To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Research has supported a link between insecure attachment and disordered eating in adolescents; however, how this influence is exerted remains unclear. This study explored whether depressive symptoms constitute a pathway through which insecure attachment to parents predicts subsequent development of disordered eating in the transition from childhood to adolescence. The study also examines whether there are differential effects regarding the attachment figure, child's gender, or reciprocity between variables. A community-based sample of Spanish youth (n = 904; 49.4% girls) was followed biennially from age 10 to 16 years. Attachment, depressive symptoms, and disordered eating were measured using the Inventory of Parental and Peer Attachment, Children's Depression Inventory, and Children's Eating Attitudes Test, respectively. Prospective data were analyzed using a dynamic panel model, which accounts for unmeasured time-invariant factors. Whereas insecure attachment to the father did not predict later depression or disordered eating, higher insecure attachment to the mother at ages 10 and 12 years predicted more disordered eating at ages 14 and 16 years via increased depressive symptoms at ages 12 and 14 years. No child's gender-specific or reverse mediational effects were found. This study suggests that an increase in depressive symptoms might be one mechanism by which insecure attachment exerts its influence on the development of eating disorders symptomatology in adolescence. Intervention efforts aimed at strengthening particularly the mother–child attachment relationship may reduce the vulnerability to develop depressive symptoms and disordered eating.
To compare diet quality and its association with excess body weight (EBW: overweight/obesity), central adiposity (CA) and CVD risk factors (CVDR) among adolescents from Brazil and USA.
Data from two cross-sectional surveys: Health Survey of São Paulo (ISA-Nutrition) and Hispanic Community Health Study/Study of Latino Youth (SOL-Youth). Dietary intake was assessed from 24-h recalls, and diet quality using the Alternate Healthy Eating Index-2010 (AHEI) developed in the USA and the Revised Brazilian Healthy Eating Index (BHEI-R). CVDR was defined as ≥3 of: obesity, elevated blood pressure, dyslipidaemia, high plasma glucose and insulin resistance. Adjusted OR for EBW, CA and CVDR by diet quality were tested using logistic regression.
São Paulo, Brazil; and Chicago, IL; Miami, FL; Bronx, NY; San Diego, CA.
Adolescents (12–16 years) living in São Paulo (n 189) and USA (n 787).
ISA-Nutrition individuals with EBW (v. without) had marginally lower (unhealthier) scores for whole grains using BHEI-R and sugary beverages using AHEI. SOL-Youth individuals with EBW had lower scores of nuts/legumes using AHEI, and Na using BHEI-R, but higher scores of whole grains and dairy using BHEI-R. In ISA-Nutrition, BHEI-R was inversely associated with EBW (OR = 0·87; 95 % CI 0·80, 0·95) and CVDR (OR = 0·89; 95 % CI 0·80, 0·98). In SOL-Youth, AHEI was inversely associated with EBW (OR = 0·93; 95 % CI 0·87, 0·99).
Dietary improvements should be made by adolescents in both USA and Brazil. Healthier diet quality as measured with the country-specific index was associated with lower odds of EBW in Brazilian and USA-Hispanic/Latino adolescents, and with lower CVDR in Brazilian adolescents.
Postprandial glycaemia and insulinaemia are important risk factors for type 2 diabetes. The prevalence of insulin resistance in adolescents is increasing, but it is unknown how adolescent participant characteristics such as BMI, waist circumference, fitness and maturity offset may explain responses to a standard meal. The aim of the present study was to examine how such participant characteristics affect the postprandial glycaemic and insulinaemic responses to an ecologically valid mixed meal. Data from the control trials of three separate randomised, crossover experiments were pooled, resulting in a total of 108 participants (52 boys, 56 girls; age: 12.5±0.6 y; BMI: 19.05±2.66 kg·m-2). A fasting blood sample was taken for the calculation of fasting insulin resistance, using the HOMA-IR model. Further capillary blood samples were taken before and 30-, 60- and 120-min after a standardised lunch, providing 1.5 g.kg-1 body mass of carbohydrate, for the quantification of blood glucose and plasma insulin total area under the curve (tAUC). Hierarchical multiple linear regression demonstrated significant predictors for plasma insulin tAUC were waist circumference, physical fitness and HOMA-IR (F(3, 98)=36.78, p<.001, Adj. R2=.515). The variance in blood glucose tAUC was not significantly explained by the predictors used (F(7, 94)=1.44, p=.198). Significant predictors for HOMA-IR were BMI and maturity offset (F(2, 102)=14.06, p<.001, Adj. R2=.021). In summary, the key findings of the study are that waist circumference, followed by physical fitness, best explained the insulinemic response to an ecologically valid standardised meal in adolescents. This has important behavioural consequences because these variables can be modified.
To describe the eating behaviour styles of Irish teens and to explore the relationships between demographic factors, BMI and dietary intake and these eating behaviour styles.
Cross-sectional data from the Irish National Teens’ Food Survey (2005–2006). The Dutch Eating Behaviour Questionnaire assessed three eating behaviour styles in teens: restrained, emotional and external eating. Data were stratified by sex and age groups.
The Republic of Ireland.
Nationally representative sample of teens aged 13–17 years (n 441).
The highest scoring eating behaviour style was external eating (2·83 external v. 1·79 restraint and 1·84 emotional). Girls scored higher than boys on all three scales (Restraint: 2·04 v. 1·56, P < 0·001, Emotional: 2·15 v. 1·55, P < 0·001 and External: 2·91 v. 2·76, P = 0·03), and older teens scored higher than younger teens on the Emotional (1·97 v. 1·67, P < 0·001) and External scales (2·91 v. 2·72, P = 0·01). Teens classified as overweight/obese scored higher than those classified as normal weight on the Restraint scale (2·15 v. 1·71, P < 0·001) and lower on the External scale (2·67 v. 2·87, P < 0·03). Daily energy intake was negatively correlated with the Restraint (r −0·343, P < 0·001) and Emotional scales (r −0·137, P = 0·004) and positively correlated with the External scale (r 0·110, P = 0·02).
External eating is the predominant eating behaviour style among Irish teens, but sex, age, BMI and dietary differences exist for each eating behaviour style. Including measures of eating behaviour styles into future dietary research could help understand both how and why as well as what people eat.
Mental health difficulties and mental disorders are common in adolescents living with HIV or who are affected by HIV because of living in HIV-affected households in low- and middle-income (LMICs) countries, but little is known about the interventions that target these individuals and whether they are effective.
This systematic review aims to address these gaps by examining what has worked and what has not worked to support the mental health of adolescents living with HIV or affected by HIV in low- and middle-income contexts (PROSPERO Number: CRD42018103269).
A systematic literature review of online databases from the year 2000 to 2018, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, included English-language publications of quantitative evaluations of psychosocial interventions aiming to improve mental health among adolescents living with HIV and adolescents from HIV-affected households (aged 10–24 years) in LMICs.
Out of 2956 articles, 16 studies from 8 LMICs met the inclusion criteria. Thirteen studies focused on adolescents affected by HIV and only three studies on adolescents living with HIV. Only five studies included were from Sub-Saharan Africa. Interventions most often used a family-strengthening approach strengthening caregiver–adolescent relationships and communication and some problem-solving in groups or individually. Five studies reported statistically significant changes in adolescent and caregiver mental health or mental well-being, five among adolescents only and two among caregivers only.
Research on what works to improve mental health in adolescents living with HIV in LMIC is in its nascent stages. Family-based interventions and economic strengthening show promise.
Hoarding disorder (HD) is characterised by difficulties in discharging or parting with possessions irrespective of their actual value, urges to save and acquire new items and excessive clutter in living areas. There is an urgent need to advance the understanding of HD in child and adolescent populations. The aim of this paper is to cover the assessment, treatment strategies and tools currently available. In general, data on assessment of paediatric HD are scant. Only one psychometrically sound scale, the Child Savings Inventory, which is a parent-rated scale used to assess the severity of hoarding symptoms, was found. However, this scale is not sufficient to produce a diagnosis of HD. Regarding treatment, there was only a limited number of case studies suggesting the effectiveness of cognitive behavioural therapy that includes exposure to discarding and not collecting new items, using contingency management for exposure and oppositional behaviour, cognitive training and instructing parents to assist with home-based exposures. In conclusion, there is an urgent need for properly validated Diagnostic and Statistical Manual of Mental Disorders assessment tools, and we encourage practitioners and researchers to develop and test a Cognitive behavioral therapy (CBT) protocol for paediatric HD based on the aforementioned components.
To test the feasibility of a browser extension to estimate the exposure of adolescents to (un)healthy food and beverage advertisements on Facebook and the persuasive techniques used to market these foods and beverages.
A Chrome browser extension (AdHealth) was developed to automatically collect advertisements seen by participants on their personal Facebook accounts. Information was extracted and sent to a web server by parsing the Document Object Model tree representation of Facebook web pages. Key information retrieved included the advertisement type seen and duration of each ad sighting. The WHO-Europe Nutrient Profile Model was used to classify the healthiness of products advertised as permitted (healthy) or not permitted (unhealthy) to be advertised to children.
Auckland, New Zealand.
Thirty-four Facebook users aged 16–18 years.
The browser extension retrieved 4973 advertisements from thirty-four participants, of which 204 (4 %) were food-related, accounting for 1·1 % of the exposure duration. Of those food advertisements, 98 % were classified as not permitted, and 33·7 and 31·9 %, respectively, of those featured promotional characters or premium offers. The mean rate of exposure to not permitted food was 4·8 (sd = 2·5) advertisements per hour spent on Facebook.
Using a Chrome extension to monitor exposure to unhealthy food and beverage advertisements showed that the vast majority of advertisements were for unhealthy products, despite numerous challenges to implementation. Further efforts are needed to develop tools for use across other social media platforms and mobile devices, and policies to protect young people from digital food advertising.
To explore, from the perspectives of adolescents and caregivers, and using qualitative methods, influences on adolescent diet and physical activity in rural Gambia.
Six focus group discussions (FGD) with adolescents and caregivers were conducted. Thematic analysis was employed across the data set.
Rural region of The Gambia, West Africa.
Participants were selected using purposive sampling. Four FGD, conducted with forty adolescents, comprised: girls aged 10–12 years; boys aged 10–12 years; girls aged 15–17 years, boys aged 15–17 years. Twenty caregivers also participated in two FGD (mothers and fathers).
All participants expressed an understanding of the association between salt and hypertension, sugary foods and diabetes, and dental health. Adolescents and caregivers suggested that adolescent nutrition and health were shaped by economic, social and cultural factors and the local environment. Adolescent diet was thought to be influenced by: affordability, seasonality and the receipt of remittances; gender norms, including differences in opportunities afforded to girls, and mother-led decision-making; cultural ceremonies and school holidays. Adolescent physical activity included walking or cycling to school, playing football and farming. Participants felt adolescent engagement in physical activity was influenced by gender, seasonality, cultural ceremonies and, to some extent, the availability of digital media.
These novel insights into local understanding should be considered when formulating future interventions. Interventions need to address these interrelated factors, including misconceptions regarding diet and physical activity that may be harmful to health.
The legacy of apartheid that legalized racial separation and discrimination continues to haunt South African society as evidenced in the growing number of verbal and violent racist attacks. Socially disadvantaged children and youth in South Africa lack social support and access to healthcare. The high incidence of head trauma in South Africa is related to the increasing rate of mental illness. In particular, mild traumatic brain injuries pose serious threats to the mental and physical health of children and adolescents. This chapter highlights the vulnerability to further trauma facing children with mild traumatic head injury when confronting security challenges and argues for the evolution of mental education to law enforcement and legal structures to provide appropriate protective care to child and adolescent victims of mild traumatic head injuries.
There is increasing evidence of a strong association between sleep and mental health in both adolescents and adults. CBT for insomnia is being applied to good effect with adults with mental health difficulties but there are few studies examining its applicability to adolescents within mental health services.
We carried out a case series analysis (n = 15) looking at the feasibility, accessibility and impact of a low-intensity sleep intervention for young people (14–25 years) being seen by a secondary care Youth Mental Health team in the UK. The intervention was based on cognitive behavioural therapy for insomnia (CBTi) and acceptance and commitment therapy (ACT) approaches and involved six individual sessions delivered on a weekly basis by a graduate psychologist. Routine outcome measures were used to monitor insomnia, psychological distress and functioning with assessments at baseline, session 3, session 6 and at 4 weeks after end of intervention. All participants scored in the clinical range for insomnia at the start of the study.
High uptake, attendance and measure completion rates were observed. Large effect sizes were observed for insomnia, psychological distress and functioning. Twelve of the fifteen participants (80%) no longer scored above threshold for insomnia at follow-up. All seven under-18s no longer met threshold for clinical ‘caseness’ on the Revised Child Anxiety and Depression Scale (RCADS) at follow-up.
The findings suggest that the intervention was well accepted by young people and feasible to apply within a secondary care setting. Strong effect sizes are encouraging but are probably inflated by the small sample size, uncontrolled design and unblinded assessments.
To assess factors influencing dietary behaviours of adolescents in Addis Ababa, Ethiopia.
Using the qualitative participatory method Photovoice, participants received training on the basics of Photovoice and took photographs related to (un)healthy eating in their environment. Transcripts of individual interviews, focus group discussions and photographs were coded for thematic analysis.
One private and one public school located in the same, central neighbourhood in Addis Ababa, Ethiopia to explore how school populations of different socio-economic status experience the same neighbourhood environment.
Twenty-six adolescents aged 14–19 years old, of which there were seventeen girls and nine boys.
Findings from the current study indicate that food safety concerns appear to be the major influencing factors for adolescents’ dietary choices. Unhealthy and unsafe foods appear to be widely available and/or affordable in adolescents’ neighbourhoods and almost half of the photographs taken by adolescents depicted poor hygiene conditions related to food vendors. Participants considered foods available in their environments as generally unsafe, calling for more packaged food.
Concerns for food safety, hygiene and affordability are the dominating factors for adolescents’ food choices. These concerns, together with limited nutrition knowledge and preference for packaged foods, could make cheap, ultra-processed packaged foods more desirable.
Self-reported measures for body mass index (BMI) are considered a limitation in research design, especially when they are a primary outcome. Studies have found some populations to be quite accurate when self-reporting BMI; however, there is mixed research on the accuracy of self-reported measurements in adolescents. The aim of this study is to examine the accuracy of self-reported BMI by comparing it with measured BMI in a sample of U.S. adolescents and to understand gender differences. This cross-sectional study collected self-reported height and weight measurements of students from five high schools in four states (Tennessee, South Dakota, Kansas and Florida). Trained researchers took height and weight of students for an objective measurement. BMI was calculated from both sources and categorized (underweight, normal, overweight and obese) using the Centers for Disease Control and Prevention's BMI-for-age percentiles. Participants (n 425; 51⋅0 % female) had a mean age of 16⋅3 years old, and the majority were White (47⋅5 %). Limits of agreement (LOA) analysis revealed that BMI and weight were underreported, and height was overreported in the overall sample, in females, and in males. LOA analysis was fair for BMI in all three groups. Overall agreement in BMI categorisation was considered substantial (Κ 0⋅71, P < 0⋅001). As BMI increased, more height and weight inaccuracies led to decreased accuracy in BMI categorisation, and the specificity of obese participants was low (50⋅0 %). This study's findings suggest that using self-reported values to categorize BMI is more accurate than using continuous BMI values when self-reported measures are used in health-related interventions.
The aim of this study was to identify relevant content among four important domains for the development and structure of a paediatric cardiac rehabilitation curriculum for young patients with congenital heart disease using a consensus approach.
A three-round e-Delphi study among congenital heart disease and paediatric exercise physiology experts was conducted. Round 1, experts provided opinions in a closed- and open-ended electronic questionnaire to identify specific elements necessary for inclusion in a paediatric cardiac rehabilitation programme. Round 2, experts were asked to re-rate the same items after feedback and summary data were provided from round 1. Round 3, the same experts were asked to re-rate items that did not reach consensus from round 2.
Forty-seven experts were contacted via e-mail to participate on the Delphi panel, 37 consented, 35 completed round 1, 29 completed round 2, and 28 completed the final round. After round 2, consensus was reached in 55 of 60 (92%) questionnaire items across four domains: exercise training, education, outcome metrics, and self-confidence.
This study established consensus towards programme structure, exercise training principles, educational content, patient outcome measures, and self-confidence promotion. By identifying the key components within each domain, there is potential to benchmark recommended standards and practice guidelines for the development of a paediatric cardiac rehabilitation curriculum to be used and tested by exercise physiologists, paediatric and adult congenital cardiologists, and other healthcare team members for optimising the health and wellness of paediatric patients with congenital heart disease.
This chapter focuses on women’s sexual and reproductive health across their lifecourse. It begins with an overview of how sexual and reproductive health has been defined historically and today. Next, it describes the leading causes of morbidity and mortality related to sexual and reproductive health globally and then turns to some specific health outcomes that primarily or exclusively impact girls and younger women, and women during their childbearing ages, as well as peri- and post-menopausal women. The chapter highlights some of the ways gender adversely impacts girls’ and women’s sexual and reproductive health and rights as well as how gendered opportunities limit women’s access to sexual and reproductive health care and services. The chapter concludes with a summary and recommendations for future research and programs.
To describe the anthropometry, socioeconomic circumstances, diet and screen time usage of adolescents in India and Africa as context to a qualitative study of barriers to healthy eating and activity.
Cross-sectional survey, including measured height and weight and derived rates of stunting, low BMI, overweight and obesity. Parental schooling and employment status, household assets and amenities, and adolescents’ dietary diversity, intake of snack foods, mobile/smartphone ownership and TV/computer time were obtained via a questionnaire.
Four settings each in Africa (rural villages, West Kiang, The Gambia; low-income urban communities, Abidjan, Cote D’Ivoire; low/middle-class urban communities, Jimma, Ethiopia; low-income township, Johannesburg, South Africa) and India (rural villages, Dervan; semi-rural villages, Pune; city slums, Mumbai; low-middle/middle-class urban communities, Mysore).
Convenience samples (n 41–112 per site) of boys and girls, half aged 10–12 years and another half aged 15–17 years, were recruited for a qualitative study.
Both undernutrition (stunting and/or low BMI) and overweight/obesity were present in all settings. Rural settings had the most undernutrition, least overweight/obesity and greatest diet diversity. Urban Johannesburg (27 %) and Abidjan (16 %), and semi-rural Pune (16 %) had the most overweight/obesity. In all settings, adolescents reported low intakes of micronutrient-rich fruits and vegetables, and substantial intakes of salted snacks, cakes/biscuits, sweets and fizzy drinks. Smartphone ownership ranged from 5 % (West Kiang) to 69 % (Johannesburg), higher among older adolescents.
The ‘double burden of malnutrition’ is present in all TALENT settings. Greater urban transition is associated with less undernutrition, more overweight/obesity, less diet diversity and higher intakes of unhealthy/snack foods.
To conduct formative research using qualitative methods among stakeholders of secondary schools to explore their perceptions, barriers and facilitators related to healthy eating and physical activity (PA) among Malaysian adolescents.
A qualitative study involving eight focus groups and twelve in-depth interviews. Focus groups and interviews were recorded and transcribed verbatim. An inductive thematic analysis approach was used to analyse the data.
Four secondary schools in Perak and Selangor states (two urban and two rural schools) in Malaysia.
Focus groups were conducted with seventy-six adolescents aged 13–14 years, and in-depth interviews were conducted with four headmasters, four PA education teachers and four food canteen operators.
Stakeholders thought that adolescents’ misperceptions, limited availability of healthy options, unhealthy food preferences and affordability were important challenges preventing healthy eating at school. Low-quality physical education (PE) classes, limited adolescent participation and teachers’ commitment during lessons were perceived as barriers to adolescents being active at school. Affordability was the main challenge for adolescents from rural schools. Stakeholders perceived that a future school-based intervention should improve the availability and subsidies for healthy foods, provide health education/training for both adolescents and PE teachers, enhance active adolescent participation in PE and develop social support mechanisms to facilitate engagement with PA.
These findings provide important insights into developing school-based lifestyle interventions to improve healthy eating and strengthening PA of Malaysian adolescents.
Borderline personality disorder (BPD) usually begins in adolescence and manifests itself in adult life. Early intervention can improve the prognosis or reduce its severity. Nevertheless, there are currently few studies of adolescent patients with severe emotion instability and borderline personality traits.
To evaluate the effectiveness of the Systems Training for Emotional Predictability and Problem Solving (STEPPS) programme in a sample of 21 adolescents (aged 13–17 years) in the Child and Adolescents Mental Health Center of Tarragona in Spain.
We evaluated BPD traits using the Diagnostic Interview for Borderline Disorder-Revised (DIB-R) and the Global Clinical Impression Scale of Illness Severity for TLP (CGI-TLP). We compared pre- and post-treatment scores for the DIB-R, CGI-GI scale, general psychopathology using the Personality Inventory for Adolescents (PAI-A) and impulsivity with the Barratt Impulsivity Scale (BIS-11). The therapeutic objectives were evaluated with the Borderline Estimate Severity over Time (BEST) scale.
There was a statistically significant improvement in the scores for the affective area and in the total score of the DIB-R, a decrease in the percentage of patients who failed to meet criteria for BPD, and an improvement (although not statistically significant) in the scores of the BEST scale throughout the treatment. The results of the CGI-GI scale showed global improvement in almost 72% of patients.
Our study suggests that STEPPS can be an effective treatment to improve BPD symptoms and is very useful in community settings with limited resources in which efficient treatment alternatives must be sought. However, this conclusion must be interpreted with caution, as there is no comparison control group.
Systematic reviews and meta-analyses suggest that behaviour change interventions have modest effect sizes, struggle to demonstrate effect in the long term and that there is high heterogeneity between studies. Such interventions take huge effort to design and run for relatively small returns in terms of changes to behaviour.
So why do behaviour change interventions not work and how can we make them more effective? This article offers some ideas about what may underpin the failure of behaviour change interventions. We propose three main reasons that may explain why our current methods of conducting behaviour change interventions struggle to achieve the changes we expect: 1) our current model for testing the efficacy or effectiveness of interventions tends to a mean effect size. This ignores individual differences in response to interventions; 2) our interventions tend to assume that everyone values health in the way we do as health professionals; and 3) the great majority of our interventions focus on addressing cognitions as mechanisms of change. We appeal to people’s logic and rationality rather than recognising that much of what we do and how we behave, including our health behaviours, is governed as much by how we feel and how engaged we are emotionally as it is with what we plan and intend to do.
Drawing on our team’s experience of developing multiple interventions to promote and support health behaviour change with a variety of populations in different global contexts, this article explores strategies with potential to address these issues.
Individuals with obesity tend to perform less well than their non-obese peers in tertiary education, but there is little evidence from non-Western countries and recent studies. The present study aimed to test whether academic attainment differed between female undergraduates with obesity (defined by body mass index (BMI)), and those who were non-obese in Kuwait, a country with very high obesity prevalence. In 400 female Kuwaiti first- and second-year Social Science students (mean age 18⋅0, sd 0⋅6 years), educational attainment was defined as the Grade Point Average (GPA) across all subjects (from 1⋅00 to 4⋅00). The mean GPA (2⋅51, sd 0⋅53) among students defined as obese by the BMI (n 163) was significantly lower than among the students defined as non-obese by the BMI (n 237; 2⋅80, sd 0⋅63; P < 0⋅001), and those defined as obese were more likely to be in the lowest quartile for the GPA (OR 3⋅03; 95% CI 1⋅90, 4⋅85), independent of socio-economic status. Similar differences were observed between students defined as having high versus normal body fatness. Female undergraduates in Kuwait with obesity have lower academic attainment than their non-obese peers, and universities should consider measures to mitigate reduced attainment among their female undergraduates.
To explore adolescents’ perceptions, knowledge and behaviours regarding nutrition and physical activity in low-income districts of Abidjan, Côte d’Ivoire, taking into consideration their caregivers’ perspectives.
Two investigators conducted six focus group discussions.
The study was carried out in two low-income suburbs, Yopougon and Port-Bouët, in Abidjan, Côte d’Ivoire.
Adolescents and their caregivers were recruited into the study via local head teachers and heads of settlement.
Overall, seventy-two participants, including forty-six adolescents and twenty-six caregivers, took part. Participants demonstrated good nutrition knowledge, relating nutritional health to a balanced diet and hygiene. Sustained physical activity was reported. However, adopting good practices was challenging due to participant’s economic circumstances. Their environment was a barrier to improving health due to dirtiness and violence, with a lack of space limiting the possibility to practice sport. Adolescents and their caregivers differed in their response to these constraints. Many caregivers felt powerless and suggested that a political response was the solution. Alternatively, adolescents were more likely to suggest new creative solutions such as youth-friendly centres within their community.
Participants were aware that their nutritional habits were not in line with what they had learnt to be good nutritional practices due to socio-economic constraints. Physical activity was part of adolescent life, but opportunities to exercise were restricted by their environment. Strategies for improving adolescent health in these settings need to be developed in collaboration with adolescents in a manner that accommodates their opinions and solutions.