The Journal of adolescent health : official publication of the Society for Adolescent Medicine最新文献

{"title":"Why are They Leaving?… Factors Associated With Attrition After Testing Among Young South Africans Recently Diagnosed With HIV: An Observational Study.","authors":"Ingrid T Katz, Tiffany Lemon, Elzette Rousseau, Siyaxolisa Sindelo, Robin Julies, Nomakaziwe Siko, Andrew Boulle, Yeonsoo S Lee, Amanda Fata, Maria Nardell, Lisa M Butler, Valerie A Earnshaw, Ingrid V Bassett, Claude A Mellins, Laura Smeaton, Linda-Gail Bekker","doi":"10.1016/j.jadohealth.2025.04.027","DOIUrl":"https://doi.org/10.1016/j.jadohealth.2025.04.027","url":null,"abstract":"<p><strong>Purpose: </strong>Young people in South Africa face unique challenges in initiating HIV treatment. There has been limited research on sociobehavioral factors influencing attrition from care among recently diagnosed adolescents and young adults (AYA).</p><p><strong>Methods: </strong>We enrolled 100 AYA who recently tested positive for HIV between April 2018 and October 2019 at two community testing sites in Cape Town. We administered a sociobehavioral survey within 2 weeks of diagnosis and 6 months of follow-up and used electronic health records to confirm linkage to care, antiretroviral therapy (ART) initiation, and viral load suppression within 1 year of diagnosis. We used descriptive statistics to explore the general relationships between clinical and sociobehavioral factors.</p><p><strong>Results: </strong>Seven participants were excluded from the analysis because they had evidence of ART initiation. Among 93 eligible participants, the majority were not linked to care (n = 82) and over 80% reported food insecurity and HIV diagnosis disclosure concerns. Of those who linked to care (n = 11), 10 initiated ART and 6 achieved viral suppression within 1 year. AYA who initiated ART were more likely to live with a parent/relative (10 of 10 vs. 57 of 83) and were more likely to have disclosed their status to household members (7 of 10 vs. 25 of 83) than noninitiators. Mean baseline scale scores for anticipated and enacted stigma were higher among ART noninitiators compared to ART initiators, with mean differences of 0.4 and 0.5, respectively.</p><p><strong>Discussion: </strong>In a sample of recently diagnosed AYA in South Africa, the majority showed no evidence of entering care within a year. All of the participants who initiated ART reported living with a relative and were more likely to disclose their HIV status than noninitiators. Further research is needed to develop effective intervention strategies to address barriers to care for AYA with HIV in South Africa.</p>","PeriodicalId":520803,"journal":{"name":"The Journal of adolescent health : official publication of the Society for Adolescent Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes Toward and Preferences for Routes of Delivery of HIV Pre-exposure Prophylaxis Among Young Transgender Men and Transmasculine People.","authors":"Jessica A Kahn, Tanya L Kowalczyk Mullins","doi":"10.1016/j.jadohealth.2025.05.029","DOIUrl":"https://doi.org/10.1016/j.jadohealth.2025.05.029","url":null,"abstract":"<p><strong>Purpose: </strong>Because delivery route may impact interest in human immunodeficiency virus pre-exposure prophylaxis (PrEP), we explored the attitudes toward and preferences of young transgender men and transmasculine youth (TG men) for PrEP delivery methods that are currently available and in development.</p><p><strong>Methods: </strong>Fifteen TG men aged 15-24 years were recruited from a Midwestern US youth-serving gender clinic. Participants completed theory-guided individual interviews assessing demographics, risk behaviors, attitudes toward and preferences for PrEP delivery routes, and experiences with hormones for vaginal bleeding management. Transcripts were analyzed using content analysis.</p><p><strong>Results: </strong>Mean age was 17.7 years (standard deviation 1.4); 12 identified as White, two biracial, and 1 Black; and 13 were sexually experienced. Oral pill benefits included ease of use, no planning around sex; barriers included adherence challenges, difficulty swallowing pills. Injection benefits included long-acting, ease of adherence; barriers included delivery as injection, discomfort with gluteal injection. Vaginal ring benefits included ease of use, long-acting; barriers included discomfort with vaginal objects, exacerbation of gender dysphoria. Topical benefits included as-needed use, ease of use; barriers included dislike of formulation, discomfort using vaginal/rectal products. Implant benefits included long-acting, ease of use; barriers included placement procedure, concerns about breakage/migration. Four of five participants who had experience with injection, implant, or intrauterine device for bleeding management reported preference for a PrEP implant. Six of nine participants who had experience with contraceptive pills reported preference for a PrEP pill.</p><p><strong>Discussion: </strong>PrEP uptake may be improved through clinicians' eliciting and addressing barriers to PrEP delivery routes identified by young TG men.</p>","PeriodicalId":520803,"journal":{"name":"The Journal of adolescent health : official publication of the Society for Adolescent Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Sexual and Reproductive Health Care Training During Pediatric Cardiology Fellowship.","authors":"Julian Hirschbaum, Grace Kung, Diane Tanaka, Roberta Williams, Dana Gal","doi":"10.1016/j.jadohealth.2025.05.013","DOIUrl":"https://doi.org/10.1016/j.jadohealth.2025.05.013","url":null,"abstract":"<p><strong>Purpose: </strong>Limited data suggest that pediatric cardiology (PC) fellows are unprepared to provide sexual and reproductive health (SRH) care to adolescents and young adults (AYA) with congenital heart disease (CHD), an expanding population. We sought to explore PC fellow training, attitudes, and clinical practices surrounding the provision of SRH care for AYA with CHD.</p><p><strong>Methods: </strong>This national survey-based study of PC fellows in American College of Graduate Medical Education accredited fellowship programs collected demographic data, data related to participant training program, participants' attitudes, practices, and experiences regarding SRH for AYA with CHD, and participants' knowledge of SRH for these patients. Bivariate logistic regression was performed to assess associations between categorical variables of interest.</p><p><strong>Results: </strong>There were 97 responses submitted and an estimated 466 PC fellows, resulting in an estimated response rate of 20%. Approximately half of the participants indicated that the training received during fellowship has not prepared them to counsel patients with heart and/or vascular disease on contraceptive options (52%) or provide preconception counseling to their patients (49%). Fewer than half of the participants indicated feeling comfortable discussing SRH with cardiology patients in fellowship (43%), while most participants do not regularly discuss or initiate discussions about SRH with cardiology patients (79%). Nearly all participants indicated that additional training resources for SRH counseling for AYA with CHD would be helpful.</p><p><strong>Discussion: </strong>Our results demonstrate that PC fellows are inadequately prepared to provide SRH care to AYA with CHD, and there is a need for curricular reform within PC fellowship programs.</p>","PeriodicalId":520803,"journal":{"name":"The Journal of adolescent health : official publication of the Society for Adolescent Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Interventions for Anxiety and Depressive Symptoms in Adolescence: Systematic Review.","authors":"Paula Kuberka, Milly Hannah Johnston, Roz Shafran, Katharine Pike, Lucy Yardley","doi":"10.1016/j.jadohealth.2025.05.021","DOIUrl":"https://doi.org/10.1016/j.jadohealth.2025.05.021","url":null,"abstract":"<p><p>The rising prevalence of anxiety and depression among adolescents highlights the need for accessible intervention solutions. The objectives of this systematic review were to (1) identify existing digital interventions for adolescent depression and anxiety, (2) assess the promise of those interventions, and (3) identify characteristics of promising interventions. Six databases (PubMed, PsycINFO, Web of Science, Embase, MEDLINE, and Google Scholar) were used to conduct searches between September and October 2023. The searches were re-run in June 2024. Twenty studies met the criteria for inclusion, leading to the identification of 17 distinct interventions for analysis. The promise of the interventions was assessed through their effectiveness, the Reach, Effectiveness, Adoption, Implementation, Maintenance framework dimensions, and risk of bias. The evaluation of interventions' promise deemed three studies as \"Quite Promising,\" six as \"Slightly Promising,\" four as \"Inconclusive Promise,\" and seven as \"Not Promising.\" All promising interventions somewhat met the Reach, Effectiveness, Adoption, Implementation, Maintenance dimensions. Variability was observed in Template for Intervention Description and Replication characteristics, including rationale, intervention provider, length and frequency of intervention, and retention. Factors that potentially contribute to the success or limitation of digital mental health interventions among adolescents are discussed. The review underscores the need to enhance the methodological rigor and to evaluate and report the real-world impact of interventions to ensure they benefit a broader demographic of young people.</p>","PeriodicalId":520803,"journal":{"name":"The Journal of adolescent health : official publication of the Society for Adolescent Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV Testing Uptake in a Sexual and Reproductive Health Service for Youth and Impact on Population-Level Prevalence of Undiagnosed HIV in Zimbabwe.","authors":"Leyla Larsson, Victoria Simms, Chido Dziva Chikwari, Christian Bottomley, Tsitsi Bandason, Owen Mugurungi, Tsitsi Apollo, Ethel Dauya, Mandikudza Tembo, Constancia Mavodza, Constance Rs Mackworth-Young, Sarah Bernays, Palwasha Y Khan, Richard J Hayes, Katharina Kranzer, Rashida A Ferrand","doi":"10.1016/j.jadohealth.2025.05.018","DOIUrl":"https://doi.org/10.1016/j.jadohealth.2025.05.018","url":null,"abstract":"<p><strong>Purpose: </strong>High rates of undiagnosed HIV persist among youth. We investigated the uptake of HIV testing within community-based integrated HIV and sexual and reproductive health (SRH) services, and the impact on population-level prevalence of undiagnosed HIV in Zimbabwe.</p><p><strong>Methods: </strong>A cluster randomized trial (CHIEDZA) was conducted in three provinces (Harare, Bulawayo, and Mashonaland East) with 8 clusters/province randomized 1:1 to integrated HIV/SRH services for youth aged 16-24 years or to routine existing services for 30 months, followed by a population-level outcome survey. HIV testing uptake within CHIEDZA services, prevalence of population-level undiagnosed HIV, and individual- and community-level factors associated with undiagnosed HIV were assessed.</p><p><strong>Results: </strong>Overall, 29,827/35,446 (84%) youth who accessed CHIEDZA took up HIV testing, with 92% (27,339/29,827) testing at their first eligible visit. Notably, 98% and 93% of females and males took up another service alongside HIV testing. In the outcome survey, HIV prevalence was 7% (n = 1,226/17,554), of whom 576 (47%) were undiagnosed. There was no difference in prevalence of undiagnosed HIV by trial arm (49% intervention; 45% control). Individual-level factors associated with being undiagnosed were male sex, higher education, no HIV testing history, and inconsistent condom use. Community-level factors associated with undiagnosed HIV were unavailability of SRH services and testing drives, and harmful social norms.</p><p><strong>Discussion: </strong>Although community-based integrated HIV/SRH achieved high HIV testing uptake, there was no impact on population-level prevalence of undiagnosed HIV. Concerted efforts are needed to identify and reach those at highest risk, and to address structural factors and prevalent social norms.</p>","PeriodicalId":520803,"journal":{"name":"The Journal of adolescent health : official publication of the Society for Adolescent Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot Study of a Digital Health Intervention to Increase HIV and Sexually Transmitted Infection Testing Uptake and Reduce Condomless Sex and Substance Use Among Adolescents.","authors":"David Cordova, Jose A Bauermeister, Sydni Warner, Zhuoxun Jiang, Frania Mendoza Lua, Sarah Khreizat, Jennifer MacLeod, Patricia Wells, Torsten B Neilands, Lauretta Ovadje, Jorge Delva, Kathryn B Fessler, Versell A Smith, Cherrie B Boyer","doi":"10.1016/j.jadohealth.2025.05.017","DOIUrl":"https://doi.org/10.1016/j.jadohealth.2025.05.017","url":null,"abstract":"<p><strong>Purpose: </strong>Enhancing HIV/sexually transmitted infection testing and reducing unsafe sexual behaviors and substance use are crucial for public health, particularly among youth. This pilot study examines the Storytelling 4 Empowerment (S4E) intervention's preliminary efficacy in these areas.</p><p><strong>Methods: </strong>Using a community-engaged research approach, we conducted a randomized controlled trial with 100 adolescents and young adults (mean age = 19.27, standard deviation = 1.62) at a youth-focused clinic in Southeast Michigan. Participants were randomized to S4E, a brief digital health intervention, or usual care. Assessments occurred at baseline, postintervention, 3 and 6 months, with statistical analyses estimating effect sizes.</p><p><strong>Results: </strong>S4E participants demonstrated higher HIV (52% vs. 12%; h = 0.95) and sexually transmitted infection (52% vs. 20.4%; h = 0.74) testing at 6-month follow-up. Reductions in condomless sex (12.9% vs. 1%; h = 0.35) and binge drinking (11.2% vs. 1.6%; h = 0.02) were reported at 3 months. Both youth and providers in the S4E group reported better clinician-youth communication than controls, and youth showed increased improvement over time (Cohen's d = 1.19 at 6 months).</p><p><strong>Discussion: </strong>The S4E intervention demonstrated significant improvements in testing, risk behaviors, and communication. These findings suggest the need for larger-scaled randomized controlled trials to confirm the intervention's efficacy for youth in clinical settings.</p>","PeriodicalId":520803,"journal":{"name":"The Journal of adolescent health : official publication of the Society for Adolescent Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Youth Mental Health in Times of Global Crises: Evidence From the German Longitudinal COVID-19 and Psychological Health Study.","authors":"Anne Kaman, Janine Devine, Michael Erhart, Ann-Kathrin Napp, Franziska Reiss, Sophie Moeller, Fionna Zoellner, Steven Behn, Ulrike Ravens-Sieberer","doi":"10.1016/j.jadohealth.2025.05.010","DOIUrl":"https://doi.org/10.1016/j.jadohealth.2025.05.010","url":null,"abstract":"<p><strong>Purpose: </strong>Global crises such as climate change, pandemics, and wars present significant challenges, particularly for children and adolescents in a vulnerable phase of development. This population-based longitudinal study aimed to examine changes in youth mental health from 2017 to 2023 in the context of global crises and investigate the effects of crises-related fears on mental health.</p><p><strong>Methods: </strong>Data on 2,671 families with children and adolescents (50.1% female) aged 7-21 years (including self-reports) who participated in at least one wave of the German population-based COVID-19 and Psychological Health study (T1: May 2020-T6: October 2023) were analyzed. Descriptive statistics and multivariate regression analyses were used to investigate changes in health-related quality of life (HRQoL), mental health problems, and depressive and anxiety symptoms. Associations with crises-related future anxiety were explored using data from T6.</p><p><strong>Results: </strong>Youth HRQoL and mental health significantly deteriorated during the pandemic in 2020-2021 compared to prepandemic data. Although mental health improved in the following years, one in five children still reported low HRQoL, mental health problems, and anxiety in 2023. By autumn 2023, crises-related worries and future anxiety were common, associated with higher risks of low HRQoL, mental health problems, and depressive and anxiety symptoms (odds ratios = 1.2-2.4).</p><p><strong>Discussion: </strong>Youth mental health deteriorated significantly during the COVID-19 pandemic and remained impaired in 2023 amid ongoing global crises. Crises-related worries are widespread and linked to poorer mental health. Targeted prevention and intervention programs are essential to help young people cope with these challenges.</p>","PeriodicalId":520803,"journal":{"name":"The Journal of adolescent health : official publication of the Society for Adolescent Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Race or Place: Neighborhood Determinants of Adolescent Obesity.","authors":"Elizabeth A Onugha, Deepali K Ernest, Ankona Banerjee, Kenneth J Nobleza, Duc T Nguyen, Omar Rosales, Abiodun Oluyomi, Jayna M Dave, Joshua A Q Samuels","doi":"10.1016/j.jadohealth.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.jadohealth.2025.03.005","url":null,"abstract":"<p><strong>Purpose: </strong>Area-based socioeconomic factors contribute significantly to the complex relationship between neighborhood characteristics and obesity. This study examined the relationship between socioeconomic characteristics of school neighborhoods and the prevalence of obesity among adolescents in the United States.</p><p><strong>Methods: </strong>We analyzed data for 21,392 students from a school-based blood pressure-screening project. Students were clustered into 28 neighborhoods based on their school matriculation, and weighted Area Deprivation Index measures were generated to represent each school's catchment area. The Area Deprivation Index was categorized into quartiles, with quartile 1 (Q1) representing schools in less-disadvantaged neighborhoods, and quartile 4 (Q4) representing schools in more disadvantaged neighborhoods. Logistic regression analyses were used to examine bivariate and adjusted associations.</p><p><strong>Results: </strong>There was a stepwise increase in obesity prevalence, with the lowest prevalence in Q1 and the highest in Q4 among Hispanic students and Black students. White and Asian students attending schools in Q1 had the lowest prevalence of obesity. Multivariable regression analysis showed that younger age, male sex, race/ethnicity, high blood pressure status, and school neighborhood were significantly associated with obesity.</p><p><strong>Discussion: </strong>Hispanic and Black students attending schools in high-poverty areas had the highest rates of obesity. Our findings suggest that, in addition to race/ethnicity, neighborhood-level poverty is a significant predictor of obesity rates, emphasizing the relationship between environmental and biological determinants of obesity.</p>","PeriodicalId":520803,"journal":{"name":"The Journal of adolescent health : official publication of the Society for Adolescent Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple Impacts on Adolescent Well-Being During COVID-19 School Closures: Insights From Professionals for Future Policy Using a Conceptual Framework.","authors":"Nicola J Gray, Catherine Chabot, Shraddha Manandhar, Insa L Backhaus-Hoven, Miranda Beck, Graça S Carvalho, Regina Alves, Min-Chien Tsai, Sachi Tomokawa, Didier Jourdan, Terje Andreas Eikemo","doi":"10.1016/j.jadohealth.2025.04.009","DOIUrl":"https://doi.org/10.1016/j.jadohealth.2025.04.009","url":null,"abstract":"<p><strong>Purpose: </strong>This study explores the impacts of school closures during the COVID-19 pandemic on the domains of adolescent well-being from the UN H6+ framework, reported by health and educational professionals worldwide.</p><p><strong>Methods: </strong>Semistructured individual online interviews were conducted in six languages during the second wave of the COVID-19 pandemic (March-December 2021) with health and education professionals who volunteered for follow-up after participating in an anonymous online survey. The UN H6+ 5-domain conceptual framework of adolescent well-being was used as a framework for the directed content analysis of the combined interview dataset.</p><p><strong>Results: </strong>A total of 60 interviews-translated into English-were analyzed from 38 education and 22 health professionals in 28 countries/territories. Participant reports showed impacts on all five adolescent well-being domains, but mainly domain 1 (good health and nutrition), domain 3 (safety and a supportive environment) and domain 4 (learning, competence, education, skills, and employability). Reflections of 2-connectedness and 5-agency were also present. Their reports included mainly negative impacts, but also some positive insights to take forward.</p><p><strong>Discussion: </strong>Policymakers must recognize impacts of school closures during the pandemic on multiple domains of adolescent well-being and the potential for widening inequalities. Schools play a critical mitigating role that goes beyond education. The call to action for the adolescent health community is to recognize and address ongoing potential long-term impacts on well-being and inequalities in their everyday practice. It is also important to advocate locally, nationally, and globally for careful consideration of the consequences of school closures in future health crises.</p>","PeriodicalId":520803,"journal":{"name":"The Journal of adolescent health : official publication of the Society for Adolescent Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Anemia Among Adolescents in Zanzibar With School-based Supplementation of Once Weekly Iron-folic Acid or Daily Multiple Micronutrients: A Cluster-randomized Trial.","authors":"Ilana R Cliffer, Innocent S Yusufu, Mashavu H Yussuf, Mary Mwanyika-Sando, Ramadhani A Noor, Frank Mapendo, Jokha Masoud, Mgeni Maulid, Seif Abdulla, Ali Salim Ali, Wafaie Fawzi","doi":"10.1016/j.jadohealth.2025.04.026","DOIUrl":"https://doi.org/10.1016/j.jadohealth.2025.04.026","url":null,"abstract":"<p><strong>Purpose: </strong>Supplementation with iron and folic acid (IFA) is recommended by the World Health Organization; however, evidence of effectiveness in adolescents is lacking. We aimed to investigate the effectiveness of school-based supplementation of IFA or multiple micronutrient supplement (MMS) in addressing anemia among secondary schools adolescents in Zanzibar, Tanzania.</p><p><strong>Methods: </strong>This was a nonmasked three-arm cluster-randomized trial in which 42 schools were randomized to weekly IFA, daily MMS, or control (standard nutrition curriculum). Students aged 10-17 years were supplemented for two 17-week periods, in 2022 and 2023. Hemoglobin was evaluated during four surveys conducted before and after each supplementation round. We used multilevel mixed effects models to estimate associations between study arm and anemia, categorized by World Health Organization cut points.</p><p><strong>Results: </strong>At baseline, 2,475 students were enrolled and 53.3% had anemia, with similar prevalence across all arms. Participants in the MMS arm had 37% lower risk of moderate or severe anemia at final endline, compared to those in the control arm (risk ratio [RR] = 0 63; 95% confidence interval [CI]: 0.41, 0.99). No differences were observed in prevalence of anemia in the IFA group compared to the control group. Effects were modified by sex (p for interaction = .004), with MMS males experiencing 68% lower risk of moderate or severe anemia compared to controls (RR = 0.32; 95% CI: 0.14, 0.70), while for females the effect was smaller and not significant (RR = 0.72; 95% CI: 0.45,1.16).</p><p><strong>Discussion: </strong>School-based supplementation with MMS may be effective in addressing anemia among adolescents; however, the specific context and appropriate complementary interventions must be considered.</p>","PeriodicalId":520803,"journal":{"name":"The Journal of adolescent health : official publication of the Society for Adolescent Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}