The number of studies examining family, community, institutional and policy factors on COVID-19 v... more The number of studies examining family, community, institutional and policy factors on COVID-19 vaccine perceptions is limited, with most concentrating on high-income countries and using predominantly quantitative methods. To address this gap, the goal of this manuscript is to qualitatively explore these factors and how they shape adolescents' perspectives on COVID-19 vaccines across diverse contexts. Focus group discussions were conducted among adolescent populations (13 -18 years) across seven countries: Ghent,
During the COVID-19 pandemic, the federal government authorized several temporary changes to the ... more During the COVID-19 pandemic, the federal government authorized several temporary changes to the Supplemental Nutrition Assistance Program (SNAP) to alleviate the increased economic hardships, including creating a new program called the Pandemic-Electronic Bene t Transfer (P-EBT) and expanding the eligibility and bene ts of SNAP. While evidence suggests that these changes may provide positive impacts for adults and younger children, very little is known about how they can mitigate food insecurity among adolescent children. To address this gap, this study evaluated the association of P-EBT and increased SNAP bene ts, with food security status among adolescents. Adolescents, ages 14-19 years, who completed an application to a Baltimore City youth employment program and lived in SNAP-eligible households, were invited to participate in two online surveys. The rst survey (Survey 1) was implemented between October 2020-January 2021, while the second survey (Survey 2) took place one year later from November 2021-January 2022 after schools had reopened. We then matched survey participants with data obtained from the Maryland Department of Human Services to obtain their household participation in food nutrition assistance programs. Our results show that there were no signi cant associations between adolescent food security and participation in any of the federal nutrition assistance programs during the COVID pandemic. While federal assistance programs during the pandemic resulted in families receiving nearly $700 more a month, they were not associated with improved food security among adolescents. Increased attention on how best to improve adolescent food security in low-income households is clearly warranted.
PURPOSE This study assesses the relationship between unequal gender perceptions, socioecological ... more PURPOSE This study assesses the relationship between unequal gender perceptions, socioecological factors, and body satisfaction among early adolescents in six urban poor settings in four countries. METHODS A cross-sectional study, part of the Global Early Adolescent Study, was conducted in Shanghai, China; Cuenca, Ecuador; Kinshasa, DRC; and three cities in Indonesia: Denpasar, Semarang, and Bandar Lampung. Bivariate and multiple linear regressions were conducted to assess the relationships between body satisfaction, perceptions of gender norms, and socioecological factors. A final sample of 7840 respondents aged between 10 and 14 years were included in the analysis. RESULTS Adolescents who endorsed more traditional sex roles and traits were more likely to be satisfied with their bodies in Kinshasa and Indonesia, while only endorsement of GST was associated with body satisfaction in Shanghai. Individual factors related to body satisfaction varied by site and included perceived health status, perception of body weight, height, and growth rate. Family and neighborhood factors related to increased body satisfaction varied by site and sex and included closeness to parents, parental communication, discussing bodily changes with anyone, parental awareness, and perception of neighborhood. CONCLUSION The results highlight the association between gender norms and social factors at individual, family, and neighborhood levels with body satisfaction. While associations differ significantly by site and sex, namely in perception of body weight and height, there exists commonalities that suggest body satisfaction, gender norms, and social context are intertwined.
The objectives of this study were to (1) explore the nature of caregiving for orphaned and non-or... more The objectives of this study were to (1) explore the nature of caregiving for orphaned and non-orphaned adolescents; and (2), examine how changes in the caretaking roles, as a result of a parental loss, impact on an orphan's sexual behaviors. A total of 52 in-depth interviews and 11 focus group discussions (n = 83) were conducted among adolescent orphans and non-orphans, as well as among 17 caregivers of orphans in Tanzania. Findings revealed three important caregiving roles that contributed to adolescent health: the provision of basic needs, advising and monitoring adolescent behaviors, and assigning household chores. Adolescent participants believed that when these roles are compromised, female orphans' sexual behaviors are impacted. Consequently, they are perceived to be at greatest risk for HIV. Comprehensive programs are needed for orphans to ensure their basic needs are being met, and to assist caregivers find extra support to carry out their caregiving responsibilities.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
In randomized controlled trials of expedited partner therapy (EPT), among patients in the EPT arm... more In randomized controlled trials of expedited partner therapy (EPT), among patients in the EPT arm, the proportion of partners believed to have taken the medication ranged from 56% to 85%. Little is known about the content of successful and unsuccessful EPT negotiations between patients and their partners. The aim of this study was to describe how patients made decisions about EPT and what they did with the EPT medication packs dispensed to them. We performed a qualitative study at the Baltimore City Health Department sexually transmitted disease clinics, which instituted an EPT pilot program in 2007. In-depth interviews were conducted with 31 patients, 1 week to 3 months after they had accepted EPT to bring to their partners. Taped interviews were transcribed verbatim and coded using ATLAS.ti 6 qualitative software. Codes were further combined into more comprehensive themes that were mapped onto the study's main aim. Participants were innovative about how to get medication to their partners and indicated a deep sense of concern and responsibility for their partners' health. On the other hand, participants reported of being anxious about the interaction and sometimes felt that they lacked the words to talk with their partners about EPT. Some participants used EPT in unexpected ways, such as giving it to people other than their sex partners or taking it themselves. Enhancing the counseling that accompanies EPT may improve patients' success in delivering it to their partners.
Bullying is a major public health concern for Indonesian adolescents, with well-documented links ... more Bullying is a major public health concern for Indonesian adolescents, with well-documented links to a range of emotional and behavioral problems. Despite such evidence, few investigations have employed qualitative methods to illuminate youth’s own perceptions of bullying and its psychosocial correlates in this context. The current study aimed to address this gap through an exploration of Indonesian adolescents’ motivations, perceptions, and beliefs regarding bullying. Building on prior quantitative findings, an explanatory sequential mixed methods approach was used to better understand the myriad ways in which bullying ties into other psychosocial challenges. Qualitative interviews were conducted with a total of 45 adolescents ages 13 to 14 (25 girls and 20 boys) in two junior high schools in Semarang between October and December 2019. Interviews were audio-recorded, transcribed verbatim, and translated into English for analysis. Qualitative data were then coded using an inductive t...
Objective: Examine how the physical cafeteria environment contributes to 6-to 8-year-olds' school... more Objective: Examine how the physical cafeteria environment contributes to 6-to 8-year-olds' school food consumption. Design: Cross-sectional observational study. Before-and-after lunch tray photos taken with iPads to capture food selection and consumption. Setting: 10 New York City public elementary school cafeterias. Participants: A total of 382 students aged 6À8 years who ate lunch in the cafeteria on observation days. Main Outcome Measures: Fruit, vegetable, or whole-grain consumption. Analysis: Pearson's chi-square and multivariate logistic regression assessed associations between cafeteria environmental factors (time to eat lunch, noise, and crowding) and vegetable, fruit, and/or whole-grain consumption with 95% confidence, adjusted for school-level demographics and clustered by school. Results: Approximately 70% of students selected fruits, vegetables, and/or whole grains. When selected, consumption was 25%, 43%, and 57%, respectively. Longer time to eat lunch was associated with higher consumption of fruits (odds ratio [OR] = 2.0; 95% confidence interval [CI], 1.1À3.8; P = .02) and whole grains (OR = 2.1; 95% CI, 1.003À4.2; P <.05). Quieter cafeterias were associated with eating more vegetables (OR = 3.9; 95% CI, 1.8À8.4; P < .001) and whole grains (OR = 2.7; 95% CI, 2.6À4.7; P < .001). Less crowding was associated with eating more fruit (OR = 2.3; 95% CI, 1.03À5.3; P = .04) and whole grains (OR = 3.3; 95% CI, 1.9À5.6; P <.001). Conclusions and Implications: Healthy food consumption by 6-to 8-year-old students is associated with cafeteria crowding, noise, and time to eat lunch. Implementing and enforcing changes to the cafeteria environment mandated by wellness policies may reduce plate waste.
Gender norms are increasingly recognized as drivers of health and wellbeing. While early adolesce... more Gender norms are increasingly recognized as drivers of health and wellbeing. While early adolescence constitutes a critical window of development, there is limited understanding about how adolescents perceive gender relations across different cultural settings. This study used a mixed-method approach, grounded in the voices of young people around the world, to construct and test a cross-cultural scale assessing the perceptions of gender norms regulating romantic relationships between boys and girls in early adolescence. Methods: The study draws on the Global Early Adolescent study (GEAS), a study focusing on gender norms and health related outcomes over the course of adolescence in urban poor settings worldwide. In-depth interviews were first conducted among approximately 200 adolescents between 10-14 years in seven sites across 4 continents to identify common scripts guiding romantic relations in early adolescence. These scripts were then transformed into a multidimensional scale. The scale was tested among 120 adolescents in each of 14 GEAS sites, followed by a second pilot among 75 adolescents in six sites. We evaluated the psychometric criteria of each subscale using principal component analysis, and parallel analysis, followed by exploratory factor analysis to guide the selection of a more parsimonious set of items. Results: Results suggested a two-factor structure, consisting of an "adolescent romantic expectations" subscale and a "Sexual Double Standard" subscale. Both subscales yielded high internal validity in each site, with polychoric Cronbach alpha values above 0.70 with the exception of Kinshasa for the adolescent romantic expectations scale (0.64) and Hanoi for the sexual double standard scale (0.61). Conclusion: This study reveals common perceptions of gendered norms about romantic engagement in early adolescence, normative for both sexes, but socially valued for boys while devaluated for girls. The findings illustrate that social hierarchies of power in romantic relationships form early in adolescence, regardless of cultural setting.
Background Women who use heroin and other drugs (WWUD) are a key population with elevated risk of... more Background Women who use heroin and other drugs (WWUD) are a key population with elevated risk of physical and sexual violence perpetrated by intimate partners and non-partners. While housing instability has been shown to be associated with violence in high-income settings, this is an underexplored topic in sub-Saharan Africa. In this research, we aimed to assess the relationship between housing instability and various forms of violence within a sample of WWUD in Dar es Salaam. Methods This analysis uses data from a parent study from 2018. A total of 200 WWUD were recruited through respondent-driven sampling methods and administered a survey. Two multivariable logistic regression models were built to assess the relationship between housing instability and physical violence (Model 1) and housing instability and sexual violence (Model 2) while controlling for a number of sociodemographic characteristics. Results Approximately 35% of participants were classified as housing unstable. Mo...
The objectives of this study were (1) to explore the consequences of parental deployment for adol... more The objectives of this study were (1) to explore the consequences of parental deployment for adolescents and their families and (2) to identify potential strategies that may help adolescents cope with a parent's deployment. Eleven focus groups were conducted among adolescents in military families, mili-tary parents, and school personnel in military-impacted schools at five mili-tary bases. Findings reveal that one of the most prominent sources of stress for families is adjusting and readjusting to new roles and responsibilities. Notably, this stress was primarily felt after the deployed parent returned. School personnel also commented that many teachers and counselors are not prepared to deal with deployment issues among the military students. These findings suggest that parents need to be better prepared to handle the stresses after a deployed parent returns. School personnel also need special training, and military-impacted schools need to offer additional opportunities for s...
The most reported sources of information about COVID-19 were news reports (government or nongover... more The most reported sources of information about COVID-19 were news reports (government or nongovernment), health professionals, family members, and teachers. However, across sites, there were differences by sex. Girls were more likely to rely on family members and teachers, whereas boys were more likely to rely on reputable health and government organizations. Adolescents determined trustworthiness of the sources using a mental ranking on whether the information was logical and could be cross-verified.
The number of studies examining family, community, institutional and policy factors on COVID-19 v... more The number of studies examining family, community, institutional and policy factors on COVID-19 vaccine perceptions is limited, with most concentrating on high-income countries and using predominantly quantitative methods. To address this gap, the goal of this manuscript is to qualitatively explore these factors and how they shape adolescents' perspectives on COVID-19 vaccines across diverse contexts. Focus group discussions were conducted among adolescent populations (13 -18 years) across seven countries: Ghent,
During the COVID-19 pandemic, the federal government authorized several temporary changes to the ... more During the COVID-19 pandemic, the federal government authorized several temporary changes to the Supplemental Nutrition Assistance Program (SNAP) to alleviate the increased economic hardships, including creating a new program called the Pandemic-Electronic Bene t Transfer (P-EBT) and expanding the eligibility and bene ts of SNAP. While evidence suggests that these changes may provide positive impacts for adults and younger children, very little is known about how they can mitigate food insecurity among adolescent children. To address this gap, this study evaluated the association of P-EBT and increased SNAP bene ts, with food security status among adolescents. Adolescents, ages 14-19 years, who completed an application to a Baltimore City youth employment program and lived in SNAP-eligible households, were invited to participate in two online surveys. The rst survey (Survey 1) was implemented between October 2020-January 2021, while the second survey (Survey 2) took place one year later from November 2021-January 2022 after schools had reopened. We then matched survey participants with data obtained from the Maryland Department of Human Services to obtain their household participation in food nutrition assistance programs. Our results show that there were no signi cant associations between adolescent food security and participation in any of the federal nutrition assistance programs during the COVID pandemic. While federal assistance programs during the pandemic resulted in families receiving nearly $700 more a month, they were not associated with improved food security among adolescents. Increased attention on how best to improve adolescent food security in low-income households is clearly warranted.
PURPOSE This study assesses the relationship between unequal gender perceptions, socioecological ... more PURPOSE This study assesses the relationship between unequal gender perceptions, socioecological factors, and body satisfaction among early adolescents in six urban poor settings in four countries. METHODS A cross-sectional study, part of the Global Early Adolescent Study, was conducted in Shanghai, China; Cuenca, Ecuador; Kinshasa, DRC; and three cities in Indonesia: Denpasar, Semarang, and Bandar Lampung. Bivariate and multiple linear regressions were conducted to assess the relationships between body satisfaction, perceptions of gender norms, and socioecological factors. A final sample of 7840 respondents aged between 10 and 14 years were included in the analysis. RESULTS Adolescents who endorsed more traditional sex roles and traits were more likely to be satisfied with their bodies in Kinshasa and Indonesia, while only endorsement of GST was associated with body satisfaction in Shanghai. Individual factors related to body satisfaction varied by site and included perceived health status, perception of body weight, height, and growth rate. Family and neighborhood factors related to increased body satisfaction varied by site and sex and included closeness to parents, parental communication, discussing bodily changes with anyone, parental awareness, and perception of neighborhood. CONCLUSION The results highlight the association between gender norms and social factors at individual, family, and neighborhood levels with body satisfaction. While associations differ significantly by site and sex, namely in perception of body weight and height, there exists commonalities that suggest body satisfaction, gender norms, and social context are intertwined.
The objectives of this study were to (1) explore the nature of caregiving for orphaned and non-or... more The objectives of this study were to (1) explore the nature of caregiving for orphaned and non-orphaned adolescents; and (2), examine how changes in the caretaking roles, as a result of a parental loss, impact on an orphan's sexual behaviors. A total of 52 in-depth interviews and 11 focus group discussions (n = 83) were conducted among adolescent orphans and non-orphans, as well as among 17 caregivers of orphans in Tanzania. Findings revealed three important caregiving roles that contributed to adolescent health: the provision of basic needs, advising and monitoring adolescent behaviors, and assigning household chores. Adolescent participants believed that when these roles are compromised, female orphans' sexual behaviors are impacted. Consequently, they are perceived to be at greatest risk for HIV. Comprehensive programs are needed for orphans to ensure their basic needs are being met, and to assist caregivers find extra support to carry out their caregiving responsibilities.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
In randomized controlled trials of expedited partner therapy (EPT), among patients in the EPT arm... more In randomized controlled trials of expedited partner therapy (EPT), among patients in the EPT arm, the proportion of partners believed to have taken the medication ranged from 56% to 85%. Little is known about the content of successful and unsuccessful EPT negotiations between patients and their partners. The aim of this study was to describe how patients made decisions about EPT and what they did with the EPT medication packs dispensed to them. We performed a qualitative study at the Baltimore City Health Department sexually transmitted disease clinics, which instituted an EPT pilot program in 2007. In-depth interviews were conducted with 31 patients, 1 week to 3 months after they had accepted EPT to bring to their partners. Taped interviews were transcribed verbatim and coded using ATLAS.ti 6 qualitative software. Codes were further combined into more comprehensive themes that were mapped onto the study&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s main aim. Participants were innovative about how to get medication to their partners and indicated a deep sense of concern and responsibility for their partners&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; health. On the other hand, participants reported of being anxious about the interaction and sometimes felt that they lacked the words to talk with their partners about EPT. Some participants used EPT in unexpected ways, such as giving it to people other than their sex partners or taking it themselves. Enhancing the counseling that accompanies EPT may improve patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; success in delivering it to their partners.
Bullying is a major public health concern for Indonesian adolescents, with well-documented links ... more Bullying is a major public health concern for Indonesian adolescents, with well-documented links to a range of emotional and behavioral problems. Despite such evidence, few investigations have employed qualitative methods to illuminate youth’s own perceptions of bullying and its psychosocial correlates in this context. The current study aimed to address this gap through an exploration of Indonesian adolescents’ motivations, perceptions, and beliefs regarding bullying. Building on prior quantitative findings, an explanatory sequential mixed methods approach was used to better understand the myriad ways in which bullying ties into other psychosocial challenges. Qualitative interviews were conducted with a total of 45 adolescents ages 13 to 14 (25 girls and 20 boys) in two junior high schools in Semarang between October and December 2019. Interviews were audio-recorded, transcribed verbatim, and translated into English for analysis. Qualitative data were then coded using an inductive t...
Objective: Examine how the physical cafeteria environment contributes to 6-to 8-year-olds' school... more Objective: Examine how the physical cafeteria environment contributes to 6-to 8-year-olds' school food consumption. Design: Cross-sectional observational study. Before-and-after lunch tray photos taken with iPads to capture food selection and consumption. Setting: 10 New York City public elementary school cafeterias. Participants: A total of 382 students aged 6À8 years who ate lunch in the cafeteria on observation days. Main Outcome Measures: Fruit, vegetable, or whole-grain consumption. Analysis: Pearson's chi-square and multivariate logistic regression assessed associations between cafeteria environmental factors (time to eat lunch, noise, and crowding) and vegetable, fruit, and/or whole-grain consumption with 95% confidence, adjusted for school-level demographics and clustered by school. Results: Approximately 70% of students selected fruits, vegetables, and/or whole grains. When selected, consumption was 25%, 43%, and 57%, respectively. Longer time to eat lunch was associated with higher consumption of fruits (odds ratio [OR] = 2.0; 95% confidence interval [CI], 1.1À3.8; P = .02) and whole grains (OR = 2.1; 95% CI, 1.003À4.2; P <.05). Quieter cafeterias were associated with eating more vegetables (OR = 3.9; 95% CI, 1.8À8.4; P < .001) and whole grains (OR = 2.7; 95% CI, 2.6À4.7; P < .001). Less crowding was associated with eating more fruit (OR = 2.3; 95% CI, 1.03À5.3; P = .04) and whole grains (OR = 3.3; 95% CI, 1.9À5.6; P <.001). Conclusions and Implications: Healthy food consumption by 6-to 8-year-old students is associated with cafeteria crowding, noise, and time to eat lunch. Implementing and enforcing changes to the cafeteria environment mandated by wellness policies may reduce plate waste.
Gender norms are increasingly recognized as drivers of health and wellbeing. While early adolesce... more Gender norms are increasingly recognized as drivers of health and wellbeing. While early adolescence constitutes a critical window of development, there is limited understanding about how adolescents perceive gender relations across different cultural settings. This study used a mixed-method approach, grounded in the voices of young people around the world, to construct and test a cross-cultural scale assessing the perceptions of gender norms regulating romantic relationships between boys and girls in early adolescence. Methods: The study draws on the Global Early Adolescent study (GEAS), a study focusing on gender norms and health related outcomes over the course of adolescence in urban poor settings worldwide. In-depth interviews were first conducted among approximately 200 adolescents between 10-14 years in seven sites across 4 continents to identify common scripts guiding romantic relations in early adolescence. These scripts were then transformed into a multidimensional scale. The scale was tested among 120 adolescents in each of 14 GEAS sites, followed by a second pilot among 75 adolescents in six sites. We evaluated the psychometric criteria of each subscale using principal component analysis, and parallel analysis, followed by exploratory factor analysis to guide the selection of a more parsimonious set of items. Results: Results suggested a two-factor structure, consisting of an "adolescent romantic expectations" subscale and a "Sexual Double Standard" subscale. Both subscales yielded high internal validity in each site, with polychoric Cronbach alpha values above 0.70 with the exception of Kinshasa for the adolescent romantic expectations scale (0.64) and Hanoi for the sexual double standard scale (0.61). Conclusion: This study reveals common perceptions of gendered norms about romantic engagement in early adolescence, normative for both sexes, but socially valued for boys while devaluated for girls. The findings illustrate that social hierarchies of power in romantic relationships form early in adolescence, regardless of cultural setting.
Background Women who use heroin and other drugs (WWUD) are a key population with elevated risk of... more Background Women who use heroin and other drugs (WWUD) are a key population with elevated risk of physical and sexual violence perpetrated by intimate partners and non-partners. While housing instability has been shown to be associated with violence in high-income settings, this is an underexplored topic in sub-Saharan Africa. In this research, we aimed to assess the relationship between housing instability and various forms of violence within a sample of WWUD in Dar es Salaam. Methods This analysis uses data from a parent study from 2018. A total of 200 WWUD were recruited through respondent-driven sampling methods and administered a survey. Two multivariable logistic regression models were built to assess the relationship between housing instability and physical violence (Model 1) and housing instability and sexual violence (Model 2) while controlling for a number of sociodemographic characteristics. Results Approximately 35% of participants were classified as housing unstable. Mo...
The objectives of this study were (1) to explore the consequences of parental deployment for adol... more The objectives of this study were (1) to explore the consequences of parental deployment for adolescents and their families and (2) to identify potential strategies that may help adolescents cope with a parent's deployment. Eleven focus groups were conducted among adolescents in military families, mili-tary parents, and school personnel in military-impacted schools at five mili-tary bases. Findings reveal that one of the most prominent sources of stress for families is adjusting and readjusting to new roles and responsibilities. Notably, this stress was primarily felt after the deployed parent returned. School personnel also commented that many teachers and counselors are not prepared to deal with deployment issues among the military students. These findings suggest that parents need to be better prepared to handle the stresses after a deployed parent returns. School personnel also need special training, and military-impacted schools need to offer additional opportunities for s...
The most reported sources of information about COVID-19 were news reports (government or nongover... more The most reported sources of information about COVID-19 were news reports (government or nongovernment), health professionals, family members, and teachers. However, across sites, there were differences by sex. Girls were more likely to rely on family members and teachers, whereas boys were more likely to rely on reputable health and government organizations. Adolescents determined trustworthiness of the sources using a mental ranking on whether the information was logical and could be cross-verified.
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