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Background: As the incidence of overweight continues to increase among children and adolescents in Guatemala, underweight remains a prominent health problem. However, the prevalence of overweight or underweight and associated risk factors has not been investigated among adolescent girls. Objective: To determine the prevalence of underweight and overweight/obesity and associated sociodemographic, dietary, and lifestyle factors among adolescent girls in Jutiapa, Guatemala. Methods: A cross-sectional study of a subsample of 392 girls aged 12 to 17 years from an agriculture-nutrition trial was conducted. Anthropometric data were obtained using standard methods. Sociodemographic, dietary, and lifestyle data were collected using a structured questionnaire. Multivariable logistic regression was conducted using underweight (body mass index [BMI] for age < 5th percentile) and overweight/obesity (BMI for age ≥ 85th percentile) as outcome variables. Results: The prevalence of underweight and overweight/obesity was 9.9% and 15.6%, respectively. Age (15-17 years), high waist circumference, high blood pressure, father being a farmer, large family (> 5 persons), hours spent watching TV, and high red meat consumption were significantly associated with underweight. Whereas being in school, high waist circumference, high blood pressure, overweight/obese mother, unemployed father, watching TV for more than 2 hours, having soft drinks at home, and meeting fruit recommendations were significantly associated with overweight/obesity. Conclusions: Our findings highlight the importance of concurrently addressing underweight and overweight/obesity among adolescent girls in rural Guatemala. Studies in various parts of the country are needed to confirm the results of the present study and for appropriate strategies to be implemented to reduce both underweight and overweight.

ObjectivesTo evaluate the efficacy of the Nurtured Heart Approach (NHA) to improve attention deficit hyperactivity disorder (ADHD) behaviors in children.MethodsIn 2017, we conducted a trial among parents (n = 104) with children ages 6–8 years diagnosed with ADHD/at risk for a diagnosis. Participants were randomly selected, but not blinded, to the immediate (NHA) or delayed (control) group. The NHA training was held online over 6 weeks.ResultsThe NHA group (−7.0 ± 8.1), but not the control group (0.2 ± 6.6), reported a decrease in inattention (p < .001). The NHA group (−7.9 ± 9.3), but not the control group (−0.5 ± 7.3), reported a decrease in hyperactivity/impulsivity (p < .001).ConclusionsThe study provides preliminary data of the NHA's potential to improve ADHD related behaviors.

Culturally grounded after-school programs (ASPs) aim to promote health and well-being among Indigenous youth. Native Spirit is a 10-session ASP that focuses on local cultural values and activities facilitated by local cultural practitioners. This pilot study used a single group, pretest-posttest design (N = 18) with Indigenous adolescents in grades 7-12 and conducted participant interviews (N = 11) to assess the impact of the program on cultural identity, self-esteem, and resilience. There were immediate post-program increases in mean strength in cultural identity (p = 0.002), resilience (p = 0.161), and self-esteem (p = 0.268). Themes related to benefits of program participation included curiosity and commitment to cultural identity, increases in self-esteem, and ability to build resilience. This study provides new insights on the relationship between cultural engagement and adolescent health.

Background Bullying is associated with negative health outcomes such as depression. Most studies target non-Latinxs, though they often experience higher rates of bullying and depression. This review examines the inclusion of Latinxs in studies of bullying and depression and factors unique to them. Methods Databases were searched for articles related to bullying and depression. Two reviewers found 957 publications and identified 17 for inclusion. Results All 17 studies demonstrated a relationship between bullying and depression. Nine examined variables unique to Latinxs. Conclusions Studies that included variables unique to Latinxs found a stronger relationship between bullying and depression. Inclusive measures and design are key to understanding and reducing the consequences of bullying in this population.

Background: The Interactive Systems Framework (ISF), a guide for translational research, encourages the balancing of traditional research and community-based participatory research (CBPR) approaches. Objectives: This paper focuses on the challenges, solutions, and lessons learned in applying the ISF to our translational research project. Methods: A community–campus partnership translated evidence-based screening guidelines on sexually transmitted infections (STIs) and depression into culturally relevant educational materials. Community health workers (CHWs) disseminated the information through a cross-over design to Hispanic women in Pima County, Arizona. Challenges, solutions, and lessons learned were identified throughout this process. Lessons Learned: We identified challenges in the areas of research design, and in the ISF systems of prevention synthesis and translation, prevention support, and prevention delivery. We successfully negotiate solutions between the scientific and local community that resulted in acceptable compromises for both groups. Conclusions: The model presented by the ISF is difficult to achieve, but we offer concrete solutions to community members and scientists to move toward that ideal.

Background Smoking is a leading risk factor for heart disease and cancer. By identifying factors associated with smoking onset, more effective prevention programs can be developed. Research questions are 1) does smoking susceptibility status change from grade six to eight, 2) are indicators of risk (perceived harm, smoking susceptibility status, positive peers, and resilience) measured in sixth grade associated with smoking susceptibility status in eighth grade and, 3) are there differences by gender in either research question? Methods The current study is a secondary analysis of data collected during the evaluation of a Safe Schools Healthy Students Project. Students were followed from grade six to grade eight, with survey data collected in each grade from August 2006 to December 2008. Participants (n = 577) were in grade six at baseline, 52% were girls and 57% identified as White, non-Hispanic. Results From grade six to grade eight the number of students in the high smoking susceptibility status doubled (5% to 17%). More boys than girls moved into the high susceptibility group over time. By eighth grade, boys were twice as likely to belong to the high smoking susceptibility group compared to girls (p = 0.01). Multiple logistic regression models showed that the positive peers' variable in grade six was protective for girls in their reported smoking susceptibility in grade eight. In contrast, higher resilience scores in grade six were protective for boys' reported smoking susceptibility in grade eight. Conclusions Smoking susceptibility rose over time for all adolescents, but boys had notably sharper increases. Positive peers and having resources important to resilience may be beneficial in preventing the attitudes that support smoking initiation. Based on these results, we recommend gender-tailored, school-based smoking prevention programs that begin in grade six.

The current study draws upon ecodevelopmental theory to identify protective and risk factors that may influence emotional distress during adolescence. Hierarchical regression analyses were used to examine the relationship among family obligations, school connectedness and emotional distress of 4,198 (51% female) middle and high school students who were primarily (59%) European American. The overall model explained 21.1% of the variance in student emotional distress. A significant interaction effect was found indicating that school connectedness moderated the relationship between family obligations and emotional distress. Specifically, for students with low to moderate levels of family obligations, a stronger sense of school connectedness was associated with lower emotional distress. The buffering effect of school connectedness was weakened as the level of family obligations increased and completely disappeared for students who experienced high levels of family obligations. The creation of a program that takes a holistic approach, in order to curtail the levels of highly emotionally distressed adolescents, must continue to address the ever changing demands that adolescents encounter and prepare youth to deal with functioning within multiple contexts and do so while maintaining emotional well-being.

Objective We estimated the prevalence of human papillomavirus (HPV) vaccination by ethnicity and race and compared vaccination use by known risk factors. Materials and methods We applied a cross-sectional design using an anonymous, online survey distributed in 2011 to female undergraduates (n = 284) between the ages of 18 and 26 years. The study was approved by the University of Arizona Institutional Review Board. Results Overall, 55% of women reported receiving the HPV vaccine. Within racial and ethnic groups, HPV vaccination was highest among American Indian/Alaska Native women with 71%, followed by Hispanic women with 68%, black/African American women with 58%, white women with 51%, and Asian/Pacific Island women with 31%. Moreover, Hispanic women were twice as likely to be vaccinated compared with white women (OR = 2.08; 95% CI = 1.14-3.78). Among unvaccinated women, 55% had discussed HPV with a provider and 56% had reported no concerns about the vaccine and/or had high levels of HPV knowledge. Conclusions Human papillomavirus vaccine is highly acceptable among college women, particularly among Hispanic women. Efforts to vaccinate should include time of college enrollment. Such efforts are critical for the large scale prevention of cervical cancer and its precursor lesions and ultimately for preventable cervical cancer mortality.

To examine the concordance between parent report and electronic medical record documentation of asthma health education provided during a single clinic visit and second-hand tobacco smoke exposure among children with asthma.Parents of children with asthma were recruited from two types of clinics using different electronic medical record systems: asthma-specialty or general pediatric health department clinics. After their child's outpatient visit, parents were interviewed by trained study staff. Interview data were compared to electronic medical records for agreement in five categories of asthma health education and for the child's environmental tobacco smoke exposure. Kappa statistics were used to identify strength of agreement. Chi square and t-tests were used to examine differences between clinic types.Of 255 parents participating in the study 90.6% were African American and 96.1% were female. Agreement was poor across all clinics but was higher within the asthma specialty clinics than the health department clinics for smoke exposure (κ = 0.410 versus 0.205), asthma diagnosis/disease process (κ = 0.213 versus -0.016) and devices reviewed (κ = 0.253 versus -0.089) with parents generally reporting more education provided. For the 203 children with complete medical records, 40.5% did not have any documentation regarding smoking exposure in the home and 85.2% did not have any documentation regarding exposure elsewhere.We found low concordance between the parent's report and the electronic medical record for smoke exposure and asthma education provided. Un- or under-documented smoke exposure and health education have the potential to affect continuity of care for pediatric patients with asthma.