Perceptions of Breastfeeding Among Adolescents and Young Adults.

Purpose: We aimed to understand adolescents' and young adults' perceptions and the extent of their knowledge about breastfeeding. Methods: Participants (adolescents and young adults in the United States, 14-24 years of age) were texted five open-ended questions about their perceptions of various aspects of breastfeeding including their initial reaction to breastfeeding, the impact on the infant and parent, how it compares with formula, and whether they were breastfed. The responses were analyzed for themes using an inductive content analysis approach. Responses were compared using χ2 tests to assess if knowledge and education about breastfeeding differed according to gender identity and age. Results: Among 1,283 participants, 829 responded (response rate = 64.4%). The average age was 18.8 (standard deviation [SD] = 2.9), with 53% female and 10% Black. Most adolescents and young adults understand there are health benefits of breastfeeding for the breastfeeding dyad (n = 589; 78.8%), yet also indicate an awareness of negative aspects (n = 256; 36.1%). Participants who identified as female or gender-variant and those who were older were more likely to refer to the emotional and bonding connections breastfeeding creates (p = 0.0011 and p = 0.0002). Males were more likely to have less knowledge about breastfeeding effects on the breastfeeding person but have more negative attitudes toward formula (p = 0.0298 and p = 0.0543). Younger respondents tended to indicate that formula was better than breast milk (p = 0.0534). Conclusion: We found a mix of positive and negative perceptions of breastfeeding among adolescents and young adults. Understanding how youth view breastfeeding can inform targeted education for this population that includes all genders and can begin before pregnancy.

Youth Perspectives and Experiences With Menstruation and Period Poverty.

PURPOSE: Period poverty is the lack of accessible menstrual education or menstrual tools. Millions of women and girls around the world experience period poverty, which can contribute to disparities in school and work performance, as well as overall quality of life. However, not much is known about youth experiences and perceptions of period poverty. This study aims to understand the personal experiences and opinions of American youth regarding knowledge about menstruation and period poverty, as well as to gauge youth attitudes of existing and future period poverty initiatives. METHODS: The MyVoice nationwide text message poll was used to ask five open-ended questions to over 1,000 youth across the United States aged 14-24 years. Responses were analyzed using content analysis by two independent researchers, and differences in coding were reviewed and resolved by discussion. RESULTS: Overall, 963 youth (80%) responded, and the sample was 54.7% self-reported male with an average age of 20.1 years (standard deviation = 2.3). Three main themes emerged: 1. Most youth, regardless of self-reported gender, have had conversations about periods but comfort discussing the topic varies, 2. Youths' knowledge of menstruation varies with personal experience, or lack thereof, and 3. Some youth have experience with period poverty, and most are overwhelmingly supportive of policies to improve access to period products. DISCUSSION: These findings suggest that normalization of discussions of menstruation, increasing awareness of the prevalence and impacts of period poverty, and greater implementation of programs to mitigate period poverty are supported by youth, and may reduce period poverty in the United States.

Youth preferences for healthcare providers and healthcare interactions: a qualitative study.

BACKGROUND: Patient-physician relationships in healthcare can influence healthcare provision, patient engagement, and health outcomes. Little is known about youth preferences on types and characteristics of their healthcare providers. The aim of this study was to assess youth perspectives on preferences for and interactions with their healthcare providers. METHODS: We posed 5 open-ended questions to 1,163 MyVoice participants, a nationwide text message cohort of United States youth aged 14-24, on April 10, 2020 related to youth preferences for healthcare providers. Content analysis was used to develop a codebook. Responses were independently coded by two reviewers with discrepancies discussed to reach consensus. Descriptive statistics were calculated for demographics and frequency of codes. RESULTS: 944 (81%) participants responded to at least one question. Respondents had a mean age of 18.9 years (SD: 2.8) and were a majority female (53.6%) and White (56.3%). Youth reported "kindness" or other personality traits (31%) and education (30%) as important in choosing their doctor. Patient-physician concordance was not important to many youths (44%) and among those who reported concordance as important (55%), having the same gender was the most noted (68%). Youth suggested respect, open conversation, and addressing issues directly to help alleviate uncomfortable situations, though some would simply switch providers. CONCLUSION: Personality and empathy are important provider characteristics valued by youth. Female respondents preferred gender concordant providers, particularly for sexual health-related issues, and non-white respondents were more likely to prefer racial concordance. Strengthening professional and interpersonal skills among youth-serving providers may improve healthcare engagement and satisfaction among youth.

Perceptions of COVID-19 Vaccine Incentives Among Adolescents and Young Adults.

Importance: Vaccine incentives have been used across the US to encourage COVID-19 vaccine uptake and include programs targeted to adolescents and young adults. However, little is known about youths' views regarding these initiatives. Objective: To assess experiences and perceptions of COVID-19 vaccine incentives in a nationwide sample of US youth. Design, Setting, and Participants: A qualitative survey study was conducted using the MyVoice text message-based polling platform from October 22 to October 29, 2021. Participants were US adolescents and young adults aged 14 to 24 years, who were sent 5 open-ended questions to assess their experiences and perceptions of COVID-19 vaccine incentives. Qualitative responses were analyzed thematically. Descriptive statistical analysis was performed in January 2022. Main Outcomes and Measures: Experiences, perceptions, and opinions related to COVID-19 vaccine incentives as measured by survey response. Results: A total of 1125 of 1206 youth (93%) responded to the survey and had a mean (SD) age of 20 (2) years, 664 (59%) identified as male, and 769 (68%) identified as non-Hispanic White. Of respondents, 871 (79%) reported having heard of vaccine incentives, and 892 (82%) believed they were a good idea or had positive attributes. Notably, 305 youth (28%) expressed concerns about vaccine incentives, citing uncertainty about their effectiveness (86 [28%]), their ethical use (63 [21%]), the impact on vaccine motivations (51 [17%]), and confidence (39 [13%]), and lack of fairness (35 [11%]). Only 73 youth (7%) reported that an incentive influenced their decision to get a COVID-19 vaccine. When asked what they thought would motivate others to get a COVID-19 vaccine, youth with an opinion (536 of 1032 [52%]) most commonly reported incentives (112 [21%]) and additional COVID-19 vaccine testing, safety, or regulation (115 [21%]). Conclusions and Relevance: COVID-19 vaccine incentives are well known to youth but not a significant self-reported motivator for vaccination. Although generally viewed favorably, more than a quarter of youth expressed concerns regarding vaccine incentives, including but not limited to their ethics, effectiveness, fairness, and impacts on vaccine motivation and confidence. Policymakers considering targeted use of COVID-19 vaccine incentives should weigh youths' perspectives on these initiatives alongside objective effectiveness and cost-effectiveness data.

Content analysis of the impact of COVID-19 on weight and shape control behaviors and social media content of U.S. adolescents and young adults.

OBJECTIVE: The current study examines impacts of the COVID-19 pandemic on weight/shape control behaviors among adolescents and young adults in the U.S., and perceived changes to related social media content. METHOD: A sample of youth (14-24 years) from MyVoice, a national text-message-based cohort, provided open-ended responses to questions on changes in eating and exercise habits due to concern about weight/shape, and social media content related to weight/shape, during the pandemic. Responses were collected using a secure online platform and analyzed using content analysis. RESULTS: Among respondents (n = 939/1153, response rate = 81%), 40.0% adopted behaviors for the purpose of weight/shape control during the pandemic. Nearly half (49.2%) reported seeing posts about weight/shape on social media during the pandemic. DISCUSSION: Findings from this study indicate that weight/shape concerns among adolescents and young adults in the U.S. may have increased due to the COVID-19 pandemic, with social media content as a potentially contributing factor.

Views on COVID-19 and Use of Face Coverings Among U.S. Youth.

PURPOSE: Little is known about the views of U.S. youth on COVID-19 or their use of face coverings. Closing this gap could facilitate messaging to promote COVID-19 risk mitigation behaviors. METHODS: In July 2020, a five-question text message survey was sent to 1,087 youth aged 14-24 years. Questions assessed youths' perceptions regarding the likelihood of contracting COVID-19, the potential impact of contracting COVID-19 on their lives, the possibility of spreading COVID-19 to others, and their use of face coverings around others with whom they do not live. Coding was conducted to assign responses to discrete categories and to identify common themes. RESULTS: Of 1,087 eligible participants, 797 (73.3%) were included in analyses. Of these participants, 27.3% believed they would likely contract COVID-19 in the next few months, 90.3% believed contracting COVID-19 would have a moderate or significant impact on their lives, 86.0% were moderately or very concerned about spreading COVID-19, and 89.2% reported wearing face coverings all or most of the time. Factors affecting face covering use included the desire to avoid contracting and spreading COVID-19, peer influence, and policy mandates. CONCLUSIONS: Youths' perceptions regarding the risk of contracting COVID-19 varied, but most believed their lives would be adversely impacted if this occurred. Most youth were concerned about spreading COVID-19 and wore face coverings, but many made exceptions to face covering use when around close contacts. Public health campaigns may be most effective if they leverage positive peer influence and appeal to youths' desire not to spread COVID-19 to others.

National Study of Youth Opinions on Vaccination for COVID-19 in the U.S.

PURPOSE: This study aimed to understand the potential barriers and facilitators to COVID-19 vaccination among youth. METHODS: Open-ended questions regarding COVID-19 vaccination were posed to a national cohort of 14- to 24-year-olds (October 30, 2020). Responses were coded through qualitative thematic analysis. Multivariable logistic regression tested the association of demographic characteristics with vaccination unwillingness. RESULTS: Among 911 respondents (response rate = 79.4%), 75.9% reported willingness to receive a COVID-19 vaccine, 42.7% had unconditional willingness, and 33.3% were conditionally willing, of which the majority (80.7%) were willing if experts deemed vaccination safe and recommended. Preferred vaccine information sources were medical organizations (42.3%; CDC, WHO) and health care professionals (31.7%). Frequent concerns with vaccination included side effects (36.2%) and efficacy (20.1%). Race predicted vaccination unwillingness (Black: odds ratio = 3.31; and Asian: odds ratio = .46, compared with white, p < .001). CONCLUSION: Most youth in our national sample were willing to receive a COVID-19 vaccine when they believe it is safe and recommended. Public health experts and organizations must generate youth-centered materials that directly address their vaccination concerns.

Youth Perceptions of Vaccination for COVID-19 in the United States.

This survey study examines opinions from a diverse sample of US youth after the initiation of mass immunization campaigns regarding COVID-19 vaccine acceptability, perceived barriers to vaccination, and anticipated changes in behavior.