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Introduction: Low health literacy levels during adolescence and young adulthood (AYA) may impact acute healthcare access and longer‐term health outcomes. Previous research in South African AYA suggests that health literacy levels are typically suboptimal but few interventions exist. This study aimed to test the acceptability and feasibility of a co‐created, interactive health literacy intervention (LifeLab‐Soweto) with AYA in Soweto, South Africa. Methods: Participants (18–24 years, n = 107) were recruited (September–October 2022) from a youth development centre database by telephone and through snowball sampling. AYA involved in the co‐creation process were excluded. Pre‐intervention data on participant age, gender identity and ability to correctly identify a normal blood pressure (BP) reading were captured via survey. Post‐intervention, participants repeated the BP question and completed a satisfaction survey. Additionally, n = 31 AYA agreed to an in‐depth interview about their LifeLab‐Soweto experience. Interview transcripts were analysed using inductive thematic analysis. Results: Participants (mean age 21 ± 2.4 years; 59% female, 39% male, 2% nonbinary) generally viewed LifeLab‐Soweto as well‐designed, relevant, simple to follow, fun, useful, and interesting, with most reporting an increased understanding of health and that they would use this new knowledge. Comparing pre‐ and post‐intervention BP question accuracy, males showed the greatest improvement in scores. Interviews showed that, while LifeLab‐Soweto was not what AYA were expecting, gains in health knowledge led AYA to consider changes in health behaviours including accessing health services. Conclusion: Life‐Soweto presents an acceptable, feasible and relevant health literacy intervention for South African youth with potential to improve health literacy and health behaviours. Patient and Public Involvement: To ensure the health literacy intervention was contextually relevant, age appropriate, and gender inclusive, a group of 40 adolescents (aged 18–24 years, male, female and non‐binary) were recruited from Soweto to firstly identify the health topics that were most pressing in their daily lives. This youth advisory group identified stress as a major challenge impacting physical and mental health, health behaviour and daily functioning. Together with the youth group, researchers from South Africa and the UK worked to co‐develop the health literacy intervention that delivers self‐directed exploration and learning of how stress impacts health, behaviour and well‐being. This manuscript describes how this cocreated intervention was received by a broader range of South African youth who were not involved in the cocreation process. [ABSTRACT FROM AUTHOR]

This study examined the relationship between individual, household, and community-level factors with obesity-related health behaviors. Households (n = 6110) were enumerated, and participants (>18 years) reported their screen time and how many sugar-sweetened beverages they consumed per day. Individuals from food insecure and higher SES households were more likely to report higher sugar-sweetened beverage consumption. Screen time was negatively associated with age (p <.01), and being female was associated with 35 minutes more screen time per day (p <.01). Community and household factors were independent drivers of behavior that need to be incorporated into individual level interventions, or considered in analyses. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore association of self-reported physical activity domains of work, leisure, and transport-related physical activity and body mass index (BMI) in 9388 adult men and women from the Africa-Wits-INDEPTH partnership for Genomic (AWI-Gen) study in Africa. Africa-Wits-INDEPTH partnership for Genomic is a large, population-based cross-sectional cohort with participants from 6 sites from rural and urban areas in 4 sub-Saharan African countries. Methods: A sex-stratified meta-analysis of cross-sectional data from men and women aged 29–82 years was used to assess the association of physical activity with BMI. Results: Overall, meeting physical activity guidelines of at least 150 minutes per week was associated with 0.82 kg/m2 lower BMI in men (β = −0.80 kg/m2; 95% confidence interval [CI], −1.14 to −0.47) and 0.68 kg/m2 lower BMI in women (β = −0.68 kg/m2; 95% CI, −1.03 to −0.33). Sex and site-specific differences were observed in the associations between physical activity domains and BMI. Among those who met physical activity guidelines, there was an inverse association between transport-related physical activity and BMI in men from Nanoro (Burkina Faso) (β = −0.79 kg/m2; 95% CI, −1.25 to −0.33) as well as work-related physical activity and BMI in Navrongo men (Ghana) (β = −0.76 kg/m2; 95% CI, −1.25 to −0.27) and Nanoro women (β = −0.90 kg/m2; 95% CI, −1.44 to −0.36). Conclusions: Physical activity may be an effective strategy to curb rising obesity in Africa. More studies are needed to assess the impact of sex and geographic location-specific physical activity interventions on obesity. [ABSTRACT FROM AUTHOR]

Background: Reliable dietary data for children are necessary to investigate associations with health outcomes. The present study aimed to develop and validate a questionnaire to determine the frequency of intakes of specific healthy and unhealthy food groups in young children. Methods: Participants were 5–9‐year‐old South African children (n = 920) from 10 urban schools. Their parents completed a demographic questionnaire and the food intake questionnaire with food pictures. Based on the literature, four healthy food groups (fruits, vegetables, milk, meat/fish/poultry/eggs) and six unhealthy food groups (hot and cold sugar‐sweetened beverages, candy, salty snacks, cakes and fast foods) were included, with five different frequency responses. Six experienced nutritionists assessed the face validity and content validity. After pilot testing, construct validity and homogeneity were determined in the participants. Convergent validity was determined using urinary sodium and potassium concentrations as biological intake markers. Results: Nutritionists confirmed face and content validity. Caregivers confirmed understanding of the questionnaire. Three factors explained 50.2% of the variance, with most unhealthy food groups as factor 1, fruits and vegetables as factor 2, and animal source protein and milk groups clustered with sugar‐sweetened beverages as factor 3. The frequency of milk group, fruits and vegetables intake correlated negatively, whereas the frequency of salty snacks and fast foods intakes correlated positively with the urinary sodium:potassium ratio. Conclusions: The healthy and unhealthy food group questionnaire has advantages of low respondent burden, as well as acceptable content and convergent validity in South African children. The questionnaire may be used to investigate associations between food intakes and health outcomes. Key points: Simplified methods to collect data on the food consumption of children are required in epidemiological studies.Intakes from specific food groups, namely fruits, vegetables, sugar‐sweetened beverages and snacks, salty snacks, and fast foods, are important.A healthy and unhealthy food group questionnaire was validated and showed acceptable content and convergent validity in South African children.The food group questionnaire has a low respondent burden. [ABSTRACT FROM AUTHOR]

Adult mental health challenges frequently stem from undiagnosed poor mental health earlier in life. With increasing levels of poor adolescent mental health and insufficient health care resources in low- and middle-income countries, mobile mental health may offer expanded service access. Little is known about mobile mental health interventions for adolescents in low- and middle-income countries. Our aim was to review the literature on mobile mental health intervention, development and use for low- and middle-income country adolescents. We searched APA PsycInfo, Web of Science, Psychiatry online, and Ebscohost databases using keywords and phrases. Screening of the 6953 retrieved articles, generated 6 articles that met the inclusion criteria. Arksey and O'Malley's adapted framework was followed using rigorous inclusion criteria and screening by two reviewers. Studies showed high heterogeneity. Two studies used short message service text messaging platforms, one used phone call reminders, two used smartphone applications (WhatsApp or game-based), and one study compared different short message service, web-based and smartphone app offerings. Generally, adolescents had a positive perception of mobile mental health interventions. Helpline messages, peer group sessions, access to a counsellor and games set in real-life environments were some of the preferred contents of mobile mental health interventions. Noted barriers include low personal mobile phone ownership, leading to lack of confidentiality, data costs and limited internet access. While adolescents in low- and middle-income countries find mobile mental health interventions acceptable and supportive, challenges remain. Mobile mental health interventions can potentially overcome barriers associated with face-to-face care, such as high cost and stigma. However, more research is needed to overcome these challenges and build the evidence-base in low- and middle-income countries for this field to grow. [ABSTRACT FROM AUTHOR]

Background: Tobacco use is a major public health risk worldwide, which has increased on the African continent over the past 40 years. Socio-economic factors impact tobacco use and exposure, but little is known about the scope of this problem in young women living in an urban, historically disadvantaged township in contemporary South Africa. This study aimed to identify the prevalence of tobacco use in a cohort of young South African women using serum cotinine, and to assess the association between a number of socio-economic and social factors and tobacco use in this setting.Methods: Secondary analysis was conducted on cross-sectional data from the Healthy Life Trajectories Initiative (HeLTI) study. Serum cotinine was measured and a cut-off of ≥ 10 ng/mL was classified as tobacco use. Household socio-economic, socio-demographic and health information were collected by an interviewer-administered questionnaire.Results: Cotinine data was available for 1508 participants, of whom 29.2% (n = 441) had cotinine levels indicative of tobacco use. In regression analyses, moderate to severe socio-economic vulnerability (score 2-3 OR 1.66, p = 0.008; score ≥4: OR 1.63, p = 0.026) and multiparity (OR 1.74, p = 0.013) were associated with tobacco use. In addition, alcohol dependence (OR 3.07, p < 0.001) and drug use (OR 4.84, p < 0.001) were associated with tobacco use.Conclusion: Young women with multiple children, moderate to severe socio-economic vulnerability, and alcohol and drug use were identified as more likely to use tobacco, indicating the need for targeted anti-tobacco interventions to curb the impact of tobacco on the growing burden of noncommunicable diseases in this setting. [ABSTRACT FROM AUTHOR]

Objective: Diabetes prevalence is increasing rapidly in rural areas of low- and middle-income countries (LMICs), but there are limited data on the performance of health systems in delivering equitable and effective care to rural populations. We therefore assessed rural-urban differences in diabetes care and control in LMICs., Research Design and Methods: We pooled individual-level data from nationally representative health surveys in 42 countries. We used Poisson regression models to estimate age-adjusted differences in the proportion of individuals with diabetes in rural versus urban areas achieving performance measures for the diagnosis, treatment, and control of diabetes and associated cardiovascular risk factors. We examined differences across the pooled sample, by sex, and by country., Results: The pooled sample from 42 countries included 840,110 individuals (35,404 with diabetes). Compared with urban populations with diabetes, rural populations had ∼15-30% lower relative risk of achieving performance measures for diabetes diagnosis and treatment. Rural populations with diagnosed diabetes had a 14% (95% CI 5-22%) lower relative risk of glycemic control, 6% (95% CI -5 to 16%) lower relative risk of blood pressure control, and 23% (95% CI 2-39%) lower relative risk of cholesterol control. Rural women with diabetes had lower achievement of performance measures relating to control than urban women, whereas among men, differences were small., Conclusions: Rural populations with diabetes experience substantial inequities in the achievement of diabetes performance measures in LMICs. Programs and policies aiming to strengthen global diabetes care must consider the unique challenges experienced by rural populations., (© 2022 by the American Diabetes Association.)