Adolescent Health Interventions Research Articles

Blended digital health intervention for adolescents at high risk with digital media use disorders: protocol for a randomised controlled trial within the Res@t-Consortium

Blended digital health intervention for adolescents at high risk with digital media use disorders: protocol for a randomised controlled trial within the Res@t-Consortium

Prevalence and associations of meeting adherence to 5-2-1-0 health guidelines with externalizing and internalizing symptoms and hygiene behaviour among school adolescents in the Philippines

ABSTRACT The purpose of this study was to look into the prevalence and associations of meeting adherence to 5-2-1-0 health guidelines (5 or more servings of fruits and vegetables/day (FV), ≤2 hours of recreational screen time/day (ST), at least 1 hour of moderate and/or vigorous physical activity (PA), and 0 sugar-sweetened beverages/day) among school adolescents in the Philippines. The 2011, 2015 and 2019 Philippines Global School-based Student Health Survey, a nationally representative survey of teenagers aged 11 to 18 provided the study’s data. Measures included self-reported demographics, peer and parental support, body mass index, six externalized and four internalized behaviours, and four hygiene behaviours, and 5-2-1-0 health guidelines. The relationship between behavioural outcomes and meeting the 5-2-1-0 health guidelines number was investigated using logistic regression models. The percentages of participants who adhered to none, one, and two, 5-2-1-0 health guidelines were 11.6%, 38.9%, and 41.8%, respectively, whereas 7.7% of participants met three (7.2%) or four (0.5%) guidelines. Compared to participants from study wave 2011, participants from study waves 2015 and 2019, and having obesity were negatively associated with adhering to 3 or 4 5-2-1-0 health guidelines, while school attendance, peer and higher parental support were positively associated with adhering to 3 or 4 5-2-1-0 health guidelines. Compared with meeting none of the 5-2-1-0 health guidelines, participants who met a higher number of recommendations were less likely to report externalizing behaviours (current alcohol use, history of intoxication, participation in physical fighting, sustained a physical injury, were physically attacked and had been bullied), internalizing behaviours (suicidal ideation, plan and attempt and psychological distress) and hygiene behaviours (inadequate tooth brushing, not always hang hygiene before meals, after toilet and with soap). Future behavioural and mental health interventions for adolescents should focus on improving their overall 5-2-1-0 behaviours while taking demographic differences into account.

Digital Health Interventions for Adolescents with Long-Term Health Conditions in South Africa: A Scoping Review.

Adolescents with long-term health conditions may benefit from digital health interventions (DHIs) to support self-management. The study aimed to map the current research on DHIs for adolescents with long-term conditions in South Africa, focusing on the types of interventions, targeted chronic conditions, and reported outcomes. The scoping review was conducted following the Joanna Briggs Institute (JBI) guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. Searches were conducted in electronic databases such as EBSCOHost (CINAHL, MEDLINE, Academic Search Ultimate, and APA PSycArticles), Wiley Online Library, and PubMed for articles published between 2014 and 2024. Studies that (1) involved adolescents with a long-term health condition (aged 15-24) residing in South Africa, (2) reported on the use of digital health technology, and (3) provided empirical evidence were included. Nine studies were included in the analysis, focusing primarily on HIV, depression/anxiety, and diabetes. Most interventions utilized WhatsApp, SMS, or social media to provide peer or healthcare worker support. Process outcomes like acceptability and feasibility dominated, with limited data on effectiveness. DHIs show potential for supporting adolescent health but cover a limited number of long-term health conditions and face barriers to effective implementation. Affordable, context-specific solutions co-designed with adolescents are crucial to enhance engagement and ensure scalability in the South African context. Registration: The protocol was registered on Open Science Framework.

Mental health interventions for adolescents living with HIV/AIDS in sub-Saharan Africa: protocol for a systematic review

IntroductionAdolescents living with HIV/AIDS in sub-Saharan Africa have heightened risk for mental health and psychosocial burden owing to their exposure to a multiplicity of adverse conditions such as stigma and...

Digital health interventions for adolescents living with HIV in low- and middle-income countries: A narrative review and logic model

Digital health interventions for adolescents living with HIV in low- and middle-income countries: A narrative review and logic model

A Scoping Review of Arts-Based Interventions with Community Based Participatory Research Approaches for Addressing Mental Health Amongst Adolescents in the United States

Arts-based practices are positively associated with the prevention and management of adolescent mental health, and community-based participatory research (CBPR) methods are shown to enhance equity in mental health interventions. This study sought to understand how CBPR approaches to research are used to assess arts-based interventions for adolescent mental health in the United States. Five databases (Embase, PsycINFO, PubMed, Scopus, and Web of Science) and Google Scholar were searched. The included studies investigate adolescents (ages 10–19), included an arts-based practice, and occurred in the United States. Of 2,810 identified articles, 21 meet inclusion criteria and are included. Extracted components included forms of art, mental health focus, points of adolescent engagement, parental engagement, adherence to CBPR principles, and demographics. Art forms included dance/movement ( n = 2), literary arts ( n = 3), media ( n = 4), music ( n = 3), theater/performance ( n = 3), and visual arts, craft, and design ( n = 12). Five mental health categories represented the included studies—General Mental Health ( n = 9), Anxiety/Depression/Suicide ( n = 6), Social Support/Loneliness ( n = 2), Trauma/Resilience ( n = 3), Emotion Regulation ( n = 1). Studies prioritized minoritized populations and strongly adhered to the principles of CBPR. This review offers a comprehensive understanding of how diverse forms of arts participation are leveraged to address and mitigate the complexities of adolescent mental illness.

The effect of group counseling based on positive psychology on the WhatsApp social media platform on the severity of premenstrual syndrome symptoms: a randomized clinical trial

BackgroundPremenstrual syndrome (PMS) is a prevalent health issue impacting women, significantly impacting their well-being and fostering a negative attitude of femininity and menstruation. We investigated the effect of group counseling based on positive psychology on the severity of PMS symptoms.MethodsParticipants in the intervention group engaged in six online sessions of group counseling focused on positive psychology via WhatsApp. Data were collected using the Premenstrual Symptoms Screening Questionnaire (PSST) before, immediately, and two months post-intervention. Analytical assessments were performed using SPSS 16 software using Chi-square, independent t-tests, and repeated measures analysis of variance (ANOVA). Comparative analyses were carried out using the Bonferroni post hoc test with a 95% confidence level.ResultsThe mean intensity of PMS symptoms in the intervention group significantly decreased from 21.60 (2.50) to 13.35 (4.727) and 14.750 (5.963) immediately and two months after the intervention; however, the difference was not significant in the control group. The results of repeated measures ANOVA showed that the effect of the intervention over time and the interaction between time and group were significant. The Eta effect size was about 0.20 and 16%, respectively (p = 0.001). According to Bonferroni post hoc test results, the difference in the mean scores of the severity of PMS symptoms before the intervention was statistically significant compared to both follow-up periods (p ≤ 0.007). However, the difference in mean scores immediately after the intervention compared to two months after the intervention was not statistically significant (p = 0.42).ConclusionUsing a positive counseling approach demonstrates efficacy in alleviating the severity of PMS symptoms in the short term. While all women can benefit from such interventions, targeting adolescents is particularly strategic, as early interventions can foster positive attitudes toward menstruation. Additionally, social media platforms like WhatsApp provide a feasible and engaging medium for adolescent health interventions. Integrating this approach into adolescent health promotion package appears to be a viable measure worthy of consideration by relevant policymakers.Trial registrationCurrent Controlled Trials IRCT20201113049377N1, Date of Registration 2020, 12, 08.

Recommendations for Using Health Service Coverage Cascades to Measure Effective Coverage for Maternal, Newborn, Child, and Adolescent Health Services or Interventions.

Recommendations for Using Health Service Coverage Cascades to Measure Effective Coverage for Maternal, Newborn, Child, and Adolescent Health Services or Interventions.

Facilitators to implementing preventive health interventions for adolescents in the emergency department: A multicenter qualitative analysis.

Adolescents frequently use the emergency department (ED) to meet their health care needs, and many use the ED as their primary source of care. The ED is therefore well situated to provide preventive health care to large numbers of adolescents. The objective of this multicenter qualitative analysis was to identify factors that influence the implementation of preventive health care interventions for adolescent patients in the ED. We conducted semistructured interviews with ED health care providers (HCPs) from five academic pediatric EDs in distinct geographic regions. We developed an interview guide to explore HCP attitudes and beliefs related to implementing preventive health interventions in the ED. Interviews were recorded, transcribed, and coded by three investigators. The Consolidated Framework for Implementation Research (CFIR) was used as a guide to code and analyze interview data. We collaboratively generated themes that represent factors that are perceived to facilitate the implementation of preventive health interventions for adolescent patients in the ED setting. We conducted 38 interviews (18 pediatric emergency medicine attendings/fellows, 11 registered nurses, five nurse practitioners, or and four physician assistants). We generated 10 themes across the five CFIR domains: innovation characteristics (designing interventions to promote adolescent engagement), inner setting (integrating interventions into ED workflow and scope, minimizing provider burden), outer setting (involving the community, aligning with departmental and institutional missions), individuals (identifying champions), and implementation process (involving key stakeholders early, having patience, and targeting all patients to reduce stigma). Factors facilitating implementation of preventive health interventions for adolescent patients in the ED encompassed multiple CFIR domains, elucidating how the delivery of preventive health interventions for this patient population in the ED requires considering numerous factors comprehensively. These data suggest methods to enhance and facilitate implementation of preventive health interventions for adolescents in the ED.

Designing Health Interventions to Meet the Needs and Experiences of Minoritized Adolescents: #DoubleTap4Health.

Engagement in preventive health behaviors (PHBs; i.e., healthy eating, sleep, and physical activity) during adolescence is associated with reduced risks for chronic conditions, such as diabetes, in adulthood. Although several interventions seek to improve adolescents' engagement in health promoting behaviors, racial- and income-based disparities across PHBs persist and may be even more pronounced for adolescents with multiple minoritized identities (e.g., Black adolescents in low-income communities). Therefore, targeted interventions that better meet the needs of minoritized adolescents are critical. The design of such interventions should include: (1) adolescent involvement, (2) cultural tailoring, (3) developmental theory, and (4) consideration of the social determinants of health. This article describes how these elements have been successfully incorporated into adolescent preventive health interventions and used to design #DoubleTap4Health, a community-based social media health intervention for Black adolescents from a low-income community. The results of a feasibility pilot of #DoubleTap4Health suggest that (1) attention to these elements in the intervention design process is feasible and advantageous to ensuring that the intervention components are appropriate and well received by adolescents, and (2) the intervention demonstrated promise as adolescents showed improved engagement in PHBs and media literacy skills. Lessons learned and next steps for intervention development are discussed. Including the above four elements in the design of preventive health interventions for adolescents from minoritized communities is critical to promoting health equity.

Digital Mental Health Interventions for Adolescents in Low- and Middle-Income Countries: Scoping Review.

Digital mental health interventions (DMHIs) are increasingly recognized as potential solutions for adolescent mental health, particularly in low- and middle-income countries (LMICs). The United Nations' Sustainable Development Goals and universal health coverage are instrumental tools for achieving mental health for all. Within this context, understanding the design, evaluation, as well as the barriers and facilitators impacting adolescent engagement with mental health care through DMHIs is essential. This scoping review aims to provide insights into the current landscape of DMHIs for adolescents in LMICs. The Joanna Briggs Institute scoping review methodology was used, following the recommendations of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Our search strategy incorporated 3 key concepts: population "adolescents," concept "digital mental health interventions," and context "LMICs." We adapted this strategy for various databases, including ACM Digital Library, APA PsycINFO, Cochrane Library, Google Scholar (including gray literature), IEEE Xplore, ProQuest, PubMed (NLM), ScienceDirect, Scopus, and Web of Science. The articles were screened against a specific eligibility criterion from January 2019 to March 2024. We analyzed 20 papers focusing on DMHIs for various mental health conditions among adolescents, such as depression, well-being, anxiety, stigma, self-harm, and suicide ideation. These interventions were delivered in diverse formats, including group delivery and self-guided interventions, with support from mental health professionals or involving lay professionals. The study designs and evaluation encompassed a range of methodologies, including randomized controlled trials, mixed methods studies, and feasibility studies. While there have been notable advancements in DMHIs for adolescents in LMICs, the research base remains limited. Significant knowledge gaps persist regarding the long-term clinical benefits, the maturity and readiness of LMIC digital infrastructure, cultural appropriateness, and cost-effectiveness across the heterogeneous LMIC settings. Addressing these gaps necessitates large-scale, co-designed, and culturally sensitive DMHI trials. Future work should address this.

Family-based sexual health intervention for adolescents; A systematic review and meta-analysis

Abstract Background Family-based interventions are important in promoting adolescent sexual health outcomes. However, the effectiveness of these interventions in promoting adolescent sexual and reproductive health (ASRH) in Lower and middle-income countries (LMIC) has not been empirically evaluated. This review aimed to summarise the effectiveness of family-based sexual and reproductive health interventions in promoting ASRH in LMIC. Methods We conducted a systematic search for studies published in English from 2000 to October 2023 using MEDLINE, PsyINFO, CINAHL, Web of Science, and EMBASE databases. Studies were included if they involved adolescents aged 10-19 years, included family members in a key intervention component, evaluated the effectiveness of the interventions using an experimental or quasi-experimental design, assessed ASRH outcomes reported by adolescents and were conducted in LMIC setting. Standardized mean difference (SMD) and 95% confidence intervals were computed and meta-analyses were conducted using random effect models. Results Ten articles involving 2,246 participants were included in the review. The studies were nostly conducted in Africa. Across studies, there was no significant impact of family-based interventions in improving adolescent sexual health knowledge (SMD=0.5, 95%CI: -1.98 to 2.98), attitudes (SMD= -0.05, 95%CI: -1.92 to 1.82), practices (SMD=0.53, 95%CI: -0.69 to 1.75), or sexual communication with their family (SMD= 0.14, 95%CI: -0.42 to 0.7). Although individual studies reported a mixed effect of family-based interventions in improving sexual health outcomes, the pooled results from the meta-analysis showed no significant impact of family-based interventions. Conclusions Our review did not find any significant impact of family-based interventions in improving ASRH in LMIC. We recommend interventions using innovative approaches and novel strategies to align with the socio-cultural and economic background of the study setting. Key messages • This study found no significant impact of family-based interventions in improving ASRH in LMIC. • Additional studies, particularly from Asia, using culturally relevant interventions is required in this area.

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.

Stakeholder perspectives on managing the adolescent sleep crisis using a transdiagnostic self-management app for sleep disturbances: A qualitative follow-up study.

Sleep problems are diverse and pervasive among the adolescent population. Current sleep health interventions are ill-equipped to address the sleep crisis. We developed DOZE (Delivering Online Zzz's with Empirical Support), which is a self-management evidence-based app for sleep disturbances. In an initial study, we found that DOZE was perceived as an acceptable and effective support for teen sleep. In a qualitative follow-up study, we engaged with students and other stakeholders to understand their experiences with implementing, disseminating, and using DOZE. The study employed a combination of qualitative surveys and semi-structured interviews to students (n = 21) and stakeholders (teachers, social workers, and researchers; n = 5), respectively. Reflexive thematic analysis was used to identify themes related to experiences implementing and engaging with the app. Students reported increased sleep regularity and sleep duration after using DOZE. Facilitators included greater integration of the app with school curriculum, timing of implementation, and researcher involvement in supporting knowledge dissemination and engagement. Barriers included worries about phone use at night and normalized poor sleep patterns among adolescents. There is need to identify ways to support implementation and engagement in different communities. Researchers continue to engage with stakeholders to support timely access to sleep health interventions for adolescents.

Educating adolescents on preventing substance use: The role of 24-h movement behaviors ─ data from 2021 Youth Risk Behavior Surveillance

BackgroundLittle is known about how adhering to the health guidelines for physical activity (PA), screen time (ST), and sleep duration (SD) relates to substance use in adolescents. Thus, this study aims to explore the potential association between adherence to the 24-h movement behavior (24-h MB) guidelines and substance use among adolescents. MethodsData from the 2019 Youth Risk Behavior Surveillance was analyzed. Participants reported their weekly PA, ST, SD, and substance use (alcohol and smoking) over the past 30 days. The mean age in the total participants was 15.56, and 48.03 % of the participants were females. Logistic regression was used in this study to explore the potential association between 24-h MB and substance use. Odds ratios (ORs) were reported alongside a 95 % confidence interval to enhance understanding of the observed association. ResultsOnly 2.22 % participants adhered to all three 24-h MB guidelines, while 47.99 % did not follow any guidelines. Notably, there was no significant difference in the odds of cigarette smoking between participants who followed none of the guidelines and those who followed some or all of them. Nevertheless, adherence to one or more guidelines was found to be associated with higher odds of abstaining from alcohol consumption compared to non-adherence (one guidelines: OR = 1.17 [1.08, 1.28], two guidelines: OR = 1.28 [1.13, 1.44]). ConclusionsAdhering to 24-h MB guidelines may reduce adolescents’ alcohol consumption, but the adherence was not significantly associated with smoking. Longitudinal studies are needed to confirm these findings. These results can inform adolescent health policies and interventions aimed at reducing substance use from the perspective of healthy time-use behaviors, which can be used for researchers and educator.

What Emotion Regulation Strategies are Associated with a General Psychopathology Factor (p) in Adolescence? Identifying Possible Transdiagnostic Targets for Intervention.

Mental health problems in adolescence are increasing and there is an urgent call for transdiagnostic interventions, as most adolescents experience problems across multiple domains. Research has identified a general psychopathology factor (p) capturing the shared variance across mental health problems. In parallel, there is empirical support for the transdiagnostic nature of emotion regulation. In the current study, we explore the associations between p and emotion regulation strategies to identify which strategies may be promising targets for intervention. Data from the population-based Youth and Mental Health Study (YAMHS) (N = 2,464, mean age 13.7years, SD 0.6) was used. The fit of different structural models of emotion regulation and psychopathology were compared, and latent factors from the final models were included in multiple regression analyses to explore the associations between p and emotion regulation strategies. A bifactor exploratory structural equation model (B-ESEM) showed best fit for modelling p. For emotion regulation strategies, an ESEM model showed best fit, including Rumination, Reactive Impulsivity, Distraction, Non-Acceptance, Problem Solving, Social Support, and Proactive Behavior. Results showed that a higher score on p was predicted by higher scores on the emotion regulation strategies Rumination (β = .38, p < .001) and Reactive Impulsivity (β = .35, p < .001), and lower scores on Problem Solving (β = -.15, p < .001). The results indicate that Rumination and Reactive Impulsivity have the strongest associations with p and may be promising targets for mental health interventions for adolescents.

Effect of a digital school-based intervention on adolescent family planning and reproductive health in Rwanda: a cluster-randomized trial.

We conducted a cluster-randomized hybrid effectiveness-implementation study of CyberRwanda, a digital family planning and reproductive health intervention for Rwandan adolescents. Sixty schools were randomized 1:1:1 to control or to one of two implementation models-self-service (self-guided access on tablets) or facilitated (peer-led clubs plus tablet access) with no masking. Eligible participants were aged 12-19 years, in secondary school levels 1 or 2, and willing to provide consent or assent/parental consent and contact information for follow-up. In 2021, 6,078 randomly selected adolescents were enrolled. At 24 months, 91.3% of participants were retained and included in the primary intention-to-treat analyses (control, n = 1,845; self-service, n = 1,849 and facilitated, n = 1,858). There were no adverse events related to the study. CyberRwanda did not affect the primary outcomes of modern contraceptive use (prevalence ratio (PR) = 1.04; 95% confidence interval (CI) = 0.76, 1.42), childbearing (PR = 1.33; 95% CI = 0.71, 2.50) and HIV testing (PR = 1.00; 95% CI = 0.91, 1.11) in the full sample. Significantly higher modern contraceptive use observed in the CyberRwanda facilitated arm in a prespecified analysis of sexually active participants suggests that longer-term evaluation is needed to examine effects as more of the study population becomes sexually active and has increased demand for contraception. ClinicalTrials.gov registration: NCT04198272 .

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...

Factors influencing adoption of sexual and reproductive health intervention for adolescents in Ebonyi, Nigeria.

School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enablers of the adoption of a school and community-embedded intervention that used community engagement, capacity building, partnerships and collaborations to deliver sexual and reproductive health services to adolescents. The intervention was implemented between 2019 and 2021 in six local government areas in Ebonyi State. The results on adoption presented here were collected four months into the mid-phase of the project, targeting adolescents, parents, adult family members, healthcare providers, local authorities, and community members. Sixteen in-depth interviews were conducted with policymakers, 14 with health service providers and 18 Focus Group Discussions (FGDs) with parents, community leaders and adolescents who were part of the implementation process. The coding reliability approach, a type of thematic data analysis was used, that involves early theme development and the identification of evidence for the themes. The adoption of school and community-embedded reproductive health intervention was strong among stakeholders at the early stages of the implementation process. Multi-stakeholder involvement and its multi-component approach made the intervention appealing, thereby enabling its adoption. However, at the later stage, the adoption was constrained by beliefs and norms about sexual and reproductive health (SRH) and the non-incentivisation of stakeholders who acted as advocates at the community level. The sustainability of the intervention may be threatened by the non-incentivisation of stakeholders and the irregular supply of materials and tools to facilitate SRH advocacy at the community level. The inclusive community-embedded reproductive health intervention was adopted by stakeholders because of the enablers which include timely stakeholder engagement. However, for it to be sustainable, implementers must address the non-incentivising of community-level advocates which serve as constraints.

Mental toughness in adolescents: bridging family relationships and depression across personality traits

BackgroundAdolescence is a pivotal stage vulnerable to mental health issues like anxiety and depression. While family relationships, mental toughness, and personality traits are known to impact adolescent mental health, their interactive and moderating roles are not fully understood.AimThis study aims to investigate the mediating role of mental toughness in the relationship between family relationships and depression among high school students, and to examine the varying impacts of personality traits on this mediation.MethodA cross-sectional study was conducted on a sample of 734 adolescents. Participants completed measures assessing family relationships, mental toughness, personality traits, and mental health outcomes (depression). Latent Profile Analysis, Multiple Regression Analysis, and Structural Equation Modeling, to investigate these relationships.ResultsThe study found that mental toughness significantly mediates the relationship between family relationships and depression. Notably, this mediating effect varied between personality type; it was more pronounced in the moderate-reserved type compared to the proactive-engaged type. LPA identified two distinct personality types of students based on their personality traits, with differential patterns of family relationships, mental toughness, and depression. Multiple regression analysis indicated that character and adaptability, components of mental toughness, were significant negative predictors of depression.ConclusionThe study contributes to understanding the dynamics of adolescent mental health, particularly in the context of Chinese high school students. It underscores the importance of considering family dynamics, personality traits, and mental toughness in developing effective mental health interventions for adolescents.