A cautionary tale: Pandemic survival lessons to sustain teen substance use prevention coalitions

Community coalitions have the potential to improve teen health outcomes by reducing risk and reinforcing protective factors across multiple community systems to mitigate teen pregnancy, violence, suicide, and teen substance use. This prevention work is achieved by developing multipronged action plans and employing community-level interventions to influence policies, systems, and environments in which youth live, learn, and play. In Washington State, nearly 100 coalitions target the complex issue of teen substance use prevention. These coalitions are representative of the diversity of community stakeholders for the prevention of teen substance use. An essential partnership and contractual requirement is a school-coalition agreement to address teen substance use. Working cooperatively, coalitions leverage resources and efforts to affect teen behavioral health by planning, implementing, and evaluating prevention efforts across multiple community systems. Every sector of the community has been disrupted by COVID-19, which has implications for teen substance use prevention. This explanatory mixed-methods phenomenological study explored how the pandemic affected community sectors, what barriers or challenges COVID-19 presented, and what adaptations to programs and service delivery were made to continue teen substance use prevention work. Comprehensive effects across 11 of 12 community sectors were reported, triggering shifts in priorities and negatively affecting morale. Transportation was an identified geographical barrier, while workforce issues were universally challenging regardless of location in the state. Technological infrastructure and digital literacy were highlighted as critical barriers to the successful implementation of coalition prevention interventions and detracted from the day-to-day functioning of coalitions. Deteriorating psychosocial health resulting from sustained uncertainty about the pandemic was compounded by contentious political discourse and division about infection mitigation requirements. Increased use of virtual platforms, new and diversified stakeholder relationships, and innovative community action methods advanced the work of teen substance use prevention despite the challenges posed by the pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Helping students C.O.P.E.: Effects of a mental health program on adolescents with challenging behaviors

Mental health concerns are rising among adolescents and have intensified since the COVID-19 pandemic (APA, 2020). Specifically, externalizing behavior challenges perceived by adults as 'aggressive' place adolescents at an increased risk for negative outcomes, including poor academic achievement and involvement with the juvenile justice system (Skiba et al., 2014). Schools have a responsibility to respond to the mental health needs of adolescent students through the implementation of evidence-based intervention (Domitrovich et al., 2010). One program that has demonstrated effectiveness towards improving these outcomes is the seven-session Creating Opportunities for Personal Empowerment (COPE) Teen program, a cognitive-behavioral skills-building intervention. In this study, the COPE program was delivered virtually, through a culturally responsive lens, to three high school students with ongoing aggressive behavior during the COVID-19 pandemic. It was hypothesized that the frequency and intensity of the aggressive behavior would decrease for each participant as a function of the COPE program. The behavior was operationally defined for each student and measured through direct observation by parents in the home setting. A single case multiple-baseline design was implemented. Visual analysis of data suggest that the frequency and intensity of aggressive behavior did not decrease as a function of the COPE program, indicating no intervention effect. Supplementary statistical analyses (e.g., log-response ratios) found varied intervention effects among students, ranging from no effects to small effects. Further, participants reported the COPE program as a helpful way to manage stress and would recommend it to their peers. The study results, limitations, and implications for future research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Understanding Connections between Nature and Stress among Conservation-Engaged Adolescents Using Photovoice Methodology.

While the literature supports positive associations between nature and adolescent mental health, mechanisms are not well understood, and assessment of nature varies widely among existing studies. To partner with the most insightful informants, we enrolled eight adolescent participants from a conservation-informed summer volunteer program, applying qualitative photovoice methodology to understand their use of nature to relieve stress. Across five group sessions, participants identified four themes: (1) Nature shows us different aspects of beauty; (2) nature helps us relieve stressful experiences by balancing our senses; (3) nature gives us space to find solutions; and (4) we want to find time to enjoy nature. At the conclusion of the project, youth participants reported that the research experience was overwhelmingly positive, enlightening, and inspired appreciation of nature. We found that, while our participants unanimously reported that nature relieved their stress, prior to this project, they were not always intentional in seeking time in nature for this purpose. Through the photovoice process, these participants noted the usefulness of nature for stress relief. We conclude with recommendations for leveraging nature to decrease adolescent stress. Our findings are relevant for families, educators, students, healthcare professionals, and anyone who works with or cares for adolescents.

Predictors of risky driving among teen drivers with ADHD during U.S. COVID-19 shelter in place orders

Factors associated with continued driving during shelter in place orders have been examined in a community sample of typically developing teen drivers, but not in teens diagnosed with Attention/Deficit-Hyperactivity Disorder (ADHD). Our objective was to examine psychosocial factors that predicted risky driving during shelter in place orders in teens with ADHD, which is important since teens with ADHD are at particular risk for poor driving outcomes. The present study is also novel in that it uses naturalistic data of risky driving rather than self-report of continued driving. Naturalistic in-car data from 56 ADHD participants (M age = 16.875 years, SD = 0.955;55.400 % were male) enrolled in an on-going study were used in the present study. Teens had an average of 26.915 months (SD = 14.343) of driving experience. Risky driving was defined as experiencing an event exceeding 0.600 g-force during the first month of COVID-19 pandemic shelter in place ordinances in Ohio, Kentucky, and Indiana, USA. A hierarchical logistic regression with a post-COVID driving event as the dependent variable was conducted. Baseline ratings of ADHD and oppositional defiant disorder/conduct disorder (ODD/CD) severity were entered in the first step of the model, while anxiety severity and parent behaviors regarding teen driving safety (monitoring and limit setting) were entered in the second step of the model. The first step of the model reached statistical significance (χ2(2, 54) = 7.577, p =.023), with only greater symptoms of ODD/CD significantly predicting a post-COVID driving event (B = 0.144, p =.020). With each point increase in ODD/CD symptoms, there was a 15.5 % increase in the probability of experiencing a high g-force event during COVID-19 restrictions. The model was no longer significant at step 2 when anxiety severity and parent behaviors were added to the model (χ2(3, 55) = 10.97p =.052). We conclude that ODD/CD symptom severity was the strongest predictor of risky driving during COVID-19 restrictions within a sample of teen drivers with ADHD. Study implications may be beneficial for clinicians who work with families of teens with ADHD;suggestions for strategies mitigating this risk are discussed. These findings also have implications for which teens with ADHD may be less positively impacted by other government mitigation strategies such as Graduated Drivers Licensing (GDL) regulations. © 2022

Experiences of the COVID-19 pandemic among young parents with foster care backgrounds: A participatory action PhotoVoice study.

The COVID-19 pandemic has had a disproportionate impact on many vulnerable populations, including youth in foster care and parents of young children. In this study, we worked with nine parenting current and former foster youth to share their experiences of the COVID-19 pandemic through photography. Data were collected between January and March 2021 during a series of three virtual PhotoVoice sessions, then transcripts of PhotoVoice sessions and participant-selected captioned photographs were analyzed using thematic analysis. Themes in participants' photographs included 1) Pandemic Parenting and 2) Making the Best of It. Findings indicate the need to expand mental health services, protect essential workers, and ensure young parents receive support navigating medical and social welfare systems and the process of receiving pandemic relief-related benefits.

Cyberchondria (Compulsive Digital Usage related to health): An Overview

Cyberchondria is one of the major concern now-a-days. Cyberchondria refers to the excessive and repeated digital health-related searching of information resulting in increased in anxiety. Such searches are compulsive and obsessional in nature. Amid the COVID-19 pandemic, cyberchondria became regular among population, as they surfed internet sites related to COVID-19 symptomatology, management etc. Surfing for digital information about symptoms and illnesses on the Internet is very common and very beneficial. However, now-a-days it is seen that this online surfing is distressing population making them more prone to hypochondriasis, panic attacks, anxiety and non-compliance with treatment. Cyberchondria management is the major among health care professionals.

Parenting Pre-teens During COVID-19 in a Rural Midwestern Community: An Interpretive Phenomenological Study.

To uncover the experiences of parenting Generation Z pre-teen children in rural communities impacted by the Stay Home Missouri order from April through May 2020. Researchers have focused on urban parents, leading to gaps in understanding the impact of the COVID-19 quarantine on rural parents and children. A qualitative study employing interpretive phenomenology. 14 white cis-male-sexed fathers and cis-female-sexed mothers living in midwestern rural communities participated in this study. Semi-structured interviews with 14 participants parenting pre-teen children were conducted. The interviews were analyzed using interpretive phenomenology. The COREQ checklist was followed. One theme that emerged from the narratives was the study participants' understandings of parenting, discovered when their routines were disrupted by the Stay Home Missouri order. This theme involved three sub-themes: 1) responding to the challenges of protecting pre-teen children; 2) coping with disrupted social relationships; and 3) renegotiating responsibilities. Professionals who work with families need to find ways to assist parents during and after a health emergency that requires quarantine. COVID-19 is not the first pandemic to endanger humanity, and the next pandemic-or a future variant of SARS-could require an additional period of local, regional, or national quarantine. Implications for professionals supporting parents during periods of severe disruption-such as future public health crises as well as large scale quarantines-are offered to assist with preparation for and coping with severe disruptions to parenting. Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-022-00507-9.

Helping students C.O.P.E.: Effects of a mental health program on adolescents with challenging behaviors

Mental health concerns are rising among adolescents and have intensified since the COVID-19 pandemic (APA, 2020). Specifically, externalizing behavior challenges perceived by adults as 'aggressive' place adolescents at an increased risk for negative outcomes, including poor academic achievement and involvement with the juvenile justice system (Skiba et al., 2014). Schools have a responsibility to respond to the mental health needs of adolescent students through the implementation of evidence-based intervention (Domitrovich et al., 2010). One program that has demonstrated effectiveness towards improving these outcomes is the seven-session Creating Opportunities for Personal Empowerment (COPE) Teen program, a cognitive-behavioral skills-building intervention. In this study, the COPE program was delivered virtually, through a culturally responsive lens, to three high school students with ongoing aggressive behavior during the COVID-19 pandemic. It was hypothesized that the frequency and intensity of the aggressive behavior would decrease for each participant as a function of the COPE program. The behavior was operationally defined for each student and measured through direct observation by parents in the home setting. A single case multiple-baseline design was implemented. Visual analysis of data suggest that the frequency and intensity of aggressive behavior did not decrease as a function of the COPE program, indicating no intervention effect. Supplementary statistical analyses (e.g., log-response ratios) found varied intervention effects among students, ranging from no effects to small effects. Further, participants reported the COPE program as a helpful way to manage stress and would recommend it to their peers. The study results, limitations, and implications for future research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Human papillomavirus vaccine uptake among teens before and during the COVID-19 pandemic in the United States.

It is unclear how the COVID-19 pandemic impacted human papillomavirus (HPV) vaccine uptake and which sociodemographic groups may have been most impacted. We aimed to assess differences in HPV vaccine uptake (initiation and completion) before and during the pandemic in the United States. We conducted a cross-sectional study using data from the 2019 to 2020 National Immunization Surveys - Teen (NIS-Teen), comparing vaccine initiation and completion rates in 2019 vs. 2020, based on confirmed reports by a healthcare provider. Weighted logistic regression analysis estimated odds of vaccine initiation and completion for both adolescent and parental characteristics. There were 18,788 adolescents in 2019 and 20,162 in 2020. There was 3.6% increase in HPV vaccine initiation (71.5% vs. 75.1%) and a 4.4% in completion (54.2% vs. 58.6%) rates from 2019 to 2020. In 2020, Non-Hispanic White teens were significantly less likely to initiate (aOR = 0.62, 95% CI: 0.49, 0.79) and complete (aOR = 0.71, 95% CI: 0.58, 0.86) vaccine uptake compared with non-Hispanic Black teens. Additionally, teens who lived above the poverty line were also less likely to initiate HPV vaccination (aOR = 0.63, 95% CI: 0.49, 0.80) or complete them (aOR = 0.73, 95% CI: 0.60, 0.90), compared to those who lived below the poverty line. During the COVID-19 pandemic in 2020, some historically advantaged socioeconomic groups such as those living above the poverty line were less likely to receive HPV vaccine. The impact of the pandemic on HPV vaccine uptake may transcend traditional access to care factors.

Interactive, Artistic, Fun, and Weird: Exploring Facilitators and Challenges to Youth Engagement across In-Person, Virtual, and Hybrid Pregnancy Prevention Programs

Although U.S. adolescent birth rates in general have declined in recent decades, they continue to be a primary public health concern due to notable disparities among adolescent birth rates. In response, pregnancy prevention program development has increasingly focused on understanding how to better serve the needs of adolescents in underserved populations. To inform future program development and implementation efforts, this qualitative study explored which attributes of programs facilitated and hindered youth engagement. We collected data from educators (N = 43) and a subset of youth program participants (N = 249) from programs implemented by 14 organizations in different community-based settings. We used three data collection methods: (1) post-session surveys completed by educators, (2) post-program implementation interviews with educators, and (3) individual and focus group interviews with youth participants. Qualitative analyses revealed that educators who skillfully facilitated interactive activities and safe and inclusive learning environments promoted engagement. Feeling uncomfortable and awkward during program activities, learning in mixed-gender settings, and COVID-19 disruptions hindered engagement. Additionally, we found that youth participants had conflicting views on learning about sexual relationships at churches. Participants and educators had conflicting views on the benefit of youth attending programs with previously acquainted friends. © 2022 The MITRE Corporation.

Pre-teen pregnancy in South Africa: (just) the tip of the iceberg

In South Africa in 2020, of the recorded 34 587 births from teen mothers, 688 were nine and 10 years young.1,2 These girls are called pre-teens. The SA Births and Deaths Registration Amendment Act (Act No. 18 of 2010) stipulates that all births must be registered within 30 days from date of occurrence.3 The data in 2020, show a slowdown in registrations within the first 30 days for months of April, October and November, coinciding with lockdown measures instituted by the government to stem rising COVID-19 cases.1

Estimating the number of US children susceptible to measles resulting from COVID-19-related vaccination coverage declines.

Measles elimination hinges on vaccination coverage remaining above 95% to retain sufficient community protection. Recent declines in routine measles vaccinations due to the COVID-19 pandemic coupled with prior models indicating the country was close to the 92% herd immunity benchmark are a cause for concern. We evaluated population-level measles susceptibility in the US, including sensitivity analyses accounting for pandemic-related impacts on immunization. We estimated the number of children aged 0-18 currently susceptible to measles and modeled susceptibility proportions in decreased vaccination scenarios. Participants were respondents to the NIS-Teen survey between 2008 and 2017 that also had provider-verified vaccination documentation. The exposure of interest was vaccination with a measles-containing vaccine (MCV), and the age at which they were vaccinated for all doses given. Using age at vaccination, we estimated age-based probabilities of vaccination and modeled population levels of MCV immunization and immunity vs. susceptibility. Currently, 9,145,026 children (13.1%) are estimated to be susceptible to measles. With pandemic level vaccination rates, 15,165,221 children (21.7%) will be susceptible to measles if no attempt at catch-up is made, or 9,454,436 children (13.5%) if catch-up vaccinations mitigate the decline by 2-3%. Models based on increased vaccine hesitancy also show increased susceptibility at national levels, with a 10% increase in hesitancy nationally resulting in 14,925,481 children (21.37%) susceptible to measles, irrespective of pandemic vaccination levels. Current levels of measles immunity remain below herd immunity thresholds. If pandemic-era reductions in childhood immunization are not rectified, population-level immunity to measles is likely to decline further.

Percentage of Children and/or Adolescents of All COVID-19 Cases: A Meta-analysis

Since the first report of COVID-19 in Wuhan, China, the disease has rapidly spread to many countries worldwide. The initial reports showed that the incidence rate in adults was higher, while children and adolescents had fewer cases of infection. However, the number of COVID-19 cases has gradually increased in children and adolescents. Therefore, this study aimed to assess the percentage of children and/or adolescents of the total patients diagnosed with COVID-19. PubMed, Embase, Web of Science and the Cochrane Library were searched to find relevant studies. All statistical analyses were conducted using StataMP 14 software. A total of 12 studies met the inclusion criteria. The final results showed that the percentage of children and/or adolescents of all COVID-19 cases was 0.06 [95% confidence interval (CI), 0.04-0.07], which meant an average of 6 cases in children per 10,000 COVID-19 cases. The percentage of children and/or adolescents with COVID-19 was 0.03 (95% CI, 0.01-0.05), 0.09 (95% CI, 0.08-0.09), 0.09 (95% CI, 0.03-0.16) and 0.04 (95% CI, 0.00-0.10) in Asia, South America, North America and Europe, respectively. The present study showed a low percentage of COVID-19 cases of children and/or adolescents, but not without infection risk. Therefore, we should pay attention to the cases of children and/or adolescents during the COVID-19 period and raise our vigilance. © 2022, Medcom Limited. All rights reserved.

Adolescent sleep - lessons from COVID-19.

Sleep in adolescents was significantly impacted by the COVID-19 pandemic. We present a commentary on a range of articles exploring COVID-19's impact on sleep in teenagers, exploring the variety of effects internationally, interactions with sleep biology and the environment, mental health, online learning and Long COVID. We conclude with vicious and virtuous flowers suggesting ways to mitigate the impacts of COVID-19 on adolescent sleep.

Promoting Adolescent Healthy Relationships (The About Us Program): Protocol for a Randomized Clinical Trial.

BACKGROUND: Romantic relationships play a critical role in adolescent development, and by middle adolescence, most young people have been involved in at least one romantic relationship, a context in which most sexual interactions occur. Research suggests adolescents lack positive models and skills related to building healthy relationships. OBJECTIVE: This project aims to test the impact of an innovative healthy relationships intervention, called About Us, implemented in school-based health centers (SBHCs) in California in a randomized controlled trial. METHODS: About Us is being tested using a 7-site, 2-group, parallel randomized controlled trial with a treatment versus control allocation ratio of 3:2 to assess the impact of the intervention relative to the standard of care among adolescents aged 14 to 18 years. Adolescents with active parental consent provide study assent at each of the 3 survey time points: baseline, 3 months postintervention, and 9 months postintervention. A stratified randomization procedure was used to ensure balance in key covariates and screening criteria across intervention groups. Through benchmark intent-to-treat analyses, we will examine the primary outcome of this study-the impact of About Us relative to the standard of care 9 months following the end of the intervention on the prevalence of vaginal or anal sex without condoms in the past 3 months. The secondary outcomes are four-fold: what is the impact of About Us relative to the standard of care 3 and 9 months following the end of the intervention, on (1) the prevalence of abstinence from vaginal or anal sex in the past 3 months, (2) composite scores of relationship communication and positive conflict resolution among participants involved in a relationship at baseline, (3) the prevalence of SBHC service use or information receipt in the past 3 months, and (4) composite scores of condom use intentions and attitudes regarding condoms and other birth control? Additionally, as part of our sensitivity analyses, two additional analyses will be implemented: modified intent-to-treat and complete case analysis. RESULTS: This project (ClinicalTrials.gov #NCT03736876) was funded in 2016 through the Family Youth Services Bureau as part of the Personal Responsibility Education Innovative Strategies program. Baseline data collection took place between February 2018 and March 2020, yielding a total of 5 cohorts and 533 study participants: 316 assigned to treatment and 217 assigned to control. Ongoing follow-up data collection continued through May 2021. CONCLUSIONS: About Us draws on developmental science to create a contextually and developmentally relevant program that addresses motivation and emotional influences in sexual decision-making. The intervention was designed for implementation within SBHCs, an understudied venue for relationship and sexual health promotion interventions. Unfortunately, COVID-19 pandemic restrictions led to school closures, interrupting ongoing programming, and in-person follow-up data collection, which has affected study attrition. TRIAL REGISTRATION: ClinicalTrials.gov NCT03736876; https://clinicaltrials.gov/ct2/show/NCT03736876. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30499.

How Black Teen Girls Navigate Social Media to Form Romantic Relationships.

The purpose of this study was to explore the use of social media within the context of heterosexual Black teen girls' romantic partner selection processes. To better understand Black teen girls' experiences, five focus groups (N = 27; aged 14-18 years) were conducted over Zoom. An inductive thematic analysis revealed four major themes: (1) the use of different platforms to gather different types of information, (2) the rules of social media scouting, (3) detecting partner qualities through social media, and (4) exploring Black teen girls' experience with social media and dating. Participants in our study primarily used Instagram to understand a potential partner's true self, while Twitter was used to assess a potential partner's political leanings. Our participants shared numerous "rules" related to the partner-scouting process. Black teen girls in our study explained that photos index a potential partner's style and hygiene, while memes were used to gauge sense of humor compatibility. More specific to Black teen girls, across all focus groups, participants shared their experiences of racism and bias, such as being associated with Black stereotypes, cultural invalidation, and being accused of "acting White." Although teen girls of various racial and ethnic groups may use social media to vet romantic partners, findings reveal that Black teen girls navigate social media in a unique way, including being highly attuned to signs of bias. Our findings suggest that in the first few months of COVID-19 social distancing had little impact on our participant's practice of using social media to vet potential romantic partners.

"Stay home so this can be over:" A national study of youth perspectives on social distancing during the COVID-19 pandemic.

Social distancing is an important public health recommendation that has been implemented to reduce the spread of COVID-19. Infections are rising among younger populations, but relatively little is known about youth social distancing behavior. Our qualitative study aims to examine youth engagement with social distancing and elucidate the reasons why guidelines are followed and broken. Members of the national MyVoice Text Message Cohort (aged 14-24) were surveyed from April 24 to April 30, 2020, through an open-ended text message poll. Responses were inductively coded and analyzed with descriptive statistics. Of the 944 youth who responded (response rate = 81.2%), 95% self-reported social distancing. However, 62% recalled instances of themselves or others breaking the guidelines and 19% expressed misconceptions about the rules. Notably, 14% of youth said they would encourage their friends to social distance by telling them it will accelerate a return to normal life. Feelings of social isolation were the most frequently cited (55%) negative impact of social distancing. Overall, responses from youth indicate significant variation in the interpretation of social distancing guidelines. Public health communications may need to address several critical misconceptions which impact the social distancing behaviors of youth. Further, safe methods for youth to interact with peers during periods of social distancing are necessary to prevent mental health impacts and to ensure adherence to social distancing guidelines.

Adolescent driving behavior before and during restrictions related to COVID-19.

INTRODUCTION: Understanding who heeds the driving-related COVID-19 restrictions is critical for assisting public health professionals improve response to this and future pandemic events. The purpose of the current study was to characterize driving behavior changes among adolescents as a function of COVID-19 restrictions. It was hypothesized that adolescent driving would be reduced by COVID-19 restrictions, especially for younger teens, non-minorities, females, non-working teens, and those with higher prosocial tendencies. METHODS: Participants were licensed drivers in "REACT," a longitudinal study of adolescent driving attention. Upon enrollment in REACT, drivers were required to be age 16 or 18, have been issued a driver's license within the last two weeks, and be fluent in written/spoken English. The current observational cohort study was of drivers reporting driving exposure between February 8 and April 22, 2020. Linear mixed-effects models estimated differences in driving changes between COVID-19 periods. RESULTS: Results indicated a decrease across pre-COVID-19 period (February 8 - March 13, 2020) in days driven per week and vehicle miles driven (VMD) was explained by the change of slope post-COVID-19 restrictions (March 14 - April 22, 2020). Post-COVID-19, driving days per week decreased by 37 % and VMD decreased by 35 %. This decrease was lower in ethnic minorities, older adolescents, and employed adolescents. Those with greater dire prosocial tendencies showed greater post-COVID-19 driving decline. DISCUSSION: Findings provide early evidence of COVID-19 restriction-related adolescent driving changes suggesting older, employed, minority teens and teens with lower prosocial tendencies are less likely to reduce driving behavior. These observations provide a foundation for more extensive studies of adolescent drivers during various driving and contact restrictions and inform future public health campaigns for social distancing.