A randomized controlled pilot study assessing feasibility and safety of a wilderness program for childhood, adolescent, and young adult cancer survivors: the WAYA study.

BACKGROUND: The majority of childhood, Adolescent and Young Adult (AYA) cancer survivors suffers from long-lasting health issues following cancer treatment. It is therefore critical to explore effective health promotion strategies to address their needs. Exposure to nature is a promising approach to support the needs of young cancer survivors. This study investigated whether it is feasible to conduct a randomized controlled trial (RCT) of a wilderness program for childhood and AYA cancer survivors. METHODS: Eligible participants were aged 16-39 years, had a cancer diagnosis, and met minimal criteria. Seventy-one individuals expressed interest and 59 were randomized to either a wilderness or a holiday program. The wilderness program involved an 8-day expedition including backpacking, sea kayaking, gorge climbing, camping, bush-craft skills, and mindfulness-practices. It was followed by a 4-day basecamp after 3 months. The comparison was an 8-day holiday program at a Spa-hotel followed by a 4-day holiday program at the same hotel after 3 months. Primary outcome was study feasibility and safety. RESULTS: Ultimately, 19 AYAs participated in the wilderness and 23 in the holiday program. All completed the study at one-year follow-up. Participants were mostly female (70%) and represented diverse cancers. Clinical characteristics were similar between study arms excepting greater age at cancer diagnosis in the wilderness program (age 19.1 vs. 12.5; p = 0.024). Program adherence and data completeness was high (> 90%) in both arms. Adverse Effects (AEs) in the wilderness vs. the holiday program were similar (Relative Risk: 1.0, 95% Confidence Interval 0.8-1.3). The most frequent AE was tiredness, all were mild to moderate in severity, and serious AEs were not reported. Nature connectedness significantly increased over time in the wilderness program participants, but not in the holiday program (p < 0.001). No differences were found between the two study arms regarding quality of life, self-esteem, or self-efficacy. CONCLUSION: It is feasible to conduct a RCT and a supervised wilderness adventure is equally safe for childhood and AYA cancer survivors as a holiday program. This pilot study lays the foundation for a larger RCT to investigate the effectiveness of wilderness programs on the health of young cancer survivors. TRIAL REGISTRATION DATE AND NUMBER: 18/02/2021, NCT04761042 (clinicaltrials.gov).

Do electronic and economic empowerment protect women from intimate partner violence (IPV) in India?

BACKGROUND: Intimate partner violence (IPV) is a major public health problem. Electronic empowerment has several positive impacts on health. No study has examined whether electronic empowerment prevents intimate partner violence. Economic empowerment has positive and negative effects on IPV victimization. The current study was conducted to investigate whether economic and electronic empowerment of women act as protective factors against IPV in India. METHODS: A national representative sample of 66,013 ever-married women from 36 member states and union territories of India has been used from the National Family Health Survey 2015 to 2016. Emotional, physical and sexual violence against women by husbands were target variables. We used bivariate and multivariate analyses. RESULTS: The prevalence of emotional violence was 13%, physical violence was 28% and sexual violence was 7%. IPV against women was as follows: The prevalence was higher among women living in rural areas, belonging to Hindu religion and those belonging to Scheduled Castes. Higher education and higher socio-economic status were found to be protective factors against IPV. The prevalence of IPV was higher among the working women, among those having knowledge of business loans for women and the recipients of such business loans. Exposure to media was found to reduce IPV. The women who used mobile phones and SMS facility experienced less violence. CONCLUSION: Economic independence of women was found to be a risk factor for IPV in India, whereas electronic empowerment was a protective factor. In the Indian context, policymakers should make use of mobile phones and support SMS use in the IPV awareness programs. Women empowerment, combined with gender equity, can reduce the prevalence of violence against women.

Co-occurrence of online and offline bullying and sexual harassment among youth in Sweden: Implications for studies on victimization and health a short communication.

Studies of co-occurrence of online and offline victimisation of bullying and sexual harassment and its associations to mental health outcomes among youth are scarce. To inform future study designs, the aim of this brief communication was to map co-occurrence of online and offline bullying and sexual harassment victimisation among adolescents. Data were collected in 2011 in nine schools in Northern Sweden, n = 1193 (boys = 566; girls = 627). Absolute and relative frequencies were calculated to find combinations of victimisation: one, two, three, or four forms. Reflecting a picture of the early days of online victimisation, in total fifty seven percent (57%) of adolescents were victimised. Single occurrence victimisation was 21.2% (offline sexual harassment was most common irrespective of gender), showing that most youths were victimised in a co-occurrence of two or more forms. Seven percent (7%) were victimised by all four forms of victimisation. Offline sexual harassment victimisation was present in the most common co-occurrences. Directions for future studies of victimisation and its associations to mental health outcomes are discussed.

Protocol of a mixed-method randomised controlled pilot study evaluating a wilderness programme for adolescent and young adult cancer survivors: the WAYA study.

INTRODUCTION: The majority of childhood, adolescent and young adult (AYA) cancer survivors suffer from long-term and late effects such as fatigue, psychological distress or comorbid diseases. Effective health promotion strategies are needed to support the health of this vulnerable group. This protocol provides a methodological description of a study that aims to examine the feasibility and safety of performing a randomised clinical trial (RCT) on a wilderness programme that is developed to support the health of AYA cancer survivors. METHODS AND ANALYSIS: The pilot RCT study has a mixed-method design, including quantitative and qualitative evaluations. Participants are AYAs, aged 16-39 years, that have been diagnosed with cancer during childhood, adolescence or young adulthood. A total of 40 participants will be randomly assigned to a wilderness programme (n=20) or a holiday programme (n=20). Both arms include participation in an 8-day summer programme, followed by a 4-day programme 3 months later. Primary outcomes are feasibility and safety parameters such as time to recruitment, willingness to be randomised, programme adherence and adverse effects. Secondary outcomes include self-reported health such as self-esteem, quality of life, self-efficacy and lived experiences. Descriptive statistics will be used to analyse outcomes and explore indications of differences between the programmes. Interviews are analysed by directed content analysis and hermeneutic phenomenology. A convergent parallel mixed-method analysis design will be applied to integrate quantitative and qualitative data. Results of this feasibility study will inform the preparation for a larger RCT with AYA cancer survivors. ETHICS AND DISSEMINATION: The study protocol is approved by the Swedish Ethical Review Authority (reference: 2020-00239). This study will be performed between January 2021 and December 2023. Results will be published in international peer-reviewed journals, presented at conferences and disseminated to participants, cancer societies, healthcare professionals and outdoor instructors. TRIAL REGISTRATION NUMBER: NCT04761042.

Online sexual victimization in youth: predictors and cross-sectional associations with depressive symptoms.

Aim: The aim was to analyze (i) the prevalence of online unwanted sexual solicitation (USS) victimization, (ii) predictors of online USS and (iii) the associations between online USS and depressive symptoms in Swedish pupils in grades 7-9. Methods: An electronic questionnaire was disseminated in 2011 in schools in a municipality in the northern part of Sweden. Total n = 1193 (boys n = 566; girls n = 627). Logistic regression models were fitted to test the cross-sectional associations between predictors of online USS and depressive symptoms, respectively. Results: One third of girls and every fifth boy reported online USS victimization. In boys, predictors associated with online USS were offline bullying and sexual harassment victimization. Only offline sexual harassment victimization was associated with online USS in girls. Girls victimized by online USS had about twice the likelihood to report depressive symptoms compared to non-victimized girls. There were no associations between online USS and depressive symptoms in boys. While offline bullying was associated with depressive symptoms in both genders, offline sexual harassment victimization increased the likelihood to report depressive symptoms in girls only. Conclusions: Online USS was common among Swedish youth, particularly among girls. Schools, parents and internet safety educators should look at co-occurrence of different forms of victimization as offline victimization was a predictor of online USS. Online USS was associated with depressive symptoms in girls and may hence be a factor driving gender inequity in mental health in youth.

A non-randomised pragmatic trial of a school-based group cognitive-behavioural programme for preventing depression in girls.

The aim of this study was to investigate the effectiveness of the DISA-programme in preventing depressive symptoms (DS) in adolescent girls, as implemented in a real-world school setting, accounting for baseline socioeconomic and psychosocial factors, and to investigate whether the effects of these baseline variables on DS differed between intervention participants and non-participants. In this non-randomised pragmatic trial, an electronic questionnaire was disseminated in 2011 (baseline) and 2012 (follow-up) in schools in one municipality in northern Sweden. Pupils (total n=275; intervention participants identified in the questionnaire: n=53; non-participants: n=222) were 14-15 years old at baseline. The groups were compared by means of SEM. DISA could not predict differences in DS at follow-up in this real-life setting. In the overall sample, sexual harassment victimisation (SH) at baseline was associated with DS at follow-up and the estimate for SH increased in the DISA-participants compared to the overall sample.

Dimensions of Peer Sexual Harassment Victimization and Depressive Symptoms in Adolescence: A Longitudinal Cross-Lagged Study in a Swedish Sample.

Sexual harassment is commonly considered unwanted sexual attention and a form of gender-based violence that can take physical, verbal and visual forms and it is assumed to cause later depression in adolescents. There is a dearth of research explicitly testing this assumption and the directional pathway remains unclear. The purpose of this study was to use a feminist theoretical framework to test competing models in respect of the direction of the relationships between dimensions of peer sexual harassment victimization and dimensions of depressive symptoms from ages 14 to 16 in adolescents. The study also aimed to investigate gender differences in these pathways. Cross-lagged models were conducted using a three-wave (2010, 2011 and 2012) longitudinal study of 2330 students (51 % females) from Sweden, adjusted for social background. Girls subjected to sexual harassment in grade seven continued to experience sexual harassment the following 2 years. There was weaker evidence of repeated experience of sexual harassment among boys. Depressive symptoms were stable over time in both genders. Sexual name-calling was the dimension that had the strongest associations to all dimensions of depressive symptoms irrespective of gender. In girls, name-calling was associated with later somatic symptoms and negative affect, while anhedonia (reduced ability to experience pleasure) preceded later name-calling. Physical sexual harassment had a reciprocal relationship to somatic symptoms in girls. In boys, name-calling was preceded by all dimensions of depressive symptoms. It is an urgent matter to prevent sexual harassment victimization, as it is most likely to both cause depressive symptoms or a reciprocal cycle of victimization and depression symptoms in girls as well as boys.

What students do schools allocate to a cognitive-behavioural intervention? Characteristics of adolescent participants in Northern Sweden.

BACKGROUND: Adolescents are a vulnerable group when it comes to the risk of developing depression. Preventing the onset of depressive episodes in this group is therefore a major public health priority. In the last decades, school-based cognitive-behavioural interventions have been a common primary prevention approach. However, evidence on what girls actually are allocated to such interventions when no researchers are involved is scarce. OBJECTIVE: To explore how a selective cognitive-behavioural program (Depression In Swedish Adolescents) developed to prevent depression in adolescents, was implemented in a naturalistic setting in schools in northern part of Sweden. The focus was on characteristics of participants allocated to the intervention. DESIGN: Cross-sectional baseline data on depressive symptoms, school environment and socio-economic factors were collected in 2011 by means of questionnaires in schools in a municipality in the northern part of Sweden. Intervention participants were identified in a follow-up questionnaire in 2012. Students (n=288) included in the analyses were in the ages of 14-15. RESULTS: Sixty-six girls and no boys were identified as intervention participants. They reported higher levels of depressive symptoms, lower personal relative affluence, more sexual harassment victimization and less peer support compared to female non-participants (n=222). Intervention participants were more likely to attend schools with a higher proportion of low parental education levels and a lower proportion of students graduating with a diploma. CONCLUSIONS: The developers of the intervention originally intended the program to be universal or selective, but it was implemented as targeted in these schools. It is important for school administrations to adhere to program fidelity when it comes to what students it is aimed for. Implications for effectivenss trials of cognitive-behavioural interventions in the school setting is discussed.