Adolescent Preferences Research Articles

Factors Related to the COVID-19 Prevention Behaviors of Adolescents: Focusing on Six Middle and High Schools in Korea.

The COVID-19 pandemic has been one of the worst infectious disasters in human history. The best way to minimize COVID-19 transmission is to follow preventive measures. This study aimed to examine the factors influencing adolescents' COVID-19 prevention behaviors. The study was conducted online from 1 to 15 February 2023 with 196 adolescents aged between 13 and 18 years of age. The collected data were analyzed using descriptive statistics, Pearson's correlation, the independent t-test, analysis of variance (ANOVA), and multiple hierarchical regression analysis. Adolescents' COVID-19 prevention behaviors were influenced by intrapersonal factors, such as knowledge of and attitudes toward COVID-19, and interpersonal factors, such as social support. Community and governmental factors had no impact. Public health education strategies should be planned to include friends and family members in programs for preventing new infectious diseases such as COVID-19 so that adolescents can learn and share what they have learned, correct wrong behavior, and understand and change infection prevention behavior. In addition, it is necessary to actively support the development of public health education with appropriate contents in accordance with the characteristics and preferences of adolescents.

Triadic Collaboration Between Adolescents, Caregivers, and Health-Care Providers to Promote Healthy Behavior

PurposeTo further elucidate the various aspects of the triadic relationship between health-care providers (HCP), adolescents, and caregivers during adolescent health-care visits, with the goal of helping HCPs better understand how they can best support adolescents to choose healthy behaviors. MethodsAdolescents (ages 13–18 years) and caregivers of adolescents were recruited to participate in qualitative interviews regarding preferences for provider interactions around health behavior change. Data analysis was conducted using inductive thematic analysis to identify and describe patterns of themes across the dataset. ResultsThirty one adolescents and 30 caregivers participated. Fourteen themes emerged in the analysis regarding adolescent and caregiver preferences for direct and indirect relationships between adolescents, caregivers, and HCPs in promoting healthy behavior. These themes were organized into a triadic collaboration framework to promote healthy behavior using an adolescent-centered and caregiver-involved approach. DiscussionThis study supports findings of previous research on triadic interactions between HCPs, adolescents, and caregivers while deepening our understanding of the HCP's role in helping adolescents to choose healthy behaviors. These themes are representative of the continuing shift toward an adolescent-centered and caregiver-involved approach to adolescent health care and provide further guidance to HCPs on how to work collaboratively with both adolescents and caregivers to promote healthy behaviors and improve health outcomes.

Модель психического и макиавеллизм как факторы внутригрупповых отношений в подростковом возрасте

<p style="text-align: justify;"><strong>Objective. </strong>Analysis of differences in social cognition skills (theory of mind) and Machiavellianism in adolescents with different levels of popularity and preference among peers. <br><strong>Background. </strong>Despite the possible consensus on the positive relationship of high social cognition skills and successful socialization, it remains important to study how theory of mind and manipulative behavior are involved in the popularity and social preferences of adolescents. <br><strong>Study design. </strong>The paper studied the differences in the theory of mind and Machiavellianism in adolescents with different levels of popularity and social preference in the peer group. Statistical differences were tested using non-parametric differences tests. <br><strong>Participants. </strong>166 students (grades 6–8) from schools in the Moscow region. Age from 13 to 14 years (<em>M</em> = 13,39; <em>SD</em> = 0,49), including 90 girls (54,2%). <br><strong>Measurements. </strong>Theory of mind was assessed using the "Reading the Mind in the Eyes" test and tasks for understanding false believes of a higher order. The Russian-language version of the Mach scale is IV. Sociometric method. <br><strong>Results. </strong>Adolescents choose peers with high social cognition skills as friends. Machiavellianism plays into the evaluation of popularity and social preference by peers. Adolescents with a higher level of Machiavellianism are rated by their peers as more popular and preferred for communication. <br><strong>Conclusions. </strong>Popular teens and teens chosen to socialize differ in social cognition and machiavellian skills.</p>

The energy content of meals with a similar macronutrient distribution may have a greater impact on appetite sensations than food preferences in adolescents with obesity: A secondary analysis

PurposeThe energy and macronutrient composition of a meal has been shown to influence postprandial appetitive responses, but it is not clear how energy content independent of macronutrient distribution affects postprandial appetite in adolescents with obesity. Extracting data from a primary study testing the effect of energy turnover on appetite, this secondary analysis assessed how fixed meals varying in energy content with similar macronutrient distributions influences postprandial appetite sensations and food reward. MethodsUsing a randomised, counterbalanced crossover design, N = 14 adolescents with obesity (Mage = 12.71, SDage = 0.99; 10 female) consumed fixed lunch meals with similar macronutrient content starting at 750 kcal in energy and progressively increasing by 250 kcal on three different test days. Liking and wanting for food images varying in fat and taste were assessed at baseline and immediately after meal consumption. Appetite sensations were assessed in half-hour intervals from baseline to 1-h post-meal. ResultsThe area under the curve for subjective hunger (p < .001, ω = 0.36), desire to eat (p < .001, ω = 0.54), and prospective food consumption (p = .004, ω = 0.32) were significantly lower after consumption of the higher calorie meals relative to the lowest. Explicit wanting for sweet foods increased after intake of the intermediate calorie meal yet decreased after the highest calorie meal (p = .014, ω = 0.09). Conversely, implicit wanting sweet bias increased after consumption of the test meal independent of energy content (p < .001, ω = 0.15). ConclusionThe consumption of additional calories without a meaningful change in macronutrient distribution may affect appetite sensations more reliably than hedonic responses to energy-dense foods in adolescents with obesity.

Preferences for Public Health Messaging Related to Bladder Health in Adolescent and Adult Women.

Objective: The purpose of this analysis was to explore adolescent and adult women's preferences for the content and delivery of public health messaging around bladder health. Materials and Methods: This was a directed content analysis of focus group data from the Study of Habits, Attitudes, Realities, and Experiences, which explored adolescent and adult women's experiences, perceptions, beliefs, knowledge, and behaviors related to bladder health and function across the life course. This article reports an analysis of the "Public Health Messaging" code, which includes participants' views on what information is needed about bladder health, attributes of messaging, and preferred locations and delivery methods. Results: Forty-four focus groups were conducted with 360 participants (ages 11-93 years) organized into six age groups. Across age groups, participants wanted messaging on maintaining bladder health and preventing bladder problems. They offered suggestions for a wide variety of methods to deliver bladder health information. Ideas for delivery methods fell into three broad categories: (1) traditional in-person modes of delivery, which included individual communication with providers in clinical settings and group-based methods in schools and other community settings where adolescent and adult women naturally gather; (2) internet-based website and social media delivery methods; and (3) static (noninteractive) modes of delivery such as pamphlets. Participants recommended the development of multiple delivery methods to be tailored for specific audiences. Conclusions: These findings can inform development of broad ranging public health messaging tailored to audiences of all ages with a goal of engaging adolescent and adult women across the bladder health risk spectrum.

Examining the Critical Need for Tailored Adolescent Opioid Education: A National Study.

Prescription opioid education can be a preventative measure for opioid misuse. However, most research focuses on adult perspectives rather than adolescents. This study aimed to understand adolescents' attitudes, perceptions, knowledge about prescription opioids, and preferences and prior educational exposure to opioid safety. Data were collected from November to December 2020. Quota sampling through Qualtrics was used to recruit a national sample of 13- to 18-year-old adolescents who lived in the United States and could understand English. A total of 774 responses were analyzed. The most frequently reported source of opioid information was speaking with parents (72%). More than half (54.7%) of participants preferred technology-based education. Participants with a personal history of opioid prescription scored no differently on safe handling and storage of opioids. There was a strong relationship between participants who reported prior knowledge of what opioids are and stopping their friend from using an opioid medication for non-medical purposes (χ2 (1, N = 684) = 3.5; p = 0.042). Participants with prior education on opioid disposal did not know that -returning opioids to the pharmacy was correct (χ2 (1, N = 425) = 3.8; p = 0.254). Participants were less knowledgeable about safe storage and disposal of opioids, preferred technology-based education, and were extremely likely to talk to their parents about opioid information. Findings reaffirm the significance of opioid safety education and communication between adolescents and parents. Adolescent demographic characteristics, preferences, and prior knowledge should be considered when providing opioid safety education.

Sports Preferences in children and adolescents in psychiatric care – evaluation of a new Questionnaire (SPOQ)

Background: As part of an exploratory and hypothesis-generating study, the Sports Preference Questionnaire (SPOQ) was developed to survey the athletic behavior of mentally ill children and adolescents, subjectively assessing physical fitness and the perceived psychological effects of physical activity. Methods: In a department of child and adolescent psychiatry, 313 patients (6 years - 18 years) were classified according to their primary psychiatric diagnosis. The patients or - in the parental version of the questionnaire - their parents reported their sports preferences on the SPOQ. As possibly influential factors, also the frequency of physical activity, the importance of a trainer, coping with everyday life through physical activity, and subjectively perceived physical fitness were assessed. Results: One in 3 patients stated that they were not physically active. Patients diagnosed with eating disorders reported, on average, a notably high frequency and degree of coping with daily life through physical activity. Patients with anxiety disorders and depression had the lowest self-perception of physical fitness. The presence of a trainer was generally considered very unimportant, but not in Attention Deficit Hyperactivity Disorder (ADHD) patients. Conclusion: The SPOQ is sensitive to differential effects of core child and adolescent disorders as well as to main covariates influencing the complex association between physical activity and emotional and behavioral disorders in children and adolescents. Based on this pilot study, the need for an efficacy study to measure the effects of sports therapy was discussed.

Mixed-methods study of development and design needs for CommitFit, an adolescent mHealth App.

Adolescent obesity remains a significant public health issue within the United States. Mobile application technology growth and popularity offer new opportunities for research and health improvement. The development of a consolidated mobile health application (mHealth app) for adolescents on these platforms has the potential to improve health outcomes. Thus, this study describes the co-development process working with adolescent users. The aims are as follows: (I) to explore the visual design and functional requirements when developing the CommitFit mHealth app, (II) to uncover the gamification techniques that incentivize adolescents to set and achieve healthy lifestyle goals, and (III) to identify adolescent expectations when using the CommitFit mHealth application. In this mixed method study, we used semi-structured interviews/task analysis and surveys of adolescents (aged 13 to 15 years) to understand their user requirements and design preferences during the development of the CommitFit mHealth app. Interviews were conducted online, via Zoom. The survey included the user design industry-standard System Usability Scale (SUS) paired with a supplemental questionnaire on the specific features and functionalities of the CommitFit mHealth app. Participants were recruited from the electronic health record from the University of Missouri Healthcare system. Ten adolescents, aged 13 to 15 years (average of 13.6 years), were interviewed and surveyed to explore adolescent preferences with visual app design and functionality. Our inductive thematic analysis found that adolescents preferred colorful, user-friendly interfaces paired with gamification in the CommitFit mHealth app. Our analysis of SUS survey data validated our user-centered and human-system design and adolescents confirmed their design, feature, and functionality preferences. Overall, adolescent users were able to confirm their preference to have educational resources, goal recommendations, leaderboard, points, reminders, and an avatar in the app. Adolescent feedback is crucial in the successful development of our adolescent-targeted mHealth app, CommitFit. Adolescents preferred vibrant colors, easy-to-use interface, gamification, customizable and personalized, and mature graphics. Adolescents were especially motivated by gamification techniques to maintain their interest in the application and their health behavior goals. Additional research is now needed to explore the clinical effectiveness of the CommitFit mHealth app, as a health and lifestyle intervention.

Does Being Prosocial Pay Off? Testing Positive Developmental Cascades of Prosocial Behavior, Social Preference, and Subjective Well-Being in Chinese Adolescents.

Positive aspects of adolescent development recently have raised researchers' interests; however, studies examining reciprocal links between prosocial behavior, social preference, and subjective well-being are lacking. The present longitudinal study investigated the bidirectional relations between prosocial behavior, social preference, and subjective well-being within a theoretical framework of the developmental cascade model. A total of 1248 Chinese adolescents (M = 13.44, SD = 0.65; 47.0% girls) were surveyed across three waves with 6-month intervals. The results of analyses utilizing the random-intercept cross-lagged panel model demonstrated that prosocial behavior was positively associated with both social preference and subjective well-being, and social preference was not associated with subjective well-being at the between-person level. At the within-person level, prosocial behavior was positively reciprocally associated with social preference, while no significant relations between prosocial behavior and subjective well-being and between social preference and subjective well-being were found. The findings highlight adolescents' prosocial behavior and social preference could mutually facilitate each other over time, which can be used to guide adolescents' positive development.

Preferences for disease-related information and transitional skills among adolescents with congenital heart disease in the early transitional stage.

The transition towards adult-focused healthcare comprises a complex process requiring careful, individualized guidance of adolescents with congenital heart disease (CHD). Detailed data on their preferences regarding disease-related information and acquirable transitional skills are mostly lacking. We examined the preferences of CHD adolescents in the early transition stage. A cross-sectional descriptive study was performed with adolescents recruited from a transition program. Two questionnaires assessing needs for information and transitional skills were used. Only questionnaires completed in the early transition stage were included. Forty-nine adolescents participated (mean age 15.9 ± 1.2years, 43% girls). 59% requested information about their heart and previous and/or future surgeries/interventions, 45% about sports and medication, and a maximum of 27% about psychosocial topics. More girls than boys requested surgical information (76% versus 46%; p = 0.04). Adolescents with severely complex CHD more often requested information about medication than those with moderately complex CHD (63% versus 28%; p = 0.02). Older adolescents were less likely to request surgical information (OR = 0.53; 95%CI [0.26-0.88]; p = 0.03). Up to 83% of the adolescents perceived their skills as insufficient, but less than 14% was interested in acquiring skills. Conclusion: Adolescents were mainly interested in medical topics, followed by lifestyle information. The informational needs tended to decrease with age. Timely gauging individual needs and delivering information, ideally in the early teens, appear important when providing person-tailored transitional care in CHD. Paradoxically, although the transitional skills were low-perceived, there was limited motivation to improve them. This paradox requires further investigation to better tailor transition interventions. Clinical trial registration:Not applicable. • Transition towards adult life and care requires careful patient guidance. A person-tailored approach is strongly encouraged. However, details on preferences regarding disease-related information and transitional skills are scarce in adolescents with CHD. • This study showed that adolescents with CHD in early transition mainly need medical-related information. Their informational needs tend to decrease with age necessitating timely gauging for interest and delivering information. Adolescents report a low need to acquire transitional skills despite low self-esteemed skills levels.

Mixed-methods Exploration of Telehealth-supported Long-acting Reversible Contraceptive Services in School-based Health Centers: How Much Added Value?

This study explored adolescent and young adult preferences and experiences with telehealth-supported long-acting reversible contraceptive (LARC) services in New York City school-based health centers (SBHCs) during COVID-19. Sequential mixed methods included post-LARC insertion surveys and in-depth interviews. Survey respondents (n=45) were aged 14-21 years and predominantly Hispanic (53.3%). Only four respondents completed a postinsertion visit via telehealth. Most (82.2%) preferred in-person for future LARC visits; none preferred telehealth. Four themes emerged in interviews (n=15): LARC self-efficacy and autonomy; SBHC convenience and accessibility; comfort with SBHC providers; and preference for in-person visits despite telehealth benefits. Although telehealth theoretically adds value to LARC service delivery, uptake and preference for telehealth in the SBHC context were low. Despite the perceived acceptability of telehealth, adolescents and young adults prefer in-person SBHC visits, suggesting SBHC access may eliminate barriers to care that telehealth seeks to overcome.

0769 Multidimensional Sleep Health in Adolescents from the General Population: Definition, Thresholds and Construct Validity

Abstract Introduction The RU-SATED model – regularity, satisfaction, alertness, timing, efficiency, and duration – captures the 24-hour experience of sleep to asses multidimensional sleep health (MSH). However, most prior evidence comes from middle-aged adults. We provide updated MSH data in adolescents by leveraging objective and self-reported sleep measures. Methods We studied 377 adolescents (16.4±2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample. Each MSH domain was categorized as “good” or “poor” using cut-offs informed by prior studies and expert consensus. Good cut-offs, assigned a score of 1, that were derived from actigraphy-measured data included: the standard deviation of sleep midpoint ≤1-h (RU), mean of sleep midpoint 2:00-4:00 (T), mean value of sleep efficiency ≥85% (E), and mean total sleep time ≥7.5-h (D). Good cut-offs derived from self-reported rating scales included the absence of insomnia symptoms (S) or excessive daytime sleepiness (A). Values considered poor based on these cut-offs were assigned a score of 0. Scores were summed across all domains to obtain a composite score ranging from 0 to 6, with higher scores indicating better MSH. Morningness and Tanner staging were self-reported, while Sleep and Arousal clusters scores on the Pediatric Behavior Scale were parent-reported. Results The mean composite score was 3.03 ± 1.30 and domains A and D were most commonly rated as poor (64.5% and 65.3%, respectively). Younger age (r=-0.13, p&amp;lt; 0.05) and identifying as non-Hispanic white (r=-0.14, p&amp;lt; 0.01) were significantly associated with higher MSH scores, while sex (r=-0.04, p=0.40), Tanner staging (r=-0.06, p=0.29) or BMI percentile (r=-0.07, p=0.15) were not. Greater morningness (r=-0.29, p&amp;lt; 0.01), less disturbed sleep (r=-0.28, p&amp;lt; 0.01) and higher arousal (r=-0.21, p&amp;lt; 0.01) scores were associated with higher MSH scores. Conclusion Our data-driven approach can be used to assess MSH in the adolescent population. Our definition captures previously identified health disparities in MSH in adults and shows optimal construct validity against self-reports of circadian preference and parent observations of adolescents’ degree of sleep disturbance and arousal. Improving sleep duration and daytime alertness appear to continue to be the most relevant domains impacting overall MSH in adolescents. Support (if any) NIH (R01HL136587,UL1TR000127)

Medical and End-of-Life Decision-Making Preferences in Adolescents and Young Adults with Advanced Heart Disease and Their Parents

Despite high disease morbidity and mortality and complex treatment decisions, little is known about the medical and end-of-life decision-making preferences of adolescents and young adults (AYA) with advanced heart disease. AYA decision-making involvement is associated with important outcomes in other chronic illness groups. To characterize decision-making preferences of AYAs with advanced heart disease and their parents and determine factors associated with these preferences. Cross-sectional survey between July 2018 and April 2021 at a single-center heart failure/transplant service at a Midwestern US children's hospital. Participants were AYAs aged 12 to 24 years with heart failure, listed for heart transplantation, or posttransplant with life-limiting complications and a parent/caregiver. Data were analyzed from May 2021 to June 2022. Single-item measure of medical decision-making preferences, MyCHATT, and Lyon Family-Centered Advance Care Planning Survey. Fifty-six of 63 eligible patients enrolled in the study (88.9%) with 53 AYA-parent dyads. Median (IQR) patient age was 17.8 (15.8-19.0) years; 34 (64.2%) patients were male, and 40 patients (75.5%) identified as White and 13 patients (24.5%) identified as members of a racial or ethnic minority group or multiracial. The greatest proportion of AYA participants (24 of 53 participants [45.3%]) indicated a preference for active, patient-led decision-making specific to heart disease management, while the greatest proportion of parents (18 of 51 participants [35.3%]) preferred they and physician(s) make shared medical decisions on behalf of their AYA, representing AYA-parent decision-making discordance (χ2 = 11.7; P = .01). Most AYA participants stated a preference to discuss adverse effects or risks of treatment (46 of 53 participants [86.8%]), procedural and/or surgical details (45 of 53 participants [84.9%]), impact of condition on daily activities (48 of 53 participants [90.6%]), and their prognosis (42 of 53 participants [79.2%]). More than half of AYAs preferred to be involved in end-of-life decisions if very ill (30 of 53 participants [56.6%]). Longer time since cardiac diagnosis (r = 0.32; P = .02) and worse functional status (mean [SD] 4.3 [1.4] in New York Heart Association class III or IV vs 2.8 [1.8] in New York Heart Association class I or II; t-value = 2.7; P = .01) were associated with a preference for more active, patient-led decision-making. In this survey study, most AYAs with advanced heart disease favored active roles in medical decision-making. Interventions and educational efforts targeting clinicians, AYAs with heart disease, and their caregivers are needed to ensure they are meeting the decision-making and communication preferences of this patient population with complex disease and treatment courses.

How is Time Alone Introduced? Experiences and Preferences of Adolescents and Parents

PurposeTime alone between health care providers and adolescent patients is a core element of quality adolescent primary care, yet not all adolescents receive this care. Clinicians' apprehension about how best to introduce time alone may contribute to lower levels of time alone. This study aims to understand how adolescent patients and their parents or guardians experience the introduction of time alone during adolescent preventive visits. MethodWe conducted semistructured interviews with adolescents, aged 11–17 years (n = 35) and a parent or guardian of the adolescent (n = 35) across metropolitan and nonmetropolitan areas of Minnesota. We used thematic analysis to describe (1) parent and adolescent experiences learning about time alone for the first time and (2) parent and adolescent reactions to this experience. ResultsKey findings from this study suggest that adolescents prefer a universal application of time alone with an option to opt out (e.g., “At this age, I always ask parents to step out for a few minutes, are you okay with that?”), rather than opt in (e.g., “Would you like your parent to step out?”). Parents noted that time alone should not be a surprise but rather should be presented as routine, so they are not left to wonder if time alone was offered to their adolescent for a particular reason. DiscussionFindings suggest universal presentation of time alone with the option for adolescents to opt out may improve acceptability of time alone and support delivery of highquality care.

Adolescents' attitudes, preferences and perceived behaviours regarding healthy eating and whole grains from a gender and health interest perspective.

A healthy diet is important not only for the growth and development of the human body but also for the prevention of chronic diseases. However, most Swedish adolescents do not follow dietary recommendations, especially the intake of whole grain is very low. To create targeted conditions for healthy food choices amongst adolescents, comprehensive knowledge of factors related to adolescents' unhealthy and healthy eating is needed. To investigate adolescents' attitudes, preferences and perceived behaviours regarding healthy eating, with a specific focus on whole grains and to evaluate differences between genders and between adolescents with higher versus lower health interest. A total of 1,178 Swedish adolescents responded to a questionnaire about their attitudes, preferences and perceived behabviours towards healthy eating and whole grains, and their general interest in nutrition and health. Results of girls and boys were compared, as well as adolescents with a higher versus lower health interest. Displays information about healthy eating among adolescents and a comprehensive set of factors that may affect their ability to eat healthier. Overall, adolescents had a positive attitude towards food and health, but less than half felt that they managed to eat healthy. The consumption of different whole grain products was low, although the willingness to eat healthier and more whole grain was high. The most reported barrier to healthy eating, as well as increasing whole grain intake, was the unavailability of tasty healthy products, taste being even more important for adolescents with a low health interest than those with a high interest. Whole grain consumption and factors increasing the willingness of whole grain consumption were most prominent not only in adolescents with high health interest but also in girls compared with boys. The results show good potential to improve dietary habits amongst adolescents. Taste and availability of healthy products were rated the most important, whilst knowledge about the products' healthiness was rated the least important, especially amongst those with low health interest. By focusing on the attitudes and preferences of adolescents, the effectiveness may increase of initiatives to improve their dietary habits.

Vitamin content in the diet among 14- to 15-year-old teenagers depending on the BMI value.

In a period of intensive growth and development, both a deficiency and an excess of nutrients may have negative consequences on health. In the case of vitamins, an ongoing deficiency can result which have a direct effect on public health. The research included all third-year middle school pupils. With the assistance of the person conducting the research, a questionnaire was completed about consumption of food products consumed every day for a period of 7 days. Energy and nutrient requirements were defined individually for each child in terms of RDA. The daily intake of group B vitamins was exceeded both in the boys' group and the girls' group. The daily intake of vitamin C and folates was higher in the boys' group than in the girls' group, but did not meet the required daily intake in any of the groups studied. In all boys' groups, the intake of vitamin D covered less than 30% of the required daily amount. It has been shown that there is a statistically significant influence of the intake of vitamins on body mass. In the girls' group, the most common statistically significant differences were between the group of underweight girls and the groups of girls with correct body weight and overweight girls. Insufficient intake of vitamins is observed most often in underweight adolescents. The incorrect amount of vitamins in the diet requires the implementation of action to improve the dietary preferences of adolescents.

Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi.

Malawi has made progress in expanding access to modern contraceptive methods over the last decade, including the introduction of depot-medroxyprogesterone acetate subcutaneous (DMPA-SC) in 2018. DMPA-SC offers women the option to self-inject at home and may benefit adolescents with unmet need for contraception due to its discretion. This qualitative study was conducted to assess perspectives and preferences of adolescents with unmet need for contraception regarding the self-injection option of DMPA-SC in Malawi. Six focus group discussions were conducted involving 36 adolescents with unmet need for contraception (aged between 15 and 19 years, married and never-married) in October 2021 in three districts in Malawi. Data were coded inductively and analyzed thematically, using Dedoose software. Two validation workshops were conducted with other adolescents with unmet need in February 2022 to elucidate the preliminary findings. DMPA-SC attributes such as discretion and reduced facility visits were ranked most appealing by both married and never-married adolescents, particularly for adolescents needing covert contraception use. Concerns about self-injection included fear of pain, injury, and doubt in ability to self-inject. Never-married adolescents had additional concerns around privacy at home if using covertly, and fears of affecting long-term fertility. Overall, health surveillance assistants (community-based healthcare workers) were voted to be the most private, convenient, and affordable sources for potential DMPA-SC self-injection training. Self-injection of DMPA-SC may offer an appealing option for adolescents in Malawi, aligning most closely to the needs of married adolescents who may wish to delay or space pregnancies conveniently and discreetly, and who also may face fewer access barriers to receiving self-injection training from health care providers. Access barriers including stigma and concerns about privacy at home for adolescents needing to use contraception covertly would need to be adequately addressed if never-married adolescents were to consider taking up this option.

Snacking Habits, Strict Diet, BMI, and Body Image of Adolescents in Three Sub-Districts in Depok and Bogor

Background: Body image is related to adolescent food preferences, which determine their nutritional status. Peri-urban areas might have different adolescents' snacking habits, strict diets, nutritional status, and body image. Objectives: This study aimed to analyze the association between adolescents' snacking habits, implementation of a strict diet, and nutritional status on their body image. Methods: This study used a mix-method, a combination of the quantitative and qualitative survey with a cross-sectional design. A total of 39 adolescents aged 15-18 who live in the peri-urban areas of Depok and Bogor were consecutively selected. The study was conducted in January 2022. Quantitative data include respondents' characteristics, body weight and height, snacking habits, and body image. Qualitative data collected were types of snacks, their reasons for buying snacks, and perceptions of ideal weight. Results: The nutritional status of the respondents was underweighted (5%), normal (92%), and overweight (3%), with snacking frequency 4-7 times/week (59%) with a weekly snacking expenditure of IDR 15,000 – 30,000 (49 %). As many as 23% of respondents performed a strict diet and perceived having a thin (21%) and fat (23%) body image. Adolescents with normal nutritional status were perceived as having fat (20.5%) and thin (15.4%) body image (p: 0,0215). There was also a relationship between diet (p: 0.0084) and weekly snacking expenditure (p: 0.0152) with body image, and there was no relationship between snacking frequency (p: 0.3123) and daily meal frequency (p-value=0.3972) with body image. Conclusions: A wrong perception of body image from actual nutritional status can affect snacking habits and the implementation of a strict diet among adolescents.

Enjoyed by Jack but Endured by Jill: An Exploratory Case Study Examining Differences in Adolescent Design Preferences and Perceived Impacts of a Secondary Schoolyard.

The school grounds provide students opportunities for respite, relaxation and relief from daily stresses during breaks in the school day. However, it is unclear whether secondary schoolyard designs adequately support the diverse and evolving needs of adolescents, particularly at a time when they are experiencing rapid emotional and physical developmental change. To investigate this, quantitative methods were used to explore differences in perceptions of schoolyard attractiveness and restorative quality based on student gender and year level. A school-wide survey was administered to approximately 284 students in years 7 to 10 at a secondary school in Canberra, Australia. Results indicate significant declines in student perceptions of schoolyard attractiveness and restorative quality. Higher ratings of schoolyard likeability, accessibility, personal connection and restorative quality of 'being away' were associated with male students across all year levels. Further work is needed to explore how schoolyard environments can better support the design preferences and well-being needs of older and female students. Such information would help planners, designers and land managers develop schoolyard designs that are more equitable in their benefits to secondary school students of different genders and year levels.

Mental Health Services Use and Social Support Among Latinx Families with Adolescents Who Engage in Suicidal Behavior

ABSTRACT Latinx communities experience a significant child mental health disparity. Research is needed to examine mental health services use and social support in Latinx adolescents, with particular attention to acculturative factors and youth who have high levels of clinical severity. The current study examined whether acculturation and enculturation, and related proxies, are associated with prior history of services use and social support in Latinx families with adolescents who had a recent suicidal crisis. Participants were 110 youths, recently admitted to psychiatric hospitalization, ages 12–17 years and their caregivers. Results indicated that approximately 20% of the overall sample did not access any formal mental health services (e.g. outpatient mental health care, primary care support, school staff support) before high acuity hospital care. First-generation status and higher caregiver enculturation were associated with a lower likelihood of formal mental health services use, even when controlling for clinical covariates. Adolescent preference for Spanish was associated with lower social support. Findings suggest that families with higher enculturation and first-generation immigrant families (both caregivers and youth born outside of the U.S.), in the context of severe clinical impairment, experience systemic and sociocultural barriers conducive to limited engagement with mental health support. Implications for improving the accessibility of mental health supports are reviewed.