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The problematic use of technology of children and adolescents is becoming a growing problem. Research has shown that excessive technology use predicts a variety of psychological and physical health problems. The aim of this study was to analyze the role of leisure time activities (structured and unstructured) in adolescents as a predictor of problematic technology use. Participants were 7723 adolescents, of which 55% were girls, from four Spanish-speaking countries (Chile, Spain, Mexico, and Peru) between the ages of 13 and 18 years. The evaluation instrument applied was the YOURLIFE project self-report questionnaire. Two executive functions were measured: goal setting and inhibitory control. Using structural equation modeling, findings indicated that structured leisure time activities predicted less PTU, whereas unstructured activities predicted more PTU, MLχ 2 (69, N = 7723) = 806.60; CFI = 0.929, RMSEA = 0.042, and the model had good predictive capacity for PTU (R 2  = 0.46). Structured and unstructured activities also showed indirect effects on PTU through executive functions. As adolescents spent more time in unstructured leisure activities, poorer goal setting, inhibitory control skills, and more PTU were found. The opposite was true for structured leisure time activities. Implications of structured leisure activities to develop executive functioning and to prevent PTU for adolescents are discussed., (© 2023. The Author(s).)

Background: Intimate partner violence (IPV) and sexual violence (SV) are significant problems world-wide, and they affect women disproportionally. Whether individuals with attention-deficit/hyperactivity disorder (ADHD) are at an increased risk of being involved in these types of violence is unclear., Methods: We carried out a systematic review and meta-analysis (PROSPERO registration CRD42022348165) of the associations between ADHD and being the victim or perpetrator of IPV and SV. Ratios of occurrence of violence were pooled in random-effects models and study risk of bias was evaluated using the Newcastle-Ottawa Scale., Results: A search on multiple databases, carried out on 7 October 2022, yielded 14 eligible studies (1 111 557 individuals). Analyses showed a higher risk of ADHD individuals being involved in IPV as perpetrators (six studies, OR 2.5, 95% CI 1.51-4.15) or victims (four studies, OR 1.78, 95% CI 1.06-3.0). Likewise, individuals with ADHD were at increased risk of being perpetrators (three studies, OR 2.73, 95% CI 1.35-5.51) or victims of SV (six studies, OR 1.84, 95% CI 1.51-2.24). Results were overall robust to different analytical choices., Conclusions: Individuals with ADHD are at an increased risk of being involved in cases of violence, namely IPV and SV, either as victims or perpetrators. Although the causal path or mediating variables for these results are still unclear, this increased risk should inform evidence-based psychoeducation with individuals with ADHD, their families, and partners about romantic relationships and sexuality.

Anonymous questionnaires are frequently used in research with adolescents in order to obtain sincere answers about sensitive topics. Most longitudinal studies include self-generated identification codes (SGICs) to match information. Typical elements include a combination of letters and digits from personal data. However, these data may make the participant feel that their answers are not truly anonymous, and some studies using these types of SGICs have been perceived as not entirely anonymous by some participants. Furthermore, data protection laws could place limits on research carried out with these codes. The objective of our article is to test an SGIC with a higher degree of anonymity. We conducted two studies. In Study 1, we tested the perceived anonymity of this new SGIC code. Adolescents aged 12 to 18 years ( N = 601) completed an anonymous questionnaire about lifestyles and risk behaviors, which also included the SGIC. Adolescents with and without risk behaviors were compared regarding whether or not they answered to the SGIC questions. We did not find any differences to suggest that participants felt identifiable. In Study 2, we assessed the efficiency of the new SGIC. At baseline, 123 students from two high schools (eighth grade) filled in questionnaires consisting of the new SGIC and their full names. Two years later, these same students (then in the 10th grade) were invited to fill in the same information again (116 students responded to this second call). A total of 97 students were present in both waves. The SGIC showed a moderate performance, with good enough indices of recall and precision. Evidence suggests that the new SGIC is a suitable tool for the anonymous matching of adolescents in follow-ups of school cohorts., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Scientific literature has shown contextual factors that predict youth development, and family variables are the most important ones. In this study, we propose a model that explains the relation between family variables (relationship with parents and family activities) and Personal Positive Youth Development (assessed through Life satisfaction, Interiority, and Self-control), across different cultures. We recruited 2867 adolescents aged 12-18 years (52% female) from three countries: Spain, Mexico, and Peru. They completed an anonymous questionnaire. We run exploratory and confirmatory factor analyses, and structural equation modelling, testing for invariance across countries and sexes. In all subsamples, positive family relationships were associated with adolescents' Life Satisfaction. In addition, time invested on family activities was associated with Interiority and with Self-control. However, some differences across cultures and sex were found in the specific associations. Theoretical and practical implications are discussed regarding how to improve adolescent development through family life., (© 2021 The Authors. Journal of Community Psychology published by Wiley Periodicals LLC.)

Introduction: Religiosity and sexuality present numerous interconnections. Little is known regarding the specific causal pathways between each religiosity dimension and sexual behavior. The objectives of this study were (1) to explore the relationship between religiosity (measured through attendance at religious services, salience, and prayer) and sexual initiation in adolescents and (2) to establish the role of sexual permissiveness as mediator of the impact produced by religiosity in sexual initiation. Methods: This study analyzes data from an ongoing school-based international study examining what young people feel and think about relationships, love, and sexuality. An anonymous, self-administered online questionnaire was developed in Spanish. A total of 4,366 students, aged 14-18, completed the questionnaire. A final sample of 2,919 questionnaires was analyzed. Two unconditional logistic regression models were fit with religiosity variables and possible confounders as independent variables (with and without permissiveness, respectively). The dependent variable was sexual initiation. A final path analysis was performed to further understand the results. Results: Our study highlights that, in predominantly Catholic and Spanish-speaking countries, the fact of attending church and praying may greatly contribute to postponing sexual relations during adolescence, even independently of their attitudes on sexual permissiveness. Conversely, the effect of salience on sexual initiation seems to be fostered only through the mediation of sexual permissiveness. Our findings point to an indirect effect of the three religiosity dimensions (and in particular, religious salience) through permissive attitudes. Conclusion: Religiosity could be a relevant factor to explain sexual initiation during adolescence., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Calatrava, Beltramo, Osorio, Rodríguez-González, De Irala and Lopez-del Burgo.)

Background: Several instruments have been developed to assess adolescent dating violence but only few have been validated in Spanish-speaking settings. Some instruments are too long and may not be feasible to include them in a multipurpose questionnaire. We developed an instrument to be used in the YourLife project, an international project about young people lifestyles., Objective: We aimed to analyze the psychometric properties of this instrument in three Spanish-speaking countries (Chile, Ecuador, and Spain)., Method: We included 1049 participants, aged 13-18 years. Exploratory and confirmatory factor analyses were conducted. Associations between dating violence and variables expected to covariate with it (substance use, school peer aggression, justification of dating violence, and relationship power imbalance), were tested., Results: Two different constructs (psychological and physical/sexual) for suffered and perpetrated violence were identified and confirmed in the three countries. The dating violence subscales had Cronbach's alpha scores higher than 0.85. The strongest associations between dating violence and variables related to it were found within the relationship power imbalance items, suggesting that these items may be useful to detect adolescent dating violence when a specific questionnaire cannot be implemented., Conclusion: This instrument seems to be adequate to assess suffered and perpetrated adolescent dating violence within a multipurpose questionnaire among schooled adolescents.

Background: Media outlets influence social attitudes toward health habits. The analysis of tweets has become a tool for health researchers. Objective: The objective of this study was to investigate the distribution of tweets about women's health and the interest generated among Twitter users. Methods: We investigated tweets posted by 25 major U.S. media outlets about pre-menopausal and post-menopausal women's health between January 2009 and December 2019 as well as the retweets generated. In addition, we measured the sentiment analysis of these tweets as well as their potential dissemination. Results: A total of 376 tweets were analyzed. Pre-menopausal women's health accounted for most of the tweets (75.3%). Contraception was the main focus of the tweets, while a very limited number were related to infertility (1.4%). With regard to medical content, the effectiveness of contraceptive methods was the most frequent topic (46.2%). However, tweets related to side effects achieved the highest retweet-to-tweet ratio (70.3). The analysis of sentiments showed negative perceptions on tubal ligation. Conclusions: The U.S. media outlets analyzed are more interested in pre-menopausal than in post-menopausal women health and focused their content on contraception, while Twitter users showed greater interest in side effects., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Alvarez-Mon, Donat-Vargas, Llavero-Valero, Gea, Alvarez-Mon, Martinez-Gonzalez and Lopez-del Burgo.)

It is crucial to identify people at risk for type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) to implement preventive interventions in order to address these pandemics. A simple score exclusively based on dietary components, the Dietary-Based Diabetes-Risk Score (DDS) showed a strong inverse association with incident T2DM. The objective was to assess the association between DDS and the risk of GDM in a cohort of Spanish university graduates. The 'Seguimiento Universidad de Navarra' project is a prospective and dynamic cohort which included data of 3455 women who notified pregnancies between 1999 and 2012. The diagnosis of GDM is self-reported and further confirmed by physicians. A validated 136-item semi-quantitative FFQ was used to assess pre-gestational dietary habits. The development of the DDS was aimed to quantify the association between the adherence to this a priori dietary score and T2DM incidence. The score exclusively included dietary components (nine food groups with reported inverse associations with T2DM incidence and three food groups which reported direct associations with T2DM). Three categories of adherence to the DDS were assessed: low (11-24), intermediate (25-39) and high (40-60). The upper category showed an independent inverse association with the risk of incident GDM compared with the lowest category (multivariate-adjusted OR 0·48; 95 % CI 0·24, 0·99; P for linear trend: 0·01). Several sensitivity analyses supported the robustness of these results. These results reinforce the importance of pre-gestational dietary habits for reducing GDM and provide a brief tool to practically assess the relevant dietary habits in clinical practice.

Introduction: Structured and unstructured leisure are known protective and risk factors, respectively, for alcohol consumption during adolescence. However, little is known about the interaction between the two leisure types and alcohol consumption., Method: A cross-sectional study was performed among high-school students in El Salvador and Peru. Schooled adolescents, aged 13-18 (N = 5640), completed a self-administered questionnaire about risk behaviors, including their leisure activities and whether they had consumed alcoholic beverages. They were classified into tertiles of the amount of time of both structured and unstructured activities. A non-conditional multivariate logistic regression was conducted to evaluate the association of both types of leisure with alcohol consumption. We also used a likelihood ratio test to assess the potential interaction of structured and unstructured leisure time in alcohol consumption., Results: Alcohol consumption was much more frequent among adolescents in the highest tertile of unstructured leisure time compared to the lowest one (Adjusted OR: 5.52; 95% CI: 4.49-6.78), and less frequent among those from the highest tertile of structured leisure time compared to the lowest one (Adjusted OR: 0.66; 95% CI: 0.55-0.80). We did not find an interaction effect between structured and unstructured leisure time with regard to initiation of alcohol consumption., Discussion: The study suggests that structured leisure is not enough to compensate for the possible harmful effect of unstructured leisure. Parents, educators and policy makers might be advised to discourage unstructured leisure among adolescents, and not simply to encourage structured leisure., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background & Aims: Gestational diabetes mellitus (GDM) prevalence is increasing worldwide. To the best of our knowledge the specific evaluation of soft drink consumption as a risk factor for developing GDM has only been conducted in the Nurses' Health Study II., Objective: To investigate the incidence of GDM according to soft drink consumption in the SUN project., Design: The "Seguimiento Universidad de Navarra" (SUN) project is a prospective and dynamic cohort which included data of 3396 women who notified at least one pregnancy between December 1999 and March 2012. A validated 136-item semi-quantitative food frequency questionnaire was used to assess soft drink consumption. Four categories of sugar-sweetened soft drink (SSSD) and diet soft drink (DSD) consumption (servings) were established: rarely or never (<1/month), low (1-3/month), intermediate (>3/month and ≤1/week) and high (≥2/week). Potential confounders were adjusted through non-conditional logistic regression models., Results: During the follow-up, we identified 172 incident cases of GDM. After adjusting for age, baseline body mass index, family history of diabetes, smoking, total energy intake, physical activity, parity, fast-food consumption, adherence to Mediterranean dietary pattern, alcohol intake, multiple pregnancy, cardiovascular disease/hypertension at baseline, fiber intake, following special diet and snacking, SSSD consumption was significantly associated with an increased risk of incident GDM, with multivariable adjusted odds ratios (OR) of 2.03 (95% confidence interval [CI]: 1.25-3.31) and 1.67 (95% CI: 1.01-2.77) for the highest and intermediate categories, respectively, versus the lowest category (p for linear trend: 0.006). Conversely, DSD consumption was not associated with GDM incidence (adjusted OR: 0.82; 95% CI: 0.52-1.31) for the highest versus the lowest category (p for linear trend: 0.258). Additional sensitivity analyses did not change the results., Conclusion: Higher consumption of SSSDs before pregnancy was an independent risk factor for GDM, however, no association was observed between DSD consumption and GDM risk., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Introduction: Sexual violence, an HIV determinant, is an integrated behavior in the D.R.Congo. We aimed to analyze the prevalence of forced sexual intercourse (FSI) among people receiving HIV Voluntary Counseling and Testing in a hospital in Kinshasa, and its association with socio-demographics, behaviors and HIV status., Methodology: Case-control study (2010-2012). Two-hundred and seventy-four cases with a new HIV+ test and 1,340 controls with an HIV- test were interviewed about HIV-related knowledge, attitudes and behaviors, including FSI., Results: Thirty-four percent of the participants declared having had FSI (38% of women and 32% of men). Being a woman, aged 25-49 and reporting multiple sexual partners were associated with reporting FSI. For men, being single was protective against FSI; and cohabiting, having a high socioeconomic status, and alcohol consumption increased the odds. For women, being single, divorced/separated and widow was associated with reporting FSI. A significant positive association was found between FSI and an HIV positive test., Conclusion: Among our Congolese population, FSI was strongly associated with HIV infection and it was also associated with alcohol consumption and multiple sexual partnerships, other key HIV determinants. These behaviors need to be identified as potential risk factors of FSI during counseling interventions. Researchers, practitioners and decision-makers should work together to get violence prevention integrated into health, social and educational policies.

The aim of this study was to investigate the association between the adherence to empirically derived dietary patterns and gestational diabetes mellitus (GDM) risk and of healthy lifestyles with the prevention of GDM defining an overall healthy score. The Seguimiento Universidad de Navarra project is a Mediterranean cohort of university graduates started in 1999. We included 3455 pregnant women. During a mean follow-up of 10·3 (sd 3·3) years, we identified 173 incident GDM cases. Two major dietary patterns were identified using principal component analysis: the Western dietary pattern (WDP) (characterised by a high consumption of meat-based products and processed foods) and the Mediterranean dietary pattern (MDP) (characterised by a high consumption of vegetables, fruits, fish and non-processed foods). A low-risk score for GDM was defined taking into account important risk factors (age, BMI and unhealthy dietary pattern) for GDM. Positive association was found in the multivariable model between the highest quartile of adherence to WDP and GDM incidence compared with the lowest quartile (OR 1·56; 95 % CI 1·00, 2·43). No association was found between adherence to the MDP and GDM incidence (OR 1·08; 95 % CI 0·68, 1·70 for the highest quartile compared with the lowest). Women who adhered to all three low-risk factors had a 76 % lower risk of GDM (OR 0·24; 95 % CI 0·10, 0·55) compared with women who did not adhere to any factor before pregnancy. In conclusion, our results reinforce the importance of dietary recommendations and other two factors (low BMI and young age at pregnancy) in pre-gravid women.

This cross-sectional study assesses the association between age of sexual initiation during adolescence and a selection of well-being outcomes regarding that first relationship. High-school adolescents from El Salvador (2,686) and from Peru (3,399) replied to a paper-pencil questionnaire. Those who were sexually initiated replied to several questions regarding their age at sexual initiation, condom use, satisfaction and reasons/circumstances for that sexual relationship. Approximately 19% of participants were sexually initiated ( n = 1,179). After retaining participants with valid responses and with sexual initiation ages between 13 and 17, the final sample for this paper consisted of 996 sexually initiated participants (526 Salvadorians and 470 Peruvians). Multiple logistic regression analyses showed that those who initiated sex at earlier ages had worse outcomes compared to those who initiated at older ages. Specifically, they had lower odds of having used a condom, of having good memories of that experience and of having had that first relationship because they were in love. Conversely, they had higher odds of having had that first sexual relationship as a result of peer pressure ("Most of my friends already had sex"), because of partner pressure ("I was afraid to lose him/her," "My partner told me he/she would leave me" or "I did not know how to say no to a person who insisted"), or as a consequence of different forms of impaired autonomy ("I was under the influence of alcohol or drugs" or "As a consequence of seeing sexual images"). Results show that sex at earlier ages is associated with worse adolescent health and well-being outcomes.

In the Democratic Republic of Congo no previous studies have assessed the factors associated with different patterns of condom use and with multiple sexual partners, and the association between condom use simultaneously taking into account multiple sexual partnerships, and HIV infection. We carried out a prospective case-control study. From December 2010 until June 2012, 1630 participants aged 15-49 getting HIV Voluntary Counseling and Testing in a hospital in Kinshasa were selected. Cases were new HIV diagnosis and controls were HIV-negative participants detected along the study period. We recruited 274 cases and 1340 controls that were interviewed about HIV-related knowledge, attitudes and behaviours. Among cases there was a high prevalence of multiple lifetime and concurrent sexual partnerships (89.8% and 20.4%, respectively) and most cases never used condoms with only 1.5% using them consistently. Condom use and multiple partnerships were associated with male, single and high-educated participants. An association was found between multiple lifetime partners and 'any condom use' (OR = 2.99; 95%CI: 2.14-4.19) but not with consistent use. Both having two or more multiple concurrent sexual partners or not using condoms were variables similarly and highly associated to HIV risk. The association found between having two or more concurrent sexual partners and HIV was slightly higher (OR = 3.58, 95%CI:2.31-5.56) than the association found between never condom use and HIV (OR = 3.38, 95%CI:1.15-9.93). We found a high prevalence of multiple lifetime sexual partners and an extremely high prevalence of inconsistent condom use, both strongly associated with HIV seropositivity. Local programmes would benefit from comprehensive interventions targeting all behavioural and sociocultural determinants.

In this paper we study whether parental knowledge of adolescents' activities varies according to socio-demographic variables, and we analyze the possible association between parental knowledge patterns and certain risk behaviors among adolescents. A cross-sectional study was performed with representative samples of high-school students in Peru and El Salvador. A questionnaire assessed risk behaviors, as well as possible determinants, including parental knowledge. The questionnaire was answered by 6208 adolescents. We observed that the greater the degree of knowledge, the lower the frequency of risk behaviors among youth. The degree of knowledge was inversely associated with children's age, and we observed that being female was associated with a greater degree of parental knowledge. The study shows that parents' supervision criteria might be influenced by gender stereotypes, which would have a harmful effect on young males, as the lower degree of knowledge puts them at higher odds of risk behaviors., (Copyright © 2016 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Background: Considering the high percentage of couples in which one or both members are HIV negative, the frequency of transmission among non-regular partners and the probabilities of non-disclosure, attention should be paid to people getting a negative HIV test at the Voluntary Counseling and Testing (VCT). Research has shown that a negative HIV test may be followed by a change in sexual behaviours. In Sub-Saharan Africa, where most HIV infections occur, there are few studies that have analysed the factors associated with changes in sexual risk behaviours after a negative HIV test at the VCT clinic. The aim of this project is to evaluate the specific factors associated with changes in sexual behaviours, three months after a negative result in an HIV test, and to analyse the effect of counseling and testing on HIV-related knowledge of participants in an outpatient centre of Kinshasa (Democratic Republic of Congo)., Methods and Design: Prospective cohort study from December 2014 until March 2016. People 15-60 year old that received VCT at Monkole Hospital (Kinshasa) were followed three months after they got a negative HIV test. In a face-to-face interview, participants replied to a baseline and a follow-up research questionnaire on HIV-related knowledge, attitudes and behaviours. At follow-up respondents were also offered a new HIV test and additional HIV counseling. Four hundred and fifteen participants completed the baseline questionnaire and 363 (87 %) came back for their 3-month follow up., Discussion: This is the first longitudinal study in the DRC that evaluates the factors associated with changes in sexual behaviours after a negative HIV test at the VCT. Participants attending the VCT services within a clinical setting are a good study population as they can be good transmitters of preventive information for other people with no access to health facilities.

Introduction: Sexually transmitted infections and unplanned pregnancies affect adolescent sexual health and are serious public health concerns. They result from sexual intercourse in adolescence, which is usually associated with multiple partners, unprotected sex, and condom misuse. This behavior is related to socio-ecological factors that influence lifestyles. The YOURLIFE project aims to find out what young people think and feel about relationships, love, and sexuality, and to assess the associations between these thoughts and attitudes, adolescents' social factors, and sexual health., Materials and Equipment: An international school-based study with a cross-sectional and optional subsequent longitudinal design. Three online questionnaires designed for adolescents aged 13/14, 15/16, and 17/18, respectively, will be used. A matching coding system will allow longitudinal follow-up when adolescents reply to follow-up surveys. Questionnaires will include questions related to sociodemographic data; information/communication technologies; leisure time; parental supervision; influences of parents/friends; information sources; messages perceived; and sexuality-related knowledge, attitudes, and opinions. The second and third questionnaires for participants aged 15/16 and 17/18 will also contain variables concerning sexual behavior. Schools will be able to use their results to tailor educational approaches targeting the needs of their students. Multivariate analyses will be performed using the larger international dataset., Expected Impact of the Study on Public Health: The YOURLIFE project will collect comprehensive information about the socio-ecological determinants of the sexual risk-taking of schooled adolescents worldwide. Effective preventive programs could be subsequently designed and tailored to the specific determinants of adolescents from different schools and settings, and also, when analyzed globally, to public health professionals.

The role of alcohol on fertility remains unclear. We aimed to investigate the association between alcohol and specific alcoholic beverages consumption and the risk of difficulty getting pregnant. We used a case-control study nested within the Seguimiento Universidad de Navarra (SUN) cohort, a prospective, dynamic and multipurpose cohort of 21,705 Spanish university graduates, followed biennially with mailed questionnaires. We identified 686 case-control pairs, matched for age and time in the cohort. Cases were women reporting difficulty getting pregnant. Controls did not consult due to difficulty conceiving and had at least one child during follow-up. After adjustment for potential confounders, we found no association between self-reported difficulty getting pregnant and the number of alcoholic beverages consumed per week, (Odds Ratio [OR] > 5 drinks/week vs. none = 1.04, 95% Confidence Interval [CI] = 0.72-1.51). No association between types of alcoholic beverage and difficulty conceiving (OR > 5 drinks of wine/week vs. none = 1.16, 95% CI = 0.72-1.88; OR > 5 drinks of beer/week vs. none = 1.06, 95% CI = 0.82-1.37; OR > 5 drinks of spirits/week vs. none = 1.24, 95% CI = 0.84-1.64) was observed. In conclusion, we found no association between alcohol intake and risk of consulting a physician due to difficulty conceiving. More studies are needed to clearly elucidate the effects of alcohol intake on women's fertility. In the meantime, recommendations about alcohol intake to couples trying to conceive have to be given cautiously.