceptions of the Physical Health Outcomes of Young People Diagnosed with First Episode Psychosis

This study explores parents’ perceptions of their son/daughter’s physical health needs following a first episode psychosis diagnosis and commencement on antipsychotic medication. The research process was guided by grounded theory methodology and data were collected using semi-structure interviews with 16 parents. Four categories were identified. Participants described the importance, challenges and strategies for their son/daughter to maintain their physical health, and the need to improve young people’s health literacy, particularly in areas of physical health, diet and lifestyle. These findings will assist health professionals to provide parents with information to better support their son/daughter to maintain their physical health.

Self-Control, Plan Quality, and Digital Delivery of Action Planning for Condom and Contraceptive Pill Use of 14-24-Year-Olds: Findings from a Clinic-Based Online Pilot Randomised Controlled Trial.

Inconsistent use of the contraceptive pill and condoms contributes significantly to poor sexual health outcomes for young people. There is evidence that action planning interventions may improve pill and condom use, but this approach is not systematically used in sexual healthcare. This study is the first to assess acceptability and feasibility of evaluating a digital intervention to support action plan formation for three sexual health behaviours with clinic attendees. It also considered the role of trait self-control and whether the intervention supported production of quality plans. Eighty-eight integrated sexual health clinic attendees aged 14-24 years (M = 20.27 years) were recruited to a pilot randomised controlled trial (RCT). Of these, 67 also completed three-month follow-up. Measures included self-reported contraceptive or condom "mishaps", theory of planned behaviour variables, and a measure of self-control. Descriptive analyses supported study acceptability and feasibility. The intervention supported pill and condom users to produce quality plans, though potential improvements were identified. Bivariate correlations suggested that high levels of trait self-control may negatively influence plan quality. Data suggest that the intervention may reduce pill or condom "mishaps". A future full RCT is likely feasible and brief digital action planning interventions may usefully be incorporated within sexual healthcare.

Sexual health outcomes for young people in state care: Cross-sectional analysis of a national survey and views of social care professionals in Wales

This paper draws upon data from two separate studies to consider sexual health outcomes for young people in state care in Wales. Cross sectional analysis of the School Health Research Network Survey (2015) examined sexual health behaviours and outcomes of young people in foster care compared to those living in private households. The findings are contextualised with qualitative data (collected 2016) from social care professionals about their practice experiences of supporting sexual health development and seeking to prevent early pregnancy for young people in state care. Findings suggest that young people in state care in Wales experience poorer sexual health outcomes compared to those not in care. Insights from professionals suggest that whilst the state care system has the potential to identify and respond to young people's needs, its effectiveness can be compromised by issues of resources, value-based judgements related to the age at which young people could and should be sexually active, and individual choice and determinism. It is suggested that statutory monitoring of sexual health related outcomes is required, together with a review of policy and practice ‘with’, rather than ‘for’, young people in state care. Finally it is argued that increased attention on the quality as well as the quantity of relationships young people in state care have with carers and professionals may provide a simple but powerful policy approach in continued efforts to secure parity in respect of sexual health and development.

The role of digital communication in patient–clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study

BackgroundYoung people (aged 16–24 years) with long-term health conditions tend to disengage from health services, resulting in poor health outcomes. They are prolific users of digital communications. Innovative UK NHS clinicians use digital communication with these young people. The NHS plans to use digital communication with patients more widely.ObjectivesTo explore how health-care engagement can be improved using digital clinical communication (DCC); understand effects, impacts, costs and necessary safeguards; and provide critical analysis of its use, monitoring and evaluation.DesignObservational mixed-methods case studies; systematic scoping literature reviews; assessment of patient-reported outcome measures (PROMs); public and patient involvement; and consensus development through focus groups.SettingTwenty NHS specialist clinical teams from across England and Wales, providing care for 13 different long-term physical or mental health conditions.ParticipantsOne hundred and sixty-five young people aged 16–24 years living with a long-term health condition; 13 parents; 173 clinical team members; and 16 information governance specialists.InterventionsClinical teams and young people variously used mobile phone calls, text messages, e-mail and voice over internet protocol.Main outcome measuresEmpirical work – thematic and ethical analysis of qualitative data; annual direct costs; did not attend, accident and emergency attendance and hospital admission rates plus clinic-specific clinical outcomes. Scoping reviews–patient, health professional and service delivery outcomes and technical problems. PROMs: scale validity, relevance and credibility.Data sourcesObservation, interview, structured survey, routinely collected data, focus groups and peer-reviewed publications.ResultsDigital communication enables access for young people to the right clinician when it makes a difference for managing their health condition. This is valued as additional to traditional clinic appointments. This access challenges the nature and boundaries of therapeutic relationships, but can improve them, increase patient empowerment and enhance activation. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information and communication failures, but clinicians and young people mitigate these risks. Workload increases and the main cost is staff time. Clinical teams had not evaluated the impact of their intervention and analysis of routinely collected data did not identify any impact. There are no currently used generic outcome measures, but the Patient Activation Measure and the Physicians’ Humanistic Behaviours Questionnaire are promising. Scoping reviews suggest DCC is acceptable to young people, but with no clear evidence of benefit except for mental health.LimitationsQualitative data were mostly from clinician enthusiasts. No interviews were achieved with young people who do not attend clinics. Clinicians struggled to estimate workload. Only eight full sets of routine data were available.ConclusionsTimely DCC is perceived as making a difference to health care and health outcomes for young people with long-term conditions, but this is not supported by evidence that measures health outcomes. Such communication is challenging and costly to provide, but valued by young people.Future workFuture development should distinguish digital communication replacing traditional clinic appointments and additional timely communication. Evaluation is needed that uses relevant generic outcomes.Study registrationTwo of the reviews in this study are registered as PROSPERO CRD42016035467 and CRD42016038792.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Leading schools that make a difference to bullying behaviour

Abstract Student bullying behaviour is a long-standing concern in New Zealand schools. International studies consistently show high rates of student reports of this behaviour. Research suggests that bullying behaviour is a socioecological and systemic phenomenon that is best addressed via systems-based and multifaceted approaches implemented using collaborative processes. Less is known about the most effective components of these multifaceted approaches. This article analyses New Zealand Wellbeing@School survey data to suggest ways forward for schools. A multilevel model was used to associate two student and two teacher measures from the same schools. The findings indicate that a mix of school-wide actions were associated with lower levels of student aggressive and bullying behaviour. Five sub-groups of actions are discussed in the light of recent New Zealand and international research. The article concludes with a call to locate anti-bullying approaches within a multifaceted and holistic framework which has the overall aim of promoting wellbeing and healthy social relationships. A holistic approach enables schools to foster protective factors such as belonging, and address risk factors that influence bullying behaviour, as well as a range of desirable education and health outcomes for young people.

An interesting conference, for some depressing reasons

Recently, I attended a conference on children and young people's health outcomes for the purpose of updating my knowledge on a subject that has long been a practice, teaching and research interest. The optimistic tone of the rhetoric seemed at odds with the lived experience of those of us broadly associated with the ‘coalface’ of care. The opening speaker, representing NHS England, despatched an impressive array of statistics acknowledging the challenges of inequality and the gaps in appropriate services. A number of clinical toolkits were mentioned, including a product of the NHS Maternity Review: a new care bundle consisting of smoking cessation and improved fetal monitoring. However, no explanation was offered as to how this care bundle might be delivered when midwife retention and recruitment is in crisis (Royal College of Midwives, 2016). A consultant psychiatrist made an inspiring speech on young people's mental health, lamenting the £17 billion cost of the failure of government to move proactively to prevent mental illness. Naming the causal link with poverty as ‘the elephant in the room’ this speaker was resigned to the fact that political short-term thinking meant that the outlook for meaningful long-term investment was bleak. The alternative plan tabled—that we should all sort it out together through joined-up thinking—was, for me, rather predictable. The ‘we’ implied were school nurses, teachers and that good old ambiguous corporate concept, ‘community’, being urged to raise awareness and address stigma while providing listening support. This rallying call to the community was all the more meaningless in the light of a later presentation by the head of public health in a London borough, who spoke with great enthusiasm about an innovative local school nurse programme to reduce child obesity. Any enthusiasm this contribution might have spread was stopped dead in its tracks when it transpired that school nursing in the same borough was likely to be decommissioned next year. It was cheering to hear of innovative practice but investment is needed for such practice to be sustained and shared.

Improving Health While Saving Money: Lessons Learned from a Supportive Housing Program for Young Adults with HIV

The Bailey House Success Through Accessing Rental Assistance and Support (STARS) Program is a 20-unit scatter-site permanent supportive housing program for homeless or unstably housed HIV-positive young adults ages 18–24. A harm reduction and strength-based approach is utilized to connect HIV+ individuals with medical care and other services while ensuring housing stability. An intensive case management team provides support such as home visits, case monitoring, accompaniment to appointments, and referrals to health and social service resources within the community. This program evaluation used clinical data mining (CDM) to implement a Return-on-Investment (ROI) analysis of the STARS supportive housing program. The evaluation compared program costs to “services as usual” through the NYC shelter system. The STARS program served 27 individuals, achieving 25 successful outcomes, during 3 years. The program’s total value (savings relative to shelter costs) yielded a 1.32 ROI. The results support practice and policy advocacy initiatives promoting supportive housing and housing first initiatives as a viable method to reduce homelessness and as a structural intervention to improve health outcomes for young people with HIV.

Exercise as antidepressant treatment: Time for the transition from trials to clinic?

Mental health and wellbeing are particularly salient during adolescence and young adulthood, with the age of onset of most mental disorders occurring between 12 and 25 years. Therefore, this is a critical time to provide early intervention to promote recovery and establish positive long-term health-related behaviors. With the aim to establish safer and potentially less complex interventions for youth mental health, interest in physical activity and exercise interventions has grown. These interventions have been shown to be highly acceptable and nonstigmatizing as a treatment approach; which is important to young help-seeking young people. This chapter reviews the evidence for exercise interventions for young people experiencing mental health concerns or a diagnosed mental disorder. The emerging evidence supports the use of physical activity and exercise interventions in youth mental health; however, further research is required to determine the required type, intensity, duration, and frequency to increase enjoyment and maintenance in order to maximize health and mental health outcomes in young people with mental health concerns.

Is increased screen time associated with the development of anxiety or depression in young people?

IntroductionEmerging evidence suggests that sedentary behaviour, specifically time spent taking part in screen-based activities, such as watching television, may be associated with mental health outcomes in young people [1]. However, recent reviews have found limited and conflicting evidence for both anxiety and depression [2].ObjectivesThe purpose of the study was to explore associations between screen time at age 16 years and anxiety and depression at 18.MethodsSubjects (n = 1958) were from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK-based prospective cohort study. We assessed associations between screen time (measured via questionnaire at 16 years) and anxiety and depression (measured in a clinic at 18 years using the Revised Clinical Interview Schedule) using ordinal logistic regression, before and after adjustment for covariates (including sex, maternal education, family social class, parental conflict, bullying and maternal depression).ResultsAfter adjusting for potential confounders, we found no evidence for an association between screen time and anxiety (OR = 1.02; 95% CI 0.95–1.09). There was weak evidence that greater screen time was associated with a small increased risk of depression (OR = 1.05, 95% CI 0.98–1.13).ConclusionsOur results suggest that young people who spend more time on screen-based activities may have a small increased risk of developing depression but not anxiety. Reducing youth screen time may lower the prevalence of depression. The study was limited by screen time being self-reported, a small sample size due to attrition and non-response, and the possibility of residual confounding. Reverse causation cannot be ruled out.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Redesign of chronic illness care in children and adolescents: evidence for the chronic care model.

This article provides an overview of the chronic care model (CCM), examines the evidence for its utility in pediatric and adolescent chronic illness, and discusses practical steps for improving chronic illness care in the pediatric medical home. Few studies have used the CCM as an improvement framework in pediatrics. However, in recent years, several quality improvement efforts based on the CCM have demonstrated improvement in important process measures or clinical outcomes in pediatric or adolescent obesity, inflammatory bowel disease, attention-deficit/hyperactivity disorder, depression, and asthma. The CCM is an improvement framework that has demonstrated success in improving the care of children and adolescents with chronic disease. More research is needed to identify priority conditions for improvement efforts, to better understand the mediators of health outcomes in pediatric chronic disease, and to rigorously demonstrate the effectiveness of new models of chronic illness care. The evidence to date suggests that the CCM may be useful in guiding the redesign of care delivery systems to improve the health outcomes of young people with chronic disease.

Secondary Education and Health Outcomes in Young People from the Cape Area Panel Study (CAPS).

AimEducation is one of the strongest social determinants of health, yet previous literature has focused on primary education. We examined whether there are additional benefits to completing upper secondary compared to lower secondary education in a middle-income country.MethodsWe performed a longitudinal analysis of the Cape Area Panel Study, a survey of adolescents living in South Africa. We undertook causal modeling using structural marginal models to examine the association between level of education and various health outcomes, using inverse probability weighting to control for sex, age, ethnicity, home language, income, whether employed in past year, region of birth, maternal educational status, marital status, whether currently pregnant and cognitive ability. Educational attainment was defined as primary (grades 1–7), lower secondary (grades 8–9) or upper secondary (grades 10–12).ResultsOf 3,432 participants, 165 (4.8%) had completed primary education, 646 (18.8%) lower secondary and 2,621 (76.3%) upper secondary. Compared to those completing lower secondary, males completing upper secondary education were less likely to have a health problem (OR 0.49; 95%CI 0.27–0.88; p = 0.02); describe their health as poor (0.52; 0.29–0.95; p = 0.03) or report that health interferes with daily life (0.54; 0.29–0.99; p = 0.047). Females were less likely to have been pregnant (0.45; 0.33–0.61; p<0.001) or pregnant under 18 (0.32; 0.22–0.46; p<0.001); and having had sex under 16 was also less likely (males 0.63; 0.44–0.91; p = 0.01; females 0.39; 0.26–0.58; p<0.001). Cigarette smoking was less likely (males 0.52; 0.38–0.70; p = <0.001; females 0.56; 0.41–0.76; p<0.001), as was taking illicit drugs in males (0.6; 0.38–0.96; p = 0.03). No associations were found between education and alcohol use, psychological distress, obesity, increased waist circumference or hypertension.ConclusionCompleting upper secondary education was associated with improved health outcomes compared with lower secondary education. Expanding upper secondary education offers middle-income countries an effective way of improving adolescent health.

Objectively measured sedentary behaviour and health and development in children and adolescents: systematic review and meta-analysis.

Sedentary behaviour has emerged as a unique determinant of health in adults. Studies in children and adolescents have been less consistent. We reviewed the evidence to determine if the total volume and patterns (i.e. breaks and bouts) of objectively measured sedentary behaviour were associated with adverse health outcomes in young people, independent of moderate-intensity to vigorous-intensity physical activity. Four electronic databases (EMBASE MEDLINE, Ovid EMBASE, PubMed and Scopus) were searched (up to 12 November 2015) to retrieve studies among 2- to 18-year-olds, which used cross-sectional, longitudinal or experimental designs, and examined associations with health outcomes (adiposity, cardio-metabolic, fitness, respiratory, bone/musculoskeletal, psychosocial, cognition/academic achievement, gross motor development and other outcomes). Based on 88 eligible observational studies, level of evidence grading and quantitative meta-analyses indicated that there is limited available evidence that the total volume or patterns of sedentary behaviour are associated with health in children and adolescents when accounting for moderate-intensity to vigorous-intensity physical activity or focusing on studies with low risk of bias. Quality evidence from studies with robust designs and methods, objective measures of sitting, examining associations for various health outcomes, is needed to better understand if the overall volume or patterns of sedentary behaviour are independent determinants of health in children and adolescents.

An implementation and outcome evaluation of a multicomponent sexuality education programme for high school students

Numerous classroom-based interventions have aimed to improve sexual health outcomes for young people, yet few have shown strong, lasting effects. Ecological approaches that address multiple levels of a young person’s environment offer largely untapped potential to positively change sexual behaviour. This paper presents results of a cluster-randomised trial of a multicomponent sexuality education intervention that integrated a classroom curriculum, parent education workshops and materials, peer advocate programme, and sexual health services at 10 urban high schools. An implementation evaluation, employing quantitative and qualitative instruments, was conducted to examine whether the individual components of the intervention were delivered as planned and how they were received by the target populations. Multilevel modelling was used to evaluate the effect of the multicomponent intervention on outcomes at one-year follow-up. Results showed that the intervention components were successfully implemented with and well received by target populations. Students receiving the multicomponent intervention reported greater increases in the use of sexual health services (odds ratio [OR] = 1.73, 95% CI = 1.09–2.75) and the likelihood of carrying a condom (OR = 2.71, 95% CI = 1.44–5.09) relative to those receiving a control condition. No effects were found for other behaviours, possibly due to low prevalence of sexual activity in the sample and the small number of schools randomised.