Adolescent Health Interventions Research Articles

Social networking in mental health interventions for adolescents.

Social networking in mental health interventions for adolescents.

Mental health interventions for adolescents living with HIV or affected by HIV in low- and middle-income countries: systematic review.

Mental health difficulties and mental disorders are common in adolescents living with HIV or who are affected by HIV because of living in HIV-affected households in low- and middle-income (LMICs) countries, but little is known about the interventions that target these individuals and whether they are effective. This systematic review aims to address these gaps by examining what has worked and what has not worked to support the mental health of adolescents living with HIV or affected by HIV in low- and middle-income contexts (PROSPERO Number: CRD42018103269). A systematic literature review of online databases from the year 2000 to 2018, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, included English-language publications of quantitative evaluations of psychosocial interventions aiming to improve mental health among adolescents living with HIV and adolescents from HIV-affected households (aged 10-24 years) in LMICs. Out of 2956 articles, 16 studies from 8 LMICs met the inclusion criteria. Thirteen studies focused on adolescents affected by HIV and only three studies on adolescents living with HIV. Only five studies included were from Sub-Saharan Africa. Interventions most often used a family-strengthening approach strengthening caregiver-adolescent relationships and communication and some problem-solving in groups or individually. Five studies reported statistically significant changes in adolescent and caregiver mental health or mental well-being, five among adolescents only and two among caregivers only. Research on what works to improve mental health in adolescents living with HIV in LMIC is in its nascent stages. Family-based interventions and economic strengthening show promise.

Adolescent Barriers in Accessing Reproductive Health Services in Developing Countries

Background : Adolescents (10–19 years) are the future leaders of our society and an untapped human resource. About one-fifth (more than 1.2bn) of the global population are adolescents, and many of the world’s adolescents live in developing nations. Adolescents are perceived to be healthy, however, they are vulnerable and exposed to many health risks leading to premature deaths. In 2015, about 1.3m adolescents died globally from causes that could have been prevented. Over two-thirds of these deaths occurred in low- and middle-income countries (LMICs) with 45 percent from Africa. Approximately 16m girls aged 15–19 years and 2.5m girls under 16 years give birth each year in developing regions. About 3m girls aged 15–19 years undergo unsafe abortions every year. Moreover, about 2m adolescents are living with human immune virus (HIV) globally, and over 41 percent of new HIV infections in every year occur among adolescents. Purpose : to explore adolescent barriers to accessing reproductive health services in developing countries. Method : Apprasial studies program using Critical Appraisal Skills Program (CASP) data sources obtained from PubMed with year period of 2009 – 2019. Results : inadequate space, no privacy, limited service hours, poor service attitude, lack of information, distance of clinics, high transportation costs, clinics aimed at married couples. lack of human resources, parental support, peer influence, religion and weak community traditions for adolescent health interventions also trigger adolescents not to access reproductive health clinics. Conclusion : adolescent barriers to accessing reproductive health services are facility level, personal level, service provider level and community level.

A Mobile Health Intervention for Adolescents Exposed to Secondhand Smoke: Pilot Feasibility and Efficacy Study.

BackgroundSecondhand smoke (SHS) exposure in children and adolescents has adverse health effects. For adolescents of lower socioeconomic status (SES), exposure is widespread, evidenced in the measurement of urinary cotinine, a major metabolite of nicotine. Direct intervention with exposed children has been proposed as a novel method, yet there is minimal evidence of its efficacy. Combining this approach with a mobile health (mHealth) intervention may be more time and cost-effective and feasible for adolescent populations.ObjectiveIn this pilot study, we assessed the feasibility and preliminary evidence of efficacy of a 30-day text message–based mHealth intervention targeted at reducing SHS exposure in adolescent populations of low SES.MethodsFor the study, 14 nonsmoking and nonvaping participants between the ages of 12-21 years exposed to SHS were enrolled. The intervention consisted of a daily text message sent to the participants over the course of a month. Text message types included facts and information about SHS, behavioral methods for SHS avoidance, or true-or-false questions. Participants were asked to respond to each message within 24 hours as confirmation of receipt. Feasibility outcomes included completion of the 30-day intervention, receiving and responding to text messages, and feedback on the messages. Efficacy outcomes included a reduction in urinary cotinine, accuracy of true-or-false responses, and participants’ perceptions of effectiveness.ResultsOf the 14 participants that were enrolled, 13 completed the intervention. Though not required, all participants had their own cell phones with unlimited text messaging plans. Of the total number of text messages sent to the 13 completers, 91% (372/407) of them received on-time responses. Participant feedback was generally positive, with most requesting more informational and true-or-false questions. In terms of efficacy, 54% (6/11) of participants reduced their cotinine levels (however, change for the group overall was not statistically significant (P=.33) and 45% (5/11) of participants increased their cotinine levels. Of the total number of true-or-false questions sent across all completers, 77% (56/73) were answered correctly. Participants’ ratings of message effectiveness averaged 85 on a scale of 100.ConclusionsIn this pilot study, the intervention was feasible as the majority of participants had access to a cell phone, completed the study, and engaged by responding to the messages. The efficacy of the study requires further replication, as only half of the participants reduced their cotinine levels. However, participants answered the majority of true-or-false questions accurately and reported that the messages were helpful.

Design process and protocol description for a multi-problem mental health intervention within a stepped care approach for adolescents in India

This paper documents the collaborative design of a mental health intervention for adolescents in India with anxiety, depression, or anger-related concerns. The process was characterized by three phases of formative activities: (1) an intensive review of the service context, (2) selection of an overall design strategy (e.g., whether to choose existing evidence-based treatments or build new treatments in context), and (3) a period of prototyping, testing, and refining. Each phase resulted in specific outputs, which were, respectively, (1) a detailed articulation of values and preferences (setting expectations for what the ideal protocol should be), (2) a set of build parameters representing a blueprint that managed strategic compromises for this context, and (3) a working protocol. We outline the steps of this design process, summarize data from an open-trial clinical case series, and illustrate the resulting working protocol, which will be tested in a future larger trial. We conclude with insights and observations likely to be relevant to protocol design activity in a variety of contexts, most particularly those in low-and-middle-income countries such as India.

The application of theory-guided oral health interventions in adolescents: a systematic review and meta-analysis of randomized controlled trials

Objective To explore theory-guided randomized controlled trials aimed at improving adolescents’ oral health and evaluate their effectiveness. Design Multiple library databases with search criteria for articles between 1990 and 2019. Main Outcome Measures Searched references were coded and screened for theory-guided interventions for adolescent oral health. Characteristics of each study (study sample, adopted theory, outcome measures, length of follow-up and main findings) were extracted and the quality of the eligible trials assessed. Effect sizes for theory-guided interventions for different follow-up periods were analysed and compared with traditional oral health education. Results About 2135 results were uncovered, 64 were extracted for further screening, and 10 studies were eligible for inclusion. For plaque presence outcomes, no statistical difference was observed between theory-guided interventions and traditional interventions at 3 months (MD: –5.94, 95% CI: –16.39 to 4.51). When the duration of observation was extended to over one year, a significant reduction was found (SMD: –0.25, 95% CI: –0.46 to –0.04). Conclusion Theory-guided interventions for improving oral hygiene status appear to be more effective than traditional interventions for adolescents in the long term. However, more comprehensive studies are required for validation to support the implementation and adoption of these programs in the clinical setting.

Barrier Protection Use by Adolescents During Sexual Activity.

Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs). This technical report discusses the new data and trends in adolescent sexual behavior and barrier protection use. Since 2017, STI rates have increased and use of barrier methods, specifically external condom use, has declined among adolescents and young adults. Interventions that increase availability of or accessibility to barrier methods are most efficacious when combined with additional individual, small-group, or community-level activities that include messages about safer sex. Continued research informs public health interventions for adolescents that increase the consistent and correct use of barrier methods and promote dual protection of barrier methods for STI prevention together with other effective methods of contraception.

Sexual Health Programs for Latinx Adolescents: A Meta-analysis.

Latinx adolescents are at risk for negative sexual health outcomes, and many interventions have been developed to reduce this risk. In this meta-analysis, we synthesized the literature on sexual health interventions for Latinx adolescents and examined intervention effects on 3 behavioral outcomes (abstinence, condom use, number of sex partners) and 3 psychological outcomes (safer sex knowledge, intentions, self-efficacy). Moderators of intervention success were explored. A systematic search of studies published through January 2019 was conducted by using PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature databases. All studies included a US-based sample of Latinx adolescents, evaluated sexual health intervention by using an experimental or quasiexperimental design, included a behavioral outcome, and were in English. Standardized mean difference (d) and 95% confidence intervals (CIs) were meta-analyzed by using random-effects models. Effect sizes from 12 studies, sampling 4673 adolescents, were synthesized. Sexual health interventions improved abstinence (d = 0.15, 95% CI: 0.02 to 0.28), condom use (d = 0.44, 95% CI: 0.18 to 0.70), number of sex partners (d = -0.19, 95% CI: -0.37 to -0.001), and sexual health knowledge (d = 0.40, 95% CI: 0.10 to 0.70), compared with control conditions. Effects were consistent across a number of demographic and clinical characteristics, although culturally tailored interventions produced greater change in condom use than nontailored interventions. There was variation across studies in measures of sexual behavior, and some elements of individual study quality were unclear. Sexual health interventions have a small but significant impact on improving safer sexual behavior among Latinx adolescents. Health educators should consider the importance of cultural tailoring to program success.

Responding to health needs of women, children and adolescents within Syria during conflict: intervention coverage, challenges and adaptations

BackgroundWomen and children suffer disproportionately in armed-conflicts. Since 2011, the protracted Syrian crisis has fragmented the pre-existing healthcare system. Despite the massive health needs of women and children, the delivery of key reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) interventions, and its underlying factors are not well-understood in Syria. Our objective was to document intervention coverage indicators and their implementation challenges inside Syria during conflict.MethodsWe conducted 1) a desk review to extract RMNCAH&N intervention coverage indicators inside Syria during the conflict; and 2) qualitative interviews with decision makers and health program implementers to explore reasons behind provision/non-provision of RMNCAH&N interventions, and the rationale informing decisions, priorities, collaborations and implementation. We attempt to validate findings by triangulating data from both sources.ResultsKey findings showed that humanitarian organisations operating in Syria adopted a complex multi-hub structure, and some resorted to remote management to improve accessibility to certain geographic areas. The emergency response prioritised trauma care and infectious disease control. Yet, with time, humanitarian organisations successfully advocated for prioritising maternal and child health and nutrition interventions given evident needs. The volatile security context had implications on populations’ healthcare seeking behaviors, such as women reportedly preferring home births, or requesting Caesarean-sections to reduce insecurity risks. Additional findings were glaring data gaps and geographic variations in the availability of data on RMNCAH&N indicators. Adaptations of the humanitarian response included task-shifting to overcome shortage in skilled healthcare workers following their exodus, outreach activities to enhance access to RMNCAH&N services, and operating in ‘underground’ facilities to avoid risk of attacks.ConclusionThe case of Syria provides a unique perspective on creative ways of managing the humanitarian response and delivering RMNCAH&N interventions, mainly in the multi-hub structure and use of remote management, despite encountered challenges. The scarcity of RMNCAH&N data is a tremendous challenge for both researchers and implementing agencies, as it limits accountability and monitoring, thus hindering the evaluation of delivered interventions.

Investigating the delivery of health and nutrition interventions for women and children in conflict settings: a collection of case studies from the BRANCH Consortium

Globally, the number of people affected by conflict is the highest in history, and continues to steadily increase. There is currently a pressing need to better understand how to deliver critical health interventions to women and children affected by conflict. The compendium of articles presented in this Conflict and Health Collection brings together a range of case studies recently undertaken by the BRANCH Consortium (Bridging Research & Action in Conflict Settings for the Health of Women and Children). These case studies describe how humanitarian actors navigate and negotiate the multiple obstacles and forces that challenge the delivery of health and nutrition interventions for women, children and adolescents in conflict-affected settings, and to ultimately provide some insight into how service delivery can be improved.

0217 Adolescents’ Evening Preference is Associated with Specific Sleep Hygiene Behaviours

Abstract Introduction Circadian tendencies are associated with individual differences in preferred timing of behaviour. Sleep hygiene encompasses a variety of habits that are necessary for healthy. Given the later bedtimes of individuals with evening circadian preferences, more time is spent being awake in the evening and this could be associated with increased or longer engagement in poor sleep hygiene. Specific sleep hygiene practices that are common in adolescents with high evening preferences may therefore be a target to improve sleep. However, the relationship between specific sleep hygiene behaviours and circadian preferences in adolescents has not been examined. The objective of this study was to examine the associations between circadian preference and specific domains of sleep hygiene behavior. Methods 127 adolescents (86 female) between 13 and 18 years old (M = 14.83, SD = 1.20) participated in the study. Circadian preferences were measured by the Morningness-Eveningness subscale of the School Sleep Habits Survey. Sleep hygiene was measured using the Adolescent Sleep Hygiene Scale (ASHS). Results Higher eveningness scores were significantly negatively associated with the ASHS physiological, behavioural arousal, cognitive emotional arousal, sleep environment, sleep stability, daytime sleep, substances use factors (r = -.20, p = <.05, r = -.27, p = <.01, r = -.32, p = <.01, r = -.18, p = <.05, r = -.41, p = <.01, r = -.28, p = <.01, r = 0.20, p = <.05 respectively) and with total sleep hygiene score (r = -.45, p = <.01). Conclusion Higher eveningness preferences in adolescents is significantly associated with poorer sleep hygiene in all domains with the exception of bedtime routine. Behavioural arousal, cognitive emotional, and sleep stability domains show the strongest inverse correlations. These findings could be used to inform the development of tailored sleep health interventions for adolescents with strong evening tendencies Support Social Sciences and Humanities Research Council (SSHRC) support for Dr. Reut Gruber.

Mila Blooms: A Mobile Phone Application and Behavioral Intervention for Promoting Physical Activity and a Healthy Diet Among Adolescent Survivors of Childhood Cancer.

Objectives: Smartphone applications ("apps") can be used to promote health behavior change and expand the reach of behavioral interventions. To date, only a few existing apps have been developed for health promotion among adolescent survivors of childhood cancer. To address this gap, we developed an app-based intervention, using game design characteristics, theory-based behavioral strategies, and assistance from a health coach to motivate health behavior change for adolescent survivors of childhood cancer. This article describes the development and initial feasibility evaluation of the intervention. Methods: Using a theoretical framework and an extensive formative process, we developed an app-based game ("Mila Blooms") that promotes healthy eating and physical activity among adolescent survivors of childhood cancer. A single-arm 8-week intervention, using this app-based game, with assistance from a health coach, was conducted among a sample of pediatric cancer survivors (n = 15) to evaluate its initial feasibility for promoting health behavior change. Results: Results from the feasibility evaluation were encouraging. The majority of enrolled participants were retained throughout the 8-week intervention (93.8%). Participant satisfaction feedback indicated positive experiences, related to ease of use and enjoyment of the app. Although there was little evidence for behavior change attributable to the app in this first stage of development, there was a solid demonstration of the viability and appeal of the game features, and there were no adverse side effects. Conclusions: Results provide insights into how gamification can be used to promote health behaviors through an app-based intervention. Mila Blooms holds promise for promoting health behavior change. Lessons learned from our experiences could be useful for the future development and implementation of app-based adolescent health interventions.

Adaptive Mobile Health Intervention for Adolescents with Asthma: Iterative User-Centered Development.

BackgroundAdolescents diagnosed with persistent asthma commonly take less than 50% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents’ difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely upon still developing self-regulation and problem-solving skills that are integral for asthma self-management. We developed an adaptive mobile health system, Responsive Asthma Care for Teens (ReACT), that facilitates self-regulation and problem-solving skills during times when adolescents’ objectively measured ICS adherence data indicate suboptimal rates of medication use.ObjectiveThe current paper describes our user-centered and evidence-based design process in developing ReACT. We explain how we leveraged a combination of individual interviews, national crowdsourced feedback, and an advisory board comprised of target users to develop the intervention content.MethodsWe developed ReACT over a 15-month period using one-on-one interviews with target ReACT users (n=20), national crowdsourcing (n=257), and an advisory board (n=4) to refine content. Participants included 13-17–year-olds with asthma and their caregivers. A total of 280 adolescents and their caregivers participated in at least one stage of ReACT development.ResultsConsistent with self-regulation theory, adolescents identified a variety of salient intrapersonal (eg, forgetfulness, mood) and external (eg, changes in routine) barriers to ICS use during individual interviews. Adolescents viewed the majority of ReACT intervention content (514/555 messages, 93%) favorably during the crowdsourcing phase, and the advisory board helped to refine the content that did not receive favorable feedback during crowdsourcing. Additionally, the advisory board provided suggestions for improving additional components of ReACT (eg, videos, message flow).ConclusionsReACT involved stakeholders via qualitative approaches and crowdsourcing throughout the creation and refinement of intervention content. The feedback we received from participants largely supported ReACT’s emphasis on providing adaptive and personalized intervention content to facilitate self-regulation and problem-solving skills, and the research team successfully completed the recommended refinements to the intervention content during the iterative development process.

Adolescent Sexual Health Interventions: Innovation, Efficacy, Cost, and the Urgent Need to Scale.

* Abbreviations: FTT — : Families Talking Together HCP — : health care provider African American and Latinx adolescents in the United States are at high risk for experiencing poor sexual health outcomes. Compared with their white peers, African American and Latina girls are nearly twice as likely to give birth before age 20.1 Rates of HIV and other sexually transmitted infections are also higher for racial and/or ethnic minority adolescents.2 The persistence of these sexual health disparities, despite decades of intervention efforts, necessitates prevention approaches that are innovative, efficacious, cost-effective, and scalable. In this issue of Pediatrics , Guilamo-Ramos et al3 provide rigorous evidence for a highly promising intervention, a triadic version of Families Talking Together (FTT). The triadic FTT intervention is innovative in that it involves African American and Latinx youth in early adolescence, their female caregivers, and their health care providers (HCPs). Of more than two dozen sexual health interventions for African American and/or Latinx adolescents that have been evaluated in randomized clinical trials,4,5 FTT is the first of which we are aware that incorporates adolescents, parents, and HCPs in a single program. Incorporating both parents and HCPs into intervention efforts is wise for several reasons: HCPs can lend additional credibility to intervention … Address correspondence to Laura Widman, PhD, Department of Psychology, North Carolina State University, 640 Poe Hall, Raleigh, NC 27695. E-mail: lmwidman{at}ncsu.edu

Issues in Community-Based Interventions for Adolescent Psychosexual Health and Life Skill Training Module

Issues in Community-Based Interventions for Adolescent Psychosexual Health and Life Skill Training Module

HEALTH PROMOTION PROGRAM FOR ADOLESCENT REPRODUCTIVE AND SEXUAL IN INDONESIA: REVIEW ARTICLE

Adolescents have a high burden of sexual and reproductive health problems and it is important to reach out to youth groups through health promotion initiatives. A literature review was carried out to identify the elements of a successful health promotion program to improve adolescent reproductive health and sex. This study identified and compiled a literature review published in 2000-2018 that focused on adolescents (10-24 years), reported reproductive and sexual health outcomes (pregnancy, sexually transmitted infections, condoms/contraceptive use, risky sexual behavior, access to health care sexual or intimate partner violence), and includes major studies that are mainly carried out in high-income countries. This report focuses on the features of the reproductive and sexual health program that were successfully identified in the interpretation and discussion of the systematic reviews included. This study identified 66 systematic reviews, of which 37 were reported on programs that were anecdotally or statistically related to the increase in program effectiveness and success. The general characteristics of effective interventions are: long-term or recurrent implementation; multi-regulation and multi-component; parental involvement; according to culture, gender, age; and the inclusion of skill development. There is a marked consistency of features increasing the effectiveness of reproductive and sexual health programs for adolescents even though wide variations in interventions are reviewed. There is a need to better implement this knowledge in future programs, and our findings provide useful guidance for optimizing the design of reproductive and sexual health interventions for adolescents.

Assessment of impact of nutritional status on pubertal development in adolescent girls of two senior secondary schools of Dehradun and to correct pubertal disorders by adolescent health counseling and adequate pharmacological intervention

Background: Adolescence is a transitional stage of physical and psychological development that occurs during the period from onset of puberty to adulthood. Adolescent nutrition is crucial for proper growth and development and a prerequisite for achieving full development potential. Aims and Objectives: The objectives of the study were as follows: (1) To find out the gross nutritional status in girl students of two senior secondary schools in Dehradun, (2) to assess the level of pubertal development in them, (3) to find out correlation of nutritional status (body mass index, BMI) with pubertal development and physical activity, and (4) to do counseling on adolescent health and pharmacological intervention as needed. Materials and Methods: A cross-sectional observational study was undertaken among 200 adolescent girls of two senior secondary schools of Dehradun. They were of 12-18 year age group studying in class VI to XII. The sample was selected by systematic random sampling Their physical examination (weight & height ) was done to calculate BMI & pubertal assessment was done by means of oral questionnaire and by showing Tanner charts. The corelation between BMI & onset of pubertal events was analyzed statistically by Chi-square test. Results: Body mass index was normal in 44%, low in 52% of students& high in 4%. On assessing pubertal events, menarche has occurred in 74% of students out of which maximum number of students attained menarche at age of 12 years followed by 13 years. Breast changes (thelarche) were present in 74.5% of students and pubic hair was present in 68% of students. A correlation was found between BMI and pubertal events. In girls with low BMI (underweight), menarche was present in 52.94% of cases, breast changes were in 52.94% of cases, regularity of periods in 42.59% of cases in girls with high BMI (overweight/obese), menarche was present in 91.66% of cases, breast changes were in 100% of cases, and regularity of periods in 36.36% of cases. Pallor was present in 37.5% of the total girls. Out of number of girls with normal weight, 80% had regular physical activity and girls with high BMI had very less regular physical activity. Conclusion: The study concluded that underweight, overweight, and anemia were the nutritional problems detected and there was a statistically significant correlation of BMI with onset of pubertal events. Those with low BMI had delayed puberty and those with high BMI had earlier onset of pubertal events. Hence, the need for correction of nutritional disorders with healthy diet, physical exercise, and clinical consultation was considered very crucial to solve the problems of early and delayed puberty. Hence, counseling the girls on adolescent’s health was encouraged in schools including imparting knowledge, nutritional education, and supplementation.

Association of Early Menarche with Adolescent Health in the Setting of Rapidly Decreasing Age at Menarche.

This study aimed to investigate the association between age at menarche (AAM) and adverse health indicators in adolescent girls. A retrospective cohort study. Population-based survey data. A total of 319,437 female participants aged 12-18years from the Korea Youth Risk Behaviour Web-based Survey. We assessed associations between AAM (categorized as ≤10, 11, and ≥12) and health indicators (poor self-rated health, high psychological stress, unhappiness, sexual initiation, and pregnancy). Covariates were individual-level (bodyweight, living with family, parent's education, household wealth, and presence of parents and siblings) and community-level factors (year of birth, single-sex education and level of school, urbanization level of school area, year of survey, and regional deprivation). Odds ratios (ORs) for each adverse health indicator were examined by each AAM group using multivariable regression analyses. For pregnancy, we calculated relative risks (RRs) using a log-binomial regression model. Age at menarche was <12 in 42% of our study population. Nearly one-half of the girls born in the early 2000s went through menarche before the age of 12years, whereas only one-third of girls born in the early 1990s went through menarche before the age of 12years. Girls who experienced menarche at age ≤10 or age 11years were more likely to show self-rated poor health (AAM≤10: OR, 1.28; 95% confidence intervals [CI], 1.22-1.34; AAM=11: OR, 1.16; 95% CI, 1.12-1.21), high stress (OR, 1.19; 95% CI, 1.14-1.23, and OR, 1.10; 95% CI, 1.06-1.14), and sexual initiation (OR, 2.21; 95% CI, 2.05-2.38, and OR, 1.32; 95% CI, 1.23-1.41) compared to those with AAM ≥12years when data were adjusted for all covariates. AAM ≤10years was associated with consistently higher odds for poor health than AAM ≥12years. The ORs of sexual initiation increased with earlier AAM. Risk of pregnancy was similar across AAM groups when individual- and community-level covariates were controlled for. Early menarche, defined as <12years, can be still a useful indicator in adolescent health interventions to identify high-risk groups in the setting of declining AAM.

HEALTH PROMOTION PROGRAM FOR ADOLESCENT REPRODUCTIVE AND SEXUAL IN INDONESIA: REVIEW ARTICLE

Adolescents have a high burden of sexual and reproductive health problems and it is important to reach out to youth groups through health promotion initiatives. A literature review was carried out to identify the elements of a successful health promotion program to improve adolescent reproductive health and sex. This study identified and compiled a literature review published in 2000-2018 that focused on adolescents (10-24 years), reported reproductive and sexual health outcomes (pregnancy, sexually transmitted infections, condoms/contraceptive use, risky sexual behavior, access to health care sexual or intimate partner violence), and includes major studies that are mainly carried out in high-income countries. This report focuses on the features of the reproductive and sexual health program that were successfully identified in the interpretation and discussion of the systematic reviews included. This study identified 66 systematic reviews, of which 37 were reported on programs that were anecdotally or statistically related to the increase in program effectiveness and success. The general characteristics of effective interventions are: long-term or recurrent implementation; multi-regulation and multi-component; parental involvement; according to culture, gender, age; and the inclusion of skill development. There is a marked consistency of features increasing the effectiveness of reproductive and sexual health programs for adolescents even though wide variations in interventions are reviewed. There is a need to better implement this knowledge in future programs, and our findings provide useful guidance for optimizing the design of reproductive and sexual health interventions for adolescents.

ADOLESCENT REPRODUCTIVE AND SEXUAL HEALTH PROMOTION PROGRAM: REVIEW ARTICLE

Adolescents have a high burden of sexual and reproductive health problems and it is important to reach out to youth groups through health promotion initiatives. A literature review was carried out to identify the elements of a successful health promotion program to improve adolescent reproductive health and sex. This study identified and compiled a literature review published in 2000-2018 that focused on adolescents (10-24 years), reported reproductive and sexual health outcomes (pregnancy, sexually transmitted infections, condoms/contraceptive use, risky sexual behavior, access to health care sexual or intimate partner violence), and includes major studies that are mainly carried out in high-income countries. This report focuses on the features of the reproductive and sexual health program that were successfully identified in the interpretation and discussion of the systematic reviews included. This study identified 66 systematic reviews, of which 37 were reported on programs that were anecdotally or statistically related to the increase in program effectiveness and success. The general characteristics of effective interventions are: long-term or recurrent implementation; multi-regulation and multi-component; parental involvement; according to culture, gender, age; and the inclusion of skill development. There is a marked consistency of features increasing the effectiveness of reproductive and sexual health programs for adolescents even though wide variations in interventions are reviewed. There is a need to better implement this knowledge in future programs, and our findings provide useful guidance for optimizing the design of reproductive and sexual health interventions for adolescents.