Toward a decolonial developmental science in Asia: Exploring adolescent development in communities from the majority world.

The field of developmental science explores the rich interplay between individuals and their contexts, which dynamically shift across time and place. In Asia, context-specific research and practice are essential for promoting culturally relevant program and policy approaches to improving adolescent well-being. This involves critically examining how localized social structures and power dynamics shape individual experiences and outcomes. The landscape for Asian adolescents today differs significantly from that of previous generations due to rapid changes in these structures, and societal transformation has created the opportunity for traditional and modern values to coexist. This commentary draws across articles from this special issue to describe the dynamics of adolescent-context relations across diverse Asian contexts using developmental science methods. This includes interrogating risk factors, opportunities, and trajectories for adolescents growing up in non-Western settings while also questioning the application of Western, adult-centric discourses on adolescent well-being globally.

Climate change impacts on child and adolescent health and well-being: A narrative review.

Background: Worldwide, the climate is changing and affecting the health and well-being of children in many ways. In this review, we provided an overview of how climate change-related events may affect child and adolescent health and well-being, including children's mental and physical health, nutrition, safety and security, learning opportunities, and family caregiving and connectedness. Methods: In this narrative review, we highlighted and discussed peer-reviewed evidence from 2012-23, primarily from meta-analyses and systematic reviews. The search strategy used a large and varied number of search terms across three academic databases to identify relevant literature. Results: There was consistent evidence across systematic reviews of impact on four themes. Climate-related events are associated with a) increases in posttraumatic stress and other mental health disorders in children and adolescents, b) increases in asthma, respiratory illnesses, diarrheal diseases and vector-borne diseases, c) increases in malnutrition and reduced growth and d) disruptions to responsive caregiving and family functioning, which can be linked to poor caregiver mental health, stress and loss of resources. Evidence of violence against children in climate-related disaster contexts is inconclusive. There is a lack of systematic review evidence on the associations between climate change and children's learning outcomes. Conclusions: Systematic review evidence consistently points to negative associations between climate change and children's physical and mental health, well-being, and family functioning. Yet, much remains unknown about the causal pathways linking climate-change-related events and mental and physical health, responsive relationships and connectedness, nutrition, and learning in children and adolescents. This evidence is urgently needed so that adverse health and other impacts from climate change can be prevented or minimised through well-timed and appropriate action.

Accelerating Well-being for Adolescents Through Transformative Public Policy: A Framework for Action.

PURPOSE: As governments around the world are shaping policy responses to advance adolescent well-being and protect their rights, the tools and resources to strengthen policy foundations, and ultimately improve their effectiveness, remain limited. This paper proposes a framework to support policy action with an explicit adolescent focus and applies it to two illustrative case studies to unpack the underlying policy conditions for success. METHODS: We develop an analytic framework with an adolescent lens that focuses on the full policy life-course, from development, to implementation, to evaluation. We then choose two illustrative case studies to apply this framework - 1) abolition of secondary school fees policy in Kenya and 2) age of marriage law in Mexico. These cases were chosen based on the existence of rigorous causal evidence of effect, alignment of salience with expert opinions, broad-based implications for adolescents across contexts, and varied levels of success at achieving intended outcomes. RESULTS: Our framework identified six key components as critical foundations for adolescent-focused policies: (1) policy features and costs, (2) implementation considerations, (3) participatory approach, (4) inclusion and coverage, (5) policy appropriateness, and (6) monitoring and evaluation, each with key adolescent-specific elements. We find that the majority of the essential policy elements are addressed in the school fees abolition policy (Kenya), but are sparser in the age of marriage law (Mexico). The results also highlight the lack of decentralized monitoring as well as meaningful adolescent engagement at any level of policy development as potential drivers of ineffectiveness of adolescent-centric policies. DISCUSSION: Our adolescent policy analysis framework can serve as an important tool to define principles in the development of effective adolescent policies. It also can serve as a useful evaluation tool to unpack the 'black box' of policy effectiveness when combined with robustly estimated effects.

Intersectionality, gender norms, and young adolescents in context: a review of longitudinal multicountry research programmes to shape future action.

Discriminatory gender norms can intersect and interact with other dimensions of discrimination-such as age, race, ethnicity, disability, education status, and sexual orientation-to shape individuals' experiences and impact their health and wellbeing. This interaction is referred to as intersectionality. Although the theory has been in circulation since the late 1980s, only recently has it gained traction in low-income and middle-income settings, and it has yet to fully penetrate global research on adolescence. The social and structural intersectional drivers of adolescent health and wellbeing, particularly during early adolescence (age 10-14 years), are poorly understood. The evidence base for designing effective interventions for this formative period of life is therefore relatively small. In this Review, we examine how gender intersects with other forms of disadvantage in the early stages of adolescence. Analysing data from hybrid observation-intervention longitudinal studies with young adolescents in 16 countries, our aim is to inform the health and wellbeing of girls and boys from a range of social contexts, including in conflict settings. Adolescents' perceptions about gender norms vary by context, depend on individual opinion, and are shaped by socioecological drivers of gender inequalities in health. Shifting those perceptions is therefore challenging. We argue for the importance of applying an intersectionality lens to improve health and wellbeing outcomes for young adolescents and conclude with five practical recommendations for programme design and research.

Reaching adolescents with health services: Systematic development of an adolescent health check-ups and wellbeing programme in Ghana (Y-Check, Ghana).

BACKGROUND: Routine health check-ups may improve adolescent health, but global guidelines are lacking. Phase 1 of the WHO-coordinated Y-Check Research Programme involved three African cities to co-produce a programme of adolescent health check-ups. We describe a systematic approach to developing a routine adolescent health check-ups and wellbeing programme (Y-Check) to contribute evidence on whether adolescent health check-ups should be part of routine health services in Ghana. METHODS: Y-Check Phase 1 was conducted in four communities in Cape Coast Ghana, over two stages using a variety of methods: (a) needs assessment and landscape analysis on the health of adolescents (existing policies/programmes, school system, adolescent health conditions) was conducted through desk-review and interviews with key informants to identify the potential content, delivery strategy and settings for adolescent health check-ups in this context; (b) co-designing the Y-Check intervention framework through person-centred participatory workshops and a consensus-building workshop with multiple stakeholders, including adolescents (10-19 years) and their parents. The study was conducted between January 2020 and October 2020. RESULTS: The Y-Check intervention consists of two check-ups with content that is tailored to the needs of younger adolescents and older adolescents; delivered at both school and community settings by a team of trained staff in multiple steps involving up to four stations. Y-Check includes a referral system for adolescents with any problems that cannot be investigated or treated on-the-spot. CONCLUSIONS: Our systematic approach to co-producing Y-Check has resulted in an intervention whose content and structure is determined by the local context, and which was adjudged by multiple stakeholders to be likely to be both useful and acceptable, and which builds on best practice. As a logical next step, the Y-Check will be subjected to pilot testing and implementation research to rigorously evaluate the feasibility, acceptability, coverage, yield of previously undiagnosed conditions and cost of these health check-ups.

Adolescent health and well-being check-up programme in three African cities (Y-Check): protocol for a multimethod, prospective, hybrid implementation-effectiveness study.

BACKGROUND: During adolescence, behaviours are initiated that will have substantial impacts on the individual's short-term and long-term health and well-being. However, adolescents rarely have regular contact with health services, and available services are not always appropriate for their needs. We co-developed with adolescents a health and well-being check-up programme (Y-Check). This paper describes the methods to evaluate the feasibility, acceptability, short-term effects and cost-effectiveness of Y-Check in three African cities. METHOD: This is a multi-country prospective intervention study, with a mixed-method process evaluation. The intervention involves screening, on-the-spot care and referral of adolescents through health and well-being check-up visits. In each city, 2000 adolescents will be recruited in schools or community venues. Adolescents will be followed-up at 4 months. The study will assess the effects of Y-Check on knowledge and behaviours, as well as clinical outcomes and costs. Process and economic evaluations will investigate acceptability, feasibility, uptake, fidelity and cost effectiveness. ETHICS AND DISSEMINATION: Approval has been received from the WHO (WHO/ERC Protocol ID Number ERC.0003778); Ghana Health Service (Protocol ID Number GHS-ERC: 027/07/22), the United Republic of Tanzania National Institute for Medical Research (Clearance No. NIMR/HQ/R.8a/Vol.IX/4199), the Medical Research Council of Zimbabwe (Approval Number MRCZ/A/2766) and the LSHTM (Approval Numbers 26 395 and 28312). Consent and disclosure are addressed in the paper. Results will be published in three country-specific peer-reviewed journal publications, and one multicountry publication; and disseminated through videos, briefs and webinars. Data will be placed into an open access repository. Data will be deidentified and anonymised. TRIAL REGISTRATION NUMBER: NCT06090006.

PROTOCOL: Child and adolescent mental health and psychosocial support interventions: An evidence and gap map of low- and middle-income countries.

This is the protocol for a Campbell review. The objective of this evidence and gap map is to provide an overview of the existing evidence on the effectiveness of interventions aimed at promoting mental health and reducing or preventing mental health conditions among children and adolescents in low- and middle-income countries.

Addressing the Mental and Emotional Health Impacts of COVID-19 on Children and Adolescents: Lessons From HIV/AIDS.

The COVID-19 pandemic has led to lasting mental health and psychosocial consequences just as were experienced with the HIV epidemic. A rapid review of published systematic reviews on HIV/AIDS and mental health outcomes and responses among children and adolescents was used to identify lessons for the COVID-19 pandemic response. The review found that HIV/AIDS responses to promote mental health, prevent ill-health and treat mental health conditions included diverse interventions at the structural or national, community, household and individual levels. Some of these responses can be easily replicated, others require substantial adaptation, and some can inform development of new innovative offline and online responses to mitigate impact of COVID-19 on mental health of children and adolescents. Programs that mitigate economic impacts including child grants, income generating activities for caregivers, food distribution, health care vouchers, and other economic empowerment interventions can be replicated with minor adjustments. Helplines for vulnerable or abused children and shelters for victims of gender-based violence can be scaled up to respond to the COVID pandemic, with minimal adaptation to adhere to prevention of contagion. Mass media campaigns to combat stigma and discrimination were successfully employed in the HIV response, and similar interventions could be developed and applied in the COVID context. Some programs will need more substantial adjustments. In health facilities, mainstreaming child-sensitive mental health training of frontline workers and task sharing/shifting to community volunteers and social workers as was done for HIV with community health workers, could advance mental illness detection, particularly among abuse victims, but requires adaptation of protocols. At the community and household levels, expansion of parenting programs can help caregivers navigate negative mental health effects on children, however, these are not often operating at scale, nor well-linked to services. Programs requiring innovation include converting adolescent and youth safe physical spaces into virtual spaces particularly for at-risk girls and young women; organizing virtual community support groups, conversations, and developing online resources. Re-opening of schools and introduction of health and hygiene policies, provides another opportunity for innovation - to provide mental health and psychosocial support to all children as a standard package of care and practice.

Intersecting Vulnerabilities: The Impacts of COVID-19 on the Psycho-emotional Lives of Young People in Low- and Middle-Income Countries.

Across diverse contexts, emerging evidence suggests that the COVID-19 pandemic is increasing levels of anxiety and stress. In calling for greater attention to people's psychosocial and emotional well-being, global actors have paid insufficient attention to the realities of the pandemic in low- and middle-income countries, where millions of people are already exposed to intersecting vulnerabilities. Chronic poverty, protracted violence, conflict and displacement, coupled with weak health, education and protection systems, provide the backdrop of many adolescents' lives. Drawing on qualitative in-country telephone interviews with over 500 adolescents in Ethiopia, Côte d'Ivoire and Lebanon, this article unpacks the age and gendered dimensions of COVID-19 and its response. We conclude by discussing the implications for COVID-19 recovery efforts, arguing that embedding adolescent-centred, inclusive approaches in education, community-based health and social protection responses, has the potential to mitigate the psycho-emotional toll of the pandemic on young people and promote resilience.

De nouvelles données probantes issues de différents contextes suggèrent que la pandémie de COVID-19 augmente le niveau d'anxiété et de stress. En appelant à une plus grande attention au bien-être psychosocial et émotionnel des populations, les acteurs mondiaux ont accordé une attention insuffisante aux réalités de la pandémie dans les pays à revenu faible et intermédiaire, où des millions de personnes sont déjà exposées à des vulnérabilités croisées. La pauvreté chronique, la violence prolongée, les conflits et les déplacements, associés à la faiblesse des systèmes de santé, d'éducation et de protection sociale, sont la toile de fond de la vie de nombreux adolescents et adolescentes. Cet article s'appuie sur des entretiens téléphoniques qualitatifs avec plus de 500 adolescent.e.s et 55 informateurs-trices clés en Éthiopie, en Côte d'Ivoire et au Liban, pour démêler les dimensions sexospécifiques et liées à l'âge de la COVID-19 et de sa réponse. Nous abordons en conclusion ce que cela implique pour les efforts de relance suite à la COVID-19, en faisant valoir que l'intégration d'approches inclusives et centrées sur les adolescent.e.s dans l'éducation, dans les réponses sanitaires et sociales à base communautaire, a le potentiel d'atténuer le bilan psycho-émotionnel de la pandémie sur les jeunes et de promouvoir la résilience.

Evaluation of child/adult pharmacokinetic differences from a database derived from the therapeutic drug literature.

Pharmacokinetics (PK) of xenobiotics can differ widely between children and adults due to physiological differences and the immaturity of enzyme systems and clearance mechanisms. This makes extrapolation of adult dosimetry estimates to children uncertain, especially at early postnatal ages. While there is very little PK data for environmental toxicants in children, there is a wealth of such data for therapeutic drugs. Using published literature, a Children's PK Database has been compiled which compares PK parameters between children and adults for 45 drugs. This has enabled comparison of child and adult PK function across a number of cytochrome P450 (CYP) pathways, as well as certain Phase II conjugation reactions and renal elimination. These comparisons indicate that premature and full-term neonates tend to have 3 to 9 times longer half-life than adults for the drugs included in the database. This difference disappears by 2-6 months of age. Beyond this age, half-life can be shorter than in adults for specific drugs and pathways. The range of neonate/adult half-life ratios exceeds the 3.16-fold factor commonly ascribed to interindividual PK variability. Thus, this uncertainty factor may not be adequate for certain chemicals in the early postnatal period. The current findings present a PK developmental profile that is relevant to environmental toxicants metabolized and cleared by the pathways represented in the current database. The manner in which this PK information can be applied to the risk assessment of children includes several different approaches: qualitative (e.g., enhanced discussion of uncertainties), semiquantitative (age group-specific adjustment factors), and quantitative (estimation of internal dosimetry in children via physiologically based PK modeling).

Impactos y respuestas COVID-19 en adolescentes: Perspectivas Globales / COVID-19 Impacts and Responses in Adolescents: Global Perspectives

Impactos potenciales del COVID-19 en adolescentes: mediatos, inmediatos y a largo plazo. Salud Básica y SHR, Salud Mental, Conexiones sociales, pobreza y perdida de vivienda, educación, violencia y conflicto. Soluciones basadas en evidencia. ¿Cómo es que los jóvenes puedes ser parte de la respuesta?