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While emerging evidence is highlighting a growing problem of food insecurity among adolescents in disadvantaged neighborhoods, very little is known about the factors that may either protect or place adolescents at higher risk for food insecurity. The primary objective for this analysis, therefore, was to examine the associations between individual-, family-, and neighborhood-level risks and protective factors and food insecurity among 452 adolescents in Baltimore, Maryland. Results show that nearly 30% of our sample were food insecure (29.4%). Food insecure youth were more likely to be unstably housed (OR 5.17, 1.24–21.62), live in larger households (OR 1.14, 1.08–1.20), and perceive their neighborhoods unsafe (OR 2.37, 1.47–3.83). Protective factors included perceiving both male and female adult support (OR 0.55 and 0.47, respectively), having a higher sense of community belonging (OR 0.91, 0.32–0.95) and having positive perceptions of their neighborhood’s physical environment (OR 0.93, 0.88–0.98). These results suggest that strengthening family and neighborhood relations and resources may promote the health of adolescents in disadvantaged urban areas.

The main objective of this paper is to understand the role of the family on the sexual experiences of adolescents from urban, disadvantaged settings in Baltimore and Johannesburg. Data were collected as part of the WAVE study, a global study of disadvantaged youth in five cities. Qualitative data were based on key informant interviews, a Photovoice exercise, community mapping, focus groups and in-depth interviews with adolescents. Quantitative data were gathered from an ACASI survey that was administered to approximately 450-500 adolescents per site. Results from the qualitative data revealed that while parents were viewed as important sources of information for sexual and reproductive health, they were often not present in the adolescents' lives. This lack of parental presence was perceived to result in adolescents feeling an overall lack of adult support and guidance. The impact of parental presence and support on adolescent sexual experience was further examined from the quantitative data and revealed a complex picture. In both Baltimore and Johannesburg, female adolescents who were raised by other relatives were less likely to report having had sex compared to those raised by two biological parents, which was not observed for males. In Johannesburg, female adolescents who were paternal orphans were less likely to have had sex compared to non-orphans; the opposite was true among males. Finally, in both sites, female adolescents who had been exposed to violence were more likely to have had sex compared to those who had not; for males, there was no significant relationship. The study demonstrates the powerful influence of both context and gender for understanding the influences of the family on adolescent sexual behaviors. Programs aiming to reduce adolescent sexual risk behaviors the need to understand the complex influences on risk behaviors in different settings and in particular, the role of mothers and fathers. Prevention strategies need to also understand and incorporate gender-specific messages and interventions in order to address the high risk of sexual behaviors among adolescents in these settings.

Approximately 1 in 9 teenagers and young adults aged 16-24 in the United States is currently disconnected from school and employment. These disconnected young people (ie, opportunity youth) are not only at high risk for long-term emotional, behavioral, and health problems, but they also represent a loss of human capital, with high social and economic costs. In this article, we offer a public health perspective on opportunity youth by describing their distribution in the population and consequences of their disconnection; proposing a conceptual model of the issue based on epidemiological principles, life course development concepts, and ecological theory; and recommending multisector strategies for preventing disconnection of young people and reengaging opportunity youth. A public health approach to the problem of opportunity youth would involve developing and investing in youth monitoring data systems that can be coordinated acrossmultiple sectors, consolidating both the delivery and funding of services for opportunity youth, developing policies and programs that encourage engagement of young people, and fostering systematic approaches to the testing and scaling up of preventive and reengagement interventions.

Background For adolescents growing up in poor urban South African settings, violence is often a part of daily life and has lasting effects on physical and mental health outcomes in adulthood. We conducted a qualitative study to document and understand the forms of interpersonal violence experienced by adolescents living in Hillbrow, Johannesburg. In this article, we explore how violence is experienced differently by adolescent boys and girls, how they conceptualise ‘dangerous’ and ‘safe’ spaces in their neighbourhood and what gaps exist in available services for youth in Hillbrow. Methods The article draws on data collected in the formative phase of the ‘Wellbeing of Adolescents in Vulnerable Environments’ (WAVE) Study of challenges faced by adolescents (15–19 years) growing up in impoverished parts of five cities. This article reports on analysis using only data from the Johannesburg site. Using both purposive and snowball sampling to select participants, we conducted in-depth interviews ( n  = 20) and community mapping exercises with female ( n  = 19) and male ( n  = 20) adolescents living in Hillbrow, as well as key informant interviews with representatives of residential shelters, CBOs, and NGOs working with youth ( n  = 17). Transcripts were coded manually and analysed using an inductive thematic analysis approach. Results Both girls and boys reported high exposure to witnessing violence and crime. For girls, the threat of sexual harassment and violence was pervasive, while boys feared local gangs, the threat of physical violence, and being drawn into substance-abuse. Home was largely a safe haven for boys, whereas for girls it was often a space of sexual violence, abuse and neglect. Some adolescents developed coping mechanisms, such as actively seeking out community theatres, churches and other places of sanctuary from violence. Community-based services and shelters that support adolescents reported a lack of resources, overall instability and difficulties networking effectively. Conclusions Adolescents in Hillbrow commonly witnessed and had direct experience of many forms of violence in their environment, and these experiences differed markedly by gender. Interventions that build young peoples’ social capital and resilience are essential for reducing violence-related trauma and long-term health and social consequences for adolescents in this community.

Adolescent dating violence is increasingly recognized as a public health problem. Our qualitative investigation sought input from urban, African-American adolescents at risk for dating violence concerning (Tjaden and Thoennes in Full report of the prevelance, incidence, and consequences of violence against women: findings from the national violence against women survey. US Department of Justice, Washington, DC, 2000) dating violence descriptions, (WHO multi-country study on women’s health and domestic violence against women: Summary report of initial results on prevalence, health outcomes and women’s responses. World Health Organization, Geneva, 2005) preferences for help-seeking for dating violence, and (Intimate partner violence in the United States. Bureau of Justice Statistics, US Department of Justice, Office of Justice Programs, Washington, DC, 2007) recommendations for a teen dating violence resource center. Four focus groups were conducted with urban, African American adolescents ( n  = 32) aged 13–24 recruited from an urban adolescent clinic’s community outreach partners. Qualitative analysis was conducted. Participants assigned a wide range of meanings for the term “relationship drama”, and used dating violence using language not typically heard among adults, e.g., “disrespect”. Participants described preferences for turning to family or friends before seeking formal services for dating violence, but reported barriers to their ability to rely on these informal sources. When asked to consider formal services, they described their preferred resource center as confidential and safe, with empathetic, non-judgmental staff. Teens also gave insight into preferred ways to outreach and publicize dating violence resources. Findings inform recommendations for youth-specific tailoring of violence screening and intervention efforts. Current evidence that slang terms, i.e., “drama”, lack specificity suggests that they should not be integrated within screening protocols. These data highlight the value of formative research in understanding terminology and help-seeking priorities so as to develop and refine dating violence prevention and intervention efforts for those most affected.

Background Women who use heroin and other drugs (WWUD) are a key population with elevated risk of physical and sexual violence perpetrated by intimate partners and non-partners. While housing instability has been shown to be associated with violence in high-income settings, this is an underexplored topic in sub-Saharan Africa. In this research, we aimed to assess the relationship between housing instability and various forms of violence within a sample of WWUD in Dar es Salaam. Methods This analysis uses data from a parent study from 2018. A total of 200 WWUD were recruited through respondent-driven sampling methods and administered a survey. Two multivariable logistic regression models were built to assess the relationship between housing instability and physical violence (Model 1) and housing instability and sexual violence (Model 2) while controlling for a number of sociodemographic characteristics. Results Approximately 35% of participants were classified as housing unstable. More than half of participants (62%) reported experiencing physical violence in the past 12 months, and more than a third (36%) reported sexual violence in the same time period. Housing instability was found to be independently associated with both physical and sexual violence victimization in the past year when adjusting for covariates (Model 1 adjusted odds ratio [AOR]: 2.40, 95% CI 1.22–4.46; Model 2 AOR: 1.93. 95% CI 1.02–3.67). Conclusion To our knowledge, this is the first study to document a significant association between housing instability and violence among WWUD communities in sub-Saharan Africa. This analysis adds to the growing body of literature on the relationship between stable housing and livelihood and health outcomes across differing populations. The cyclical nature of housing instability and violence may be disrupted through housing programming that provides safety, security, and stability for WWUD.

Background While adolescents’ access and utilization of health services is critical for ensuring their health, very few seek care, and if they do, it is primarily from family members, friends, or other non-formal sources of care. Examining the influence of the social context on adolescent health care seeking behaviors may provide us with a better understanding for how interventions can increase adolescents’ utilization of formal health care services. Methods The study is based on qualitative and quantitative data collected as part of the Well Being of Adolescents in Vulnerable Environments (WAVE) study, one of the first global studies to focus on very disadvantaged urban adolescents (aged 15–19 years) across five diverse sites, which include: Baltimore (USA), Ibadan (Nigeria), Johannesburg (South Africa), New Delhi (India), and Shanghai (China). Qualitative data was based on numerous methodologies, including key informant interviews, a Photovoice exercise, community mapping, focus groups and in-depth interviews. Quantitative data was gathered from a cross-sectional Audio Computer Assisted Self Interview (ACASI) survey that was administered to approximately 450–500 adolescents per site, yielding a total of 2,393 adolescents. Respondent-driven sampling was used to ensure the sample include out-of-school youth and unstably housed youth who are often underrepresented in school-based or household-based samples. Results While adolescents in Baltimore, New Delhi, and Johannesburg were more likely to seek health services if they felt illness symptoms, a fairly large proportion of adolescents indicated that even when they needed health care, they didn’t seek it. In Johannesburg, more than 30 % of adolescents did not seek care even when they knew it was needed. Similarly, nearly a quarter of adolescents in Baltimore and in Shanghai indicated not seeking care when needed. Qualitative data indicated that adolescents exhibited a general lack of trust in providers and often felt embarrassed or stigmatized for seeking services. Multivariate analysis revealed that perceived fear and exposure to community violence was associated with a decreased likelihood of seeking care, while adult support from the home increased adolescents’ likelihood to seek care in Baltimore and Johannesburg. Conclusions Adolescent health care seeking patterns vary substantially by setting and gender. Neighborhood and family environments are important contexts in which health seeking behaviors are shaped. Efforts to connect adolescents to health care will need to target neighborhood safety as well as trust and support among adults outside of provider settings.

A deeper understanding of how structure and environment shape the sexual and reproductive health vulnerabilities of youths across a range of outcomes has implications for the development of successful policies and programs. We have discussed some of the key structural and environmental factors that influence the sexual and reproductive health of adolescents, particularly in low- and middle-income countries, and the importance of engaging adolescents in identifying solutions. We have highlighted 2 case studies that describe structural or environmental approaches to improving adolescent sexual and reproductive health and made recommendations to more systematically incorporate attention to structure and environment to improve global adolescent health.

CONTEXT: There is little research on STIs among young people in Nigeria. It is important to determine gender differences in health-seeking behaviors among youth with self-reported STI symptoms. METHODS: Data from 538 males and females aged 15–24 with at least one STI symptom were drawn from the 2003 and 2005 National HIV/AIDS and Reproductive Health Surveys. Bivariate and multivariate analyses were conducted to determine gender differences among those who had sought treatment for their STI symptoms, and the factors related to seeking treatment from formal health care sources versus informal sources. RESULTS: A greater proportion of males than of females had sought treatment for their STIs (64% vs. 48%). Among those who had sought treatment, 60% of females had gone to formal sources, most commonly a government clinic; 54% of males had sought care from informal sources, most commonly a traditional healer. Females had lower odds than males of having sought STI treatment (odds ratio, 0.6). Among both males and females, economic status was positively associated with seeking treatment from a formal source rather than an informal source (2.4–4.2); among females, 22–24-year-olds were more likely than those aged 15–18 to have sought treatment from a formal source (2.5). CONCLUSION: Programs and policies that aim to increase treatment of STIs among young people in Nigeria need to target males and females differently. Contexto: Hay poca investigación sobre las ITS entre las personas jóvenes en Nigeria. Es importante determinar las diferenceias de género en los comportamientos de búsqueda de atención a la salud entre los jóvenes que reportan síntomas de ITS. Méthodos: Datos de 538 hombres y mujeres de 15–24 años de edad, con al menos un síntoma de ITS, se obtuvieron de las Encuestas Nacionales de VIH/SIDA y Salud Reproductiva (conocido por sus siglas en inglés, NARHS) de 2003 y 2005. Mediante análisis bivariado y multivariado, se determinó las diferencias de género entre los que habían buscado tratamiento para sus síntomas de ITS; y los factores relacionados con la búsqueda de tratamiento en fuentes de servicios de salud formales versus fuentes informales. Resultados: Se encontró que una mayor proporción de hombres que de mujeres había buscado tratamiento para sus ITS (64% vs. 48%). Sin embargo, entre las y los jóvenes que habían buscado tratamiento, una mayor proporción de mujeres que de hombres acudió a fuentes formales (60% vs. 46%); las fuentes más comúnmente usados eran las clínicas del gobierno entre las mujeres, y los curanderos entres los varones. Las mujeres tuvieron menor probabilidad que los hombres de haber buscado tratamiento para ITS (razón de momios, 0.6). Tanto entre los hombres como entre las mujeres, la condición económica se asoció positivamente con la búsqueda de tratamiento de una fuente formal de servicios, en vez de una informal (2.4–4.2); entre las mujeres, las de 22–24 años tuvieron mayor probabilidad que las de 15–18 años de haber buscado tratamiento de una fuente formal (2.5). Conclusión: Los programas y políticas que buscan aumentar el tratamiento de las ITS en la gente joven de Nigeria, necesitan dirigir acciones a hombres y mujeres de manera diferenciada. Contexte: La recherche sur les IST parmi les jeunes du Nigéria n'est guère développée. Il importe de déterminer les différences de genre dans les comportements de recherche de soins parmi les jeunes présentant des symptômes d'IST autodéclarés. Méthodes: Les données relatives à 538 hommes et femmes de 15 à 24 ans présentant au moins un symptôme d'IST ont été extraites des enquêtes nationales sur le VIH/sida et la santé génésique (NARHS) de 2003 et 2005. Des analyses bivariées et multivariées ont été menées pour déterminer les différences de genre parmi les jeunes qui avaient cherché à faire soigner leurs symptômes d'IST et les facteurs relatifs à la recherche d'un traitement auprès de sources de soins de santé formelles ou informelles. Résultats: Les hommes avaient cherché en plus grande proportion à faire traiter leur IST (64% vs 48% des femmes). Parmi les jeunes qui s'étaient fait soigner, 60% des femmes s'étaient adressées à des sources formelles, le plus généralement une clinique publique, et 54% des hommes avaient consulté des sources informelles, le plus souvent un guérisseur traditionnel. Les femmes présentent une plus faible probabilité de recherche de traitement d'IST (rapport de probabilités, 0,6). Pour les hommes comme pour les femmes, le rang économique est associé positivement à la recherche de soins auprés d'une source formelle plutôt qu'informelle (2,4–4,2); parmi les femmes, celles de 22 à 24 ans se réválent plus susceptibles que celles de 15 à 18 ans de s'être adressées à une source formelle (2,5). Conclusion: Les programmes et politiques visant à accroître le traitement des IST parmi les jeunes du Nigéria doivent cibler différemment les hommes et les femmes.