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Background: Youth participation makes an essential contribution to the design of policies and with the appropriate structures, and processes, meaningful engagement leads to healthier, more just, and equal societies. There is a substantial gap between rhetoric and reality in terms of youth participation and there is scant research about this gap, both globally and in South Africa. In this paper we examine youth participation in the Adolescent and Youth Health Policy (AYHP) formulation process to further understand how youth can be included in health policy-making. Methods: A conceptual framework adapted from the literature encompassing Place, Purpose, People, Process and Partnerships guided the case study analysis of the AYHP. Qualitative data was collected via 30 in-depth, semi-structured interviews with policy actors from 2019-2021. Results: Youth participation in the AYHP was a 'first' and unique component for health policy in South Africa. It took place in a fragmented policy landscape with multiple actors, where past and present social and structural determinants, as well as contemporary bureaucratic and donor politics, still shape both the health and participation of young people. Youth participation was enabled by leadership from certain government actors and involvement of key academics with a foundation in long standing youth research participatory programmes. However, challenges related to when, how and which youth were involved remained. Youth participation was not consistent throughout the health policy formulation process. This is related to broader contextual challenges including the lack of a representative and active youth citizenry, siloed health programmes and policy processes, segmented donor priorities, and the lack of institutional capability for multi-sectoral engagement required for youth health. Conclusion: Youth participation in the AYHP was a step toward including youth in the development of health policy but more needs to be done to bridge the gap between rhetoric and reality. [ABSTRACT FROM AUTHOR]

This paper presents empirical and methodological findings from an art-based, participatory process with a group (n = 16) of adolescent and young advisors in the Western Cape Province of South Africa. In a weekend workshop, participants reflected on their participation in 12 years of health and development-related research through theatre, song, visual methodologies and semi-structured interviews. Empirical findings suggest that participants interpreted the group research encounter as a site of empowerment, social support and as a socio-political endeavour. Through song, theatre and a mural illustration, they demonstrated that they value 'unity' in research, with the aim of ameliorating the conditions of adolescents and young people in other parts of South Africa and the continent. Methodological findings document how participants deployed art-based approaches from South Africa's powerful history of activism, including the struggle against apartheid, the fight for anti-retroviral therapy and more recent social movements towards decolonization., (© The Author(s) 2022. Published by Oxford University Press.)

Aims: Access to healthcare, especially among adolescents, is a public health issue with long-lasting health and socio-economic consequences. Adolescence is a distinctive growing period for developing healthcare behaviour that can either improve or worsen future health conditions. Hence, the need for quality healthcare behaviour among adolescents who usually constitute a large proportion of any country's population, is imperative. This paper thus examines the impact of medical aid coverage and other socio-economic factors in determining South African adolescents' utilisation of either private or public healthcare facilities in the event of illness. By extension, the study investigates the effects of pertinent parental characteristics on South African adolescents' choices of either private or public healthcare facilities. Subject and methods: Data come from the population-weighted 2018 General Household Survey (GHS). Units of analysis include adolescents within the ages of 10 and 19 years. The empirical analysis relies primarily on a regressions-based model and instrumental variable approach. Results: Result indicates that younger adolescents are more likely to use public healthcare facilities in the event of illness than older adolescents. However, adolescents who are medically covered are less likely to utilise public healthcare facilities in the event of illness. Further findings suggest that the likelihood of using public healthcare facilities is higher among adolescents who are black Africans, live in relatively poor households, large households and rural areas. Conclusion: Further implementation and review of any national health policy such as the National Health Insurance (NHI) scheme needs to address and take into consideration adolescents' healthcare utlisation and socio-economic variations in their healthcare utilisation. [ABSTRACT FROM AUTHOR]

At-risk families and caregivers from low-and middle-income countries have been shown to benefit from parenting interventions. But there is limited evidence on the impact of interventions on adolescent parents. This paper considers the effects of a parenting programme targeting adolescent parents in South Africa, emphasising parenting and adolescent well-being outcomes. Secondly, it explores whether such an intervention can influence adolescent depression and parenting behaviours. Using a quasi-experimental, longitudinal design, data was collected over 2015–2017 from 113 adolescent parents (aged 12–22 years) who attended three secondary schools in Cape Town. Adolescents (biological and non-biological parents) were assigned to intervention (parenting programme participation) and control groups. They completed assessments on parenting, adolescent well-being, and social context at three time-points. Inter-group, and time-period differences were examined, and analyses on whether depression moderates programme effects on outcomes were conducted. At the ten-month follow-up, positive parenting and resilience improved for biological and non-biological parents and in both study groups. For the non-biological intervention group parents, depression rates increased over time. Intervention adolescents with high depression risk showed smaller improvements in supportive parenting than their control group counterparts. Although adolescents increased in positive parenting and resilience, it is unclear whether and how the intervention contributed to these results. As the intervention group included more adolescents at high risk of depression at follow-up, this study highlights the importance of including mental health support in interventions targeting adolescents in LMIC contexts. The study is limited by a small sample size and reliance on self-reported data. [ABSTRACT FROM AUTHOR]

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Introduction: South African youth and adolescents face a high burden of (Sexually Transmitted Infections) STIs, HIV and unintended pregnancies, but uptake of services remains low. To address this, tailored and scalable interventions are urgently needed. We developed a framework to fill the gap and translate the impact of facility‐level attributes into a cost‐effectiveness analysis for increasing HIV/contraceptive service uptake in adolescents using a discrete choice experiment (DCE). Methods: We used a DCE (n = 805) conducted in Gauteng, South Africa, which found that staff attitude, confidentiality, Wi‐Fi, subsidized food, afternoon hours and youth‐only services were preferred attributes of health services. Based on this, we simulated the uptake of services adapted for these preferences. We divided preferences into modifiable attributes that could readily be adapted (e.g. Wi‐Fi), and challenging to modify (more nuanced attributes that are more challenging to cost and evaluate): staff attitude and estimated the incremental change in the uptake of services using adapted services. Costs for modifiable preferences were estimated using data from two clinics in South Africa (2019 US$). We determined the incremental cost‐effectiveness ratio (ICER) for additional adolescents using services of 15 intervention combinations, and report the results of interventions on the cost‐effectiveness frontier. Results: Greatest projected impact on uptake was from friendly and confidential services, both of which were considered challenging to modify (18.5% 95% CI: 13.0%−24.0%; 8.4% 95% CI: 3.0%−14.0%, respectively). Modifiable factors on their own resulted in only small increases in expected uptake. (Food: 2.3% 95% CI: 4.0%−9.00%; Wi‐Fi: 3.0% 95% CI: −4.0% to 10.0%; Youth‐only services: 0.3% 95% CI: −6.0% to 7.0%; Afternoon services: 0.8% 95% CI: −6.0% to 7.0%). The order of interventions on the cost‐effectiveness frontier are Wi‐Fi and youth‐only services (ICER US$7.01−US$9.78 per additional adolescent utilizing HIV and contraceptive services), Wi‐Fi, youth‐only services and food (ICER US$9.32−US$10.45), followed by Wi‐Fi, youth‐only services and extended afternoon hours (ICER US$14.46–US$43.63). Conclusions: Combining DCE results and costing analyses within a modelling framework provides an innovative way to inform decisions on effective resource utilization. Modifiable preferences, such as Wi‐Fi provision, youth‐only services and subsidized food, have the potential to cost‐effectively increase the proportion of adolescents accessing HIV and contraceptive services. [ABSTRACT FROM AUTHOR]

This study aimed to assess the association of childhood trauma, stressful life events and HIV stigma with mental health in South African adolescents from the Cape Town Adolescent Antiretroviral Cohort (CTAAC). The Childhood Trauma Questionnaire, Life Events Questionnaire and the HIV Stigma Scale for South African Adolescents Living with HIV was used to assess childhood trauma, stressful life events and stigma in adolescents living with perinatally acquired HIV and healthy controls enrolled in the CTAAC. These measures were associated with mental health outcomes including the Beck-Youth Inventories, Child Behaviour Checklist, Columbian Impairment Scale, Childrens Motivation Scale, Conners Scale for Attention Deficit Hyperactivity Disorder using Pearson correlations and self-reported alcohol use, using Spearman-rank correlation. 63.7% of adolescents reported at least one childhood trauma on the CTQ. Significant associations were reported between CTQ measures and Beck-Youth Inventories. Emotional abuse was associated with anxiety, anger, depression and disruptive behaviour. Emotional neglect was associated with poor self-concept and disruptive behaviour. LEQ total score was significantly associated with Beck-Youth Inventories including anxiety, depression, anger and disruptive behaviour scales. HIV stigma was significantly associated with Beck-Youth Inventories including depression, anger and disruptive behaviour. Childhood trauma, stressful life events and HIV stigma in South African adolescents are associated with anxiety, depression, anger, disruptive-behaviour and poor self-concept. This study highlights the importance of enquiring about exposure to a variety of traumas, particularly those commonly experienced by South African adolescents. In addition, it is important to understand the impact of trauma exposure on each individuals mental health and functioning. [ABSTRACT FROM AUTHOR]

There is substantial evidence that exposure to family adversity significantly and negatively impacts positive adolescent development by placing adolescents at increased risk of experiencing developmental difficulties, including conduct problems. Although the mechanisms responsible for these effects are still largely unknown, a novel line of inquiry in the resilience field conceptualizes positive adaptation, following exposure to atypical adversity, as resulting from complex interactions of systems at multiple ecological levels. The purpose of the present analysis was to apply this multisystemic resilience framework to the study of positive adaptation following exposure to family adversity in a sample of Canadian adolescents (n = 230; mean age 16.16, SD = 1.38) and South African adolescents (n = 421; mean age = 15.97, SD = 1.19) living in economically volatile communities dependent on the oil and gas industry. Cross-sectional survey data were used to investigate the mechanisms through which family adversity exercises its impact on adolescent conduct problems by accounting for their caregiving, peer, and community resources. Results of two moderated mediation analyses showed that family adversity impacts adolescent externalizing mental health negatively, via disrupted caregiving, when other resources are also considered. For the Canadian adolescents, these negative impacts were protectively moderated by peer support, but not moderated by appreciation for community traditions. In contrast, peer support showed no significant protective effect for the South African sample, while a strong appreciation for community traditions was positively and significantly associated with conduct difficulties. Contextual dynamics (e.g., social unrest) provide a plausible explanation for the discrepant results and bring attention to the importance of theorizing resilience in context. [ABSTRACT FROM AUTHOR]