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BACKGROUND: Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental health challenges like depression and anxiety and can even support the use of evidence-based strategies like cognitive behavioral therapy (CBT). In our increasingly connected world, youth mentors can meet with young people on a web-based platform at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based CBT skills for addressing depression and anxiety more accessible than ever. As such, when trained and supervised by licensed clinicians, mentors are an untapped resource to support youth with mental health challenges. OBJECTIVE: The objective of this study was to develop and assess the feasibility and acceptability of Appa Health (Appa), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development, pilot testing process, and preliminary quantitative and qualitative outcomes of Appas 12-week smartphone app program which combines web-based near-peer mentorship with short-form TikTok-style videos teaching CBT skills created by licensed mental health professionals who are also social media influencers. METHODS: The development and testing processes were executed through collaboration with key stakeholders, including young people and clinical and research advisory boards. In the pilot study, young people were assessed for symptoms of depression or anxiety using standard self-report clinical measures: the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 scales. Teenagers endorsing symptoms of depression or anxiety (n=14) were paired with a mentor (n=10) based on preferred characteristics such as gender, race or ethnicity, and lesbian, gay, bisexual, transgender, queer (LGBTQ) status. Quantitative survey data about the teenagers characteristics, mental health, and feasibility and acceptability were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content. RESULTS: Participants reported finding Appa helpful, with 100% (n=14) of teenagers expressing that they felt better after the 12-week program. Over 85% (n=12) said they would strongly recommend the program to a friend. The teenagers were engaged, video chatting with mentors consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from week 1 to week 12, supporting qualitative data suggesting that mentoring combined with CBT strategies has the potential to positively impact youth mental health and warrants further study. CONCLUSIONS: Appa Health is a novel smartphone app aiming to improve the well-being of youth and reduce anxiety and depressive symptoms through web-based mentoring and engaging CBT video content. This formative research sets the stage for a large-scale randomized controlled trial recently funded by the National Institutes of Health Small Business Innovation Research program.

Adverse Childhood Experiences (ACEs) have been definitively linked with cross-domain life course well-being. While scales measuring the ten "Conventional" ACEs (ACEs-C; intrafamilial experiences of abuse, neglect, and household dysfunction) are parsimonious, use of such scales alone may fail to capture crucial information about adversity, particularly in youth growing up in underresourced areas. Patterns and disparities in Conventional and Expanded ACEs (ACEs-E; experiences more common in impoverished and densely populated areas) were examined in the large, primarily Black Chicago Longitudinal Study cohort. This cohort has been followed from the 1980s to the present. Participants in the present study, comprising over 70% of the original sample, responded to a follow-up survey between 2012 and 2017. ACE information was collected both prospectively and retrospectively. Overall ACE prevalence and differences in ACEs by sex and risk were explored using logistic regression with adjusted and unadjusted odds ratios, and chi-squared tests. Higher sociodemographic risk in early childhood was associated with higher rates of ACEs-C through adolescence. Males endorsed higher rates of ACEs-E, particularly relating to violent crime. Nearly 1/5 of participants reported only ACEs-E, which are often not measured when assessing ACEs. Findings underscore enduring effects of early childhood risk factors on ACE exposure, as well as contributions of community characteristics to childhood adversity. Given strong associations between ACEs, environment, and well-being, enhancing inclusivity in our understanding of childhood adversity is a public health priority.

As technologies continue to evolve at exponential rates, online platforms are becoming an increasingly salient social context for adolescents. Adolescents are often early adopters, savvy users, and innovators of technology use. This not only creates new vulnerabilities but also presents new opportunities for positive impact-particularly, the use of technology to promote healthy learning and adaptation during developmental windows of opportunity. For example, early adolescence appears to represent a developmental inflection point in health trajectories and in technology use in ways that may be strategically targeted for prevention and intervention. The field of adolescent health can capitalize on technology use during developmental windows of opportunity to promote well-being and behavior change in the following ways: (1) through a deeper understanding of the specific ways that developmental changes create new opportunities for motivation and engagement with technologies; (2) by leveraging these insights for more effective use of technology in intervention and prevention efforts; and (3) by combining developmental science-informed targeting with broader-reach technologic approaches to health behavior change at the population level (e.g., leveraging and changing social norms). Collaboration across disciplines-including developmental science, medicine, psychology, public health, and computer science-can create compelling innovations to use digital technology to promote health in adolescents.

PurposeAccidents and unintentional injuries account for the greatest number of adolescent deaths, often involving use of alcohol and other substances. This article describes the iterative design and development of Interactive Narrative System for Patient-Individualized Reflective Exploration (INSPIRE), a narrative-centered behavior change environment for adolescents focused on reducing alcohol use. INSPIRE is designed to serve as an extension to clinical preventive care, engaging adolescents in a theoretically grounded intervention for health behavior change by leveraging 3D game engine and interactive narrative technologies.MethodsAdolescents were engaged in all aspects of the iterative, multiyear development process of INSPIRE through over 20 focus groups and iterative pilot testing involving more than 145 adolescents. Qualitative findings from focus groups are reported, as well as quantitative findings from small-scale pilot sessions investigating adolescent engagement with a prototype version of INSPIRE using a combination of questionnaire and interaction trace log data.ResultsAdolescents reported that they found INSPIRE to be engaging, believable, and relevant to their lives. The majority of participants indicated that the narrative's protagonist character was like them (84%) and that the narrative featured virtual characters that they could relate to (79%). In the interactive narrative, the goals most frequently chosen by adolescents were "stay in control" (60%) and "do not get in trouble" (55%).ConclusionsWith a strong theoretical framework (social-cognitive behavior change theory) and technology advances (narrative-centered learning environments), the field is well positioned to design health behavior change systems that can realize significant impacts on behavior change for adolescent preventive health.

Educators and researchers are increasingly interested in evaluating and promoting socio-emotional learning (SEL) beginning in early childhood (Newman & Dusunbury in 2015; Zigler & Trickett in American Psychologist 33(9):789-798 https://doi.org/10.1037/0003-066X.33.9.789, 1978). Decades of research have linked participation in high-quality early childhood education (ECE) programs (e.g., public prekindergarten, Head Start) to multidimensional wellbeing. ECE programs also have demonstrated potential to be implemented at large scales with strong financial returns on investment. However, relatively few studies have investigated the effects of ECE programs on SEL, particularly compared to smaller-scale, skills-based SEL interventions. Furthermore, among studies that have examined SEL, there is a general lack of consensus about how to define and measure SEL in applied settings. The present paper begins to address these gaps in several ways. First, it discusses conceptual and methodological issues related to developmentally and culturally sensitive assessment of young children's socio-emotional functioning. Second, it reviews the empirical research literature on the impacts of three types of early childhood programs (general prekindergarten programs; multi-component prekindergarten programs; and universal skills-based interventions) on SEL. Finally, it highlights future directions for research and practice.

Introduction: The role of structural inequalities in the long-term benefits of early childhood programs has not been assessed. Previous findings in the Chicago Longitudinal Study, an early childhood cohort investigation with low-income families, indicate that Child–Parent Center (CPC) participation beginning in preschool was associated with a variety of positive health behaviors. In this secondary analysis, we assessed if structural inequalities (neighborhood poverty, history of discrimination) modified the magnitude of associations between CPC and health and education outcomes (cardiovascular health, body mass index, educational attainment) 30 years later. Method: The Chicago Longitudinal Study cohort of 1,539 children (93% Black, 7% Hispanic) grew up in high-poverty neighborhoods and attended CPCs or the usual district programs. At midlife (ages 32–37, M = 34.9 years, 2012–2017), 1,073 participants completed telephone interviews on structural inequalities, health, and education. Regression analyses were conducted with inverse propensity score weighting. Results: After accounting for structural inequality, CPC participation was significantly associated with outcomes. Mean differences on Framingham risk scores, for example, were significant for CPC preschool at ages 3 and 4 (coefficient = −2.15, p =.004, standardized difference = −0.20). Neighborhood poverty moderated (reduced) the association between CPC and cardiovascular health. Neighborhood poverty and perceived discrimination had independent contributions with outcomes. Discussion: Findings show that structural inequalities, especially poverty, directly influence and/or moderate long-term effects of CPC participation. Increasing neighborhood resources and socioeconomic status may help comprehensive programs sustain their impacts. Early childhood and sociostructural influences reflect the increasing importance of community contexts to health promotion. Public Significance Statement: This study shows evidence that neighborhood poverty in adulthood is associated with a significant reduction in the estimated effect of preschool participation in the Child–Parent Center program on midlife cardiovascular health. Both neighborhood poverty and history of discrimination were detrimental to measured well-being, especially the former. Despite these detrimental influences, the Child–Parent Center program—a large-scale, evidence-based intervention—was associated with beneficial long-term effects on cardiovascular health and educational attainment. Increasing community resources and supports is an important avenue for promoting and sustaining early childhood learning gains. [ABSTRACT FROM AUTHOR]