Multi-level alignment processes in the sustainment of a youth substance use treatment model following a federal implementation initiative: A mixed method study.

INTRODUCTION: Government agencies have identified evidence-based practice (EBP) dissemination as a pathway to high-quality behavioral health care for youth. However, gaps remain about how to best sustain EBPs in treatment organizations in the U.S., especially in resource-constrained settings like publicly-funded youth substance use services. One important, but understudied, determinant of EBP sustainment is alignment: the extent to which multi-level factors that influence sustainment processes and outcomes are congruent, consistent, and/or coordinated. This study examined the role of alignment in U.S. states' efforts to sustain the Adolescent Community Reinforcement Approach (A-CRA), an EBP for youth substance use disorders, during the COVID-19 pandemic. METHODS: In this mixed methods study, the qualitative investigation preceded and informed the quantitative investigation. We interviewed state administrators and providers (i.e., supervisors and clinicians) from 15 states that had completed a federal A-CRA implementation grant; providers also completed surveys. The sample included 50 providers from 35 treatment organizations that reported sustaining A-CRA when the COVID-19 pandemic began, and 20 state administrators. In qualitative thematic analyses, we applied the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to characterize alignment processes that interviewees described as influential on sustainment. We then used survey items to quantitatively explore the associations described in qualitative themes, using bivariate linear regressions. RESULTS: At the time of interview, staff from 80 % of the treatment organizations (n = 28), reported sustaining A-CRA. Providers from both sustainer and non-sustainer organizations, as well as state administrators, described major sources of misalignment when state agencies ceased technical assistance post-grant, and because limited staff capacity conflicted with A-CRA's training model, which was perceived as time-intensive. Participants described the pandemic as exacerbating preexisting challenges, including capacity issues. Sustainer organizations reported seeking new funding to help sustain A-CRA. Quantitative associations between self-rated extent of sustainment and other survey items largely followed the pattern predicted from the qualitative findings. CONCLUSIONS: The COVID-19 pandemic amplified longstanding A-CRA sustainment challenges, but treatment organizations already successfully sustaining A-CRA pre-pandemic largely continued. There are missed opportunities for state-level actors to coordinate with providers on the shared goal of EBP sustainment. A greater focus on alignment processes in research and practice could help states and providers strengthen sustainability planning.

Correcting mortality estimates among children and youth on antiretroviral therapy in southern Africa: A comparative analysis between a multi-country tracing study and linkage to a health information exchange.

OBJECTIVES: The objective of this study is to assess the outcomes of children, adolescents and young adults with HIV reported as lost to follow-up, correct mortality estimates for children, adolescents and young adults with HIV for unascertained outcomes in those loss to follow-up (LTFU) based on tracing and linkage data separately using data from the International epidemiology Databases to Evaluate AIDS in Southern Africa. METHODS: We included data from two different populations of children, adolescents and young adults with HIV; (1) clinical data from children, adolescents and young adults with HIV aged ≤24 years from Lesotho, Malawi, Mozambique, Zambia and Zimbabwe; (2) clinical data from children, adolescents and young adults with HIV aged ≤14 years from the Western Cape (WC) in South Africa. Outcomes of patients lost to follow-up were available from (1) a tracing study and (2) linkage to a health information exchange. For both populations, we compared six methods for correcting mortality estimates for all children, adolescents and young adults with HIV. RESULTS: We found substantial variations of mortality estimates among children, adolescents and young adults with HIV reported as lost to follow-up versus those retained in care. Ascertained mortality was higher among lost and traceable children, adolescents and young adults with HIV and lower among lost and linkable than those retained in care (mortality: 13.4% [traced] vs. 12.6% [retained-other Southern Africa countries]; 3.4% [linked] vs. 9.4% [retained-WC]). A high proportion of lost to follow-up children, adolescents and young adults with HIV had self-transferred (21.0% and 47.0%) in the traced and linked samples, respectively. The uncorrected method of non-informative censoring yielded the lowest mortality estimates among all methods for both tracing (6.0%) and linkage (4.0%) approaches at 2 years from ART start. Among corrected methods using ascertained data, multiple imputation, incorporating ascertained data (MI(asc.)) and inverse probability weighting with logistic weights were most robust for the tracing approach. In contrast, for the linkage approach, MI(asc.) was the most robust. CONCLUSIONS: Our findings emphasise that lost to follow-up is non-ignorable and both tracing and linkage improved outcome ascertainment: tracing identified substantial mortality in those reported as lost to follow-up, whereas linkage did not identify out-of-facility deaths, but showed that a large proportion of those reported as lost to follow-up were self-transfers.

Community-Derived Recommendations for Improving Gender Affirmation of Black and Latine Transgender/Nonbinary Youth.

BACKGROUND: Gender affirmation is a process by which gender-diverse individuals are supported in their gender identity. Parents are critical in how gender-diverse youth, including Black and Latine transgender/nonbinary youth (BLTY), access various forms of gender affirmation-for example, social and medical transition. Culturally relevant supports are needed to bolster how BLTY and their parents navigate gender affirmation. PURPOSE: This study aimed to explore recommendations for aiding BLTY and parents in navigating the youth's gender journey. METHODS: Semi-structured interviews were conducted with parents of BLTY, BLTY, and BLT young adults (BLTYAs) recruited from clinics, community organizations, and social media. Interviews focused on gender affirmation and recommendations to promote BLTY's gender affirmation. Primary and secondary analysts coded transcripts using a priori and emergent codes. For this analysis, excerpts pertaining to recommended supports were analyzed to identify themes. RESULTS: Ten parents of BLTY, 10 BLTY (14-18 years), and 23 BLTYAs (18-30 years) participated. Participants provided recommendations at different socio-ecological levels. On the societal level, participants recommended improvements in media representation of racial and ethnic minority gender-diverse individuals. For organizations, participants recommended more clinicians who shared minoritized identities, clinicians knowledgeable in gender-affirming care, affordability of gender-affirming services, and school-based education regarding gender diversity. On interpersonal/individual levels, they suggested culturally informed peer support among BLTY and parents, including support groups, peer mentors, and camps with individuals who share their minoritized identities. CONCLUSIONS: Participants provided salient insights to supporting gender affirmation of BLTY, which can inform intervention development for BLTY and their families.

Black and Latine transgender/nonbinary youth (BLTY) have multiple minoritized identities as they are both racial/ethnic minorities and are gender diverse. These youth face unique challenges in being supported in their gender identity, and their parents face barriers to supporting their gender journey. Unfortunately, approaches to assisting BLTY and their parents in navigating this journey are poorly understood. We interviewed 10 BLTY, 10 related parents of the BLTY, and 23 Black and Latine transgender/nonbinary young adults (BLTYAs) recruited from clinics, community organizations, and social media. In this study, we explored their recommendations for better supporting and affirming BLTY. These recommendations targeted different areas of BLTY's lives. On a broader societal level, participants advocated media representation of gender-diverse individuals of color. For medical and mental health organizations, participants recommended more clinicians knowledgeable in supporting gender-diverse youth and more clinicians who share similar backgrounds with BLTY. For interpersonal and individual relationships, they recommended peer support groups and mentors for BLTY and parents of BLTY. These comprehensive recommendations from BLTY, parents, and BLTYAs can be implemented to better support BLTY in their gender identity through culturally based interventions in different domains.

Tobacco and Nicotine Product Use Transitions by Race and Ethnicity: Results from a Latent Transition Analysis Using Data from the Truth Longitudinal Cohort (2020-2022).

OBJECTIVE: To examine use and frequency patterns across e-cigarettes, cigarettes, and little cigars, cigars, and cigarillos (LCCs) over time and determine whether patterns differ by race and ethnicity. METHODS: Data was obtained from the Truth Longitudinal Cohort of youth and young adults between September 2020 and June 2022. Latent class and transition analyses were used to classify participants (N = 4448) into subgroups, based on frequency of tobacco product use in the past 30 days, and to estimate the probability of use pattern transitions by race and ethnicity, adjusted for the effects of gender, financial situation, parental education, household tobacco use, and sensation seeking. RESULTS: Four latent classes were identified: former/noncurrent users, predominantly frequent to daily (FTD) e-cigarette users, predominantly FTD e-cigarette and LCC users, and predominantly FTD cigarette with polytobacco users. Use trajectories differed by race and ethnicity. A lower proportion of those who identified as non-Hispanic Black (60.0%) remained e-cigarette and LCC users, relative to those who identified as non-Hispanic White (86.0%), Hispanic or Latino (86.0%), and another race and ethnicity (79.0%). A lower proportion of those who identified as Hispanic or Latino (54.0%) and another race and ethnicity (59.9%) remained cigarette with polytobacco users, relative to those who identified as non-Hispanic White (76.0%) and non-Hispanic Black (72.0%). A greater proportion of non-Hispanic Black respondents transitioned from e-cigarette and LCC user to former/noncurrent user (40.0%) and polytobacco user to e-cigarette and LCC user (11.0%), relative to other racial/ethnic groups. CONCLUSION: More research is needed to determine why tobacco use trajectories differ by race and ethnicity. Such research will be important in informing comprehensive approaches that promote evidence-based prevention policies and programs.

Exploring How Youth Use TikTok for Mental Health Information in British Columbia: Semistructured Interview Study With Youth.

BACKGROUND: TikTok (ByteDance) experienced a surge in popularity during the COVID-19 pandemic as a way for people to interact with others, share experiences and thoughts related to the pandemic, and cope with ongoing mental health challenges. However, few studies have explored how youth use TikTok to learn about mental health. OBJECTIVE: This study aims to understand how youth used TikTok during the COVID-19 pandemic to learn about mental health and mental health support. METHODS: Semistructured interviews were conducted with 21 youths (aged 12-24 years) living in British Columbia, Canada, who had accessed TikTok for mental health information during the COVID-19 pandemic. Interviews were audio-recorded, transcribed verbatim, coded, and analyzed using an inductive, data-driven approach. RESULTS: A total of 3 overarching themes were identified describing youth's experiences. The first theme centered on how TikTok gave youth easy access to mental health information and support, which was particularly helpful during the COVID-19 pandemic to curb the effects of social isolation and the additional challenges of accessing mental health services. The second theme described how the platform provided youth with connection, as it gave youth a safe space to talk about mental health and allowed them to feel seen by others going through similar experiences. This helped normalize and destigmatize conversations about mental health and brought awareness to various mental health conditions. Finally, the last theme focused on how this information led to action, such as trying different coping strategies, discussing mental health with peers and family, accessing mental health services, and advocating for themselves during medical appointments. Across the 3 themes, youth expressed having to be mindful of bias and misinformation, highlighting the barriers to identifying and reporting misinformation and providing individualized advice on the platform. CONCLUSIONS: Findings suggest that TikTok can be a useful tool to increase mental health awareness, reduce stigma, and encourage youth to learn and address their mental health challenges while providing a source of peer connection and support. Simultaneously, TikTok can adversely impact mental health through repetitive exposure to mentally distressing content and misleading diagnosis and treatment information. Regulations against harmful content are needed to mitigate these risks and make TikTok safer for youth. Efforts should also be made to increase media and health literacy among youth so that they can better assess the information they consume online.

Classroom Voices: Youth Perspectives to Direct School-based Sexual Health Education.

Sexual health education is a well-known, evidence-based intervention that can improve adolescent health outcomes, increase protective health behaviours, and decrease risky health behaviours. Providing sexual health education in school settings offers opportunities for discussion of critical health topics and can improve the school environment for all students. However, not all sexual health education is taught equitably across classroom environments. As part of a mixed-methods study to describe school-based sexual health education, we conducted focus groups and interviews with recently graduated high school students in New Mexico, a geographically and ethnically diverse state in the US Southwest. Thirty-one young people shared their experiences, explored the sexual health education content they had been taught, and offered recommendations to improve sexual health education. Three key themes were developed: young people wanted and needed sexual health education taught in school settings; the sexual health education currently taught in school is not helpful and sometimes harmful; and the individuals who teach sexual health education are critically important. These findings can inform and support school staff and administrators addressing barriers to school-based sexual health education delivery, particularly in schools within marginalised communities with limited resources. The results support including youth as stakeholders in the planning, delivery and evaluation of school-based sexual health education; and the development of sexual health education training for teachers, with the goal of improving health outcomes for all youth populations.

Clinical pathway development to standardize pharmacological medication management of agitation in pediatric inpatient settings.

Objective: Acute agitation in pediatrics is commonly encountered in hospital settings, can contribute to significant physical and psychological distress, and management is highly varied in practice. As such, the development of a standardized pharmacologic guideline is paramount. We aimed to develop a novel clinical pathway (CP) for management of acute agitation for all hospitalized pediatric patients in Canada. Methods: Healthcare professionals in Canada with expertise in treating and managing pediatric agitation formed a working group and developed a CP through conducting a literature review, engaging key partners, and obtaining interdisciplinary consensus (iterative real-time discussions with content experts). Once developed, the preliminary CP was presented to additional internal and external partners via multiple grand rounds and a webinar; feedback from participants guided final CP revisions. Results: The working group created a pediatric inpatient CP to guide pharmacologic management of agitation and serve as an easy-to-use clinical and educational resource with three complementary sections including: 1) a treatment algorithm, 2) a quick reference medication chart, and 3) two supporting documents, which provide a general overview of non-pharmacologic strategies prior to CP implementation and an illustrative scenario to accompany the medication chart to ensure effective utilization. Conclusions: This is the first CP to standardize pharmacological treatment and management of acute agitation in children in inpatient settings in Canada. Although further research is warranted to assess implementation and support process improvement, the CP can be adapted by individual institutions to assist in prompt pharmacological management of pediatric agitation to potentially improve outcomes for patients, families, and healthcare professionals.

Objectif: L'agitation aiguë en pédiatrie survient couramment en milieu hospitalier, elle peut contribuer à une détresse physique et psychologique significative, et la prise en charge en est très variée dans la pratique. Ainsi, l'élaboration de lignes directrices pharmacologiques standardisées est essentielle. Nous cherchions à développer un nouveau parcours clinique (PC) de la prise en charge de l'agitation aiguë pour tous les patients pédiatriques hospitalisés au Canada. Méthodes: Les professionnels de la santé au Canada qui ont l'expertise du traitement et de la prise en charge de l'agitation pédiatrique ont formé un groupe de travail et développé un PC en menant une revue littéraire, en embauchant des partenaires cibles, et en obtenant un consensus interdisciplinaire (discussions itératives en temps réel avec des experts en contenu). Une fois développé, le PC préliminaire a été présenté à des partenaires internes et externes additionnels lors de multiples grandes rondes et à un webinaire; les commentaires des participants ont guidé les révisions finales du PC. Résultats: Le groupe de travail a créé un PC pour patient psychiatrique hospitalisé afin de guider la prise en charge pharmacologique de l'agitation et de servir de ressource clinique et éducative facile à utiliser munie de trois sections complémentaires notamment : 1) un algorithme de traitement, 2) un tableau des médicaments de référence, et 3) deux documents de soutien, qui offrent un aperçu général de stratégies non-pharmacologiques avant la mise en œuvre du PC et un scénario illustré pour accompagner le tableau des médicaments afin d'assurer une utilisation efficace. Conclusions: C'est le premier PC qui normalise le traitement pharmacologique et la prise en charge de l'agitation aiguë chez les enfants en milieu hospitalier au Canada. Bien que plus de recherche soit justifiée afin d'évaluer la mise en œuvre et de soutenir l'amélioration du processus, le PC peut être adapté par les institutions individuelles afin d'aider à une gestion pharmacologique rapide de l'agitation pédiatrique et de potentiellement aider à la gestion pharmacologique de l'agitation pédiatrique pour les patients, les familles et les professionnels de la santé.

An environmental scan of mental health services for indigenous youth in Canada.

Background: There is an urgent need for culturally and contextually relevant mental health support for First Nations, Inuit and Métis youth. Objective: Our aim was to identify mental health and wellness services that are currently available to Indigenous youth across Canada. Methodology: As a first step, we conducted a web-based environmental scan of services tailored to Indigenous youth. Specific factors were examined for each program, including organization type and mission, types of services, and who provides services. Results: One hundred and seventeen programs were found, with 54% being non-profits and 34% being on-reserve. Four core features were identified. The first was a strengths-based focus, rather than a pathology/deficit-focus, in programs' vision and mission statements, reflected in words like wellness and resilience. The second (87% of included programs) was the integration of mental health services with a range of other services and supports (e.g., health, employment, housing). The third was the provision of land-based programming (in 34% of programs) such as camps or hunting. Such programs were framed as promoting wellness and healing and strengthening identity. The fourth was the role of community members without formal mental health professional training (in 42% of programs), for example, as youth workers or knowledge keepers. This stems not only from the dearth of specialists in many Indigenous settings, but also a valuing of Indigenous knowledge. Conclusion: These core features in mental health services for Indigenous youth may be promising avenues for communities seeking to strengthen the services they offer to First Nations, Inuit and Métis youth.

Contexte: Il y a un besoin urgent de soutien en santé mentale adapté à la culture et au contexte pour les jeunes des Premières Nations, Inuits et Métis. Objectif: Nous cherchions à identifier les services de santé mentale et de bien-être actuellement disponibles pour les jeunes autochtones du Canada. Méthodologie: Dans un premier temps, nous avons mené une analyse environnementale en ligne des services adaptés aux jeunes autochtones. Des facteurs spécifiques ont été examinés pour chaque programme, notamment le type et la mission de l'organisation, les types de services offerts, et les prestataires de ces services. Résultats: Cent dix-sept programmes ont été recensés, dont 54 % étaient sans but lucratif et 34 % situés dans une réserve. Quatre caractéristiques principales ont été identifiées. La première était l'accent mis sur les forces plutôt que sur la pathologie ou le déficit, reflété dans les énoncés de vision et de mission des programmes, où des termes comme bien-être et résilience étaient utilisés. La deuxième caractéristique (présente dans 87 % des programmes) était l'intégration des services de santé mentale avec une gamme d'autres services et soutiens (p.ex., santé, emploi, logement). La troisième était l'offre de programmes liés au territoire (dans 34 % des programmes) comme des camps ou des activités de chasse, conçus pour promouvoir le bien-être, la guérison et le renforcement de l'identité. La quatrième caractéristique était le rôle des membres de la communauté sans formation professionnelle officielle en santé mentale (dans 42 % des programmes), par exemple en tant que travailleurs auprès des jeunes ou gardiens du savoir. Cela découle non seulement du manque de spécialistes dans de nombreux contextes autochtones, mais aussi de la valorisation des connaissances autochtones. Conclusion: Ces principales caractéristiques des services de santé mentale pour les jeunes autochtones peuvent constituer des avenues prometteuses pour les communautés cherchant à consolider les services qu'elles offrent aux jeunes des Premières Nations, Inuits et Métis.

Mental health service use of young people in child welfare services in Quebec, Canada.

Background: Youth involved in child welfare have high rates of mental health problems and are known to receive mental health services from multiple settings. Still, gaps remain in our understanding of service use patterns across settings over the course of youth's involvement with child welfare. Objective: To examine the settings, reasons for contact, persons involved in initiating care, and timing of each mental health service contact for individuals over their involvement with the child welfare system, and to identify factors that predict multi-setting use. Methods: Data on mental health service contacts were collected retrospectively from charts for youth aged 11-18 (n=226) during their involvement with child welfare services in Montreal, Quebec. Logistic regression analysis was conducted to determine predictors of multi-setting mental health services use (defined as ≥3 settings). Results: 83% of youth had at least one mental health service contact over the course of their child welfare services follow-up, with 45% having multi-setting use. Emergency Departments were the top setting for mental health services. Youth with a higher number of placements and from neighborhoods with greater social and material deprivation were significantly likelier to use ≥3 mental health service settings over the course of their follow-up. Conclusion: These findings suggest a need for enhanced collaboration between youth-serving sectors to ensure that continuous and appropriate mental health care is being offered to youth followed by child welfare systems. The relationship between placement instability and multi-setting mental health service use calls for specific policies to ensure that young people do not experience multiple discontinuities of care.

Contexte: Les jeunes impliqués dans le système de la protection de la jeunesse ont des taux élevés de problèmes de santé mentale et il et ils reçoivent souvent des services de santé mentale dans plusieurs types d'établissements. Pourtant, des lacunes subsistent dans notre compréhension des trajectoires d'utilisation des services à travers divers contextes au cours du suivi d'un jeune dans le système de protection de la jeunesse. Objectif: Examiner les contextes, les raisons pour les contacts, les personnes impliquées dans l'initiation des soins, et le moment de chaque contact avec les services de santé mentale pour les personnes pendant la durée de leur suivi en protection de la jeunesse et identifier les facteurs qui prédisent une trajectoire impliquant de multiples établissements. Méthodes: Des données sur les contacts avec les services de santé mentale ont été recueillies rétrospectivement des dossiers de jeunes de 11 à 18 ans (n=226) leur suivi en protection de la jeunesse à Montréal, Québec. Une analyse de régression logistique a été menée pour déterminer les prédicteurs de l'utilisation des services de santé mentale multi-établissements (définie à ≥3 établissements). Résultats: Quatre-vingt-trois pour cent des jeunes avaient au moins un contact avec un service de santé mentale au cours de leur suivi en protection de la jeunesse, et 45 % avaient une trajectoire impliquant de multiples établissements. Les services d'urgence étaient l'établissement le plus fréquenté pour les services de santé mentale. Les jeunes ayant un nombre plus élevé de placements et provenant de quartiers d'une plus grande défavorisation sociale et matérielle étaient significativement plus susceptibles d'utiliser ≥3 établissements de services de santé mentale au cours de leur suivi. Conclusion: Ces résultats démontrent le besoin d'une collaboration améliorée entre les secteurs des services aux jeunes pour faire en sorte que les jeunes en protection de la jeunesse reçoivent des soins de santé mentale continus et appropriés. La relation entre l'instabilité de placement et les trajectoires complexes à travers les services de santé mentale exige de politiques spécifiques afin d'assurer que les jeunes ne connaissent pas de multiples discontinuités de soins.

Psychodynamic psychotherapy for gender dysphoria is not conversion therapy.

Over the last ten years, there has been a substantial increase in the number of children and adolescents referred to gender clinics for possible gender dysphoria. The gender affirming model of care, a dominant treatment approach in Canada, is based on low quality evidence. Other countries are realizing this and making psychosocial treatments and/or exploratory psychotherapy a first line of treatment for gender related distress in young patients. Psychodynamic (exploratory) psychotherapy has established efficacy for a range of conditions, and has been used in youth and adults with gender dysphoria. In Canada, the adoption of psychodynamic psychotherapy for gender dysphoria is impeded by some academics who argue that it may violate laws against conversion therapy. Psychodynamic psychotherapy is not conversion therapy and should be made available in Canada as a treatment modality for gender dysphoria.

Healthism, rural individualism and self-help: youth mental health in Northwest Tasmania.

Rural Australian youth exhibit high rates of mental ill-health, exacerbated by reduced access to mental health services. While the need for innovative solutions is well-established rural youth themselves are frequently excluded from the dialogue, creating a significant gap in evidence and the development of relevant service provision that reflects young people's lived experiences. Drawing on the concepts of individualism and healthism and research highlighting the continuing importance of relationships and trust in the lives of young people in a digital society, we aim to better understand how rural youth understand mental health and navigate mental health services and information. Using a qualitative methodology, we held 2 small focus groups with a total of 8 young people in rural Tasmania to identify aspects of rural mental healthcare that require improvement and to contribute to developing new and innovative solutions. Findings indicate that rural Tasmanian youth face numerous structural, social, and cultural barriers to positive mental health. Rural self-reliance and generational differences in attitudes towards mental health can negatively affect youths' help-seeking behaviours. Findings from this study suggest a need to combine technology-and community-based approaches creating a multi-generational approach to combat mental ill-health among rural youth.

Use of disposable e-cigarettes among youth who vape in Canada, England and the United States: Repeat cross-sectional surveys, 2017-2023.

AIMS: To measure changes over time (between 2017 and 2023) in disposable e-cigarette use and popular brands among youth in Canada, England and the United States (US) who vaped. DESIGN: Nine waves of repeat cross-sectional data from the International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Survey. SETTING: Online surveys conducted in Canada, England and the US between 2017 and 2023. PARTICIPANTS: Youth aged 16 to 19 years who had vaped in the past 30 days (n = 19 710). MEASUREMENTS: Usual type (disposable, cartridge/pod, tank) and brand of e-cigarette used; covariates sex at birth, age, race/ethnicity, cigarette smoking status, vaping on ≥20 of the past 30 days. FINDINGS: In 2017, the majority of youth who vaped in the past 30 days reported using refillable tank e-cigarettes, whereas disposable e-cigarettes were the least commonly used product type in Canada (10.0%), England (8.6%) and the US (14.4%). Cartridge/pods overtook tank devices in Canada and the US by 2020; however, by 2023, disposables were the leading type of e-cigarette used by youth who vaped in all three countries (Canada = 58.5%; England = 83.2%; US = 67.3%). The shift to disposables occurred among all socio-demographic groups, with few differences by vaping and smoking status. The percentage of youth who vaped that reported 'no usual' brand also decreased substantially from 2017 (29% to 42%) to 2023 (11% to 17%). The rise of disposable e-cigarettes appeared to be driven primarily by individual brands in the US (Puff Bar in 2020/2021, Elf Bar in 2022/2023) and England (Elf Bar in 2022/2023). CONCLUSIONS: The e-cigarette market has evolved rapidly with notable shifts in the types of e-cigarettes used by youth who vape in Canada, England and the United States. Although the timing differed across countries, major shifts in device types appear to be driven by individual brands and were often accompanied by increases in vaping prevalence among youth.

Child and adolescent exposure to unhealthy food marketing across digital platforms in Canada.

BACKGROUND: Children and adolescents are exposed to a high volume of unhealthy food marketing across digital media. No previous Canadian data has estimated child exposure to food marketing across digital media platforms. This study aimed to compare the frequency, healthfulness and power of food marketing viewed by children and adolescents across all digital platforms in Canada. METHODS: For this cross-sectional study, a quota sample of 100 youth aged 6-17 years old (50 children, 50 adolescents distributed equally by sex) were recruited online and in-person in Canada in 2022. Each participant completed the WHO screen capture protocol where they were recorded using their smartphone or tablet for 30-min in an online Zoom session. Research assistants identified all instances of food marketing in the captured video footage. A content analysis of each marketing instance was then completed to examine the use of marketing techniques. Nutritional data were collected on each product viewed and healthfulness was determined using Health Canada's 2018 Nutrient Profile Model. Estimated daily and yearly exposure to food marketing was calculated using self-reported device usage data. RESULTS: 51% of youth were exposed to food marketing. On average, we estimated that children are exposed to 1.96 marketing instances/child/30-min (4067 marketing instances/child/year) and adolescents are exposed to 2.56 marketing instances/adolescent/30-min (8301 marketing instances/adolescent/year). Both children and adolescents were most exposed on social media platforms (83%), followed by mobile games (13%). Both age groups were most exposed to fast food (22% of marketing instances) compared to other food categories. Nearly 90% of all marketing instances were considered less healthy according to Health Canada's proposed 2018 Nutrient Profile Model, and youth-appealing marketing techniques such as graphic effects and music were used frequently. CONCLUSIONS: Using the WHO screen capture protocol, we were able to determine that child and adolescent exposure to the marketing of unhealthy foods across digital media platforms is likely high. Government regulation to protect these vulnerable populations from the negative effects of this marketing is warranted.

"Everyone has their own problems and realities so the religious community cannot judge someone." Contraception motivations and perceived consequences among young contraceptive users who practice a religion in Burkina Faso.

BACKGROUND: Numerous factors at the individual, interpersonal, and societal levels are related to contraceptive use (or non-use) among adolescents and youth. Little is known about the role of religion as an individual and community-level influencer of contraceptive use among young women. METHODS: Using in-depth interviews with 24 young contraceptive users ages 18-24 who practice their Catholic, Protestant or Muslim religion in two cities in Burkina Faso, this study examines motivations and perceived consequences of contraceptive use. By including users of modern contraception who were both single and married, a range of perspectives are provided. RESULTS: Generally, the young women interviewed who practice their religion and use contraception perceived that their religion was not supportive of contraceptive use. A few exceptions were provided, including perceived acceptance of use of some methods for married women for spacing purposes; this was specifically identified as acceptable among Muslim respondents. Sexual activity and contraceptive use were not acceptable by any of the religions for unmarried young women. That said, young women, both married and unmarried, reported their motivations for use that often related to their and their children's health and the realities of life. Contraceptive use was considered a private matter which meant that the religious community would not find out about women's use. CONCLUSIONS: Recognizing that some women are willing and able to use contraception even without the perceived support of their religious communities might help to push social norms to change and be more accepting of contraceptive use that meets young women's and families' circumstances.

"My resistance melts away": The role of mindfulness in supporting participatory researchers' efforts to share power with youth co-researchers.

Youth participatory action research (YPAR) is an approach widely utilized in various social science disciplines (e.g., community psychology, social work, public health), which requires researchers to share power with youth co-researchers and to collaborate across identities to work equitably. Understanding what approaches and practices support YPAR adult facilitators' ability to share power is a vital area of knowledge that can support greater freedom in how researchers approach YPAR. Mindfulness offers a powerful set of tools for adult researchers to track their reactions and equitably collaborate with youth co-researchers. Drawing on insights from our youth participatory research, the present study employed a collaborative autoethnography to integrate our unique experiences as YPAR facilitators. We reflected on a core research question: How does mindfulness inform and support our YPAR work? Two major themes emerged that relate to power-sharing in YPAR: (1) Mindfulness supports our ability to overcome barriers to being present in facilitating YPAR groups; (2) Facilitator presence fosters deeper connection with youth co-researchers and stronger collaboration. Mindfulness can provide researchers a holistic, strengths-based approach in youth collaboration, and may also provide skillful tools for researchers to counter the pressures of White supremacy culture in academia.

Positive Youth Development Approach to School Safety: A Comprehensive Conceptual Framework.

BACKGROUND: Youth violence, victimization, and bullying are pervasive in schools across the United States and are detrimental for learning and healthy development. K-12 school safety is an increasingly urgent issue to research and understand from multiple perspectives. Physical and psychological safety in school is linked to better student and school outcomes and is fundamental to fostering well-being and prosocial behavior. METHODS: Despite research demonstrating positive outcomes associated with school safety, there is no comprehensive conceptual model in the literature that considers precursors, strategies, mechanisms, and outcomes of school safety together. The current paper presents an equity-centered comprehensive model of school safety, which is intended as a holistic representation of the multiple factors and pathways that contribute to school safety and positive youth development. RESULTS: This model can guide research and practice through an equity-centered and comprehensive approach. This model can enable practitioners, researchers, and policymakers to make informed decisions and reach consensus regarding planning and decisions related to reducing violence and establishing supportive school environments. CONCLUSION: Our model suggests that a comprehensive approach can ensure the safety and well-being of students and staff. By thinking ecologically, schools, communities, and stakeholders can ensure that all aspects of the school context are included in school safety.

Sex-related differences in young binge drinkers on the neurophysiological response to stress in virtual reality.

Background: Stress is one of the main environmental factors involved in the onset of different psychopathologies. In youth, stressful life events can trigger inappropriate and health-damaging behaviors, such as binge drinking. This behavior, in turn, can lead to long-lasting changes in the neurophysiological response to stress and the development of psychological disorders late in life, e.g., alcohol use disorder. Our aim was to analyze the pattern of neurophysiological responses triggered with the exposition to a stressful virtual environment in young binge drinkers. Methods: AUDIT-3 (third question from the full AUDIT) was used to detect binge drinking (BD) in our young sample (age 18-25 years). According to the score, participants were divided into control (CO) and BD group. Next, a standardized virtual reality (VR) scenario (Richie's Plank) was used for triggering the stress response while measuring the following neurophysiological variables: brain electrical activity by electroencephalogram (EEG) and cortisol levels through saliva samples both measurements registered before and after the stressful situation. Besides, heart rate (HR) with a pulsometer and electrodermal response (EDA) through electrodes placed on fingers were analyzed before, during and after the VR task. Results: Regarding the behavior assessed during the VR task, BD group spent significantly less amount of time walking forward the table and a tendency toward more time walking backwards. There was no statistically significant difference between the BD and the CO group regarding time looking down, but when we controlled the variable sex, the BD women group displayed higher amount of time looking down than the rest of the groups. Neurophysiological measurements revealed that there was not any statistically significant difference between groups in any of the EEG registered measures, EDA response and cortisol levels. Sex-related differences were found in HR response to VR scenario, in which BD women displayed the highest peak of response to the stressor. Also, the change in heartbeat was higher in BD women than men. Conclusion: Unveiling the neurophysiological alterations associated with BD can help us to prevent and detect early onset of alcohol use disorder. Also, from our data we conclude that participants' sex can modulate some stress responses, especially when unhealthy behaviors such as BD are present. Nevertheless, the moment of registration of the neurophysiological variables respect to the stressor seems to be a crucial variable.

NPCs in video games: a reflective resource for sports coaches and participant engagement.

This perspective article explores the potential of non-player characters (NPCs) in video games as a reflective tool for coaches to enhance participant engagement in sports. While coaches traditionally focus on movement skill instruction, their role extends to fostering young people's immersion in sports contexts and potentially contribute to the possibility of lifelong participation. However, challenges persist in translating coaching theory in coach education programs into practice, including the awareness of roles and how to make young people immersion in sports. Integrating elements from video games, where NPCs play pivotal roles in shaping player experiences, presents a possible avenue for re-thinking the role of coach, especially in participation. By drawing parallels between NPCs and coaches, this article advocates for a new reflection tool for coaching roles. Future research should investigate the effectiveness of leveraging NPCs to enhance athlete engagement and motivation, ultimately creating dynamic and inclusive coaching environments that cater to the evolving needs of participants.

SCAT5 baseline values, test-retest reliability, and reliable change metrics in high school athletes.

OBJECTIVE: In the United States, more than 1 million sport-related concussions afflict children annually, with many cases undetected or unreported. The Sport Concussion Assessment Tool (SCAT) is widely used to detect concussions in high school, collegiate, and professional sports. The objective of this study was to establish baseline values for the SCAT version 5 (SCAT5) in high school athletes. METHODS: Baseline SCAT5 evaluations were conducted in students (ages 14-19 years) from 19 high schools in central Illinois who were participating in various school-sponsored sports. The SCAT5 evaluations were retrospectively extracted from the electronic medical record system for analysis. Statistical analyses included the Wilcoxon rank-sum test for continuous variables and the chi-square test for categorical variables, considering significance at p < 0.05. Test-retest reliability at < 6 months, 10-14 months, and 16-20 months was computed using intraclass correlation and Spearman's rho (ρ). Reliable change indices are provided using the Iverson formula. RESULTS: A total of 2833 unique athletes were included, and the average age was 15.5 ± 1.14 (SD) years. There were 721 female (25.5%) and 2112 male (74.5%) athletes. Students ≥ 15 years old had more prior concussions (p < 0.001), and male athletes were more frequently hospitalized for head injury (p = 0.013). Female athletes exhibited a significantly higher prevalence of mood disorders (14.7% vs 4.6%, p < 0.001), whereas attention-deficit/hyperactivity disorder was more common in male athletes (5.2% vs 13.2%, p < 0.001). Symptom number and severity were significantly greater in female athletes (3.17 ± 4.39 vs 2.08 ± 3.49, p < 0.001; 5.47 ± 9.21 vs 3.52 ± 7.26, p < 0.001, respectively), with mood-related symptoms representing the largest differences. Female athletes and students ≥ 15 years old performed better on most cognitive assessments. Female athletes and students < 15 years old performed better on the modified Balance Error Scoring System (p < 0.001). Test-retest reliability was poor to moderate for most assessment components. Reliable change index cutoff values differed slightly by sex, with female athletes often having a greater cutoff value. CONCLUSIONS: This study underscores the variability of SCAT5 baseline values influenced by age, sex, and medical history among adolescent athletes. It provides a robust dataset, delineating baseline values stratified by sex and age within this demographic. Additionally, the results provide enhanced guidance to clinicians for interpretation of change and reliability of baselines.