Journal of Adolescent Health最新文献

Purpose: Caloric restriction and excessive exercise create an energy imbalance with medical sequelae in restrictive eating disorders. We examined the effect of acute and chronic energy imbalance on admission illness severity and refeeding outcomes in adolescents and young adults with anorexia nervosa (AN) and atypical AN.

Methods: Secondary data analysis from the Study of Refeeding to Optimize Inpatient Gains, a multicenter randomized trial comparing higher- versus lower-calorie refeeding in 120 youth with AN or atypical AN hospitalized with medical instability. Vital signs were measured daily. Acute energy balance was calculated as caloric output (exercise recall plus estimated resting energy expenditure) subtracted from caloric input (dietary recall) before admission. Chronic energy imbalance variables included magnitude, rate, and duration of weight loss before admission. Regression analyses examined associations among energy balance, illness severity, and refeeding outcomes; dominance analyses examined the relative importance of energy balance.

Results: Among 82 participants (91% female), admission mean (SD) age was 16.5 (2.5) years, %median body mass index was 85 (10) and acute energy balance was -898 (678) kilocalories. Those with more negative acute energy balance before admission required more days (-0.18, [95% CI, -0.35, -0.02] p = .03) and kilocalories to restore medical stability (-431.10, [95% CI, -857.06, -5.13] p = .047). Acute energy balance was a more important predictor than weight suppression in determining these outcomes.

Discussion: More acute negative energy balance was associated with a need for more intensive refeeding, which supports the inclusion of preadmission dietary recall and exercise assessments, alongside weight history, to inform individualized refeeding protocols.

Purpose: Evidence on the effect of menstrual health and hygiene (MHH) interventions on education is scarce. This trial assessed the effect of a multicomponent intervention on school attendance, urogenital health, and other wellbeing outcomes among schoolgirls in rural Gambia.

Methods: A cluster-randomised controlled trial was conducted between July 2019 and December 2020 in 50 villages across 2 regions of The Gambia, selecting one school per village. Using restricted randomisation, half of the villages received a 3-month NGO-led intervention, which included Peer education camps, Mother's outreach sessions, Community meetings and improving school water, sanitation, and hygiene (WASH). The other 25 villages received no intervention. The primary outcome was self-reported schoolgirls' absenteeism of at least one-day due to last period. Secondary outcomes included: urinary tract infections measured with symptoms and biochemical markers, reproductive tract infections symptoms, menstruation-related wellbeing, social support and knowledge, attitudes, and practices toward menstruation. All menstruating schoolgirls 13 years and older were eligible for outcome assessment. We analyzed data on an intention-to-treat basis.

Results: Outcome assessment included 3556 schoolgirls (1832 [51.5%] in the intervention group and 1724 [48.5%] in the control group). Self-reported school absenteeism was only slightly lower in the intervention arm than the control arm (15.6% vs. 17.1%, risk difference = -1.4%, 95% CI = -4.6%-1.9%). The intervention had no effect on urogenital health but had broad positive effects on menstrual knowledge, attitudes, wellbeing, and social support.

Discussion: The multicomponent MHH intervention had no effect on absence due to last period, but achieved improvements in MHH knowledge, experiences, and needs.

Purpose: Investigating drinking motives among minors across various countries is crucial for understanding the broader social context of alcohol consumption. Thus, this study aimed to examine the differences and similarities in drinking motives among 15-16-year-old adolescents who consume alcohol across 16 European countries.

Methods: The data were obtained from the European School Survey Project on Alcohol and Other Drugs database. The analysis focused on 15-16-year-old school-going students across 16 European countries (Denmark, Estonia, Finland, Germany, Greece, Iceland, Italy, Latvia, Lithuania, The Netherlands, Norway, Poland, Portugal, Romania, Sweden, and Spain). The students were presented with a series of questions pertaining to drinking motives, aimed at elucidating the reasons behind their alcohol consumption within the past 12 months.

Results: A total of 52,141 students participated, with 75.2% reporting lifetime alcohol consumption and 65.8% reporting alcohol consumption in the past year. Among those who drank in the past year (n = 34,295), 3 distinct drinking motive factor groups were identified: enhancement and social motives, coping motives, and conformity motives. Enhancement and social motives were most prevalent across all countries, followed by coping motives, with conformity motives less common.

Discussion: This largest drinking motive study, conducted to date, examined drinking motives among 15-16-year-old students across 16 European countries. There is a significant positive correlation between alcohol intoxication prevalence and mean score on enhancement and social motives at an aggregate level, which suggests a stronger presence of enhancement and social motives in cultures with a more intoxication-oriented drinking pattern.

Purpose: Opioid use disorder (OUD) is a growing public health crisis. However, no study to date has systematically evaluated the burden of OUD among adolescents and young adults (AYAs). We aimed to report the global level and trends of OUD burden among AYAs.

Methods: Data were obtained from the Global Burden of Disease study 2019, which was conducted from 1990 to 2019 in 204 countries. AYAs were defined as individuals aged 15-39 years, and the study period was 1990-2019. The burden of OUD was evaluated in terms of case numbers and age-standardized rates per 100,000 population.

Results: In 2019, there were 2,396,734 incident cases, 14,502,031 prevalent cases, 43,447 deaths, and 8,651,931 disability-adjusted life years of OUD among AYAs globally. High-income North America had the greatest regional burden, with the United States having the highest burden nationally. From 1990 to 2019, age-standardized incidence rate (ASIR), age-standardized prevalence rate, age-standardized mortality rate, and age-standardized disability-adjusted life years rate (ASDR) showed upward trends, with average annual percentage change of 0.62, 0.81, 1.55, and 1.01, respectively. Despite the burden of OUD was higher in males than in females, the increment in ASIR was greater in females than in males after 2014. Nationally, OUD burden showed increasing trends in ASIR, age-standardized prevalence rate, and ASDR across 150+ countries, with the United States experiencing the greatest increase in age-standardized mortality rate and ASDR. Meanwhile, there was a positive correlation between sociodemographic index and OUD burden, with higher sociodemographic index associated with a higher burden of OUD in 2019.

Discussion: OUD in AYAs is a major global public health issue, and the burden of OUD is increasing. This alarming trend underscores the urgent need for comprehensive prevention strategies, targeted interventions, and effective treatment options tailored to younger populations.

Purpose: Many prior studies on adolescent electronic nicotine delivery systems (ENDS) did not differentiate regular users from light users or experimenters. This study was conducted to investigate the longitudinal behavioral transitions among adolescent ENDS users.

Methods: Data were drawn from Waves 2, 3, 4, 4.5, and 5 (October 2014-November 2019) of the Population Assessment of Tobacco and Health (PATH) Study and analyzed in 2023. A total of 894 participants (1) who reported at least one day of ENDS use within the past 30 days at any of the waves; and (2) who had ENDS use data on at least 2 different waves were retained in the final analysis sample (N = 894). Markov multistate models were fitted to estimate transition hazard rates between experimental use, nonfrequent use, frequent use, and no use.

Results: Whereas experimental use grew from 2.6% at Wave 2 to 15.4% at Wave 5, nonfrequent use grew from 2.9% to 18.9%, and frequent use grew from 0.3% to 18.8%. Sixty-five percent of experimental use reverted to no use whereas 20% of experimental use progressed to either nonfrequent (12%) or frequent ENDS use (8%) in a year. Once ENDS use is initiated, the percentage progressing to frequent ENDS use jumped to 19% while 20% staying as nonfrequent use in a year. The average past 30-day use frequency of those who reported "fairly regular" use increased over time (6.2 days at Wave 2 to 15.7 days at Wave 5).

Discussion: These findings demonstrate worrisome tendency of increasing intensity of ENDS use in today's adolescents.

Purpose: Childhood adversity is linked to poorer adult health; prior research has established a reciprocal association between health and civic engagement. However, little research has examined the relationship between adverse childhood experiences (ACEs) and civic engagement. We examined whether ACEs are associated with civic engagement at ages 18-26 years and evaluated the potential moderating role of perceived survival expectations (PSE) (i.e., likelihood of living to age 35).

Methods: Data are from Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health. Multivariable linear regression using survey weights was used to model associations between experiencing 0, 1, 2-3, or 4+ ACEs and civic engagement (composite score) overall and by type of ACE (i.e., child maltreatment, violent victimization in the community, family member suicide, family substance abuse, divorce, household member incarceration, and family member death). An ACE by PSE interaction term was tested.

Results: Twelve thousand two hundred eighty eight participants were included. Experiencing 2-3 ACEs (β = -0.14; confidence interval [CI]: -0.23, -0.043) and 4+ ACEs (β = -0.17; CI: -0.32, -0.025) were each associated with lower civic engagement compared to experiencing no ACEs. Violent victimization (β = -0.14; CI: -0.22, -0.058) and family substance abuse (β = -0.13; CI: -0.21, -0.049) were negatively associated with civic engagement, accounting for multiple comparisons. There was no evidence of moderation by PSE.

Discussion: ACEs, particularly violent victimization in the community and family substance abuse, may shape civic development. Interventions could promote civic engagement and lessen the impact of childhood adversity on individual and community health.

Youth placed in U.S. juvenile detention facilities face multilevel barriers that contribute to disparate sexual and reproductive health (SRH) outcomes when compared to their peers in the general adolescent population. Minimal information is available about evidence-based interventions that have been effective in changing these outcomes. The aim of this scoping review was to focus on the current state of SRH and identify recommendations for SRH care. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews guidelines, we searched electronic databases for publications published through March 2024. The search terms were designed to find intervention studies focusing on SRH in U.S. juvenile detention facilities. Eighteen articles were identified, all of which found some combination of positive results. While some intervention content focused on SRH knowledge and attitudes, the majority of studies had sexual risk behaviors in combination with sexually transmitted infections, substance use, or partner violence as their focus. The minimal number of research interventions focused on the structurally vulnerable population of youth in detention facilities across the United States underscores a significant gap in the existing literature, with negative health outcomes for juveniles in detention facilities.