PURPOSE:Concerns about the mental health and well-being of younger generations is a recurring theme across countries and time. Adolescence is debated as a period of volatility ("storm and stress") or growth. Recent trends have reignited worries about youth mental health and well-being, particularly for females, and revived a deficit-based view of adolescence. To advance understanding, this study adopts a dual-factor approach that incorporates both negative and positive well-being domains. Mental health trends were compared across two grade-matched Australian adolescent cohorts assessed 5 years apart. METHODS:Data were drawn from cross-sectional cohorts of year 7 students (12-13 years) in one Australian jurisdiction: 2,085 in 2018 and 2,378 in 2023. Positive affect, happiness, resilience, depression, and anxiety were assessed using latent profile analysis to identify mental health profiles, which were then compared between cohorts and gender. RESULTS:Four profiles were identified: complete mental health, symptomatic but positive, resilient but disaffected, and troubled. Approximately 80% of students were classified in profiles reflecting some positive mental health. Between 2018 and 2023, the proportion with complete mental health declined by 7.93%, while those categorized as troubled increased by 4.76%. Declines were most pronounced among female students. DISCUSSION:Findings highlight both resilience and vulnerability in adolescent mental health. While most students continue to show positive well-being, the decline among females signals an urgent need for gender-sensitive approaches. At the same time, the results add nuance to accounts of a youth mental health 'crisis' to some degree, by highlighting positive domains of well-being which are often overlooked.
Universal school-based mental health programs for adolescents intend to promote wellbeing, but some evidence suggest that they may also cause harm. This scoping review aimed to map the state of knowledge on potential harms associated with these programs from the recent literature. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, four databases were searched for peer-reviewed studies published between 2019 and 2024. Articles were included if they evaluated a universal school-based mental health program for adolescents (13-18 years) and reported at least one quantitative outcome measure. Potential harms identified were classified into five harm types based on the observed data. Results showed that, of the 58 included studies, 29% (17 of 58) reported at least one type of potential harm. Statistically significant change in the overall sample was examined in all studies, with 16% (nine of 58) showing deterioration in at least one outcome. Statistically significant change by subgroup (e.g., age, gender, and baseline mental health) was examined in 21 studies, with 29% (six of 21) of these showing deterioration in at least one subgroup. Additional harms were identified through clinically meaningful deterioration, qualitative participant feedback, and safety protocols. Our findings confirm that universal school-based mental health programs can be associated with potential harms. Implications for research and practice are discussed.
PURPOSE:The primary objective of this study is to elucidate the role of age at menarche in depression in adulthood and explore the implications of this association. METHODS:We conducted a study involving 9,826 adult female participants from the National Health and Nutrition Examination Survey (NHANES) between 2015 and August 2023. Age at menarche was categorized as early (<12 years), normal (12-14 years), or late (≥15 years). Depression was assessed using the 9-item Patient Health Questionnaire (PHQ-9) and clinical diagnoses. Logistic regression and restricted cubic spline analyses were performed to address the study objectives. In addition, subgroup analyses were conducted based on demographic, lifestyle, and clinical characteristics. RESULTS:The depression group had a significantly higher proportion of young adults (aged 18-30 years) compared to the nondepression group (26.46% vs. 20.52%, p < .001). Conversely, the nondepression group included a greater proportion of older adults (over 60 years) than the depression group (29.53% vs. 23.98%, p < .001). After comprehensive adjustments, early menarche was significantly associated with increased depression risk (adjusted odds ratio [aOR] = 1.224, 95% confidence interval [CI]: 1.003-1.493, p = .047). Restricted cubic spline analyses revealed an L-shaped nonlinear pattern (p for nonlinearity = 0.006), with optimal age at menarche around 12 years. Subgroup analyses confirmed consistent associations without significant interactions. DISCUSSION:Early menarche is linked to increased depression risk, especially among women aged 18-30 years. Menarche at 12 years may serve as a key point for early intervention to prevent depression in young women.
PURPOSE:Adolescence is a critical developmental period marked by heightened vulnerability to initiating substance use, with long-term implications for health and behavior. Nicotine, alcohol, and cannabis are the most commonly used substances among adolescents. Their use often co-occurs but few studies have described or quantified the patterns and doses of substance co-use in this vulnerable population. METHODS:We used data from six waves of the Adolescent Brain Cognitive Development study. Substance use was measured through a web-based timeline followback interview, and outcomes are operationalized into substance use quantity (in standard units), single use, and co-use (use of two substances on the same day) of alcohol, cannabis, and nicotine. Group differences of average dose in standard units between single use and co-use for each substance class were analyzed using linear mixed-effects modeling in years 4-6. RESULTS:The average dose of nicotine was significantly higher when co-used with alcohol (4.32; 95% confidence interval [CI]: 2.55-6.09; p < .001) or when co-used with cannabis (4.41; 95% CI: 2.76-6.05; p < .001) in year 6; nicotine trends were similar in years four and five. In year 6, the average dose of alcohol was higher when co-used with cannabis (1.87; 95% CI: 0.37-3.36; p = .004) or co-used with nicotine (1.64; 95% CI: 0.06-3.22; p = .03) compared to single use of alcohol. The average dose of cannabis was not significantly different when used singularly or co-used with either alcohol or nicotine in our study years. DISCUSSION:During adolescence, the co-use of substances (namely alcohol and nicotine) may lead to higher average doses compared to single-substance use.
PURPOSE:To investigate the percent of adolescents who receive human papillomavirus (HPV) vaccine with one or more other vaccines recommended for adolescents in a single medical visit. METHODS:Data from the 2023 National Immunization Survey-Teen were analyzed. Timing of receipt of HPV vaccine, tetanus, diphtheria, and acellular pertussis vaccine (Tdap), quadrivalent meningococcal conjugate vaccine (MenACWY), and influenza vaccine was assessed using provider-reported vaccination histories. RESULTS:In 2023, among adolescents aged 13-17 years, 69.5% received HPV vaccine with one or more other vaccines recommended for adolescents in a single medical visit. In addition, 47.8% received specifically HPV vaccine, Tdap, and MenACWY together in a single medical visit. DISCUSSION:The HPV vaccine is commonly given with other vaccines recommended for adolescents in a single medical visit. These findings demonstrate variation in simultaneous vaccination patterns, suggesting that flexibility in the recommended adolescent vaccination schedule allows for different approaches to vaccination across clinical settings and family preferences while maintaining adherence to the recommended schedule.
Purpose "Abrazos, no balazos" (Hugs, not gunshots) is the approach to violence used by the Federal Mexican government from 2018 to 2024. This study identifies distinct conceptually useful latent class growth trajectories in the annual intensity of risk for exposure to events and fatalities from violence against civilians and battles for adolescents and young adults (AYAs) in México from 2018 to 2024. Methods Data are from the Armed Conflict Location and Event Data project. Latent class growth analyses were conducted with four longitudinal dependent variables assessed in seven sequential years (2018-2024). Results In most of the Mexican states, AYAs experienced low intensity-flat trajectories (p >.096) in the annual intensity of risk for exposure to events and fatalities from violence against civilians and battles. AYAs who lived in states with extremely, markedly, or moderately elevated 2018 intensities of risk for exposure to violence experienced decreasing trajectories (p =.000). One latent class with a mildly elevated-increasing trajectory (p =.000) in the annual intensity of risk for exposure to violence was identified for each of the four longitudinal dependent variables. Discussion During the time that the Federal Mexican government used the "Abrazos, no balazos" approach, AYAs in the majority of the states in México had intensity of risk for exposure to violence and armed conflict trajectories that were consistent with the goals of primary and secondary violence prevention. Violence prevention efforts should be augmented in states with unfavorable trajectories.
PURPOSE:Universal well-being assessments in schools may support early identification of pupils needing mental health support. However, little is known about how privacy and confidentiality concerns influence pupils' acceptability of assessments and willingness to engage authentically. This study examined how hypothetical identification, where responses are linked to pupils and shared with key stakeholders, affects pupils' anticipated honesty and engagement, and whether known help-seeking barriers predict negative responses. METHODS:Cross-sectional data were collected from 12,377 primary (ages 8-10) and secondary pupils (ages 11-17) across 55 schools in England. Pupils reported whether their responses would change if identifiable and shared with school staff, parents/guardians, or external professionals. Responses indicating reduced honesty or likelihood of disengagement were coded as negative. Predictors were examined using mixed-effects logistic regression models, including demographics, school connectedness, and mental well-being. RESULTS:Identification and data sharing influenced pupils' anticipated engagement, particularly in secondary schools. Identification by school staff elicited the highest proportion of negative responses in both phases, whereas external professionals elicited the fewest. Most primary pupils reported they would respond authentically, while a larger proportion of secondary pupils indicated they would respond less honestly or disengage when responses were identifiable and shared. Across primary and secondary samples, low well-being, low school connectedness, and being female were associated with greater likelihood of negative response. DISCUSSION:Pupils' anticipated engagement with well-being assessments is shaped by who accesses their data, with marked developmental differences. Strengthening trust, privacy, and connectedness, and supporting pupils' autonomy, may improve the acceptability and response accuracy.
PURPOSE:Immigrant adolescents are exposed to multiple health risk factors. This study aimed to compare the burden of multimorbidity and psychological distress, along with associated exposure factors, among accompanied and unaccompanied immigrant adolescents seeking care in a hospital-based unit for vulnerable populations. METHODS:This monocentric observational cohort was undertaken in Marseille, France (2019-2024), and included 384 adolescents aged 10-17 years who had arrived within the previous 5 years. The Cumulative Illness Rating Scale assessed the multimorbidity, and the Protect questionnaire assessed the risk of psychological trauma as a major component of psychological distress. RESULTS:The mean Cumulative Illness Rating Scale was 3.98 (standard deviation: 2.64). Multimorbidity was common, with 35.4% of participants having impairment of ≥ 3 organ systems. The most frequent impairments involved the eye, ear, nose, throat or teeth (48.7%), musculoskeletal and integumentary systems (46.4%), and mental health conditions (25.3%). Multimorbidity was independently associated with chronic medical history before migration (adjusted OR = 1.40, p < .0005) and during migration (adjusted OR = 1.94, p = .005). The risk of psychological trauma was independently associated with unaccompanied immigrant adolescent status (adjusted OR = 4.27, p < .05) and physical morbidity burden (adjusted OR = 1.18, p < .05). Patients had less emergency department visits during and after care in this hospital-based unit. DISCUSSION:Immigrant adolescents seeking care experience a high burden of multimorbidity and psychological distress. This risk requires particular attention, especially for unaccompanied adolescents, despite the lack of a convenient screening tool. A comprehensive care pathway is needed to reduce health inequalities in this extremely vulnerable population.
PURPOSE:Research on adolescents' suicide risk has mainly focused on individual/interpersonal risk. Relational protective factors (e.g. connectives and recognition for prosocial behavior) need more attention. Guided by a socioecological framework, we hypothesized that stronger social bonds and recognition are associated with lower suicide risk, directly and indirectly through associations with lower individual/interpersonal risk. METHODS:Using the 2023 Pennsylvania Youth Survey (190,151 students), suicide risk was measured by four dichotomous variables: suicidal ideation, plan, attempt, and injury by attempt. Individual and interpersonal risk factors included substance use, depression, and bullying victimization. Relational protective factors included social bonds and recognition across family, school, and community domains. Rurality and demographic covariates were included. Generalized structural equation modeling estimated direct and indirect pathways. RESULTS:Most common suicide risk was suicidal ideation (16%), followed by plan (13%), attempt (5%), and injury by attempt (1%). While substance use, depression, bullying victimization, and rurality were associated with higher suicide risk, stronger social bonds and recognition were directly and indirectly associated with lower risk. Among social bonds, family attachment had the largest direct association. School commitment showed the largest indirect association through lower individual/interpersonal risk. Among social recognition, community domains had the largest direct association. Family recognition had the largest indirect association via social bonds and lower risk factors. DISCUSSION:Social bonds and recognition across family, school, and community domains are key relational protective factors for adolescent suicide risk through interconnected pathways. Prevention efforts require coordinated, multisector collaboration to build supportive relational environments, with attention to rural adolescents.
Oral nicotine pouches (ONPs) have recently gained popularity among adolescents. This systematic review and meta-analysis aims to address the literature gap and public health implications of ONP use. Specifically, it focuses on the use prevalence, user characteristics, associated factors, and co-use with other substances. Following a comprehensive database search conducted until September 2025, 14 eligible studies were identified after title/abstract and full-text screening using Rayyan Software. Quality and risk of bias were assessed using the Joanna Briggs Institute Critical Appraisal Tools for cross-sectional studies. Data analysis consisted of a descriptive synthesis and 2 random-effects meta-analyses to estimate the pooled prevalence of ever and current nicotine pouch use among adolescents, followed by sex-stratified subgroup analyses to compare prevalence between males and females. Analysis showed that the ever use of ONPs was more prevalent than the current use. Key user characteristics were male gender, older age, and Hispanic ethnicity. Furthermore, ONP use was strongly associated with the co-use of other tobacco products and substances. ONP use among adolescents reflects rising experimentation, demographic disparities, and emerging health risks, underscoring the urgent need for targeted regulation and research.
PURPOSE:To estimate the prevalence of driving under the influence of cannabis (DUIC) and identify associated factors among U.S. young adult drivers reporting past-year cannabis use. METHODS:This cross-sectional study analyzed pooled 2021-2024 National Survey on Drug Use and Health. The analytic data were restricted to drivers aged 18-25 years who reported past-year cannabis use (N = unweighted 17,141; weighted N = 10,814,381). The outcome was self-reported past-year DUIC. Independent variables included demographics, substance use, mental health, cannabis-related perceptions, and driving behaviors. These relationships were assessed by modified Poisson regression. RESULTS:The weighted prevalence of DUIC was 28.0%, representing approximately over three million young adults. DUIC prevalence increased with cannabis use frequency, from 2.51 times higher among those using cannabis 12-49 days (adjusted prevalence ratio [APR]: 2.51; 95% confidence interval [CI]: 2.29-2.75) to 3.63 times higher among those reporting use on 300-365 days (APR: 3.63; 95% CI: 3.60-3.76), compared with those using cannabis 1-11 days. Cannabis use disorder (APR: 2.34; 95% CI: 2.06-2.65), simultaneous alcohol and cannabis use (APR: 1.29; 95% CI: 1.28-1.30), and perceived easy cannabis availability (APR: 2.36; 95% CI: 2.33-2.39) were also associated with higher prevalence of DUIC. Nonenrollment in school and living in a state with a medical cannabis law were associated with lower DUIC prevalence. DISCUSSION:DUIC is highly prevalent among U.S. young adults who use cannabis, with a clear graded association across categories of cannabis use frequency. Public health interventions should address frequent use, cannabis use disorder, alcohol-cannabis co-use, and perceived cannabis availability.
PURPOSE:There are growing concerns that social media may negatively impact adolescents' mental health. However, most studies are cross-sectional, or short-term longitudinal studies, limiting conclusions about long-term effects. We examined if time spent on social media at age 15/16 is positively associated with symptoms of depression and anxiety 5 years later, and explored effect modification by gender, socioeconomic status, and physical activity. METHODS:We analyzed data from a nationally representative cohort of Swedish adolescents. In 2017, 5,535 ninth-grade students (age 15/16) completed a self-report survey. In 2022, 3,193 completed a follow-up assessment. The number of hours per day on social media was self-reported; depression and anxiety were measured using the Patient Health Questionnaire-4. RESULTS:In unadjusted linear regression models, time spent on social media at age 15/16 was positively associated with anxiety and depression 5 years later, but these associations were no longer significant after adjusting for confounders (b = -0.00, 95% confidence interval: -0.03,0.03; b = 0.02, 95% confidence interval: -0.00,0.05). No significant effect modification by gender, socioeconomic status, or physical activity was observed. DISCUSSION:Although initial findings suggested a link between time spent on social media and later mental health symptoms, the associations did not persist after adjustment for confounders. This indicates that time spent on social media may have limited long-term effects on mental health. These findings are, however, limited to self-reported time spent on social media and further investigation into different types of social media activities are needed to better understand how social media use should be regulated.
