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The purpose of this study was to examine the influence of mode of administration (internet-based, web survey format versus pencil-and-paper format) on responses to the Dimensions of Tobacco Dependence Scale (DTDS). Responses from 1,484 adolescents that reported using tobacco (mean age 16 years) were examined; 354 (23.9%) participants completed a web-based version and 1,130 (76.1%) completed a paper-based version of the survey. Both surveys were completed in supervised classroom environments. Use of the web-based format was associated with significantly shorter completion times and a small but statistically significant increase in the number of missing responses. Tests of measurement invariance indicated that using a web-based mode of administration did not influence the psychometric functioning of the DTDS. There were no significant differences between the web- and paper-based groups' ratings of the survey's length, their question comprehension, and their response accuracy. Overall, the results of the study support the equivalence of scores obtained from web- and paper-based versions of the DTDS in secondary school settings. [ABSTRACT FROM AUTHOR]

The authors examine the comparability of paper and voice formats of the Massachusetts Youth Screening Instrument-Second Version (MAYSI-2) as well as each format’s concordance with the Voice Diagnostic Interview Schedule for Children (DISC) among adjudicated youth. Comparability is assessed among 248 youths admitted to a South Carolina Assessment Center. Mean scores and alpha coefficients are calculated, and area under the curve and positive and negative predictive values are used to compare concordance to the DISC. Paper and voice formats are significantly correlated, have similar alpha coefficients, and have comparable concordance with the DISC, suggesting that the MAYSI-2 paper and voice formats are comparable instruments. The voice format may be preferable to the paper format for screening justice youth for mental health problems because it may reduce incomplete data and increase reporting of stigmatized behaviors and because of its ability to automatically generate scored reports and aggregate data. [ABSTRACT FROM AUTHOR]

Grandmothers exist in all societies. Especially in the non-western Majority World, where Elders are both highly respected and responsible for transmitting their knowledge to younger generations, there is extensive anecdotal evidence of Grandmothers' role in health promotion and healing. However, due to Eurocentric and reductionist views of families and communities, in the extensive past research on maternal, child and adolescent health issues across Africa, Asia, Latin America and the Middle East, and in Indigenous societies in North America, Australia and New Zealand, scant attention has been given to the role of Grandmothers. This paper addresses this oversight and supports the imperative to decolonize health promotion in the non-western world by building on non-western worldviews, roles and values. Based on an eclectic body of both published and gray literature, this review presents extensive evidence of Grandmothers' involvement across the life cycle of women and children and of the similar core roles that they play across cultures. While in some cases Grandmothers have a negative influence, in most cases their involvement and support to younger women and children is beneficial in terms of both their advisory and their caregiving roles. For future research and interventions addressing maternal, child and adolescent health, the conclusions of this review provide strong support for: adoption of a family systems framework to identify both gender-specific and generation-specific roles and influence; and the inclusion of Grandmothers in community health promotion programs dealing with different phases of the life cycle of women and children. [ABSTRACT FROM AUTHOR]

This study examined how information obtained from an adolescent screening instrument administered in a medical clinic is affected by the method of data collection and knowledge that a summary report would be given to the provider. The Adolescent Health Review (AHR) was administered to 610 adolescent patients randomly assigned to 1 of 3 conditions to test the effect of mode of administration (paper vs. computer) and disclosure of results to the provider versus only to researchers (using the computer version). The AHR obtained information on mental health, sexual experiences, and use of psychoactive substances. Response patterns varied by mode of administration, with the paper version generally eliciting higher, and arguably more accurate, rates of disclosure. Knowing that the results would be provided to the doctor further attenuated disclosure. Results suggest that the paper version's higher rates of reporting must be weighed against the computer version's benefits of automated scoring and reporting. [ABSTRACT FROM AUTHOR]

Aims: Preventing smoking and aiding cessation among youth and young adults carries the possibility of reducing future smoking prevalence significantly. This paper estimates the impact on future smoking prevalence of 25 year olds by increasing tobacco prices, securing indoor smoke-free homes and implementing school-based multi-tiered interventions. Methods: Utilizing a multi-state Markov model, a status quo projection of the smoking prevalence from years 2017 to 2030 were compared with projections of the smoking prevalence in 2030 considering the impact of the three prevention strategies. Results: In a status quo projection, 27.0% of Danish 25-year-old females are expected to be smokers in 2030, while 13.2% would be smokers in 2030 were all three prevention strategies in effect from 2019. By itself, increasing tobacco prices by 50% reduced the prevalence of smokers among 25-year-old females to 14.8% in 2030, a relative reduction of 47.5%. For 25-year-old males in 2030 the reductions were similar, with a prevalence of 16.6% when all three prevention strategies were in effect, a relative reduction of 51.5%. Conclusions: Implementing increasing tobacco prices, indoor smoke-free homes and school-based multi-tiered interventions in Denmark is likely to significantly decrease youth smoking prevalence in the future. However, these three strategies will not produce a smoke-free generation without other initiatives. [ABSTRACT FROM AUTHOR]

In Australia and internationally, Indigenous children are seriously overrepresented in the child welfare system. This article provides an overview of literature investigating the needs of Indigenous children in residential care facilities. The provision of culturally safe and trauma-informed therapeutic care to Indigenous children and young people in residential care recognizes that the trauma and violence that they have experienced is exacerbated by their Indigeneity due to the colonial histories presenting. Utilizing a systematic scoping review methodology, the study returned a total of 637 peer-reviewed articles that were identified and reviewed for inclusion. The process of exclusion resulted in the inclusion of eight peer-reviewed studies and 51 reports and discussion papers sourced from gray literature. Findings from this study, though dearth, indicate that trauma-informed and culturally safe interventions play a significant role in Indigenous children's health and well-being while in care. Their experiences of abuse and neglect transcend individual trauma and include intergenerational pain and suffering resulting from long-lasting impacts of colonization, displacement from culture and country, genocidal policies, racism, and the overall systemic disadvantage. As such, a therapeutic response, embedded within Indigenous cultural frameworks and knowledges of trauma, is not only important but absolutely necessary and aims to acknowledge the intersectionality between the needs of Indigenous children in care and the complex systemic disadvantage impacting them. [ABSTRACT FROM AUTHOR]

While in the Nordic countries we have well-developed welfare policies and several structural, statutory measures in place aiming to promote public health, studies from these countries are often absent from systematic reviews of research literature assessing the effects of policy measures designed to promote health. Using adolescent health promotion and efforts related to primary prevention of obesity as an example, this short commentary aims to illustrate the paucity of well-designed studies investigating the effects of public health policies affecting adolescents. This paper argues that the Nordic research community is in a good position to help fill this gap, and to contribute more widely to the international literature on evaluation of policy interventions. [ABSTRACT FROM AUTHOR]

This formative research study was designed to collect opinion data from adolescents historically underrepresented in adolescent dating abuse (ADA) research measure development. Eight in-person focus groups and 7 telephone-based one-on-one interviews were conducted with U.S. youth aged from 11 to 20 years (N =48). We conducted two focus groups with Black, Multiracial, Latinx, Native American, and LGBTQ+ youth. Seven LGBTQ+ youth participated in one-on-one telephone-based interviews. Focus group participants and interview subjects were asked the same 11 questions from a semi-structured focus group question guide. Five questions were on the topic of dating behaviors in general. In addition, six questions were asked for reactions to a paper-based list of 75 abusive acts. Youth generated ideas for 10 new possible cyber-ADA items and 14 emotionally abusive items for inclusion on the ADA measurement instrument. They did not generate any new physical or sexual ADA items. Youth identified 14 acts that they felt should not be on the measure, either because the acts were not abusive and too common, because they could not understand the item, or because it seemed unrealistic as an act of ADA. The study faced several limitations and was a good first step toward enriching the cultural inclusivity of ADA measurement instrument. Continued attention to inclusionary research that seeks to understand the cultural milieux of diverse participants is essential for violence prevention scholarship and subsequent health programming and policy that derive from it. [ABSTRACT FROM AUTHOR]

This article reports a systematic review of literature published between 1994 and 2004 on the effects of performing arts for health in young people aged 11-18. The review includes research on music, performance, drama and dance in community settings and non-curricular mainstream education. A total of 17 electronic databases were searched and 3670 papers identified, 104 of which met relevance criteria. Full text scrutiny of 85 papers was undertaken and 14 of these were identified for review. The research was heterogeneous, making overall synthesis of results inappropriate. The review demonstrates that research on the impact of the performing arts on young people is at a relatively early stage. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has impacted the world since the first cases were reported in China in January 2020. The secondary mental health impacts of the pandemic are thought to be significant. Obsessive–compulsive disorder is a condition defined by recurrent obsessions and compulsions. It has been hypothesised that the focus on hygiene and contamination during the pandemic could exacerbate obsessive–compulsive symptoms in young people. Method: A systematic literature review was conducted. Papers were sought looking at the effect of the pandemic on obsessive–compulsive disorder in young people. Results: Six published cross-sectional and longitudinal studies were identified, of which four studies investigated clinic samples with a diagnosis of obsessive–compulsive disorder and two looked at community adolescent populations. Five out of the six studies found that obsessive–compulsive symptoms were exacerbated during the COVID-19 pandemic. Conclusion: The COVID-19 pandemic appears to be associated with a worsening of obsessive–compulsive symptoms in young people. Being in treatment seems to have a protective effect. Maintaining mental health services during a pandemic is vital. It is important to be aware of the implications of pandemic on obsessive–compulsive symptoms in young people in order to allow them to access appropriate treatments. More research is needed in this area. [ABSTRACT FROM AUTHOR]

Civil war in Syria has resulted in the largest refugee group and the newest wave of refugees resettling in countries worldwide. Although they have experienced war, migration, and great trauma, resettlement introduces a new set of obstacles including cultural adjustment, language learning, and the development of a new social network. This paper is a qualitative analysis of the acculturation, mental health, and academic experience of Syrian refugee adolescents in the United States. The study is unique in its use of an ecological framework to organize emerging themes, and integrates responses from parents and adolescents to provide a comprehensive understanding of this experience. Moreover, the researchers focus on an important setting for support and intervention: the school system. Implications and recommendations for assessment, intervention, and programming are provided. [ABSTRACT FROM AUTHOR]

Introduction: Occupation-based interventions could help to address a growing mental health crisis among young people and adolescents. To develop new interventions and avoid research waste, a review of the academic literature is needed that systematically identifies and describes interventions designed to improve the mental health and wellbeing of 11–25 year-olds. Aim: The scoping review aims to systematically review the academic, literature to identify and describe key characteristics of intervention studies using occupation to improve adolescents' and young people's mental health and wellbeing, exploring the range of interventions, reviewing reporting quality and illuminating gaps for further research. Method: An iteratively developed scoping review protocol informs a systematic database search and review of the literature. Core characteristics are extracted and described, using the TIDIER guidelines and the CASP assessment tool. Results: Five occupational therapy-based interventions, and 69 other occupation-based studies representing a wide breadth of approaches, outcomes and settings were identified. Conclusions: Robust development, testing and reporting of occupation-based and occupation-focused intervention studies to promote and support mental health and wellbeing in adolescents and young people are needed. Interventions should be co-designed, developmentally appropriate and scaffold development. However, better agreement is needed about core outcomes measurement in this area. [ABSTRACT FROM AUTHOR]

Qualitative longitudinal research is a useful method for studying adolescent development, not least because the dimension of temporality in the analysis of longitudinal studies can help researchers understand the complexity of transitions during this unique and dynamic life stage. The Gender and Adolescence: Global Evidence programme is a multi-year cross-country longitudinal study of adolescents in low- and middle-income countries. This article presents the methodological opportunities and challenges involved in analyzing such datasets, and seeks to offer insights for researchers undertaking qualitative longitudinal research. To ensure that both breadth and depth of such data are accurately represented in the analysis, a range of analytical approaches can be used. In this article, we provide key examples of how this data has been analyzed across a cohort of adolescent participants, exploring changes both pre- and post-Covid-19 including interactions with critical health and education services, and within individual life histories, exploring individual adolescent trajectories over multiple time points. Furthermore, we highlight how including caregivers' and key informants' perspectives can enhance triangulation of results. We show the importance of using a range of different approaches when analyzing a qualitative longitudinal dataset. [ABSTRACT FROM AUTHOR]

In this paper the authors explore the impact of loss of a parent to suicide on adolescents in military families using Marcia's identity status theory and the Roy adaptation model (RAM). After describing a brief case study of a 13-year-old boy in a military family who lost his father in this manner, these two theories are applied to better understand his struggle to develop and maintain a healthy identity and adapt to numerous relocations, deployments, and then loss. The military family stressors are seen as weakening the resilience of children in such families, making them more vulnerable to the impact of parent loss. Implications for nurses and other healthcare professionals are discussed. [ABSTRACT FROM AUTHOR]

Aims: This paper aims to give a description of the Danish National Youth Study 2014 in terms of study design, study population and questionnaire content. The differences between participants and non-participants regarding socioeconomic characteristics are also described. Methods: The Danish National Youth Study 2014 was a web-based survey with data collected through self-completion questionnaires administered in the classroom. There were two questionnaires: one for students, with >250 core questions; and one for school leaders on the school environment. Data collection took place at 119 high schools and 10 vocational schools. Results: A total of 75,853 students participated (70,674 high school students and 5179 vocational school students). In the participating schools, 85% of high school students and 69% of vocational school students took part in the survey. A total of 166 school leaders responded. Among the high school students, 61% were girls, and among vocational school students, 24% were girls. The average age was 17.9 years for high school students and 20.9 years for vocational school students. Participants were more likely than non-participants to be of Danish origin and to have parents with higher educational levels and a higher disposable income. Conclusions: The Danish National Youth Study 2014 contributes to knowledge on adolescent health behaviour, health and well-being. It is unique in its size, diversity of questionnaire content, high participation rate and possibility of linkage to various national registers through the Danish Civil Registration System. The study offers great opportunities for health planning and a wide range of future research projects. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic had a detrimental impact on adolescent mental health, but few studies have explicitly compared adolescents' mental health across countries, nor have they explored how different uses of media by adolescents in different countries may serve as protective or detrimental factors. To explore these associations, we use data collected from 958 South Korean adolescents and 1,253 United States (U.S.) adolescents in spring 2022 (ages 14–18). U.S. adolescents scored higher on anxiety and loneliness, relative to South Korean adolescents, and U.S. adolescents' social media use frequency related positively to these variables. Conversely, South Korean adolescents' social media use frequency was not related to anxiety or depression, and was negatively related to loneliness. Thus, social media use appears to relate detrimentally to U.S. adolescents' mental health but relates in a more protective way to South Korean adolescents' mental health. We discuss differential social media use and country differences to contextualize these findings. [ABSTRACT FROM AUTHOR]

This article describes the virtual implementation of Photovoice activities conducted as part of a project that sought to gather youths' perspectives on neighborhood and housing conditions, community redevelopment, and health and well-being in Baltimore. We discuss the original in-person design and how activities were implemented virtually, in light of coronavirus disease 2019 (COVID-19) physical distancing guidelines. Challenges to virtual implementation included establishing rapport with youth and families during recruitment and data collection, encouraging active participation during discussion sessions, and varying technological skills among youth. Facilitators of virtual implementation included partnering with a community organization, piloting virtual sessions to assess participant's technology skills, and providing various ways for youth to participate during discussion sessions, engage in group activities, and receive hands-on instruction. This article showcases the ways in which virtual implementation of Photovoice activities can be successfully implemented with youth and provides recommendations for future Photovoice projects that include virtual activities. [ABSTRACT FROM AUTHOR]

School nurses have reported stress and worry caring for young people experiencing mental health problems, but why this occurs and how they respond has not been well-explored. In this study researchers generated a substantive theory of the experiences of secondary school nurses who encountered young people with mental health problems using the original method of grounded theory. Thirty-one Western Australian school nurse participants reported that students presented with complex mental and social health needs that were not easily resolved. This was conceptualized as an untenable burden. Participants countered this by engaging in the three-stage process of tactical prioritizing. During an initial period of strategic assimilation into the school and broader community, participants referred students to external service providers. This was frequently inadequate, and participants found themselves grappling with unmet student mental health needs. Participants responded by implementing nursing strategies for optimizing outcomes in the lives of young people, while simultaneously engaging in managing self to support their own well-being. [ABSTRACT FROM AUTHOR]

In the context of the COVID-19 pandemic, we investigated associations between specific COVID-19-related changes and its impact on generalized anxiety disorder (GAD) levels among vulnerable young adults living with HIV (YALHIV) in a low-resource setting in Southern Uganda. This research utilized data from 500 YALHIV aged 19 to 25 from the Suubi+Adherence-R2 COVID-19 Supplement study. Disruptions were assessed using an 8-item modified Coronavirus Impact Scale, while anxiety was measured with the GAD-7 questionnaire. Hierarchical logistic regression analysis and multivariate linear regression were employed, guided by the Social Determinants of Health framework. Key findings highlighted changes in routines, family income, stress from the pandemic, changes in family stress and discord, and reduced access to mental health services heightened levels of probable GAD for YALHIV during the pandemic. Additionally, female young adults showed greater levels than males. These results underscore the urgency to develop tailored support mechanisms for YALHIV, especially during challenging and unprecedented times. [ABSTRACT FROM AUTHOR]

Objective: This paper provides an overview of the National Mental Health Benchmarking Project (NMHBP) which explored the value of benchmarking within the four main program areas of public sector mental health (general adult, child and adolescent, older persons and forensic). The NMHBP involved a series of forums which enabled participating organizations to benchmark themselves against each other, with a view to understanding variability in performance against a range of key performance indicators (KPIs). Method: Twenty-three mental health organizations took part in the NMHBP. The forums culminated in each mental health organization documenting its performance against relevant KPIs. The processes, impacts and outcomes of the NMHBP were evaluated via a multi-methods evaluation. Results: There was considerable variability across program streams for many of the KPIs, much of which could be explained by contextual factors. Within program streams there was considerable intra-organization variability. Participants found the examination of intra-organization variability on particular indicators to be useful. Conclusions: The NMHBP has shown that benchmarking is possible. Managers and clinical leaders will need to champion benchmarking and highlight its utility in relation to quality improvement and service development if the accountability goals of the Fourth National Mental Health Plan are to be realized. [ABSTRACT FROM AUTHOR]

Child health literacy is a 'hot topic' of late, as researchers and practitioners work to attain an equitable and healthy future. Health literacy emphasizes the wide range of skills that people need to access, understand, evaluate and use health information to promote good health. In light of the recognition that health literacy is an important determinant of health for adults, addressing child health literacy early on is essential to maximize future health outcomes. Meeting children's specific needs arguably includes the delivery of information that can be easily accessed and understood by younger age groups. While much academic discourse pertains to the importance of building parental health literacy, there is less literature that explicitly focuses on child-centred health literacy. On the premise that health literacy is an asset, this paper provides an argument for investing in children's health literacy by working with children to encourage meaningful contributions in research and practice. [ABSTRACT FROM AUTHOR]

This paper investigates stress related to schoolwork among students in academic upper secondary schools. The research questions asked are: 1. To what degree does students’ schoolwork stress vary between academic classes?; And 2. are perceptions of classroom goal orientation, academic achievement, sex and parental education related to schoolwork stress?A cross-sectional survey was done in the final year of upper secondary school in 71 school classes from 13 schools. A total of 1955 students in academic education programs were invited to participate in the survey, and 1511 completed the survey; the response rate was 77%. The outcome measure was a composite measure of schoolwork stress (alpha = 0.81). Multilevel modeling was used to estimate school class-level effects.The mean value of schoolwork stress was 4.0, on a scale of 1 (very little schoolwork stress) to 6 (very high schoolwork stress). About half of the students reported a score of 4 or higher. The analysis showed that individual characteristics explained most of the variation in schoolwork stress. Girls experienced a much higher level of schoolwork stress than boys (mean values of 4.3 and 3.6, respectively). There was also a significant class-level effect, estimated to 6% of the variance. Students’ perceptions of classroom goal orientation was also associated with schoolwork stress. The main contribution was the discovery of significant variations in schoolwork stress between school classes. We also found that higher mastery climate was linked to lower schoolwork stress, whereas higher performance climate was linked to higher schoolwork stress. [ABSTRACT FROM AUTHOR]

Most people start experimenting with and/or initiating health-compromising behaviors and establishing behavioral patterns during adolescence. Possible selves and episodic future thinking have been used to foster behavioral changes. In this study, we aimed to (1) develop a program incorporating possible selves and episodic future thinking to decrease the risks associated with health-compromising behaviors, and (2) examine the feasibility and fidelity of implementing this intervention among Taiwanese adolescents. A novel combination of existing intervention approaches tailored for the Taiwanese context was applied to develop a school-based intervention, which we named the Future Mapping Master program. This program contains four core units: exploring the self, setting goals, developing strategies and problem solving, and understanding the threats of health-compromising behaviors. It includes daily episodic future thinking visualization exercises. The feasibility evaluation was conducted with 88 adolescents aged 12–14 years. Feedback from teachers and students supported the proposed program's feasibility and revealed favorable reactions to the intervention. The Future Mapping Master program is feasible and offers promising strategies for implementation in Taiwanese school settings. [ABSTRACT FROM AUTHOR]

Introduction: Telehealth interventions to advance adolescent sexual health have evolved and are being used to promote adolescent sexual health knowledge and healthy sexual behaviors. However, as this area of intervention modality expands, there is a need to pause and examine the effects of telehealth interventions on adolescent sexual health outcomes. Addressing this knowledge gap will inform researchers and practitioners on the current state of evidence of telehealth interventions and inform further intervention development and testing. This study aimed to explore the meta-effects of telehealth interventions on self-efficacy of using condoms, condom use practices, and sexually transmitted infection testing behaviors among adolescents. Methods: A systematic review and meta-analysis of randomized controlled trials were conducted. Seven databases (Academic Search Complete, CINAHL, EMBASE, MEDLINE, PubMed, OVID (UpToDate), and Web of Science) were searched for relevant full-text articles from the inception to May 2021. The revised Cochrane risk-of-bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random effects model to calculate the pooled effects of telehealth interventions for adolescents. Stata 16.0 was used for statistical analysis. Results: A total of 15 studies (N = 5499) that used telehealth interventions with adolescents were included in the analysis. Telehealth interventions were found to increase self-efficacy for condom use (standardized mean difference: 0.22; 95% confidence interval: 0.08–0.36), practice for condom use (standardized mean difference: 0.35; 95% confidence interval: 0.23–0.47), and being screened/tested for sexual transmitted infections (standardized mean difference: 0.61; 95% confidence interval: 0.31–0.92). Discussion: Telehealth interventions show promise as effective intervention delivery solutions for improving self-efficacy and certain sexual health behaviors among adolescents. These telehealth strategies could be important alternatives to in-person visits to accessing sexual health information or services near where they live. Future research should consider testing telehealth strategies where there is evidence of impact to move the field forward. [ABSTRACT FROM AUTHOR]

Background: Despite an increased focus on the importance of spirituality to human health, including adolescent health outcomes there remains an absence of evidence-based programs to address the spiritual needs of patients and families. A critical barrier is the absence of a clear conceptual understanding and operational definitions of spirituality for adolescents/young adults (AYAs) with cancer. The purposes of this concept analysis were to (a) clarify the concept of spirituality in the context of the AYAs' cancer experience and (b) generate a definition based on a review of the literature examining spiritual development and the role of spirituality in AYAs' health and cancer treatment. Method: We used Roger's evolutionary concept analysis method to identify antecedents, attributes, and consequences of spirituality in the context of AYAs' cancer using thematic analysis and included identification of case exemplars. Results: Of the 86 articles identified, 21 met our inclusion criteria. Analysis revealed four attributes of spirituality in AYAs with cancer: meaning and purpose, connectedness, life-long universal experience, and independent of or related to religion and faith traditions. Identified antecedents included the presence of spiritual resources, chronic illness, belief, or wonder about a higher power, and existential questions. Identified consequences included hope, meaning, feelings of peace, and enhanced well-being and illness acceptance. Based on the findings, we generated a definition of spirituality in AYAs with cancer. Discussion: Findings inform the development of measures and spiritual care interventions specific to AYAs with cancer. An important limitation to address in future research is the absence of AYAs' first-person accounts of their own spirituality. [ABSTRACT FROM AUTHOR]

The debate on the effectiveness and merit for the amount of time, effort, and resources to culturally adapt health promotion and prevention programs continues. This may be due, in large part, to the lack of theory in commonly used methods to match programmatic content and delivery to the culture of a population, particularly at the deep structural level. This paper asserts that prior to the cultural adaptation of prevention programs, it is necessary to first develop a conceptual framework. We propose a multiphase approach to address key challenges in the science of cultural adaptation by first identifying and exploring relevant cultural factors that may affect the targeted health-related behavior prior to proceeding through steps of a stage model. The first phase involves developing an underlying conceptual framework that integrates cultural factors to ground this process. The second phase employs the different steps of a stage model. For Phase I of our approach, we offer four key steps and use our research study as an example of how these steps were applied to build a framework for the cultural adaptation of a family-based intervention to prevent adolescent alcohol use, Guiding Good Choices (GGC), to Chinese American families. We then provide a summary of the preliminary evidence from a few key relationships that were tested among our sample with the greater purpose of discussing how these findings might be used to culturally adapt GGC. [ABSTRACT FROM PUBLISHER]

Aims: This paper presents a model that encompasses pathways and mechanisms working over adolescence that contribute to adult health inequalities. We review evidence on the four mechanisms: socially differential exposure, tracking, socially differential tracking, and socially differential vulnerability. Methods: We conducted literature searches in English-language peer-reviewed journals using PubMed (from 1966 to May 2009) and PsycINFO, and combined these with hand-searches of reference lists, journals, and authors of particular relevance. Results: Most health indicators are socially patterned in adolescence and track into adulthood, with higher risks of adverse outcomes among individuals from lower socioeconomic positions. Adolescent health behaviours track into adulthood. Smoking, physical activity, and especially fruit and vegetable intake are socially patterned, while evidence for social patterning of alcohol use is less consistent. Relational dimensions like lone parenthood and bullying are socially patterned and track over time, and there are indications of a socially differential vulnerability to the effects of these types of relational strain. Very little research has investigated the social patterning of the above indicators over time or studied social vulnerability of these indicators from adolescence to adulthood. However, all four mechanisms seem to be active in establishing social differences in adult educational attainment. Conclusions: We find the Adolescent Pathway Model useful for providing an overview of what elements and mechanisms in adolescence may be of special importance for adult health inequalities. There is a lack of knowledge of how social patterns of health, health behaviours, and social relations in adolescence transfer into adulthood and to what extent they reflect themselves in adult health. [ABSTRACT FROM AUTHOR]

This paper presents the findings of the third stage of a research study, the overall aim of which was to evaluate the educational preparation for cancer and palliative care nursing for children and adolescents in England. The specific aim of this stage was to define the attributes of `threshold' and `higher level' practice in nursing in order to inform the outcomes of future educational programmes.The research design involved children, their parents and their nurses at two different stages in the study. The first stage was the construction of the research instruments, in this case video and audio recordings of episodes of care in which the children participated. The second stage was the review of the recordings by the children, their parents and other stakeholders involved in their care. Service users were also involved in the management of the project.The study findings suggested that although there was considerable agreement between service users and other stakeholders about the characteristics of adequate or threshold practice, for both cancer and palliative care, there was less agreement about what constituted higher level or expert practice — other than `more of the same but better'. The key areas of importance for future professional development courses were agreed as partnership working, clinical skills, multidisciplinary working and the personal attributes of the nurse. [ABSTRACT FROM PUBLISHER]

Neighborhood research, the body of work examining how the built environment affects residents, has been actively pursued across the social sciences in the past decade. Within this work, researchers focus mainly on adult residents and rely on crude census reports to measure the neighborhood space. As there are many problems associated with census data, researchers are currently surveying residents about their perceptions of their neighborhoods. Since young people are not recognized in this research agenda, this paper describes a qualitative study with 10 early adolescents in New York City, aged 11 to 13 years, and their perceptions of their neighborhoods. Results from this study serve as a foundation for quantitative work exploring the relationship between different neighborhood measurements and their association to adolescents' health. [ABSTRACT FROM AUTHOR]

In response to demand from young teenagers, a nurse-led 'condom club' was established in 1996. This paper reports the use of the service from 1996 to 1999 by retrospective case note review. Two hundred and eighty-six individual males and 327 individual females made 655 and 824 visits, respectively. Condoms were accessed by 495 individuals, but girls also requested emergency contraception and pregnancy testing. Young teenagers were reluctant to have screening for sexually transmitted infections (STIs), but in those that did, 50% were found to have an STI. It is concluded that young teenagers will access a nurse-led sexual health advice service. The use of nursing staff allows greater flexibility of access. Geographical accessibility was also shown to be important. [ABSTRACT FROM AUTHOR]

Recent media and academic reports project rising levels of girls' violence and a narrowing gender gap. In response, the authors investigate 21st century trends in girls' violence as reported across multiple official and unofficial longitudinal sources: Uniform Crime Reports (UCR) arrest and juvenile court referral statistics; National Crime Victimization Survey (NCVS) victimization data; and three sources of self-reported violent offending—Monitoring the Future, Youth Risk Behavior Surveillance System, and National Survey on Drug Use and Health. Augmented Dickey-Fuller time-series tests and intuitive plot displays show much overlap in each source's portrayal of trends in girls' violence and the youth gender gap. Specifically, there is no systematic change in the gender gap for homicide, aggravated assault, nor the violent crime index. However, UCR police arrests and juvenile court referrals show a moderate female-to-male rise for simple assault during the early decades of the 21st century. This rise in official statistics is not borne out in NCVS counts based on victims' reports nor in self-reported violent-offending counts. Net-widening policy shifts and more gender-neutral enforcement have apparently elevated somewhat the arrest proneness of adolescent females for simple assault. Rather than girls having become more violent, triangulating data sources revealed a decline in both girls' and boys' violence levels, considerable similarity in their violent-offending trends, and little or no systematic change in the gender gap. [ABSTRACT FROM AUTHOR]

Objective: Child and adolescent mental health (CAMH) disorders are a major public health problem in Australia, especially outside metropolitan areas. The issue is compounded by a shortage of child and adolescent psychiatrists (CAPs). CAMH receives minimal coverage in health professional training, training opportunities are scarce, and support for generalist health professionals, who treat most cases, is lacking. Novel approaches to early medical education and teaching are required to strengthen the available skilled workforce in rural and remote settings. Method: This qualitative study explored the factors influencing medical student engagement in a CAMH videoconferencing workshop as part of the Rural Clinical School of WA. Results: Our results confirm the priority of personal characteristics of medical educators, over clinical and subject matter expertise, on student learning. This research affirms that general practitioners are well-placed to facilitate recognition of learning experiences, especially given that students may not readily recognise exposure to CAMH cases. Conclusion: Our findings support the effectiveness, efficiencies, and benefits of utilising general medical educators in supporting child and adolescent psychiatry expertise in delivering subspecialty training within medical school curricula. [ABSTRACT FROM AUTHOR]

Health education in one form or another has been a traditional part of public education at the primary and secondary school level. Common approaches have attempted to teach sound habits related to, for example, nutrition, safety, hygiene, physical activity, and more recently, smoking and the use of drugs. These approaches have been justified with reference to a generally accepted belief in the ‘desirability’ of such teaching. More recently, additional emphasis has been directed at health education for children as the links between behavior and health have become more obvious and as the rapidly accelerating costs of treating rather than preventing sickness have been experienced. The objective of the paper is to examine the responses of the research community to the apparent need for more effective health education for children. [ABSTRACT FROM AUTHOR]

Exposure to adverse childhood experiences is a risk factor for the development of serious psychiatric and somatic illness. Although trauma-focused therapy is effective in reducing symptoms, not all children benefit from it. To improve treatment efficacy, the children's perspective on what they perceive as helpful versus hindering is necessary. This study aimed, retrospectively, to explore how children exposed to family violence experienced treatment at the Child and Adolescent Mental Health Service. Seventeen children and youths were interviewed 4–5 years after treatment. The thematic analysis resulted in five themes: confusion, the need to feel heard, fear of consequences, feelings of pain, and identifying oneself as an agent. The results emphasize the importance of the therapeutic relationship, and that trust, genuine interest, and reciprocity are necessary for the child to engage in treatment. However, neither the child's own agency nor external obstacles such as continuous exposure to abuse should be underestimated in terms of the child's engagement. [ABSTRACT FROM AUTHOR]

Primary care providers are well positioned to address the sexual and reproductive health (SRH) needs of adolescents; however, gaps often exist in the delivery of quality SRH services in primary care. Our objective was to identify specific opportunities to improve the delivery of adolescent SRH services in primary care. We conducted in-depth interviews with 25 primary care providers from various disciplines across rural and urban areas of Minnesota and conducted thematic analysis of transcribed data. Participants identified salient opportunities in three areas: (1) training and resources for providers (e.g., related to minor consent laws or addressing sensitive subjects), (2) practices and procedures (e.g., time-alone procedures and policies for confidential screening and sharing test results), and (3) education for adolescents (e.g., knowing their rights and accessing confidential SRH services). Study findings provide actionable opportunities to improve delivery of adolescent SRH services in primary care. [ABSTRACT FROM AUTHOR]

Addressing racism within health systems and services is critical to addressing health vulnerabilities and promoting health equity for racialized populations. Currently, there is limited knowledge about the ways in which racism affects health services for adolescents. A scoping review was undertaken following the Joanna Briggs Institute Manual for Evidence Synthesis methodology and guided by the research questions: (1) What are the characteristics of the literature examining racism in health service use for adolescents? (2) What are the foci of the literature on systemic racism and health services for adolescents? A systematic literature search was conducted in April 2021 to identify all relevant published studies. The search identified 3049 unique articles, with a total of 13 articles included in this review. Multiple levels of racism were examined in the included articles across various health care settings. Five foci were identified: racism prevention, missed care, quality of care, racial bias, and experiences of racism. Our review indicates a current emphasis on interpersonal racism within this field of study, with emergent discussion of the impact of systemic racism. However, greater attention is needed that would investigate multiple forms of racism (institutional, interpersonal, internalized) in relation to specific contexts and adolescent populations. [ABSTRACT FROM AUTHOR]

Background and aims: According to recent criticism, survey-based measures of adolescent psychosomatic complaints have poor content validity insofar as they conflate trivial with severe complaints. It is argued that this means that estimates of prevalence and trends in complaints may reflect trivial complaints that are not indicators of health problems. In this study, two observable implications of this criticism were investigated: (a) that self-reported psychosomatic complaints should have a bimodal distribution; and (b) that the increase in complaints over time should be of approximately equal size throughout the distribution of complaints. Methods: Three decades (1985/1986–2017/2018) of repeated cross-sectional data from the Swedish Health Behaviour in School-aged Children survey were used. Psychosomatic complaints were measured using the screening instrument Health Behaviour in School-aged Children symptom checklist. Histograms, bar charts and quantile regression models were used for the analysis. Results and conclusions: With regard to the first implication, the results showed that the distribution of complaints was not bimodal and that there were no clusters of respondents. This suggests that binary categorisations of students can be reductive and conceal important variations across students. With regard to the second implication, the results showed that the increase in complaints was greatest among students who report frequent and co-occurring complaints. This suggests that reports of increasing complaints in adolescents cannot be explained as being primarily due to a greater inclination to report trivial complaints. It is concluded that any conflation of trivial and more severe complaints in surveys of psychosomatic complaints is not reflected in population-based estimates. [ABSTRACT FROM AUTHOR]

Prior research demonstrates a clear association between deviant peers and delinquent behavior, but it is unclear whether stable relationships provide stronger sources of influence than ephemeral ties. The current study addresses this gap by testing whether individuals are more likely to adjust their delinquent behaviors to be similar to their stable friends compared to their transient affiliations. Drawing from network data in the National Longitudinal Study of Adolescent to Adult Health, we use Stochastic Actor Oriented Models to estimate whether stable friendships condition the peer-delinquency link. Our results suggest the stability of friendships does not impact whether an individual will adopt the delinquency of their friends; adolescents were not more or less likely to conform to their stable and enduring friends compared to their transient and short-lived ties. We discuss the study's implications for understanding peer effects and status-seeking behaviors during adolescence. [ABSTRACT FROM AUTHOR]

The paper examines the impact of the initiative taken by a non-government organization -- SelfEmployed Women's Association (SEWA) -- in Ahmedabad, a city in western India to impart knowledge about sexual and reproductive health to adolescent girls. Quasi-experimental design was used for data collection from beneficiary and non-beneficiary households in two rural blocks and two cities of Gujarat. Non-beneficiary households from control areas were selected with similar socio-economic characteristics. The study noted that the girls from control areas were not much different with respect to awareness about reproductive and sexual health compared to those who were exposed to training imparted by SEWA. While the girls who participated in health training received information on menstrual hygiene, their household situation was not always conducive to allow them to practice what was taught. Girls were keen to learn about what is safe sex or how to deal if confronted with difficult boy-girl interaction. The need to include discussion on such issues with young girls is evident and timely. Any intervention to improve the conditions of adolescent girls cannot be limited to providing information about hygiene or giving additional nutritional supplement (as is done in the government centres), but it is important to create a space for them to express their concerns. Also, there is a need for interaction with parents to make them sensitive towards health of their young girls and help them pursue their goals. [ABSTRACT FROM AUTHOR]

Psychological capital (PsyCap) is a term coined in organizational psychology and refers to a person's development of states that motivate behavior. Also known in the literature as PsyCap, this construct typically refers to positive states of hope, self-efficacy, resilience, and optimism that are amenable to intervention and that are related to subjective well-being and life satisfaction. The aims of this systematic scoping review were to explore how PsyCap is described in youth mental health literature and how PsyCap and mental health are related. Results from four databases were reported following PRISMA guidelines. A total of 772 studies were identified and 16 studies were fully reviewed, including an overall sample of 6,772 youth from six countries. PsyCap has a positive relationship with mental health in youth. Future studies should involve school nurses to validate the constructs that characterize PsyCap and validate an instrument for measuring PsyCap in youth mental health in English. [ABSTRACT FROM AUTHOR]

Many challenges exist related to ensuring adolescent privacy with health care providers (HCPs), and the rapid integration of telehealth visits has created additional complexities in organizing privacy for adolescents. Through interviews with adolescent patients and their parents (n = 34), this qualitative analysis aimed to explore the complicated relationship and balance of adolescent alone time with HCPs, parental presence and support, and organization of privacy in order to consider how privacy during telehealth visits may contribute to adolescents' healthy development. A framework by Blum et al. (2014) proposed four central goals of adolescent development: emotional security, engagement with learning, self-efficacy, and decision-making skills. This conceptual framework was used to outline the ways in which adolescent privacy during telehealth impacts adolescent development. Some adolescents reported that having their parents present during their telehealth visit afforded reassurance and comfort, and many parents explained that they served as a role-model during their adolescent's telehealth visit. However, other adolescents felt higher emotional security when they could establish an independent relationship with their HCP, with many describing how privacy during their telehealth visit enabled them to have more sensitive discussions with their HCP. Adolescents and parents also reported that telehealth allowed increased experiential learning for adolescents, given their proficiency with technology and ability to access their health care visits autonomously. Furthermore, the organization of privacy was complicated by a lack of understanding whose responsibility it was to facilitate alone time between the adolescent and HCP, as well as external factors such as location and quality of technology and the proximity of family members in the home. By ensuring opportunities for private healthcare encounters, both in telehealth and in-person visits, HCPs and parents can help support adolescents in achieving successful and healthy development. [ABSTRACT FROM AUTHOR]

Body weight dissatisfaction has been described as a marker for various health diseases, given its direct association with social, physical, and emotional suffering. We investigated the association between body weight dissatisfaction and health risk behaviors in adolescents. This was a cross-sectional study conducted with 668 adolescents aged 14–19 years in the city of São José, southern Brazil. Body weight satisfaction/dissatisfaction was assessed using a questionnaire validated for the investigated population. Health risk behaviors included smoking, alcohol, illicit drugs, medication, non-prescription anabolic steroids, not using seatbelt, unsafe sexual behavior and not knowing how to deal with day-to-day stress. Among males, 66.1% were dissatisfied with their body weight (32.1% due to thinness and 34.0% due to overweight). Among females, 80.0% were dissatisfied with their body weight (24.5% due to thinness and 55.5% due to overweight). There were no significant differences regarding health risk behaviors according to body weight satisfaction/dissatisfaction and sex. Compared to males who were satisfied with their body weight, those who were dissatisfied due to being overweight were more likely to be using tobacco (OR: 2.9; 95% CI: 2.1–4.2), alcohol (OR: 1.7; 95% CI: 1.5–1.9) and anabolic steroids (OR: 2.7; 95% CI: 1.2–5.7). Compared to females who were satisfied with their body weight, those who were dissatisfied due to thinness were more likely to be consuming alcoholic beverages (OR: 1.6; 95% CI: 1.2–2.0) and less likely to be consuming illicit drugs (OR: 0.5; 95% CI: 0.3–0.8). Interventions aimed at health education regarding the non-adoption of risk behaviors such as alcohol and tobacco use, as well as the non-use of anabolic steroids, and favoring the maintenance of general health, may be important for adolescents with body dissatisfaction. These data suggest that health risk behaviors such as adolescent male use of tobacco, alcohol, and anabolic steroids and the use of alcohol and drugs by female adolescents can be related to body weight dissatisfaction. [ABSTRACT FROM AUTHOR]

Introduction and Aims: The Beads of Life (BOL) approach uses a narratively informed methodology 'to enable children and young people to make sense of their cancer journey in ways that make them stronger'. We will share feedback from BOL groups and reflect on changes made over time. Method: Between 2014 and 2019, we have run 14 groups. Participants were aged 13–25, had received a diagnosis of cancer and were either on or had completed treatment. Quantitative and qualitative feedback was gathered at each workshop and 1 month later, with qualitative data then being analysed using thematic analysis. Results: 106 young people attended the groups. Young people reported that sharing experiences of cancer was useful, that they enjoyed the group and that they were highly likely to recommend it to others. Feedback remained consistent a month post-intervention. Qualitative feedback showed the value young people placed on meeting others, sharing their stories and on things they learnt about themselves from the group. Discussion: Themes support the intention of the intervention to provide a safe space for young people to share and reflect on their cancer journey, to connect with others and to enable peer support and mutual learning. [ABSTRACT FROM AUTHOR]

Aims: We present self-reported data on physical and mental health at age 17 years from 82% of Norwegians born in 2001. Methods: In Norway, the Armed Forces require that each resident who reaches the age of 17 years completes a self-administered declaration of health that is used for military selection. The declaration collects information on height and weight, various clinically diagnosed diseases, mental and behavioural disorders, and other health conditions where clinical diagnosis is not required. In 2018, there were 65,913 adolescents born in 2001 living in Norway, of whom 10,223 were exempt from completing the declaration; declarations were therefore sent to 55,690 participants. We included 54,132 participants who completed the declaration (response rate 97.2%): 27,220 male and 26,912 female respondents. Results: We found that 18% of male and 28% of female respondents reported at least one clinically diagnosed disease, mental disorder or behavioural disorder. Among health condition where clinical diagnosis was not required, 19% of male and 37% of female respondents reported anxiety/depression affecting daily life and 10 versus 18% reported migraines/recurring headaches. The respondents probably represent the healthiest part of the total cohort of 17-year-old Norwegians because those who are exempt from completing the declaration are already considered unfit for military service. Conclusions: These data represent a rich resource for further research. Similar data exist for the birth cohorts in 1993–2003. We encourage further research that can help decision-makers identify areas of concern that should be targeted for interventions. [ABSTRACT FROM AUTHOR]

India experiences a substantial burden of cervical cancer and accounts for nearly one third of cervical cancer deaths worldwide. While human papillomavirus (HPV) vaccines have been introduced subnationally in some states, HPV has not yet been rolled out nationally. Given the target age group, schools are the most common delivery channel for HPV vaccines, but this fails to account for local girls who never attended or no longer attend school. We conducted a qualitative, design-informed, community-based study conducted in Uttar Pradesh, India. We assessed facilitators and barriers among out-of-school girls and proposed program characteristics to inform the design of pro-equity HPV vaccine delivery programs for out-of-school girls. Programs should improve parental knowledge of the risk of cervical cancer, engage vaccinated girls as vaccine champions, utilize varied media options for low-literacy populations, and ensure that HPV vaccine services are accessible and flexible to accommodate out-of-school girls. In areas with poor or irregular school attendance among adolescent girls, HPV vaccine coverage will remain suboptimal until programs can effectively address their needs and reach this priority population. Our findings present a meaningful opportunity for program planners to purposefully design HPV vaccination programs according to these parameters, rather than modifying existing programs to include HPV vaccine. Adolescent girls, their parents, and other community members should be involved in program design to ensure that the program can effectively meet the needs of adolescent girls who are not in school. [ABSTRACT FROM AUTHOR]

The author discusses a study by the FACTS Study Group which investigated the natural history and treatment outcomes of midshaft clavicle fractures in adolescents. Topics include hypothesis made by the FACTS group about clavicle fractures in adolescents; finding of the authors on fracture shortening, superior displacement, and angulation; and the high risk of failure of the repair of the unstable shoulder like anterior cruciate ligament (ACL) reconstruction.

Young people experiencing houselessness are at high risk for revictimization. As has been identified in other populations, symptoms of psychological distress may be an indirect pathway by which initial victimization may increase risk for later revictimization among youth experiencing houselessness. The current study used cross-sectional mediation analyses to examine the hypothesis that there would be an indirect effect of interpersonal victimization that occurred before young people left home on subsequent victimization while experiencing houselessness, through posttraumatic stress disorder (PTSD) and depression symptoms. Youth (N = 245) residing in a shelter provided responses during an in-person interview screening prior to participating in a larger clinical study. Relevant to the current study, youth reported victimization experiences before and after leaving home (Childhood Trauma and Juvenile Victimization Questionnaires, respectively), and PTSD and depression symptoms on the Mini International Neuropsychiatric Interview. Results replicated and extended previous findings determining high rates of victimization among houseless young people both before (92%) and after (75%) leaving home. Further, exposure to more types of childhood victimization significantly predicted likelihood of experiencing more types of victimization after leaving home. Significant indirect effects of childhood victimization risk on revictimization after leaving home were found, occurring through both PTSD and depression symptoms. Results are discussed in terms of existing theories of revictimization, with particular emphasis on the state-dependence theory of victimization. These findings have implications for intervention with young people experiencing houselessness, particularly with regard to addressing the consequences of childhood victimization and trauma-informed support systems. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review aims to examine the effectiveness of interventions that seek to improve outcomes of grandchildren raised by grandparents. Method: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken. We searched in Education Resources Information Center (ERIC), Family Studies Abstracts, PubMed, PsycINFO, Social Work Abstracts, Sociological Abstracts, Web of Science, and Google Scholar. Results indicated that grandchildren who participated in these interventions had improvement in their socio-emotional, mental, and behavioral outcomes but had mixed educational outcomes, regardless of research designs and evaluation methods. Two out of eight studies were of high quality, while the rest needed improved rigor in designs and analyses. Conclusions: The review summarized evidence for interventions to improve grandchildren's outcomes and pointed out directions for future research and practice. [ABSTRACT FROM AUTHOR]

Youth can transmit COVID-19 to adults, but few communication materials exist for engaging youth in COVID-19 prevention behaviors. We describe the process of leveraging a community–academic partnership in a rapid response initiative to engage youth in a contest (i.e., Youth-Led Creative Expression Contest to Prevent COVID-19 across Texas) to develop creative public health messaging centered on the prevention of COVID-19 transmission and infection for their peers. Core activities included developing a request for applications that solicited submission of creative expression materials promoting the use of COVID-19 prevention behaviors (mask-wearing, social distancing, handwashing, not touching the face) from Texas youth in elementary, middle, and/or high school; sending the request for applications to 48 organizations in Austin, Brownsville, Dallas, El Paso, Houston, and San Antonio in summer 2020; and recruiting a youth advisory board to score submissions and award prizes. We report on youth engagement in the COVID communication contest across Texas and use statistics (chi-square and t -tests) to characterize and compare youth participants and their creative expression artwork. The contest resulted in 3,003 website views and 34 submissions eligible for scoring. Each submission averaged >2 prevention behaviors. On average, winning submissions included a higher number of prevention behaviors than nonwinning submissions. The prevention behavior "not touching the face" was included more often in winning submissions than nonwinning submissions. Elementary school children were less likely to include a mask in their submission compared with older youth. Existing community–academic networks can engage youth in the development of geographically and age-tailored communication materials. [ABSTRACT FROM AUTHOR]

The National School Lunch Program provides nutritious and inexpensive lunches, but low participation and food waste are challenges in many schools. Interventions aim to improve participation in the program, but little is known about how students' perceptions affect their participation. This study explored how middle school students in a rural state perceive school food service staff, food served, and lunchroom atmosphere. An online survey was administered to middle school students at six schools participating in a larger lunchroom intervention. Mean perception scores were calculated for all measures. Multilevel logistic regression was used to examine the relationship between perceptions and consumption. Overall perceptions of staff, food, and atmosphere were positive, and students classified as school lunch eaters had more positive perceptions in all three areas than noneaters. Interventions to increase participation in school lunch programs and promote consumption of healthy food items should address multiple factors that contribute to school lunch participation. [ABSTRACT FROM AUTHOR]