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Traumatic brain injury (TBI) is a serious public health concern and overrepresented among justice-involved populations. An emerging area of research focuses on the complex, interrelated and unmet health and social needs of justice-involved women and youth with TBI. Evidence of these needs continues to grow, yet the health and justice systems continue to underperform in supporting the health and social care of justice-involved women and youth. This commentary is a call to action to begin to redress these gaps. We first provide an overview of the needs of women and youth with TBI that affect their transition from custody to community, including those related to victimization, trauma, mental health, substance use, and homelessness. We then highlight the current gaps in knowledge and practice with respect to interventions for women and youth with TBI at transition from custody. The available evidence for the impact of interventions on people with head injury who are justice-involved is sparse, especially studies of interventions focused on women and youth. We conclude with a call for implementation science studies to support translation from research to practice, emphasizing that researchers, practitioners, policy makers, and women and youth at transition should collaborate to develop, implement, and evaluate accommodations and interventions for TBI. To have meaningful, positive impacts on the systems that serve these women and youth, interdisciplinary service delivery approaches should aim to prevent, raise awareness, identify, and provide timely support and services for the varied needs of women and youth with TBI in transition. [ABSTRACT FROM AUTHOR]

The aim of the study is to examine the relationship between the phenomenon of commercial openness and child and youth health. The study sample consists of BRICS-T (Brazil, Russia, India, China, South Africa and Turkey) countries. The study was analyzed in the light of asymmetric components in the period between 1990-2021. ARDL (Auto Regressive Distributed Lag) bounds test approach was used for co-integration analysis between variables. The causality relationship of the variables was analyzed with the Breitung Candelon frequency domain method, and finally, OLS and FMOLS methods were used in parameter estimation. According to the parameter results, the increase in trade openness in BRICS-T countries has a reducing effect on child and youth mortality and contributes to the improvement of public health. [ABSTRACT FROM AUTHOR]

Background: In 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16–24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers' perceptions, practices, and recommendations on youth cannabis use. Methods: This mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16–24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis. Results: The survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services. Conclusion: Youth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms. [ABSTRACT FROM AUTHOR]

Background: Heterogeneous mental health outcomes during the COVID-19 pandemic are documented in the general population. Such heterogeneity has not been systematically assessed in youth with autism spectrum disorder (ASD) and related neurodevelopmental disorders (NDD). To identify distinct patterns of the pandemic impact and their predictors in ASD/NDD youth, we focused on pandemic-related changes in symptoms and access to services. Methods: Using a naturalistic observational design, we assessed parent responses on the Coronavirus Health and Impact Survey Initiative (CRISIS) Adapted For Autism and Related neurodevelopmental conditions (AFAR). Cross-sectional AFAR data were aggregated across 14 European and North American sites yielding a clinically well-characterized sample of N = 1275 individuals with ASD/NDD (age = 11.0 ± 3.6 years; n females = 277). To identify subgroups with differential outcomes, we applied hierarchical clustering across eleven variables measuring changes in symptoms and access to services. Then, random forest classification assessed the importance of socio-demographics, pre-pandemic service rates, clinical severity of ASD-associated symptoms, and COVID-19 pandemic experiences/environments in predicting the outcome subgroups. Results: Clustering revealed four subgroups. One subgroup—broad symptom worsening only (20%)—included youth with worsening across a range of symptoms but with service disruptions similar to the average of the aggregate sample. The other three subgroups were, relatively, clinically stable but differed in service access: primarily modified services (23%), primarily lost services (6%), and average services/symptom changes (53%). Distinct combinations of a set of pre-pandemic services, pandemic environment (e.g., COVID-19 new cases, restrictions), experiences (e.g., COVID-19 Worries), and age predicted each outcome subgroup. Limitations: Notable limitations of the study are its cross-sectional nature and focus on the first six months of the pandemic. Conclusions: Concomitantly assessing variation in changes of symptoms and service access during the first phase of the pandemic revealed differential outcome profiles in ASD/NDD youth. Subgroups were characterized by distinct prediction patterns across a set of pre- and pandemic-related experiences/contexts. Results may inform recovery efforts and preparedness in future crises; they also underscore the critical value of international data-sharing and collaborations to address the needs of those most vulnerable in times of crisis. [ABSTRACT FROM AUTHOR]

This manuscript reports on a youth‐driven health assessment engaging youth of color in identifying community health priorities during the coronavirus disease 2019 (COVID‐19) pandemic. Photovoice, a participatory visual ethnographic health assessment strategy, was used to explore the question: What does health or healthiness mean to you and/or your community? Youth captured images that represented their priorities. The photos were discussed using the SHOWed framework and analyzed thematically. Four themes related to community health were identified. Additionally, youth captured their narrative of COVID‐19 as "a revealing force that highlights systemic inequities, driving individuals and communities to both cultivate their resilience and take healthcare into their own hands in response to government and policy level failures." Youth are acutely aware of the historical and structural inequities that create multi‐level barriers to healthcare access. Health inequities existed long before the pandemic, but the current crisis requires us to examine ways to transform the healthcare landscape moving forward. [ABSTRACT FROM AUTHOR]

Background: With most mental health problems established during childhood/adolescence, young people must be a key focus of public mental health approaches. Despite the range of factors known to influence mental health, evidence for effective interventions is lacking for this age group. This study aimed to define priorities for future public health intervention-focused research to support youth mental health by engaging with transdisciplinary stakeholder groups.Methods: Our coproduction approach involved priority-setting workshops with young people, researchers, practitioners and policy-makers. Each workshop focused on three thematic areas: social connections and relationships; schools and other education settings; and key groups at greater risk of mental ill-health, specifically LGBTQ+ and care-experienced young people. Workshop outputs were synthesized to define research priorities.Results: This paper presents the research priorities that were defined through the priority-setting workshops, and our reflections on the coproduction approach to guide future similar activities undertaken by others. Ten priorities for youth public mental health research were defined, covering the following areas: building supportive relationships; whole system approaches; social media; support at times of transition; improving links between different services; development and training for those who support young people; staff mental health; engaging with families; awareness of and access to services; and out-of-school and community settings.Conclusions: These research priorities can inform future intervention development to support youth public mental health. Our transdisciplinary approach means the identified research priorities are likely to be relevant to young people's experiences and needs, and to fit with the needs of those working in practice and policy to support young people. [ABSTRACT FROM AUTHOR]

Constitutional mandates require access to medical testing and treatment in correctional settings, including sexual and reproductive health (SRH) care services. These same mandates do not apply to youth supervised in the community, who represent the majority of justice-involved youth. Waiting until youth are in detention settings to provide access to SRH services misses an opportunity to improve health outcomes for youth who have earlier points of contact with the system. This mixed-methods study explored structural intervention development and policy geared toward increasing access to and uptake of SRH prevention, treatment, care, and support services for court-involved, nonincarcerated (CINI) youth. Data were collected from a nationwide survey (N = 226) and qualitative interviews (N = 18) with juvenile justice (JJ) and public health (PH) system stakeholders between December 2015 and January 2017. Results suggest both PH and JJ stakeholders perceive CINI youth as having substantial, largely unmet SRH care needs due to a lack of services, policies, or procedures to address these needs. Barriers to implementing programs and policies to improve SRH services for this population include limited resources (e.g., staffing, time); perceived irrelevance for juvenile court, probation, or other community supervision settings; and concerns about confidentiality, privacy, and information sharing. Recommendations for effective intervention included colocating services, justice-to-community referrals, and service linkages (e.g., through a community health navigator), and staff education around youth SRH confidentiality and information-sharing practices. Public Policy Relevance Statement: Identifying ways the juvenile justice and public health systems can partner in the community to promote access and linkage to sexual and reproductive health (SRH) services for justice-involved youth is key to informing public policy geared toward reducing adolescent disparities in access to healthcare services. Data collected from public health and juvenile justice key stakeholders provide novel insight into the system-level barriers to implementing programs and policies to address SRH needs of court-involved, nonincarcerated youth. Findings address each system's perceived relevance in addressing these types of needs and present ways these systems might effectively collaborate to address current SRH service gaps and unmet needs for these underserved youth. [ABSTRACT FROM AUTHOR]

Background: Age is a critical factor in substance use and related outcomes, with adolescence being a particularly sensitive period. Early initiation of substance use has been linked with higher risk for developing substance use disorders. In Ontario, Canada, substance use is common among youth, yet treatment is underutilized, suggesting the potential for an unmet need in terms of substance use care. Despite these challenges, there is limited research examining factors that contribute to youth substance use and youth-specific barriers to substance use care. To fill this knowledge gap, this study sought to include the unique perspectives of service providers who work directly with youth to examine these issues.Methods: We used a cross-sectional mixed-methods design to examine factors that contribute to substance use among youth and identify youth-specific barriers to substance use among a sample of 54 Ontario-based youth service providers. Data collection included an online survey completed by all study participants followed by qualitative interviews of a subsample of 16 participants. Data analysis included basic frequency tabulations for survey results and thematic qualitative analyses to identify common themes.Results: Licit substances were identified as the most commonly used among youth, where 94% of respondents identified cannabis use and 81% identified alcohol use. Thematic analyses identified the role of dominant substance use discourses in normalizing certain substances (i.e., cannabis and alcohol) while also endorsing stigmatizing beliefs and sentiments. According to youth service providers, the intersection of these two discourses simultaneously lead to an increase in substance use while deterring youth from seeking substance use care.Conclusions: Normalization and stigmatization are two dominant discourses around youth substance use, with important implications for public health interventions. Key public health strategies, as identified by participants, to reduce the overall negative effect of these factors include the need to reframe substance use discourse, from a moral failing to a public health issue and to educate youth about the impacts of use. To accomplish this goal educational campaigns to raise awareness around the health effects of use and address stigmatization are needed. Educational reforms are also needed to ensure that these programs are integrated into the school system. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of poor mental health continues to rise among youth; however, large-scale interventions to improve mental and physical health remain a public health challenge. Time spent in nature is associated with improved health among youth. This study aimed to assess youth experiences with nature and the self-perceived impact on their mental and physical health among a nationwide sample of US youth.Methods: In September 2020, five open-ended questions that aimed to assess perceptions regarding nature were posed to 1174 MyVoice youth, aged 14-24 years. Qualitative responses were analyzed using thematic analysis, and data were summarized using descriptive statistics.Results: The mean (SD) age of the 994 respondents (RR = 84.7%) was 18.9 (2.7) years; 47.4% were female, and 57.4% Non-Hispanic White. Among youth, many felt that spending time in nature positively impacted their mental health, with 51.6% mentioning that it made them "feel calm when I am out in nature"; 22.1% said that it relieved stress or "reduces my anxiety," and 17.1% felt that being in nature positively impacted their physical health and "makes me feel more active and in shape." However, 7.0% said it negatively impacted their health, such as "It makes me feel isolated." Most youth (87.8%) want to spend more time in nature, with 22% mentioning barriers (i.e., busy schedules, built environment, and COVID-19) impeding them from doing so.Conclusions: Youth in our sample generally report feeling physically and mentally better when spending time in nature and want to spend more time in nature. Public health policies and practices that eliminate barriers and actively support time spent outside may be a feasible and acceptable practice to promote overall well-being among youth. [ABSTRACT FROM AUTHOR]

The purpose of this Special Issue is to describe innovative school-related initiatives to reduce the population prevalence of youth mental health concerns. In this introduction to the Special Issue, we identify strategies that have not worked as well as those that have promise in improving youth mental health outcomes. We then provide a brief overview of each article in this issue. The first several articles focus on a comprehensive countywide approach to child and youth mental health that developed out of a unique tax initiative. In combination, these projects screen school-age youth in the county three times a year; support all county schools in providing universal, selective, and indicated interventions based on these screening data; deliver a mentoring program and school-based psychiatric care to youth with more intensive needs; and provide no-cost evidence-based evaluations, referrals, and ongoing progress monitoring to any family with concerns about their child's mental health. Three additional articles in the Special Issue expand the focus to include other national models, including a statewide initiative in Georgia to bring mental health services to every school, policy issues related to school mental health in South Carolina, and cost analysis strategies for specifying the economic benefit of mental health initiatives. [ABSTRACT FROM AUTHOR]

In this concluding article for the Special Issue, we attempt to summarize lessons learned from these various implementation and evaluation projects. We focus on the following four points: (a) correcting misperceptions of mental health; (b) identifying, training, and coaching system change implementers; (c) distinguishing strategies for launching versus sustaining systemic interventions; and (d) the role of culture in implementation and outcomes. [ABSTRACT FROM AUTHOR]

Objective: We aim to assess youth awareness of and opinions about Title X policy changes in 2019.Study Design: We analyzed data from four open-ended questions and demographic items collected through MyVoice, a national text message survey of youth aged 14-24. We calculated descriptive statistics to summarize awareness of and opinions about Title X. We integrated the quantitative findings with qualitative themes to achieve deeper understanding of the beliefs that inform youth opinions.Results: Seven hundred and fifty youth responded to the text message survey (58.0% response rate). The majority (74.9%) was unaware of recent Title X changes. Most (79.3%) were unsupportive of these changes, and a sizable portion (40%) worried these changes could impact them. Opposition to Title X changes was based upon five themes: (1) youth need to be aware of their health options, including abortion; (2) the policy will undermine reproductive rights; (3) the policy is unfair; (4) the policy is unconstitutional; (5) the policy will threaten public health and health services, including affordable and safe abortion. Those who supported Title X changes (13.8%) described moral objections to abortion and beliefs that the government should not be responsible for abortion care.Conclusions: Most youth in this sample were unsupportive of Title X changes. Limited youth awareness of Title X changes suggests that better youth outreach is needed regarding sexual and reproductive health (SRH) policies.Implications: Although youth represent 40% of clients who receive SRH services through Title X, more efforts are needed to inform and engage them in salient policy changes that may directly affect their SRH health and health care access. [ABSTRACT FROM AUTHOR]

From birth to young adulthood, society places a premium on nurturing development to promote health, wellbeing and productivity. Headspace in Australia and similar international models have shown that barriers to care can be reduced and access to professional mental health care can be enhanced by establishing youth-friendly primary care-based mental health services that are stigma-free, co-designed and offer a soft entry to care.[10] However, an integrated primary care youth service is only one piece of a fully-fledged mental health system for young people. This means public health approaches that target the malleable social and economic determinants of mental disorders and the reinvention of headspace backed by the assembly and scaling up of specialist 12-25 youth mental health services. [Extracted from the article]

Using a social determinants of health framework, we argue that the majority of evidence-based interventions focused on child and adolescent mental health are limited by their focus on individual youth (and sometimes families). While necessary, these interventions are insufficient for addressing the midstream- and upstream/macro-level determinants of mental health in society. We illustrate our perspective through four examples from youth mental health and related services, in which midstream and upstream interventions—i.e., at the community and public policy levels—need to be prioritized along with downstream treatments to improve population mental health and reduce social inequalities in mental health outcomes. [ABSTRACT FROM AUTHOR]

A youth café is a relaxed, drug-free and alcohol-free meeting space for young people. The youth café model has become a prominent form of policy provision for young people in Ireland over the past decade, with in excess of 160 youth cafés now in operation. While the youth café model is not unique to Ireland, there has been little published research internationally on the perspectives of young people regarding the role of youth cafés in their lives. Drawing on qualitative research with 102 young people from 10 youth cafés in Ireland, this article presents findings in relation to six thematic areas: feeling supported; belonging and connection; personal and identity development; safety; alcohol and drugs; and education. The findings indicate that the attraction of the model for young people is that it respects their individualised preferences for engagement whilst providing them with a sense of ownership and connection. It is argued that the values and principles underpinning the model are instrumental in creating care-full' spaces that enhance the well-being of children and young people. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of this article are to: (a) describe the rationale and development of the Youth Compendium of Physical Activities (Youth Compendium); and (b) discuss the utility of the Youth Compendium for audiences in research, education, community, health care, public health, and the private sector.Methods: The Youth Compendium provides a list of 196 physical activities (PA) categorized by activity types, specific activities, and metabolic costs (youth metabolic equivalents of task [METy]) as measured by indirect calorimetry. The utility of the Youth Compendium was assessed by describing ways in which it can be used by a variety of audiences.Results: Researchers can use METy values to estimate PA levels and determine changes in PA in intervention studies. Educators can ask students to complete PA records to determine time spent in physical activities and to identify health-enhancing activities for classroom PA breaks. Community leaders, parents, and health care professionals can identify activity types that promote healthful behaviors. Public health agencies can use the METy values for surveillance and as a resource to inform progress toward meeting national physical activity guidelines. Applications for the private sector include the use of METy in PA trackers and other applications.Conclusion: The National Collaborative on Childhood Obesity Research Web site presents the Youth Compendium and related materials to facilitate measurement of the energy cost of nearly 200 physical activities in children and youth. The Youth Compendium provides a way to standardize energy costs in children and youth and has application for a wide variety of audiences. [ABSTRACT FROM AUTHOR]

The role of therapeutic residential care (TRC) is changing. In fact, this article reframes the terminology of TRC and uses “residential interventions” to more accurately reflect that residential programs provide time-limited “intervention” and treatment efforts must connect and extend to families and communities. Such changes are being compelled by necessity and innovation. Necessity is demanding evidence, data, and durable positive outcomes for this expensive intervention. Innovation is transforming basic service delivery through meaningful inclusion of youth and families and effective collaboration with community-based organizations. Service elements that confound this changing role are being reconsidered, including reductions in length of stay, a focus on long-term permanency, and the location of the actual intervention from program-centric practice to interventions in the home and community. [ABSTRACT FROM AUTHOR]

There is a prevalent view in England that family-based care is the preferred placement option for children placed in out-of-home care. Nonetheless, it is acknowledged that for some young people residential group care can offer the best chance of positive outcomes, transition, and in some cases a route to permanence. With an emphasis on innovation, there has been a recent governmental focus on the role and purpose of these placements. This conceptual paper explores how the political and legislative context has influenced the current opinion and use of residential care, as well as examining the importance of factors such as attachment and relationships, parenting/intervention, the notion of home, a sense of belonging, and adolescent development. Evidence exploring associated risk and resilience factors is also discussed. We question whether adopting a child development perspective and moving the discourse away from placement type to placement purpose would better support children and young people to fulfill their life chances. Residential care undoubtedly offers a different experience to that of family-based care, although, further research assessing a wider range of attributable outcomes is necessary to understand how policy and practice can intervene to best support development and opportunity for children placed in out-of-home care. [ABSTRACT FROM AUTHOR]

This article addresses an apparent paradox between academic and policy depictions of American Indian reservations as "broken" and "unhealthy" places, and Indigenous youth perceptions of reservations as spaces of "health" and "wellness." Public health literature often frames reservations as damaged, health-denying places, chronicling the extraordinarily high rates of suicide, substance abuse, as well as vast health disparities. Despite these dire statistics, our research with Native youth in San Diego County found that young people chose to primarily emphasize their positive experiences with, and attachments to, their reservations. In this article, we share strength- and desire-based narratives to explore how reservations can serve as spaces of wellness for Indigenous youth, despite ongoing settler colonial harm. We seek to expand the discussion on the unintended consequences of deficit-centered scholarship by arguing that health research should also engage with the narratives of hope and desire that are reflective of the way many Native youth feel about their communities. In this article, we urge scholars and practitioners to rethink how we conduct health research to include methodologies that listen to the narratives and experiences of those who, day in and day out, navigate settler colonial landscapes, while continuing to create spaces of hope and healing. [ABSTRACT FROM AUTHOR]

Introduction: Nonsmoking youth form a high-risk group and are at increased risk of ill-effects caused due to secondhand smoke (SHS). The objective is to determine the prevalence and correlates of SHS exposure among the nonsmoking youth in India from global adult tobacco survey (GATS), 2009–10. Methods: Secondary data analysis of GATS, 2009–10 was done to find the correlates of SHS at three different settings – house, workplace - indoor, and public place. All the sociodemographic variables were tested for association with SHS exposure using multivariate analysis. Prevalence ratio with 95% confidence interval [CI] was used to report the risk. Results: The prevalence of SHS was 48.6% (95% CI: 47.7%–49.5%) at house, 25.5% (95% CI: 23.5%–27.6%) at workplace - indoors, and 42.7% (95% CI: 41.7%–43.7%) at public places. SHS exposure among females was found to be higher at house; youth living in rural area were found at increased risk to SHS at both household and public places; and inverse relationship was seen between SHS exposure and education level at both household and workplace - indoors. Overall, the study showed that smokeless tobacco users were at increased risk of SHS exposure at all the three settings. Conclusion: Being female, living in rural area, lower education status, lower socioeconomic status, and use of smokeless tobacco were found to be associated with SHS exposure among nonsmoking youth in India. [ABSTRACT FROM AUTHOR]

This study explores the correlates of early sexual debut and risk factors of sexually transmitted infections (STIs) among the youth in Malawi. Data was obtained from the Malawi Demographic Health Survey 2010. Out of a sample of 2987 males and 9559 females aged 15–24 years, 1405 males and 5217 females were considered. Chi-square and multivariate analysis was performed and findings presented by gender. The results indicate that females aged 15–19 years (OR=4.18), who were Muslims (OR=1.42), with no education (OR=3.99), were significantly more likely to initiate sexual debut early. Meanwhile, males aged 15–19 years (OR=3.50), from the northern region (OR=2.35) and of the Chewa ethnic group (OR=1.45) were significantly more likely to initiate sexual debut early. Muslims males (OR=0.57), from the poorest (OR=0.69) households were significantly less likely to initiate sexual debut early. Females who initiate sex earlier form a distinct risk group in this study. Specific intervention is therefore needed for young females in their early teen years before they initiate sexual debut. [ABSTRACT FROM AUTHOR]

Introduction: The rapid increase in electronic cigarette (e-cigarette) smoking among U.S. youth requires data regarding the age pattern of initiation risk for effective tobacco use prevention.Methods: Data from the 2014 National Youth Tobacco Survey (N=20,680, aged 11-19 years, 50.6% male) were analyzed using survival analysis in 2016 to quantify the likelihood of e-cigarette use initiation by age, overall and by gender and racial/ethnic groups.Results: The estimated mean age of e-cigarette initiation was 17.50 (95% CI=17.47, 17.52) years. The estimated hazards of e-cigarette use initiation were 0 up to age 6 years, increased slowly from age 7 to 11 years, and continued with an accelerated increase up to age 17 years before it slowed down. There were significant gender (male > female) and racial/ethnicity (from high to low: multiracial, white, Hispanic, African, and Asian) differences in the age pattern.Conclusions: E-cigarette smoking is initiated as young as age 7 years. Different from conventional cigarette smoking with peak initiation risk at age 14-15 years, the likelihood of initiating e-cigarette smoking continues to increase up to age 18 years. The unique age pattern and significant gender and racial/ethnic differences provide useful data to support further research to strengthen tobacco use prevention in the U.S. [ABSTRACT FROM AUTHOR]

Background: There is an increasing incidence of type 2 diabetes mellitus (T2DM) in young urban South-Asians. We tested the effect of a pragmatic trimonthly lifestyle modification (LSM) programme (P-LSM) versus a less-intensive 12-monthly control LSM (C-LSM) intervention on a primary composite endpoint of predictors of cardio-metabolic disease (new onset T2DM, hypertension, impaired glucose tolerance (IGT), impaired fasting glycaemia (IFG) and markers of cardio-renal disease) in participants aged 5-40 years with risk factors for T2DM.Methods: This was a randomised controlled trial performed at the National Diabetes Centre, Sri-Lanka. We individually randomised 4672 participants at risk of T2DM, of whom 3539 (mean age 22.5 (range 6-40 years, 48% males) received either trimonthly (P-LSM n = 1726) or 12-monthly (C-LSM n = 1813) peer educator advice aimed at reducing weight, improving diet, reducing psychological stress and increasing physical activity.Results: During a median follow-up of 3 years, the cumulative incidence of the primary endpoint was n = 479 in P-LSM (74 per 1000 person years) vs. 561 in C-LSM (96 per 1000 person years), with an incident rate ratio (IRR) of 0.89 (95% CI 0.83-0.96, P = 0.02). In post hoc analyses, new onset dysglycaemia (T2DM, IFG and IGT), was the major contributor to the composite and was significantly reduced by P-LSM (IRR 0.9, 95% CI 0.83-0.97, P = 0.01). A significant impact of P-LSM on the incidence of the composite endpoint was noted in 1725 participants (P-LSM n = 850, C-LSM n = 875) aged below 18; P-LSM n = 140 (48 per 1000 person years) versus C-LSM n = 174 (55.4 per 1000 person years), with an IRR of 0.83 (95% CI 0.73-0.94, P = 0.004).Conclusions: In a young at-risk South-Asian population, a pragmatic LSM programme significantly reduces the incidence of predictors of cardio-metabolic disease. Our results highlight the importance of early intervention in young at-risk subjects.Trial Registration: World Health Organization international clinical trial registry platform ( SLCTR/2008/003 ). Registration Date: March 28, 2008. Retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: Recent studies analysing the trends in antipsychotic (AP) prescriptions for children and adolescents have raised concerns regarding the influence of socioeconomic status. Previous findings have also shown variable prescription rates for first-generation (FG) and second-generation (SG) APs. Method: Our objectives were to assess the proportion of patients from low-income families receiving APs and the most commonly prescribed APs in France. We conducted a descriptive analysis of AP drugs dispensed during a 1-year period (July 1, 2013-June 30, 2014) in a northwestern region of France with 941,857 subjects less than 18 years old. All data were extracted from an exhaustive, individual and anonymous social security database. We obtained each subject's socioeconomic status (by identifying their affiliation with a specific social security program) and also collected sociodemographic data, drug type, prescribing and dispensing dates and amount, and prescriber type (e.g., hospital physician, general practitioner, psychiatrist, paediatrician). Results: There were two main novel findings. First, we found that the proportion of patients with AP prescriptions was nearly ten times higher in low-income families than in the general population: 35.9% of CMU-C patients compared to 3.7% in all of Pays de la Loire (X2 = 7875.1, p < 0.001). Additionally, we found a higher rate of FGAP than SGAP prescriptions (65% vs. 57%). Conclusions: Our study suggests two types of AP misuse that could provide interesting targets for public healthcare interventions. First, our results strongly suggest an over-representation of patients from low-income families. Low-income families primarily resided in areas with low physician density and appeared to receive drugs to treat their conditions more frequently than other individuals. This increased prescription rate is a public health issue, potentially requiring political action. Second, the use of FGAPs did not adhere to the latest recommendations for drug use in this population, and this discrepancy should be addressed with informational campaigns targeted to medical practitioners. [ABSTRACT FROM AUTHOR]

Young people aged 15-24 years constitute a huge proportion of Nigeria's population and have enormous potential for socio-economic development. However, the fulfillment of that potential is dependent on how society meets their present needs and aspirations. We examined the evidence from 2003 to 2013 to establish whether there has been improvement in social conditions and opportunities for young people in Nigeria. We used the 2003, 2008 and 2013 Nigerian DHS data to estimate young people's wellbeing. Indicators of wellbeing were: unemployment rate, uneducated and unemployed young people, literacy rate; support for schooling, young people not graduating secondary school on time, young people in households where either parent lacks secondary education, teenage pregnancy and young people not covered by health insurance. We used bi-variate statistics and logistic regression to highlight determinants of wellbeing. Unemployment rate increased from 57.0 % in 2008 to 59.2 % in 2013 while the proportion of those who were both uneducated and unemployed was 12.6 % in 2013 (vs. 13.0 and 14.1 % in 2003 and 2008, respectively). Only 0.6 and 0.5 % of young people received support for schooling in 2008 and 2013, respectively. Literacy rate increased from 50.9 % (measured for only women) in 2003 to 71.0 % in 2013. Nearly all young people were not covered by health insurance. There is improvement in young people's wellbeing during the under considered, although progress is still unsatisfactory, with more efforts required. [ABSTRACT FROM AUTHOR]

Introduction: Among the health outcomes measures are the questionnaires of perceived health aimed at children and young people that allow assessing perceptions from the same subjects and their parents, guardians or proxy. It is the case of the Health-related quality of life for instrument children and adolescents KIDSCREEN52 proxy version. Objective: To val idate, l inguist ical ly, the proxy KIDSCREEN-52 instrument in parents with school children and adolescents from Colombia. Methodology: The direct and inverse translation method was used which consisted of three stages: a) agreement with the research group and the original authors of the test b) direct translation with the participation of two people with a degree in languages, c) group interviews to 72 parents or guardians of school children and adolescents from 8 to 18 years of public and private educational institutions from two Colombian cities and, from the six socioeconomic strata. Outcomes: Syntactical changes were included in the introduction of the questionnaire, semantic changes in the demographic and anthropometric questions. Regarding the degree of difficulty in understanding the item valued by parents or guardians (being 1 without difficulty, and 5 with more difficulty in understanding), it was identified that, in general, the average valued with 1 of difficulty in understanding was 96.05%, no item was valued with the maximum degree of difficulty. The dimension that had the highest degree of difficulty, corresponded to the items of the financial resources scale, particularly in younger children; this aspect refers to parents that usually do not administer money, issues identified in the observations of peers or guardians during cognitive interviews. Conclusions: The combination of translation strategies and interviews allows proposing a version of parents suited to the Colombian context to be used in a study of metric validation. [ABSTRACT FROM AUTHOR]

Background: The success of chlamydia screening programmes relies on their ability to effectively target those with greatest need. Young people from disadvantaged backgrounds may be at greater need for chlamydia screening, but existing evidence on the variation of prevalence with social position is inconclusive. We carried out a systematic review to examine variation in chlamydia prevalence in populations and possible sources of this variation. Methods: Studies were eligible if they reported chlamydia prevalence derived from population-based samples that included young people aged 15-24 years from Europe, North America or Australia. Systematic searches of the following databases were undertaken from their inception to November 2014: MEDLINE, Embase, Web of Science and PsychINFO. There were no restrictions by language or publication date. Independent screening for eligibility and data extraction were carried out by two reviewers. Where possible, data were pooled in a meta-analysis using a random effects model. Heterogeneity was further investigated using meta-regression techniques. Results: Of 1248 unique titles and abstracts and 263 potentially relevant full texts, 29 studies were eligible for inclusion. There was relatively strong evidence that disadvantaged young people had an increased risk of having a chlamydia infection across multiple measures of disadvantage, including lower educational attainment (OR 1.94, 95 % CI: 1.52 to 2.47), lower occupational class (OR 1.49, 95 % CI: 1.07 to 2.08) and residence in deprived areas (OR 1.76, 95 % CI: 1.15 to 2.71) with an overall OR of 1.66 (95 % CI: 1.37 to 2.02). Socioeconomic disadvantage was associated with chlamydia infection in both men and women. There was weaker evidence that prevalence estimates also varied by gender and age. Conclusions: This review provides evidence of a consistent association between socioeconomic disadvantage and higher risk of Chlamydia infection. This association may reflect a number of factors including social variation in engagement with Chlamydia control programmes. Chlamydia screening could therefore reduce or increase health inequalities, depending on service provision and uptake by different socioeconomic groups. [ABSTRACT FROM AUTHOR]

Youth gang involvement is a serious public health challenge as adolescents involved in gangs are more likely than others to engage in violence and aggression. To better understand gang involvement, we examined the role of protective (empathy and parental support) and risk (peer deviance and lack of safety at school) factors, as well as their interactions, in predicting adolescent gang affiliation. The study involved a sample of 26,232 students (53.4% females; mean age = 14.62, SD = 1.69) participating in the California Healthy Kids Survey (CHKS), a survey investigating a wide range of youth health and risk behaviors administered in all California schools every 2 years. Using hierarchical linear modeling (HLM), findings indicated that high levels of empathy and parental support were associated with a lower likelihood of affiliating with a gang. Associating with deviant peers and perceiving the school as unsafe were positively correlated with gang membership. At the school level, lack of safety and type of school (special education, vocational, or alternative school vs. comprehensive schools) were associated with greater probability of gang membership. Empathy mitigated the association between deviant peers and gang membership. Aggr. Behav. 41:386-397, 2015. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

ObjectiveTo systematically review literature examining the association between vegetable home availability and vegetable intake in youth.DesignArticles were identified through December 2012 using a search of PubMed, PsychINFO and OVID/Medline databases, using the following keywords in varying combinations: home, environment, availability, vegetable, intake, consumption, children. Quantitative studies examining home vegetable availability and vegetable intake in children and adolescents were included. Fifteen studies were included that met inclusion criteria.SettingStudies were conducted in the USA (n 8), Australia (n 1), Greece (n 1), Iceland (n 1), Denmark (n 1), the UK (n 1), the Netherlands (n 1) and a combination of nine European countries (n 1).SubjectsVarious populations of children and adolescents were examined.ResultsSeven of the studies (47 %) found a positive association between vegetable availability and intake, with the others reporting null findings. There were no clear patterns of association by study design, age of subjects included, comprehensiveness of measures, or inclusion of covariates in analyses. Child report of home availability was associated with child vegetable intake (n 6, all found a positive association), while parent report of home availability was only minimally associated (n 9, one found a positive association; P=0·001 from post hoc Fisher’s exact test comparing parent v. child report).ConclusionsParent perception of availability may be closer to truth, given the parental role in food shopping and preparation. Therefore, to impact child vegetable intake, absolute availability may not be as important as child perception of vegetables in the home. Child perception of availability may be altered by level of familiarity with vegetables. [ABSTRACT FROM AUTHOR]

Overweight/obesity among youth is a grave concern in the USA due to its potential impact on illness such as hypertension, high cholesterol, type 2 diabetes and asthma. This paper reports on the design and usage of iN Touch, a mobile self-management application for tracking observations of daily living (ODLs) in a health coaching program for low-income, urban, minority youth 13-24 years with overweight/obesity. We applied a youth-centered, participatory design approach to design and implementation of the technology and intervention with a representative 10-member youth advisory board. The recommendations were implemented prior to launching the technology in an intervention phase. The application with food, exercise, mood and socializing trackers along with pictures and notes was delivered on an iPod Touch to 24 participants. Mixed methods were applied to evaluate technology acceptance including system-generated data, questionnaires and exit interviews. There was good engagement among participants who recorded 2,117 ODLs over 6 months. The mean rating for usefulness was 3.50/5, SD = 1.18 and for ease of use, 3.83/5, SD = 1.27. Qualitative analysis of exit interviews found that design recommendations were fulfilled and the resulting technology was compelling. Future papers will report on the health impacts of iN Touch. [ABSTRACT FROM AUTHOR]

Background: For better perception of adolescent overweight and obesity as a global public health problem, systematic collection of baseline data is urgently needed in India. Objective: A community-based study was undertaken for better perception of the prevalence and correlates of obesity in an adolescent urban community in Katihar, Bihar. Materials and Methods: A cross-sectional study was conducted among urban adolescents in the eastern part of India to find out prevalence of overweight and obesity and sociodemographic correlates by interview technique followed by clinical examination with ethical consideration. Results: Out of 400 adolescent study participants, 21% were overweight or obese. The study showed that there was a significant association between less consumption of vegetable foods, fruits, meals cooked outside the home, alcohol consumption, yoga practice, socioeconomic status, and the occurrence of overweight/obesity in the adolescents. Conclusions: We attempted to find out the prevalence and risk correlates of overweight and obesity among adolescents and found it quite alarming compared to developed countries. The urban underserved population in India has difficulty to access quality healthcare and not conscious enough to seek healthcare until critically ill. Community-based studies are required to highlight the problem of obesity among urban adolescents by a comprehensive approach. [ABSTRACT FROM AUTHOR]

Background & objectives: Diabetes mellitus is a major public health problem worldwide. With the rising incidence of diabetes in India, it becomes particularly relevant to ascertain its prevalence in various ethnic groups. The objective of this study was to find out the presence of diabetes mellitus in the 'Dawoodi Bohra youth community' and also to assess the factors responsible for it. Methods: A house-to-house study was conducted and 2179 subjects were questioned randomly; children below 18 yr of age were excluded. A questionnaire was given to each member and questions were also asked to test their level of awareness regarding diabetes which was graded on a 5-pointer scale where 1 meant 'very poor' and 5-'excellent'. Diabetes was diagnosed using GOD-POD (oxidase-peroxidase) method according to the WHO criteria. Results: Total number of diabetic subjects found was 246 (11.29%) with a mean age of 60.21±10.91 years. The condition was more common in males (58.94%). The highest prevalence was recorded in the age group of 65-69 yr (22.01%) and none had diabetes in the age group 11-24 yr. Pedigree analysis showed that 109 (44.30%) subjects had at least one affected relative and 23 (9.34%) had at least two diabetic family members; 52 were found to have parents with diabetes. On the 5-pointer scale, the overall care in diabetic subjects was 3.76±0.56 as compared to 2.86±0.60 in non-diabetic subjects (p<0.001). Interpretation &conclusions: Our results indicated that the marital alliances, familial aggregation and lifestyle could be the major factors which enhanced the chances of diabetes in this community. This research work also reflected poor awareness among these people regarding their health and diseases. [ABSTRACT FROM AUTHOR]

The transitioning of youth from pediatric to adult care systems is often fraught with discontinuity, miscommunication and gaps in care. This is most significant for youth with special health care needs. A panel discussion on transitioning youth to adult care systems that was part of a learning collaborative held by The RI Care Transformation Collaborative (CTC) is presented here, illustrated by a pertinent case of a youth with type 1 diabetes. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: In parallel with the obesity epidemic, consumption of sugar-sweetened beverages (SSB) has risen over the same period. Our aim was to investigate associations between the consumption of SSB in childhood and adolescence with subsequent changes in body fatness in early adulthood. SUBJECTS/METHODS: A longitudinal study of 9-year-old children (n=283) enrolled in the Danish part of the European Youth Heart Study with a 6-year and 12-year follow-up. Data were collected at ages 9, 15 and 21 years. Multivariate regression analyses with adjustment for potential confounders were used to evaluate the effect of SSB consumption at 9 and 15 years and change in SSB consumption from 9–15 years on subsequent change in body fatness until 21 years. RESULTS: Subjects who consumed more than one serve of SSB daily at age 15 years had larger increases in body mass index (BMI) (β=0.92, P=0.046) and waist circumference (WC) (β=2.69, P=0.04) compared to non-consumers over the subsequent 6 years. In addition, subjects who increased their SSB consumption from age 9–15 years also had larger increases in BMI (β=0.91, P=0.09) and WC (β=2.72, P=0.04) from 15–21 years, compared to those who reported no change in consumption. No significant association was observed from 9–21 years. CONCLUSION: This study provides new evidence that SSB consumption in adolescence and changes in SSB consumption from childhood to adolescence are both significant predictors of change in body fatness later in early adulthood. [ABSTRACT FROM AUTHOR]

Background: Substance use and weight gain among youth increase the risk for future disease. As such, the purpose of this study is to examine how many Canadian youth are currently failing to meet substance use and weight gain related public health guidelines. Methods: Data from the 2010–11 Youth Smoking Survey were used to examine grade 9 to 12 students meeting seven different guidelines by sex and by grade. Results: Among Canadian youth, 8.8% were current smokers, 18.8% were current marijuana users, 25.5% were current binge drinkers, 22.5% were considered overweight or obese, 31.2% did not meet physical activity guidelines, 89.4% exceeded sedentary behaviour guidelines, and 93.6% reported inadequate fruit and vegetable intake. The mean number of risk factors per student was 2.9 (±1.2); only 0.5% of youth reported having none of the risk factors. Conclusion: Students rarely met all seven public health guideline examined, and the vast majority of actually reported having two or more modifiable risk factors for disease. [ABSTRACT FROM AUTHOR]

Then aims of the current study were 1) to provide cross-national estimates of the prevalence of physical fighting and weapon carrying among adolescents aged 11–15 years; (2) To examine the possible effects of physical fighting and weapon carrying on the occurrence of physical (medically treated injuries) and emotional health outcomes (multiple health complaints) among adolescents within the theoretical framework of Problem Behaviour Theory. 20,125 adolescents aged 11–15 in five countries (Belgium, Israel, USA, Canada, FYR Macedonia) were surveyed via the 2006 Health Behaviour in School Aged Children survey. Prevalence was calculated for physical fighting and weapon carrying along with physical and emotional measures that potentially result from violence. Regression analyses were used to quantify associations between violence/weapon carrying and the potential health consequences within each country. Large variations in fighting and weapon carrying were observed across countries. Boys reported more frequent episodes of fighting/weapon carrying and medically attended injuries in every country, while girls reported more emotional symptoms. Although there were some notable variations in findings between different participating countries, increased weapon carrying and physical fighting were both independently and consistently associated with more frequent reports of the potential health outcomes. Adolescents engaging in fighting and weapon carrying are also at risk for physical and emotional health outcomes. Involvement in fighting and weapon carrying can be seen as part of a constellation of risk behaviours with obvious health implications. Our findings also highlight the importance of the cultural context when examining the nature of violent behaviour for adolescents. [ABSTRACT FROM AUTHOR]

Objectives: To examine whether the free swimming initiative in Bristol was associated with higher uptake in more affluent areas ('inverse use law'). Study design: Secondary analysis of statistical data on free swimming session attendances in Bristol, recorded from January to June 2010. Individual postcode data were linked to lower-layer super output area (LSOA) of residence and the specific pool attended. Methods: The dataset comprised 58,582 swims by 13,881 unique individuals between January and June 2010. The influence of age group, gender, season, distance from pool and area deprivation score (English Index of Multiple Deprivation) on swimming uptake rates was examined. Results: Higher uptake rates were found amongst girls and older children. Higher attendance was also related to proximity to pool and warmer season. No association was found between area deprivation and uptake rate (P = 0.31). Lower uptake rates in deprived areas were more marked if they were further away from a pool and in the winter season (P-value for interactions <0.001). Conclusions: The termination of the free swimming initiative in England may have removed an opportunity to promote physical activity across the social gradient. The evaluation of public health initiatives should examine effects across the social gradient, and clarify which aspects of interventions enhance the participation of poorer sections of society. [ABSTRACT FROM AUTHOR]

Street children, or children who live and/or spend time on the streets, are a vulnerable group of considerable concern to the global public health community. This paper describes the results of two linked qualitative studies conducted with children living or spending time on the street and in orphanages in and around urban areas in the Republic of Georgia between 2005 and 2006. The studies examined perceived causes of children going to the street, as well as indicators of healthy functioning and psychosocial problems among these children. Results on causes indicated a range of "push" factors leading children to the street and "pull" factors that keep children living on the street. Findings also showed a range of internalizing and externalizing mental health symptoms among children on the street and within orphanages. Some differences in responses were found between children living on the street and in institutions. It is important to understand the perspectives of these vulnerable populations to guide decisions on appropriate interventions that address their primary problems. [ABSTRACT FROM AUTHOR]

Background/Objectives:Vitamin D levels are often observed to be low in Canadian youth, despite the mandatory fortification of fluid milk. We identified modifiable correlates of plasma vitamin D concentrations to inform public health efforts to remediate low-vitamin D status.Subjects/Methods:We recruited 159 children aged 8-11 years, who were at at high risk of obesity, non-systematically during different seasons. Vitamin D status was assessed by measuring plasma 25-hydroxyvitamin D (25(OH)D) using a radioimmunoassay. Dietary intake, including vitamin supplements, was measured using three dietitian-administered 24 h diet recalls. Fat mass was measured by dual energy X-ray absorptiometry. Accelerometers were worn for 7 days to estimate physical activity. Independent correlates of plasma 25(OH)D concentrations were identified using multiple regression in an analysis controlling for season of measurement.Results:Approximately, 7% of youth had hypovitaminosis D (25(OH)D 37.5 nmol/l) during winter and spring when vitamin D levels are at their nadir. Only 55% of participants had vitamin D levels, which the Institute of Medicine considers optimal (25(OH)D >50 nmol/l). The mean dietary vitamin D intake, 6.6 mcg, was well below current recommendations set at 15 mcg. A serving increase in milk consumption and a s.d. increase in physical activity were associated with only a 2.9 and 2.1 nmol/l increase in plasma 25(OH)D, respectively. There was no association between 25(OH)D and adiposity.Conclusions:Our results indicate the challenges of obtaining adequate vitamin D intake from the current food supply to support a level of 25(OD)D >50 nmol/l. [ABSTRACT FROM AUTHOR]

As obesity rates have climbed, the planning literature has identified possible connections between health and the built environment. This paper reports on the results of focus group discussions with planners and policy-members in Atlantic Canada, a region with high youth obesity rates. Planner participants showed limited knowledge of the way that planning and zoning policies could affect healthy eating options for youth. They believed that the built environment affected mobility outcomes but commonly attributed obesity to lifestyle choices. The research identifies the need for greater communication and collaboration amongst different government departments and levels to increase understanding of potential links between the built environment and health outcomes for youth. [ABSTRACT FROM AUTHOR]

Background: To curb the tobacco epidemic a combination of comprehensive interventions are needed at different levels. Smoking uptake is a multi-factorial process that includes societal factors as well as social and individual characteristics. An understanding of the process is essential in order to model interventions. The aim of this study was to explore the role of smoking for young smokers by focusing on the mechanisms that facilitate young people starting to smoke as well as what could have prevented them from starting. Methods: A qualitative research design using focus group discussions was chosen as the basis for a content analysis approach. Eight focus groups were conducted with five to six participants in each (four groups with boys, four with girls). The informants were purposively selected to represent smokers in the age range of 15-16 years within the county. The total number of group participants was 44; 21 were girls and 23 boys. The study was performed at 7-9th grade schools in Västerbotten County in northern Sweden. Results: Three themes related to different aspects of youth smoking behaviour emerged from the analysis. Theme 1) "gaining control" reflects what makes young people become smokers; theme 2) "becoming a part of the self" focuses on what facilitates youths to start smoking; theme 3) "concerned adults make a difference" indicates what may prevent them from starting. Conclusion: Young smokers described starting to smoke as a means of gaining control of feelings and situations during early adolescence. Smoking adolescents expect adults to intervene against smoking. Close relations with concerned adults could be a reason for less frequent smoking or trying to quit smoking. Interventions aimed at normative changes, with consistent messages from both schools and parents about the negative aspects of tobacco seem to be a feasible approach for preventing youth from using tobacco. [ABSTRACT FROM AUTHOR]

Background: There is an urgent need for more carefully developed public health measures in order to curb the obesity epidemic among youth. The overall aim of the "EuropeaN Energy balance Research to prevent excessive weight Gain among Youth" (ENERGY)-project is the development and formative evaluation of a theory-informed and evidence-based multi-component school-based and family-involved intervention program ready to be implemented and evaluated for effectiveness across Europe. This program aims at promoting the adoption or continuation of health behaviors that contribute to a healthy energy balance among school-aged children. Earlier studies have indicated that school and family environments are key determinants of energy-balance behaviors in schoolchildren. Schools are an important setting for health promotion in this age group, but school-based interventions mostly fail to target and involve the family environment.Methods: Led by a multidisciplinary team of researchers from eleven European countries and supported by a team of Australian experts, the ENERGY-project is informed by the Environmental Research Framework for Weight gain Prevention, and comprises a comprehensive epidemiological analysis including 1) systematic reviews of the literature, 2) secondary analyses of existing data, 3) focus group research, and 4) a cross European school-based survey.Results and Discussion: The theoretical framework and the epidemiological analysis will subsequently inform stepwise intervention development targeting the most relevant energy balance-related behaviors and their personal, family-environmental and school-environmental determinants applying the Intervention Mapping protocol. The intervention scheme will undergo formative and pilot evaluation in five countries. The results of ENERGY will be disseminated among key stakeholders including researchers, policy makers and the general population.Conclusions: The ENERGY-project is an international, multidisciplinary effort to develop and test an evidence-based and theory-informed intervention program for obesity prevention among school-aged children. [ABSTRACT FROM AUTHOR]

Background: A lack of physical activity (PA) and the occurrence of overweight and obesity among school-aged youth have become a major societal problem. Arising from the general concern about the future generations' health, schools have been found to be potentially important settings to promote positive health behaviour, since all pupils can be reached spending large amounts of time in the school environment. Moreover, it is beyond doubt that physical education (PE) has a key role to play. As in other European countries, the Flemish PE goals identify the importance of PA in the development and maintenance of good health. However, the discrepancy between the important role attributed to PE with regard to the development of a healthy and physically active lifestyle and the currently observed increasing sedentary and unhealthy behaviour of children and youth, is one of the reasons to question the efficiency of the current PE curricula. Aims: Within the framework of the Flemish education system, this paper aims to document on the pathways by which PE and schools can contribute to establish lifetime adherence to sport and physical activity in order to enhance and maintain young people's health later in life. From a public health perspective, this is one of the main challenges for PE in the forthcoming decades. Methods: The current PE curriculum requirements and implementation in Flemish schools are described as a starting point. Then, evidence-based recommendations are formulated in order to optimise the content and delivery of the PE curriculum towards its health-related goals. Conclusions: School PE has been recognised as the foundation base of the PA participation pyramid. Nevertheless, there is a need to move beyond the PE and school curriculum. Especially, schools, parents and the community should work together to encourage children and youth to be physically active. As a consequence, the PE teachers' role should not be restricted to the education of pupils during PE lessons, but should be expanded to include guiding youths in the process of becoming physically active both inside and outside school and for life. PE teachers have to accept this responsibility and this effort has to be recognised by the school board. [ABSTRACT FROM AUTHOR]

Background: In 2005, the American Journal of Public Health published an article that indicated that 22% of the overall decline in youth smoking that occurred between 1999 and 2002 was directly attributable to the truth® social marketing campaign launched in 2000. A remaining key question about the truth campaign is whether the economic investment in the program can be justified by the public health outcomes; that question is examined here. Methods: Standard methods of cost and cost–utility analysis were employed in accordance with the U.S. Panel on Cost-Effectiveness in Health and Medicine; a societal perspective was employed. Results: During 2000–2002, expenditures totaled just over $324 million to develop, deliver, evaluate, and litigate the truth campaign. The base-case cost–utility analysis result indicates that the campaign was cost saving; it is estimated that the campaign recouped its costs and that just under $1.9 billion in medical costs was averted for society. Sensitivity analysis indicated that the basic determination of cost effectiveness for this campaign is robust to substantial variation in input parameters. Conclusions: This study suggests that the truth campaign not only markedly improved the public''s health but did so in an economically efficient manner. [Copyright &y& Elsevier]

Background: Televised anti-tobacco advertising has been shown to be effective for discouraging smoking initiation; however, purchasing broadcasting time is very costly. This study investigated the relative impact of the broadcast volume (media weight) and the emotional content of an ad as predictors of advertising recall. Methods: The data come from a random-digit-dialed survey conducted in 2001 and 2002 of 3863 youth aged 12–17. Media weight was based on commercial TV ratings data. The emotional intensity of advertisements was derived from the ratings made by independent youth judges. Results: Data analyses were conducted between 2005 and 2007. Results indicated that media weight was a significant predictor of recall, but the emotional content of the ad was an even stronger predictor. Also, ads low in emotional intensity required more media weight than those high in emotional intensity to achieve the same amount of increase in recall. Conclusions: This study extends prior research that highlights the importance of emotional intensity for effective anti-tobacco advertising. It also indicates that, relative to unemotional advertisements, emotionally arousing advertisements require fewer broadcasts to achieve the same level of recall, and hence are likely to be less costly to a public health campaign. [Copyright &y& Elsevier]