We test the associations between peri-urban mothers’ paid work and reported health in Asawase, Ghana and Sebeta, Ethiopia using data from the Family Health and Wealth Study. The analytic sample is 608 and 667 mothers in Asawase and Sebeta respectively, aged 15 to 49. Dependent measures are self-rated health (SRH), self-reported health problems (SRHP), and chronic disease (CD) status. Independent variables include work/remuneration status. Bivariate and multivariate analyses are presented. Our results showed that in Asawase and Sebeta respectively, 88.3% and 80.1% of mothers had no CD; 88.3% and 91.9% reported very good/good health; 73.4% and 55.5% had no health problems. Ethiopian mothers remunerated for their work other than by cash alone reported better health, on all three outcomes compared with their non-working counterparts [CD-AOR (95%CI):1.98(1.18-3.33); SRH: 3.49(1.39-8.80); SRHP: 1.40(1.04-1.88)]. Findings from Ghana were not as clear. Investigation of women’s multiple family roles is warranted to understand pathways to better health.

OBJECTIVES:To estimate national need for family planning services among men in the United States according to background characteristics, access to care, receipt of services, and contraception use.METHODS:We used weighted data from the 2006-2010 National Survey of Family Growth to estimate the percentage of men aged 15 to 44 years (n = 10 395) in need of family planning, based on sexual behavior, fecundity, and not trying to get pregnant with his partner.RESULTS:Overall, 60% of men were in need of family planning, defined as those who ever had vaginal sex, were fecund, and had fecund partner(s) who were not trying to get pregnant with partner or partner(s) were not currently pregnant. The greatest need was among young and unmarried men. Most men in need of family planning had access to care, but few reported receiving family planning services (< 19%), consistently using condoms (26%), or having partners consistently using contraception (41%).CONCLUSIONS:The need for engaging men aged 15 to 44 years in family planning education and care is substantial and largely unmet despite national public health priorities to include men in reducing unintended pregnancies.

Purpose: Intimate partner violence (IPV) affects one in three women globally, with adolescent and young adult women at highest risk. Less is known about IPV perpetration. We compare the prevalence and correlates of IPV perpetration among 15- to 19-year-old adolescent males in Baltimore (United States), Johannesburg (South Africa), Delhi (India), and Shanghai (China).Methods: A cross-sectional survey was conducted in 2013 with males aged 15-19 recruited via respondent-driven sampling from disadvantaged neighborhoods in four cities: Baltimore (United States), New Delhi (India), Johannesburg (South Africa), and Shanghai (China); total n - 751 ever-partnered men. We describe the prevalence of past-year physical and sexual IPV perpetration and evaluate associations with gender norm attitudes, mental health, substance use, victimization experiences, and demographic factors.Results: Past-year physical or sexual IPV perpetration ranged from 9% in Shanghai to 40% in Johannesburg. Factors associated with past-year perpetration across multiple sites included: binge drinking (Johannesburg adjusted odds ratio [AOR] = 2.8, Baltimore AOR = 6.7, and Shanghai AOR = 3.2), depressive symptoms (Johannesburg AOR = 2.4 and Shanghai AOR = 2.2), victimization in the home (Baltimore AOR = 2.5, Shanghai AOR = 2.7, and Johannesburg AOR = 1.7), and community violence victimization (Baltimore AOR = 7.0, Delhi AOR = 4.1, and Johannesburg AOR = 2.8). Equitable gender norm attitudes were protective against IPV perpetration in Johannesburg and Shanghai. Demographic factors (e.g., age, employment, and education) were inconsistently associated with IPV perpetration across sites.Conclusions: Past-year IPV perpetration was prevalent with differences identified across settings. Findings suggest the need to scale up evidence-based interventions targeting adolescents in disadvantaged urban communities in order to address many modifiable factors associated with IPV perpetration in this study. (C) 2016 Society for Adolescent Health and Medicine. All rights reserved.

The Centers for Disease Control and Prevention and Healthy People 2020 call for improvements in meeting men's reproductive health needs but little is known about the proportion of men in need. This study describes men aged 35 to 39 in need of family planning and preconception care, demographic correlates of these needs, and contraception use among men in need of family planning. Using data from Wave 4 (2008-2010) of the National Survey of Adolescent Males, men were classified in need of family planning and preconception care if they reported sex with a female in the last year and believed that they and their partner were fecund; the former included men who were neither intentionally pregnant nor intending future children and the latter included men intending future children. Men were classified as being in need of both if they reported multiple sex partners in the past year. About 40% of men aged 35 to 39 were in need of family planning and about 33% in need of preconception care with 12% in need of both. Current partner's age, current union type, and sexually transmitted infection health risk differentiated men in need of family planning and preconception care (all ps < .01) and participants' race/ethnicity further differentiated men in need of preconception care (p < .01). More than half of men in need of family planning reported none of the time current partner hormonal use (55%) or condom use (52%) during the past year. This study identified that many men in their mid-30s are in need of family planning or preconception care.

PurposeOur primary objective was to examine the effectiveness of a multi-component mental health intervention integrated in an employment training program. The intervention was aimed at reducing depressive symptoms and improving engaged coping strategies among low-income adolescents and young adults ages 16-22. We also examined whether intervention effects varied by gender. The number of adolescents and young adults neither connected to school nor the workforce is estimated to be nearly 6 million. Consequently, a growing number of employment training programs have been developed to place these youth on a more positive life course trajectory. However, mental health concerns among adolescents and young adults in employment training programs are prevalent and pose a barrier to achievement of key program milestones (e.g., educational advancement, employment). This study is the first to rigorously assess the effectiveness of a mental health intervention for adolescents and young adults in employment training programs.MethodsA quasi-experimental study was conducted; adolescents and young adults from one employment training program site were intervention participants, while youth from a second site using the same program model were enrolled as comparisons. Study recruitment occurred between September 2008-May 2012. Baseline assessments were conducted at the time of employment training program enrollment via an audio computer assisted self-interview. Follow-up data collection occurred 6 and 12 months after recruitment. 782 youth newly enrolling in the employment training programs ages 16-22 and not in foster care were recruited for study participation (N = 270 comparison; N = 512 intervention). Propensity score matching adjusted for observed baseline differences between intervention and comparison groups. Primary outcomes were depressive symptoms measured by the CES-D and engaged coping strategies measured by the Children's Coping Strategies Checklist.ResultsIntervention males with high baseline depressive symptoms exhibited a statistically significant decrease in depressive symptoms at 12 months (95% CI = -9.58, -.866; p = .019) compared to similar men in the comparison group. A dosage effect was observed at 12 months post-intervention, whereby men with greater intervention exposure showed greater improvement in depressive symptoms compared to similar men with lower intervention doses. Intervention men and women were more likely than comparison group participants to increase their engaged coping skills, with statistically significant differences found for men at 6 months and for women at 12 months.ConclusionsThis study suggests that interventions for adolescents and young adults provided in employment training programs can be effective in reducing depressive symptoms and improving engaged coping strategies. Given the growing number of adolescents and young adults using such programs and the mental health needs of this population, increased efforts should be made to deliver mental health interventions in these settings that usually focus on academic and job skills. Ways to extend intervention impact for females and those with less depressive symptomatology at program enrollment should be explored.Sources of SupportRobert Wood Johnson Foundation, Centers for Disease Control & Prevention, The Jacob and Hilda Blaustein Foundation, The Abell Foundation, The Leonard and Helen R. Stulman Foundation, The Annie E. Casey Foundation, Aaron Straus and Lillie Straus Foundation, & The France-Merrick Foundation. PurposeOur primary objective was to examine the effectiveness of a multi-component mental health intervention integrated in an employment training program. The intervention was aimed at reducing depressive symptoms and improving engaged coping strategies among low-income adolescents and young adults ages 16-22. We also examined whether intervention effects varied by gender. The number of adolescents and young adults neither connected to school nor the workforce is estimated to be nearly 6 million. Consequently, a growing number of employment training programs have been developed to place these youth on a more positive life course trajectory. However, mental health concerns among adolescents and young adults in employment training programs are prevalent and pose a barrier to achievement of key program milestones (e.g., educational advancement, employment). This study is the first to rigorously assess the effectiveness of a mental health intervention for adolescents and young adults in employment training programs. Our primary objective was to examine the effectiveness of a multi-component mental health intervention integrated in an employment training program. The intervention was aimed at reducing depressive symptoms and improving engaged coping strategies among low-income adolescents and young adults ages 16-22. We also examined whether intervention effects varied by gender. The number of adolescents and young adults neither connected to school nor the workforce is estimated to be nearly 6 million. Consequently, a growing number of employment training programs have been developed to place these youth on a more positive life course trajectory. However, mental health concerns among adolescents and young adults in employment training programs are prevalent and pose a barrier to achievement of key program milestones (e.g., educational advancement, employment). This study is the first to rigorously assess the effectiveness of a mental health intervention for adolescents and young adults in employment training programs. MethodsA quasi-experimental study was conducted; adolescents and young adults from one employment training program site were intervention participants, while youth from a second site using the same program model were enrolled as comparisons. Study recruitment occurred between September 2008-May 2012. Baseline assessments were conducted at the time of employment training program enrollment via an audio computer assisted self-interview. Follow-up data collection occurred 6 and 12 months after recruitment. 782 youth newly enrolling in the employment training programs ages 16-22 and not in foster care were recruited for study participation (N = 270 comparison; N = 512 intervention). Propensity score matching adjusted for observed baseline differences between intervention and comparison groups. Primary outcomes were depressive symptoms measured by the CES-D and engaged coping strategies measured by the Children's Coping Strategies Checklist. A quasi-experimental study was conducted; adolescents and young adults from one employment training program site were intervention participants, while youth from a second site using the same program model were enrolled as comparisons. Study recruitment occurred between September 2008-May 2012. Baseline assessments were conducted at the time of employment training program enrollment via an audio computer assisted self-interview. Follow-up data collection occurred 6 and 12 months after recruitment. 782 youth newly enrolling in the employment training programs ages 16-22 and not in foster care were recruited for study participation (N = 270 comparison; N = 512 intervention). Propensity score matching adjusted for observed baseline differences between intervention and comparison groups. Primary outcomes were depressive symptoms measured by the CES-D and engaged coping strategies measured by the Children's Coping Strategies Checklist. ResultsIntervention males with high baseline depressive symptoms exhibited a statistically significant decrease in depressive symptoms at 12 months (95% CI = -9.58, -.866; p = .019) compared to similar men in the comparison group. A dosage effect was observed at 12 months post-intervention, whereby men with greater intervention exposure showed greater improvement in depressive symptoms compared to similar men with lower intervention doses. Intervention men and women were more likely than comparison group participants to increase their engaged coping skills, with statistically significant differences found for men at 6 months and for women at 12 months. Intervention males with high baseline depressive symptoms exhibited a statistically significant decrease in depressive symptoms at 12 months (95% CI = -9.58, -.866; p = .019) compared to similar men in the comparison group. A dosage effect was observed at 12 months post-intervention, whereby men with greater intervention exposure showed greater improvement in depressive symptoms compared to similar men with lower intervention doses. Intervention men and women were more likely than comparison group participants to increase their engaged coping skills, with statistically significant differences found for men at 6 months and for women at 12 months. ConclusionsThis study suggests that interventions for adolescents and young adults provided in employment training programs can be effective in reducing depressive symptoms and improving engaged coping strategies. Given the growing number of adolescents and young adults using such programs and the mental health needs of this population, increased efforts should be made to deliver mental health interventions in these settings that usually focus on academic and job skills. Ways to extend intervention impact for females and those with less depressive symptomatology at program enrollment should be explored. This study suggests that interventions for adolescents and young adults provided in employment training programs can be effective in reducing depressive symptoms and improving engaged coping strategies. Given the growing number of adolescents and young adults using such programs and the mental health needs of this population, increased efforts should be made to deliver mental health interventions in these settings that usually focus on academic and job skills. Ways to extend intervention impact for females and those with less depressive symptomatology at program enrollment should be explored.

Preconception care for men focuses on prevention strategies implemented prior to conception of a first or subsequent pregnancy to improve pregnancy and infant outcomes. Little is known about U.S. men in need of preconception care. This analysis describes the proportion of men in need of preconception care and associations of these needs by background characteristics, related health conditions, access to care and receipt of services.

IMPORTANCE:Recent estimates indicate that 6.5 million adolescents and young adults in the United States are neither in school nor working. These youth have significant mental health concerns that require intervention.OBJECTIVE:To determine whether a mental health intervention, integrated into an employment training program that serves adolescents and young adults disconnected from school and work, can reduce depressive symptoms and improve engaged coping strategies.DESIGN, SETTING, AND PARTICIPANTS:A quasi-experimental study was conducted; 512 adolescents and young adults newly enrolling in one employment training program site were intervention participants, while 270 youth from a second program site were enrolled as controls. Participants were aged 16 to 23 years and not in foster care. Study recruitment took place from September 1, 2008, to May 31, 2011, with follow-up data collection occurring for 12 months after recruitment. Propensity score matching adjusted for observed baseline differences between the intervention and control groups.MAIN OUTCOMES AND MEASURES:Depressive symptoms measured on a Center for Epidemiologic Studies Depression Scale (CES-D) and engaged coping strategies.RESULTS:The mean age of participants was 19 years, 93.7% were African American, and 49.4% were male. Six- and 12-month follow-up rates were 61.0% (n = 477) and 56.8% (n = 444), respectively. Males in the intervention group with high baseline depressive symptoms exhibited a statistically significant decrease in depressive symptoms at 12 months (5.64-point reduction in CES-D score; 95% CI, -10.30 to -0.96; P = .02) compared with similar males in the control group. A dosage effect was observed at 12 months after the intervention, whereby males with greater intervention exposure showed greater improvement in depressive symptoms compared with similar males with lower intervention doses (effect on mean change in CES-D score, -3.37; 95% CI, -6.72 to -0.09; P = .049). Males and females in the intervention group were more likely than participants in the control group to increase their engaged coping skills, with statistically significant differences found for males (effect on mean change in CES-D score, 0.32; 95% CI, 0.14-0.50; P = .001) and females (effect on mean change in CES-D score, 0.19; 95% CI, 0.01-0.37; P = .047) at 12 months.CONCLUSIONS AND RELEVANCE:Given the growing number of adolescents and young adults using employment training programs and the mental health needs of this population, increased efforts should be made to deliver mental health interventions in these settings that usually focus primarily on academic and job skills. Ways to extend the effect of intervention for females and those with lower levels of depressive symptoms should be explored.

Purpose: Gender-based violence (GBV) is a global health and human rights issue with individual and social determinants. Youth are considered high risk; national influences include norms, policies and practices. By age, nation, and region, we contrast key GBV indicators, specifically intimate partner violence (IPV) and forced sexual debut among adolescent and young adult women using Demographic and Health Surveys across low-and middle-income countries.Methods: National prevalence estimates were generated among adolescents (15-19 years) and young adults (20-24 years) for lifetime and the past-year physical and sexual IPV among ever-married/ cohabitating women (30 nations) and forced sexual debut among sexually experienced women (17 nations). Meta-analyses provided regional estimates and cross-national comparisons, and compared the past-year IPV prevalence among adolescent and young adult women to adult women.Results: An estimated 28% of adolescent and 29% of young adult women reported lifetime physical or sexual IPV, most prevalent in the East and Southern Africa region. Regional and cross-national variation emerged in patterns of violence by age; overall, young adult women demonstrated higher risk for the past-year IPV relative to adult women (meta-analysis odds ratio, 1.20; 95% confidence interval, 1.10-1.37) and adolescents had a comparable risk (meta-analysis odds ratio, 1.07; 95% confidence interval,.91-1.23). Forced sexual debut was estimated at 12% overall, highest in the East and Southern Africa region.Conclusions: GBV is pervasive among adolescent and young adult women in low-and middleincome countries. The unique risk to youth varies across nations, suggesting an ageeplace interaction. Future research is needed to clarify contextual determinants of GBV. Findings provide direction for integrating youth within GBV prevention efforts. (C) 2015 Society for Adolescent Health and Medicine. All rights reserved.

The global adolescent population is larger than ever before and is rapidly urbanizing. Global surveillance systems to monitor youth health typically use household-and school-based recruitment methods. These systems risk not reaching the most marginalized youth made vulnerable by conditions of migration, civil conflict, and other forms of individual and structural vulnerability. We describe the methodology of the Well-Being of Adolescents in Vulnerable Environments survey, which used respondent-driven sampling (RDS) to recruit male and female youth aged 15-19 years and living in economically distressed urban settings in Baltimore, MD; Johannesburg, South Africa; Ibadan, Nigeria; New Delhi, India; and Shanghai, China (migrant youth only) for a cross-sectional study. We describe a shared recruitment and survey administration protocol across the five sites, present recruitment parameters, and illustrate challenges and necessary adaptations for use of RDS with youth in disadvantaged urban settings. We describe the reach of RDS into populations of youth who may be missed by traditional household-and school-based sampling. Across all sites, an estimated 9.6% were unstably housed; among those enrolled in school, absenteeism was pervasive with 29% having missed over 6 days of school in the past month. Overall findings confirm the feasibility, efficiency, and utility of RDS in quickly reaching diverse samples of youth, including those both in and out of school and those unstably housed, and provide direction for optimizing RDS methods with this population. In our rapidly urbanizing global landscape with an unprecedented youth population, RDS may serve as a valuable tool in complementing existing household-and school-based methods for health-related surveillance that can guide policy. (C) 2014 Society for Adolescent Health and Medicine. All rights reserved.

Purpose: Globally, adolescents are at risk of depression, traumatic stress, and suicide, especially those living in vulnerable environments. This article examines the mental health of 15- to 19-year-old youth in five cities and identifies the social support correlates of mental health.Methods: A total of 2,393 adolescents aged 15-19 years in economically distressed neighborhoods in Baltimore, MD; New Delhi, India; Ibadan, Nigeria; Johannesburg, South Africa; and Shanghai, China were recruited in 2013 via respondent-driven sampling to participate in a survey using an audio computer-assisted self-interview. Weighted logistic regression and general linear models were used to explore the associations between mental health and social supports.Results: The highest levels of depression and posttraumatic stress symptoms were displayed in Johannesburg among females (44.6% and 67.0%, respectively), whereas the lowest were among New Delhi females andmales (13.0% and 16.3%, respectively). The prevalence of suicidal ideation ranged from 7.9% (New Delhi female adolescents) to 39.6% (Johannesburg female adolescents); the 12-month prevalence of suicide attempts ranged from 1.8% (New Delhi females) to 18.3% (Ibadan males). Elevated perceptions of having a caring female adult in the home and feeling connected to their neighborhoods were positively associated with adolescents' levels of hope across the sites while negatively associated with depression and posttraumatic stress symptoms with some variation across sites and gender.Conclusions: Adolescents living in the very economically distressed areas studied register high levels of depression and posttraumatic stress. Improving social supports in families and neighborhoods may alleviate distress and foster hope. In particular, strengthening supports from female caretakers to their adolescents at home may improve the outlooks of their daughters. (C) 2014 Society for Adolescent Health and Medicine. All rights reserved.

Numerous reports and studies have exhorted public health officials to target more prevention efforts toward adolescents who compose about 18% of the world's population and whose behaviors as they mature can set the course for their future health and eventual life expectancy [1UNICEFThe state of the world’s children 2011: Adolescence—an age of opportunity. The United Nations Children’s Fund, New York, New York2011www.unicef.org/sowc2011/pdfs/Demographic-Trends.pdfGoogle Scholar, 2Sawyer S.M. Afifi R.A. Bearinger L.H. et al.Adolescence: A foundation for future health.Lancet. 2012; 379: 1630-1640Abstract Full Text Full Text PDF PubMed Scopus (1278) Google Scholar, 3WHOHealth for the world’s adolescents: A second chance in the second decade. World Health Organization, Geneva, Switzerland2014Google Scholar]. These calls have been bolstered by an accumulating body of evidence documenting indicators of comparative health of adolescents across countries and across time [[4]Patton G.C. Coffey C. Cappa C. et al.Health of the world's adolescents: A synthesis of internationally comparable data.Lancet. 2012; 379: 1665-1675Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar]. The Well-Being of Adolescents in Vulnerable Environments (WAVE) study was launched to complement this evidence base. It focuses on a very vulnerable segment of the adolescent population, young people who live in the poorest neighborhoods of some of the world's largest cities. Although economic development and urbanization worldwide have generally led to more opportunity, higher education, better access to health care, and lower morbidity and mortality, less is known about the well-being of adolescents growing up in disadvantaged neighborhoods with limited access to health, education, and social services. The share of the urban population living in these impoverished enclaves is substantial and growing, especially in countries with rapid rural to urban migration. However, it is difficult to find comparable statistics across countries. Both levels of urbanization and poverty vary substantially across low-, middle-, and high-income countries. For example, 32% of the Indian population is estimated to live in urban areas, contrasted to just over 50% in China and Nigeria, 63% in South Africa, and 83% in the United States [[5]World Bank. World development indicators: Urbanization. Table 3.12, 2014. Available at: http://wdi.worldbank.org/table/3.12. Accessed October 13, 2014.Google Scholar]. In Nigeria, it is estimated that 34% or the urban population lives below the poverty line [[6]World Bank. World development indicators: Poverty rates at national poverty lines Table 2.7, 2014. Available at: http://wdi.worldbank.org/table/2.7. Accessed October 13, 2014.Google Scholar]. In South Africa, about 30% of urban dwellers are poor [[7]Statistics South Africa. Poverty trends in SA: An examination of absolute poverty between 2006 and 2011. 2014. Report No.03-10-06:34 Available at: http://beta2.statssa.gov.za/publications/Report-03-10-06/Report-03-10-06March2014.pdf. Accessed October 13, 2014.Google Scholar]. In India, the statistic is 14% [[6]World Bank. World development indicators: Poverty rates at national poverty lines Table 2.7, 2014. Available at: http://wdi.worldbank.org/table/2.7. Accessed October 13, 2014.Google Scholar], and in the United States, 20% of the people living in the largest urban areas reside in census tracts with concentrated poverty [[8]Kingsley G.T. Pitingolo R. Concentrated poverty and regional equity: Findings from the National Indicators Partnership's Shared Indicator Initiative. The Urban Institute, Washington, DC2013Google Scholar]. The WAVE study was designed to focus specifically on adolescents growing up in highly impoverished sections in Baltimore, Ibadan, Johannesburg, New Delhi, and Shanghai [[9]Decker M. Marshall B.D. Emerson M. et al.Respondent-driven sampling for an adolescent health study in vulnerable urban settings: A multi-country study.J Adolesc Health. 2014; 55: S6-S12Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar]. The choice of cities was related to the home bases of the participating institutions, which included Johns Hopkins Bloomberg School of Public Health, the Population Council, New Delhi, India, the Shanghai Institute of Planned Parenthood Research, the University of Ibadan/University College Hospital Ibadan, Nigeria, and the Witwatersrand Reproductive and HIV Institute, Johannesburg, South Africa. This focus was chosen because the team recognized that youth living in these deteriorated urban areas are vulnerable to health challenges from dirty and crowded physical environments, few education or job opportunities, frequent encounters with violence, crime and drugs, often dangerous working conditions, and limited health services, especially for adolescents. The team sought to document these problems systematically and to examine factors associated with poorer and better health to identify potential vectors for improving the well-being of these youth. As Blum [[10]Blum R. Distressed communities as a breeding ground for non-communicable conditions.J Adolesc Health. 2014; 55: S4-S5Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar] points out in his commentary in this volume, the physical and social environment adolescents grow up in can both mitigate and magnify health problems. The team sought to measure both the positive and negative aspects of the adolescents' environments from the youths' perspectives. Studying adolescents in these areas of concentrated poverty is challenging. School-based surveys can miss youth who have dropped out or sporadically attend school, situations that are common among the urban poor. Household surveys can miss youth who move frequently, lack a regular place to stay, or circulate through relatives and friends' homes; and poor youth are more likely to lack residential stability. In addition, many urban settings are characterized by high-rise apartments and abandoned buildings, making residents hard to access. Also, some cities house a high number of migrants who are either not documented or lack a permanent home. Surveillance using conventional sampling frames can therefore miss the adolescents who are the most vulnerable to health problems. In order not to exclude these youth, the team designed a study using respondent-driven sampling, a strategy that has been used extensively to sample rare or hidden and at risk populations like men who have sex with men, drug users, or sex workers. Its use with adolescents has been limited to studies of street children and homeless youth [11Johnston L.G. Thurman T.R. Mock N. et al.Respondent-driven sampling: A new method for studying street children with findings from Albania.Vulnerable Child Youth Stud. 2010; 5: 1-11Crossref Scopus (15) Google Scholar, 12Gwadz M.V. Cleland C.M. Quiles R. et al.CDC HIV testing guidelines and the rapid and conventional testing practices of homeless youth.AIDS Educ Prev. 2010; 22: 312-327Crossref PubMed Scopus (21) Google Scholar]. To our knowledge, this sampling strategy has not been used for comparative research with marginalized youth although it has been proposed as a strategy [[4]Patton G.C. Coffey C. Cappa C. et al.Health of the world's adolescents: A synthesis of internationally comparable data.Lancet. 2012; 379: 1665-1675Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar]. The first article in this issue by Decker et al. [[9]Decker M. Marshall B.D. Emerson M. et al.Respondent-driven sampling for an adolescent health study in vulnerable urban settings: A multi-country study.J Adolesc Health. 2014; 55: S6-S12Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar] describes the study methodology and the challenges that were overcome as we carried out the study using similar protocols in five different cities with distinct cultural environments. In addition to detailing our methods and providing context for the subsequent articles, this article will be a resource for researchers who want to undertake respondent-driven sampling or cross-national studies of adolescents. The second article, by Mmari et al. [[13]Mmari K. Lantos H. Blum R. et al.A global study on the influence of neighborhood contextual factors on adolescent health.J Adolesc Health. 2014; 55: S13-S20Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar], focuses on the adolescents' perceptions of their physical and social environment and how these perceptions are associated with their health. In the earlier qualitative phase of our research, we found that youth across the sites were very much focused on the unhealthful aspects of their physical and social environment when they were asked to talk about or depict their health [[14]Mmari K. Blum R. Sonenstein F. et al.Adolescents' perceptions of health from disadvantaged urban communities: Findings from the WAVE study.Soc Sci Med. 2014; 104: 124-132Crossref PubMed Scopus (51) Google Scholar]. These analyses distinguish between different aspects of the youth's neighborhood environment: physical deterioration, social cohesion, perceptions of safety and fear, and observed violence. Although the neighborhoods studied were all chosen because they represented the poorest sections in the participating cities, there is great variability across sites in the adolescents' ratings of their communities. Those from Baltimore and Johannesburg give their communities the lowest ratings, and those from Ibadan and Shanghai provide the highest ratings, with those from New Delhi in the middle. It is worth noting that in spite of its location in a high-income country, the Baltimore neighborhood had some of the lowest ratings. In contrast, Ibadan with its high ratings is located in a lower middle-income country with substantially fewer resources. Although the youth across the sites hold varied views of their neighborhoods' physical characteristics, their reports about their access to social capital in four domains: family, school, peers, and neighborhood are similar across the sites. The next article in the issue, by Marshall et al. [[15]Marshall B.D. Astone N. Blum R. et al.Social capital and vulnerable urban youth in five global cities.J Adolesc Health. 2014; 55: S21-S30Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar], examines the supports available to the adolescents in these neighborhoods from caring adults in their homes, teachers in their schools, trusted friends, and neighborhood connections. The surprising lack of variation across the sites suggests that structural constraints of urban poverty may operate similarly across the sites in the distribution of social resources. This article also assesses the relationship between the adolescents' perceptions of their supports in these four domains and participants' demographic characteristics, which are often used as indicators of social capital such as school enrollment, perceived relative wealth, availability of two parents, and housing stability. These associations are inconsistent and vary by site and gender. Nonetheless, across the sites, direct measures of social capital are associated with good health. For young women, the indicators of social capital across the four domains are positively associated with self-reported health. Across both young men and women, the indicators of neighborhood social capital appear to be the most important. The fourth article in the issue examines the mental health of the adolescents across the five city neighborhoods and whether access to social support is associated with more positive health [[16]Cheng Y. Li X.C. Lou C. et al.The association between social support and mental health among vulnerable adolescents in five cities: Findings from the study of the well-being of adolescents in vulnerable environments.J Adolesc Health. 2014; 55: S31-S38Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar]. Cheng et al. report that adolescents in these very economically distressed areas register high levels of self-reported depression, post-traumatic stress, and suicide ideation. In Johannesburg, for example, more than 40% of the adolescents report depressive symptom scores above the cut point. In Baltimore and Ibadan, the levels are also high with more than one quarter of the adolescents registering high levels of symptoms. The lowest levels are reported among Shanghai males (17%) and Delhi females (13%). Adolescents with more access to social support report better mental health scores. Elevated perceptions of having a caring female adult in the home and feeling connected to their neighborhoods are positively associated with levels of hope and negatively associated with depression and post-traumatic stress with some variation across sites and gender. Substance use is common among the adolescents in these impoverished urban areas. Olumide et al. report very high levels of substance use with about two-thirds of the adolescents reporting lifetime use of at least one substance [[17]Olumide A. Robinson A. Levy P. et al.Predictors of substance use among vulnerable adolescents in five cities: Findings from the Well-Being of Adolescents in Vulnerable Environments study.J Adolesc Health. 2014; 55: S39-S47Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar]. Within each site, the most common type of substance varies. In Ibadan, Johannesburg, and Shanghai, alcohol is most common. Marijuana is the most common in Baltimore (55%), although alcohol is also high (52%). Inhalants are most common in Delhi (15%). Current cigarette smoking is the highest in Johannesburg (33%) and the lowest in Delhi and Ibadan (4%). Being female and in school are generally associated with lower alcohol and cigarette use across the study sites. The association between social support and current use of alcohol and cigarettes is inconsistent although having caring adults in the home generally correlates with lower use and high levels of peer support correlate with higher use in some sites. The sexual and reproductive health issues among adolescents in these five similarly disadvantaged sites are very different. Brahmbhatt et al. report that among the youth studied, heterosexual experience is not common in New Delhi, Ibadan, and Shanghai where rates varied from less than 1% in New Delhi to 16% in Ibadan among females, and among males, 16% in New Delhi and 26% in Shanghai [[18]Brahmbhatt H. Kagesten A. Emerson M. et al.Prevalence and determinants of adolescent pregnancy in urban, disadvantaged settings across five cities.J Adolesc Health. 2014; 55: S48-S57Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar]. It is not clear whether the low levels of reported sexual experience reflect under-reporting of a highly stigmatized behavior, the lack of married youth recruited into the sample, or other factors. The levels of reported sexual experience are much higher in Baltimore and Johannesburg with the majority of youth reporting sexual experience. Among the sexually experienced, pregnancy is common especially in Baltimore where over half of these females report a pregnancy. Factors associated with pregnancy among the sexually experienced in Baltimore and Johannesburg are being out of school, greater community violence, and the perception of a poor physical environment. The final article focuses on the young women in the five neighborhoods and their experiences with sexual violence and intimate partner violence [[19]Decker M. Peitzmeier S. Olumide A. et al.Prevalence and health impact of intimate partner violence and non-partner sexual violence among female adolescents aged 15-19 years in vulnerable urban environments.J Adolesc Health. 2014; 55: S58-S67Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar]. Decker et al. report that upward of 25% of ever-partnered women experience past-year intimate partner violence in Baltimore, Ibadan, and Johannesburg, and over 10% of adolescent women in Baltimore and Johannesburg report nonpartner sexual violence. These findings confirm partners as the primary perpetrators of gender-based violence among these adolescents. Both intimate partner violence and nonpartner sexual violence are associated with poor health across domains of substance use, sexual and reproductive health, mental health, and self-rated health in Baltimore and Johannesburg where sufficient cases allowed additional analyses. The prevalence of violence suggests that in some settings, disadvantaged urban environments serve as incubators of gender-based violence risk for young women. The articles in this supplement as a whole depict the common and unique experiences of adolescents from very different cultures, in countries at different levels of economic development but all living in the least affluent sections of their cities. Adolescents in Baltimore and Johannesburg appear to experience the most severe health consequences with high rates of mental health problems, substance use, sexual experience and pregnancy, and sexual violence. They also give their communities very poor scores in terms of the physical environment and violence. Although these communities appear to be the most toxic, adolescents in the other cities also have very elevated levels of mental health problems and substance use relative to the general population. As Blum notes in the commentary, these conditions set the stage for later life chronic health problems [[10]Blum R. Distressed communities as a breeding ground for non-communicable conditions.J Adolesc Health. 2014; 55: S4-S5Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar]. The WAVE study has broken new ground by attempting to draw comparable health profiles of 15- to 19-year-old youth in similarly impoverished circumstances in five cities across the globe. Much can be learned from efforts such as these when researchers familiar with their own domestic situations join together to plan and design a study that can be implemented across their countries and cultures. Much work also remains to develop valid measures that work reliably across different settings and to improve sampling strategies to represent populations that are hard to reach. Coordinating this present study and the preparation of this volume have been a singular learning experience. This research described in these articles was supported by Young Health Programme, a partnership between AstraZeneca, Johns Hopkins Bloomberg School of Public Health, and Plan International, a leading global children's charity. In Ibadan, the study was funded by the Bill and Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins Bloomberg School of Public Health through its funding to the Center for Population and Reproductive Health, University of Ibadan.

Purpose: Adolescent substance use has numerous consequences. Our goals in this article are to compare the prevalence and correlates of substance use among ethnically diverse adolescents.Methods: Data were from 2,332 adolescents aged 15-19 years recruited via respondent-driven sampling from disadvantaged settings in five cities. Multivariate logistic regression was used to identify correlates of current substance use.Results: About half of the respondents were male. Most adolescents (73.4%) were currently enrolled in school and identified a father (86.2%) and mother (98.6%) figure and strong peer support. Sixty-two percent reported lifetime use of at least one substance. Overall, the most common substances ever used were alcohol (44.6%), cigarettes (26.2%), and marijuana (17.9%). Mean age at first use of alcohol was 14.2 +/- 3.1 years. Current alcohol use was highest in Johannesburg (47.4%) and lowest in Delhi (2.1%). The mean age at first use of cigarettes was 14.4 +/- 2.8 years. Current cigarette smoking was highest in Johannesburg (32.5%) and lowest in Delhi (3.7%). Male gender predicted current alcohol use in all sites, older age (17-19 years) was also a predictor in Baltimore. Male gender (Johannesburg and Shanghai), older age (Baltimore and Shanghai), and being out of school (Baltimore, Johannesburg, and Shanghai) predicted current cigarette smoking. Absence of a caring father figure was predictive for current alcohol use in Baltimore and Shanghai. Stronger peer support predicted alcohol (Johannesburg and Shanghai) and cigarette use (Johannesburg).Conclusions: Substance use is still a major issue among adolescents around the world, underscoring the need for continued research and interventions. (C) 2014 Society for Adolescent Health and Medicine. All rights reserved.

Family planning service quality and clients' satisfaction with services are important determinants of clients' contraceptive use and continuation. We examine women's experiences at family planning clinics on a range of dimensions, including patient-centered communication (PCC), and identify experiences associated with higher ratings of service quality and satisfaction. New female clients (n = 748), ages 18-35 years, from clinics in three major metropolitan areas completed computer-administered interviews between 2008 and 2009. Factors associated with primary outcomes of service quality and satisfaction were assessed using multinomial and ordinary logistic regression, respectively. Higher scores on a Clinician-Client Centeredness Scale, measuring whether clinicians were respectful, listened, and provided thoughtful explanations, were associated with perceptions of good quality care and being very satisfied. Higher scores on a Clinic Discomfort Scale, measuring staff and waiting-room experiences, were associated with reduced satisfaction. Clients' interactions with clinicians, especially PCC, influence their perceptions of service quality, whereas their satisfaction with services is also influenced by the facility environment. These measures are adaptable for agencies to identify the factors contributing to their own clients' satisfaction-dissatisfaction with care and perceptions of service quality.

Purpose: The impact of pregnancy on the health and livelihood of adolescents aged 15-19 years is substantial. This study explored sociodemographic, behavioral, and environmental-level factors associated with adolescent pregnancy across five urban disadvantaged settings.Methods: The Well-Being of Adolescents in Vulnerable Environments study used respondent-driven sampling (RDS) to recruit males and females from Baltimore (456), Johannesburg (496), Ibadan (449), New Delhi (500), and Shanghai (438). RDS-II and poststratification age weights were used to explore the odds associated with "ever had sex" and "ever pregnant"; adjusted odds of pregnancy and 95% confidence interval were developed by site and gender.Results: Among the sexually experienced, pregnancy was most common in Baltimore (females, 53% and males, 25%) and Johannesburg (females, 29% and males 22%). Heterosexual experience and therefore pregnancy were rare in Ibadan, New Delhi, and Shanghai. Current schooling and condom use at the first sex decreased the odds of pregnancy among females in Baltimore and Johannesburg participants. Factors associated with higher odds of pregnancy were early sexual debut (Johannesburg participants and Baltimore females) being raised by someone other than the two parents (Johannesburg females); alcohol use and binge drinking in the past month (Baltimore participants); greater community violence and poor physical environment (Baltimore males and Johannesburg participants).Conclusions: The reported prevalence of adolescent pregnancy varies substantially across similarly economically disadvantaged urban settings. These differences are related to large differences in sexual experience, which may be underreported, and differences in environmental contexts. Pregnancy risk needs to be understood within the specific context that adolescents reside with particular attention to neighborhood-level factors. (C) 2014 Society for Adolescent Health and Medicine. All rights reserved.

Clinic guides to successfully engage young males aged 15-24 in sexual and reproductive healthcare are lacking. This study's goal was to explore factors influencing young males' use of sexual and reproductive healthcare to inform such a guide. 49 males were recruited to participate in focus groups from communities with high sexually transmitted disease (STD) rates in a northeastern city. Groups were stratified by age (4 among 15-19 yrs; 5 among 20-24 yrs), race/ethnicity (7 African American; 2 Latino) and sexual behavior (7 heterosexual; 2 non-heterosexual). Trained male moderators were matched to participants' race/ethnicity and groups were conducted in English and Spanish, depending on need. Participants were queried on factors influencing young males' use of sexual/reproductive healthcare using a brief self-administered survey and via a focus group moderator guide. Groups lasted 60 minutes, and were audio-taped and transcribed. Two researchers coded transcripts, categorized codes and conducted content analyses. A third researcher corroborated findings. Brief survey descriptive statistics were conducted. This study was IRB approved. 90% of participants reported sexual behavior. In the last year, 25% reported no regular doctor or insurance, 40% no STD/HIV test, and 30% no STD/HIV counseling by a doctor. Content analyses identified 5 domains influencing young males' use of sexual/reproductive healthcare: accessibility, clinic visibility, confidentiality, patient-centered care and interpersonal factors. Identified themes within each domain serving as barriers and/or facilitators of care included: 1) accessibility - (a) availability of affordable/free services, (b) transportation, and (c) availability of walk-in services; 2) clinic visibility - (a) help to locate and receive services including clinic marketing via traditional (e.g., TV) or new technology (e.g., phone apps); 3) confidentiality - (a) fear providers do not maintain confidentiality and (b) applauding doctors who assure confidentiality; 4) patient-centered care - (a) preference for female providers and (b) wanting to choose one's own clinician; and 5) interpersonal factors - (a) fears of positive STD test results and (b) stigma associated with being tested for STDs. Themes did not vary by participants' sexual behavior. Language barriers at clinics were discussed among Latino groups (e.g., needing translators and materials in Spanish). In exploring source of sexual/reproductive healthcare, the majority of participants reported mothers (84%) and doctors (81%) as most helpful sources. Although 44% of participants reported the Internet as an information source, participants discussed having mixed feelings trusting this source and concerns about search history privacy. Few participants reported having searched for a clinic to go to for a personal concern on a home computer (43%) or mobile device (23%) despite access to such devices. Participants discussed specific factors influenced their sexual and reproductive healthcare use that can be easily incorporated into a clinic guide to assist in linking them to care (e.g., clinic access information, confidentiality assurances, patient-centered care). Future work should evaluate whether a tailored guide for young males results in their increased care use and explore ways to address the continued fear and stigma of a HIV/STD diagnosis.

Context Out‐of‐school black males aged 15–24 have higher levels of sexual risk‐taking than in‐school black males of the same age. However, few sexual risk reduction curricula are focused on out‐of‐school male youth . Methods A sexual and reproductive health intervention conducted at a Baltimore youth employment and training program in 2008–2010 was evaluated in a study involving 197 youth aged 16–24 from a predominantly black population. Ninety‐eight participants received three one‐hour curriculum sessions on consecutive days; 99 served as controls. At baseline and three months later, participants completed a survey assessing demographic characteristics and various knowledge, attitude and behavior measures. Regression analysis with random effects was used to assess differences between intervention participants and controls in changes in outcomes over time . Results In analyses adjusting for baseline characteristics, intervention participants showed greater improvements in outcomes between baseline and follow‐up than did controls. Specifically, a male who received the intervention was more likely than a control male to report increases in knowledge of STDs and health care use (odds ratio, 1.6 for each), frequency of condom use (1.8), use of lubricant with condoms (23.6), communication with a provider about STDs (12.3) and STD testing (16.6) . Conclusion These findings suggest the potential benefits of integrating safer‐sex and health care information into a sexual and reproductive health curriculum for out‐of‐school male youth .

The Well-being of Adolescents in Vulnerable Environments (WAVE) is a global study of young people living in disadvantaged urban communities from Baltimore, MD, Johannesburg, South Africa, Shanghai, China, New Delhi, India and Ibadan, Nigeria. WAVE was launched in the summer of 2011 to: 1) explore adolescents' perceived health and their top health challenges; and 2) describe the factors that adolescents perceive to be related to their health and health care utilization. Researchers in each site conducted in-depth interviews among adolescents; community mapping and focus groups among adolescents; a Photovoice methodology, in which adolescents were trained in photography and took photos of the meaning of 'health' in their communities; and key informant interviews among adults who work with young people. A total 529 participants from across the sites were included in the analysis. Findings from the study showed that gender played a large role with regards to what adolescents considered as their top health challenges. Among females, sexual and reproductive health problems were primary health challenges, whereas among males, tobacco, drug, and alcohol consumption was of highest concern, which often resulted into acts of violence. Personal safety was also a top concern among males and females from Baltimore and Johannesburg, and among females in New Delhi and Ibadan. Factors perceived to influence health the most were the physical environment, which was characterized by inadequate sanitation and over-crowded buildings, and the social environment, which varied in influence by gender and site. Regardless of the study site, adolescents did not consider physical health as a top priority and very few felt the need to seek health care services. This study highlights the need to focus on underlying structural and social factors for promoting health and well-being among adolescents in disadvantaged urban environments.