tag:theconversation.com,2011:/global/topics/adolescents-3182/articlesAdolescents – The Conversation2024-02-29T13:38:58Ztag:theconversation.com,2011:article/2235332024-02-29T13:38:58Z2024-02-29T13:38:58ZHow teens benefit from being able to read ‘disturbing’ books that some want to ban<figure><img src="https://images.theconversation.com/files/578696/original/file-20240228-24-s5xddp.jpg?ixlib=rb-1.1.0&rect=47%2C59%2C7892%2C5190&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Young readers report becoming more thoughtful after reading stories that feature characters who face complex challenges.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/student-choosing-a-book-on-library-royalty-free-image/959761242?phrase=teens+books&adppopup=true">FG Trade via Getty Images</a></span></figcaption></figure><p>Should we worry, as <a href="https://pen.org/report/book-bans-pressure-to-censor/">massive book-banning efforts</a> imply, that young people will be harmed by certain kinds of books? For over a decade and through hundreds of interviews, my colleague, literacy professor <a href="https://www.albany.edu/education/faculty/peter-johnston">Peter Johnston</a>, and I have <a href="https://www.tcpress.com/teens-choosing-to-read-9780807768686">studied</a> how adolescents experience reading when they have unfettered access to young adult literature. Our findings suggest that many are helped rather than harmed by such reading.</p>
<p>For one study, we spent a year in a public middle school in a small, mid-Atlantic town, observing and talking to eighth grade students whose teachers, rather than assigning the “classics” or traditional academic texts, <a href="https://doi.org/10.1002/rrq.46">let students choose what to read</a> and gave them time to read daily in class. To support student engagement, they made available hundreds of contemporary books that are relevant to the students’ lives. The books included many of the <a href="https://docs.google.com/spreadsheets/d/1a6v7R7pidO7TIwRZTIh9T6c0--QNNVufcUUrDcz2GJM/edit#gid=9827573720">titles currently being challenged</a>, according to PEN America, which is a nonprofit that advocates against censorship, among other things. The titles include Ellen Hopkins’ “<a href="https://www.simonandschuster.net/books/Identical/Ellen-Hopkins/9781416950066">Identical</a>,” Jay Asher’s “<a href="https://penguinrandomhousehighereducation.com/book/?isbn=9780451478290">Thirteen Reasons Why</a>,” Patricia McCormick’s “<a href="https://www.encyclopedia.com/arts/educational-magazines/sold">Sold</a>,” and others that were banned because of themes of sex and violence.</p>
<p>We were interested in what the students perceived to be the consequences of reading young adult literature. They tended to read books they described <a href="https://doi.org/10.1080/09500782.2024.2317944">as “disturbing</a>.” At the end of the school year, we interviewed 71 of the students about changes in their reading and relationships with peers and family. </p>
<p>We also asked open-ended questions about how, if at all, they had changed as people since the beginning of the year. Beyond reading substantially more than they had previously, they reported positive changes in their social, emotional and intellectual lives that they attributed to reading, the kinds of books they read and the conversations those books provoked.</p>
<p>Here are six ways students told us they had been changed by reading and talking about edgy young adult books. </p>
<h2>1. They became more empathetic</h2>
<p>The students chose mostly fiction, with characters whose life circumstances in many cases differed from their own, including those associated with race, gender, sexuality, culture, language, mental health and household income. Because fiction <a href="https://doi.org/10.1016/j.tics.2016.06.002">provides windows into the minds of others</a>, it has the <a href="https://www.science.org/doi/10.1126/science.1239918">potential to improve empathy</a>, which becomes <a href="https://doi.org/10.1371/journal.pone.0055341">more probable when readers get emotionally involved in stories</a>.</p>
<p>This is consistent with what the students reported. As one student explained after reading a book about a bullied character, “Like when you see people … you think, well, they don’t have problems or whatever, but then some of the ones I’ve read, you can just understand people better.”</p>
<h2>2. They improved relationships</h2>
<p>The books contained stark realities about humanity. For instance, some books dealt with how children and teens might be exploited by adults or how mental illness might radically affect a person’s behavior.</p>
<p>Students shared that as they read, they were encountering some of this information for the first time. Their initial instinct, they said, was to find someone else who had read the book and talk about it. </p>
<p>Consequently, students who rarely talked to each other came together over books. In the process, they learned about each other, became friends or at least developed greater appreciation for each other. They also talked to family members, including parents, some of whom they convinced to read the books. </p>
<p>Relationships in books made teens rethink their own relationships. “Her mom was all rude to her,” one student recalled about a character. “It kind of had me feeling bad, ‘cause I was rude to my aunt, and my situation could have been worse.” </p>
<p>Students shared that reading about characters in dire circumstances changed how they thought about their own families. For instance, several admitted that reading a book about a girl their age who was abducted and abused by an adult male made them more likely to listen to their parents’ advice about safety. Others reading that same book reported becoming more protective of siblings.</p>
<h2>3. They became more thoughtful</h2>
<p>Reading about the decisions characters made gave the teens a chance to see the potential consequences of their own future choices.</p>
<p>Some described positive characters as role models. Others described using characters who made questionable decisions as cautionary tales and tools of self-reflection. </p>
<p>Statements such as one student’s comment that “I have changed because I think more about things before I do them” were common and were related to problems teens were already facing or could see on the horizon. These problems included toxic relationships, substance abuse, gang-related activity and risky sexual behaviors. </p>
<h2>4. They were happier</h2>
<p>Despite the fact that many students chose books with serious and unsettling content, students claimed reading made them feel better.</p>
<figure class="align-center ">
<img alt="A girl lies on her back on a bench reading a book that she is holding." src="https://images.theconversation.com/files/578709/original/file-20240228-26-6snxit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578709/original/file-20240228-26-6snxit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578709/original/file-20240228-26-6snxit.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578709/original/file-20240228-26-6snxit.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578709/original/file-20240228-26-6snxit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578709/original/file-20240228-26-6snxit.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578709/original/file-20240228-26-6snxit.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Teens say reading books can boost their mood.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/teenage-girl-reading-book-outdoors-royalty-free-image/1223187399?phrase=teens+books&adppopup=true">Westend61 via Getty Images</a></span>
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<p>Some explicitly attested to the pleasure of reading. “It’s the happiest I’ll get,” one student stated about the time she spent with the books.</p>
<p>More frequently, students described how mental trips through books helped them reconsider their own worries compared with characters with much harder lives.</p>
<p>“You do get an appreciation for what you do have, and, like, for being thankful for the happiness and joy in your life,” one explained. “Some of those books, it’s crazy what’s in there.”</p>
<h2>5. Books helped students heal</h2>
<p>Some students reported that books helped them heal from depression and grief.</p>
<p>“When I was younger, I lost my best friend,” one student shared after reading about a character whose mother died. “It was really hard for me, but books like that really take me back and help me remember her but without getting really upset.” </p>
<p>Many pointed to good feelings they got from meaningful book conversations with peers. That is not surprising given the link between <a href="https://doi.org/10.1007/s10902-007-9083-0">positive social relationships and young people’s happiness</a>.</p>
<h2>6. They became better readers</h2>
<p>Some of the books were difficult for students to read, but they persisted even though they had to work harder to understand them. Other research has found that this persistence is <a href="https://doi.org/10.1080/00220973.2010.481503">related to the interest</a> that students had in the subjects of the books.</p>
<p>Students reported rereading large chunks of books or even entire books to clear up confusion about storylines, and asking teachers and peers for help with problems such as unfamiliar vocabulary. Their scores on <a href="https://doi.org/10.1002/rrq.46">end-of-year reading tests improved</a>, whereas scores for other students remained flat. That is not surprising, since the students in our study <a href="https://doi.org/10.1002/rrq.404">read so much</a>. Also, they read mainly fiction, <a href="https://doi.org/10.1002/berj.3498">which is correlated with better reading skills</a> compared with other genres.</p>
<p>Students said they started visiting public libraries and bookstores. Declarations like “I’m a bookworm now” suggested they began viewing themselves as readers. They also reported larger changes. “I think I got smarter,” one student remarked. </p>
<p>The positive transformations reported by students we interviewed cannot be generalized, but experimentally controlled studies yield related findings. For instance, <a href="https://doi.org/10.1016/j.learninstruc.2019.101216">adolescents who read and talk to each other</a> about stories with social themes report greater motivation to read, greater use of reading strategies, such as rereading what they don’t understand, and insight into human nature than those who do not.</p>
<p>Our research left us reflecting on why we want young people to read in the first place. Do we want them to reap the social, emotional, moral and academic benefits that reading confers? If so, preserving their access to relevant books – even the “disturbing” ones – matters a lot.</p><img src="https://counter.theconversation.com/content/223533/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gay Ivey does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Amid calls to ban certain books from libraries and schools, research shows that students benefit when they have the ability to choose which materials they want to read.Gay Ivey, Professor of Literacy, University of North Carolina – GreensboroLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2214022024-02-04T19:09:48Z2024-02-04T19:09:48ZNew research shows some gains but fresh difficulties in combating child sexual abuse<p><a href="https://doi.org/10.1177/1524838017738726">Child sexual abuse</a> is common in Australia. The best evidence of this comes from the 2023 <a href="https://www.acms.au/">Australian Child Maltreatment Study</a> (ACMS), which surveyed 8,500 Australians aged 16 and over. The ACMS found 28.5% of the national population <a href="http://dx.doi.org/10.5694/mja2.51873">has experienced sexual abuse before age 18</a> by any person (adult or adolescent). Women were twice as likely as men to have experienced sexual abuse (37.3%-18.8%). Among 16-to-24-year-olds, prevalence was slightly lower (25.7%), but again with a massive gender disparity (35.2%-14.5%).</p>
<p>Reducing child sexual abuse is a major challenge for <a href="https://link.springer.com/article/10.1057/jphp.2016.21">public health and gender equality</a>. Its health outcomes depend on many factors, including the identity of the perpetrator and the nature of the abuse. This means not everyone who experiences child sexual abuse has the same outcomes. </p>
<p>However, the abuse is often devastating and <a href="https://doi.org/10.1146/annurev-clinpsy-081219-">uniquely traumatic</a> throughout <a href="https://doi.org/10.1017/S0954579422001146">life</a>. It is <a href="http://dx.doi.org/10.5694/mja2.51870">strongly associated with mental disorders</a> (for example, major depressive disorder) and <a href="http://dx.doi.org/10.5694/mja2.51877">health risk behaviours</a> (such as self-harm and suicide).</p>
<p>Despite all the attention given to the issue, there has not been high-quality research on who the main perpetrators are, their relationship to the victim, and whether strategies put in place to end such abuse have been effective. Our <a href="https://doi.org/10.1016/j.chiabu.2023.106562">latest research</a> offers the best evidence to date of important trends.</p>
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<h2>Who inflicts child sexual abuse?</h2>
<p><a href="https://doi.org/10.1016/j.chiabu.2023.106562">Our analysis</a> identified four different types of adult who inflict child sexual abuse:</p>
<ol>
<li>parents or adult family members</li>
<li>institutional adult caregivers such as teachers</li>
<li>other known adults</li>
<li>unknown adults.</li>
</ol>
<p>We also identified four classes of perpetrators aged under 18:</p>
<ol>
<li>siblings</li>
<li>known adolescents (not in romantic relationships)</li>
<li>known adolescents (in romantic relationships)</li>
<li>unknown adolescents.</li>
</ol>
<p>This is important because while it is well understood that adults inflict child sexual abuse, discussions about its prevention often overlook that it is often inflicted by people aged under 18, and do not consider perpetration by specific groups. </p>
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Read more:
<a href="https://theconversation.com/major-study-reveals-two-thirds-of-people-who-suffer-childhood-maltreatment-suffer-more-than-one-kind-202033">Major study reveals two-thirds of people who suffer childhood maltreatment suffer more than one kind</a>
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<h2>Child sexual abuse by adults</h2>
<p>Child sexual abuse by adults has always been and remains a major problem. The ACMS <a href="https://doi.org/10.1016/j.chiabu.2023.106562">found</a> a devastating 18.5% of all Australians aged 16 and over had experienced child sexual abuse by an adult. </p>
<p>Nearly 12% of Australians aged 16-24 have experienced child sexual abuse by an adult. The vast majority of adult perpetrators are known to the child. This continued prevalence today is deeply concerning and demands we renew our efforts to reduce it.</p>
<p>However, child sexual abuse by adults <a href="https://doi.org/10.1016/j.chiabu.2023.106562">has declined</a>, especially by parents/adult family members and institutional adults. This is <a href="https://doi.org/10.1016/j.chiabu.2023.106562">likely the result of</a> increased awareness and parental supervision, school-based prevention programs, and laws and policies regulating institutions. This is an immense achievement, and we must intensify our efforts to reduce sexual abuse of children by adults.</p>
<h2>Child sexual abuse by adolescents</h2>
<p>Worryingly, child sexual abuse by adolescents aged under 18 <a href="https://doi.org/10.1016/j.chiabu.2023.106562">has increased</a> in recent years. The ACMS found 18.2% of Australians aged 16-24 (nearly 1 in 5) experienced sexual abuse by an adolescent before age 18. The majority is inflicted against girls by:</p>
<ol>
<li><p>male adolescents the victim knew, and who were not their current or former boyfriend</p></li>
<li><p>current or former boyfriends. </p></li>
</ol>
<p>Increased adolescent perpetration <a href="https://www.panmacmillan.com.au/9781760988128/">reflects a culture</a> that lacks understanding of respectful relationships and consent. These conditions have driven major initiatives such as <a href="https://www.teachusconsent.com/">Teach Us Consent</a> and have galvanised other new approaches to reduce teen sexual violence. </p>
<p>This increase may also be <a href="https://doi.org/10.1016/j.chiabu.2023.106562">influenced by</a> perceived pressure to have sexual experiences, media representations of gender norms, lower parental supervision (especially at occasions involving alcohol) and access to violent pornography online.</p>
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Read more:
<a href="https://theconversation.com/there-are-reports-some-students-are-making-sexual-moaning-noises-at-school-heres-how-parents-and-teachers-can-respond-220136">There are reports some students are making sexual moaning noises at school. Here's how parents and teachers can respond</a>
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<h2>From evidence to opportunity</h2>
<p>It is horrifying to learn of continued adult-perpetrated child sexual abuse and increased teen-on-teen sexual violence. But this evidence provides an opportunity for those involved in its prevention and the community to reduce sexual violence in the next generation. </p>
<p>Prevention efforts directed towards teens have great preventive potential. Much child sexual abuse by teens is influenced by lack of empathy, a desire for immediate sexual gratification, and male sexual entitlement. This is obviously not to demonise all young adolescent males, as the data indicate most do not inflict sexual violence. </p>
<p>However, increased child sexual abuse perpetration by males in this age group highlights a contemporary normalisation of sexual violence. This shows there is still a long way to go in teaching young people about respectful relationships.</p>
<h2>What more can be done?</h2>
<p>Parents are integral in reducing child sexual abuse. Educating children about their bodies, healthy relationships, consent, sex, empathy and gender equality instils key prosocial <a href="https://link.springer.com/article/10.1057/jphp.2016.21">attributes required</a> to reduce sexual violence.</p>
<p>Governments also play a huge role in <a href="https://doi.org/10.5694/mja2.51872">implementing preventive public health approaches</a>. Recent progress by Australian <a href="https://www.childsafety.gov.au/">government agencies</a>, <a href="https://theconversation.com/mandatory-consent-education-is-a-huge-win-for-australia-but-consent-is-just-one-small-part-of-navigating-relationships-177456">program efforts</a> and <a href="https://www.dss.gov.au/sexual-consent/the-commonwealth-consent-policy-framework">policy frameworks</a> are extremely encouraging. Their continuance will embed prevention in the long term.</p>
<p>School-based sexual abuse prevention programs <a href="https://doi.org/10.1002/14651858.CD004380.pub3">have been shown</a> to increase children’s <a href="https://doi.org/10.1016/j.chiabu.2023.106489">protective behaviours and knowledge</a>. <a href="https://doi.org/10.1177/1524838018772855">Emerging scientific consensus</a> indicates age-appropriate sexuality education from early childhood through secondary school builds social and emotional skills that <a href="https://link.springer.com/article/10.1057/jphp.2016.21">minimise the likelihood</a> of perpetration.</p>
<p>In a landmark advance, the <a href="https://www.abc.net.au/news/2022-02-17/mandatory-consent-lessons-to-be-taught-in-schools/100841202">Australian government</a> recently committed to mandating consent education in the National Curriculum. </p>
<p>This is a promising response to the outpouring of testimony by Australian teenagers on <a href="https://www.teachusconsent.com/">Teach Us Consent</a>. Effective implementation of this policy, and mature engagement in this conversation by parents and wider society, will be pivotal to reducing child sexual abuse. This is particularly necessary given the constant battle between positive healthy relationships education and the media consumed by teens in TV, movies, social media and pornography that promote problematic attitudes to gender and sexuality.</p>
<h2>Shaping our future</h2>
<p>As a society, it is time to further prioritise the prevention of sexual violence, and instil in boys and young men the knowledge, dispositions and skills required for healthy sexual development. We must change the still too-common <a href="https://www.panmacmillan.com.au/9781760988128/">sense of entitlement to girls’ and women’s bodies</a>. Instead, we must help boys and men develop more empathy and respect for girls and women. </p>
<p>Prioritising prevention and building sexual and emotional literacy is our best chance of reversing the recent trend in adolescent-perpetrated child sexual abuse and sustaining reductions in adult-perpetrated abuse.</p><img src="https://counter.theconversation.com/content/221402/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ben Mathews is the Lead Investigator of the Australian Child Maltreatment Study (ACMS). The ACMS received research funding from the National Health and Medical Research Council, and additional funding and contributions were provided by the Department of the Prime Minister and Cabinet, Department of Social Services, the Australian Institute of Criminology. </span></em></p><p class="fine-print"><em><span>Chanel Contos is the founder of Teach Us Consent.</span></em></p>While there are signs that adult perpetration of child sexual abuse is declining, new research shows adolescent perpetration is rising.Ben Mathews, Professor, School of Law, Queensland University of TechnologyChanel Contos, Chair of Global Youth Commitee for Global Institute for Women's Leadership, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2174952024-01-10T23:10:59Z2024-01-10T23:10:59ZBreaking the curve: A call for comprehensive scoliosis awareness and care<figure><img src="https://images.theconversation.com/files/568748/original/file-20240110-29-9agwvv.jpg?ixlib=rb-1.1.0&rect=1417%2C0%2C7257%2C5787&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Scoliosis is a prevalent and underappreciated condition across Canada.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/breaking-the-curve-a-call-for-comprehensive-scoliosis-awareness-and-care" width="100%" height="400"></iframe>
<p><a href="https://www.cbc.ca/news/canada/wait-times-marketplace-1.6620306">Cael</a> was a typical 15-year-old — until the discovery of an already advanced abnormal curvature of his spine. </p>
<p>“I felt like the Hunchback of Notre Dame,” Cael told CBC News, recalling the emotionally draining and gruesome two-year wait for spinal surgery during which his curve progressed to a whopping 108 degrees.</p>
<p><a href="https://doi.org/10.1016/s0140-6736(08)60658-3">Scoliosis is an abnormal twisting and curving of the spine that can develop at any age, but mostly occurs during rapid growth spurts in children</a>, and as part of spine aging in adults over the age of 60. </p>
<p>Of all types of scoliosis in children, adolescent idiopathic scoliosis is the most prevalent, <a href="https://doi.org/10.1016/j.semarthrit.2016.07.013">accounting for as many as nine in 10 cases and impacting up to one in 20 adolescents globally</a>. On the other end of the age spectrum, a staggering <a href="https://doi.org/10.1097/01.brs.0000160842.43482.cd">two-thirds of older adults are also affected</a>.</p>
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Read more:
<a href="https://theconversation.com/explainer-everything-you-need-to-know-about-scoliosis-28409">Explainer: everything you need to know about scoliosis</a>
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<p>In clinical care, research and education related to scoliosis, disparities persist worldwide. Despite its widespread prevalence, scoliosis often goes undiagnosed, or has delayed diagnosis as in Cael’s case. It also receives limited attention in clinical and public health education, leading to significant gaps in health care.</p>
<p>This general lack of awareness has serious implications for thousands of people like Cael.</p>
<h2>Gaps in effective care</h2>
<p>In the United States, fewer than half of states legislate <a href="https://doi.org/10.1186/1748-7161-8-17">school-based scoliosis screening in children</a>. Even worse, Canada discontinued screening back in <a href="https://canadiantaskforce.ca/wp-content/uploads/2016/09/1994-red-brick-en.pdf">1979</a> because it was not considered cost-effective. </p>
<p>Pediatricians’ <a href="https://cps.ca/en/documents/position/greig-health-record-technical-report">screening</a> practices vary, and some cases of scoliosis in children are only discovered when an unrelated chest X-ray reveals a curved spine. With about <a href="https://doi.org/10.1007/s00586-011-2074-1">30 per cent of cases being hereditary</a>, parents may not recognize the signs early on.</p>
<p>The <a href="https://www.srs.org/Files/Patient-Brochures/Patient.Adolescent_Idiopathic_Scoliosis_Handbook_for_Patients.pdf">recommended care</a> in North America involves bracing for mild to moderate curves (25° to 45°) and surgery for curves exceeding 45°. Shockingly, <a href="https://doi.org/10.1097/brs.0b013e318059b5f7">32 per cent of Canadian children</a>, like Cael, face delayed referrals, discovering significant curves when they finally see specialists.</p>
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<img alt="X-ray images of two human torsos showing signs of scoliosis" src="https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=530&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=530&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=530&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=666&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=666&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=666&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Radiologic comparison of adult idiopathic scoliosis (A) and adult degenerative scoliosis (B).</span>
<span class="attribution"><span class="source">(Cho KJ, Kim YT, Shin SH, Suk SI)</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>Despite documented success in managing scoliosis through early <a href="https://doi.org/10.1016/j.spinee.2015.01.019">screening</a>, <a href="https://doi.org/10.1016/j.physio.2023.07.005">exercise rehabilitation</a> and <a href="https://doi.org/10.1056/nejmoa1307337">brace</a> treatment, global health-care education often neglects this condition. </p>
<p>The general lack of global awareness leaves physicians, nurses and other practitioners unaware of effective treatments and referral processes, contributing to the misunderstanding and under-treatment of patients. Consequently, when children with scoliosis eventually reach specialists for care, they may encounter challenges navigating the health-care system as they transition into adulthood.</p>
<h2>Sex disparities</h2>
<p>It is unclear why adolescent idiopathic <a href="https://doi.org/10.1016/j.semarthrit.2016.07.013">scoliosis affects mainly girls</a>. The more severe the curve, the more likely the patient is female. Due to their specific biology, <a href="https://doi.org/10.1016/j.semarthrit.2016.07.013">females</a> also face a five-fold higher risk of progressive deformities and are 10 times more likely, compared to males, to require surgery.</p>
<p>Despite generally uncomplicated <a href="https://doi.org/10.1097/00007632-200107010-00015">pregnancies and deliveries</a>, women with scoliosis often face <a href="https://doi.org/10.1097/bpo.0000000000002499">difficulties receiving pain control</a> during labour, with higher epidural failure rates. Moreover, they often suffer pregnancy-related back pain, and their spine <a href="https://doi.org/10.7759/cureus.46782">curvature may worsen after pregnancy</a>.</p>
<h2>Health-care access barriers</h2>
<p>Health-care access in the U.S. is influenced by a range of factors including race, income and health insurance coverage. </p>
<p>Patients with <a href="https://doi.org/10.1097/bpo.0000000000002551">better insurance</a> plans tend to seek pediatric orthopedic care at a younger age. Those with public insurance tend to have worse spine curvatures by the time they reach a scoliosis specialist; this is particularly striking among Black patients with public insurance, who are <a href="https://doi.org/10.1097/bpo.0000000000002213">67 per cent less likely</a> to be diagnosed at a stage early enough for effective brace treatment compared to Black patients with private insurance.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/iMmQZ6J6WrE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A brief overview on recognizing idiopathic scoliosis produced by Veritas Health.</span></figcaption>
</figure>
<p>While Canada’s health-care system covers spinal fusion for severe scoliosis, the lack of a national insurance program in the U.S. leads to varying out-of-pocket expenses for patients. </p>
<p>Those without insurance often cannot afford surgery at all. </p>
<p>But even with Canada’s universal coverage, patients typically wait <a href="http://waittimes.alberta.ca/WaitTimeTrends.jsp?rcatID=56&rhaID=All_34_&doSearch=true&urgencyCode=9&facilityID=-9_&checkedRegionNo=0&oldCheckedRegionNo=0&oldCheckedFacilityNo=0&ifDisplayFacility=false&ifDisplayPhysician=false&command=goToAccessGoals&chartType=access_goal&subChartType=90_75_50_25_AVERAGE_&disabledChartType=trend&status=processAjax&ifHavingFPTMeasurement=true#WaitTimeInfo">an entire year</a> for surgery due to a shortage of providers. Because of regional variability in resources such as access to spinal surgeons, funding and specialized facilities, some kids, like Cael, wait even longer, experiencing physical, emotional and psychological burdens, while their curves get progressively worse. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-healthy-is-the-canadian-health-care-system-82674">How healthy is the Canadian health-care system?</a>
</strong>
</em>
</p>
<hr>
<p>Delayed surgery in Canada cost the health-care system <a href="https://www.childrenshealthcarecanada.ca/en/child-health-advocacy/no-child-elects-wait_october2023.pdf">$44.6 million</a> due to more complex surgeries, extended hospital stays, readmission and re-operation rates.</p>
<h2>Workforce and research disparities</h2>
<p>Ongoing gender disparities in the health-care workforce and lack of research funding for this female-predominant condition continue to hamper effective action.</p>
<p><a href="https://doi.org/10.1016/j.wneu.2018.09.152">Fewer than five per cent of spinal surgeons</a> identify as women. <a href="https://journals.lww.com/annalsofsurgery/toc/2011/04000">Glass-ceiling</a> effects surround women surgeons in this male-dominated culture, perpetuating gendered training environments, being held to higher standards and earning lower wages. The dearth of senior women role models and mentors is a further barrier for career advancement and retention.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/canadas-health-care-crisis-is-gendered-how-the-burden-of-care-falls-to-women-215751">Canada’s health-care crisis is gendered: How the burden of care falls to women</a>
</strong>
</em>
</p>
<hr>
<p>Furthermore, <a href="https://doi.org/10.1038/d41586-023-01472-5">research funding</a> for diseases, such as scoliosis, that mainly affect females has historically lagged far behind funding for male-predominant diseases. <a href="https://doi.org/10.1002/9781119374855.ch26">Improving workforce diversity</a> is an important facet of addressing health disparities and shaping research agendas.</p>
<p>Inequities abound in scoliosis care and research. The impact of lack of awareness and delayed care extends beyond physical challenges. The patient and their family suffer emotionally, incurring significant financial burden while fearing the future. </p>
<p>The message is clear, we must do better for this underserved population.</p><img src="https://counter.theconversation.com/content/217495/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Scoliosis is a treatable condition, but only if detected early. Greater awareness of the condition and its dynamics will greatly aid in patient care moving forward.Sanja Schreiber, Adjunct Professor, Faculty of Rehabilitation Medicine - Physical Therapy, University of AlbertaEmily Somers, Professor of Internal Medicine, Environmental Health Sciences, and Obstetrics & Gynecology, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2188742023-12-18T13:20:32Z2023-12-18T13:20:32ZStudents could get more sleep and learn better if school started a little later<figure><img src="https://images.theconversation.com/files/564471/original/file-20231208-27-k39utf.jpg?ixlib=rb-1.1.0&rect=23%2C11%2C3916%2C2280&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">About 58% of middle schoolers and 73% of high schoolers do not get enough sleep.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/girl-is-tired-and-sleeping-at-the-desk-in-classroom-royalty-free-image/1503343198?phrase=students+sleeping+in+class">JackF via iStock / Getty Images Plus</a></span></figcaption></figure><p>Nearly three-quarters of high school students do not get enough sleep on school nights, according to the <a href="https://www.cdc.gov/healthyschools/features/students-sleep.htm">Centers for Disease Control and Prevention</a>.</p>
<p>The National Sleep Foundation recommends that teens sleep for <a href="https://doi.org/10.1016/j.sleh.2014.12.010">eight to 10 hours per night</a>. But various factors hinder this, including early school start times and <a href="https://doi.org/10.1093/sleep/16.3.258">shifts in adolescents’ circadian rhythms</a> – the biological internal clock that regulates the sleep-wake cycle and repeats roughly every 24 hours. <a href="https://theconversation.com/school-start-times-and-screen-time-late-in-the-evening-exacerbate-sleep-deprivation-in-us-teenagers-179178">Healthy sleep is crucial</a> for teens’ physical, cognitive and emotional development. When teens don’t get enough sleep, it can have lifelong impacts. They range from <a href="https://doi.org/10.1111/j.1365-2869.2011.00934.x">poor mental health</a> to <a href="https://doi.org/10.5664/jcsm.10156">lower attendance and graduation rates</a>.</p>
<p>As a neurologist <a href="https://scholar.google.com/citations?user=sTqquL0AAAAJ&hl=en">specializing in sleep disorders</a>, I have studied the profound importance of sleep in optimizing the body and mind. I believe insufficient sleep among adolescents is a public health crisis. This is why I reached out to my local state representative in Pennsylvania, <a href="https://www.legis.state.pa.us/cfdocs/legis/home/member_information/house_bio.cfm?id=1951">Rep. Jill Cooper</a>, a member of the House Education Committee, in October 2023 and pushed for legislative change. The resulting <a href="https://legiscan.com/PA/bill/HB1848/2023">proposed bill</a> would mandate that middle and high schools start no earlier than 8:15 a.m. by the 2026-27 school year.</p>
<p>While parents, educators and school administrators cannot alter biology, they can change school start times to allow students to obtain sufficient sleep for academic success and physical and mental well-being. In fact, the American Academy of Pediatrics <a href="https://doi.org/10.1542/peds.2014-1697">recommends pushing back school start times</a> to 8:30 a.m. or later.</p>
<p>Around the world, <a href="https://worldpopulationreview.com/country-rankings/average-school-day-length-by-country">school start times vary considerably</a>, from 7 a.m. in Brazil to 9 a.m. in Finland. While I’m not aware of any global dataset or research on the relationship between school start times and academic performance, Finland was ranked No. 2 on the list of <a href="https://worldpopulationreview.com/country-rankings/education-rankings-by-country">best educational systems</a> in the Global Citizens for Human Rights report in 2020. Canada, where the average school day begins at 8:30 a.m., was ranked No. 4.</p>
<h2>Sleep and the teenage brain</h2>
<p>Parents may notice that their kids, who were once early birds, start to sleep later and later as they hit their teen years. This is not just due to typical teen behavior like playing video games late at night, but rather it’s a <a href="https://doi.org/10.1093/sleep/16.3.258">biological response</a>.</p>
<p>During adolescence, changes in hormone levels, along with physical and brain maturation, lead to natural shifts in the circadian rhythm. The body tends to delay the release of melatonin, the hormone responsible for bringing on drowsiness at night. </p>
<p>Consequently, teens often find it <a href="https://doi.org/10.1016/j.pcl.2011.03.003">challenging to fall asleep early</a>, leading to a later bedtime. This delayed circadian rhythm also results in a preference for waking up later in the morning. These changes clash with societal and cultural expectations such as early school start times, often contributing to sleep deprivation among teenagers.</p>
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<iframe src="https://player.vimeo.com/video/694426344" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Changes in hormones and the circadian rhythm make it difficult for teens to fall asleep and wake up early. Healthy Hours via Vimeo</span></figcaption>
</figure>
<p>More than 80% of public middle and high schools across the United States <a href="https://nces.ed.gov/pubs2020/2020006/index.asp">start before 8:30 a.m.</a>, with 42% starting before 8 and 10% before 7:30. Consequently, bus pickup for some children can be as early as <a href="https://www.orlandosentinel.com/2015/04/18/5-am-bus-rides-630-walks-to-school-all-too-early/">5 a.m. in some districts</a>. What follow are four negative outcomes associated with early school start times.</p>
<h2>Hindered academic success</h2>
<p>Numerous studies have linked early school start times to poorer performance on <a href="https://doi.org/10.1542/peds.2014-1697">academic tests</a>. </p>
<p>One study looked at <a href="https://doi.org/10.5664/jcsm.10156">school start times, graduation rates and attendance rates</a> for 30,000 students in 29 high schools across seven states. It found a significant improvement in attendance rates, from 90% to 93%, and graduation rates, from 80% to 90%, four years after delaying school start times to 8:30.</p>
<p>Sleep deprivation has been shown to worsen <a href="https://doi.org/10.1093/sleep/zsab051">memory, learning ability, attention span</a>, <a href="https://doi.org/10.1016/B978-0-444-53702-7.00007-5">creativity</a>, <a href="https://doi.org/10.1177/019263650208663302">school attendance</a> and <a href="https://doi.org/10.1001/archpediatrics.2010.96">first-period tardiness</a> – a perfect storm for poor academic performance. </p>
<h2>Poorer mental health</h2>
<p>A recent <a href="https://www.hhs.gov/sites/default/files/sg-youth-mental-health-social-media-advisory.pdf">advisory from the U.S. surgeon general</a> raised the alarm on the harmful impacts of social media on youth mental health. Researchers have unearthed mounds of evidence on the negative effects, including <a href="https://theconversation.com/mounting-research-documents-the-harmful-effects-of-social-media-use-on-mental-health-including-body-image-and-development-of-eating-disorders-206170">poor body image</a>. In these discussions, however, a simple yet powerful solution for improving mental well-being is often overlooked – the profound impact of sleep. </p>
<p>During REM sleep – or the dream state – our memories consolidate and we process emotions. Insufficient sleep increases the risk of <a href="https://doi.org/10.1111/j.1365-2869.2011.00934.x">depression</a>, <a href="https://doi.org/10.1542/peds.2014-1696">anxiety</a> and <a href="https://doi.org/10.1093/sleep/27.7.1351">suicide</a> among adolescents. One study showed that for every extra hour of sleep among adolescents, their <a href="https://doi.org/10.1016/j.smrv.2018.07.003">risk of suicide decreased</a> by 11%. </p>
<h2>Impaired physical health and social behavior</h2>
<p>Sleep is fundamental for physical well-being. For both children and adults, it plays a key role in essential bodily functions. During slow-wave sleep – or deep sleep – our bodies restore themselves: Our <a href="https://doi.org/10.1007/s00424-011-1044-0">immune system strengthens</a> to keep us healthy. And our waste-clearing glymphatic system <a href="https://doi.org/10.3389/fnins.2021.639140">eradicates neurotoxic proteins</a>, which are linked to diseases like Alzheimer’s. </p>
<p>Sleep deprivation is associated with higher rates of <a href="https://doi.org/10.1155/2012/476914">obesity</a>, <a href="https://doi.org/10.5664/jcsm.6288">diabetes, cardiovascular problems, chronic health conditions</a>, <a href="https://doi.org/10.1016/j.sleep.2019.03.008">physical injuries</a> and weakened immune function. Sleep-deprived students are more likely to fall asleep when sedentary, such as when driving a car. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603528/">Motor vehicle accidents</a> related to driving while drowsy are especially prevalent among teen drivers.</p>
<p>Sleep-deprived students are also more likely to demonstrate aggression, struggle with social communication and engage in risk-taking behaviors. One study found that the amount of sleep that high school students get is directly related to their <a href="https://doi.org/10.1001/jamapediatrics.2018.2777">engagement in unsafe behaviors</a>, such as substance abuse, risky driving, aggressive behavior and tendency toward self-harm. </p>
<h2>An economic cost</h2>
<p>The economic ramifications of this crisis may not be immediately obvious, but they are undeniable. Contrary to <a href="https://lacomadre.org/2019/10/beyond-students-late-school-start-times-could-impact-parents-and-transportation-budgets/">concerns that delayed school start times might increase transportation costs</a> by changing bus schedules, a 2017 study conducted by the nonprofit RAND Corp. found that the economic benefits <a href="https://doi.org/10.7249/RR2109">far outweigh the expenses</a>. </p>
<p>The study showed that a universal shift to 8:30 a.m. school start times would result in an $8.6 billion gain in the U.S. economy over two years. Investing in delayed school start times, therefore, isn’t a drain on resources. Instead, it contributes to a healthier future for generations to come.</p><img src="https://counter.theconversation.com/content/218874/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joanna Fong-Isariyawongse does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most teens aren’t getting enough sleep, leading to poorer academic performance. Early school start times combined with natural changes in hormones and the circadian rhythm could be to blame.Joanna Fong-Isariyawongse, Associate Professor of Neurology, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2141202023-12-11T13:12:45Z2023-12-11T13:12:45ZTeens don’t know everything − and those who acknowledge that fact are more eager to learn<figure><img src="https://images.theconversation.com/files/559672/original/file-20231115-17-n1mpi2.jpg?ixlib=rb-1.1.0&rect=0%2C24%2C8179%2C4279&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What makes some students eager to work hard and others prefer to avoid the struggle?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/shot-of-a-student-struggling-with-schoolwork-in-a-royalty-free-image/1324921324">Kobus Louw/E+ via Getty Images</a></span></figcaption></figure><p>If you, like me, grew up in the 1980s and 1990s, you may have come across the classic refrigerator magnet, “Teenagers, leave home now while you still know everything.”</p>
<p>Perhaps you know a teen, or maybe you were a teen, like this: pop-star energy, a little too confident in your opinions, a little too certain that no one could know what you know. Adolescence is the period of life when people transform from children into adults. To handle the transition successfully, people need to shed parental dependencies and <a href="https://doi.org/10.1016/j.dr.2012.01.001">become more autonomous and independent</a>. So it makes sense that teens think – or at least act like – they know everything.</p>
<p>I’m a <a href="https://scholar.google.com/citations?view_op=search_authors&mauthors=tenelle+porter&hl=en&oi=ao">scholar</a> of how people, at any stage of life, handle the fact that they do not actually know everything.</p>
<p>My research has examined what happens to young people who, amid the emotional, social and hormonal storms of adolescence, find themselves relatively willing to acknowledge that their knowledge and perspective are actually limited. This is an attribute scholars like me call “intellectual humility,” which describes a person’s recognition that there are gaps in what they know and that those gaps make their beliefs and opinions fallible.</p>
<p>My colleagues and I wondered whether anything was different about teens who recognize this fallibility – who are intellectually humble – and those who don’t. We really weren’t sure, because the answer is not obvious. On one hand, being aware of their own ignorance and fallibility might be an asset for teenagers by making them more <a href="https://doi.org/10.1038/s44159-022-00081-9">teachable and open-minded</a>, and perhaps even <a href="https://doi.org/10.1007/s13164-023-00679-9">more likable</a>. On the other hand, perhaps awareness of their ignorance could be so overwhelming that it makes them feel defeated and helpless, essentially shooting young people in the foot before they have even gotten off the starting line of their adult life. </p>
<p>We wondered whether, and to what extent, intellectual humility is beneficial for youth and to what extent it might actually be harmful.</p>
<h2>Anticipating failure</h2>
<p><a href="https://doi.org/10.1016/j.lindif.2020.101888">In a series of studies</a> that collectively enrolled over 1,000 participants, high school students rated themselves on the degree to which they agreed with statements like “I acknowledge when someone knows more than me about a subject” and “I question my own opinions, positions and viewpoints because they could be wrong” as indicators of intellectual humility. </p>
<p>We then asked students to imagine that they had failed a quiz in a new class and, critically, what they would do next. Students rated a series of possible responses to this setback, including more mastery-oriented responses, such as “study harder next time,” and more helpless responses, such as “avoid this subject in the future.”</p>
<p>The students who had rated higher in intellectual humility more strongly endorsed the mastery responses, showing that the intellectually humbler they were, the more they said they would try to learn the difficult material. The students’ degree of intellectual humility did not coincide with their helplessness ratings. In other words, the intellectually humbler students were not more defeated and helpless. Rather, they were more interested in improving.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/559673/original/file-20231115-27-o33b7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Students hunch over desks, writing on paper." src="https://images.theconversation.com/files/559673/original/file-20231115-27-o33b7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559673/original/file-20231115-27-o33b7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559673/original/file-20231115-27-o33b7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559673/original/file-20231115-27-o33b7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559673/original/file-20231115-27-o33b7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559673/original/file-20231115-27-o33b7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559673/original/file-20231115-27-o33b7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When faced with tests and other challenges, some students are eager to learn to perform better.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/teeanage-students-doing-a-test-in-the-classroom-royalty-free-image/1356636065">FG Trade/E+ via Getty Images</a></span>
</figcaption>
</figure>
<h2>Actually encountering failure</h2>
<p>We wanted to know more, especially whether students’ hypothetical behavior would be the same as their actual behavior. Our next two studies addressed this question. </p>
<p>One study had three phases. We started by measuring adolescents’ intellectual humility with a self-reporting questionnaire like the one we’d used before. </p>
<p>Then we returned to their classrooms months after the questionnaire, on a day when the teacher returned an actual, graded unit test. As students saw their test feedback and grades, we asked them to rate different options for what they might do to prepare for the next test.</p>
<p>The intellectually humbler students endorsed items like “try to figure out things that confuse me” and “ask myself questions to make sure I understand the material” more strongly than the less intellectually humble students, regardless of whether they performed well or poorly on the test. </p>
<p>For the last phase of this study, we waited until the end of the school year and asked the teacher – who did not know students’ intellectual humility scores – to rate each student’s eagerness to learn. According to the teacher’s ratings, the intellectually humbler students took on learning with more gusto. </p>
<p>In the other study, with another group of students, we again gave them the questionnaire on intellectual humility. Then we asked them to complete a challenging puzzle that tapped into their actual persistence and challenge-seeking behavior. </p>
<p>The intellectually humbler students preferred challenging puzzles more than easy ones that they already knew how to do, spent longer trying to solve the challenging puzzles and made more attempts at solving puzzles even after they had failed than their less humble peers.</p>
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<h2>The role of mindset</h2>
<p>Collectively, those studies gave us additional confidence that intellectually humbler students were more teachable and willing to work harder than their more defensive, less humble peers – not only by their own accounts but also according to a teacher and as measured by an actual behavioral task.</p>
<p>But we didn’t know whether the intellectual humility caused that openness to learning. We wanted to know if encouraging students to be more intellectually humble would actually make students more focused on learning and mastery and less likely to throw up their hands and surrender in the face of a challenge.</p>
<p>So we randomly assigned participants to read one of two articles, one about the benefits of being intellectually humble, the other about the benefits of being highly certain. These articles looked like they had been written for a popular media outlet, but they were actually written by us. </p>
<p>As a cover story, we asked for participants’ feedback on the article: Was it intelligible? Could a young person understand it? What was the main idea? </p>
<p>Next, we asked participants to do a second, ostensibly unrelated activity. We asked them to imagine specific objects and rotate them in their minds’ eyes. These were tricky problems, taken from dental school admissions exams, aimed at determining a person’s spatial visualization skills.</p>
<p>After they finished the problems, we told participants they had done well on some questions and failed others. This feedback was made up so that it would be consistent for every participant. Prior researchers have <a href="https://doi.org/10.1177/0146167207312960">used a similar procedure</a> because it is difficult for people to determine whether they had answered these questions correctly or not, making both success and failure feedback equally plausible.</p>
<p>Then we asked if they would be interested in taking a tutorial on the material they failed. The results were dramatic: Upon hearing that they failed a series of questions, 85% of those who had read the article about the benefits of intellectual humility chose to invest in learning more about the failed subject. But just 64% of those who had read about the benefits of certainty chose to learn more.</p>
<p>In all of these studies, intellectually humbler adolescents showed in a variety of ways and via a variety of different measures that, when they got something wrong, they cared about getting it right the next time. Rather than throw up their hands and declare themselves to be helpless in the face of ignorance, intellectually humbler students set to work on learning more. </p>
<p>Other researchers’ findings that corroborate these results show that young people higher in intellectual humility are <a href="https://doi.org/10.1080/17439760.2019.1579359">more motivated to learn</a> and <a href="https://doi.org/10.1016/j.lindif.2021.102012">earn higher grades</a>, in part because they are more open to corrective feedback.</p>
<p>We are continuing our research into how intellectual humility shapes teenagers’ lives and how parents, teachers and society can promote it. Some of our recent work has looked at how schools make it either <a href="https://doi.org/10.1016/j.cedpsych.2022.102081">easier</a> or <a href="https://doi.org/10.1037/mot0000289">harder</a> for young people to express intellectual humility. We also have questions about how much American parents, teachers and adolescents value intellectual humility. As with any research, we really don’t know what we’ll find, but we’re excited to learn.</p><img src="https://counter.theconversation.com/content/214120/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tenelle Porter receives funding from the John Templeton Foundation. This article was produced with support from UC Berkeley's Greater Good Science Center and the John Templeton Foundation as part of the GGSC's initiative on Expanding Awareness of the Science of Intellectual Humility.
</span></em></p>Being aware of ignorance and fallibility can make people more teachable, and perhaps it could make people feel helpless and disempowered.Tenelle Porter, Assistant Professor of Psychology, Rowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2114162023-10-24T15:23:00Z2023-10-24T15:23:00ZTeens and screens: 7 ways tried-and-true parenting approaches can help navigate family conflict<figure><img src="https://images.theconversation.com/files/555040/original/file-20231020-19-7slxda.jpg?ixlib=rb-1.1.0&rect=44%2C98%2C5595%2C3538&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Understanding how and why conflicts around devices and screen time are unfolding will help families foster healthy relationships with each other and with digital technologies.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/teens-and-screens-7-ways-tried-and-true-parenting-approaches-can-help-navigate-family-conflict" width="100%" height="400"></iframe>
<p>Conflict is a normal and functional part of <a href="https://doi.org/10.1111/cdep.12278">the parent-adolescent relationship, contributing to the development of social, emotional and problem-solving skills</a>. </p>
<p>However, when conflicts become stuck, rigid and persistent, they can hinder healthy emotional experiences. </p>
<p>In today’s digital age, where screens and digital devices have become an integral part of daily life, parent-adolescent conflicts surrounding digital experiences have become increasingly common. </p>
<p>Over <a href="https://www.pewresearch.org/internet/2020/07/28/parenting-children-in-the-age-of-screens/">70 per cent of parents with children under the age of 12 express concern about their child’s screen time</a>, and majority of parents report fighting <a href="https://digitalwellnesslab.org/wp-content/uploads/Digital_Wellness_Lab-Parent_Survey-Media_Use_and_Remote_Learning-Visual_Summary.pdf">with their children over digital matters, with more than one-third reporting such conflicts on a daily basis</a>. </p>
<p>It is important to better understand how and why these conflicts may be unfolding, and what families can do to foster healthy relationships with each other and digital technologies.</p>
<h2>Parenting and adolescent perspectives</h2>
<figure class="align-right ">
<img alt="A youth on their phone looks deep in thought." src="https://images.theconversation.com/files/555038/original/file-20231020-15-w14x1m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/555038/original/file-20231020-15-w14x1m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555038/original/file-20231020-15-w14x1m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555038/original/file-20231020-15-w14x1m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555038/original/file-20231020-15-w14x1m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555038/original/file-20231020-15-w14x1m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555038/original/file-20231020-15-w14x1m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Adolescents embrace digital technologies as tools allowing them to connect with peers on their own terms.</span>
<span class="attribution"><span class="source">(The Gender Spectrum Collection)</span></span>
</figcaption>
</figure>
<p>During normal development, parent-adolescent conflict <a href="https://doi.org/10.1002/9781444390896">often unfolds due to clashes between teenagers’ yearning for independence and parents’ concerns for their safety</a>. </p>
<p>Adolescents embrace digital technologies as tools for <a href="https://doi.org/10.1037/0012-1649.42.3.395">self-expression, identity exploration and social interaction</a>. The digital landscape <a href="https://doi.org/10.1111/jora.12643">provides platforms to assert their independence, individuality and connect with peers on their own terms</a>.</p>
<p>At the same time, parents are uncertain about <a href="https://doi.org/10.1177/17456916211072458">children’s digital experiences that didn’t exist in their own childhoods</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nostalgia-for-childhoods-of-the-past-overlooks-childrens-experiences-today-183805">Nostalgia for childhoods of the past overlooks children’s experiences today</a>
</strong>
</em>
</p>
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<h2>Content, social connections</h2>
<p>Conflicts can include concerns around screen time, videogaming, online safety, privacy and how internet content will affect youth development, health and habits (related to peer networks, sexuality, ideologies, substance use or exposure to advertising and commerce). </p>
<figure class="align-left ">
<img alt="A teen with skateboard looking at phone." src="https://images.theconversation.com/files/555036/original/file-20231020-19-ylhn5o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/555036/original/file-20231020-19-ylhn5o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555036/original/file-20231020-19-ylhn5o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555036/original/file-20231020-19-ylhn5o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555036/original/file-20231020-19-ylhn5o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555036/original/file-20231020-19-ylhn5o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555036/original/file-20231020-19-ylhn5o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some parents worry if digtial habits may cause some lasting harm to their child’s social and emotional development.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>With social media, parents worry about age-appropriate content and cyberbullying, while adolescents value social media for social connections. Privacy concerns contribute to conflicts as parents monitor online activities for safety, which adolescents may find intrusive, leading to secrecy and resistance.</p>
<p>Given how <a href="https://www.tampabay.com/opinion/2023/06/03/lets-free-teens-social-media-addiction-column">media amplifies</a> research <a href="https://www.cbc.ca/news/canada/london/is-too-much-screen-time-harming-children-western-study-finds-link-to-anxiety-depression-1.6932356">highlighting potential harm to youth’s personal safety and healthy development</a>, parents may worry whether these technologies or digtial habits <a href="https://doi.org/10.31887/DCNS.2020.22.2/codgers">may cause some lasting harm to their child’s social and emotional development</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tiktok-is-more-than-just-a-frivolous-app-for-lip-syncing-and-dancing-podcast-182264">TikTok is more than just a frivolous app for lip-syncing and dancing – Podcast</a>
</strong>
</em>
</p>
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<h2>Challenge of establishing boundaries, limits</h2>
<p>Parenting in the digital age has been fraught with uncertainty. Nonetheless, the same evidence-supported parenting practices that worked for guiding youth over several previous generations remain applicable and effective for navigating digital issues. </p>
<p>For parents, the goal may be clear: to raise children who are self-regulated and capable of responsible self-management, while simultaneously nurturing quality relationships with their kids and aiding in the development of mature communication skills.</p>
<p>Navigating conflicts and disagreements about screens can provide a valuable opportunity to achieve these goals. </p>
<h2>Tips on productive conversations</h2>
<p><strong>1. Seek understanding & embrace open communication:</strong> Sometimes, issues stem from misunderstandings and a lack of validation. Parents and children can work together by seeking to understand each other’s perspectives and encourage open dialogue. Parents can start by taking a genuine interest in learning about their kids’ digital interests and experiences. </p>
<p>Ask open-ended questions to facilitate discussions and promote active <a href="https://www.commonsensemedia.org/articles/4-conversations-to-have-with-older-kids-and-teens-about-their-screen-time-habits">listening to one another’s thoughts and feelings about digital technologies without judgement or interruption</a>. This approach can help youth feel heard and valued, alleviating the sometimes entrenched positions that parent and child can hold.</p>
<figure class="align-center ">
<img alt="A dad talking with a teen." src="https://images.theconversation.com/files/555365/original/file-20231023-15-ygnlql.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555365/original/file-20231023-15-ygnlql.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555365/original/file-20231023-15-ygnlql.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555365/original/file-20231023-15-ygnlql.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555365/original/file-20231023-15-ygnlql.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555365/original/file-20231023-15-ygnlql.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555365/original/file-20231023-15-ygnlql.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Parents can start by taking a genuine interest in learning about their kids’ digital interests and experiences.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p><strong>2. Be informed & stay current:</strong> Exploring the digital world together, understanding preferred platforms and content and potential risks can foster open discussions about online safety, privacy and responsible digital citizenship. Parents not only gain valuable insights, but also send a powerful message that they are engaged and committed to listening to their child’s thoughts and well-being. </p>
<p><strong>3. Set clear boundaries, together:</strong> Some limits and expectations <a href="https://doi.org/10.1177/17456916211072458">are needed to guide responsible digital experiences</a>. Collaboratively establishing boundaries and rules enables setting expectations that meet everyone’s wants and needs. </p>
<p>With these expectations clear, subsequent negotiation and compromise should be smoother when and if disagreements arise. While parents maintain a pivotal role in setting limits, involving youth in the decision-making process can be highly beneficial. Importantly, when children have a say in setting limits, <a href="https://doi.org/10.1016/j.appdev.2019.101073">they are more likely to abide by them</a>. This approach also helps youth develop a sense of responsibility, self-control and problem-solving skills. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/digital-platforms-alone-dont-bridge-youth-divides-121222">Digital platforms alone don't bridge youth divides</a>
</strong>
</em>
</p>
<hr>
<p><strong>4. Not abstinence, but reinforcement:</strong> Although abstinence from digital technologies <a href="https://doi.org/10.1177/21677026211028983">might seem like a good idea, a more balanced approach is</a> more effective. Outright denial of access can lead to <a href="https://doi.org/10.1037/a0029484">conflicts and secrecy</a>.
To encourage positive behaviour, parents can adopt a strategy of reinforcement to leverage children’s strong desires for any activity, digital or otherwise, <a href="https://doi.org/10.1177/17456916211072458">through reward as well as negative consequences</a> for ignoring agreed-upon boundaries: for example, breaking curfew may result in a reduction in allotted digital time.</p>
<p>Reward means positive consequences: initiating or completing chores without reminders could earn additional digital time. </p>
<p>If a parent grants their child two hours of screen time on Saturday mornings, they can reward positive behaviours throughout the week incrementally. </p>
<p>This direct, quantifiable and contingent approach to consequences empowers a child’s sense of control over their access.</p>
<figure class="align-center ">
<img alt="A mom and daughter with a laptop and cellphone having fun." src="https://images.theconversation.com/files/555358/original/file-20231023-21-v9f5pn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555358/original/file-20231023-21-v9f5pn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555358/original/file-20231023-21-v9f5pn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555358/original/file-20231023-21-v9f5pn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555358/original/file-20231023-21-v9f5pn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555358/original/file-20231023-21-v9f5pn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555358/original/file-20231023-21-v9f5pn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Parents and youth can successfully traverse the digital landscape together.</span>
<span class="attribution"><span class="source">(Pexels/Rdne stock project)</span></span>
</figcaption>
</figure>
<p><strong>5. Promote critical thinking:</strong> As with any behaviour of concern, <a href="https://www.commonsense.org/education/articles/5-videos-that-get-teens-thinking-critically-about-media">it is important for youth to think critically about their digital habits</a>. </p>
<p>Discussing the content they consume is a good way to teach youth to distinguish between positive and negative influences, question the credibility of online sources and make informed choices. </p>
<p><strong>6. Lead by example:</strong> One way to cultivate <a href="https://doi.org/10.1177/17456916211072458">healthy digital habits is for parents to model the behaviour</a> they wish to see in their child. Parents would also benefit from considering their own digital experiences and maintaining healthy digital habits. It may be helpful for parents to reveal their own digital struggles and management techniques in ways that are appropriate to children’s and youth’s maturity and the parent-child relationship.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/youth-have-a-love-hate-relationship-with-tech-in-the-digital-age-109453">Youth have a love-hate relationship with tech in the digital age</a>
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</em>
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<p><strong>7. Revisit and adjust:</strong> Screen time and digital guidelines need periodic adjustments as children grow, gain more responsibility and digital needs and preferences change. </p>
<p>Through keeping an eye towards the basic goals of maintaining a healthy relationship and developing youth social and emotional competence, parents and youth can successfully traverse the digital landscape together.</p><img src="https://counter.theconversation.com/content/211416/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tom Hollenstein receives funding from Social Sciences and Humanitiess Research Council of Canada and the Natural Sciences and Engineering Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Katie Faulkner receives funding from Social Sciences and Humanities Research Council of Canada. </span></em></p>Navigating disagreements about screens can provide parents with valuable opportunities to foster quality relationships and raise children who can manage themselves responsibly.Tom Hollenstein, Professor of Developmental Psychology, Department of Psychology, Queen's University, OntarioKatie Faulkner, Masters student in Developmental Psychology, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2067022023-10-04T19:04:49Z2023-10-04T19:04:49ZI think my teen is depressed. How can I get them help and what are the treatment options?<figure><img src="https://images.theconversation.com/files/544471/original/file-20230824-29-js41sa.jpg?ixlib=rb-1.1.0&rect=29%2C0%2C4891%2C3260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Unsplash</span></span></figcaption></figure><p>Moody, withdrawn, down. These words are often used by parents of teens. And young people may say they feel so “depressed” about upcoming exams, or that the world is “just so depressing” these days.</p>
<p>But how do you know if your teen is experiencing what health professionals call “major depression”? And when should you seek help? </p>
<p>First, let’s understand what is meant by this term. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10228578/">Major depression</a> is characterised by persistent low mood and/or irritability and loss of interest or pleasure in usual activities for at least two weeks. It also includes physical symptoms, such as sleep disturbance and fatigue, and cognitive symptoms, such as negative thoughts about themselves and the future, difficulty concentrating or making decisions. </p>
<p>Major depression is more than brief sadness, or an expected reaction to loss or a stressful event. </p>
<p>While the diagnosis is the same for adolescents and adults, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10228578/">teens may be more likely</a> to present with irritability and mood changes rather than the low mood typical of adults. </p>
<h2>Increasing over time</h2>
<p>There is evidence depression is increasing among young people, with an <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2782796">international study in 2021</a> estimating 25% of children and adolescents experienced elevated depression symptoms – double pre-pandemic levels. While Australia was not included in this study, a recent Australian study showed psychological distress have <a href="https://doi.org/10.1016/j.psychres.2023.115356">spiked</a> in Australian millennials (born between the early 1980s and late 1990s) and Gen-Z Australians (born late 1990s to early 2010s). </p>
<p>While the cause of this increase is unclear, it is likely due to <a href="https://mentalhealththinktank.org.au/wp-content/uploads/2023/08/Mental_Health_Recovery_Package_Australias-Mental-Health-Think-Tank.pdf">multiple factors</a>, such as financial pressures, social isolation, and climate change, and made worse by the <a href="https://pubmed.ncbi.nlm.nih.gov/36970258/">COVID pandemic</a>. </p>
<p>Given the understandable distress experienced by many young people, how can parents or carers know when to seek help? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-parents-can-play-a-key-role-in-the-prevention-and-treatment-of-teen-mental-health-problems-192927">How parents can play a key role in the prevention and treatment of teen mental health problems</a>
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<h2>Listen up</h2>
<p>Begin by talking to your child. Let them know you have noticed some changes and you are concerned about them. If your child opens up about their difficulties, listen carefully and validate their feelings. Being able to talk about difficulties, and knowing support is there if they need may be enough for some teens. </p>
<p><a href="https://parents.au.reachout.com/common-concerns/mental-health/depression-and-teenagers">Read up on depression</a> from <a href="https://headspace.org.au/explore-topics/supporting-a-young-person/depression/">reputable sources</a>, so you are better equipped to understand and support a young person. </p>
<p>Try not to dismiss a teen’s feelings or punish irritable behaviour. It can be tempting to remind them of positives or offer solutions – but this can often backfire, leaving them feeling misunderstood. While it might be difficult or uncomfortable to talk openly with your teen about their mental health, it is often a <a href="https://aifs.gov.au/media/most-teenagers-turn-parents-and-friends-help">huge relief</a> for them. </p>
<p>Professional help may be needed if they are highly distressed, or if their difficulties are having a significant impact on their usual activities and relationships (this may include withdrawing from many activities, avoiding school, or avoiding friends and family most of the time). </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CpMfprROau0/?img_index=1","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Start with a GP</h2>
<p>The good news is, effective treatments are available. </p>
<p>The first step to finding appropriate treatment will likely be supporting your teen to see a GP. Again, simply talking through their concerns with the doctor may be very helpful. Your young person might prefer to discuss this with the GP without you.</p>
<p>The GP may <a href="https://www.health.gov.au/our-work/better-access-initiative">refer them to a mental health professional</a>, such as a <a href="https://psychology.org.au/psychology/about-psychology/seeing-a-psychologist-faqs">psychologist</a> or <a href="https://www.healthdirect.gov.au/psychiatrists-and-psychologists">psychiatrist</a>. </p>
<p>Teens can also go directly to an organisation like <a href="https://headspace.org.au">Headspace</a>, which provides information, support and services to young people aged 12 to 25 and their families and friends via centres across Australia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-first-sleep-health-program-for-first-nations-adolescents-could-change-lives-206286">The first sleep health program for First Nations adolescents could change lives</a>
</strong>
</em>
</p>
<hr>
<h2>What does depression treatment look like?</h2>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10228578/">recent review</a> on recognising and managing teen depression examined clinical practice guidelines from Canada, Australia, the United Kingdom, the United States and New Zealand found a comprehensive treatment approach is typically used. </p>
<p>Treatment can include:</p>
<ul>
<li><p>education about depression and its treatment</p></li>
<li><p>lifestyle interventions (such as improving sleep, diet and exercise)</p></li>
<li><p>psychological therapy (often focused on understanding and changing unhelpful thinking patterns)</p></li>
<li><p>prescription of antidepressants when needed. </p></li>
</ul>
<p>Whether to start a teen on <a href="https://australianprescriber.tg.org.au/articles/antidepressants-in-adolescence.html">antidepressant medication</a> can be a difficult decision. It should be a collaborative decision involving the teen, their parents and health professionals. </p>
<p>Like all medication, antidepressants have side effects and potential risks. They are typically used in cases of severe depression, or if psychological treatments have been unsuccessful. Suicidal thoughts or behaviour are a <a href="https://www.aacap.org/aacap/medical_students_and_residents/mentorship_matters/developmentor/Do_Antidepressants_Increase_the_Risk_of_Suicide_in_Children_and_Adolescents.aspx">possible side effect of antidepressants</a> for a small proportion of adolescents and should be carefully monitored. However, untreated depression is also a risk factor for suicide, so the potential benefits and risks of antidepressant use by teens needs to be carefully considered. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CxAZ5ZTBrhe/?img_index=1","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Assessing risk</h2>
<p>Suicidal thoughts and self-harm are common in depression but can be effectively treated. </p>
<p>Suicide risk assessment is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10228578/">critical part</a> of any treatment for depression, and should include the development of a <a href="https://au.reachout.com/articles/how-to-make-a-safety-plan">safety plan</a> with the teen and their parents or carers. Safety plans can be very helpful in times of distress, listing helpful coping strategies and contact details for family, friends and health professionals.</p>
<p>If you are concerned your teen <a href="https://parents.au.reachout.com/common-concerns/mental-health/suicide-and-teenagers">might be at risk of suicide</a>, take it seriously. Ask them direct questions, such as “Are you thinking about suicide?”. Get professional support as soon as possible and take the young person to the nearest emergency department or call 000 if you are worried about their immediate safety. You can also contact Kids Helpline 24 hours a day 1800 55 1800.</p>
<p>Importantly, look after yourself. Supporting a teen with depression can take a toll and lead to significant tension in a household. </p>
<p>Find someone (other than your child) you can confide in. Make sure you’re getting rest, nutrition and exercise. Seek professional support if you find yourself struggling. Taking care of yourself means you are better equipped to support your child. </p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call <a href="https://www.lifeline.org.au/">Lifeline</a> on 13 11 14 or <a href="https://kidshelpline.com.au/">Kids Helpline</a> on 1800 55 1800.</em></p><img src="https://counter.theconversation.com/content/206702/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Louise Birrell receives funding from the National Health and Medical Research Council, the Australian government and Australian Rotary Health. </span></em></p><p class="fine-print"><em><span>Andrew Baillie is employed by the University of Sydney in a position half funded by Sydney Local Health District and he receives funding from the National Health and Medical Research Council and the Medical Research Future Fund. </span></em></p><p class="fine-print"><em><span>Maree Teesson is Chair of Australia's Mental Health Think Tank which is funded by the BHP Foundation. She is Director of The Matilda Centre, The University of Sydney. She is chair of the Million Minds Mission. She receives funding from the National Health and Medical Research Council, the Australian Government, BHP Foundation, Paul Ramsay Foundation and other research organisations. She is co-director of OurFutures Institute a not-for-profit company established to distribute evidence resources to education organisations. </span></em></p><p class="fine-print"><em><span>Erin Kelly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Teen depression is on the rise but effective help is available. We look at what parents can do to support their teen.Louise Birrell, Researcher at The Matilda Centre for Research in Mental Health and Substance Use, University of SydneyAndrew Baillie, Professor of Allied Health, University of SydneyErin Kelly, Research Fellow and Clinical psychologistMaree Teesson, Professor & Director of The Matilda Centre. Chair, Australia's Mental Health Think Tank, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2125362023-09-10T20:05:52Z2023-09-10T20:05:52Z7 red flags your teen might be in an abusive relationship – and 6 signs it’s escalating<figure><img src="https://images.theconversation.com/files/547111/original/file-20230908-17-c5ry5k.jpg?ixlib=rb-1.1.0&rect=34%2C34%2C5716%2C3733&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-silhouette-couple-walking-holding-hands-256187347">Shutterstock</a></span></figcaption></figure><p>Australian teens need adults to help them recognise red flags for potentially abusive relationships.</p>
<p>The Australian Bureau of Statistics <a href="https://www.aihw.gov.au/reports/domestic-violence/family-domestic-sexual-violence-australia-2019/contents/summary">estimates</a> 2.2 million adults have been victims of physical and/or sexual violence from a partner since the age of 15. Almost <a href="https://www.anglicare-tas.org.au/young-in-love-and-in-danger/">one in three Australian teens</a> aged 18–19 report experiences of intimate partner violence in the previous year. </p>
<p>But physical, sexual, or psychological abuse in teen intimate relationships remains an invisible issue. The <a href="https://www.dss.gov.au/ending-violence">First National Action Plan to End Violence Against Women and Children</a> fails to mention it at all and
<a href="https://journals.sagepub.com/doi/full/10.1177/08861099221108381">Australia lacks</a> youth-specific domestic violence support services. </p>
<p>We know teens are experiencing intimate partner violence that is putting their lives in danger. But they are dependent on <a href="http://rcfv.archive.royalcommission.vic.gov.au/">informal networks</a> for assistance. Abuse can impact all parts of their lives and their age and stage of development make them even more vulnerable to its effects. </p>
<p>I <a href="https://www.anglicare-tas.org.au/young-in-love-and-in-danger/">interviewed</a> 17 young people about their experiences of teen intimate partner violence from when they were under 18. They wanted support and insight from the adults around them.</p>
<h2>‘I hadn’t experienced a proper relationship before’</h2>
<p><a href="https://www.jahonline.org/article/S1054-139X(19)30815-8/fulltext">Limited relationship experience</a> can prevent young people identifying red flags for intimate partner violence. Interviewee Elise said:</p>
<blockquote>
<p>As a young teen, I hadn’t experienced a proper relationship before; I just kind of thought this is how it is.</p>
</blockquote>
<p>While physical and sexual violence cross clear lines, <a href="https://www.anrows.org.au/publication/it-depends-on-what-the-definition-of-domestic-violence-is-how-young-people-conceptualise-domestic-violence-and-abuse/">Australian teens</a> report difficulty recognising more subtle forms of violence and control, such as emotional and technology-facilitated abuse. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-government-has-released-its-action-plans-to-end-violence-against-women-and-children-will-they-be-enough-211606">The government has released its action plans to end violence against women and children. Will they be enough?</a>
</strong>
</em>
</p>
<hr>
<h2>7 red flags that can happen early</h2>
<p>Young people identified red flags in their past intimate relationships and described how difficult it was to see them in the moment. On their own these behaviours and actions may not be problematic. For example, spending lots of time together is a relatively normal part of a new intimate relationship.</p>
<p>But concern should arise when these behaviours become part of a pattern. They can become integrated into everyday life, making them difficult to recognise – and they can escalate over time. Here are some examples of red flags for teen intimate relationships that can begin a pattern of violence and abuse:</p>
<ol>
<li><p>being together all the time, using technology to monitor location when not together and a sense of always “being on call”</p></li>
<li><p>sharing passwords to <a href="https://www.sciencedirect.com/science/article/abs/pii/S0747563219304315">social media accounts</a> or devices (or setting up shared profiles)</p></li>
<li><p>turning up unannounced or “as a surprise”</p></li>
<li><p>saying “I love you” very early in the relationship, talking about living together or having children. This is sometimes called “<a href="https://www.thehotline.org/resources/signs-of-love-bombing/">love bombing</a>”</p></li>
<li><p>showering with gifts and grand gestures</p></li>
<li><p>contacting someone’s friends or family to find out where they are</p></li>
<li><p>framing controlling behaviours as “care” or “concern”.</p></li>
</ol>
<p>Young person Gina said:</p>
<blockquote>
<p>We had a joint Facebook [account], because I wasn’t allowed to really talk to people without him seeing it […] He had to have the password.</p>
</blockquote>
<p>Ingrid’s partner framed control as care:</p>
<blockquote>
<p>He’d just perpetually check where I am, and then sometimes he’d just turn up […] He’d be like, ‘I’m just checking that you’re safe.’</p>
</blockquote>
<p>If a teen begins to feel like their autonomy and freedom to make choices are being restricted, it is a clear cause for concern. Jamie said:</p>
<blockquote>
<p>I didn’t have contribution into simple things like what movie to watch.</p>
</blockquote>
<p>Sam felt like they had to spend time with their partner, even if they didn’t want to: </p>
<blockquote>
<p>I’d spend hours […] just watching them play video games, because I didn’t feel like I could go and do something else […] And I hate video games.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/think-you-might-be-dating-a-vulnerable-narcissist-look-out-for-these-red-flags-205565">Think you might be dating a 'vulnerable narcissist'? Look out for these red flags</a>
</strong>
</em>
</p>
<hr>
<h2>6 red flags that suggest escalation</h2>
<p>Increasingly problematic (but still difficult to see) behaviours include: </p>
<ol>
<li><p>framing the relationship as unique or fated, such as saying the partner is the only person who truly understands them and nobody else could ever “love you like I do” </p></li>
<li><p>isolating a partner by making it difficult for them to spend time with others </p></li>
<li><p>assuming sexual activity will happen because “they are in a relationship”</p></li>
<li><p>framing feelings of jealousy as evidence of love</p></li>
<li><p>“suggesting” how they should dress or look or encouraging exercise or diet changes </p></li>
<li><p>insults passed off as “just a joke”.</p></li>
</ol>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/547112/original/file-20230908-17-gz8i1l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="teen couple sits together on pier near water" src="https://images.theconversation.com/files/547112/original/file-20230908-17-gz8i1l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547112/original/file-20230908-17-gz8i1l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547112/original/file-20230908-17-gz8i1l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547112/original/file-20230908-17-gz8i1l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547112/original/file-20230908-17-gz8i1l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547112/original/file-20230908-17-gz8i1l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547112/original/file-20230908-17-gz8i1l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Wanting to spend lots of time together is normal in a loving relationship. But patterns of control are not.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/holidays-vacation-love-people-concept-happy-572926015">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-couldnt-escape-i-wasnt-entirely-sure-i-wanted-to-confusing-messages-about-consent-in-young-adult-fantasy-fiction-156961">'I couldn’t escape. I wasn’t entirely sure I wanted to': confusing messages about consent in young adult fantasy fiction</a>
</strong>
</em>
</p>
<hr>
<h2>How can you help?</h2>
<p><a href="https://protect-au.mimecast.com/s/2mIMCL7rNltR83rxJc5_OOF?domain=academic.oup.com">Research shows</a> parents are in a unique position to support teens to foster healthy relationships. Interviewee Addison was among those asking for guidance:</p>
<blockquote>
<p>Anybody that can see the relationship [has] red flags. Anybody that is worried for me, I want them to tell me.</p>
</blockquote>
<p>Safe and reliable adults can act as role models, ensure safety, involve professionals and empower teens to build safe and healthy relationships.</p>
<p>We can do this by building trusting, open relationships with the teens in our lives, giving them a chance to talk and listening without judgement. If your teenager does not want to talk to you, help them find another person to talk to instead. It’s important to remember they may not respond the way we hope, but providing support and talking about relationships <a href="https://protect-au.mimecast.com/s/C6LCCMwv0mfqmJ1KQUNkx6d?domain=journals.sagepub.com">can decrease the risk</a> of them ending up in an abusive relationship.</p>
<p>And we need a national plan to prevent and respond to teen intimate partner violence. It is not the responsibility of teens or their families to solve this issue. </p>
<hr>
<p><em>If you suspect your teen is in an abusive relationship, contact 1800 RESPECT (1800 737 732) for advice and information. If you or someone you know is in immediate danger, contact 000.</em></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/stuck-in-a-talking-stage-or-situationship-how-young-people-can-get-more-out-of-modern-love-200914">Stuck in a 'talking stage' or 'situationship'? How young people can get more out of modern love</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/212536/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anglicare Tasmania funded the original research project where data for this article was collected.</span></em></p>Teenagers are experiencing intimate partner violence and abuse that is putting their lives in danger. And they want help from others to spot the early warning signs.Carmel Hobbs, Postdoctoral Research Fellow, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2110462023-08-30T04:19:59Z2023-08-30T04:19:59ZToo many young people who’ve been in detention die prematurely. They deserve better<figure><img src="https://images.theconversation.com/files/544694/original/file-20230825-25-a34sg8.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-jail-147711227">Shutterstock</a></span></figcaption></figure><p>Young people in contact with the criminal justice system – be it under community-based orders or in youth detention – are among the <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(19)30217-8/fulltext">most marginalised</a> in our society. And the health and health-care disadvantage faced by these young people may be evident for years.</p>
<p><a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00144-5/fulltext">Our research</a> found high levels of largely-preventable diseases and avoidable premature deaths for these young people in Australia. This indicates inadequate health care both in youth detention and in the community.</p>
<p>It’s time we provided health care for people in youth detention that’s culturally safe and equivalent to what’s available in the community. That includes access to Australia’s so-called universal health-care scheme, Medicare. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/locking-up-kids-damages-their-mental-health-and-sets-them-up-for-more-disadvantage-is-this-what-we-want-117674">Locking up kids damages their mental health and sets them up for more disadvantage. Is this what we want?</a>
</strong>
</em>
</p>
<hr>
<h2>Children as young as 10</h2>
<p>Australian courts can sentence children as young as ten who are convicted of a criminal offence to a community-based order, or to youth detention. </p>
<p>During the 2021-22 financial year, <a href="https://www.aihw.gov.au/getmedia/3fe01ba6-3917-41fc-a908-39290f9f4b55/aihw-juv-140.pdf.aspx?inline=true">4,350 young people</a> aged ten to 18 were detained at some point, typically for eight days or less.</p>
<p>Almost 50% of young people under youth justice supervision <a href="https://www.aihw.gov.au/getmedia/3fe01ba6-3917-41fc-a908-39290f9f4b55/aihw-juv-140.pdf.aspx?inline=true">are Indigenous</a>, and they are 24 times more likely than non-Indigenous young people to go into youth detention.</p>
<p>Young people in detention commonly have <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(19)30217-8/fulltext">very poor health</a>. This includes high rates of one or more physical and mental health problems, cognitive and neurodevelopmental disabilities, and substance dependence. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1689828524939788288"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-social-determinants-of-justice-8-factors-that-increase-your-risk-of-imprisonment-203661">The social determinants of justice: 8 factors that increase your risk of imprisonment</a>
</strong>
</em>
</p>
<hr>
<h2>What we found</h2>
<p>In the nearly 25 years of data covered in our study, <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00144-5/fulltext">we found</a> young people with a history of contact with the youth justice system died at a rate more than four times higher than those of the same age and sex in the general Australian population.</p>
<p>We found those most at risk of dying prematurely were Indigenous children, males, and those whose first contact with the youth justice system was before they were 14 years old.</p>
<p>Until now, there’s been a remarkable lack of evidence on the burden of noncommunicable diseases, such as cancers and cardiovascular diseases, among young people during and after contact with the youth justice system. However, we found that compared with their peers, these young people have nearly double the rate of dying from such diseases.</p>
<p>For young Indigenous males, cardiovascular and digestive diseases, including chronic liver diseases, were particularly prominent (and largely preventable) causes of death.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-nations-people-in-the-nt-receive-just-16-of-the-medicare-funding-of-an-average-australian-183210">First Nations people in the NT receive just 16% of the Medicare funding of an average Australian</a>
</strong>
</em>
</p>
<hr>
<h2>What we need</h2>
<p>Our findings highlight the need for young people involved with the justice system to access high-quality and holistic health care that’s age- and culturally appropriate. This is essential to identify and manage their complex health conditions, both during periods of supervision and – critically – after return to the community. </p>
<p>Aboriginal Community Controlled Health Organisations are <a href="https://link.springer.com/article/10.1186/s12889-020-09943-4">well placed</a> to provide this and to support continuity of care as these children transition in and out of detention.</p>
<p>But the Northern Territory is the only jurisdiction where they are funded to provide health care in youth detention.</p>
<p>Aboriginal Community Controlled Health Organisations are unable to access Commonwealth funding to support health care in detention elsewhere.</p>
<p>Discriminatory exclusion from access to Medicare, which typically prevents access to Aboriginal Community Controlled Health Organisations in detention, is an example of the “<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00243-9/fulltext">inverse care law</a>”. This is when those most in need of high-quality health care are least likely to receive it.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1320998841097711616"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/victorias-prison-health-care-system-should-match-community-health-care-180558">Victoria’s prison health care system should match community health care</a>
</strong>
</em>
</p>
<hr>
<h2>Progress has been slow so far</h2>
<p>Health-care reform in youth justice is clearly and urgently required, but progress has been slow. One reason is the lack of independent oversight of these systems. </p>
<p>Despite <a href="https://www.ombudsman.gov.au/industry-and-agency-oversight/monitoring-places-of-detention-opcat">ratifying</a> the UN Optional Protocol to the Convention against Torture in 2017, Australia has <a href="https://theconversation.com/australias-twice-extended-deadline-for-torture-prevention-is-today-but-weve-missed-it-again-197793">yet to establish</a> the mechanisms required under this protocol to permit independent scrutiny of places of detention. </p>
<p>As a priority, we need to meet our international obligations – through both permitting unfettered access to all youth detention centres and investing appropriately in <a href="https://www.ombudsman.gov.au/industry-and-agency-oversight/monitoring-places-of-detention-opcat">independent scrutiny</a> – in every state and territory.</p>
<p>Australia is also lagging behind in routine monitoring of health and health care in youth detention. More than five years ago, the Australian Institute of Health and Welfare <a href="https://www.aihw.gov.au/reports/youth-justice/health-justice-involved-young-people-2016-17/summary">recommended</a> producing regular reports on health care in youth justice settings. But there is still no Commonwealth or state/territory funding or mechanism for this critical monitoring.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-twice-extended-deadline-for-torture-prevention-is-today-but-weve-missed-it-again-197793">Australia's twice extended deadline for torture prevention is today, but we've missed it again</a>
</strong>
</em>
</p>
<hr>
<h2>Why we need to lift our game</h2>
<p>Improving the health of this marginalised group is important to improving health equity, closing the gap, and preventing the tragic loss of young lives. </p>
<p>Australia can no longer ignore that some of our most disadvantaged children are dying at a much faster rate than expected, and from causes that are largely preventable. Doing so would amplify cycles of racism and social exclusion. </p>
<p>Under the <a href="https://www.unicef.org.au/united-nations-convention-on-the-rights-of-the-child">UN Convention on the Rights of the Child</a> all children, including those in contact with the youth justice system, have the right to the highest attainable standard of health. We owe it to them to make this a reality.</p><img src="https://counter.theconversation.com/content/211046/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lucas Calais Ferreira receives funding from Suicide Prevention Australia.</span></em></p><p class="fine-print"><em><span>Stuart Kinner receives funding from the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Professor Susan Sawyer is a member of the Youth Justice Act Independent Expert Group for the Victorian Government, Department of Justice and Community Safety.</span></em></p><p class="fine-print"><em><span>Alex Brown does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Children as young as ten don’t have access to Medicare if detained. And they’re dying of largely preventable diseases.Lucas Calais Ferreira, Postdoctoral Research Fellow, The University of MelbourneAlex Brown, Professor of Indigenous Genomics, Australian National UniversityStuart Kinner, Professor of Health Equity, Curtin UniversitySusan M Sawyer, Professor of Adolescent Health The University of Melbourne; Director, Royal Children's Hospital Centre for Adolescent Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2079752023-07-28T12:19:57Z2023-07-28T12:19:57ZFixing the global childhood obesity epidemic begins with making healthy choices the easier choices – and that requires new laws and policies<figure><img src="https://images.theconversation.com/files/539667/original/file-20230726-15-ftjegw.jpg?ixlib=rb-1.1.0&rect=14%2C51%2C4877%2C3388&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Clean and safe city parks can be important factors in supporting kids' health and well-being. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com.mx/detail/ilustraci%C3%B3n/children-playing-in-the-city-park-ilustraciones-libres-de-derechos/478266830?phrase=children+playing+in+green+parks&adppopup=true">paci77/DigitalVision Vectors via Getty Images</a></span></figcaption></figure><p>The global childhood obesity epidemic has exploded. Over the past four decades, the world has witnessed a <a href="https://doi.org/10.1016/S0140-6736(17)32129-3">tenfold increase</a> in <a href="https://theconversation.com/obesity-in-children-is-rising-dramatically-and-it-comes-with-major-and-sometimes-lifelong-health-consequences-202595">obesity in children and adolescents</a> between 5 and 19 years old. </p>
<p>More than 124 million children across the world are <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight#cms">currently considered to be obese</a>. In children under age 5, obesity used to be nearly unheard of. Now, more than 38 million young children live with this condition. </p>
<p>Researchers now estimate that there are <a href="https://doi.org/10.1016/S0140-6736(17)32129-3">more obese children than underweight children worldwide</a>. Children and adolescents who are obese are <a href="https://doi.org/10.1111/obr.12334">more likely to become obese adults</a>, setting them up for a lifelong trajectory of poor health. </p>
<p>With this growth in childhood obesity comes an <a href="https://www.cdc.gov/obesity/basics/consequences.html">increase in associated poor mental and physical health outcomes</a>. Conditions that were once rare in children are <a href="https://doi.org/10.1016/j.mayocp.2016.09.017">now becoming increasingly common</a>. These debilitating and costly diseases include <a href="https://www.who.int/news-room/fact-sheets/detail/hypertension#">hypertension</a>, <a href="https://www.cdc.gov/diabetes/basics/type2.html">type 2 diabetes</a> and others. </p>
<p>I am a <a href="https://scholar.google.com/citations?user=4WSwC68AAAAJ&hl=en&authuser=1">public health researcher</a> who studies and teaches about the factors underlying the obesity epidemic. My research seeks to understand what is driving these trends. Why are more and more people, including children, becoming obese?</p>
<h2>Parsing the numbers</h2>
<p>Childhood obesity was once <a href="https://doi.org/10.1038/sj.ijo.0802804">predominantly an issue within developed nations</a>. But it has become an emerging health concern even in the poorest countries and regions.</p>
<p>The standard <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">measure used to determine obesity</a> in children and adolescents has long been the body mass index, or BMI. This is a measure of an individual’s height as compared to their weight. Children whose BMI is a set threshold above the mean, or average, are considered obese. The role of BMI in defining obesity in children and adults may be changing, however. </p>
<p>Although BMI remains a low-cost and practical method for assessing obesity across populations – such as estimating the percentage of children in a particular nation who are obese – <a href="https://theconversation.com/bmi-alone-will-no-longer-be-treated-as-the-go-to-measure-for-weight-management-an-obesity-medicine-physician-explains-the-seismic-shift-taking-place-208174">growing evidence has shed light on its limitations</a> for use at the individual and clinical level. <a href="https://www.ama-assn.org/press-center/press-releases/ama-adopts-new-policy-clarifying-role-bmi-measure-medicine">Leading medical organizations</a> and researchers are encouraging physicians to consider the use of alternative measures, which may change the way children are screened for health risks related to their weight at the doctor’s office.</p>
<h2>Critical role of parents and caregivers</h2>
<p>In essence, childhood obesity is the result of kids eating and drinking more calories than they are burning off through play, movement and growth. Because of this, researchers have largely focused on understanding the individual eating and physical activity habits of these kids. </p>
<p>In the case of childhood obesity, researchers like me also know that parental figures play critical roles in both <a href="https://doi.org/10.1111/j.1748-720X.2007.00111.x">mirroring and creating opportunities</a> for physical activity and healthy eating. </p>
<p>However, attempts to address childhood obesity have often focused excessively on <a href="https://doi.org/10.1093/heapro/daq052">individual behaviors of parents and children</a> and too little on the environment where children and their families live. Research and statistics make it clear that this approach has failed and that new strategies are needed to understand and address why more children are becoming obese.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&rect=8%2C16%2C5483%2C3639&q=45&auto=format&w=1000&fit=clip"><img alt="A male and female adult shop for vegetables with a child and examine tomatoes from a stall at a farmer's market." src="https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&rect=8%2C16%2C5483%2C3639&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539634/original/file-20230726-19-188nvv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Parents and caregivers play a major role in creating opportunities for healthy eating.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com.mx/detail/foto/family-shopping-at-organic-farmers-market-imagen-libre-de-derechos/602378307">Thomas Barwick/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<h2>Social determinants of childhood obesity</h2>
<p>Social determinants of health refer to the conditions where people live, learn, work, play and worship that affect health and quality of life.</p>
<p>The U.S. Department of Health and Human Services has <a href="https://health.gov/healthypeople/priority-areas/social-determinants-health">described five broad categories</a> of social determinants of health. These include: </p>
<ul>
<li>economic stability </li>
<li>education access and quality</li>
<li>health care access and quality</li>
<li>neighborhood and the built environment, such as access to sidewalks and playgrounds</li>
<li>social and community context </li>
</ul>
<p>Social determinants can promote health. For example, neighborhoods with access to safe parks and green spaces and healthy food retailers may support healthy eating and physical activity for families. </p>
<p>But social determinants can also facilitate or encourage unhealthy behaviors. Because of their underlying role in contributing to health outcomes like childhood obesity, social determinants have been described as the “<a href="https://doi.org/10.1177/00333549141291S206">causes of the causes</a>.” In other words, if poor diet is one of the causes of childhood obesity, then the social determinants that shape a child and their family’s food environment – such as lack of neighborhood grocery stores or limited income to purchase healthy foods – would be a cause of that poor diet.</p>
<h2>Role of processed foods and physical inactivity</h2>
<p>Globally, people are spending more time in cars and less time walking – one of the most basic forms of physical activity. Even in the poorest nations, <a href="https://www.ucl.ac.uk/dpu-projects/drivers_urb_change/urb_infrastructure/pdf_transport/HABITATII_Abraham_poolong_kuala_lumpur.pdf">private car ownership rates</a> are skyrocketing. Kids who would inadvertently be engaging in physical activity just by <a href="https://doi.org/10.1016/j.jenvp.2010.04.005">walking or biking to school</a> are more likely to be taking cars and buses to school instead. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/HBTUcBgBVV4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Inactivity from, for instance, excessive time spent sitting in front of the TV and other devices and lack of safe areas to play after school, is a major driver of the childhood obesity crisis.</span></figcaption>
</figure>
<p>When it comes to food, societies in the U.S. and around the world are <a href="https://doi.org/10.1017/S1368980018003762">producing and consuming more calorie-dense</a> <a href="https://theconversation.com/ultraprocessed-foods-like-cookies-chips-frozen-meals-and-fast-food-may-contribute-to-cognitive-decline-196560">ultra-processed foods</a>. Advertisers are targeting children with these food products and sugar-sweetened beverages online and on television. </p>
<p>But for working parents with long hours or those who are unable to afford healthy groceries, these are often the easiest or affordable options for feeding their children. In fact, poor families are more likely to live in communities designated as “<a href="https://doi.org/10.1007/s12115-016-9993-8">food deserts</a>,” areas where there are few or no grocery stores and a high concentration of fast-food restaurants and convenience stores.</p>
<p>And children’s lifestyles have changed drastically, shifting away from outdoor physical activity into an increasingly sedentary way of life, in large part due to <a href="https://doi.org/10.1071/he16026">social media</a> and <a href="https://doi.org/10.1016/j.jadohealth.2010.02.016">screen time</a>. The role of screen time in the childhood obesity epidemic is a <a href="https://doi.org/10.1542%2Fpeds.2016-1758K">significant and growing area of concern</a> and research. </p>
<p>In my own research in Peruvian communities, parents identified many of these same factors as <a href="https://doi.org/10.1080/13557858.2019.1591347">barriers to their children being physically active</a>. Mothers complained about the lack of safe spaces for their kids to play. Local parks were full of crime, and yards were congested with traffic and other safety hazards. Mothers felt it was safer for their young children to be inside watching TV than outside playing. </p>
<p>This example is not unique to Peru. Parents around the world are contending with these challenges.</p>
<h2>Addressing the underlying causes</h2>
<p>The field of public health prioritizes <a href="https://doh.wa.gov/community-and-environment/worksite-wellness/healthy-nutrition-guidelines/cafeterias/guidelines/easy-choices">making the healthy choice the easy choice</a>. Combating the childhood obesity epidemic means making healthy eating an easier choice for children and families than staying inside and eating processed foods. </p>
<p>However, the reality is that much of the world’s population now lives, works, plays and worships in places that make it more difficult to choose healthy behaviors.</p>
<p><a href="https://doi.org/10.1016%2Fj.amepre.2014.07.011">Policies</a> and <a href="https://www.ncbi.nlm.nih.gov/books/NBK114231/">programs</a> that address the social determinants of health are a critical part of curbing the childhood obesity epidemic. These include investing in community resources like playgrounds and <a href="https://www.nationalparks.org/explore/programs/open-outdoors-for-kids">free programs</a> that get kids outside. </p>
<p>Some nations and even U.S. cities have implemented “<a href="https://doi.org/10.1001/jamanetworkopen.2022.15276">sin taxes</a>” on sugar-sweetened beverages to discourage consumption. In Chile, policies have been created that <a href="https://doi.org/10.1186/s12966-023-01454-w">limit television advertising of unhealthy food</a> products toward children. Other policy examples include tax incentives and <a href="https://www.cdc.gov/obesity/downloads/healthier_food_retail.pdf">programs that increase access to healthy foods</a> and lower their cost. </p>
<p>In my view, every kid should be able to swim in the safe and accessible community pool rather than relying on their living room TVs to escape the blistering summer heat, or access fresh and affordable produce in their neighborhood instead of having to rely on fast food as the only close food resource. Childhood obesity is a preventable condition that communities can reduce most effectively by increasing access to resources that will allow them to live healthy lives.</p><img src="https://counter.theconversation.com/content/207975/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathleen Trejo Tello has previously received funding from National Institutes of Health's Fogarty International Center.</span></em></p>Obese children outnumber underweight ones globally, and ‘social determinants’ in kids’ lived environments play a fundamental role. Obesity in kids can lead to a lifetime of poor health.Kathleen Trejo Tello, Assistant Professor of Public Health, College of CharlestonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2082702023-07-10T18:07:26Z2023-07-10T18:07:26ZSex or social media? The sacrifices we’re willing to make to stay online<figure><img src="https://images.theconversation.com/files/535668/original/file-20230704-20-uh6ied.jpg?ixlib=rb-1.1.0&rect=22%2C22%2C4970%2C2784&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some adolescents even describe feeling a sense of stress and poor emotional well-being when not online.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/sex-or-social-media-the-sacrifices-were-willing-to-make-to-stay-online" width="100%" height="400"></iframe>
<p>Your alarm clock goes off, it’s time to start your day. What’s the first thing you do? What about right before you go to bed? If your answer is scrolling social media, <a href="https://www.reviews.org/mobile/cell-phone-addiction/">you’re not alone</a>. People are spending increasing amounts of time on social media, with reports from 2023 suggesting an average worldwide usage of <a href="https://datareportal.com/reports/digital-2023-global-overview-report">two and a half hours</a> a day.</p>
<p>With more social media apps and websites coming online, that amount of time is likely to increase. U.S. tech company Meta recently launched <a href="https://www.bbc.com/news/technology-66112648">Threads</a>, the newest social media platform vying for our time. The app is meant to rival Elon Musk’s Twitter.</p>
<p>With <a href="https://www.statista.com/statistics/617136/digital-population-worldwide/">4.8 billion</a> social media users worldwide as of 2023, social media has become a mainstay in everyday life, particularly among younger generations. Some adolescents even describe feeling a sense of <a href="https://doi.org/10.1016/j.addbeh.2020.106364">stress and poor emotional well-being</a> when not online. So much so that terms like FOMO (fear of missing out) and <a href="https://doi.org/10.4103%2Fjfmpc.jfmpc_71_19">Nomophobia (No Mobile Phone Phobia)</a> have been popularized to explain the feelings and thoughts some people experience when disconnected from their smartphone or their social media.</p>
<h2>Social media use</h2>
<p>As we become increasingly dependent on social media for entertainment and information, it can be challenging to create space between ourselves and our social media profiles. So much so that <a href="https://link.springer.com/article/10.1057/ejis.2012.1">too much enjoyment from and time spent</a> on social media can result in strong usage habits, and in more extreme cases, addiction. </p>
<p>As researchers who study societal relationships with these technologies, we began to wonder the lengths young adults might go to maintain their connection to social media. To answer this question, <a href="https://www.igi-global.com/article/a-social-media-give-and-take/324106">we conducted a study</a> of 750 Canadians, aged 16-30 years old, who regularly use social media. We asked them about their social media usage patterns, their relationship with social media and the sacrifices they would be willing to make to remain on social media.</p>
<p>Our findings showed that smartphones were the most used method for accessing social media and approximately 95 per cent of participants had access to at least two social media accounts, with Instagram, Facebook, and YouTube among the most popular.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/536133/original/file-20230706-16210-hcw4hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pair of hands typing on a keyboard." src="https://images.theconversation.com/files/536133/original/file-20230706-16210-hcw4hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536133/original/file-20230706-16210-hcw4hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536133/original/file-20230706-16210-hcw4hs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536133/original/file-20230706-16210-hcw4hs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536133/original/file-20230706-16210-hcw4hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536133/original/file-20230706-16210-hcw4hs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536133/original/file-20230706-16210-hcw4hs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">As we become increasingly dependent on social media for entertainment and information, it can be challenging to create space between ourselves and our social media profiles.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Additionally, nearly half reported checking social media nine or more times a day, whereas only about one in every 10 people checked social media twice a day or less. The most popular times of day that people accessed their phone were in the morning and evening. However, access during the afternoon, at night and on the weekend was still frequent. </p>
<p>Interestingly, despite an average age just over 24 years old, nearly half of the young adults surveyed indicated they have had a social media account for close to or more than a decade, suggesting prolonged usage and interest from an early age. </p>
<h2>What trade-offs are young adults willing to make?</h2>
<p>Respondents were asked to consider what they would be willing to sacrifice to maintain their social media presence. Trade-offs fell into the following categories: food/drink, hobbies, possessions, career, appearance, relationships, health and life. </p>
<p>Approximately 40 per cent of respondents were willing to give up caffeine, alcohol and video games. Another 30 per cent or so were willing to give up playing sports, watching TV and eating at their favourite restaurant for an entire year. </p>
<p>When asked to make appearance or possession-related trade-offs, another 10 to 15 per cent said they would rather gain 15 pounds, shave their head, give up their driver’s licence, never travel again and live without air conditioning. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/536134/original/file-20230706-29-m1fn6s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="People using laptops and smartphones sitting on the ground." src="https://images.theconversation.com/files/536134/original/file-20230706-29-m1fn6s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536134/original/file-20230706-29-m1fn6s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=369&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536134/original/file-20230706-29-m1fn6s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=369&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536134/original/file-20230706-29-m1fn6s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=369&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536134/original/file-20230706-29-m1fn6s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=464&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536134/original/file-20230706-29-m1fn6s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=464&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536134/original/file-20230706-29-m1fn6s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=464&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">With 4.8 billion social media users worldwide as of 2023, social media has become a mainstay in everyday life, particularly among younger generations.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>When asked to make more serious trade-offs relating to their relationships, health, or life, fewer were willing to make the sacrifice. For example, fewer than five per cent of participants said they would be willing to contract a sexually transmitted infection, or be diagnosed with a life-threatening illness like cancer rather than give up social media.</p>
<p>However, nearly 10 out of every 100 participants did say they would accept being unable to have children, give up sex or give up one year of their life to maintain their social media connections. When asked to give up more years of life, almost five out of every 100 and three out of every 100 participants said they would give up five or 10 years of their life, respectively.</p>
<p>Some young adults are willing to give up a considerable amount to maintain their access to social media. Notably, participants were far more likely to make food, drink and hobby-related sacrifices, followed by possessions and appearance-related trade-offs, compared to more serious concessions. However, knowing that even a small proportion of participants were willing to make health and life-related sacrifices is, quite honestly, scary. </p>
<p>We are not the kind of researchers who want to rid the world of social media. Quite the opposite, we use it ourselves. Rather, like most things in this world, we see the benefits and consequences and want to encourage conversations, reflection and thinking about how and why we use social media.</p><img src="https://counter.theconversation.com/content/208270/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paige Coyne receives funding from SSHRC.</span></em></p><p class="fine-print"><em><span>Sarah Woodruff receives funding from SSHRC.</span></em></p><p class="fine-print"><em><span>Bailey Csabai does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Social media has become a mainstay in everyday life, particularly among younger generations. And some are even willing to make trade-offs to stay online.Paige Coyne, PhD Candidate, Department of Kinesiology, University of WindsorBailey Csabai, Research and Graduate Assistant, Faculty of Human Kinetics, University of WindsorSarah Woodruff, Professor, Director of the Community Health, Environment, and Wellness Lab, University of WindsorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2062562023-05-24T16:45:39Z2023-05-24T16:45:39ZBetter bipolar diagnosis may reduce suicide rates in boys – new research<figure><img src="https://images.theconversation.com/files/527977/original/file-20230524-27-9gr7qc.jpg?ixlib=rb-1.1.0&rect=35%2C0%2C4000%2C2658&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sorrowful-kid-on-city-street-415361539">Lopolo/Shutterstock</a></span></figcaption></figure><p>Suicide rarely happens in the absence of severe mental health problems. Research indicates that psychiatric disorders <a href="https://acamh.onlinelibrary.wiley.com/doi/epdf/10.1111/j.1469-7610.2006.01615.x">are prevalent in up to 90%</a> of adolescents who die from suicide. In particular, what are known as affective disorders, such as major depressive disorder and bipolar disorder, are present in 44%-76% of cases. </p>
<p>This means that severe mental illness is the most <a href="https://www.nejm.org/doi/10.1056/NEJMra1902944">influential and preventable predictor</a> of death by suicide. </p>
<p>Bipolar disorder is a serious mental health condition characterised by recurring, alternating episodes of elevated (manic) and depressed moods. It underlies roughly <a href="https://doi.org/10.1017/S0033291713000329">5% of all suicides</a> among young people.</p>
<p>The majority of adults with bipolar disorder start having mood symptoms in their youth. But there is often a long delay between the onset of symptoms and correct diagnosis and treatment.</p>
<p>So the question is whether this gap puts vulnerable young people at risk of suicide. Our new research, <a href="https://doi.org/10.1001/jamapsychiatry.2023.1390">published in in JAMA Psychiatry</a>, hints this may be the case. We found fewer suicides among boys in Swedish regions with more bipolar diagnoses.</p>
<p>National registry data suggests that severe mental disorders in Swedish adolescents are unequally recognised and treated in general. And despite national treatment guidelines advocating for their use, our reserach appears to suggest that major academic hospitals do not consistently prioritise evidence-based treatments such as the mood stabiliser <a href="https://theconversation.com/bipolar-treatment-can-be-improved-by-focusing-less-on-antidepressants-and-more-on-lithium-118875">lithium</a> or <a href="https://theconversation.com/electroconvulsive-therapy-calls-to-have-it-suspended-ignore-the-evidence-175969">electroconvulsive therapy</a> for adolescents. </p>
<p>Conversely, smaller counties with hospitals that are not affiliated with universities seem to be <a href="https://www.nature.com/articles/s44184-022-00013-8">leading providers of such treatments</a>.</p>
<p>These findings suggest there is a potential gap in knowledge regarding the diagnosis and treatment of severe mental illness in youth at Swedish universities.
And such unequal access is likely to exist in many places beyond Sweden. </p>
<p>Importantly, we <a href="https://www.nature.com/articles/s41467-023-36973-4">recently demonstrated</a> that Swedish regions with higher implementation rates of evidence-based psychiatric treatments in Swedish 15-19-year-old males also had substantial reductions in excess suicide deaths in adolescents. </p>
<p>This indicates that early diagnosis and treatment for severe mental illness may be key for successful suicide prevention in male adolescents across the world.</p>
<h2>Bipolar diagnosis</h2>
<p>We know that the onset of bipolar disorder in youth is associated with more recurrences, greater rates of substance abuse and a greater likelihood of suicide attempts and violence. But there are good treatments, with lithium <a href="https://www.bmj.com/content/346/bmj.f3646">being the most effective</a> at reducing suicide in adults. </p>
<p>Treatments for adolescents have been less researched. There is compelling evidence that lithium is associated with decreased suicide attempts, less depression and better psychological and social functioning, compared to other <a href="https://www.sciencedirect.com/science/article/abs/pii/S0890856719313991?via%3Dihub">mood-stabilising medication</a>. </p>
<p>However, the specific potential for lithium treatment to prevent suicide deaths in adolescent bipolar disorder has not been extensively investigated.</p>
<p>Despite retrospective studies showing that more than half of adults with bipolar disorder experience their <a href="https://www.sciencedirect.com/science/article/abs/pii/S0006322304001088">first mood disorder symptoms</a> before 18, practices of diagnosing the disorder in youth have been controversial. Doctors may be hesitant to diagnose and treat youth in case they are wrong.</p>
<p>There are also indications of widespread clinical <a href="https://www.nature.com/articles/s41467-023-36973-4">misattribution of severe mental illness</a> symptoms to alternative causes, such as <a href="https://pubmed.ncbi.nlm.nih.gov/20933172/">autism</a>, <a href="https://link.springer.com/article/10.1007/s00787-021-01811-9">obsessive-compulsive disorder </a> or <a href="https://www.nature.com/articles/s44184-022-00013-8#ref-CR24">pediatric acute onset neuropsychiatric syndrome</a> (Pans).</p>
<p>International clinical guidelines therefore have different recommendations for the diagnosis of bipolar disorder. For example, the UK’s National Institute for Health and Care Excellence guidelines posit substantially stricter criteria for diagnosing bipolar disorder in adolescents than in adults. It requires the <a href="https://www.nice.org.uk/guidance/cg185">presence of mania</a>) for a diagnosis, which isn’t always a symptom at the start.</p>
<p>This isn’t the case for the American Academy of Child and Adolescent Psychiatry. It <a href="https://www.jaacap.org/article/S0890-8567(09)61968-7/fulltext">recommends</a> sticking with the standard classification system, the Diagnostic and Statistical Manual of Mental Disorders (DSM), for both children and adults.</p>
<figure class="align-center ">
<img alt="Teenage boy having counselling with mental health professional during therapy session." src="https://images.theconversation.com/files/527976/original/file-20230524-15-oj5lmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/527976/original/file-20230524-15-oj5lmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/527976/original/file-20230524-15-oj5lmb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/527976/original/file-20230524-15-oj5lmb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/527976/original/file-20230524-15-oj5lmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/527976/original/file-20230524-15-oj5lmb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/527976/original/file-20230524-15-oj5lmb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Diagnosis and treatment is key to reducing suicide rates.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/black-teenage-boy-having-counselling-mental-2015355308">Drazen Zigic/Shutterstock</a></span>
</figcaption>
</figure>
<p>We know that early <a href="https://doi.org/10.1176/appi.ajp.2017.17090972">pharmacological</a> and <a href="https://doi.org/10.1186/s40345-016-0060-6">non-pharmacological</a> treatments for bipolar disorder have been shown to be effective in improving long-term outcomes. </p>
<p>But effective treatment relies on a correct diagnosis. And <a href="https://doi.org/10.1111/acps.13490">this is often delayed</a> for bipolar disorder. In fact, research suggests an average time to diagnosis is about 6.7 years from disease onset.</p>
<h2>New research</h2>
<p>Our <a href="https://doi.org/10.1001/jamapsychiatry.2023.1390">latest reseach</a> was based on cross-sectional Swedish national registry data covering the years 2008–2021. This included 585 confirmed suicide deaths. </p>
<p>There were substantial regional variations. Some regions reported rates up to six times higher than the national average, while others did not report any cases at all. Notably, 87.5% of the regions with the highest diagnosis rates were not affiliated with medical research universities. </p>
<p>Among the university-affiliated regions, Uppsala stood out by diagnosing approximately five times more adolescents with bipolar disorder compared to other major Swedish regions such as Stockholm, Gothenburg and Skåne. </p>
<p>We demonstrated that regional diagnosis rates of bipolar disorder in adolescent males were strongly linked to lower suicide death rates – about 4.7% lower than the national average. Psychiatric care and the prevalence of depression and schizophrenia rates, on the other hand, had no impact on suicides.</p>
<p>This association could not be confirmed in girls. This could be down to statistical problems or the potential widespread misdiagnosis of bipolar disorder in females.
Female adolescents were about three times more often diagnosed with bipolar disorder compared to males. And males were also nearly twice as likely to die by suicide.</p>
<p>The picture of how to prevent suicide in young people is becoming increasingly clear. Not only have we shown that evidence-based treatment can help prevent suicide young people, but now also that early diagnosis of bipolar disorder may play a role. This is probably data that health authorities across the world needs to take seriously.</p>
<p>There may be more insights soon. Our research group remains committed to investigating the full extent and consequences of health inequities in the diagnosis and treatment of youth with severe mental illness.</p><img src="https://counter.theconversation.com/content/206256/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is often a long delay between the onset of bipolar symptoms and correct diagnosis and treatment which puts vulnerable young people at risk of suicide.Adrian Desai Boström, Postdoctoral Researcher in Psychiatry, Karolinska InstitutetPeter Andersson, PhD candidate in Psychiatry, Karolinska InstitutetLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2015582023-04-10T20:02:12Z2023-04-10T20:02:12ZHow can I help my teen quit vaping?<figure><img src="https://images.theconversation.com/files/518067/original/file-20230328-18-s4t4vt.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C1276%2C956&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-in-blue-shirt-talking-to-a-young-man-in-white-shirt-8550841/">Kindel Media/Pexels</a></span></figcaption></figure><p>You’re driving your teen home from school when they open up to you about their vaping. What started off as an occasional puff of an e-cigarette has turned into something more serious. </p>
<p>“I was curious and just wanted to try it,” they say. “All my friends were doing it and I wanted to do it too.”</p>
<p>But now they are vaping more often and getting anxious when they can’t access their vape. They want to quit but they aren’t sure how.</p>
<p>Here are some practical tips to help your teen stop vaping.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sex-and-lies-are-used-to-sell-vapes-online-even-we-were-surprised-at-the-marketing-tactics-we-found-200446">Sex and lies are used to sell vapes online. Even we were surprised at the marketing tactics we found</a>
</strong>
</em>
</p>
<hr>
<h2>I don’t want to lecture. But what can I do?</h2>
<p>You’ve seen <a href="https://www.abc.net.au/news/2023-03-29/qld-vaping-larger-vapes-enter-market-doctors-call-action-teens/102153474">the news</a> and you know e-cigarettes <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.51890">are harmful</a>. </p>
<p>You might want to reprimand your child, or say “If your friends jumped off a cliff, would you do it?”. But you know criticism and <a href="https://www.psychologytoday.com/au/blog/growing-friendships/201809/want-your-child-listen-and-learn-don-t-lecture">lecturing</a> <a href="https://academic.oup.com/ntr/article-abstract/12/3/191/1041894?redirectedFrom=fulltext&login=true">don’t work</a>. So, what do you do?</p>
<p>First, acknowledge it’s a great sign your teen wants to quit and is asking for help. We know motivation is critical to behaviour change. </p>
<p>But if you’re a parent of a teen who isn’t ready to try quitting, you need to work on boosting their motivation to quit first.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/my-teens-vaping-what-should-i-say-3-expert-tips-on-how-to-approach-the-talk-196205">My teen's vaping. What should I say? 3 expert tips on how to approach 'the talk'</a>
</strong>
</em>
</p>
<hr>
<h2>Boost their motivation to quit</h2>
<p>Talk with your teen about their vaping. Ask them what led to them wanting to quit and their reasons for wanting to give up. You can both use those reasons to help motivate quitting.</p>
<p>Use that knowledge to balance the benefits of quitting with the costs of not quitting. You can do this using <a href="https://www.nova.edu/gsc/forms/client_handout_3_1_decisional_balance_exercise.pdf">a practical exercise</a>.</p>
<p>Discuss potential barriers that might get in the way of quitting.
What is your teen worried will happen if they try to quit? Have they been using vaping to relax and are worried they will become more anxious? Are they worried about losing friends? Do they think they won’t be able to quit?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1640117707084566528"}"></div></p>
<p>Once you have an idea of the costs and benefits your child perceives, you’ll be in a better position to help them. For example, if they have been using vapes to relax, help them find other ways of reducing stress. </p>
<p>It might also help to tap into their values and use these to highlight that their vaping isn’t aligned with who they want to be. </p>
<p>For example, if they are skipping class to vape but are usually a diligent student, discuss this discrepancy and the longer-term impact of their dependence (for example, not getting into uni).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-parents-guide-to-why-teens-make-bad-decisions-88246">A parent's guide to why teens make bad decisions</a>
</strong>
</em>
</p>
<hr>
<h2>Set a goal</h2>
<p>Once your child is motivated, it’s time to set a goal to quit. Work with your teen to develop a SMART goal that is <strong>S</strong>pecific, <strong>M</strong>easurable, <strong>A</strong>chievable, <strong>R</strong>elevant, with a <strong>T</strong>imeframe.</p>
<p>That goal might be to quit vaping by a certain date. But your teen may need to set smaller goals first. This might mean “This week, I will only vape on Monday, Wednesday and Friday.”</p>
<p>Once achieved, these goals can be made more challenging until gradually, your teen has succeeded in quitting vaping. </p>
<p>Make sure you reward your teen or they reward themselves for achieving their goals, even the small ones.</p>
<p>Next, if your teen has been using nicotine vapes – and many vapes <a href="https://www.mja.com.au/journal/2019/210/3/nicotine-and-other-potentially-harmful-compounds-nicotine-free-e-cigarette">contain nicotine</a> even if they are not labelled as such – they may be addicted. </p>
<p>Contact the Quitline (details below) or see your GP to discuss support for your teen. They may need extra help weaning off e-cigarettes. A nicotine tapering plan may help.</p>
<h2>How to handle the setbacks</h2>
<p>Your teen will likely have some trouble quitting. Remember those barriers from earlier? Create coping plans. What will your teen do if they are feeling stressed and want to reach for their vape? What will your teen do if they are at a party and are offered a puff?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1557622847920635905"}"></div></p>
<p>These strategies may help your teen:</p>
<ul>
<li><p>keeping busy by doing puzzles, drawing, or playing games on the phone</p></li>
<li><p>changing locations. Encourage your teen to get out and about. They can go to the gym, outside for a walk, or head to the footy</p></li>
<li><p>reminding your teen about the reasons they want to quit and the costs of not quitting</p></li>
<li><p>helping them practise saying “no” to a vape</p></li>
<li><p>having snacks or gum they can grab when they have the urge to vape. </p></li>
</ul>
<h2>Show compassion</h2>
<p>There are many reasons people vape. Among them is a vaping industry, <a href="https://www.tobaccoinaustralia.org.au/chapter-18-e-cigarettes/18-1-the-ecigarettemarket">with deep pockets</a>, that’s expert at <a href="https://theconversation.com/sex-and-lies-are-used-to-sell-vapes-online-even-we-were-surprised-at-the-marketing-tactics-we-found-200446">manipulating</a> young people to start and continue vaping.</p>
<p>So be compassionate and try not to judge your teen. Lecturing, criticising and being punitive won’t help them quit. Position yourself as someone they can rely on.</p>
<hr>
<p><em>More support and information about quitting vaping is available from
<a href="https://lungfoundation.com.au/lung-health/protecting-your-lungs/e-cigarettes-and-vaping/for-parents/">Lung Foundation Australia</a> and
<a href="https://www.quit.org.au/articles/teenvaping/">Quitline</a> (ph: 13 7848).</em></p><img src="https://counter.theconversation.com/content/201558/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Michelle Jongenelis receives funding from the National Health and Medical Research Council. She is affiliated with the Australian Council on Smoking and Health, the Public Health Association of Australia, and the World Federation of Public Health Associations' Tobacco Control Working Group.</span></em></p>Criticism and lecturing won’t help. This will.Michelle Jongenelis, Associate Professor, Melbourne Centre for Behaviour Change, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2021512023-03-23T07:51:28Z2023-03-23T07:51:28ZTB kills 75,000 children in Africa every year: how this can stop<figure><img src="https://images.theconversation.com/files/516948/original/file-20230322-26-dpm8er.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There have been substantial improvements in some areas of TB therapeutics. </span> <span class="attribution"><span class="source">Punit Paranjpe/AFP via Getty Images</span></span></figcaption></figure><p><em>Tuberculosis (TB) is a preventable and curable disease. Half of the world’s 30 highest TB burden countries are in Africa. In many of these countries, TB is the leading cause of death across age groups, but especially among children. Globally, TB is the <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022/tb-disease-burden/2-2-tb-mortality">leading cause of death</a> by any single infectious agent (above COVID-19 and HIV).</em></p>
<p><em>The people most affected by TB are often the most socio-economically marginalised, with the fewest reserves to take them through the treatment journey. This is extremely challenging, with complex, often delayed diagnosis, many months of treatment, and often long-term effects after treatment. The Conversation Africa’s Ina Skosana spoke to Graeme Hoddinott, a socio-behavioural science lead at the Desmond Tutu TB Centre, Stellenbosch University, and an African Academy of Sciences ARISE Fellow.</em></p>
<hr>
<h2>What’s the TB burden among young people?</h2>
<p>In Africa, of the <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022/tb-disease-burden/2-1-tb-incidence">three million people</a> who develop TB disease every year, nearly 160,000 are children 0-4 years old, and another 160,000 are 5-14 years old. Every year, about <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022/tb-disease-burden/2-2-tb-mortality">500,000 people in Africa</a> die because of TB. Children make up 15% (75,000) of these deaths. </p>
<p>Less than half of the children aged 0-14 who have TB are diagnosed – so they never even start treatment.</p>
<h2>What are some of the drivers?</h2>
<p>TB is transmitted between people through the air. When a person with TB coughs or breathes out, some of the TB bugs are expelled to float in the air. If someone else then breathes the bugs in, they cause a new infection. There are several factors that increase the risk of TB transmission. These include actions that increase the number of bugs in the air, such as not wearing a mask and coughing more. And actions that increase exposure, such as spending long periods of time breathing the air in. </p>
<p>A person might breathe the TB bugs in (that is, become infected), but not become ill. This is known as latent TB. Sometimes, though, the TB bugs are able to multiply and escape the body’s immune system. As the number of bugs increases, the person begins to experience symptoms such as coughing, drenching sweats and weight loss. This is then called TB disease. </p>
<p>A variety of factors increase the risk of progressing from TB infection to disease. These are factors that might impede the body’s natural immune functioning, such as undernourishment or smoking. </p>
<p>Children (especially young children) have less developed immune systems. This makes their chance of progressing from infection to disease higher than it is for adults. </p>
<p>Prevention of infection can be done through reducing risks of transmission, for example by opening windows to allow the bugs to blow away. Also, if a person with TB is on treatment, then the number of bugs they expel is dramatically reduced. That’s why it’s important to get an early diagnosis and start treatment.</p>
<p>Where there is an exposure risk, we can also use medicines to reduce the chance of developing disease – this is called TB preventive therapy. The most recent World Health Organization <a href="https://apps.who.int/iris/bitstream/handle/10665/331170/9789240001503-eng.pdf">guidelines</a> suggest that preventive therapy be offered to everyone who has significant exposure risk to an adult or adolescent with TB. For example, think about young children who are sharing a bed with their mother. If she has TB, then the child should be offered preventive therapy, as should other people who share their home. </p>
<p>Unfortunately, in most settings in Africa, implementation of TB preventive therapy is either non-existent or extremely sub-optimal. Historically, the only available TB preventive regimen was a once-daily treatment for six months that is burdensome to administer; new regimens are becoming available. Unfortunately, the limited resources available to TB services have prioritised TB treatment and not prevention. </p>
<h2>Where are the gaps?</h2>
<p>There have been <a href="https://www.nejm.org/doi/10.1056/NEJMoa2104535">substantial</a> <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-017-2377-x">improvements</a> in some areas of <a href="https://www.ingentaconnect.com/content/iuatld/ijtld/2023/00000027/00000003/art00005;jsessionid=2sjtfaionun19.x-ic-live-03">TB therapeutics</a>, with <a href="https://erj.ersjournals.com/content/48/5/1503">shorter</a>, more <a href="https://www.ingentaconnect.com/content/iuatld/ijtld/2023/00000027/00000002/art00006">palatable</a> regimens and more <a href="https://www.ingentaconnect.com/content/iuatld/ijtld/2023/00000027/00000001/art00005">easy-to-use</a> <a href="https://www.ingentaconnect.com/content/iuatld/ijtld/2022/00000026/00000012/art00006">formulations</a>. However, these are not universally available and are still not optimal. Even “shorter” treatment is four months long. Health systems are poorly equipped to support continuity of care when patients (including children and adolescents) move between facilities.</p>
<p>Far too many children who initiate both TB preventive therapy and TB treatment <a href="https://www.jahonline.org/article/S1054-139X(22)00778-9/fulltext">are lost</a> to <a href="https://www.ingentaconnect.com/content/iuatld/pha/2022/00000012/00000004/art00003">follow-up</a>. TB programmes across the world have yet to operationalise the high-minded ideals of “<a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001357">patient-centred care</a>”. The experiences of adolescents and young people (10-24 years old) accessing TB services are often especially <a href="https://www.jahonline.org/article/S1054-139X(22)00778-9/fulltext">problematic</a>. For example, <a href="https://www.mdpi.com/2076-0817/10/12/1591">adolescents report</a> being assumed to have HIV, being shouted at for being sexually active (even if they are not) and being told to access TB services at times when they are in <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000989">school</a>. </p>
<p>There is also limited integration between health services and other sectors (like basic education) to make care easier to get. There remain <a href="https://www.ingentaconnect.com/content/iuatld/ijtld/2017/00000021/a00111s1/art00013">high rates</a> of TB-associated <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1250-8">stigma</a>, and the <a href="https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-018-0777-3">costs of TB care</a> (economic, social and psychological) can be <a href="https://thorax.bmj.com/content/76/4/387">catastrophic and long-lasting</a>. </p>
<h2>How must TB programmes be tailored?</h2>
<p>A fraction of the funding and collective effort that was mobilised for COVID-19 could realistically push towards TB elimination. Perversely, instead, resources redirected towards COVID-19 have <a href="https://www.theglobalfund.org/en/news/2021/2021-09-08-global-fund-results-report-reveals-covid-19-devastating-impact-on-hiv-tb-and-malaria-programs/">set the global TB programme back</a> by a decade’s worth of progress. </p>
<p>TB programmes must be tailored by listening to the preferences and priorities of people affected by TB, by working to address the real-world limitations experienced by frontline health services, and by continuing to develop better, more acceptable therapeutics; especially medicines that are more acceptable for children and easier for caregivers to prepare and administer. </p>
<p>But really all of that can only make a big difference if we all wake up to this leading cause of death, especially among children, and care more.</p><img src="https://counter.theconversation.com/content/202151/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Graeme Hoddinott is a fellow of the African Research Initiative for Scientific Excellence (ARISE) programme. His ARISE research is focused on optimising care for adolescents with tuberculosis. The ARISE programme is implemented by the African Academy of Sciences (AAS) with support from the European Commission and the African Union Commission.</span></em></p>Less than half of the children aged 0-14 who have TB are diagnosed – so they never even start treatment.Graeme Hoddinott, Socio-behavioural Scientist and Senior Researcher, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2009852023-03-20T18:51:40Z2023-03-20T18:51:40ZProtecting children from exploitation means rethinking how we approach online behaviour<figure><img src="https://images.theconversation.com/files/514964/original/file-20230313-1698-qqk3ao.jpg?ixlib=rb-1.1.0&rect=0%2C86%2C5248%2C3406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Perpetrators often utilize the numerous social media, messaging apps, games and forums available online to initiate contact with potential victims.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Raising children in the digital age is increasingly challenging. Many younger people are relying more on screens for social interactions. They experiment with new media sharing options, such as TikTok, Snapchat and BeReal, but without necessarily having the ability to consider long-term consequences. </p>
<p>This is normal, as children still have an <a href="https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/The-Teen-Brain-Behavior-Problem-Solving-and-Decision-Making-095.aspx">underdeveloped prefrontal cortex</a>: the part of the brain that is responsible for reasoning, decision-making and impulse control.</p>
<p>Parents, who are tasked with anticipating the consequences of digital interactions, are overwhelmed. Many parents might lack the digital literacy to guide their children through the numerous social media options, messaging apps and other online platforms available today. </p>
<p>This situation can lead to children falling victim to online sexual exploitation. <a href="https://doi.org/10.17705/1jais.00652">In our research</a>, we collected data from a diverse group of experts in the U.S. and U.K. This included interviews with internet safety non-profits, safeguarding teams, cybercrime police officers, digital forensics staff and directors of intelligence. A main cause behind the <a href="https://2017-2021.state.gov/online-sexual-exploitation-of-children-an-alarming-trend/index.html">rapid escalation</a> of online child sexual exploitation is the ability to share explicit content online. </p>
<p>Our research unveiled four distinct stages used by perpetrators. </p>
<h2>Perpetrators and escalation</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/514769/original/file-20230311-20-9x2k1u.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/514769/original/file-20230311-20-9x2k1u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514769/original/file-20230311-20-9x2k1u.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514769/original/file-20230311-20-9x2k1u.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514769/original/file-20230311-20-9x2k1u.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514769/original/file-20230311-20-9x2k1u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514769/original/file-20230311-20-9x2k1u.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514769/original/file-20230311-20-9x2k1u.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A figure showing how child sexual exploitation takes place online.</span>
<span class="attribution"><span class="source">Author provided</span></span>
</figcaption>
</figure>
<p>In <strong>Stage 1</strong>, perpetrators utilize various technological tools and networks, such as social media, messaging apps, games and online forums, to initiate contact with potential victims. They often create false identities by using fake images to develop convincing digital personas, through which they approach children, such as pretending to be a “new kid on the block” seeking new friends.</p>
<p>In <strong>Stage 2</strong>, perpetrators use tactics like posing as a similar-aged child to build trust with potential victims. This can happen over a considerable period of time. In one case we studied, a 12-year-old in Lee County, N.C., received 1,200 messages from the same perpetrator over 2 years. During this stage, offenders may send their own explicit images to lower a victim’s suspicion, and may target multiple victims until successful.</p>
<p>In <strong>Stage 3</strong>, perpetrators engage in online extortion. <a href="https://www.cbc.ca/news/canada/manitoba/teen-boys-sextortion-scams-data-1.6541791">They use photographs provided by victims or manipulate innocent photos to appear sexual or pornographic</a>. Perpetrators then share these images to their victims to keep them in a state of suspended humiliation. This is further escalated when perpetrators threaten to share these embarrassing images with the victim’s friends, teachers or family unless their victims send more explicit photos or videos.</p>
<p>Many extortion techniques and direct threats are being used at this stage. It is difficult to imagine the psychological pressures this can create for children. In one case described to us, a 12-year-old girl uploaded 660 sexually explicit images of herself to a cloud-based storage account controlled by a 25-year-old perpetrator before seeking help.</p>
<p>In <strong>Stage 4</strong>, perpetrators start trafficking these images on <a href="https://www.computerworld.com/article/2588287/networking-peer-to-peer-network.html">peer-to-peer networks</a>, the dark web and even child pornographic networks.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/3vDe0EVUYMI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A video outlining how child sexual exploitation can take place online.</span></figcaption>
</figure>
<h2>Preventing online exploitation</h2>
<p>There are common mistakes that parents can avoid to help prevent exploitation. By sharing these, it is our hope that parents, policymakers, school boards and even children will rethink their approach to online behaviour.</p>
<p><strong>1. “That won’t happen to us!”</strong>
Many victims and their families fall prey to <a href="https://thedecisionlab.com/biases/optimism-bias">optimism bias</a>, thinking that negative events are unlikely to happen to them. However, online crimes can affect anyone. Unfortunately, these incidents occur more frequently than most people realize. No family is exempt from the potential dangers of the online world.</p>
<p><strong>2. “Everyone else is doing it!”</strong>
Parents oversharing pictures of their children online has become commonplace. Many cannot resist the pressure or temptation to post photos of their children on social media. Very often, it is these photographs that are edited and distorted to appear as pornographic. All family members need to resist the pressure to overshare pictures online.</p>
<p><strong>3. “My kids don’t mind!”</strong>
Many children today have a digital presence that was initiated and maintained by their parents without their consent. This disregard for children’s privacy not only undermines their autonomy, but can also have a <a href="https://www.nytimes.com/2019/09/02/opinion/children-internet-privacy.html">lasting impact on their self-confidence</a>, their personal and professional future, and the parent-child relationship. </p>
<p>Creating a digital life for children at a young age could also desensitize them to the importance of online privacy. The assumption that children will not mind is erroneous. In one case, a court in Rome <a href="https://www.independent.co.uk/news/world/europe/facebook-fines-woman-son-photos-post-social-media-court-italy-rome-a8155361.html">decided that a mother should take down all images of her son from Facebook</a> and pay a €10,000 fine if she continued to post photos without his consent.</p>
<p><strong>4. “We cannot keep up with their technology!”</strong>
Many parents are overwhelmed and intimidated when they cannot keep up with their kids. As technology continues to play a critical role in children’s lives, improving digital literacy of parents through online resources and schools needs to become a priority. Parents need to seek and receive support to understand the technology their children are using.</p>
<p><strong>5. “They’re just online, talking to friends!”</strong>
Despite being very involved and interested in who their children talk to on the way home from school or at their friends’ houses, parents might not be as aware of who their children talk to online. Just like they show an interest in their child’s real-world interactions, the benefits and dangers of online behaviour need to be an equally important and frequent topic of conversation. </p>
<p>Online child sexual exploitation is a grave and multifaceted issue that demands our unwavering attention. Only by carefully considering these critical concerns can we hope to prevent children from falling victim to these crimes.</p><img src="https://counter.theconversation.com/content/200985/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dionysios Demetis has received funding from HEIF. </span></em></p><p class="fine-print"><em><span>Jan Kietzmann does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many children and adolescents fall victim to online exploitation, but there are some steps parents can take to protect their children online.Jan Kietzmann, Professor, Gustavson School of Business, University of VictoriaDionysios Demetis, Senior Lecturer in Management Systems, University of HullLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1986022023-03-13T13:37:17Z2023-03-13T13:37:17ZChild victims of sexual violence aren’t heard or understood: Nigerian study<figure><img src="https://images.theconversation.com/files/510685/original/file-20230216-20-wtgoaz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Child abuse is above the global average in Nigeria. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/december-2022-nigeria-abuja-schoolgirls-sit-in-camp-news-photo/1245730561?phrase=children%20%20nigeria&adppopup=true">Annette Riedl/Getty Images</a></span></figcaption></figure><p>Violence against children is a global problem. A <a href="https://cdn.who.int/media/docs/default-source/documents/child-maltreatment/global-status-report-on-violence-against-children-2020/who-gsrpvac-2020-magnitude-consequences-infographic-en.pdf?sfvrsn=7660e3db_18">2020 Global Status Report</a> revealed that every year, almost one billion children globally encounter some form of violence, such as neglect, physical abuse and sexual abuse.</p>
<p>All forms of violence affect children in different ways, but sexual violence in particular <a href="https://www.tandfonline.com/doi/full/10.1080/01488376.2021.1979710">embodies trauma that lasts for a long time</a>. </p>
<p>It is linked to negative health consequences <a href="https://www.unicef.org/media/89096/file/CSAE-Report-v2.pdf">such as</a> reproductive health issues, impairments in brain functioning, poor immune system and higher risks of sexually transmitted diseases. Beyond the poor physical health outcomes, it also leaves victims with a wide range of psychological problems including <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234201">trauma</a>, <a href="https://www.tandfonline.com/doi/abs/10.1080/10826084.2019.1618337">depression</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960751/">anxiety</a>. </p>
<p>The <a href="https://www.who.int/news-room/fact-sheets/detail/child-maltreatment#:%7E:text=Key%20facts&text=One%20in%205%20women%20and,form%20of%20forced%20sexual%20contact.">World Health Organization reports</a> that one in five women and one in 13 men report having been sexually abused as a child. </p>
<p>The Nigerian government has <a href="https://www.ohchr.org/sites/default/files/Documents/HRBodies/CRC/StudyViolenceChildren/Responses/Nigeria.pdf">policies</a> aimed at addressing the varying forms of violence against children, as well as strategies to provide care, rehabilitation and reintegration of victims. Protection for children is legislated in the <a href="https://www.refworld.org/pdfid/5568201f4.pdf">Child’s Rights Act 2003</a>.</p>
<p>But a <a href="https://www.unicef.org/nigeria/media/6696/file/16%20facts%20document.pdf#page=8">UNICEF report</a> based on 2014 figures says one in four Nigerian girls and one in 10 Nigerian boys have been sexually abused.</p>
<p><a href="https://onlinelibrary.wiley.com/doi/10.1111/cch.12975">Our study</a> explored the subjective experiences of female adolescent survivors of child sexual violence who tried reporting their experiences to adults. We found that they were sometimes discouraged from speaking out, and were even blamed for what had happened to them. Adults should learn to give children safe spaces where they can be heard, understood, believed and supported.</p>
<h2>What we did</h2>
<p>We interviewed 11 female adolescents who had experienced at least one episode of sexual abuse or molestation. Participants for this study were part of a larger study in which participants were randomly selected by trained research assistants during a child sexual violence awareness campaign and asked if they were willing to participate in the study. Those who accepted were told about the nature and purpose of the study. They were also assured of confidentiality and told they were free to withdraw from the study at any point, without any consequences. Consent was equally given by school authorities, and informed consent to participate was obtained from the participants. </p>
<p>The researchers decided to focus on female adolescents aged 15 to 17 who had experienced at least one incident of sexual abuse or molestation and who could communicate in English. The types of abuse included in the study ranged from kissing to fondling genitals and vaginal intercourse. The responses from 11 survivors were included in the present study. Eleven responses are considered adequate as studies exploring lived experiences do not require a large sample. The interviewees were students from different secondary schools in Benue State, north-central Nigeria, who were attending a child sexual violence awareness programme. Consent to undertake the study was obtained from their parents. </p>
<p>The students were informed about the nature and purpose of the study and those who agreed to take part were interviewed in sessions which lasted around six to 13 minutes for each participant.</p>
<p>The interviewees discussed issues around their experiences of sexual abuse and opening up about it. Audio recordings of the interviews were transcribed and analysed. Here we highlight the themes that recurred.</p>
<h2>What we found</h2>
<p>We wanted to understand what happens within the primary environment of the victim and how front line health and social workers as well as parents and others can extend support to victims.</p>
<p>We found that parents, teachers, siblings and other relatives were implicated in decisions not to speak up about abuse. Because of the reactions that some victims received in the process of speaking out, eight of them concluded that it was better to stay silent.</p>
<p>All the participants reported they had begged the abusers to stop, to no avail. Some had cried. One interviewee said she “screamed silently”. </p>
<p>The interviewees said that after the abuse incidents they began to look for people they could talk to, people who would understand them. They reported experiencing trauma in this process, followed by feelings of stigma.</p>
<p>They also reported that they were blamed for the events. They experienced verbal abuse, were called names by parents and in some instances were ignored.</p>
<p>Coupled with the shame they already felt, some had no option but to withdraw and keep to themselves.</p>
<p>These findings agree with previous <a href="https://www.sciencedirect.com/science/article/pii/S0145213420300508">studies</a>. They also go further, to show that children are not listened to by parents and other people significant to them at the time of abuse. Even when adults hear them, the children are not understood; they are rather blamed. </p>
<h2>What we need to do</h2>
<p>While children are the primary victims, the physical and psychosocial health effects of abuse will be felt by families and the community at large. Families, communities and governments should combine their efforts to tackle this problem. </p>
<p>Governments need to enforce policies that criminalise child sexual violence. More importantly, adults who are within the primary environment of abuse (like parents, wardens, teachers and religious leaders) must learn to listen and make meaning from the voices of abused children. Families and all front line health, education and welfare professionals need to be trained to respond to violence against children, listen therapeutically and offer tailored interventions. </p>
<p>Children should be encouraged to speak up, be provided with safe spaces to do so and be assured of protection. Children can also speak out more promptly if they experience, see or hear any abuse situations.</p>
<p>Even though the patterns may be similar, every sexual abuse case is unique. It is only in listening to the individual stories that collective and meaningful progress can be made.</p>
<p>There is very little children can do. However, if they are given safe spaces, they will speak up.</p><img src="https://counter.theconversation.com/content/198602/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Adults don’t always listen to or understand children when they are abused.Steven Kator Iorfa, Doctoral Researcher, University of PortsmouthJames Edem Effiong, Senior Lecturer, University of UyoTanya Johri, PhD Research Scholar, University of DelhiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2002292023-03-09T23:52:16Z2023-03-09T23:52:16ZSuicide attempts rose among children and adolescents during the COVID-19 pandemic, especially for girls<p>Will the kids be alright? There was hope that children and adolescents would “bounce back” as the pandemic progressed, but sadly, the data suggest otherwise. </p>
<p>Twenty-five percent of children and adolescents reported that they have <a href="https://doi.org/10.1001/jamapediatrics.2021.2482">experienced significant depression</a>. The incidence and hospitalization rates for new onset eating disorders <a href="https://doi.org/10.1001/jamanetworkopen.2021.37395">increased by 60</a> per cent during the COVID-19 pandemic.</p>
<p>Precipitants of mental illness have also increased dramatically for children and adolescents in the pandemic. Screen time <a href="https://doi.org/10.1001/jamapediatrics.2022.4116">increased by 50 per cent</a>, physical activity <a href="https://doi.org/10.1001/jamapediatrics.2022.2313">decreased by 20</a> per cent, <a href="https://doi.org/10.3390/children10020279">loneliness increased</a>, family violence <a href="https://doi.org/10.1016/j.eclinm.2022.101634">increased</a>, and parent <a href="https://doi.org/10.1016/S2215-0366(21)00074-2">depression and anxiety doubled</a>. </p>
<p>Many of the experiences and opportunities that help children and teens build identity, friendships, supports and personal growth were also <a href="https://doi.org/10.1001/jamapediatrics.2022.0791">stripped away during the pandemic</a>.</p>
<h2>Child and adolescent suicide attempts</h2>
<p>An unfortunate, but commonly used, indicator of the state of children’s and adolescents’ mental health is suicide attempts. There has been repeated discussion as to whether suicide attempts were within historic trends, or have increased during the pandemic among children and adolescents. </p>
<p>To inform this discussion, our research team conducted a systematic review, published in <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(23)00036-6/fulltext"><em>Lancet Psychiatry</em></a>, of the literature on 11.1 million children’s and adolescents’ emergency department visits in 18 countries.</p>
<figure class="align-center ">
<img alt="A teen girl with green hair talking to a school counsellor" src="https://images.theconversation.com/files/514525/original/file-20230309-729-1am03b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514525/original/file-20230309-729-1am03b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514525/original/file-20230309-729-1am03b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514525/original/file-20230309-729-1am03b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514525/original/file-20230309-729-1am03b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514525/original/file-20230309-729-1am03b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514525/original/file-20230309-729-1am03b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Girls may be more comfortable than boys talking with a health-care professional about their feelings.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In our study, we compared the rate of children’s and adolescents’ emergency department visits for suicide attempts that occurred before the pandemic, to the rate that occurred during the pandemic. In doing so, we provide the most rigorous test to date of whether the number of children and adolescents presenting to the emergency department for suicide attempts has increased, decreased or stayed the same during the pandemic.</p>
<p>We found that the rate of suicide attempts for children and adolescents increased by 22 per cent during the pandemic compared to before the pandemic. Specifically, we found that on average, in any given emergency department setting, there were 102 child and adolescent visits per month for suicide attempts before the pandemic, which increased to 125 during the months of the pandemic.</p>
<p>The pandemic has been difficult for many, and the results of our study highlight just how difficult, and potentially fatal, it has been for children and adolescents.</p>
<h2>Girls attempt suicide more than boys</h2>
<p>When we looked deeper into who was more likely to show increases in suicidal behaviour, we found that the rate of emergency department visits during the pandemic increased by 39 per cent for girls, and by six per cent for boys. </p>
<p>This finding is consistent with previous data on teen suicide, which shows that while girls are more likely to attempt suicide and seek mental health care for their distress, boys are <a href="https://doi.org/10.1001/jamapsychiatry.2020.0596">more likely to die by suicide</a>.</p>
<p>There are several factors that may be contributing to these gender differences. First, girls are more likely than boys to seek <a href="https://doi.org/10.1177/070674371305800504">help when they are distressed</a>, even when that distress is severe and <a href="https://doi.org/10.1177/07067437211058602">potentially life-threatening</a>.</p>
<p>Second, girls are also more likely to have, and sought care for, underlying mental health disorders, such as depression or anxiety, which are more common <a href="https://doi.org/10.1001/jamapsychiatry.2019.3523">among adolescent girls than adolescent boys</a>.</p>
<p>Third, girls may be more comfortable talking with a health-care professional about their feelings. As a society we may also, either intentionally or unintentionally, encourage girls to think and talk about their feelings more than we do for boys. This may lead boys to think or feel that it’s not okay to admit to thoughts of hopelessness, death and suicide, or seek help <a href="https://doi.org/10.1016/j.jadohealth.2017.07.024">when they occur</a>.</p>
<h2>Prevention is key to fostering well-being</h2>
<p>Our research allows us to say more conclusively that the frequent and prolonged exposure to pandemic stressors (such as repeated school closures, social distancing, online learning), combined with limited access to protective supports (for example, extracurriculars, sports, community centres, school counsellors), have likely led to a mental health crisis, the likes of which children and teens have never experienced before. </p>
<figure class="align-center ">
<img alt="A group of boys on a soccer field, talking with their coach" src="https://images.theconversation.com/files/514527/original/file-20230309-24-yxpscj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514527/original/file-20230309-24-yxpscj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514527/original/file-20230309-24-yxpscj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514527/original/file-20230309-24-yxpscj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514527/original/file-20230309-24-yxpscj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514527/original/file-20230309-24-yxpscj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514527/original/file-20230309-24-yxpscj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pandemic stressors like school closures, social distancing and online learning, combined with limited access to protective supports like sports, extracurriculars, community centres and school counsellors, have likely led to a mental health crisis.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This crisis requires immediate attention from governments and policymakers. The needs of children and adolescents must be central in health care decision making.</p>
<p>The mental health crisis can be de-escalated through the creation and implementation of prevention strategies and supports. There is very good evidence that it’s better to create <a href="https://cehd.uchicago.edu/?page_id=237">upstream solutions to prevent mental illness</a>, than costly downstream interventions to mitigate mental illness in individuals once it’s established.</p>
<p>Prevention strategies should be implemented early in development, to help children and adolescents gain greater comfort in identifying and expressing their emotions. Mental health care needs to be accessible, convenient and cost effective, spanning “<a href="http://dx.doi.org/10.1139/facets-2021-0078">promotion, prevention, early intervention and treatment</a>.”</p>
<p>Prevention strategies should be mindful of the gender differences in suicidal behaviour among girls and boys, and tailor their initiatives accordingly. Strategies for girls should focus on bolstering supports in health-care settings since girls are likely to engage in help-seeking. Strategies for boys should focus on reducing stigma related to mental distress to increase boys’ comfort in reaching out, and engaging with, adults that they trust and mental health services.</p>
<p>It is important that countries and governments prioritize the mental health of children and adolescents to help reduce the burden of mental illness and improve overall health and well-being. There is no better investment than in the lives of children and adolescents, as they are the next generation of societal contributors and citizens.</p>
<p><em>Information on suicide prevention <a href="https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/suicide">can be found here</a>. Distress lines in Canada are open 24 hours a day. Kids Help Phone: 1-800-668-6868. <a href="https://talksuicide.ca/">Talk Suicide Canada</a>: 1-833-456-4566 or text 45645. Québec residents: 1-866-277-3553. If you live outside of Canada, please look up a suicide help line in your geographical location.</em></p><img src="https://counter.theconversation.com/content/200229/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sheri Madigan receives funding from the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, the Alberta Children's Hospital Foundation, an anonymous donor, and the Canada Research Chairs program.</span></em></p><p class="fine-print"><em><span>Daphne Korczak receives funding from Canadian Institutes of Health Research, the SickKids Research Institute, and the SickKids Foundation. Dr. Korczak is the Chair of the Mental Health Task Force of the Canadian Pediatric Society.
</span></em></p><p class="fine-print"><em><span>Jackson Hewitt receives funding from the Social Sciences and Humanities Research Council.</span></em></p><p class="fine-print"><em><span>Nicole Racine receives funding from the Social Science and Humanities Research Council, the Canadian Institues of Health Research, the CHEO foundation, and uOttawa Faculty of Social Sciences. She is affiliated with Strong Minds Strong Kids Psychology Canada. </span></em></p><p class="fine-print"><em><span>Tracy Vaillancourt receives funding from Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council of Canada, and the Canada Research Chairs program. Vaillancourt is the chair of the Royal Society of Canada (RSC) COVID-19 Task-Force and was the chair of the RSC Children and Schools working group.</span></em></p>The rate of suicide attempts in children and adolescents increased by 22 per cent during the pandemic compared to before the pandemic.Sheri Madigan, Professor, Canada Research Chair in Determinants of Child Development, Owerko Centre at the Alberta Children’s Hospital Research Institute, University of CalgaryDaphne Korczak, Child and Adolescent Psychiatrist, SickKids' Chair in Child and Youth Medical Psychiatry, Associate Professor, University of TorontoJackson Hewitt, Graduate Student, Clinical Psychology, University of CalgaryNicole Racine, Assistant professor, School of Psychology, L’Université d’Ottawa/University of OttawaTracy Vaillancourt, Tier 1 Canada Research Chair in School-Based Mental Health and Violence Prevention, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1982212023-03-08T20:33:03Z2023-03-08T20:33:03ZSocial media addiction disrupts the sleep, moods and social activities of teens and young adults<figure><img src="https://images.theconversation.com/files/509965/original/file-20230214-28-2onfti.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4909%2C3636&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Social media developers design apps and platforms to create dependencies in users.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>It took a half century for the first American Surgeon General Report to establish the link between <a href="https://www.history.com/this-day-in-history/surgeon-general-announces-link-between-smoking-cigarettes-and-cancer">tobacco and lung cancer</a>. In response, companies infiltrated media and genetically modified tobacco leaves to make them <a href="https://www.fda.gov/tobacco-products/health-effects-tobacco-use/nicotine-why-tobacco-products-are-addictive">even more addictive</a>. </p>
<p>Curiously, tech companies developed similar compelling algorithms to <a href="https://doi.org/10.1038/s41467-018-03126-x">create dependence among users</a> — these technologies <a href="https://doi.org/10.1016/j.copsyc.2021.12.007">appear innocuous</a>, but should be regulated. There are objectionable consequences regarding the influence of algorithms because <a href="https://doi.org/10.1177/2056305119845678">they manipulate users</a> by <a href="https://doi.org/10.1177/2056305120915613">creating false perceptions, dependencies and addiction</a>.</p>
<p>Today’s youth are among the first generations to not have experienced life before the internet. For many, their most important generational memory will be that of security concerns associated with terrorism or <a href="https://doi.org/10.1108/S0742-730120210000039004">the recent pandemic</a>.</p>
<p>Advancements in communications and internet technologies have produced a virtually integrated world; <a href="https://doi.org/10.1016/j.chb.2020.106618">parents, guardians and educators struggle to make sense of how to manage youth online</a>.</p>
<h2>Designed to be addictive</h2>
<p>Research in neuroscience has established <a href="https://doi.org/10.1177/2167696818821803">that adolescence lasts into one’s 20s</a> — and beyond for youth with neurodevelopmental disorders — making universities a prime site for addressing and managing problematic social media use.</p>
<p>Social media are designed to be addictive — <a href="https://doi.org/10.1038/s41467-018-03126-x">driven and reinforced by dopamine</a>. Teens and emerging adults are susceptible to acceptance and rejection through social media, making them particularly responsive to such media and emotionally addicted. </p>
<p>Daily use of social media is associated with a significantly <a href="https://doi.org/10.1016/j.jad.2020.05.106">increased risk of self-harm and depression for adolescents</a>. The <a href="https://doi.org/10.1556/2006.4.2015.010">added sleep cycle disruptions</a> explain part of the <a href="https://doi.org/10.1016/j.sleep.2019.01.029">association with depressive symptoms</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/509966/original/file-20230214-20-9mzjma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a teenaged boy lies in bed in the dark, his face illuminated by his phone screen" src="https://images.theconversation.com/files/509966/original/file-20230214-20-9mzjma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509966/original/file-20230214-20-9mzjma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509966/original/file-20230214-20-9mzjma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509966/original/file-20230214-20-9mzjma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509966/original/file-20230214-20-9mzjma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509966/original/file-20230214-20-9mzjma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509966/original/file-20230214-20-9mzjma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">An addiction to social media can disrupt teenagers’ sleep patterns.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Even moderate screen use is associated with <a href="https://doi.org/10.1016/j.pmedr.2018.10.003">mental health difficulties that require medication</a>. The <a href="https://doi.org/10.3390/ijerph17176035">lockdowns</a> caused by the <a href="https://doi.org/10.1111/pcn.13134">COVID-19 pandemic</a> only <a href="https://doi.org/10.1016/j.psychres.2019.112686">aggravated</a> the <a href="https://doi.org/10.1016/j.dr.2020.100897">situation</a>.</p>
<h2>Finding belonging</h2>
<p>Youth peruse social media to <a href="https://doi.org/10.1038/s41467-018-03126-x">derive a sense of belonging or to avoid challenges</a> in their offline lives. Compared to live interactions, online socialization has been associated with <a href="https://doi.org/10.1016/j.jad.2020.05.106">intolerance to negative emotions and poor concentration</a>. </p>
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Read more:
<a href="https://theconversation.com/want-to-delete-your-social-media-but-cant-bring-yourself-to-do-it-here-are-some-ways-to-take-that-step-176149">Want to delete your social media, but can't bring yourself to do it? Here are some ways to take that step</a>
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<p>As a result, youth experience an inability to manage <a href="https://doi.org/10.3390/ijerph17124566">frustration</a>, fear, <a href="https://doi.org/10.1016/j.pmedr.2018.10.003">sadness</a> and academic difficulties. These risks could lead to problems in education, work and relationships.</p>
<p>One study revealed that young people were <a href="https://doi.org/10.3390/ijerph17124566">motivated to scroll as a coping mechanism or out of habit or boredom</a>. The researchers found that staying off social media for one week led to less FOMO — the fear of missing out on social events.</p>
<p>Another study found that staying off social media for one week led to <a href="https://doi.org/10.1089/cyber.2021.0324">significant reductions in depression and anxiety in 154 young adults</a>. In yet another study, university students were instructed to limit their use for each application to 10 minutes daily, while a control group used social media as usual. The group taking a break reported <a href="https://doi.org/10.1089/cyber.2020.0217">an overall improvement in well-being</a>, achieved mainly through sleep quality.</p>
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<a href="https://images.theconversation.com/files/510159/original/file-20230214-24-85lqr6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a young sad-looking boy pushes a phone away" src="https://images.theconversation.com/files/510159/original/file-20230214-24-85lqr6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510159/original/file-20230214-24-85lqr6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510159/original/file-20230214-24-85lqr6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510159/original/file-20230214-24-85lqr6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510159/original/file-20230214-24-85lqr6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510159/original/file-20230214-24-85lqr6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510159/original/file-20230214-24-85lqr6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Giving up social media is similar to giving up other addictive substances.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Short breaks from being online — even as little as two and a half hours at a time — has a positive effect on perceived life satisfaction. A study of 65 university students used daily journals to track social media use and experienced emotions. The control group used social media as usual, but the group who abstained <a href="https://doi.org/10.1007/s11126-020-09852-0">experienced improved behaviors and feelings during and after abstinence</a>.</p>
<h2>Overcoming addiction</h2>
<p>Weaning someone off social media is similar to giving up a food, drug, gambling or alcohol addiction. Cognitive behavioural approaches — such as keeping a daily journal, reading on paper, listening to music or podcasts, planning social activities, sharing meals with friends and family, physical activity, active transportation, a daily gratitude practice and bundling mundane activities with enjoyable ones — <a href="https://doi.org/10.1007/s11126-020-09852-0">can help support the transition</a>. </p>
<p>Such strategies create tolerance for solitude at times when a user may be tempted to go online. After giving up social media for a week, users experienced less distress, more active behaviour, and a more positive outlook on how to live life more mindfully and efficiently. </p>
<p>There is consensus that social media is deliberately designed to introduce and sustain addiction. The overuse of social media is detrimental to well-being. Therefore, we suggest that universities launch a “challenge” campaign that sensitizes and discourages leisure screen use for a period of 72 hours each semester to foster student organizational, affective, and cognitive growth. This would set the stage for better life-long habits and success.</p><img src="https://counter.theconversation.com/content/198221/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Addiction to social media can affect the emotional well-being of adolescents and young adults. But staying offline — even for only a few hours a day — can help.Linda Pagani, Professor, School of Psychoeducation and researcher at CHU Sainte-Justine, Université de MontréalAmélie Gilker Beauchamp, Étudiante à la maîtrise en psychoéducation, Université de MontréalBeatrice Necsa, Masters student, Psychoeducation, Université de MontréalBenoit Gauthier, Candidat au doctorat en sciences humaines appliquées, Université de MontréalKianoush Harandian, PhD Candidate, School of Psychoeducation, Université de MontréalLaurie-Anne Kosak, Masters student, Psychoeducation, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2000522023-02-23T13:17:13Z2023-02-23T13:17:13ZHow to help teen girls’ mental health struggles – 6 research-based strategies for parents, teachers and friends<figure><img src="https://images.theconversation.com/files/511459/original/file-20230221-22-bwnz8d.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6038%2C4019&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Social media can sometimes damage the self-esteem of teen girls.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/bad-news-over-the-phone-royalty-free-image/614833928?phrase=teenage%2Bgirl%2Bdepressed">stock-eye/iStock via Getty Images Plus</a></span></figcaption></figure><p>It’s a well-established fact that children’s and teens’ mental health <a href="https://doi.org/10.1177%2F20503121221086712">took a hit during the pandemic</a>. But new research suggests that teen girls in particular are suffering in unprecedented ways.</p>
<p>A survey by the Centers for Disease Control and Prevention that was published in early February 2023 found that, in 2021, 57% of high school girls reported experiencing “persistent feelings of <a href="https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf">sadness or hopelessness in the past year</a>,” <a href="https://www.axios.com/2023/02/13/teen-girls-sadness-violence-cdc-report">up from 36% in 2011</a>. That’s nearly twice as high as the 29% of males who reported having those feelings in 2021.</p>
<p>What’s worse, 30% of the girls surveyed reported seriously considering suicide and 13% attempted suicide one or more times in 2021. That is beyond shocking. It’s appalling.</p>
<p>We are a <a href="https://www.marccenter.org">research team</a> that studies children and their <a href="https://www.marccenter.org/research-resources">social and emotional development</a>, and during the pandemic we’ve been specifically focused on mental health in children and adolescents. Since 2020, we’ve seen more changes in girls, overall, including increases in depression and thoughts of suicide. </p>
<p>In our view, a number of key factors have converged to create this mental health crisis in teen girls.</p>
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<figcaption><span class="caption">The stress experienced by teens is unique and significant.</span></figcaption>
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<h2>A perfect storm of factors</h2>
<p>Previous CDC research has shown that the COVID-19 pandemic <a href="https://www.cdc.gov/nssp/partners/Understanding-the-impact.html">disproportionately affected girls</a>. And in a 2021 study that our team conducted with 240 teens, 70% of girls said that they “very much” <a href="https://doi.org/10.3390/pediatric13030064">missed seeing people</a> during the pandemic, compared with only 28% of boys reporting that sentiment. </p>
<p>A second factor is social media, which can be a <a href="https://www.ingentaconnect.com/content/prin/csj/2018/00000052/00000004/art00009">wonderful source of support</a> but also, at times, a crushing blow to the <a href="https://doi.org/10.1016/j.copsyc.2022.101304">self-esteem and psychological well-being of girls</a>. </p>
<p>Finally, we think that all young people are struggling with issues like climate change and social upheaval. These aren’t just abstractions for many boys and girls: They are their future. Children and teens are usually neither <a href="http://www.ourenergypolicy.org/wp-content/uploads/2013/05/American-Teens-Knowledge-of-Climate-Change.pdf">indifferent to nor unaware of political realities</a>. </p>
<p>So how can parents, teachers and friends help girls through this crisis? </p>
<p>Here are six strategies that research shows can work.</p>
<h2>1. More emphasis on social support</h2>
<p>Social and emotional connectivity between humans is likely one of the most potent weapons we have against significant stress and sadness. Studies have found strong links between a <a href="https://doi.org/10.1016/j.childyouth.2018.03.001">lack of parental and peer support</a> and depression during adolescence. Support from friends can also <a href="https://doi.org/10.1007/s10802-013-9844-7">help mitigate the link</a> between extreme adolescent anxiety and suicidal thoughts. In one study of teens, <a href="https://doi.org/10.1006/jado.2000.0353">social support was linked to greater resilience</a> – such as being better able to withstand certain types of social cruelty like bullying. </p>
<h2>2. Supporting one another instead of competing</h2>
<p>During the 1970s and 1980s, competition between women was seen as something that held women back. Unfortunately, this message seems to have been lost in the <a href="https://online.king.edu/news/social-media-and-body-image/">tsunami of media coverage</a> about bodies, looks and social achievement. Research has found that <a href="https://doi.org/10.1016/j.chb.2015.09.011">social media encourages competition between girls</a>, particularly around their physical appearance. </p>
<p>Teaching girls at young ages to be cheerleaders for one another – and modeling that behavior as grownups – can help ease the sense of competition that today’s teens are facing.</p>
<h2>3. Showcasing achievements</h2>
<p>Thinking about your own appearance is natural and understandable. But an overemphasis on what you look like is clearly not healthy, and it is <a href="https://doi.org/10.1111/j.1471-6402.2006.00265.x">strongly associated with depression and anxiety</a>, especially in women. </p>
<p>Adults can play a key role in encouraging girls to value other qualities, such as their artistic abilities or intelligence. Childhood can be a canvas for children to discover where their talents lie, which can be a source <a href="https://doi.org/10.1002/sce.21066">of great satisfaction in life</a>.</p>
<p>One way that adults can help is simply by acknowledging and celebrating those qualities. For instance, at the <a href="https://www.marccenter.org/">Massachusetts Aggression Reduction Center</a>, an organization we direct and manage that is focused on prevention of bullying and cyberbullying, staff members post female achievements – be they intellectual, artistic, scientific, athletic or literary – on social media channels every Friday, using the hashtag #FridaysForFemales. </p>
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<figcaption><span class="caption">This young woman once felt sad, anxious and trapped.</span></figcaption>
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<h2>4. Empowering women</h2>
<p>Girls look to grown women for examples of how they can behave and what they can do. You may not be the chief executive officer of a huge corporation, but maybe you are a wonderful teacher, or maybe you run a small business that provides an important product or service. Modeling pro-women attitudes means valuing <a href="https://globalvolunteers.org/global-role-of-women/">all of the roles</a> that people play in a society.</p>
<p>In addition, teaching the history behind women’s movements and other important steps toward equality, such as the <a href="https://www.archives.gov/milestone-documents/19th-amendment">women’s right to vote</a>, is key to empowering girls to value themselves and their roles. Women played central roles in <a href="https://www.nationalww2museum.org/students-teachers/student-resources/research-starters/women-wwii">war efforts during World War II</a>. Women have led <a href="https://nmaahc.si.edu/sites/default/files/images/black_women_civil_rights_movement_5.pdf">social movements and fought for people’s rights</a>. And women have been <a href="https://www.nobelprize.org/prizes/physics/1903/marie-curie/biographical/">renowned scientists</a>, <a href="https://oxfordsummercourses.com/articles/famous-female-writers-in-history/">writers</a>, <a href="https://www.harpersbazaar.com/culture/art-books-music/g7916/best-female-artists/">artists</a> and experts in virtually every other profession you can name.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and white image of Marie Curie sitting in front of a work table watching as her daughter adjusts an instrument." src="https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=850&fit=crop&dpr=1 600w, https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=850&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=850&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1068&fit=crop&dpr=1 754w, https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1068&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/511780/original/file-20230222-20-xuao0x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1068&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Marie Curie, seated, was a Polish-born physicist and pioneer in radioactivity. Together with her husband she won a Nobel Prize for Physics in 1903. Her daughter, Irene, standing in photo, won a joint Nobel Prize for Chemistry in 1935.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/marie-curie-and-her-daughter-irene-1925-mc-polish-born-news-photo/171191031?phrase=marie%20curie&adppopup=true">Culture Club/Hulton Archive via Getty Images</a></span>
</figcaption>
</figure>
<h2>5. An honest look at social media</h2>
<p>Social media represents a unique form of human interaction that has taken on an outsize role in the lives of teens. This is magnified for teenage girls, for whom every social media interaction may feel <a href="http://doi.org/10.1177/2056305119886025">consequential and potentially cataclysmic</a>.</p>
<p>Interacting in a fun and positive way with peers on social media platforms can be a <a href="https://doi.org/10.15804/tner.2016.46.4.01">positive and affirming experience</a>. On the other hand, seeing the things that others post, and comparing it with your own stuff, can make people of any age feel anxious about how they’re appearing, and whether they’re being socially included or excluded. This anxiety applies to both boys and girls, but the potential for emotional distress <a href="https://doi.org/10.1089/cyber.2019.0079">seems to be higher for girls</a>. </p>
<p>Awareness of how social media has the capacity to <a href="https://doi.org/10.1016/j.bodyim.2017.09.001">influence your feelings and mental health</a> seems to help people keep some distance from their interactions on social media. Adults can help girls by discussing with them how social media influences their feelings, their self-perception and even their body image. </p>
<h2>6. Teaching kids to recognize their feelings</h2>
<p>Learning to recognize and label feelings doesn’t come automatically for many people. The good news, though, is that kids can learn ways to help themselves when they’re experiencing <a href="https://doi.org/10.3390/jcm9103064">anxiety or depression</a>. Kids can learn to appreciate how hugging their dog, playing a board game, or talking with their parent(s) can help reduce anxiety, once they understand the feelings.</p>
<p>We think it’s worth noting that everything discussed here can also be helpful for boys, who are by no means <a href="https://www.apa.org/monitor/2022/01/special-childrens-mental-health">immune to mental health problems</a>. Encouraging achievement recognition, understanding how moods can be influenced by social media, and increasing support for both boys and girls is a positive step as we move toward a post-pandemic world.</p>
<p><em>This article has been updated to correct Marie Curie’s place of birth.</em></p><img src="https://counter.theconversation.com/content/200052/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The mental health of teenagers has grown far worse over the last decade. But a new report shows that, compared with boys, teen girls are disproportionately experiencing sadness and hopelessness.Elizabeth Englander, Professor of Psychology, Bridgewater State UniversityMeghan K. McCoy, Adjunct Faculty in Psychology and Childhood Studies, Bridgewater State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1976762023-02-20T13:20:19Z2023-02-20T13:20:19ZResearch on teen social media use has a racial bias – studies of white kids are widely taken to be universal<figure><img src="https://images.theconversation.com/files/510724/original/file-20230216-26-kwzkku.jpg?ixlib=rb-1.1.0&rect=0%2C23%2C5123%2C3382&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">White teens and teens of color do not have identical online experiences.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/teenagers-laying-on-floor-using-technology-royalty-free-image/543195707">JGI/Jamie Grill/Tetra images via Getty Images</a></span></figcaption></figure><p>Most research on teen social media use has been conducted on <a href="https://doi.org/10.1177/1461444813520477">white teens</a> <a href="https://doi.org/10.1177/0093650208321782">and college students</a>. As a result, it is unclear to what extent overlooked populations such as racial and ethnic minorities, sexual and gender minorities and other vulnerable adolescent populations may be using social media in different ways.</p>
<p>You may have read about research on teen social media use in newspapers or other media outlets, but you might not be aware of the limitations of that research. Rarely do press reports mention the details of the sample populations studied. Instead, they generalize research that <a href="https://pubmed.ncbi.nlm.nih.gov/35665564/">is often based largely on white teens</a> to all youths.</p>
<p>What is missing, then, especially when it comes to teens of color? We are a <a href="https://scholar.google.com/citations?user=ZuHbDP0AAAAJ&hl=en">senior research scientist</a> and <a href="https://scholar.google.com/citations?user=PaaNZUwAAAAJ&hl=en">doctoral student</a> who study the benefits and challenges of <a href="https://www.wcwonline.org/Youth-Media-Wellbeing-Research-Lab/youth-media-wellbeing-research-lab">teen social technology and digital media use</a>. We and our colleague <a href="https://wellesley.academia.edu/RachelHodes">Rachel Hodes</a> recently published a <a href="https://www.cambridge.org/core/books/handbook-of-adolescent-digital-media-use-and-mental-health/marginalized-and-understudied-populations-using-digital-media/11A8E212846491FFEA02A32EAFDC401E">book chapter</a> on how marginalized and understudied populations use social media. </p>
<p>We found that commonly accepted portrayals of teens online distort or obscure the experiences of teens of color. These teens often have different online experiences, face different harms and <a href="https://doi.org/10.1017/9781108976237.011">may be using social media to share and present</a> underrepresented aspects of themselves and their experiences.</p>
<h2>Particular harms</h2>
<p>On the negative side, teens who are members of racial and ethnic minorities face discrimination online, including racial slurs or jokes, negative stereotyping, body shaming and even threats of harm. The <a href="https://doi.org/10.1111/cdev.13350">first study of its kind</a> to investigate the mental health implications of online discrimination for Black and <a href="https://theconversation.com/stop-using-latinx-if-you-really-want-to-be-inclusive-189358">Latino</a> sixth through 12th graders over time found that these groups had increased risk of depression and anxiety. </p>
<p>In our work at the Youth, Media & Wellbeing Research Lab, we demonstrated that Black and Latino fifth through ninth graders <a href="https://www.bc.edu/content/dam/bc1/schools/lsoe/sites/isprc/Diversity%20Challenge/DC%20Presenter%20Program%20as%20of%209_25_20.pdf">adopt social media at a younger age</a> than their white peers, further exposing them to behavioral health difficulties like sleep disruption. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/510727/original/file-20230216-14-bzqyz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="an Asian teenage girl wearing headphones in a dark room types on a laptop keyboard" src="https://images.theconversation.com/files/510727/original/file-20230216-14-bzqyz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510727/original/file-20230216-14-bzqyz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510727/original/file-20230216-14-bzqyz5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510727/original/file-20230216-14-bzqyz5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510727/original/file-20230216-14-bzqyz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510727/original/file-20230216-14-bzqyz5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510727/original/file-20230216-14-bzqyz5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Asian American teens often face racism and bullying online.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/asian-young-woman-playing-online-games-on-laptop-royalty-free-image/1249868515">staticnak1983/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>Despite having the <a href="https://www.pewresearch.org/internet/2001/12/12/asian-americans-and-the-internet/">highest reported access</a> to the internet and social media, Asian American youths still remain underrepresented in studies on digital media and well-being. Asian Americans in later adolescence and early adulthood – 18- to 24-year-olds – are <a href="https://doi.org/10.1037/aap0000109">more likely to be cyberbullied</a> than their white or Latino counterparts. </p>
<p>They are also the least likely to report negative experiences on social media in order to avoid embarrassment and maintain a positive image to the outside world. The global pandemic <a href="https://doi.org/10.3389/fcomm.2020.00039">triggered a rapid resurgence</a> of hate toward and racial profiling of Asian American communities, which has driven an increase in <a href="https://doi.org/10.1037/sah0000275">discrimination against Asian Americans</a>, <a href="https://phys.org/news/2021-03-asian-americans-biggest-incidents-online.html">including online</a>.</p>
<h2>Community and coping</h2>
<p>But there is also a growing body of research on the positive effects on youths of color of <a href="https://doi.org/10.1177/2056305120928488">social media that’s designed to be inclusive</a>. Our lab demonstrated that Black and Latino youths ages 11 to 15 were more likely than white and Asian adolescents to <a href="https://www.bc.edu/content/dam/bc1/schools/lsoe/sites/isprc/Diversity%20Challenge/DC%20Presenter%20Program%20as%20of%209_25_20.pdf">join online groups that made them feel less lonely and isolated</a>. These online communities included group chats on Snapchat, House Party, WhatsApp, Discord, anime fanfiction sites and sports and hobby-related groups. </p>
<p>There were differences between the Black and Latino youths we studied. Black adolescents preferred YouTube video content about relationships or friendships, whereas Latino youths were more likely to seek ways to cope with stress and anxiety. Latino youths were also more likely to use social media to stay in touch with relatives. In general, <a href="https://clalliance.org/wp-content/uploads/2020/06/Social-Media-and-Youth-Wellbeing-Report.pdf">having a sense of belonging on social media</a> has profound effects for young people of color.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/510726/original/file-20230216-24-7c241k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a black teenage boy looks at a smart phone he's holding in both hands" src="https://images.theconversation.com/files/510726/original/file-20230216-24-7c241k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510726/original/file-20230216-24-7c241k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510726/original/file-20230216-24-7c241k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510726/original/file-20230216-24-7c241k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510726/original/file-20230216-24-7c241k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510726/original/file-20230216-24-7c241k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510726/original/file-20230216-24-7c241k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Black teens often seek video content about relationships.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/low-angle-view-of-serious-teenage-boy-using-mobile-royalty-free-image/1136196122">Maskot via Getty Images</a></span>
</figcaption>
</figure>
<p>There is limited research that delves into the opportunities and experiences of Asian American and Indigenous adolescents as they explore racial and ethnic identity, especially during early (ages 10 to 13) and midadolescence (ages 11 to 17), and the role that social media plays in this process. </p>
<p>In a study of older adolescents and young adults (ages 18 to 25), Asian Americans reported using social media to seek social support during difficult times <a href="https://doi.org/10.1037/aap0000109">in more private online channels</a>, which could be a way of avoiding the stigma around mental illness that persists in many Asian cultures. Our current <a href="https://www.thebobaproject.com/">NIH collaboration</a> with Brigham and Women’s Hospital is in the early stages of investigating how Chinese American parents and peers discuss racism and discrimination in online and offline contexts. </p>
<p><a href="https://doi.org/10.1177/2056305120948223">Recent research</a> conducted in response to the rise in racism aimed at Asian Americans has found camaraderie and resistance to discrimination in online spaces. This is similar to what has been seen on <a href="https://doi.org/10.1177/1527476413480247">Black Twitter</a>. While this effect has yet to be documented in adolescents, it is another example of the power of collective racial and ethnic identity in an online community. </p>
<h2>Recognizing differences</h2>
<p>Across all marginalized populations there are untapped opportunities for research and design of social media. Offline risk factors such as bullying, victimization and behavioral problems spill into online spaces, heightening the risk of negative experiences on social media. We believe that researchers and technology developers can avoid amplifying online risks associated with different racial and ethnic identities. </p>
<p>At the same time, we also believe that researchers can focus on positive minority youth development on social media. Being a member of a group that is overlooked or faces discrimination can <a href="https://doi.org/10.1016/j.socscimed.2009.06.022">galvanize people and give them a sense of purpose</a>. They can tackle a mutual goal of community building and authenticity, which, in turn, may promote healthy youth development.</p><img src="https://counter.theconversation.com/content/197676/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Linda Charmaraman receives funding from the National Institutes of Health, Morningstar Family Foundation, and Boston Children's Hospital Digital Wellness Lab. Occasionally, she is a consulting expert with the Jed Foundation and Meta's Wellbeing Creator Collective.</span></em></p><p class="fine-print"><em><span>J. Maya Hernandez, Ph.D. does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Black, Latino, Asian and Indigenous teens have different online experiences – both positive and negative – than their white peers. These differences are overlooked when research focuses on white kids.Linda Charmaraman, Director of Youth, Media & Wellbeing Research Lab, Wellesley CollegeJ. Maya Hernandez, Ph.D., Ph.D. Candidate in Social Ecology, University of California, IrvineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1966342023-01-08T13:26:53Z2023-01-08T13:26:53ZType 2 diabetes in young people puts their eyes at risk<figure><img src="https://images.theconversation.com/files/501160/original/file-20221214-15950-g5r5q3.jpg?ixlib=rb-1.1.0&rect=5%2C7%2C989%2C654&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When it comes to eye care, regular visits to the optometrist or ophthalmologist can detect the early signs of diabetic damage.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Sixteen-year-old Karl is seen for the first time in my optometry practice. He was referred to me for a fluctuating vision problem. During his examination, I saw signs suggesting he may have diabetes, which could have explained the fluctuating vision. This suspicion became a reality when his family doctor confirmed the diagnosis. Karl’s world was turned upside down.</p>
<p>As an optometrist, I invite you to dive into a reality that should concern us all.</p>
<h2>What is diabetes?</h2>
<p>Diabetes is an insidious disease. Its symptoms <a href="https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/symptoms-causes/syc-20355318">(thirst, need to urinate often, fatigue, weight loss, darker skin areas on the neck and underarms)</a> often go unnoticed, at least in the early stages of the disease.</p>
<p>Diabetes affects the lives of <a href="https://data.worldbank.org/indicator/SH.STA.DIAB.ZS?locations=XU">one in 14 people in Canada (7 per cent) and one in 10 in North America (10 per cent)</a>.</p>
<p>Two types of diabetes can be diagnosed:</p>
<ul>
<li><p><a href="https://www.diabete.qc.ca/en/understand-diabetes/all-about-diabetes/types-of-diabetes/type-1-diabetes/">Type 1</a>, which is insulin-dependent and develops when the body cannot produce the insulin needed to metabolize the sugars we ingest and which feed our tissues</p></li>
<li><p><a href="https://www.canada.ca/en/public-health/services/diseases/type-2-diabetes.html">Type 2</a>, which develops when insulin is produced, but in insufficient quantities. Sometimes the insulin that is produced is ineffective in doing its job.</p></li>
</ul>
<p>Type 1 diabetes is usually associated with the development of the disease in childhood and adolescence. Type 2, the most common, usually develops later in life, <a href="https://www.diabete.qc.ca/en/understand-diabetes/all-about-diabetes/types-of-diabetes/">often after age 50</a>.</p>
<h2>A counter-intuitive diagnosis, but not a rare one</h2>
<p>From this definition, it would have been logical to conclude that Karl was affected by Type 1 diabetes, the course and treatment of which are well controlled by physicians. However, in his case, and after the required testing, his doctor identified Type 2 diabetes. This diagnosis is counter-intuitive and poses significant challenges. The speed of onset, the initial severity of the disease and the mechanisms of resistance, or of reduced insulin secretion, may be different in patients who develop the disease at a younger age <a href="https://pubmed.ncbi.nlm.nih.gov/15735201/">than in adults</a>.</p>
<p>In addition, treatment options, involving trial and error, become more complex due to the much longer duration of this type of disease when it starts at a young age. Both major and minor changes <a href="https://pubmed.ncbi.nlm.nih.gov/12090830/">that affect the blood vessels in the Type 2 diabetic patient</a> can have serious consequences that are difficult to predict since the course of treatment can continue for 40 to 60 years.</p>
<p>However, Karl’s situation is not exceptional. <a href="https://www.thelancet.com/pdfs/journals/landia/PIIS2213-8587(17)30186-9.pdf">More and more young people and adolescents</a>, especially those who are <a href="https://pubmed.ncbi.nlm.nih.gov/12241736/">overweight, obese, and sedentary</a>, are affected by Type 2. Almost 75 per cent of them have <a href="https://www.cdc.gov/diabetes/basics/type2.html">parents or siblings with diabetes</a>.</p>
<p>While at first sight, this confirms genetics as a risk factor for developing the disease, in this specific case, it was more a consequence of <a href="https://www.cdc.gov/diabetes/basics/type2.html">poor lifestyle habits, especially dietary habits, and lack of physical activity</a>, which are often shared by the whole family.</p>
<h2>Impact on vision</h2>
<p>The fact that Karl developed Type 2 diabetes earlier, rather than later in life also puts him at a higher risk of developing eye complications. An <a href="https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2786928">article</a> about this topic recently caught my attention. This study looked at the records of 1,362 people with diabetes living in Minnesota, so, in North America and then extrapolate to Canada. The data was compiled between 1970 and 2019, which also allows us to measure the evolution of the situation over the last decades.</p>
<p>The results are astonishing: young people with Type 2 diabetes (compared to Type 1 diabetics of the same age) are 88 times more likely to develop retinopathy (abnormal blood vessels and/or hemorrhages in the retina). In addition, the risk of this retinopathy becoming “proliferative,” and therefore threatening to vision, is increased 230 times. There is also a 49-fold increase in the risk of fluid accumulation in the retina (macular edema) and a 243-fold increase in the risk of developing a mature cataract at a young age. The latter requires surgery which is riskier in young people than in the case of age-related senile cataracts.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="photograph of a fundus" src="https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vascular and metabolic complications of diabetes visible on the fundus (hemorrhages, exudates).</span>
<span class="attribution"><span class="source">(Langis Michaud)</span>, <span class="license">Fourni par l'auteur</span></span>
</figcaption>
</figure>
<p>What should we remember from this? That the major problems, which often require surgical interventions to save vision, occur much more rapidly in young Type 2 diabetics than in those affected by Type 1. These patients must therefore be followed more closely. Indeed, almost one in two Type 2 patients will develop some form of retinopathy within one to eight years of diagnosis. In comparison, one in three Type 1 diabetics will develop retinopathy between six and 10 years following diagnosis.</p>
<h2>Significant repercussions</h2>
<p>Already having increased significantly in the last 10 years, the prevalence (number of cases) of Type 2 diabetes in young people is predicted to <a href="https://pubmed.ncbi.nlm.nih.gov/23173134/">quadruple by 2050</a>. This prediction is most alarming for health professionals, but also for policymakers and managers of public health agencies. The lifetime cost of direct medical care for a single diabetic patient aged 25-44 years was <a href="https://pubmed.ncbi.nlm.nih.gov/23953350/">US$125,000 in 2013</a>. These costs have since increased and many more dollars need to be added to cover the period between 15 and 25 years, which is not taken into account. Indeed, if 20 per cent of the youth population develops diabetes by 2050, millions (perhaps billions?) of health-care dollars will have to be spent on their care by our governments.</p>
<p>The long-term quality of life of people with diabetes is also reduced. <a href="https://pubmed.ncbi.nlm.nih.gov/30345893/">Another study</a>, this time of young people with Type 1 diabetes, shows that their disease has a negative impact on their life. They have to devote a lot of time to their care (missing activities with their friends). And the burden of their disease on their relatives weighs heavily on their shoulders. The fear of hypoglycemia (lack of sugar that can lead to coma) or of developing serious complications of the disease also affects them. Achieving autonomy is more difficult for these adolescents, and their quality of life is proportional to the freedom they can or cannot exercise.</p>
<h2>Eat well, exercise and visit your optometrist</h2>
<p>Type 1 diabetes is difficult to prevent, mainly because we don’t know all the reasons why it occurs and to proactively screen for it. The situation is different for Type 2 diabetes, which is strongly associated with unhealthy lifestyle in young people. Eating a healthy diet, exercising regularly, and combating sedentary lifestyles, including limiting screen leisure time (to less than two hours per day), are good ways to avoid or delay the onset of diabetes in young people. Screen time is also associated with <a href="https://pubmed.ncbi.nlm.nih.gov/28288985/">insulin resistance</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/31270831/">obesity</a> in young people. In other words, healthy lifestyles must be encouraged and especially shared within the family unit.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="young children ride bikes" src="https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Healthy habits are good ways to avoid or delay the onset of diabetes in young people.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>As far as eyes are concerned, regular visits to the optometrist or ophthalmologist can detect early signs of diabetic complications <a href="https://guidelines.diabetes.ca/cpg/chapter30">(signs are seen in up to 30 per cent of patients shortly after diagnosis)</a>. These health professionals can also detect other oculo-visual problems arising from the disease, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518369/">loss of ability to focus up close (accommodation), partial paralysis of certain muscles of the eye resulting in double vision, delayed healing of surface corneal changes, dry eye or glaucoma</a>. Testing should be done <a href="https://guidelines.diabetes.ca/cpg/chapter30">at the time of medical diagnosis of diabetes</a>, or in anyone with a high-risk profile (heredity, obesity, sedentary lifestyle).</p>
<p>Since healthy lifestyle habits are an integral part of the treatment of the disease, it is not too late for Karl to enjoy a happier future. But it is important not to neglect regular follow-ups by his medical doctor and frequent visits to his family optometrist.</p><img src="https://counter.theconversation.com/content/196634/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Langis Michaud ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>The risk of developing eye complications is high in young people with Type 2 diabetes, which is increasingly affecting children and adolescents, especially those who are more sedentary.Langis Michaud, Professeur Titulaire. École d'optométrie. Expertise en santé oculaire et usage des lentilles cornéennes spécialisées, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1929272022-12-01T13:41:18Z2022-12-01T13:41:18ZHow parents can play a key role in the prevention and treatment of teen mental health problems<figure><img src="https://images.theconversation.com/files/494260/original/file-20221108-24-2nnrfi.jpg?ixlib=rb-1.1.0&rect=6%2C12%2C4015%2C2653&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Early detection is key to treating depression in teenagers.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sad-young-girl-royalty-free-image/888960804?phrase=teen%2Bdepression">dragana991/iStock via Getty Images Plus</a></span></figcaption></figure><p>More than 44% of teens reported <a href="https://www.cdc.gov/mmwr/volumes/71/su/su7103a3.htm">persistent feelings of sadness and hopelessness</a> in the first half of 2021, according to a report from the Centers for Disease Control and Prevention. The early 2022 report, which was based on an online survey, also found that nearly 20% had seriously considered suicide, and 9% attempted suicide. </p>
<p>The COVID-19 pandemic is a likely contributor to these startling figures, but rates of teen mental illness have been <a href="https://doi.org/10.1016/j.jadohealth.2019.04.033">rising over the past decade</a>. </p>
<p>One crucial factor that has received little attention in supporting teen mental health is the role that parents can play.</p>
<p>This is surprising, since research has clearly established that <a href="https://doi.org/10.1007%2Fs10567-015-0182-x">participation by a caregiver</a> in their child’s mental health treatment is directly related to a successful outcome. A key reason for this is that parents generally interact with their teen on a daily basis and can model and cultivate coping skills. </p>
<p>Yet, for mental health professionals, it can be challenging to integrate parents into teens’ treatment when there are discrepancies between the perspectives, goals and expectations of teens and parents. In addition,
<a href="https://www.guttmacher.org/gpr/2000/08/minors-and-right-consent-health-care">consent and privacy</a> laws sometimes limit providers’ abilities to disclose key details about a teen’s mental health to parents. </p>
<p>As researchers <a href="https://www.solutionsnetwork.psu.edu/t32-grant/fellows">studying childhood trauma</a> <a href="https://scholar.google.com/citations?user=wcuxj5gAAAAJ&hl=en">and adolescent development</a>, we see parents and caregivers as a critical link in addressing the urgent mental health crisis among teens. </p>
<h2>The teenage years can be brutal</h2>
<p>Parents often <a href="https://www.washingtonpost.com/parenting/2022/10/18/teen-years-dread-parenting/">dread the teenage years</a>, anticipating mood swings, risk-taking behaviors and endless arguments. Some of this is developmentally normal: Teens are developing their identities, testing limits and <a href="https://doi.org/10.1111/cdep.12278">asserting their autonomy</a>. These combined factors can lead to hostility and <a href="https://doi.org/10.1111/cdep.12278">a lower-quality</a> parent-teen relationship. </p>
<p>Physically, <a href="https://theconversation.com/school-start-times-and-screen-time-late-in-the-evening-exacerbate-sleep-deprivation-in-us-teenagers-179178">teens are sleep-deprived</a>, in part due to <a href="https://doi.org/10.1542/peds.2014-1697">overly early</a> <a href="https://www.cdc.gov/sleep/features/schools-start-too-early.html">school start times</a> and hormonal changes associated with puberty. As a result, teens can be irritable and sensitive to stressors. They also haven’t developed the <a href="https://doi.org/10.1177/0963721413480170">self-control to manage their reactions</a>. </p>
<p>And it’s important to note that half of all mental illness emerges <a href="https://www.nami.org/about-mental-illness/mental-health-conditions">by age 14 and 75% by age 24</a>, making adolescence a <a href="https://theconversation.com/anxiety-detection-and-treatment-in-early-childhood-can-lower-risk-for-long-term-mental-health-issues-an-expert-panel-now-recommends-screening-starting-at-age-8-192380">highly sensitive period for the prevention</a> and treatment of mental health problems.</p>
<h2>Signs and symptoms of a mental health concern</h2>
<p>Mental health problems in teens can sometimes take unexpected forms. Depression and anxiety can manifest as irritability and noncompliance, which parents may reasonably view as disrespect and laziness. Understanding what is beneath those behaviors is challenging. Teens are quite secretive, so they may not disclose the extent of their struggles. </p>
<p>Traumatic experiences like <a href="https://www.mcleanhospital.org/essential/mental-health-impact-bullying-kids-and-teens">bullying</a>, <a href="https://www.cdc.gov/violenceprevention/intimatepartnerviolence/teendatingviolence/fastfact.html">dating violence</a> and <a href="https://www.nsvrc.org/sites/default/files/publications/2019-02/Teenagers_508.pdf">sexual harassment and assault</a> are unfortunately too common in adolescence and can cause drastic changes in behavior and affect.</p>
<p>Although anxiety is a normal emotional response at any age, about a third of adolescents <a href="https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder#part_155096">have some type of anxiety disorder</a>, and about 10% experience severe impairment as a result. Teens struggling with chronic anxiety may experience agitation or irritability, issues with sleep, perfectionist tendencies, or may try to avoid stressful things altogether. </p>
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<figcaption><span class="caption">Keeping a journal, exercising regularly and maintaining a sleep routine are three ways for teens to cope with stress.</span></figcaption>
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<p>Among teens, <a href="https://www.nimh.nih.gov/health/statistics/major-depression">17% struggle with depression</a>. Depression generally involves a loss of interest or pleasure in daily activities, but it is more than feeling blue. For teens, symptoms of depression may look like withdrawing from family or social activities, shutting down during conversations or conflict, lethargy, difficulty concentrating, hopelessness about the future or negative feelings of self-worth. </p>
<p>Depression can also be associated with <a href="https://theconversation.com/why-do-teens-engage-in-self-harm-clinical-psychologists-explain-how-to-help-teens-reduce-their-emotional-distress-181419">self-harm</a> and suicide.</p>
<p>In determining whether a teen is experiencing a mental illness, parents should consider how behaviors are affecting their teens’ everyday lives and plans for the future. Those who are falling behind in school, damaging important relationships or engaging in high-risk behaviors may be most likely to be experiencing a mental health issue – as opposed to typical teenage challenges. </p>
<h2>A shortage of mental health care</h2>
<p>Despite the growing need for mental health care, the U.S. has <a href="https://www.aacap.org/AACAP/Press/Press_Releases/2018/Severe_Shortage_of_Child_and_Adolescent_Psychiatrists_Illustrated_in_AAACP_Workforce_maps.aspx">a dire shortage of professionals</a> to meet the demand. Insurance companies create barriers to accessing mental health care by restricting the numbers of <a href="https://www.gao.gov/assets/gao-22-104597.pdf">in-network providers</a> and approved sessions. As a result, many providers prioritize patients who will <a href="https://www.theatlantic.com/health/archive/2016/06/the-struggle-of-seeking-therapy-while-poor/484970/">pay out of pocket</a>. </p>
<p>Parents and teens may wait months for an appointment, and the quality and effectiveness of the services they receive are highly variable. All the while, symptoms may worsen, straining the family and compromising teens’ social and academic opportunities.</p>
<h2>The powerful role parents can play</h2>
<p>This is where parents come in, since they can <a href="https://doi.org/10.1111/j.1467-9507.2007.00389.x">serve as role models</a> for teens’ coping and emotional development. </p>
<p>While good sleep, consistent exercise and quality meals can often be the first line of defense in preventing and managing symptoms of mental health problems, there are several behavioral strategies for parenting struggling teens. Indeed, foster parents care for children with complex histories of trauma, and many of the <a href="https://www.cebc4cw.org/program/together-facing-the-challenge/detailed">behavior management strategies</a> taught to foster parents may be useful for traditional family settings as well. </p>
<p>When teens are unkind or disrespectful, parents may take it personally. But parents who are aware of and able to manage their own triggers can react calmly to challenging behavior, creating opportunities for effective communication with their teen. </p>
<p>Building and maintaining the parent-teen connection, such as by watching a TV show together or other low-pressure opportunities to be together, is key. These experiences <a href="https://doi.org/10.1016/j.pop.2014.05.004">create safe spaces and opportunities for teens</a> to communicate about difficult emotions or situations. Parents who assist teens in recognizing, talking about and dealing with difficult thoughts and feelings help them to understand how their thoughts and feelings can affect their behavior. </p>
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<figcaption><span class="caption">Set up a behavior contract with your teen.</span></figcaption>
</figure>
<p>Parents can also help their teens manage negative emotions by <a href="https://kidshealth.org/en/teens/self-esteem.html">reinforcing their self-esteem</a> and strengths and encouraging self-efficacy. Parents who offer praise to their teens who are working hard to overcome challenges – as opposed to focusing solely on the outcome – can help teens see their worth beyond their accomplishments. </p>
<p>At the same time, teens require boundaries that allow them to build self-reliance, exercise independence and practice compromise in certain situations. Behavior contracts – in which teens and their parents agree to certain conditions in writing – can provide a structured way to establish shared expectations. </p>
<p>When consequences are necessary, natural consequences allow teens <a href="https://sites.duke.edu/tftc/files/2020/06/March-2020-DB-TH-article.pdf">to learn without parental intervention</a>. For example, if a teen stays up late the night before a big softball game, their coach may bench them for playing poorly. Parents can help teens to connect the frustration and disappointment they experience to their choices regarding sleep, which can be more helpful for their future decision-making than getting into an argument with a parent about their decision or receiving a parent-imposed consequence, such as removing phone privileges. </p>
<p>When natural consequences are not an option, discipline should be specific, time-limited and focused on a specific outcome, such as not allowing preferred activities until homework and chores are complete.</p>
<p>It is also important that parents <a href="https://www.psychologytoday.com/us/blog/promoting-empathy-your-teen/201707/how-avoid-power-struggles-your-teen">avoid power struggles</a> with their teens by modeling respectful communication without trying to manage the teen’s reaction or perspective. Teens are unlikely to admit to being wrong – particularly in a heated moment – and if the point is made, there is rarely a benefit to insisting upon a particular reaction such as a forced apology.</p>
<p>Parents can best support their teens by maintaining connection alongside enforcing structure and discipline. While challenging behaviors can be the status quo of adolescence, parents should be on the lookout for signs that might reflect a pervasive mental health issue, since early detection and treatment is crucial.</p><img src="https://counter.theconversation.com/content/192927/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nearly 1 in 5 US teenagers battle depression. But parents can help by communicating openly, creating a behavior contract and finding low-pressure opportunities to interact with their teen.Toria Herd, Postdoctoral Researcher in Psychology, Penn StateSarah A. Font, Associate Professor of Sociology and Public Policy, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1954772022-11-30T09:11:42Z2022-11-30T09:11:42ZEnding HIV as a public health threat – 3 essential reads<figure><img src="https://images.theconversation.com/files/497976/original/file-20221129-24-kfmdkj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>In 2014 the United Nations set an <a href="https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2014/november/20141118_PR_WAD2014report">ambitious goal</a>: to end the AIDS pandemic by the year 2030. </p>
<p>There have been significant advances in HIV treatment and prevention. Access to antiretroviral therapy has saved millions of lives. The UN estimates that since 2010 there’s been a <a href="https://www.unaids.org/en/resources/fact-sheet">52%</a> decrease in AIDS-related deaths. New infections have also fallen drastically.</p>
<p>But we’re far from out of the woods. A recent <a href="https://www.unaids.org/en/resources/documents/2022/in-danger-global-aids-update">report</a> warns that this progress is in danger if current conditions of inequality prevail. Experts across the board have identified inequality as a major challenge to efforts to end AIDS. </p>
<p>Over the years public health experts have written numerous articles for The Conversation Africa about the drivers of this pandemic. We’ve selected three here which highlight the complexity of the problem. </p>
<h2>Addressing inequalities</h2>
<p>UNAIDS executive director Winnie Byanyima <a href="https://theconversation.com/head-of-unaids-unpacks-the-knock-on-effects-of-covid-19-and-what-needs-to-be-done-168909">argues</a> that HIV, like COVID, feeds off inequalities. In an interview with Imraan Valodia, head of the Southern Centre for Inequality Studies at South Africa’s University of the Witwatersrand, Byanyima highlights how women who don’t have access to basic rights such as health and education pay the price in poverty, ill health and sometimes even death. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/head-of-unaids-unpacks-the-knock-on-effects-of-covid-19-and-what-needs-to-be-done-168909">Head of UNAIDS unpacks the knock-on effects of COVID-19. And what needs to be done</a>
</strong>
</em>
</p>
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<h2>The vulnerability of women and girls</h2>
<p>Adolescent girls and young women are particularly vulnerable to HIV infection. It’s estimated that every week 4,900 women between 15 and 24 years old acquire HIV. Women in this age group are twice as likely as their male counterparts to be living with HIV. Unequal gender dynamics often make it difficult for young women to negotiate whether, when, or how they want to have sex. But there is a way for adolescent girls and young women to protect themselves without having to negotiate condom use. Pre-exposure prophylaxis, or PrEP, is a pill containing antiretroviral drugs that can help prevent HIV. Morten Skovdal, associate professor of health psychology, <a href="https://theconversation.com/six-ways-to-improve-hiv-prevention-pill-uptake-among-young-women-in-zimbabwe-184494">asked</a> Zimbabwean healthcare workers for pointers on how to improve access to PrEP for young women.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/six-ways-to-improve-hiv-prevention-pill-uptake-among-young-women-in-zimbabwe-184494">Six ways to improve HIV prevention pill uptake among young women in Zimbabwe</a>
</strong>
</em>
</p>
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<h2>Barriers to treatment</h2>
<p>The risk of HIV infection and the uptake of treatment or prevention measures are influenced by several factors. These include biology, people’s behaviour and their social contexts. Behavioural scientist Hilton Humphries <a href="https://theconversation.com/how-inequality-drives-hiv-in-adolescent-girls-and-young-women-172624">explains</a> how individuals make decisions about whether to use PrEP, in the context of structural inequalities that sustain risk – things that individuals can’t always control.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-inequality-drives-hiv-in-adolescent-girls-and-young-women-172624">How inequality drives HIV in adolescent girls and young women</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/195477/count.gif" alt="The Conversation" width="1" height="1" />
Experts across the board have identified inequality as a major challenge to efforts to end AIDS.Ina Skosana, Health + Medicine Editor (Africa edition)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1921492022-11-16T14:35:47Z2022-11-16T14:35:47ZEducation in Kenya’s informal settlements can work better if parents get involved – here’s how<figure><img src="https://images.theconversation.com/files/494689/original/file-20221110-13-iiqx2x.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Anthony Asael/Art in All of Us via Getty Images</span></span></figcaption></figure><p>Education is a public good. All children should have access to education as a human right, irrespective of their gender, socioeconomic or disability status. </p>
<p>This is reinforced and validated by countries’ commitment to <a href="https://iite.unesco.org/publications/education-2030-incheon-declaration-framework-action-towards-inclusive-equitable-quality-education-lifelong-learning/">Sustainable Development Goal 4</a>. Its promise is inclusive and equitable education, and lifelong learning for all children. </p>
<p>This right is not assured, however. About <a href="https://www.unicef.org/turkiye/en/press-releases/more-104-million-children-and-young-people-1-3-are-out-school-countries-affected-war">303 million</a> children and adolescents aged between five and 17 are out of school. </p>
<p>Research studies have underscored that parental involvement and empowerment make a difference to student education outcomes and well-being. There are <a href="https://www.proquest.com/openview/9e3a9e802f80705150dceec414b8ed1c/1?pq-origsite=gscholar&cbl=41842">five ways</a> in which parents can improve students’ schooling outcomes: </p>
<ul>
<li><p>meeting basic parental obligations</p></li>
<li><p>family involvement in the home</p></li>
<li><p>exchange and collaboration at the community level</p></li>
<li><p>active communication between teachers and parents</p></li>
<li><p>opportunities for parents to offer their services in school as volunteers. </p></li>
</ul>
<p>Over the past nine years, my research through the <a href="https://aphrc.org/wp-content/uploads/2020/01/Advancing-Learning-outcomes-brief.pdf">Advancing Learning Outcomes for Transformational Change</a> (A LOT Change) programme in Kenya has shown that when parents get involved, students’ academic and psychosocial attributes improve.</p>
<p>This study – which ran from 2013 to 2022 in Nairobi – has shown that parents are enablers, motivators and facilitators of their children’s education at all levels of schooling. This runs from the early years, through the provision of <a href="https://gh.bmj.com/content/bmjgh/6/4/e004436.full.pdf">nurturing care</a>, to the completion of the basic education cycle. </p>
<h2>The research</h2>
<p>To establish the impact of parents’ involvement in adolescent lives, the African Population and Health Research Center implemented the A LOT Change programme in Korogocho and Viwandani in Nairobi, Kenya. Korogocho and Viwandani are informal settlements.</p>
<p>The community-based programme was implemented among adolescent girls between 2013 and 2015, and between girls and boys in primary school from 2016 to 2018. A cohort of secondary school students was followed from primary school between 2019 and 2022. </p>
<p>The programme provided after-school support and mentorship in life skills. It also provided school transition subsidies, and exposed parents to guidance and counselling to support their adolescents’ schooling. It further gave girls and boys opportunities to enhance their leadership skills through training and motivational talks. </p>
<p>ALOT Change sought to secure the future of children in urban informal settlements by improving learning outcomes, leadership skills and social behaviour. It also aimed to improve the transition rate for girls and boys aged 12 to 19 to secondary school. </p>
<p>The initiative was informed by the realisation that teachers – and schools in general – cannot do it all. They need the support of parents and communities to effectively nurture the educational aspirations of adolescents. </p>
<h2>Findings on the importance of parents</h2>
<p>A LOT Change initiatives improved parental involvement in children’s education. This included encouraging parents to actively communicate with their children, provide homework support and follow up on academic performance. Parents also got to know who their children associated with, or their whereabouts if the children weren’t home. </p>
<p><strong>Enhanced communication between parents and adolescents:</strong> Parents who participated in the programme noted that establishing <a href="https://aphrc.org/publication/advancing-learning-outcomes-and-leadership-skills-among-children-living-in-informal-settlements-of-nairobi-through-community-participation-2/">open communication channels</a> bridged the generation gap between them and their children. This made them more useful to their children than their parents had been to them. </p>
<p>Evidence from the programme reinforced the effectiveness of two-way communication – parent and child spending enough time together and expressing their opinions. </p>
<p>A father from Viwandani said this of his relationship with his daughter: </p>
<blockquote>
<p>I can say before this project, she was not open, but nowadays she is open and tells me whatever is going on in her life.</p>
</blockquote>
<p><strong>Monitoring progress in school and homework support:</strong> My findings showed that one of the ways in which parents can monitor their children’s progress is by following up on their <a href="https://aphrc.org/publication/advancing-learning-outcomes-and-leadership-skills-among-children-living-in-informal-settlements-of-nairobi-through-community-participation-2/">participation in school</a>. This requires that parents have a good relationship with teachers. As a mother explained: </p>
<blockquote>
<p>You must collaborate with the teacher since sometimes some children go to roam around, and when as parents we are called by the teacher, we refuse to go. So we must work together and become one.</p>
</blockquote>
<p>On the subject of homework support, a father from one of the study sites explained: </p>
<blockquote>
<p>Initially, when the child comes with the book, you as parents are not even bothered to look at it. But when we attend the (ALOT Change) meetings, we are told what is happening so we know where to start or follow up with our children. </p>
</blockquote>
<p><strong>Knowledge of adolescents’ whereabouts:</strong> The need to know the whereabouts of adolescents and the friends they keep is of utmost importance. One mother said:</p>
<blockquote>
<p>The children could easily be pressured into engaging in the many social ills around them … as parents, we contribute because you look at the friends your children walk with … in this community, the friends are the ones who mislead. </p>
</blockquote>
<p>When parents were asked about their obligations to adolescents, they prioritised the provision of basic needs, such as food and shelter. As one mother said:</p>
<blockquote>
<p>It is a parent’s responsibility to make sure that she gets to know the progress of the child, and also it is a parent’s responsibility … to give them food, shelter. </p>
</blockquote>
<p><strong>Championing success at the community level:</strong> Parents also reported that they had teamed up with the larger community to be champions of change. They were passing on lessons learned from ALOT Change to community members who were not part of the programme. </p>
<p>A mother from Korogocho observed that:</p>
<blockquote>
<p>If you see a child doing other things, you just ignore because he is not yours. That does not help us or Kenya. Maybe this child would have been a leader. </p>
</blockquote>
<h2>Way forward</h2>
<p>Parental involvement is a major ingredient in a child’s educational success. Parents are leaders in the home and collaborators with teachers. This means parents need to provide basic necessities, provide a safe environment where a child studies and know the whereabouts of their children when they are not in school. They also need to offer support with school work. </p>
<p>Overall, the success of adolescents in school is an outcome of communication.</p><img src="https://counter.theconversation.com/content/192149/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Benta A. Abuya does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Parents are enablers, motivators and facilitators of their children’s education.Benta A. Abuya, Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1923802022-10-17T12:30:31Z2022-10-17T12:30:31ZAnxiety detection and treatment in early childhood can lower risk for long-term mental health issues – an expert panel now recommends screening starting at age 8<figure><img src="https://images.theconversation.com/files/489609/original/file-20221013-13-iqoxtv.jpg?ixlib=rb-1.1.0&rect=372%2C40%2C6337%2C4406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People who experience anxiety in childhood are more likely to deal with it in adulthood too.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/worried-mom-comforting-depressed-teen-daughter-royalty-free-image/1221847312?phrase=anxiety%20kids&adppopup=true">fizkes/iStock via Getty Images Plus</a></span></figcaption></figure><p><em>The U.S. Preventive Services Task Force, an independent panel of experts in primary care and prevention, issued a final recommendation on Oct. 11, 2022, <a href="https://doi.org/10.1001/jama.2022.16936">published in the journal JAMA</a>, stating that all children and adolescents between the ages of 8 and 18 should be screened for anxiety, regardless of whether they have symptoms. The recommendation follows a systematic review that evaluated the potential harms and benefits of screening.</em> </p>
<p><em>The Conversation asked Elana Bernstein, a school psychologist who researches child and adolescent anxiety, to explain the task force’s recommendations and what they might mean for kids, parents and providers.</em></p>
<h2>1. Why is the task force recommending young kids be screened?</h2>
<p>Nearly 80% of chronic mental health conditions <a href="https://doi.org/10.1097/YCO.0b013e32816ebc8c">emerge in childhood</a>, and when help is eventually sought, it is often years after the problem’s onset. In general, recommendations to screen for mental health disorders are based on research demonstrating that youths do not typically seek help independently, and <a href="https://doi.org/10.1097/CHI.0b013e318160e3a0">that parents</a> and <a href="https://doi.org/10.1007/s12310-014-9125-9">teachers</a> are not always skilled at correctly identifying problems or knowing how to respond.</p>
<p>Anxiety is the <a href="https://dx.doi.org/10.1176%2Fappi.focus.20150029">most common</a> mental health problem affecting children and adolescents. Epidemiological studies indicate that <a href="https://doi.org/10.1016/j.jpeds.2018.09.021">7.1% of children are diagnosed with anxiety disorders</a>. However, studies also estimate that upwards of 10% to 21% of children and adolescents struggle with an anxiety disorder and as many as <a href="https://childmind.org/wp-content/uploads/2021/09/CMI_2018CMHR.pdf">30% of children</a> experience moderate anxiety that interferes with their daily functioning at some time in their life.</p>
<p>This tells us that many kids experience anxiety at a level that interferes with their daily functioning, even if they are never formally diagnosed. Additionally, there is a <a href="https://doi.org/10.1080/15374416.2015.1046177">well-established evidence base</a> for treating childhood anxiety. </p>
<p>The task force evaluated the best available research and concluded that, while there are gaps in the evidence base, the benefits of screening are clear. Untreated anxiety disorders in children <a href="https://doi.org/10.1007/s10802-007-9194-4">result in added burdens</a> to the public health system. So from a cost-benefit perspective, the cost-effectiveness of screening for anxiety and providing preventive treatment is favorable, while, as the task force pointed out, the harms are negligible. </p>
<p>The task force recommendation to screen kids as young as age 8 is driven by the research literature. Anxiety disorders are most likely to first show up during the elementary school years. And the typical age of onset for <a href="https://doi.org/10.1016/j.jaac.2010.05.017">anxiety is among the earliest</a> of all childhood mental health diagnoses. The panel also pointed to a lack of accurate screening instruments available to detect anxiety among younger children; as a result, it concluded that there is not sufficient evidence to recommend screening children age 7 or younger. </p>
<p>Anxiety disorders can persist into adulthood, particularly those disorders with early onsets and those that are left untreated. Individuals who experience anxiety in childhood are more likely to deal with it in adulthood, too, along with other mental health disorders <a href="https://doi.org/10.1111/j.1469-7610.2007.01812.x">like depression</a> and an overall diminished quality of life. The task force considered these long-term impacts in making its recommendations, noting that screening in children as young as 8 may alleviate a preventable burden for families.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/dT_W9LFJxx0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The US task force’s recommendations include screening for all children beginning at age 8, regardless of whether they show symptoms of anxiety.</span></figcaption>
</figure>
<h2>2. How can care providers identify anxiety in young kids?</h2>
<p>In general, it is easier to accurately identify anxiety when the child’s symptoms are behavioral in nature, such as refusing to go to school or avoiding social situations. While the task force recommended that screening take place in primary care settings – such as a pediatrician’s office – the research literature also supports <a href="https://doi.org/10.1177/10598405211056647">in-school screening for mental health problems</a>, including anxiety. </p>
<p>Fortunately, in the past three decades, considerable advances have been made in mental health screening tools, including for anxiety. The evidence-based strategies for identifying anxiety in children and adolescents are centered on collecting observations from multiple perspectives, including the child, parent and teacher, to provide a complete picture of the child’s functioning in school, at home and in the community. </p>
<p>Anxiety is what’s called an internalizing trait, meaning that the symptoms may not be observable to those around the person. This makes accurate identification more challenging, though certainly possible. Therefore, psychologists recommend including the child in the screening process to the degree possible based on age and development.</p>
<p>Among the youths who are actually treated for mental health problems, nearly two-thirds <a href="https://www.nasponline.org/resources-and-publications/resources-and-podcasts/mental-health/school-psychology-and-mental-health/comprehensive-school-based-mental-and-behavioral-health-services-and-school-psychologists">receive those services at school</a>, making school-based screening a logical practice. </p>
<h2>3. How would the screening be carried out?</h2>
<p>Universal screening for all children, including those with no symptoms or diagnoses, is a preventive approach to identifying youths who are at risk. This includes those who may need further diagnostic evaluation or those would benefit from early intervention. </p>
<p>In both cases, the aim is to reduce symptoms and to prevent lifelong chronic mental health problems. But it is important to note that a screening does not equate to a diagnosis, something that the task force highlighted in its recommendation statement. </p>
<p>Diagnostic assessment is more in-depth and costs more, while screening is intended to be brief, efficient and cost-effective. Screening for anxiety in a primary-care setting may involve completion of short questionnaires by the child and/or parent, similar to how <a href="https://doi.org/10.1542/peds.2011-2654">pediatricians frequently screen kids</a> for <a href="https://theconversation.com/what-causes-adhd-and-can-it-be-cured-170179">attention-deficit/hyperactivity disorder, or ADHD</a>. </p>
<p>The task force did not recommend a single method or tool, nor a particular time interval, for screening. Instead, care providers were advised to consider the evidence in the task force’s recommendation and apply it to the particular child or situation. The task force did point to multiple available screening tools such as the <a href="https://www.pediatricbipolar.pitt.edu/resources/instruments">Screen for Child Anxiety Related Emotional Disorders</a> and the <a href="https://www.phqscreeners.com/select-screener">Patient Health Questionnaire Screeners</a> for generalized anxiety disorder, which accurately identify anxiety. These assess general emotional and behavioral health, including questions specific to anxiety. Both are available at no cost. </p>
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<figcaption><span class="caption">A discussion of the differences between normal worry and anxiety.</span></figcaption>
</figure>
<h2>4. What are care providers looking for when screening for anxiety?</h2>
<p>A child’s symptoms can vary depending on the type of anxiety they have. For instance, social anxiety disorder involves fear and anxiety in social situations, while specific phobias involve fear of a particular stimulus, such as vomiting or thunderstorms. However, many anxiety disorders share symptoms, and children typically do not fit neatly into one category. </p>
<p>But psychologists typically observe some common patterns when it comes to anxiety. These include negative self-talk such as “I’m going to fail my math test” or “Everyone will laugh at me,” and emotion regulation difficulties, like increased tantrums, anger or sensitivity to criticism. Other typical patterns include behavioral avoidance, such as reluctance or refusal to participate in activities or interact with others.</p>
<p>Anxiety can also show up as physical symptoms that lack a root physiological cause. For example, a child may complain of stomachaches or headaches or general malaise. In fact, studies suggest that spotting youths with anxiety in pediatric settings may simply occur through <a href="https://doi.org/10.1016/j.cbpra.2007.08.003">identification of children with medically unexplained physical symptoms</a>.</p>
<p>The distinction we are aiming for in screening is identifying the magnitude of symptoms and their impact. In other words, how much do the symptoms interfere with the child’s daily functioning? Some anxiety is normal and, in fact, necessary and helpful. </p>
<h2>5. What are the recommendations for supporting kids with anxiety?</h2>
<p>The key to an effective screening process is that it be connected to evidence-based care. </p>
<p>The good news is that we now have decades of high-quality research demonstrating how to effectively intervene to reduce symptoms and to help anxious youth cope and function better. These include both medications or therapeutic approaches like cognitive behavioral therapy, which <a href="https://doi.org/10.1016/j.jaac.2020.05.005">studies show to be safe and effective</a>.</p>
<p><em>This is an updated version of an <a href="https://theconversation.com/why-a-us-task-force-is-recommending-anxiety-screening-in-kids-8-and-older-181562">article originally published on May 13, 2022</a>.</em></p><img src="https://counter.theconversation.com/content/192380/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elana Bernstein has received funding from her organization to examine school-based practices for youth with anxiety. She is currently working collaboratively on a federally funded (HRSA) grant aimed at improving behavioral health workforce education and training. Additionally, as part of a national research team focused on improving mental health screening practices, she is collaborating to develop a screening tool for emotional well-being in teens. This project was recently funded through the Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut via their Mechanisms Underlying Mind-Body Interventions & Measurement of Emotional Well-Being (M3EWB) Network, which is funded through the NIH (Grant #: NIH U24AT011281).</span></em></p>Anxiety is the most common mental health issue facing children and adolescents. But research shows that early screening – including in school settings – can identify children who are at risk.Elana Bernstein, Assistant Professor of School Psychology, University of DaytonLicensed as Creative Commons – attribution, no derivatives.