Well-being Of Youth Research Articles

아동청소년복지 종사자 역량에 관한 요구 분석

Objectives The purpose of this study was to provide basic data to explore the direction of practice of strengthen-ing the professional competency of child and youth welfare workers.
 Methods The subjects of the study were collected from 163 child and youth welfare workers from July 2022 to March 2023. The measurement tools were based on 14 standards of The NASW Standards for Social Work Practice in Child Welfare of the National Association of Social Workers.
 Results As a result of the study, according to the method of deriving the priorities of Borich need and The Locus for Focus model, the common high needs were ‘Administration’, ‘professional development’, ‘qualification’, and ‘collaboration’. And the next needs were ‘advocacy’ and ‘supervision’.
 Conclusions Based on the research results, strengthening qualification standards for professional development and reinforcement, preparing a systematic supervision system, institutional reorganization to improve excessive workload and caseload, opening of essential courses in conservative education to create an appropriate horizontal communication system and flexible organizational culture, active advocacy activities was suggested.

Social well-being and social success of Russian youth

Based on research data from the Institute of Sociology of the Federal Scientific Research Center of the Russian Academy of Sciences, the article examines the dynamics and specifics of the social well-being of young people through the prism of comparing objective indicators of income and its subjective assessments. The specifics of young people's perception of their social success in combination with ideological attitudes towards self-sufficiency are also considered. It is shown that today's youth have significantly reduced the chances of achieving relatively high incomes in the early stages of life, but the chances of youth groups sliding towards the poverty line have not increased either. Even though since 2003 the number of the most well-to-do among young people has decreased, the share of the least well-to-do youth has remained stable. Against this background, the general standards of life for young people have risen, and the boundaries of trouble have become more blurred. The category of social well-being has expanded, and the role of income as one of its key markers has decreased. Nevertheless, for Russian youth, a relatively long cycle of reaching the maximum level of social well-being remains. It is demonstrated that the Russian youth has high expectations regarding their own achievements in the future. At the same time, it is distinguished by a characteristic youth vision of the criteria for success in life, associated with the problems and expectations of a particular stage of the life cycle. It is also shown that the degree of self-realization of both young people and Russians is significantly associated with many objective characteristics of the individual. Thus, the higher the position occupied by an individual in various status hierarchies, the better he evaluates the degree of realization of his own plans. In turn, the feeling of social outsider ship stimulates the formation of attitudes towards extreme individualism, the readiness to achieve what is desired at any cost. A healthy understanding of social success correlates with the priority setting of moral norms and regulations.

Non-suicidal self-injury, suicidal behaviors, and mental health symptoms among sexual minority youth with juvenile justice system involvement

Sexual minority youth have long remained an understudied population within the juvenile justice system, despite emerging evidence suggesting that sexual minority youth are overrepresented. Recent literature indicates that system-involved sexual minority youth may have more behavioral health concerns than their heterosexual counterparts. Even so, more work is needed to elucidate the unique needs of sexual minority youth who become involved in the system, especially as it pertains to suicidal behaviors and non-suicidal self-injury (NSSI). The present study provided a descriptive evaluation of the prevalence of sexual minority youth making early system contact and their mental health concerns. Of the 218 justice-involved youth from a Northeastern family court in the sample, over a quarter identified as a sexual minority (n = 58). Our findings indicated that these youth evidenced significantly higher scores on a mental health screener compared to their heterosexual counterparts, evidencing greater symptomology on scales indicative of depression/anxiety, thought disturbance, etc. Further, sexual minority youth reported higher rates of lifetime, past year, and past month NSSI as well as lifetime and past year suicide attempts. These findings highlight the need to support the well-being of sexual minority youth in the juvenile justice system by screening for and addressing their mental health needs in this unique setting.

The Appa Health App for Youth Mental Health: Development and Usability Study.

Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental health challenges like depression and anxiety and can even support the use of evidence-based strategies like cognitive behavioral therapy (CBT). In our increasingly connected world, youth mentors can meet with young people on a web-based platform at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based CBT skills for addressing depression and anxiety more accessible than ever. As such, when trained and supervised by licensed clinicians, mentors are an untapped resource to support youth with mental health challenges. The objective of this study was to develop and assess the feasibility and acceptability of Appa Health (Appa), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development, pilot testing process, and preliminary quantitative and qualitative outcomes of Appa's 12-week smartphone app program which combines web-based near-peer mentorship with short-form TikTok-style videos teaching CBT skills created by licensed mental health professionals who are also social media influencers. The development and testing processes were executed through collaboration with key stakeholders, including young people and clinical and research advisory boards. In the pilot study, young people were assessed for symptoms of depression or anxiety using standard self-report clinical measures: the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 scales. Teenagers endorsing symptoms of depression or anxiety (n=14) were paired with a mentor (n=10) based on preferred characteristics such as gender, race or ethnicity, and lesbian, gay, bisexual, transgender, queer (LGBTQ) status. Quantitative survey data about the teenagers' characteristics, mental health, and feasibility and acceptability were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content. Participants reported finding Appa helpful, with 100% (n=14) of teenagers expressing that they felt better after the 12-week program. Over 85% (n=12) said they would strongly recommend the program to a friend. The teenagers were engaged, video chatting with mentors consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from week 1 to week 12, supporting qualitative data suggesting that mentoring combined with CBT strategies has the potential to positively impact youth mental health and warrants further study. Appa Health is a novel smartphone app aiming to improve the well-being of youth and reduce anxiety and depressive symptoms through web-based mentoring and engaging CBT video content. This formative research sets the stage for a large-scale randomized controlled trial recently funded by the National Institutes of Health Small Business Innovation Research program.

Prevalence and Risk Factors of Early Initiation of Alcohol Consumption and Smoking in School-Aged Adolescents

Introduction: Despite a constant focus on prevention of health-risk behaviors among adolescents and young people in many countries and regions, teenagers still show interest and engage in smoking and alcohol consumption. Objective: To study the prevalence and risk factors of early initiation of alcohol consumption and smoking in schoolaged children in order to substantiate and develop appropriate preventive measures to be taken in secondary schools of Yekaterinburg. Materials and methods: In 2022, we conducted an anonymous questionnaire-based cross-sectional study of 742 secondary school students in grades 8 to 11 (aged 14–18 years) living in Yekaterinburg. We assessed associations between the use of psychoactive substances, behavioral risk factors, such as daily routine, physical activity, attitude to smoking and alcohol consumption, health literacy, disease prevention habits, and psychosocial factors, and health. The data were analyzed using Pearson’s chi-squared test and the Student’s t-test; odd ratios (OR) were calculated with the 95 % confidence interval. Results: The proportion of cigarette smokers and alcohol consumers among school-aged adolescents amounted to 21.3 % and 43.4 %. Among the risk factors contributing to early initiation of smoking and alcohol consumption, the most significant were bad relationships with adults (parents and teachers), lack of parental support, poor awareness of adverse effects of alcohol consumption and smoking, loyal attitude of parents and schoolchildren to the problem. The use of psychoactive substances correlated statistically with poor well-being of the school-aged youth. Conclusion: We observed lower prevalence rates of smoking and alcohol consumption in the adolescents compared with the 2000s. This problem, however, still requires preventive interventions. The established risk factors should be taken into account when developing school-based prevention programs.

Welche Bildung fördert die Kinder- und Jugendhilfe, und welche nicht?

ZusammenfassungSoziale Arbeit und Sozialpädagogik betonen die Eigenständigkeit ihres Bildungsverständnisses in Abgrenzung zu schulischer Qualifizierung für den Arbeitsmarkt. Der Beitrag gibt einen Einblick in die einschlägige Fachdiskussion und ihre gesellschaftspolitische Situierung. Vor diesem Hintergrund wird aufgezeigt, dass diese Abgrenzung theoretisch prekär ist und problematische Implikationen haben kann.

Self-efficacy in life skills and satisfaction among adolescents in school transitions.

Life skills, according to the World Health Organization, can promote youth well-being through educational school programs. Among life skills, decision-making and problem-solving skills can help adolescents consciously choose their career path.The Italian school system, in fact, requires students, already at a young age (13-14 years old) to make important decisions about their future, like for example choosing the high school that they would like to attend. This study aims to analyze differences in decision-making, self-efficacy, and life satisfaction in a sample of adolescents in secondary school in Italy. It aims to analyze whether there are differences in those dimensions according to students' age, gender, regularity, and future choice intentions. Here we present a cross-sectional study involving 2104 students, balanced by gender, and attending upper secondary school in Italy. Participants completed Soresi and Nota's questionnaires on life satisfaction and Caprara's questionnaire on problem-solving self-efficacy. The data were processed using MANOVA. Research results show significant differences in self-efficacy and school satisfaction in relation to the age at which school transition occurred. Specifically, incoming preadolescents (13-14 years old) scored lower than outgoing late adolescents (17-18 years old) in both decision-making self-efficacy and school satisfaction. Girls scored lower than boys in decision-making self-efficacy. Students who expressed the intention to drop out of school scored lowest on both the self-efficacy and perceived support satisfaction scales. The results highlight the importance of promoting the development of self-efficacy in life skills and school satisfaction to help students in school transitions.

잠재계층분석을 이용한 한국 청소년 사이버불링 가해행태 분석

This study aims to categorize adolescent cyberbullying perpetration using a person-centered approach, as opposed to the conventional variable-centered method. The goal is to create an academic foundation for tailoring cyberbullying prevention strategies that align with unique perpetration patterns shown by individual adolescents. To achieve this goal, the study utilized data from the 「Korean Children and Youth Welfare Panel Study 2018」conducted by the Korea Institute of Child and Adolescent Welfare. Using Latent Class Analysis (LCA), we identified latent groups of adolescents with comparable cyberbullying perpetration patterns. These groups were then studied to uncover distinctions in demographic charateeristics (gender), mental health factors (aggression, depression, grit), antisocial behaviors (delinquency), and relational factors (teacher relationships, friendships, parental caregiving attitudes). The key findings are as follows: First, a statistically significant model has been derived, which includes two to five latent groups, each displaying unique patterns of cyberbullting perpetration behavior. Second, considering model fit, types of perpetration behavior, and sample sizes, a four-group latent model has been determined as the most appropriate for achieving the research objectives. These four latent groups are labeled as: 'Low-Level Perpetration Group (n=2,087)', 'Verbal Aggression · Cyber Prison · Flaming Concentrated Group (n=36)', 'Verbal Aggression Concentrated Group (n=74)', and 'High-Level Perpetration Group (n=5)'. Third, there are no significant differences observed in the characteristics of the members within each latent cyberbullying perpetration group. However, unexpected outcomes are noted concerning delinquency, teacher relationships, and positive parental caregiving attitudes (warmth, autonomy support, structure). Consequently, the need for further research on categorizing types of adolescent cyberbullying perpetration and conducting detailed analyses for each type is proposed.

Life satisfaction and associated social factors among college students in Kottayam district, Kerala

Background: Fostering youth wellbeing is a pressing concern for educators and mental health professionals. It is generally acknowledged that among many constructs, understanding and promoting social support and life satisfaction are essential to achieving this goal. This study was conducted to assess the level of life satisfaction and social support and to determine the relationship of social support and socio-demographic factors with life satisfaction among students of arts and science colleges in Kottayam district. Methods: A cross-sectional study was conducted among 464 undergraduate students from arts and science colleges of Kottayam district selected through two stage random sampling. Data were collected from the students using a self-administered questionnaire consisting of socio-demographic questionnaire, the satisfaction with life scale and the Multidimensional Scale of Perceived Social Support (MSPSS). Data analysis was done using SPSS version 25. Results: Among the 464 study participants, majority (74.1%) were having high social support. 51(11%) students were found to be extremely satisfied with life and 96 (20.7%) satisfied with life. The life satisfaction scores among female study participants was found to be statistically significantly higher than males (Z=2.433, p=0.015). Life satisfaction had a statistically significant positive correlation with total perceived social support (Spearman’s rho=0.391, p<0.001) and perceived support from family (Spearman’s rho=0.394, p<0.001), friends (Spearman’s rho=0.187, p<0.001) and significant others (Spearman’s rho=0.280, p<0.001). Conclusions: Regular assessment of social support and life satisfaction of college students should be done. Steps should be taken ensure adequate social support to college students.

A BRIGHTER TOMORROW: PRIORITIZING CHILD AND ADOLESCENT MENTAL HEALTH IN PAKISTAN

ABSTRACT There is a crucial need for recognising children and adolescents as an integral part of society, especially in a nation with a significant youth demographic. Pakistan's 280 million population, includes 100 million youth, and require urgent investment in mental well-being, particularly addressing psychiatric disorders like depression and anxiety, especially for women, whose welfare is often neglected.At present, Pakistan has an alarming shortage of psychiatrists, with one of the lowest numbers in the WHO Eastern Mediterranean Region. Despite existing policies, there is a clear lack of tailored laws addressing the specific needs of children and adolescents. The efforts made by organisations like the College of Physicians and Surgeons Pakistan and Sindh Mental Health Authority are acknowledged, but nonetheless, there is a pressing need for a robust policy. The progress made by neighbouring countries in formulating and implementing mental health policies, particularly emphasising the importance of mental health within a holistic healthcare system, is noteworthy.An emphasis has been laid on the urgency of the situation, advocating for prompt action, comprehensive policies, and unwavering commitment. The proposed future directions include a call to actively prioritise the mental well-being of youth to shape a brighter future for Pakistan.

Youth Lens methodology: Critical participatory action research with youth in Cleveland, Ohio

Research on youth well-being is often driven by adult researcher voices, while youth experiences are neglected. Youth participatory action research (YPAR) is a distinct and powerful approach to capture youth experiences unique to particular social settings and leverage these voices to produce action and change through research. YPAR can be used to challenge oppression, mitigate the researcher-participant hierarchy, and build a social justice-oriented methodology, particularly when it uses a critical and intersectionality lens, rooted in a wider understanding of racial oppression. This methodology paper analyzes our Youth Lens methodology, which uses Critical YPAR to explore African American youth perceptions of how the neighborhood environment shapes health and well-being in Cleveland, Ohio. We describe, in detail, our methodology which was used to examine the history of redlining and systemic racism in the city and how it has driven present-day health and socioeconomic disparities. Further, we reflect in this paper not only on the methodology, but on our own role in the research. We end with implications for collaborative research with youth.

5 The Relationship between National Paediatric Research Funding and Health Outcomes in Canada

Abstract Introduction The Canadian Institutes of Health Research (CIHR) is Canada's federal funding agency for health research. CIHR invests approximately $1 billion each year to support health research. A recent cross-sectional analysis of 14,060 paediatric grants from the National Institutes of Health (NIH) showed that funding for paediatric research was correlated with level of disease burden, although certain conditions were identified as either over- or under-funded. Objectives The objective of this study was to determine the relationship between national paediatric research funding and health outcomes in Canada. Methods Health research grants (project, operating, foundation, team, and catalyst grants) related to paediatrics were identified annually for each of 6 financial years (2015-16 to 2020-21) through systematic keyword searches of CIHR’s research funding database. Two researchers extracted data on the disease or topic being studied, and coded each grant according to the top 50 causes of mortality, top 10 causes of hospitalization, and 8 well-being dimensions (as defined by the Canadian Index of Child and Youth Well-being). Inter-rater reliability was first established and then 20% of grants were double-coded and reviewed for consistency. Data were then used to summarize total annual funding for paediatric research and compared to paediatric health outcomes. Results A total of 1703 grants with total funding in the amount of $702,217,490 related to paediatric research were identified in the period between 2015-16 and 2020-21 ($74,944,445 in 2015-16, $87,447,167 in 2016-17, $103,754,359 in 2017-18, $124,277,052 in 2018-19, $132,734,406 in 2019-20, and $179,060,060 in 2020-21). A total of 248 abstracts (14.6% of all included grants) were identified as focused on one of the top 4 leading causes of paediatric mortality. These included accidents ($3,709,863), intentional self-harm (suicide) ($8,529,544), congenital malformations, deformations, and chromosomal anomalies ($30,230,136), and malignant neoplasms ($61,550,990). A total of 379 grant abstracts (22.3%) were identified as focused on a leading cause of paediatric hospitalization. These included disorders related to short gestation and low birth weight ($33,381,731), mood (affective) disorders ($32,236,327), anxiety disorders ($10,445,260), and other mental health disorders ($56,584,714). The top dimensions of well-being identified as being studied were “Feeling happy and respected” (218 grants, $78,315), “Feeling protected” (89 grants, $34,166,781), and “Feeling secure” (83 grants, $27,158,835). Conclusion This analysis indicates that there is general alignment of health research funding in Canada with paediatric mortality, hospitalization, and well-being indicators. Understanding paediatric research funding patterns can help inform prioritization of specific paediatric areas for future strategic funding.

Mental health in society's margins: poor n-3 PUFA intake and psychological well-being of homeless youth.

Dietary intake of long-chain n-3 PUFA (n-3 PUFA), particularly EPA and DHA, has been associated with psychological well-being, but little is known about the n-3 PUFA intake of homeless youth. The current study determined the association between depression and anxiety symptoms and n-3 PUFA intake and erythrocytes status in homeless youth. Totally, 114 homeless youth aged 18-24 years were recruited from a drop-in centre. n-3 PUFA dietary intake was assessed using an FFQ, and erythrocytes status was determined by gas chromatography (GC). Linear regression models were used to determine the relationship between psychological well-being and n-3 PUFA intake and status. The mean intakes of EPA and DHA for all participants (0·06 ± 0·13 g/d and 0·11 ± 0·24 g/d) were well below recommended levels, and mean erythrocytes EPA + DHA (n-3 index) in the cohort (2·42 %) was lower than reported for healthy, housed adolescents and those with clinical depression. There was no association of n-3 PUFA intake and erythrocytes status with either depression or anxiety. However, the relationships of depression with dietary EPA (P = 0·017) and DHA (P = 0·008), as well as erythrocytes DHA (P = 0·007) and n 3-index (P = 0·009), were significantly moderated by sex even after adjusting for confounders. Specifically, among females, as the intake and status of these n-3 PUFA decreased, depression increased. Our findings show poor dietary intake and low erythrocytes status of n-3 PUFA among homeless youth, which is associated with depressive symptoms among females.

Understanding youth well-being in the family context: the role of democracy, warmth, and disclosure

ABSTRACT This study applies a nonexperimental quantitative design to investigate youth well-being within the family context. Structural equation model analyses of information from 1883 seventh grade youths revealed: Democratic parenting (β = 0.43, p < .001), maternal warmth (β = 0.23, p < .001), and paternal warmth (β = 0.43, p < .05) were positively associated with youth disclosure, which in turn was associated with academic (β = 0.44, p < .001), emotional (β = 0.13, p < .05), and social (β = 0.43, p < .001) well-being the following year; paternal warmth and emotional well-being were directly linked (β = 0.16, p < .01); and youth disclosure and emotional well-being were associated stronger for girls (β = 0.33, p < .001) compared to boys (β = 0.11, p > .05). Future well-being research should consider parent–youth relationships, and youths could be involved in family policy-making and fostering supportive family environments.

Sexual minority youth in romantic relationships: Associations with youth well-being.

This study investigated differences in depressive symptoms, loneliness, and self-esteem for monosexual (lesbian, gay) and plurisexual (bisexual, pansexual, queer) sexual minority youth (SMY) by relationship status (single, partnered) and relationship configuration (same-gender partner, different-gender partner). Participants included 338 SMY (Mage = 19.10 years) who reported on their relationship status, partner's gender identity, well-being, and ability to confide in partner about LGBTQ issues. Results indicated that for plurisexual youth, single status was associated with greater loneliness; plurisexual youth with same-gender partners reported fewer depressive symptoms and marginally greater ability to confide in their partner about LGBTQ issues than those with different-gender partners. Findings reveal similarities across SMY while also highlighting some unique challenges among plurisexual youth with different-gender partners.

Nexus between Participation in Agriculture and Youth Welfare in Bomet County, Kenya

Nexus between Participation in Agriculture and Youth Welfare in Bomet County, Kenya

Religiosity and psychological well-being of Chinese college students in Hong Kong: the role of gratitude and hope

ABSTRACT Previous studies in Western countries have confirmed the relationship between religiosity and psychological well-being. However, there is limited research exploring the role of gratitude and hope in the relationship between religion and the psychological well-being of Chinese youth. This study investigates the mediating role of gratitude and hope in the effects of religiosity on well-being. A cross-sectional survey was administered to 191 Chinese college students aged 18–30 in Hong Kong. The study revealed that religiosity was directly related to psychological well-being and indirectly associated with it through gratitude and hope. The results of this study supported that increasing religiosity could enhance gratitude and hope and is beneficial to Chinese youth’s psychological well-being. Social Service agencies can consider incorporating gratitude, hope and religiosity into interventions to improve youth well-being. Further studies could examine whether gratitude and hope mediate the relationship between religiosity and psychological well-being among young people in other cultures.

Psychosocial Factors Associated With Time to Recovery After Concussion in Adolescent Ice Hockey Players.

To investigate the association between psychosocial factors and physician clearance to return to play (RTP) in youth ice hockey players after sport-related concussion. Prospective cohort study, Safe to Play (2013-2018). Youth hockey leagues in Alberta and British Columbia, Canada. Three hundred fifty-three ice hockey players (aged 11-18 years) who sustained a total of 397 physician-diagnosed concussions. Psychosocial variables. Players and parents completed psychosocial questionnaires preinjury. Players with a suspected concussion were referred for a study physician visit, during which they completed the Sport Concussion Assessment Tool (SCAT3/SCAT5) and single question ratings of distress and expectations of recovery. Time to recovery (TTR) was measured as days between concussion and physician clearance to RTP. Accelerated failure time models estimated the association of psychosocial factors with TTR, summarized with time ratios (TRs). Covariates included age, sex, body checking policy, days from concussion to the initial physician visit, and symptom severity at the initial physician visit. Self-report of increased peer-related problems on the Strengths and Difficulties Questionnaire (TR, 1.10 [95% CI, 1.02-1.19]), higher ratings of distress about concussion outcomes by participants (TR, 1.06 [95% CI, 1.01-1.11]) and parents (TR, 1.05 [95% CI, 1.01-1.09]), and higher parent ratings of distress about their child's well-being at the time of injury (TR, 1.06 [95% CI, 1.02-1.09]) were associated with longer recovery. Greater pre-existing peer-related problems and acute distress about concussion outcomes and youth well-being predicted longer TTR. Treatment targeting these psychosocial factors after concussion may promote recovery.

Assessing the Gendered General Strain Theory Over Time in Individuals with a Residential Care History

ABSTRACT The gendered general strain theory posits that differences in delinquency across gender are due to differences in coping with negative emotions. The present study tests its validity over a 10-year follow-up. We measured exposure to strain, levels of anxiety/depression, anger/irritability, and delinquent behaviors through questionnaires and interviews during residential care (T1) and then 10 years later (T2) in a sample of 80 men and 54 women who were placed in youth welfare and juvenile justice institutions in Switzerland during childhood/adolescence. We observed that, in men, less delinquency at T1 and more symptoms of anxiety/depression at T1 are related to less delinquency at T2. In women, none of the emotional variables nor strain predicted delinquency over time. Results give important insights regarding the risk factors related to long-term delinquency in men but only partially support the gendered general strain theory.

Expanding the early intervention offer: A new care pathway for children's wellbeing practitioners in a south London child and adolescent mental health service.

Child and Adolescent Mental Health Services (CAMHS) have been under recent increased demand, with increasingly limited resources, contributing to longer waiting lists, and a growing proportion of rejected referrals due to limited capacity and increasing thresholds. Child and Wellbeing Practitioners (CWPs) provide an opportunity to meet the needs of rejected referrals. We aimed to determine the feasibility of a new and direct referral route within a South London CAMHS. All referrals rejected to the local CAMHS in one year were assessed for inclusion to an embedded child and youth wellbeing in schools team (CYWS), and data collected on reasons for rejection, demographics and eligibility for the CYWS team. Of the 1,322 referrals made to CAMHS in this period, 317 were rejected. The most common reason for referral rejection was not meeting the severity threshold. One third of rejected referrals were judged to be eligible for inclusion to the CYWS team. Therefore, a significant number of children and young people (CYP) being rejected by CAMHS would be eligible for assessment and possible treatment under the CYWS team, making a new referral route potentially feasible, allowing more CYP to access mental health support and have a positive impact on waiting times.