Adolescents

This qualitative case study explored the experiences of one Canadian adolescent with symptom-persistent Lyme disease. Lyme disease is the most prevalent vector-borne illness in North America, and infection rates are rising across Canada. Peak incidence occurs in children aged 5–9 years, making it a significant childhood infectious disease. This involves collaboration with an adolescent with symptom-persistent Lyme disease in Canada to address a gap in the literature. This empirical research was guided by the central research question: “What is the experience of an adolescent with symptom-persistent Lyme disease in Canada?” The purpose of this study was to understand the unique experiences of symptom-persistent Lyme disease in Canada by emphasizing one adolescent’s unique voice. The findings of this case study demonstrate the challenges this adolescent faced in receiving appropriate diagnosis and treatment for Lyme disease, pointing to a need for increased awareness among health professionals regarding the impact and prevalence of tick-borne illnesses for young people, their caregivers, and their healthcare providers. Additional findings suggest that collaborative healthcare may be beneficial for patients with symptom-persistent Lyme disease, and health researchers should continue to engage young people to ensure accurate representation of their experiences. Full article

The social and emotional health of adolescents is increasingly a concern worldwide. To date, there remains a lack of research on how school climate influences adolescents’ learning experiences and their social and emotional health. To address this gap in the literature, this critical review addresses the role that the school climate plays in an adolescent’s school life and emotional well-being. This article takes a critical approach and outlines the key issues in research on the secondary school climate in the digital and real-life sense and the implications for adolescent’s well-being. We first outline the definitional and methodological issues regarding research on school climate in adolescence. We then outline why mental health is a key issue for adolescents across the globe and conclude with a list of implications for theory, research, and practice. Thus, this article builds on past, current, and ongoing research on adolescents’ emotional well-being and school climate across the globe. The article provides new directions and recommendations for future research on inclusive educational philosophies and positive psychology and suggestions for practice aimed to best support adolescents’ learning experience and mental well-being. Full article

Global interest in child, early, and forced marriage and unions (CEFMU) is reflected in a large and growing body of research and interventions. Those interventions have focused on raising the minimum age of marriage, establishing laws and penalties for those who ignore these minimums, investing more heavily in girls’ education, addressing structural inequalities, and bringing about gender and social norm change. Missing has been any discussion of the right to leave marriage. As we learn more about the forces that drive child marriages and unions and what works to prevent them, rare is any mention of how these marriages sometimes end and what happens when they do. Human rights standards focus on the ability to choose “if, when, and whom to marry”. We posit that without the ability to decide if and when to leave marriage, marriage cannot be considered a choice. This paper explores why the right to leave marriage matters so deeply, describes the obstacles to girls’ access to divorce and to protections after divorce or separation, and links these to the factors that drive child, early, and forced marriages and unions. Full article

Direct experiences of sexual harassment have been found to be associated with substance use and poor mental health among girls. Indirect experiences, such as witnessing the sexual harassment of others, may be indicative of a climate supportive of sexual harassment against girls and elicit similar adverse outcomes. The current study sought to assess reports of witnessing sexual harassment and associations with substance use and mental heath outcomes among adolescent girls. The data were from questionnaires among girls (n = 152) ages 15–19 recruited from a health clinic serving a low-resource community in San Diego County. Using crude and adjusted regression models, we assessed witnessing the sexual harassment of girls (past year) as well as the frequency of witnessing such acts in relation to substance use, anxiety, depression, and suicidal ideation. The adjusted models included demographics and direct experiences of sexual harassment (past 6 months) as covariates. The participants had an average age of 17, and 76% were Latina. The majority (70%) reported witnessing sexual harassment (past year); 65% reported directly experiencing sexual harassment (past 6 months). Among those reporting witnessing, most witnessed sexual harassment at school (69%), at a party (45%), in their neighborhood (34%), or on public transport (33%). In adjusted logistic regression models, witnessing sexual harassment was significantly associated with past 30-day alcohol use, ever using drugs, feeling depressed (past 30 days), feeling anxious (past 30 days), and past-year suicidal ideation (ORs range 2.9–18.2). The findings suggest that, in addition to direct experiences of sexual harassment, indirect experiences of witnessing the sexual harassment of others may also be associated with negative outcomes regarding girls’ health and well-being. Full article

Background: Considering its deleterious effects on health, as well as the importance of information to support actions, strategies, and public policies, the present study was developed, aiming at identifying and classifying the main variables associated with ultra-processed foods consumption in Brazilian adolescents. Data sources: Targeting observational studies involving samples of Brazilian adolescents (11 to 19 years old), which evaluated possible associations between the consumption of ultra-processed foods and individual, interpersonal, environmental, and public policy variables, in October 2022, a systematic review was conducted, consulting electronic databases (Lilacs, Pubmed, Scielo, Scopus, and Web of Science), Google Scholar, and the reference lists of included articles. Data synthesis: The descriptive synthesis consisted of 11 papers, representing nine original studies. The main variables identified were: sedentary behavior (specially screen time), studying at a private school, having a higher body mass index, and being female. Conclusions: Based on this evidence, it is important to direct actions, strategies, and public policies aimed at confronting the consumption of ultra-processed foods for these groups. Full article

Understanding the determinants that influence obesity among children and adolescents is critical to the prevention of obesity and obesity-related diseases later in life. The findings presented here broaden the understanding of obesity-related challenges by adding analyses that compare nutritional indicators among boys and girls between the ages of 11 and 16 years, by exploring the more recent literature to examine if past trends have continued or not, and by synthesizing the recent findings concerning the causes and determinants of such trends in obesity. Both data from 2005 and the more recent literature review have shown that the consumption of high calorie foods and snacks, greater screen time, body image, and depressive factors play a significant role regarding obesity during adolescence in Thailand. There continues to be a trend of increasing obesity among adolescents in Thailand, and this may be more of a concern in boys. Interviews with health professionals and parents from the 2005 study suggested that girls were more aware of their physical appearance, and there was more societal acceptance to be obese as a boy in Thailand compared to girls. These findings can inform nutritional education practices and policies. Full article

Cases of teenage pregnancy remain high in Eastern Province of Zambia—contributing to health, economic, and social problems. This study sought to determine the effect of exposure to boarding schooling on pregnancy among school-going teenagers, taking into account individual and school characteristics. This was a retrospective case-control study involving 261 cases and 522 controls obtained from nine boarding and nine day secondary schools, between 2019 and 2021. STATA 16.1 MP was used for all statistical analyses at a 5% level of significance. Unadjusted and adjusted effects were obtained using logistic regression analysis—taking into account 18 school clusters. Cases had a mean age of 17.4 years (±1.14 years), controls were 16.1 years (±1.71 years) old on average, and 315 (40%) of the participants were exposed to boarding schooling. The unadjusted odds of pregnancy in the exposed and unexposed (day scholars) girls were 0.25 and 0.73, respectively (cOR = 0.34, CI: 0.24–0.48, p < 0.0001). Adjusting for other characteristics, teenage girls in boarding schools had 60% lower odds of pregnancy (aOR = 0.40, CI = 0.16–1.00, p = 0.049). In light of this evidence, enrollment of teenage girls in boarding schools is encouraged to help mitigate teen pregnancy in the province. Additionally, a multicenter prospective study is recommended. Full article

(1) Background: In adolescence, the onset of physical signs of sexual maturity and early sexual contact have become increasingly common. However, most adolescents are not adequately prepared for this event, which can lead to significant negative consequences for young people. This study aimed to evaluate knowledge about sexuality during adolescence. (2) Methods: A quantitative, descriptive, and correlational design was used, with 289 students from a school in the northern region of Portugal. From an online questionnaire, sociodemographic information and the Sexuality Knowledge Questionnaire were used to collect data. (3) Results: Most adolescents (54.0%) were female and aged between 15 and 17 years, with an average knowledge score of 17.04. The worst results were found in the dimensions of first sexual intercourse and sexual concerns, with men scoring lower, and the dimension of sexually transmitted infections and HIV/AIDS, where women performed better. The best scores were in the sexuality and sexual pleasure dimension, with women performing better, and the counseling and care in sexual and reproductive health dimension, where men performed better. (4) Conclusions: The approach to sexuality education must be constant throughout the life cycle, and it is essential to provide appropriate information to adolescents about issues related to sexuality. Full article

Most of the research examining student motivation, particularly achievement goals, has relied on experimental or survey methods that narrow the number and type of goals students can report. A few researchers have asked students open-ended questions, either using surveys or interviews, about what they want to accomplish and their reasons for studying or trying to achieve. These studies have generally found a larger number of goals across a broader set of categories (e.g., social-comparison, internal standard, social, work-avoidance, utilitarian) than is typically examined in research on achievement goals. In this study, we asked a sample of 152 undergraduate students at one university in California (USA) to describe how they defined success in two different classes: One they liked and one they disliked. Our objectives were to examine how students described their definitions for success, whether those definitions differed for liked and disliked classes, and to learn about students’ perceptions regarding the sources of their definitions of success. The results indicated that students’ definitions of success were more varied in classes they liked than in those they disliked. In addition, their definitions focused more on developing competence and positive relationships with the teacher in classes they liked, but they focused on getting a good grade, completing the class, and avoiding work in classes they disliked. The results also indicated that students perceived different sources of the same definitions of success for liked and disliked classes, with a greater emphasis on bad teaching and difficult course material in the disliked class. The implications for conceptualizing the methodology for studying achievement goals are discussed. Full article

Background: Risky sexual behaviors remain common among adolescents regardless of those with comprehensive knowledge of safer sex practices. Self-efficacy has been shown to have a positive relationship with safer sex practices. Thus, investigating self-efficacy, and enhancing it to agency is important. The current study explores the predictors of self-efficacy for avoiding risky sexual behaviors and what limits agency among sexually active adolescents (15–19 years) in Northern Uganda. Methods: The study consisted of a sub-sample of 396 sexually active adolescents (145 in school, 251 out of school) interviewed as part of a household survey for the program on Advancing Sexual Reproductive Health and Rights in Northern Uganda. Poisson and Poisson regression models with survey weights were implemented in Stata. Results: A total of 94% of male and 64% of female adolescents reported self-efficacy to avoid unsafe sex, including using condoms and avoiding multiple sexual partnerships or transactional sex. At multivariable analysis, a higher proportion of adolescents who listened to a radio or television program about sexual and reproductive health within the past 12 months had self-efficacy as compared to others (PR = 1.13, p-value = 0.002). Similarly, higher proportions of adolescents who knew all the sexual and reproductive health (SRH) rights (PR = 1.33, p-value = 0.007) and who had comprehensive knowledge about pregnancy, prevention of sexual transmission infections, and sources of SRH services (PR = 1.24, p-value = 0.013) had self-efficacy as compared to others. However, among those who reported self-efficacy, 42% of the girls and 53% of the boys could not uphold their self-efficacy in actual sexual encounters in the past 12 months. Partner’s refusal or girls’ fear to ask their sexual partner to use a condom were commonly cited reasons. Alcohol consumption was associated with failure to act on one’s self-efficacy (RR = 0.74, p-value = 0.048). Conclusions: Programs should target self-efficacy beliefs and attempt to enhance them into agency by increasing positive and decreasing negative expectations associated with risky sexual behavior. Full article

Mobile software applications (apps) have transformed how individuals oversee and maintain their own health. One way that girls can monitor their menstrual cycles is through the increasingly widespread use of mobile menstrual tracking apps. This study aimed to examine menstrual symptom tracking for adolescents in English and Chinese apps, exploring menstrual literacy, cross-cultural differences, and framing, or presentation, of symptoms. The mixed-methods content analysis involved 15 popular free menstrual tracking apps in English (n = 8) and Chinese (n = 7), sampled from December 2022 to January 2023. A quantitative analysis of qualitative data was conducted through manual coding of content and automatically analyzing sentiment, or emotional tone, using a computational approach. We found that (1) menstrual literacy on symptom management or treatment was generally insufficient, (2) there were more available emotional than physical symptoms in English than Chinese apps, and (3) symptoms were framed more negatively than positively somewhat more in Chinese than English apps. Our findings emphasize the urgency to provide better evidence-informed communication about symptoms, either presented more positively or neutrally, in menstrual tracking apps for adolescent users. Since adolescence is a critical developmental stage that requires ample support, we recommend that digital menstrual trackers be crucially improved and future research should investigate how they can uniquely shape attitudes and experiences, and subsequent sexual and reproductive health empowerment and bodily autonomy. Full article

Adolescent pregnancies adversely impact mental and reproductive health as well as educational and socio-economic outcomes. In Kakamega County, Kenya, 20% of adolescents begin childbearing by age 19. To inform interventions to reduce adolescent pregnancy, Jhpiego used the Barrier Analysis methodology, which is based on the Doer/Non-Doer study model, in which participants are categorized according to whether they are “Doers” or “Non-Doers” of the study behavior. This study examines the determinants of the behavior, “young unmarried women currently use modern contraceptive methods”. Participants included young women aged 15–19 who were sexually active, unmarried, and were using (“Doers”) or not using (“Non-Doers”) modern contraception. The findings reveal that the majority of Doers (88%) and Non-Doers (80%) understand the pregnancy risk associated with non-use, and there is no statistically significant difference between Doers’ and Non-Doers’ understanding of contraceptive benefits. Knowledge of side effects and misconceptions, such as the belief that contraception causes infertility, does not deter Doers from using contraception. Seventy percent of Doers note that contraception is accessible/available, while 39% of Non-Doers state the opposite. Doers are almost three times more likely than Non-Doers to say that most people approve of their contraceptive use, while Non-Doers are twice as likely as Doers to say that most people would not approve. Doers are four times more likely to indicate approval from their mothers and boyfriends. Non-Doers are five times more likely than Doers to have specific professional goals for the future. These findings illustrate the importance of moving away from fear-based messaging and instead highlighting social acceptability and contraception’s role in achieving future goals. Full article

So far, many studies indicated that youth experience mental problems during crises, such as the COVID-19 crisis, but little attention has been paid to the relation to age-adequate functioning and its association to layered social environments. This study addresses this gap by investigating the association between social environments (i.e., household, friends, and neighbourhood) during the COVID-19 crisis with youth’s mental problems and age-adequate functioning. In total, 673 youth (mean age = 19.87, 73.4% girls) were surveyed online during the COVID-19 outbreak. In line with predictions, worse contact with household members was associated with more internalizing symptoms. A lack of privacy was associated with more internalizing and externalizing symptoms and difficulties achieving personal and school and professional milestones. Living with a vulnerable other was associated with more internalizing symptoms and difficulties achieving school and professional milestones. Worse contact with friends was associated with difficulty achieving social milestones. Additionally, neighbourhood risk moderated the association between living with a vulnerable other and school and professional milestones. A lack of privacy stood out as the most important factor associated to youth’s mental problems and achievement of developmental milestones. Future research should indicate to what extent these findings are COVID-19 crisis-specific or can generalize to other crises. Full article

Adolescents and young women in Mozambique experience high levels of unintended pregnancies, with induced abortion being a common outcome. Stigma and gender norms are likely to negatively impact experiences of pregnancy and abortion, and hamper access to information and services. We assessed knowledge, attitudes, practices, and experiences around pregnancy and abortion in six communities in Nampula and Zambézia provinces. We conducted 19 triad interviews with young women and girls, 19 focus group discussions with male and female adult community members, and 15 in-depth interviews with young women with abortion experience. Participants described how gender values, norms, and practices affect girls’ risk of unintended pregnancy and their experiences of pregnancy and abortion. The drivers of adolescent pregnancy included transactional sex and gender-based violence, including early marriage, and gender roles and expectations that lead parents and others to oppose contraception. Stigma around abortion, early or unintended pregnancy, and adolescent sexuality is fueled by gender norms and contributes to girls seeking unsafe abortions. Pregnancy and abortion decision making often involves male partners and family members. In conclusion, gender norms strongly influence the occurrence and outcome of unintended pregnancies and abortion in Mozambique. While abortion legislation was recently liberalized, gender values, norms, and practices inhibit young women’s and girls’ access to services and need to be addressed in policy and programming. Full article

Intimate partner violence (IPV) occurs in high proportions among young women, with long-lasting adverse health and social outcomes. Recent research findings suggest that experiencing economic vulnerability may influence the ways in which young women experience or are at risk for IPV, including economic abuse. Economic abuse, a form of IPV, involves a partner’s control over money and other economic resources or activities. This study explored economic vulnerability and IPV, including economic abuse, among young Nigerian women reporting a recent history of IPV. In-depth interviews (n = 25) were conducted with women aged 18–30 years who had experienced IPV in the past year. Women were recruited from community and health facilities in low-income neighborhoods of Ibadan, Nigeria. A semi-structured interview guide was used to gather data on women’s economic vulnerability (e.g., food security, living situation, employment/education opportunities, family financial support, economic independence) and experiences of IPV. An analysis was conducted using a thematic analysis approach. The coding scheme was based on interview protocols, adding open codes from emergent themes identified in the interviews. On average, participants were 21 years old, most had children (68%) and reported to be cohabitating with a male partner (56%), and 48% had less than a secondary level of education. Among the emergent themes, women reported economic vulnerability as being financially dependent on a male partner for basic needs. Among this sample, economic vulnerability was exacerbated by limited education, training, and work opportunities, and a disproportionate burden of household labor. Economic vulnerability precipitated all forms of IPV, including economic abuse, as well as sexual and pregnancy coercion. Economic abuse was reported to occur when male partners controlled household finances and denied women adequate allowance to purchase household food, including food for children. Findings from this qualitative study suggest that interventions promoting educational and employment opportunities may be critical to reducing financial reliance on male partners and young women’s vulnerability to economic abuse and other forms of IPV. More research and programmatic work are needed on food deprivation as a form of economic abuse affecting women and their children. Full article

Background: Over 40 years of research implicates perfectionism in eating disorders in childhood and adolescence. However, the nature of this relationship remains understudied. To address this gap, we performed a systematic review and a meta-analysis to quantify the magnitude of the associations between perfectionism (i.e., unidimensional perfectionism, perfectionistic strivings, and perfectionistic concerns) and eating-related symptoms during childhood and adolescence. Methods: The literature search was conducted using five electronic databases in accordance with PRISMA guidelines: MEDLINE, Embase, CINAHL Complete, APA PsycINFO, and EMB Reviews. A total of 904 studies were identified; a total of 126 were included in the systematic review, and 65 in the meta-analysis (N = 29,268). Sensitivity analyses were also carried out to detect potential differences in age and clinical status. Results: All the associations we investigated were both significant and positive. Small effect sizes were found between eating global scores and unidimensional perfectionism, perfectionistic strivings, and perfectionistic concerns (r_es = 0.19, r_es = 0.21, r_es = 0.12, respectively) and remained significant in each age group in both clinical and community samples. Perfectionistic concerns were moderately associated with all eating measures, especially in community samples and samples with a mean age under 14. Conclusions: Psychological interventions specially designed to target perfectionistic concerns in the early stages of development may help prevent the onset or reduce the intensity of eating-related symptoms during childhood and adolescence. Full article

Peer-facilitated curriculum-based programs, including Stepping Stones, have been shown to be effective in preventing HIV and reducing gender-based violence (GBV). We conducted a qualitative study in early 2017 to hear perspectives of adolescent girls and young women (AGYW) participating in the USAID-funded Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe Women (DREAMS) intervention (administered by the President’s Emergency Fund for AIDS Relief (PEPFAR) in northern Uganda that featured 10 peer-facilitated sessions of a Stepping Stones curriculum. The study focused on asking AGYW how the initiative had affected their lives and on identifying lessons learned that could support future initiatives. A total of 56 AGYW were interviewed, including the peer facilitator and 6–7 randomly selected participants of nine DREAMS groups in Northern Uganda. Overwhelmingly, participants indicated that regular HIV testing and knowing their status, knowledge and an increased use of family planning, and knowing how to respond to GBV were among the results of their participation. However, a problematic finding was that peer group discussions relating to reducing GBV included advising AGYW about how to adjust their own behavior in ways that would reduce tension with their male partners, rather than shifting harmful gender norms. This is not consistent with the Stepping Stones program and prompted a retrospective review of factors related to how the program was implemented to better understand this result. Our study points to the important role facilitators play in shifting challenging gender norms, and the importance of fidelity to original program designs, as well as appropriate adaptations for different contexts. Our findings also signal the need for funders to allow sufficient time to pilot and adapt models. Full article

Millions of girls and young women participate in organized sports annually as a vehicle for developing a strong sense of self, social bonds, a positive body image and a sense of agency. Although the benefits of sport engagement are experienced by many girls, the overwhelming evidence of experiences of gender-based violence in sport cannot be ignored (e.g., USA Gymnastics, Hockey Canada). This paper will address gender-based violence experienced by adolescents in sport with a focus on psychological violence. The literature is replete with evidence that girls experience higher rates of gender-based psychological violence in sport than boys, and as a result, incur developmental costs. Psychological violence is experienced by girls in sport in the form of demeaning comments, body shaming, inequitable media coverage and funding and the ongoing policing of women’s bodies in sport through sexualized sport attire and physiological testing. The causes and effects of psychological violence will be addressed along with recommendations to prevent and address gender-based violence in sport. Full article

Female adolescents experience exacerbated vulnerability to the effects of gender inequities in refugee settings, where there is often a lack of protective societal structures and the politicization of their access to sexual and reproductive health (SRH) services, which result in an increase in teenage pregnancy as compared to non-refugee settings. In the Mugombwa refugee camp in Rwanda, there were 47 adolescent childbirths in 2021 alone. This study explores the perspectives of female adolescents on the barriers underpinning adolescent unplanned pregnancy in the Mugombwa refugee camp. Focus group discussions were conducted with 16 adolescent girls between the ages of 10 and 19. The findings were analyzed using inductive and deductive thematic analysis. Barriers at the individual, interpersonal, communal, and institutional levels underpin unplanned adolescent pregnancy. Socio-cultural barriers of poverty and transactional sex, poor knowledge of contraceptives, negative peer influence, sexual coercion, poor parent–adolescent communication, negative health worker attitudes, selective SRH community outreach, and the inaccessibility of contraceptives emerged as themes influencing the sexual behavior of adolescents and unplanned pregnancies. The socio-cultural barriers and systemic facilitators of gender inequality associated with being an adolescent female in a refugee camp must be prioritized to alleviate adolescent unplanned pregnancy. Full article