Bridge Nodes Linking Depression and Medication Taking Self-Efficacy Dimensions Among Persons With HIV: A Secondary Data Analysis.

Depression and low medication taking self-efficacy are among the most important mechanisms contributing to poor adherence to treatment and care for persons with HIV (PWH). While the overall negative relationship between depression and medication taking self-efficacy has been well established, little is known on the precise pathways linking depression and medication taking self-efficacy. Thus, it is critical to identify a specific item of depression and medication taking self-efficacy that derives the overall negative relationship. The current study is a secondary data analysis using the baseline data from a randomized controlled trial that aims to support PWH to self-manage antiretroviral therapy regimens via mHealth technology and community health workers to monitor their adherence using a self-management app. A total of 282 participants were included. The machine-learning based network analysis was conducted to explore the structure of the depression and medication taking self-efficacy network and to identify bridge nodes between depression and medication taking self-efficacy. Our study identified difficulty concentrating on things and confidence to stick to treatment schedule when not feeling well are important bridge nodes connecting the network of depression and medication taking self-efficacy. Future studies should focus on developing interventions that would target the bridge pathway and examine their effectiveness in reducing depression and increasing medication taking self-efficacy.

Building a healthy nation: A white paper on Olympic sports and the Indian education system.

The Indian education system has produced top-class global corporate leaders in recent decades. The combination of a solid educational foundation, work ethic, adaptability, technical and analytical skills, leadership abilities, networking, entrepreneurial spirit, and cultural values collectively contribute to the success of Indian students and professionals in the corporate world. On the contrary, India's overall performance in Olympic sports has been modest compared to its population and potential. The education system of any country has a significant role in sporting success. To fully harness the potential of sports in schools, addressing these challenges and creating a supportive environment that values and promotes sporting abilities alongside academic excellence is essential. This will require concerted efforts from various stakeholders, including the schooling system, educational institutions, government, sports organizations, corporate sponsors, and the community. This white paper aims to systematically organize the available knowledge and debates around India's sporting performance in the background of mainstream education culture. This paper also addresses the systemic devaluation, exclusion, disfranchisement, and stereotyping of sports and sportspersons in India. One key argument put forward in this paper is to extend absolute equivalence to Olympic sports disciplines (e.g., football) at par with general academic disciplines (e.g., mathematics) in terms of examinations and award of qualifications within the mainstream education system of India. And India must host the Olympics before 2047.

A Latent Profile Analysis of Religious Parents' Responses to Their Sexual and Gender Diverse Child.

Prior research indicates that religious parents can have negative, positive, or ambivalent responses to their child's sexual orientation and gender identity (SOGI). Yet, to our knowledge no research has quantitatively examined patterns of sexual and gender diverse (SGD) youth's perceptions of their religious parents' responses to their SOGI. Without examining variations in these patterns, we are unable to better understand the experiences of SGD youth with religious parents. In the current paper, we examined patterns of SGD youth's perceptions of their religious parents' SOGI-specific rejection, acceptance, and SOGI change efforts. We also examined if these patterns differed by SGD youth's individual and contextual factors. The analytic sample consisted of online responses from 5,686 SGD youth (Mage = 15.95). We found four distinct profiles: Positive Parental Response, Moderate Negative Parental Response, Low Parental Response, and High Negative Parental Response. The largest profile was the Positive Parental Response, suggesting that many SGD youth perceived positive responses from their religious parents. SGD youth with diverse gender identities and intersecting identities, such as race/ethnicity, were more vulnerable to religious parents' negative responses. Findings have implications for existing resources and programs aimed at strengthening SGD youth's relationship with their religious parents.

Extensive social media use and frequency of current e-cigarette use among US youth.

Introduction: Both electronic cigarette (e-cigarette) and social media use among youth are public health concerns. While the health impacts of extensive social media use and frequent use of e-cigarettes have been discussed independently in the literature, little is known about the relationship between the two. This study aims to examine the potential association between extensive social media use and the frequency of current, e-cigarette use among United States (US) youth. Methods: Data from the 2022 National Youth Tobacco Survey (NYTS) were analyzed. The sample included 23,655 middle and high school students aged 9-18 years. Frequency of current e-cigarette use was categorized based on past-30 day use (i.e., never/former, 1-9 days, 10-29 days, or 30 days). Social media use was dichotomized into less than 4 hours daily and 4+ hours daily (i.e., extensive use). Multivariable multinomial logistic regression estimated the relationship between social media use and e-cigarette use frequency. Results: Over one-third (35.8 %) of youth used social media extensively and 8.6 % reported current use of e-cigarettes. Extensive social media use was associated with daily e-cigarette use (OR: 1.94, 95 % CI: 1.48-2.56) but not with other use categories. Older age, female sex, lower grades, current other tobacco use, and family tobacco use were also associated with daily e-cigarette use. Conclusions: Extensive social media use is associated with daily e-cigarette use among US youth. Public health interventions should consider the influence of social media on tobacco use behaviors and tailor prevention strategies to address this potential modifiable risk factor.

Self-Stigma of Canadian Youth With ADHD and Their Parents.

OBJECTIVE: ADHD is subject to stigma from the general population. Exposure to stigma poses the risk of developing self-stigma of youth and parents, but few studies have focused on self-stigma of ADHD. Furthermore, parental factors have been implicated in self-stigma of youth, but no previous research has assessed the association between self-stigma of parents and youth. Therefore, the objective of this study was to better understand the experience of self-stigma of youth and their parents in the context of ADHD. METHOD: Fifty-five youth with ADHD (aged 8-17) and one parent reporter per youth completed surveys to report their experiences. RESULTS: The results of this study found that both youth and parents reported significantly lower self-stigma scores compared to most previously published research. Parents of boys reported higher self-stigma scores compared to parents of girls. Youth who reported higher self-stigma also reported lower self-esteem. Self-stigma scores in youth were predicted by inattentive symptoms but not hyperactive/impulsive symptoms or parental self-stigma. CONCLUSION: Results emphasize the importance of understanding self-stigma of ADHD, symptom severity, and the need for interventions for families with ADHD.

A national evaluation of a multi-modal, blended, digital intervention integrated within Australian youth mental health services.

BACKGROUND: Youth mental health (YMH) services have been established internationally to provide timely, age-appropriate, mental health treatment and improve long-term outcomes. However, YMH services face challenges including long waiting times, limited continuity of care, and time-bound support. To bridge this gap, MOST was developed as a scalable, blended, multi-modal digital platform integrating real-time and asynchronous clinician-delivered counselling; interactive psychotherapeutic content; vocational support; peer support, and a youth-focused online community. The implementation of MOST within Australian YMH services has been publicly funded. OBJECTIVE: The primary aim of this study was to evaluate the real-world engagement, outcomes, and experience of MOST during the first 32 months of implementation. METHOD: Young people from participating YMH services were referred into MOST. Engagement metrics were derived from platform usage. Symptom and satisfaction measures were collected at baseline, 6, and 12 (primary endpoint) weeks. Effect sizes were calculated for the primary outcomes of depression and anxiety and secondary outcomes of psychological distress and wellbeing. RESULTS: Five thousand seven hundred and two young people from 262 clinics signed up and used MOST at least once. Young people had an average of 19 login sessions totalling 129 min over the first 12 weeks of use, with 71.7% using MOST for at least 14 days, 40.1% for 12 weeks, and 18.8% for 24 weeks. There was a statistically significant, moderate improvement in depression and anxiety at 12 weeks as measured by the PHQ4 across all users irrespective of treatment stage (d = 0.41, 95% CI 0.35-0.46). Satisfaction levels were high, with 93% recommending MOST to a friend. One thousand one hundred and eighteen young people provided written feedback, of which 68% was positive and 31% suggested improvement. CONCLUSIONS: MOST is a highly promising blended digital intervention with potential to address the limitations and enhance the impact of YMH services.

Sleep health among youth outside of the gender binary: Findings from a national Canadian sample.

OBJECTIVES: Sleep is important for adolescent health. The unique needs of suprabinary youth (youth with gender identities outside of the gender binary), along with the growing number of youth with these identities, underscores the need to better understand sleep health within this population. The current study's objectives were to (1) examine differences in sleep health between suprabinary and binary youth and (2) explore how social support, peer victimization, and technology use accounted for these differences. METHODS: Data were drawn from the 2017/2018 Health Behavior in School Aged Children Survey. Adolescents (individuals ages 14 to 17, n = 10,186), indicated whether they were suprabinary (n = 182) or binary (n = 10,004), and completed measures of sleep health (difficulty falling asleep, difficulty staying awake, weekday and weekend sleep length), covariates (age, family affluence, race/ethnicity, depressive symptoms), as well as variables that may account for differences between suprabinary and binary youth (family, friend, and teacher support, as well as peer victimization, and technology use before bed). RESULTS: Suprabinary youth reported worse sleep health on all outcomes, and differences persisted for both difficulty falling asleep and weekday sleep hours accounting for covariates. Significant indirect effects between suprabinary status were observed across all sleep outcomes for family support and school climate. Indirect effects for sleep quality were also observed via peer victimization. CONCLUSIONS: Findings support the relevance of looking at basic health processes like sleep to better understand how the stressors associated with suprabinary status impact health outcomes among this vulnerable population.

Associations between gut microbiota and osteoporosis or osteopenia in a cohort of Chinese Han youth.

Osteoporosis (OP) is a common metabolic bone disease characterized by low bone mass and microstructural deterioration of bone. Changes in the composition and structure of gut microbiota (GM) are related to changes of bone mass and bone microstructure. However, the relationship between GM and bone mineral density (BMD) is complex, and data are especially scarce for Chinese Han youth. Therefore, 62 Chinese Han youth participants were recruited. Furthermore, according to the T-score evaluation criteria of the World Health Organization (WHO), we divided the BMD levels of participants into three groups: osteoporosis\BDL, osteopenia\BDM, normal bone density\BDH, and the associations between GM community and BMD groups were conducted. According to alpha and beta diversity analysis, significant differences were found in the microbial richness and composition between groups. The dominant phyla of GM in a cohort of Chinese Han youth were Bacteroidota (50.6%) and Firmicutes (41.6%). Anaerobic microorganisms, such as g_Faecalibacterium and g_Megamonas, account for the largest proportion in the gut, which were mainly Firmicutes phylum. The dominant genera and species in the three BMD groups were g_Prevotella, g_Bacteroides, g_Faecalibacterium, g_Megamonas, s_Prevotella copri, s_unclassified_g_Faecalibacterium, s_unclassified_g_Prevotella, s_unclassified_g_Bacteroides and s_Bacteroides plebeius. g_Faecalibacterium, g_Bacteroides and g_Ruminococcus differed between the BDH and BDL groups as well as between the BDH and BDM groups. LEfSe showed three genus communities and eight species communities were enriched in the three BMD groups, respectively. The associations between microbial relative abundance and T-score was not statistically significant by Spearman and regression analysis. In conclusion, the alpha diversity indexes in the BDH group were higher than in the BDL group, and several taxa were identified that may be the targets for diagnosis and therapy of OP.

The health behaviors differences among male and female school-age adolescents in the Middle East and North Africa region countries: a meta-analysis of the Global School-based Student Health Survey data.

Background: Understanding gender disparities in adolescent health behaviors is crucial for developing targeted health promotion strategies. This study uses data from the Global School-based Student Health Survey (GSHS) across 17 MENA countries to analyze gender differences in adolescent health behaviors, aiming to provide a comprehensive overview for both boys and girls. Methods: This meta-analysis incorporates data from recent years of the GSHS, covering 17 MENA countries. The objective was to assess and compare health behaviors between adolescent girls and boys. A random-effects model was employed to calculate odds ratios for gender comparisons in these behaviors. Statistical analyses and modeling were performed using JAMOVI software. Results: In most MENA countries, boys consumed more vegetables compared to girls. Girls were less likely to frequent fast food establishments (OR = 0.82, 95% CI: 0.69-0.98) and generally exhibited better self-care behaviors. Boys reported a higher prevalence of physical altercations (OR = 2.18, 95% CI: 1.88-2.51) and were more involved in fights (OR = 3.00, 95% CI: 2.46-3.67). Girls were more likely to miss school without permission and were consistently described as kinder and more helpful across various income levels. However, in some countries such as Oman and Tunisia, boys missed school more frequently. There were no significant gender differences in parental oversight of homework or knowledge of students' activities, but girls were reported to have stronger parental relationships and better parental understanding of their problems and free time, with exceptions in Morocco and the Palestinian Territory-Gaza. Boys were more likely to engage in smoking (OR = 3.57, 95% CI: 2.69-4.76) and other substance use. Conversely, girls reported higher levels of physical inactivity and loneliness, but also demonstrated greater kindness and helpfulness in school settings and stronger parental relationships. Conclusion: Policymakers in the MENA region should develop and implement gender-specific interventions targeting key areas such as hygiene practices, physical activity, and substance use. By focusing on these targeted strategies, they can address the distinct health behaviors and needs of both boys and girls. Effective interventions in these areas are crucial for improving overall health outcomes and promoting healthier lifestyles, thereby enhancing adolescent health and well-being across the region.

Identifying Psychosocial and Ecological Determinants of Enthusiasm In Youth: Integrative Cross-Sectional Analysis Using Machine Learning.

BACKGROUND: Understanding the factors contributing to mental well-being in youth is a public health priority. Self-reported enthusiasm for the future may be a useful indicator of well-being and has been shown to forecast social and educational success. Typically, cross-domain measures of ecological and health-related factors with relevance to public policy and programming are analyzed either in isolation or in targeted models assessing bivariate interactions. Here, we capitalize on a large provincial data set and machine learning to identify the sociodemographic, experiential, behavioral, and other health-related factors most strongly associated with levels of subjective enthusiasm for the future in a large sample of elementary and secondary school students. OBJECTIVE: The aim of this study was to identify the sociodemographic, experiential, behavioral, and other health-related factors associated with enthusiasm for the future in elementary and secondary school students using machine learning. METHODS: We analyzed data from 13,661 participants in the 2019 Ontario Student Drug Use and Health Survey (OSDUHS) (grades 7-12) with complete data for our primary outcome: self-reported levels of enthusiasm for the future. We used 50 variables as model predictors, including demographics, perception of school experience (i.e., school connectedness and academic performance), physical activity and quantity of sleep, substance use, and physical and mental health indicators. Models were built using a nonlinear decision tree-based machine learning algorithm called extreme gradient boosting to classify students as indicating either high or low levels of enthusiasm. Shapley additive explanations (SHAP) values were used to interpret the generated models, providing a ranking of feature importance and revealing any nonlinear or interactive effects of the input variables. RESULTS: The top 3 contributors to higher self-rated enthusiasm for the future were higher self-rated physical health (SHAP value=0.62), feeling that one is able to discuss problems or feelings with their parents (SHAP value=0.49), and school belonging (SHAP value=0.32). Additionally, subjective social status at school was a top feature and showed nonlinear effects, with benefits to predicted enthusiasm present in the mid-to-high range of values. CONCLUSIONS: Using machine learning, we identified key factors related to self-reported enthusiasm for the future in a large sample of young students: perceived physical health, subjective school social status and connectedness, and quality of relationship with parents. A focus on perceptions of physical health and school connectedness should be considered central to improving the well-being of youth at the population level.

Benefits, barriers and recommendations for youth engagement in health research: combining evidence-based and youth perspectives.

BACKGROUND: Youth engagement refers to the collaboration between researchers and youth to produce research. Youth engagement in health research has been shown to inform effective interventions aimed at improving health outcomes. However, limited evidence has identified promising practices to meaningfully engage youth. This synthesis aims to describe youth engagement approaches, frameworks, and barriers, as well as provide both evidence-based and youth-generated recommendations for meaningful engagement. MAIN BODY: This review occurred in two stages: 1) a narrative review of existing literature on youth engagement and 2) a Youth Advisory Council (YAC) to review and supplement findings with their perspectives, experiences, and recommendations. The terms 'youth engagement' and 'health research' were searched in Google Scholar, PubMed, Web of Science, Scopus, and PsycINFO. Articles and non-peer reviewed research works related to youth engagement in health research were included, reviewed, and summarized. The YAC met with research team members and in separate youth-only forums to complement the narrative review with their perspectives. Types of youth engagement include participation as research participants, advisors, partners, and co-investigators. Barriers to youth engagement were organized into youth- (e.g., time commitments), researcher- (e.g., attitudes towards youth engagement), organizational- (e.g., inadequate infrastructure to support youth engagement), and system-level (e.g., systemic discrimination and exclusion from research). To enhance youth engagement, recommendations focus on preparing and supporting youth by offering flexible communication approaches, mentorship opportunities, diverse and inclusive recruitment, and ensuring youth understand the commitment and benefits involved. CONCLUSIONS: To harness the potential of youth engagement, researchers need to establish an inclusive and enabling environment that fosters collaboration, trust, and valuable contributions from youth. Future research endeavors should prioritize investigating the dynamics of power-sharing between researchers and youth, assessing the impact of youth engagement on young participants, and youth-specific evaluation frameworks.

Engaging and partnering with youth in research related to healthcare is important, but often not done well. As researchers, we recognize that youth perspectives are needed to make sure we are asking the right questions, using appropriate research methods, and interpreting the results correctly. We searched the literature to identify challenges researchers have faced engaging youth in health research, as well as strategies to partner with youth in a meaningful way. We worked closely with 11 youth from across Canada with experience in healthcare, who formed a Youth Advisory Council. The youth advisors reviewed the literature we found and discussed how it fit with their own experiences and perspectives through group meetings with the research team. Youth advisors divided into four groups to co-author parts of this paper, including identifying the importance, benefits, and challenges of engaging in research and providing reflections on their positive and negative previous experiences as youth advisors. This paper provides an overview of recommendations for researchers to engage with youth in a meaningful way, including how they communicate and meet with youth, recognize their contributions, and implement feedback to improve the experiences of youth partners.

What is the relationship between raising the minimum legal sales age of tobacco above 20 and cigarette smoking? A systematic review.

INTRODUCTION: There is considerable interest in raising the age of sale of tobacco above the conventional age of 18. We systematically reviewed whether raising the minimum legal sales age of tobacco (MLSA) to 20 or above is associated with reduced prevalence of smoking compared to an MLSA set at 18 or below. METHODS: Following a pre-registered protocol on PROSPERO (ref: CRD42022347604), six databases of peer-reviewed journals were searched from January 2015 to April 2024. Backwards and forwards reference searching was conducted. Included studies assessed the association between MLSAs ≥20 with cigarette smoking or cigarette sales for those aged 11-20. Assessments on e-cigarettes were excluded. Pairs of reviewers independently extracted study data. We used ROBINS-I to assess risk of bias and GRADE to assess quality of evidence. Findings were also synthesised narratively. RESULTS: 23 studies were reviewed and 34 estimates of association were extracted. All extracted studies related to Tobacco 21 laws in the United States. Moderate quality evidence was found for reduced cigarette sales, moderate quality evidence was found for reduced current smoking for 18 - 20 year olds, and low quality evidence was found for reduced current smoking for 11 - 17 year olds. The positive association was stronger for those with lower education. Study bias was variable. CONCLUSIONS: There is moderate quality evidence that Tobacco 21 can reduce overall cigarette sales and current cigarette smoking amongst those aged 18- 20. It has potential to reduce health inequalities. Research in settings other than the United States is required. IMPLICATIONS: This systematic review on raising the minimum legal sale age of tobacco to 20 or above demonstrates there is moderate quality evidence that such laws reduce cigarette sales, and moderate quality evidence they reduce smoking prevalence amongst those aged 18-20 compared to a minimum legal sale age of 18 or below. The research highlights potential benefits in reducing health inequalities, especially individuals from lower educational backgrounds. Studies are limited to the United States, highlighting a need for more global research to assess the impact of these policies in other settings.

Study protocol for a pre/post study on knowledge, attitudes and behaviors regarding STIs and in particular HPV among Italian adolescents, teachers, and parents in secondary schools.

Sexually transmitted infections (STIs) are one of the most important issues related to sexual and reproductive health, as it is estimated that more than 1 million new infections are acquired every day worldwide and data on the prevalence and incidence of these infections, especially among young people, are increasing. Nevertheless, there are some knowledge and behavioral gaps, and young people need more support from their school and family network to protect themselves and their peers. Therefore, we have designed a multicenter prospective intervention study involving public lower and upper secondary school students, their parents and teachers (ESPRIT). The intervention will take place in the school year 2023-2024, where students will meet with experts and be involved in peer education, while adults (parents and teachers) will participate in distance and face-to-face trainings. All target groups will complete KAP (knowledge, attitudes, practice) questionnaires before and after participating in the intervention to measure its effectiveness. The results of this study will help to assess and improve the level of knowledge of lower and upper secondary school students, parents and teachers about STIs and HPV in particular, raise awareness of sexual and reproductive health issues, including vaccination, among lower and upper secondary school students and their families, and evaluate the effectiveness of these interventions in terms of improving knowledge and changing attitudes and behaviors. The study protocol has been approved by the Regional Unique Ethics Committee of Friuli Venezia Giulia (CEUR-2023-Sper-34). The project is being carried out with the technical and financial support of the Italian Ministry of Health-CCM.

Empowering youth as agents of change: Gaps and opportunities for meaningful youth engagement (MAYE) for sustainable nutrition, climate and public health programmes.

Addressing the intersection of food insecurity, malnutrition and climate change in Sub-Saharan Africa requires meaningful adolescent and youth engagement to drive sustainable change. Drawing on empirical evidence and collective experiences from youth-led initiatives and coalitions, four gaps and opportunities to better involve youth in programmes are discussed, including, the need to: (1) standardise the definition of youth to improve programme design and data harmonisation, (2) provide capacity building and mentorship for youth leadership in health service delivery, (3) foster youth leadership and multisectoral collaboration in food and health systems and (4) enhance capacity development for non-youth actors to support genuine youth participation. This viewpoint underscores the importance of involving African youth in public health nutrition, climate change and food security programmes design and implementation-as drivers of change to addressing hunger and climate crises. By centering youth voices and experiences, programmes and policies can better address African communities' complex challenges, fostering inclusivity, sustainability and resilience in achieving better nutrition and public health programmes and outcomes.

Evaluating Operation Good Food & Beverages, a Black Youth-Driven Public Advocacy Campaign.

BACKGROUND: Food and beverage (F&B) marketing practices that contradict health guidelines are particularly concerning for children and adolescents, who are developmentally more susceptible than adults to persuasive advertising and to Black communities, due to ethnically-targeted marketing, contributing to higher rates of obesity and other diet-related chronic diseases. Accordingly, here we evaluated Operation Good Food and Beverages (OGF&B), an online social marketing campaign calling for shifting toward more marketing of healthier F&B to Black youth and Black communities. METHODS: OGF&B was developed and implemented by a multidisciplinary team of academic, advocacy, and advertising partners and active for four months in 2022 during the COVID-19 pandemic. Primary campaign components were social media content (e.g., TikTok, Instagram), and an informational website with a signable petition and a social media toolkit. Our mixed-methods evaluation used qualitative data to contextualize quantitative metrics like online impressions, website visits, and petition signatures. Qualitative data consisted of analysis of social media content and thematic elements from 15 interviews with campaign advisors, youth consultants, and influencers. RESULTS: The campaign achieved 3,148,869 impressions, 3,799 unique website visits, and 1,077 petition signatures. Instagram Reels and content featuring people had higher engagement. Instagram Reels received more likes than static posts or TikTok videos. Interviewees who participated mentioned personal values and community welfare as key motivations. Social media influencers who declined participation noted time constraints and lack of compensation as barriers. CONCLUSION: Despite pandemic-related restrictions that precluded in-person engagement, this brief campaign implementation period provided useful insights for leveraging OGF&B or similar campaigns.

Predictors of stigma perception by people with type 1 diabetes: A cross-sectional analysis of the BETTER registry.

AIMS: This study investigates stigma predictors across ages and genders, addressing a critical gap in understanding diverse populations to reduce related suboptimal clinical and psychosocial outcomes. METHODS: Cross-sectional analysis of self-reported data from BETTER, a Canadian registry of people with type 1 diabetes. Participants (n = 709) completed the 19-item-Diabetes-Stigma Assessment-Scale (DSAS-1) categorized into treated differently, blame and judgment, and identity concerns sub-scales. Associations with diabetes distress (DDS-17-score/102), depression (PHQ-9-score/27), social-support (ESSI-score/34), fear of hypoglycemia (HFS-II-score/132), and hyperglycemia-avoidance-behaviours (HAS-score/88) were computed. RESULTS: Perceived stigma was highest in youth aged 14-24 years (46·0 ± 15·6, p < 0·001) and women (41·2 ± 15·7, p = 0·009), compared to other age groups and men. Blame and Judgment contributed to most of stigma perception. Youth perceived significantly more blame and judgment (p < 0·001) and identity concerns (p = 0·001) compared to middle-aged adults and seniors. Women perceive significantly more blame and judgment compared to men (p < 0·001). The perception of being treated differently was not reported to be an issue across ages and genders. Participants with higher scores of depression, diabetes-distress, fear of hypoglycemia, hyperglycemia-avoidance behaviours, and lesser social-support, reported increased stigma. CONCLUSIONS: Stigma varies by age and gender, underscoring the need for targeted interventions to reduce it. Challenging stereotypes and reducing stigma-related stressors are essential for better outcomes.

'Like walking with someone as opposed to trying to catch up to them'-Dynamics at play when clinicians and young people formulate together.

OBJECTIVE: The aim of the present study was to explore the social process of formulation in talk therapy between young people and clinicians. DESIGN: Qualitative semi-structured interview study. METHOD: Ten young people (male = 6, female = 4, age range = 16-23 years) and nine clinicians from various disciplines within a youth mental health service were interviewed. Constructivist grounded theory was used for the analysis. RESULTS: Four themes were constructed from the data; a 'level playing field' between young person and clinician enables formulation, formulating is a constant process of getting it right and getting it wrong, emotional expression and attunement get us closer to each other and to understanding, and 'formulation versus diagnosis' can create tension in the therapy room. The constructivist grounded theory devised demonstrated how the dynamics of power, collaboration, openness, and the therapeutic relationship are constantly in flux during the process of formulation. CONCLUSION: The paper presents a constructivist grounded theory which incorporates dynamics relating to power, collaboration, and openness. The importance of the therapeutic relationship is also emphasised. The theory encourages continuous and recursive personal reflection by the therapist as to how they can be optimally attuned to the dynamics of power, collaboration, and openness with young people.

An Analysis of Tobacco and Marijuana Use by Middle School and High School Bisexual and Homosexual Students Surveyed by the National Youth Tobacco Survey From 2020 to 2022.

OBJECTIVES: This study aimed to analyze tobacco and marijuana use by middle and high school students identifying as bisexual, gay, lesbian, or heterosexual using data from the National Youth Tobacco Survey (NYTS) spanning from 2020 to 2022. By comparing substance use patterns among different sexual orientation groups, the study sought to identify disparities and potential socioeconomic factors influencing these behaviors. METHODS: Data from the 2020 to 2022 NYTS were analyzed, focusing on responses regarding ever use of cigarettes, e-cigarettes, and marijuana by students of varying sexual orientations. Descriptive statistics and chi-square tests were employed to analyze differences in substance use and socioeconomic indicators between sexual orientation groups. RESULTS: Of the 37 541 students included in the analysis, significant differences in substance use were observed among bisexual, gay, lesbian, and heterosexual students. Bisexual and gay/lesbian students exhibited higher rates of ever use of cigarettes, e-cigarettes, and marijuana compared to heterosexual students. In addition, socioeconomic differences, such as lower rates of family vehicle ownership and reduced access to vacations, were noted among bisexual and gay/lesbian students. CONCLUSIONS: The findings underscore significant differences in tobacco and marijuana use by adolescents based on sexual orientation, mirroring differences observed in LGBTQ adults. These results highlight the importance of targeted interventions, educational initiatives, and support systems tailored to the unique needs of LGBTQ youth. Addressing socioeconomic disparities and fostering inclusive environments are crucial steps in promoting the health and well-being of LGBTQ adolescents. Continued research and collaborative efforts are essential in mitigating health disparities and creating equitable environments for all adolescents.

Identification of treatment elements for adolescents with callous unemotional traits: a systematic narrative review.

Adolescents with callous unemotional (CU) traits are at risk for poor quality-of-life outcomes such as incarceration, suicide, and psychopathy. It is currently unknown which treatments are implemented with CU adolescents specifically and which elements make up these interventions. A narrative systematic review was used to identify the treatments and common elements used with CU adolescents (12-18 years). Eligible studies were randomized controlled trials and quasi-experimental studies evaluating psychosocial interventions, delivered within a clinical context, and directed towards the adolescent or their family. Eight studies with 1291 participants were included. Significant decreases in CU traits were demonstrated only in a minority of studies. The most utilized practice elements were set goals for treatment, practice interpersonal/communication skills, prepare for termination, and teach parents skills and strategies; the most utilized process elements were formal therapy, practice exercises, important others, and flexible/adaptive. A majority of the studies did not report an implementation element. While theoretical frameworks for CU children are employed with CU adolescents, there is still uncertainty regarding their suitability for this age group. Given the limited empirical evidence, there is a critical need for further exploration.

Developing community-based physical activity interventions and recreational programming for children in rural and smaller urban centres: a qualitative exploration of service provider and parent experiences.

BACKGROUND: Children's physical inactivity is a persisting international public health concern. While there is a large body of literature examining physical activity interventions for children, the unique physical activity context of low-density communities in rural areas and smaller urban centres remains largely underexplored. With an influx of families migrating to rural communities and small towns, evaluations of health promotion efforts that support physical activity are needed to ensure they are meeting the needs of the growing populations in these settings. The aim of this community-based research was to explore service providers' and parents' perspectives on physical activity opportunities available in their community and recommendations toward the development and implementation of efficacious physical activity programming for children in rural communities and smaller urban centres. METHODS: Three in-person community forums with recreation service providers (n = 37 participants) and 1 online community forum with the parents of school-aged children (n = 9 participants) were hosted. An online survey and Mentimeter activity were conducted prior to the community forums to gather participants' views on the barriers and facilitators to physical activities and suggestions for activity-promoting programs. The service provider and parent discussions were audio-recorded, transcribed verbatim, and analyzed following a deductive approach guided by Hseih and Shannon's (2005) procedure for direct content analysis. A code list developed from the responses to the pre-forum survey and Mentimeter activity was used to guide the analysis and category development. RESULTS: Seven distinct categories related to the existing physical activity opportunities and recommendations for programs in rural communities and smaller urban centres were identified during the analysis: (1) Recovery from Pandemic-Related Measures, (2) Knowledge and Access to Programs, (3) Availability, (4) Personnel Support, (5) Quality of Programs and Facilities, (6) Expenses and Subsidies, and (7) Inclusivity and Preferences. CONCLUSION: To improve the health and well-being of children who reside in low-density areas, the results of this study highlight service provider and parent recommendations when developing and implementing community-based physical activity programs and interventions in rural and smaller urban settings, including skill development programs, non-competitive activity options, maximizing existing spaces for activities, and financial support.