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Background: Healthy sleep is crucial for the physical and mental wellbeing of adolescents. However, many adolescents suffer from poor sleep health. Little is known about how to effectively improve adolescent sleep health as it is shaped by a complex adaptive system of many interacting factors. This study aims to provide insights into the system dynamics underlying adolescent sleep health and to identify impactful leverage points for sleep health promotion interventions. Methods: Three rounds of single-actor workshops, applying Group Model Building techniques, were held with adolescents (n = 23, 12–15 years), parents (n = 14) and relevant professionals (n = 26). The workshops resulted in a multi-actor Causal Loop Diagram (CLD) visualizing the system dynamics underlying adolescent sleep health. This CLD was supplemented with evidence from the literature. Subsystems, feedback loops and underlying causal mechanisms were identified to understand overarching system dynamics. Potential leverage points for action were identified applying the Action Scales Model (ASM). Results: The resulting CLD comprised six subsystems around the following themes: (1) School environment; (2) Mental wellbeing; (3) Digital environment; (4) Family & Home environment; (5) Health behaviors & Leisure activities; (6) Personal system. Within and between these subsystems, 16 reinforcing and 7 balancing feedback loops were identified. Approximately 60 potential leverage points on different levels of the system were identified as well. Conclusions: The multi-actor CLD and identified system dynamics illustrate the complexity of adolescent sleep health and supports the need for developing a coherent package of activities targeting different leverage points at all system levels to induce system change. [ABSTRACT FROM AUTHOR]

Background: Teenage pregnancies cause serious health, social and economic consequences including death among adolescent girls worldwide. It is estimated that in 2019 about 55% of unintended pregnancies among adolescent girls aged 15–19 years ended up in abortions, which are often unsafe in developing countries. Little was known about the magnitude of teenage pregnancy and its associated factors in Dodoma Tanzania. Therefore, the study aimed at establishing the magnitude and factors associated with teenage pregnancies among adolescents in Dodoma Region Tanzania. Method: It was a community-based analytical cross-sectional study that included 539 adolescent girls aged 15 to 19 years old. A multistage sampling technique was used to recruit study participants. An interviewer-administered structured questionnaire was used to collect data. Data were analyzed by using SPSS v23. Descriptive statistics were used to describe the distribution of the entire study variable while the inferential statistics helped to establish factors associated with teenage pregnancy among adolescent girls and the level of significance was set at two sides of less than 0.05. Results: The magnitude of teenage pregnancy in Dodoma was 29%. After controlling for possible confounders, factors associated with teenage pregnancy were; urban residence [AOR: 3.02, 95%CI: (1.60–5.68), p = 0.001], low mothers' education status [AOR: 3.46, 95%CI: (1.47–8.11), p = 0.004]; Poor knowledge on sexual and reproductive health [AOR: 2.09, 95%CI: (1.2–3.63), p = 0.009]; Low family economic status [AOR: 3.83, 95%CI: (1.77–8.30), p = 0.001]; Peer group [AOR: 2.92, 95%CI: (1.33–6.40), p = 0.007]; Early marriage [AOR: 2.58, 95%CI: (1.57–4.26), p < 0.0001]; and Sexual abuse [AOR: 13.56, 95%CI: (7.98–23.06), p < 0.0001]. Conclusion: This study found a high magnitude of teenage pregnancy among youth in Dodoma. Teenagers who were more likely to teenage pregnancy were those with limited knowledge about sexual and reproductive health living in urban, from families with low economic status, their mothers had a low level of education, from a culture that encourage early marriages, with the influence of peer and who experienced sexual abuse. An innovative intervention study to come up with a cost-effective strategy to address the challenge of teenage pregnancy in Dodoma is highly recommended. Plain English summary: The study is reporting the status of teenage pregnancy among adolescents aged 15–19 years in the Dodoma Region. Dodoma Region is the capital city of Tanzania and it is among the fastest-growing city of Tanzania. The region has the highest population of youth in Tanzania. In addition, the study is reporting on factors associated with teenage pregnancy. A range of factors that have been reported by previous studies was assessed in this study to test whether they are significant factors in this population. These factors were sociodemographic factors (age, sex, marital status, education, occupation), social factors (Peer pressure, sexual abuse), familial factors (Household socio-economic status, domestic violence, marital status,), behavioral factors (like age at first sexual intercourse, early marriage, and contraceptive use, perception on teenage pregnancy, family income, peer pressure, and casual sex) and knowledge on sexual and reproductive health. The findings from this study are key to the development of a focused intervention study that will work out the strategies to be used to solve the problem of teenage pregnancies in Dodoma Region Tanzania. [ABSTRACT FROM AUTHOR]

Background: Latina adolescents in the USA report some of the lowest rates of physical activity of any demographic subgroup; this is paralleled by a markedly higher lifetime risk of obesity, type 2 diabetes, and other conditions related to inactivity. Despite this, to date, no fully powered clinical trials have tested physical activity interventions specifically for this population. High use of mobile technologies (including text messages, smartphone apps, and social media) suggests this could be an appropriate intervention channel, while also having potential for broad reach. This paper describes the protocol for Chicas Fuertes, a fully powered randomized trial of a mobile technology-based physical activity intervention for Latina adolescents.Methods: We plan to recruit 200 Latina teens (age 13-18) in San Diego, CA, currently engaging in ≤ 150 min/week of moderate-to-vigorous physical activity (MVPA) to be assigned 1:1 to the intervention or control groups. Those randomly assigned to the intervention group receive a one-on-one goal setting session followed by 6 months of mobile technology-based intervention, including a personalized website, Fitbit activity tracker and app, individually tailored text messages based on Fitbit data, and daily intervention content on Instagram. Those randomized to the control group receive only a Fitbit activity tracker. The main outcome is change in weekly minutes of MVPA from baseline to 6 months, measured both objectively (ActiGraph accelerometers and Fitbit Inspire HR) and subjectively (7-Day Physical Activity Recall Interview). Additional outcomes are maintenance of activity change at 12 months and changes in psychosocial constructs, including social support and self-efficacy, engagement with mobile technology channels, and costs of intervention delivery. We are also examining the potential mediators and moderators of the intervention. The efficacy of the intervention is analyzed using a mixed effects regression model, adjusting for any potential confounders not balanced by randomization. All analyses of accelerometer measured MVPA are also adjusted for wear time.Discussion: The Chicas Fuertes trial uses widely available mobile technologies to target critical health behavior, physical activity, in Latina teens, a population with a high lifetime risk of lifestyle-related diseases. The results will speak to the efficacy and acceptability of the intervention, which has the potential for broad dissemination.Trial Registration: ClinicalTrials.gov NCT04190225 . Registered on November 20, 2019. [ABSTRACT FROM AUTHOR]

Background: Positive-interaction parenting early in childhood is encouraged due to its association with behavioural development later in life. The objective of this study was to examine if the level of positive-interaction parenting style differs among teen, optimal age, and advanced age mothers in Canada, and to identify the characteristics associated with positive-interaction parenting style separately for each age group.Methods: This was a cross-sectional secondary analysis of the National Longitudinal Survey of Children and Youth. First-time mothers with children 0-23 months were grouped into: teen (15-19 years, N = 53,409), optimal age (20-34 years, N = 790,960), and advanced age (35 years and older, N = 106,536). The outcome was positive-interaction parenting style (Parenting Practices Scale); maternal socio-demographics, health, social, and child characteristics were considered for backward stepwise multiple linear regression modeling, stratified for each of the age groups.Results: Teen, optimal age, and advanced age mothers reported similar levels of positive- interaction parenting style. Covariates differed across the three age groups. Among optimal age mothers, being an ever-landed immigrant, childcare use, and being devoted to religion were found to decrease positive-interaction parenting style, whereas, higher education was found to increase positive-interaction parenting style. Teen mothers were not found to have any characteristics uniquely associated with positive-interaction parenting. Among advanced age mothers, social support was uniquely associated with an increase in positive-interaction parenting. Very good/excellent health was found to be positively associated with parenting in teens but negatively associated with parenting in advanced age mothers.Conclusion: Characteristics associated with positive-interaction parenting varied among the three age groups. Findings may have public health implications through information dissemination to first-time mothers, clinicians, researchers, and public health facilities. [ABSTRACT FROM AUTHOR]

Background: In some developing countries a woman's decision to utilize maternal health care services is not made by the woman herself but by other family members. The perception of family members regarding who is the most influential person for making the decision to utilize these services is inconclusive. Hence, this study aimed to determine the perceived influential person on utilization of antenatal care (ANC) and delivery care services among teen, young adult and adult pregnant women from the perspective of the woman themselves, their husband and their mother-in-law, identify the factors associated with the woman being the most influential person, and assess the level of agreement between the woman's and her husband's response to the woman being the most influential person. Methods: A cross-sectional study was conducted at Paropakar Maternity and Women's Hospital and Tribhuvan University Teaching Hospital in Kathmandu district, Nepal. Purposive sampling technique was used to select 315 women of which 105 were from each age group and their accompanied husbands (n = 315) and mothers-in-law (n = 315). The proportion of perceived influential person and mean priority score of the perceived influence with its 95% confidence interval (CI) was calculated. The factors associated with the woman perceived as the most influential person were analyzed by multivariate logistic regression model. The agreement was analyzed using unadjusted and prevalence adjusted kappa statistic. Results: Among teens and young adults and their husband and mother-in-law, the woman's husband was perceived as the most influential person. Among adults, the most influential person for ANC was the woman herself but for delivery care was the woman's husband. A woman of adult age, having a non-indigenous ethnicity or who was not referred was more likely to perceive herself as the most influential person in the decision to utilize delivery care. A fair to poor level of agreement was found on the perception of the most influential person for ANC and delivery care utilization. Conclusions: Both women and their husbands influenced the decision to utilize ANC and delivery care but husbands were more influential, especially in teens and young adults. Thus, husband's involvement is crucial as a strategy to improve maternal health care utilization in Nepal. [ABSTRACT FROM AUTHOR]