Vulnerable Group Of Adolescents Research Articles

The Impact of COVID-19 Pandemic on Mental Health of Adolescents With Chronic Medical Conditions: Findings From a German Pediatric Outpatient Clinic

PurposeThe impact of the COVID-19 pandemic on the mental health of adolescents is of great concern, especially in the vulnerable group of adolescents with chronic medical conditions. The aim of this study was to examine this impact on the mental health of adolescents with chronic medical conditions treated in a German pediatric outpatient clinic. MethodsChanges in the mental health status of adolescents with chronic medical conditions treated in a German pediatric outpatient clinic during the COVID-19 pandemic were explored via validated screening tools for anxiety and depression. ResultsThe relative risk for adolescents with chronic medical conditions to develop clinically relevant symptoms of anxiety or depression was significantly higher (odds ratio 1,78 [confidence interval 1.06–3.04]) during the pandemic. DiscussionThis study identifies the COVID-19 pandemic as a potential additional risk for adolescents with chronic medical conditions to develop clinically relevant signs of anxiety or depression.

The Kusa manga, a secondary prevention program for cannabis use in adolescence based on emotional regulation: Preliminary data

IntroductionFrance is one of the European countries with the highest prevalence of cannabis use, particularly in adolescence. Emotional regulation (ER) is one of the major risk factor in the etiology and the maintenance of cannabis use disorder and therefore is a key target for prevention programs. ObjectivesThis study aimed to evaluate the feasibility and the impact of a prevention program focusing on ER (especially on various emotional skills like awareness, emotional clarity and reactivity, ER strategies, and the level of emotional awareness) and on cannabis use among adolescents from various institutions. MethodIn total, 87 adolescents from various institutions were included. ER was assessed by the Emotion Regulation Questionnaire, the Difficulties in Emotion Regulation Scale, the Emotion Reactivity Scale and the Adolescent Levels of Emotional Awareness Scale; cannabis use was assess by the Cannabis Abuse Screening Test (CAST). All participants were assess before preventive intervention (T0) and four months after the end of the program (T1). ResultsBetween T0 and T1, for all participants, there was an increase of emotional awareness, a decrease of emotional sensitivity, intensity and persistence, and an increase of the level of emotional awareness (total, self and others). There was no significant difference between T0 and T1 in CAST scores. ConclusionsThe prevention program showed encouraging results with a vulnerable group of adolescents in institutional care, particularly those from the Child Social Care (Aide sociale à l’enfance) and Child Forensic Institution (Protection judiciaire de la jeunesse) by showing an effect on different components of ER but not directly on cannabis use.

Child Maltreatment, Mental Health, and Self-Reported Health Among Adolescent Girls in Child Welfare: Mediating Pathways.

Child maltreatment is common in the US and has been shown to be associated with physical and psychological health problems in adolescence and adulthood. Based on the allostatic load theory, this study examined the association between different types of child maltreatment (emotional, physical, and sexual abuse, and physical neglect) and self-rated health, and the mediating roles of post-traumatic stress and depression in these relationships. Participants were 249 girls involved in the child welfare system, ages 12-19 years, the majority of whom were African American. A one item self-reported general health measure, the Child Trauma Questionnaire-Short Form (CTQ-SF), Child PTSD Symptom Scale (CPSS) and the Child Depression Inventory (CDI) measured self-reported health, child maltreatment,and posttraumatic and depression symptoms, respectively. Higher levels of emotional, physical, and sexual abuse, and physical neglect were significantly associated with poorer ratings of health. PTSD and depression were significant mediators between histories of childhood emotional, physical, and sexual abuse and physical health. In conclusion, results indicate that the pathways from child abuse to physical health problems in adolescents are through psychological distress. Trauma focused interventions to reduce symptoms of PTSD and depression among this vulnerable group of adolescents are essential to improve health.

The psychosocial consequences of covid-19 in adolescents with nonsuicidal self-injury

BackgroundYoung people have been especially affected by the psychosocial consequences of the covid-19 pandemic. Covid-19 has potentially also been more stressful for vulnerable groups with mental health problems.MethodsIn this cross-sectional study, the psychosocial effects of covid-19 in a vulnerable group of adolescents with nonsuicidal self-injury (NSSI) from a sample of 1602 Swedish high-school students were examined. Data were collected in 2020 and 2021. First, adolescents with and without NSSI were compared on how they perceived the psychosocial impact of covid-19, and second, a hierarchical multiple regression analysis was used to examine whether lifetime NSSI experience was associated with perceived psychosocial consequences of covid-19, when demographic variables and symptoms of mental health problems were controlled for. Interaction effects were also examined.ResultsSignificantly more individuals with NSSI reported being burdened by covid-19 compared to those without NSSI. When demographic variables and mental health symptoms were controlled for, adding NSSI experience did not, however, increase the amount of variance explained in the model. The total model explained 23.2% of the variance in perceived psychosocial impact of covid-19. Perceiving the family’s financial situation as poor and neither good nor bad, studying a theoretical high school program, symptoms of depression and difficulties with emotion regulation were significantly associated with perceived negative psychosocial impact of the covid-19 pandemic. There was a significant interaction effect between NSSI experience and depressive symptoms. The effect of NSSI experience was larger when depressive symptoms were lower.ConclusionsLifetime NSSI experience in itself was not associated with psychosocial covid-19 consequences when other variables were controlled for, whereas symptoms of depression and difficulties with emotion regulation were. Results imply that vulnerable adolescents with mental health symptoms need special attention and access to mental health support in order to prevent further stress and worsening of mental health symptoms in the wake of the covid-19 pandemic.

Are adolescents' physical activity and body-related factors associated with medically attended injuries?

Injuries are the major cause of disability and death during adolescence, representing a significant public health burden among youth. Body-related factors such as body composition and cardiovascular fitness (CVF) may affect adolescents' vulnerability to injuries. As evidence is lacking, we aimed to explore the associations of medically attended injuries with adolescents' physical activity (PA) and body-related factors, and whether these associations are modified by age, gender and family affluence. We used data on 888 11- to 15-year-old adolescents (mean age = 13.5, 56% boys) from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia. We used binary logistic regression analysis to assess the association of medically attended injuries with adolescents' PA and body-related factors (body composition, CVF), considering age, gender and family affluence. Adolescents were more likely to report medically attended injuries if they were physically very active (odds ratio/confidence interval OR/CI:2.76/1.83-4.15) or active (OR/CI:1.91/1.27-2.87) rather than inactive. Body-related factors were not associated with medically attended injuries among adolescents. Moreover, age, gender and family affluence did not modify the association of medically attended injuries with adolescents' PA and body-related factors. The only exception was the modifying effect of gender: the association of medically attended injuries with being very active was stronger in boys (OR/CI: 3.04/1.32-6.99). Very physically active adolescent boys are the most vulnerable group of adolescents in terms of injuries. PA promotion programmes should further consider gender-specific strategies aimed at preventing injuries.

Dual-harm in adolescence and associated clinical and parenting factors

PurposeBoth aggression toward others and self peak in adolescence and interpersonal violence and suicide are among the leading causes of death in young people worldwide. Individuals who show both aggression toward others and self, i.e. dual-harm, may experience the worst outcomes. The current study investigates clinical and parenting factors associated with dual-harming in adolescence, to provide new insights for prevention and treatment.MethodsIn a prospective cohort of adolescents, oversampled on emotional and behavioral problems (n = 1022; aged 12–17 years), we investigated co-occurrence in harm toward others and self and presented findings in an area-proportional Euler diagram. Four harm groups (no harm, other-harm, self-harm, and dual-harm) were compared on intelligence scores, general functioning, emotional and behavioral problems, substance use, parental hostility, and harsh parenting with ANCOVAs and logistic regressions.ResultsIn adolescents that other-harmed, the risk of self-harm was 1.9 times higher than for those who did not harm others. Dual-harm adolescents reported worse overall functioning, more emotional and behavioral problems, more parental hostility and harshness, and were more likely to use substances than those who did not engage in aggressive behaviors. No evidence of differences in intelligence scores between groups were found.ConclusionThese findings highlight a vulnerable group of adolescents, at risk of future suicide, violent offending, and the development of severe psychopathology. Dual-harm is a promising marker for early intervention and referral to specialized mental health professionals. Further research is needed to examine underlying pathways and risk factors associated with persistent dual-harm trajectories into adulthood.

Identifying gaps in training on sexual health for caregivers of adolescents in foster care

ABSTRACT Youth in foster care are a vulnerable group of adolescents that experience worse sexual health outcomes, including higher rates of STIs, HIV, and early and repeat pregnancy, compared to youth not in foster care. Caregivers of youth in foster care may play a critical role in improving the sexual health of youth in their care. However, many caregivers of youth in foster care do not talk to youth about sexual health, and few studies have directly asked caregivers about the trainings they may need to provide better sex education to youth. This exploratory study examined the training needs of caregivers of youth in foster care. Participants were a state-wide sample of 347 caregivers of youth in foster care in North Carolina, United States, who completed an online survey that asked about training needs. Almost half (49.0%) of participants state that they do not feel fully prepared to parent youth in foster care. Seventy-two percent of participants indicated they would like to receive more training on at least one of the three topics relevant to adolescent relationships and sexual health. By topic, the percentage of participants who desired more information included: peer pressure and friendships (48.1%); sexuality and sexual risk reduction (e.g. healthy relationships, pregnancy, STIs) (43.8%); and puberty and physical development (40.3%). Another area that most participants expressed a desire for more training was adolescent technology use (56.2%) – which is relevant to adolescent relationships and sexuality given a rise in the use of technology-based platforms to meet relationship partners, look at pornography, and share sexual messages and photos. Many caregivers desire additional training on how to engage with youth about sexuality and sexual risk reduction. Training caregivers of youth in foster care may be an effective strategy for improving the sexual health outcomes of this vulnerable population of youth.

Sleep and depressive symptoms in adolescents with type 1 diabetes not meeting glycemic targets

AimsAdolescents with type 1 diabetes (T1D) are at risk for problems with self-management and suboptimal glycemic control, and depressive symptoms and sleep disturbances predict poorer diabetes outcomes. Despite evidence for associations between adolescent depressive symptoms and sleep in the general population, few studies have investigated this link in the vulnerable group of adolescents with T1D not meeting glycemic targets. The current study sought to assess both depressive symptoms and sleep in relation to diabetes indicators in adolescents with T1D. Methods120 adolescents (ages 13–17 years) with above target glycemic control completed measures of depressive symptoms, sleep duration and quality, and self-management; parents also reported on adolescents’ diabetes management. Clinical data (i.e., HbA1c) were extracted from medical records. ResultsIn our sample, 40% of adolescents reported at least mild depressive symptoms, and 26% reported clinically significant sleep disturbances. Adolescents with sleep disturbances were more likely to report at least mild symptoms of depression, and both depressive symptoms and sleep quality were associated with poorer diabetes management. No significant differences emerged regarding HbA1c or frequency of blood glucose monitoring. ConclusionsThe current findings highlight the importance of clinical assessment of both depressive symptoms and sleep in the vulnerable group of adolescents with T1D.

Bullying Experience among Adolescents with a Turkish Migration Background in Germany: Ethnic Class Composition, Integration, and Religiosity as Protective Factors?

Bullying is a worldwide problem that has serious effects on the mental health of both victims and perpetrators. Although bullying seems related to increasing globalization and migration, it has seldom been researched in this context. This exploratory study examined bullying experiences and related depressive symptoms among a sample of adolescents with a Turkish migration background in a German school context (N = 103, 56.7% female, MAge = 16.17, SDAge = 1.36). The study focuses on three migration-related variables as potentially salutogenic factors: Ethnic class composition, acculturation, and religiosity. While the ethnic class composition did not show any effect, an integration acculturation strategy and religiosity proved to be protective factors against bullying experience. The negative prediction of integration on depressive symptoms was not consistent throughout the multivariate analyses. The results are discussed against the background of new impulses for bullying intervention programs for this vulnerable group of adolescents from a Turkish migration background.

An easy mark: YAL characters on the autism spectrum targeted by bullies

Exposing middle school students to characters with disabilities in young adult literature will not only forward an agenda of diversity in literature, but also teach readers about bullying and its repercussions for a vulnerable group of adolescents. The connections created through studying these novels can help build and strengthen a safe, inclusive, and supportive environment for all students. This article provides an overview of three novels that feature a main character on the autism spectrum who was bullied and describes the experience from a first-person perspective. Using these novels in middle school classrooms provides possibilities for students to make personal connections to bullying, learn acceptance, and learn more about themselves. Suggestions for activities and discussions that emanate from the use of these novels can help teach empathy and inclusion in the middle school setting, where feeling safe and included can be the gatekeeper to academic success and emotional well-being.

Improving lives by accelerating progress towards the UN Sustainable Development Goals for adolescents living with HIV: a prospective cohort study

SummaryBackgroundLow-income and middle-income countries (LMICs) face major challenges in achieving the UN's Sustainable Development Goals (SDGs) for vulnerable adolescents. We aimed to test the UN Development Programme's proposed approach of development accelerators—provisions that lead to progress across multiple SDGs—and synergies between accelerators on achieving SDG-aligned targets in a highly vulnerable group of adolescents in South Africa.MethodsWe did standardised interviews and extracted longitudinal data from clinical records at baseline (2014–15) and 18-month follow-up (2016–17) for adolescents aged 10–19 years living with HIV in the Eastern Cape province of South Africa. We used standardised tools to measure 11 SDG-aligned targets—antiretroviral therapy adherence, good mental health, no substance use, HIV care retention, school enrolment, school progression, no sexual abuse, no high-risk sex, no violence perpetration, no community violence, and no emotional or physical abuse. We also assessed receipt at both baseline and follow-up of six hypothesised development accelerators—government cash transfers to households, safe schools (ie, without teacher or student violence), free schools, parenting support, free school meals, and support groups. Associations of all provisions with SDG-aligned targets were assessed jointly in a multivariate path model, controlling for baseline outcomes and sociodemographic and HIV-related covariates, and adjusted for multiple outcome testing. Cumulative effects were tested by marginal effects modelling.Findings1063 (90%) of 1176 eligible adolescents were interviewed. Three provisions were shown to be development accelerators. Parenting support was associated with good mental health (odds ratio 2·13, 95% CI 1·43–3·15, p<0·0001), no high-risk sex (2·44, 1·45–5·03, p=0·005), no violence perpetration (2·59, 1·63–4·59, p<0·0001), no community violence (2·43, 1·65–3·86, p<0·0001), and no emotional or physical abuse (2·38, 1·65–3·76; p<0·0001). Cash transfers were associated with HIV care retention (1·87, 1·15–3·02, p=0·010), school progression (2·05, 1·33–3·24, p=0·003), and no emotional or physical abuse (1·76, 1·12–3·02, p=0·025). Safe schools were associated with good mental health (1·74, 1·30–2·34, p<0·0001), school progression (1·57, 1·17–2·13, p=0·004), no violence perpetration (2·02, 1·45–2·91, p<0·0001), no community violence (1·81, 1·30–2·55, p<0·0001), and no emotional or physical abuse (2·20, 1·58–3·17, p<0·0001). For five of 11 SDG-aligned targets, a combination of two or more accelerators showed cumulative positive associations, suggesting accelerator synergies of combination provisions. For example, the fitted probability of adolescents reporting no emotional or physical abuse (SDG 16.2) with no safe schools, cash transfers, or parenting support was 0·25 (0·16–0·34). With cash transfer alone it was 0·37 (0·33–0·42), with safe school alone 0·42 (0·30–0·55), and with parenting support alone 0·44 (0·30–0·59). With all three development accelerators combined, the probability of adolescents reporting no emotional or physical abuse was 0·76 (0·67–0·84). After correcting for multiple tests, four of the SDG-aligned targets (antiretroviral therapy adherence, no substance use, school enrolment, and no sexual abuse) were not associated with any hypothesised accelerators.InterpretationThe findings suggest the UN's accelerator approach for this high-risk adolescent population has policy and potential financing usefulness. Services that simultaneously promote several SDG targets, or combine to support particular targets, might be important to meet not only health-related targets, but also to ensure that adolescents in LMICs thrive within a new development framework.FundingNuffield Foundation, UK Research and Innovation Global Challenges Research Fund, UKAID, Janssen Pharmaceutica, International AIDS Society, John Fell Fund, European Research Council, Economic and Social Research Council, Philip Leverhulme Trust, and UNICEF.

Self-reported frequency of sex as self-injury (SASI) in a national study of Swedish adolescents and association to sociodemographic factors, sexual behaviors, abuse and mental health

BackgroundSex as self-injury has become a concept in Swedish society; however it is a largely unexplored area of research, not yet conceptualized and far from accepted in the research field. The use of sex as a way of affect regulation is known in the literature and has, in interviews with young women who sell sex, been compared to direct self-injury, such as cutting or burning the skin. The aim of this study was to investigate the self-reported frequency of sex as self-injury and the association to sociodemographic factors, sexual orientation, voluntary sexual experiences, sexual risk-taking behaviors, sexual, physical and mental abuse, trauma symptoms, healthcare for psychiatric disorders and non-suicidal self-injury.MethodsA representative national sample of 5750 students in the 3rd year of Swedish high school, with a mean age of 18 years was included in the study. The study was questionnaire-based and the response rate was 59.7%. Mostly descriptive statistics were used and a final logistic regression model was made.ResultsSex as self-injury was reported by 100 (3.2%) of the girls and 20 (.8%) of the boys. Few correlations to sociodemographic factors were noted, but the group was burdened with more experiences of sexual, physical and emotional abuse. Non-heterosexual orientation, trauma symptoms, non-suicidal self-injury and healthcare for suicide attempts, depression and eating disorders were common.ConclusionsSex used as self-injury seems to be highly associated with earlier traumas such as sexual abuse and poor mental health. It is a behavior that needs to be conceptualized in order to provide proper help and support to a highly vulnerable group of adolescents.

Adolescents' smoking experiences, family structure, parental smoking and socio-economic status in Ciudad Juárez, Mexico.

BackgroundCigarette smoking is the leading cause of preventable death worldwide. Tobacco use and secondhand-tobacco smoke (SHS) exposure are classified as a pediatric disease. In Mexico, the prevalence of smoking has decreased among adults but paradoxically increased among adolescents, particularly among young females. This study was designed to determine the association between adolescents’ smoking experiences (smoking behaviors and second hand smoke [SHS] exposure), family structure, parental smoking and socio-economic status (SES) in Ciudad Juárez, Mexico.MethodsThis is a cross-sectional, population-based study. Data was collected from sixth-grade students (N = 506) attending school in Ciudad Juárez, Mexico. Descriptive analyses were conducted. The relationship between key outcome variables (adolescents smoking and SHS exposure) and independent variables (family structure, parental smoking, and SES level) were examined. Adjusted odds ratios were calculated. Multiple logistic regression analysis was performed while controlling for possible confounders (i.e. gender and age).ResultsThe overall prevalence of ever/lifetime smoking and SHS exposure at home was 29.6 and 41.1 %, respectively. Results of the logistic regression analysis show that being a member of a non-intact family [(OR = 2.20; 95 % CI = 1.21–3.90) and (OR = 2.45; 95 % CI = 1.19-4.10) respectively], having parents who smoke [(OR = 4.41; 95 % CI = 2.15–5.46) and (OR = 4.95; 95 % CI = 2.25-7.12) respectively], and living in low SES setting [(OR = 1.73; 95 % CI = 1.43–3.30) and (OR = 1.99; 95 % CI = 1.16-4.00) respectively] are significantly associated with ever smoking and SHS exposure at home among sixth grade students.ConclusionsThe findings of our study show that tobacco use and SHS exposure are strongly associated with adolescents living in low SES, non-intact households that have parents that smoke. To be effective, tobacco strategies specifically tailored for this particularly vulnerable group of adolescents would require a comprehensive, multi-faceted approach centered on prevention, cessation and protection.

Encouraging human immunodeficiency virus self-testing among vulnerable group of adolescents: A World Health Organization initiative

Encouraging human immunodeficiency virus self-testing among vulnerable group of adolescents: A World Health Organization initiative

Natural mentoring among older youth in and aging out of foster care: A systematic review

Due to their histories of caregiver maltreatment, living instability, and potential attachment challenges associated with out-of-home care, older foster youth represent a particularly vulnerable group of adolescents at increased risk for a number of poor well-being outcomes. However, research supports the notion that a relationship with a competent, caring adult, such as a mentor, may serve protectively for vulnerable youth, and a nascent yet growing body of literature suggests that naturally occurring mentoring relationships from within youth's social networks are associated with improved outcomes among young people in foster care during adolescence and the transition to adulthood. This systematic review is the first to comprehensively identify, synthesize, and summarize what we currently know from nearly a decade of theories, concepts, and research findings pertaining to natural mentoring among adolescent youth in foster care. A bibliographic search of seven databases and personal outreach to mentoring researchers and practitioners through a national listserv yielded 38 English-language documents from academic sources and the gray literature pertaining to natural mentoring among older foster youth. We identified quantitative studies that have been conducted to test the theories and hypotheses that have emerged from the qualitative studies of natural mentoring among youth in foster care. Together, this literature suggests that natural mentoring is a promising practice for youth in foster care. Based on our findings from the systematic review, we make practice recommendations to encourage the facilitation of natural mentoring within child welfare contexts and outline an agenda for future research that more rigorously investigates natural mentoring among older youth in foster care.

The Relationship Between Substance Use and Sexual Health Among African-American Female Adolescents with a History of Seeking Mental Health Services

BackgroundThis study examined relationships between substance use patterns and problems and sexual health outcomes among low-income, urban, African-American female adolescents with a history of seeking mental health services. MethodsParticipants were recruited from outpatient mental health clinics serving urban, primarily low-income youth and families in Chicago, Illinois, as part of a 2-year, longitudinal investigation of HIV risk behavior during which they completed interviews every 6 months (five time points). Girls who completed at least one follow-up interview were invited to participate in a sixth wave of assessment to assess trauma exposure, substance use problems, and sexual risk. The current study (n = 177) examined the association between sexual risk behavior and substance use problems reported at the most recent interview (ages 14–22) and substance use patterns and sexually transmitted infections (STI) reported at all six times points. Multiple regression examined the combined and unique effects of different patterns of substance use and substance use problems as correlates of sexual risk behavior and STIs. FindingsSubstance use problems were associated with increased sexual risk behavior and increased likelihood of experiencing STIs. Substance use patterns were associated with sexual risk behavior. ConclusionsResults suggest that specific patterns of substance use and substance use problems are important to address in sexual health promotion among low-income, urban, African-American girls with a history of seeking mental health services. Understanding the nuances of these relationships is important in informing how to best serve this vulnerable group of adolescents who experience significant sexual risk and mental health care disparities.

Overweight and obese adolescents: what turns them off physical activity?

A systematic review of qualitative studies was undertaken to understand the barriers to physical activity experienced by adolescents who were overweight or obese. From a search of electronic databases and ‘grey’ literature, published between 1950 and 2009, 15 studies met the inclusion criteria. Bronfenbrenner’s model of human development provided an ecological lens for identifying and synthesising barriers to physical activity. Two reviewers appraised study quality. Miles and Huberman’s cross-case analysis was integrated with thematic networking to synthesize the individual, interpersonal and environmental level barriers for boys and girls of different ethnicities and socioeconomic status, across school settings and generalised context. Thirty-five barriers were identified, 13 of which occurred in physical activity situations in the school setting, 18 were not linked to a specific setting, and the remainder were common across both contexts. The fact that these barriers emerged from studies that focused on topics such as victimisation and mental health is particularly poignant and reflects the potentially pervasive influence of adolescent’s excessive weight not only in relation to physical activity situations but other aspects of their lives. Furthermore, socioeconomic status and ethnicity was poorly considered, with only one study linking these participant characteristics to quotations and discussing the potential implications. At present, there are few qualitative studies with sufficiently thick description or interpretive validity that provide insight into this vulnerable group of adolescents, and give them a voice to influence policy and practice.

American Academy of Pediatrics: Health care for children and adolescents in the juvenile correctional care system.

Over the past decade, there has been a dramatic increase in the population of juvenile offenders in the United States. Juveniles detained or confined in correctional care facilities have been shown to have numerous health problems. Such conditions may have existed before incarceration; may be closely associated with legal problems; may have resulted from parental neglect, mental health disorders, or physical, drug, or sexual abuse; or may develop within the institutional environment. Delinquent youths are often disenfranchised from traditional health care services in the community. For these adolescents, health care provided through correctional services may be their major source of health services. Pediatricians and correctional health care systems have an opportunity and responsibility to help improve the health of this underserved and vulnerable group of adolescents.