Browsing by Subject "adolescent"

Substance use disorders are one of the most common psychiatric diagnoses among adolescents; marijuana is the illicit drug used most frequently by youth. Treatment dropout and relapse following treatment are common; innovative strategies are needed to improve treatment outcomes for youth substance abusers. The aim of this study was to develop and evaluate the feasibility of a virtual reality (VR) cue reactivity paradigm for adolescent cannabis abusers and to compare it to a video cue reactivity paradigm. Forty-two treatment-seeking youth with a cannabis use disorder completed the study, which incorporated three parts. During Part 1, drug and neutral video clips were shown to 11 youth and five substance-abuse experts who provided craving/usefulness ratings for each video clip. During Part 2, five youth met in a focus group and then individually to provide input on the development of the VR paradigm. During Part 3, 26 youth completed a laboratory procedure involving neutral and drug-related video clips and VR presentations. Heart rate, skin conductance, and skin temperature were measured as well as craving. Higher levels of craving and skin conductance were observed during drug-related presentations. The presentations did not significantly differ in their ability to elicit craving and arousal. Results suggest that youth can experience subjective and physiological reactivity to VR drug cues warranting further study with a larger, more diverse sample. Implications are discussed.

Peer support is one theoretically grounded and developmentally informed approach to support the unique psychosocial challenges faced by adolescents and young adults (AYAs) living with childhood onset chronic conditions (COCCs). Working alliance is presented as one well-established construct to understand the underlying mechanisms of peer support in this population. This exploratory study sought to describe the working alliance trajectory in a peer support intervention for AYAs with a COCC.

The present study was a substudy of a randomized controlled trial examining the efficacy of a one-to-one telephone-based peer coaching intervention for AYAs with a COCC designed to promote self-management and patient activation. The present study aimed to describe the working alliance trajectory from the perspective of the AYA over the first four coaching sessions and to examine AYA, peer coach, and dyadic characteristics (gender, age, race, COCC category) that influence the working alliance trajectory. This study also utilized qualitative analyses to describe core aspects of the AYA-peer coach relationship over time. AYAs completed a self-report measure to assess their perceived working alliance following the first four peer coaching sessions. For 32 AYA-peer coach dyads, linear random coefficient regression models for longitudinal data were conducted to describe the trajectory of overall working alliance across the first four coaching sessions. AYAs perceived a strong working alliance in the first peer coaching session, which was maintained across three subsequent sessions. There were no significant differences in working alliance trajectory across AYA, peer coach, and dyadic characteristics. Although not significantly significant, a trend emerged in which AYAs and peer coaches with the same COCC had a decrease in working alliance over time, while AYAs and peer coaches with a different COCC had an increase in working alliance over time. Qualitative findings revealed themes describing peer coach skills consistent with the working alliance construct (warmth/empathy/genuineness, alignment with AYA’s goals) as well as the ability to integrate similar experiences to build a trusting relationship and provide support, which may be unique to the peer relationship. Findings from the present study serve as a foundation for future efforts to capture the underlying mechanisms of peer support for AYAs with a COCC, which can inform the design of research and clinical programming that effectively leverage peer support to promote outcomes.

Background: The role of grandparents has changed in response to social, economic and demographic factors, which may operate both in favour of or against the relationship between grandparents and their grandchildren. The potential positive impact of the grandparent-grandchild relationship on the development of adolescent grandchildren has been increasingly recognized, although relatively few studies have directly related this relationship to measures of child well-being. This study aims to examine the association between grandparent-grandchild interactions and socio-emotional and cognitive outcomes among adolescent grandchildren in Sri Lanka. Methods: This cross-sectional study was conducted within schools, temples, homes and community buildings in Galle District. An interviewer-assisted survey was used to collect data about the adolescent participants’ demographics, family and household information, grandparent relationships, empathy, and socio-emotional development. A cognitive test was used to assess the adolescents’ cognitive development. Univariate, bivariate and multivariate analyses were used to examine the association between the grandparent-grandchild relationship and adolescent outcomes. Results: Our results indicate that grandparent-grandchild relationships are significantly associated with adolescent socio-emotional and cognitive development. Conclusions: This study underlines the importance of the grandparent-grandchild relationship.

Background: Mental health challenges comprise a significant share of the global disease burden among adolescents. In many global settings, mental health services are limited and few adolescent mental health interventions (AMH) exist or have been sustained. This qualitative study sought to explore stakeholder perspectives on factors that influence sustainable implementation of AMH interventions in East and Southern Africa, and to explore youth leaders’ perspectives on and experiences with delivering a mental health intervention tailored to adolescents living with HIV in Tanzania. Methods: In-depth interviews lasting between 30-60 minutes were conducted virtually with 12 participants. One focus group discussion with six participants lasting 1.5 hours was conducted in Tanzania. Data were recorded and transcribed and then coded and analyzed using Nvivo 12 Pro software. Results: Sufficient political will, civil society involvement, multisectoral approaches, health system integration, and mental health awareness are important factors for sustainable implementation. Major constraints to sustainable implementation include the absence of these factors, as well as stigma, low mental health literacy, and insufficient funding and health system capacity. Conclusions: Mental health awareness, contextual fit, and the meaningful engagement of key stakeholders influences the sustainable implementation of AMH interventions. These findings have several important implications for policy and practice.

Background: Youth living with HIV have worse health outcomes compared to adults or children. Few interventions have been developed engaging youth in their care to promote resilience. Peer-led education is one potential way to boost confidence and bolster resilience while also improving HIV knowledge of youth living with HIV (YLHIV). Peer youth leaders (PYL) can be effective educators because they are seen as trustworthy and relatable to their peers. PYL themselves may also benefit from increased resilience and empowerment after taking on leadership position at their monthly adolescent HIV clinic. This study evaluated the acceptability, feasibility, and effectiveness of using PYL to teach an HIV education. Methods: Seven HIV-infected youth were recruited based on their previous enrollment in a mental health intervention for HIV-infected youth. Those who demonstrated confidence, excellent adherence, and upstanding behavior were chosen to become PYL. PYLs were trained by a doctor, social worker, and previously trained group leaders of a mental health intervention to teach an HIV education curriculum adapted from the Baylor International Pediatric AIDS Initiative. Trainings occurred once a week for two to three hours in preparation for teaching at the monthly adolescent HIV clinic. Two PYLs taught one-hour lessons to youth during the monthly adolescent HIV clinic. Approximately 25 clinic attendees were asked to volunteer to complete pre/post knowledge assessments and provided feedback on the PYL model. Acceptability and feasibility of using PYL to deliver an HIV curriculum to YLHIV was evaluated through attendance records, fidelity checklists and feedback notes that were documented by trained group leaders who supervised PYL curriculum delivery. In depth interviews were conducted to evaluate change in fears, motivations, and resilience among PYL before and after assuming the leadership role. PYL resilience was measured using the Connor-Davidson Scale at baseline (prior to starting the teaching role) and 6 months after initiating training. Results: A PYL model of delivering an HIV curriculum was both feasible and acceptable as reported by youth attending monthly adolescent HIV clinic and PYL. Qualitative findings showed peer education created safe discussion spaces, reduced stress of participants, and enhanced beliefs of importance in maintaining good adherence. HIV knowledge was improved as measured by self-report, and improvement did not meet statistical significant (p =0.057). PYL leaders demonstrated trends toward improved resilience as measured by Connor-Davidson Resilience Scale and increased confidence, feelings of self-worth, sense of purpose, social support, and optimism and decreased internal stigma based on in-depth interviews. Conclusions: Results demonstrated the PYL model of teaching an HIV curriculum was feasible and acceptable. PYL had improved resilience as a result of taking on a leadership role at their monthly adolescent HIV clinic. Future evaluation of YLHIV retention in care and health outcomes as a result of participation in the PYL education should be explored.

Although it has been hypothesized that chronic emotional invalidation by a parent may have lasting effects on later ability to regulate emotions, and possibly increase the chances of experiencing symptoms of psychopathology, the possible mechanisms surrounding this relationship have not been adequately explored. Further, many investigations have used retrospective reports of invalidation, which may be subject to bias. This pilot study of 19 adolescent-parent dyads explored associations between invalidation, experiential avoidance, and child symptoms of psychopathology in a cross sectional design. Retrospective reports of invalidation as well as an observationally-coded measure of invalidation during laboratory discussions of emotion were utilized, and compared for agreement. The feasibility and acceptability of a larger investigation of these questions is also discussed. It was found that adolescent-reported recalled invalidation seemed to show a stronger pattern of association with observationally coded invalidation than do parent reports. Additionally, several alternative mechanistic hypotheses showed some promise for further exploration. This pilot study was found to be acceptable to participants; however, recruitment of adolescents from a clinical population - and their parents to participate with them - was the greatest obstacle to feasibility for a larger study.

Background: Adolescence is a critical risk period for the onset of mental health difficulties. Youth living with HIV (YLWH) face additional challenges navigating peer and romantic relationships due to stigma and disclosure, putting youth more at risk for mental health difficulties. This study explored changes in resilience of youth enrolled in a mental health intervention by examining development protective factors to address challenges over a six-year period. Methods: YLWH in Moshi, Tanzania were recruited who enrolled in a mental health intervention, Sauti ya Vijana (SYV) and participated in an in-depth interview as a part of a prior needs assessment study, both of which also included demographic, mental health measures, and stigma measures. The first in-depth interview took place in 2013/2014; which was paired with a subsequent interview in 2020. Both interviews explored youth experiences with mental health, protective factors, and challenges. Resilience in respondents was defined as positive adaptations made in response to challenges. Results: Five youth completed in-depth interviews. Three participants were male; mean age of was 23.4 years (SD 0.9 years). PHQ9, SDQ, and UCLA scores decreased a average of 5.8 (SD 5.9), 9.4 (SD 5.7), and 6.0 points (SD 10.0), respectively; Berger stigma scores increased an average of 4.6 points (SD 5.4). The primary challenge youth described was stigma; the primary protective factor for resilience and mental health was social support. Conclusions: YLWH face many challenges; however, protective factors improved youth resilience to face these challenges. Youth need consistent support and resources as they transition into adulthood.

Background: While adolescent nutrition has not historically garnered attention in public health programming, assessing adolescent nutrition is necessary in addressing cycles of chronic disease, intergenerational malnutrition, and poor developmental trajectory. Mid-upper arm circumference (MUAC), while mostly used as a tool to screen for undernutrition in children under 5, has the potential to offer a simple, low-resource alternative or supplement to BMI in assessing nutrition in adolescent populations. This study seeks to generate more data on adolescent nutrition in Tanzania, to understand the relationship between BMI and MUAC among adolescents, and to consider current age-specific cutoffs for adolescents.

Methods: This study analyzed anthropometric data from a sample of adolescents in primary school in Bagamoyo, Tanzania. A Spearman’s correlation coefficient was used to determine the relationship between BMI and MUAC and bivariate analysis was used to explore whether anthropometric categories of height, BMI, and MUAC vary according to pubertal and food security status. Additional post-hoc analysis was conducted to explore stunting among this population.

Results: The majority of adolescents in this population were of normal nutritional status. Thirty-eight percent of males compared to 3% of females were stunted. BMI and MUAC were significantly correlated (r=0.6530, p=0.000), with a

stronger correlation among females (r= 0.7736, p=0.000) than males (r=0.5878, p=0.000) and a stronger correlation among non-stunted (r=0.7797, p=0.000) when stunted individuals were removed from the sample. There was no correlation between BMI and MUAC among individuals categorized at overweight according to BMI (r=0.088, p=0.868). There were no significant differences in age-specific anthropometric categories according to self-reported pubertal status or food-insecurity status.

Conclusion: MUAC is a promising measure to be used for determining undernutrition when BMI calculation is not possible. More research is needed on a more nutritionally diverse population to better understand the relationship between BMI and MUAC in under and overnourished individuals and between stunted and non-stunted individuals. More country level data collection on adolescent nutrition including BMI and MUAC is needed to inform programmatic and policy decisions.