Who’s got the power? Expressions of empowerment among in-school adolescents enrolled in the Girls Achieve Power (GAP Year) trial in three peri-urban settings of South Africa

Background: Empowerment is when a person gains mastery of their life and environment. This paper describes three central elements of empowerment (agency, resources, and institutional structures) expressed by adolescents, discussing implications for strengthening adolescent sexual reproductive health, HIV, and violence prevention programming. Methods: A cross-sectional survey was conducted (April 2017 – May 2018) as part of the GAP Year trial among grade eight learners (12 – 18 years) from 26 lowest quintile public high schools in Khayelitsha, Soweto and Thembisa townships, South Africa. Data were on empowerment experiences using a knowledge, attitudes, and practices survey. Descriptive and chi-square test statistics were employed, assessing the association between sociodemographic and domains of empowerment. Results: A total of 2383 adolescents in 26 schools completed the baseline survey: 63.1% female, mean age 13.7 years, 96.9% Black African. Agency: Males (4.04 vs 3.94, p=0.008) and those 15 – 18 years (4.10 vs 3.95, p=0.027) expressed stronger decision-making capacity. Females (3.18 vs 2.92, p<0.001) indicated a greater sense of collective action. Females (0.77 vs 0.72, p=0.008), those aged 12 -14 years (0.76 vs 0.71, p=0.027) and those with at least one parent/guardian employed (p=0.014) had stronger leadership confidence. Resources: Those 12-14 years expressed higher self-esteem (2.18 vs 2.08, p=0.017). Males (2.24 vs 1.87, p<0.001) and those who had at least one parent/guardian employed (p=0.047) had a higher perception of freedom from gender-based violence. Males showed greater mobility (2.89 vs 2.66, p=<0.001). Institutional structures: Coloured participants showed more positive norms than their Black counterparts (5.38 vs 2.12, p=0.005). Conclusions: Males expressed greater empowerment around decision-making, gender-based violence and mobility; females expressed greater collective action and leadership. Working across the ecological model, interventions addressing sex differences, targeting adolescents of all ages, and parental unemployment may strengthen expressions of empowerment, especially adolescents’ safety, mobility, aspirations, and future hopes.

Adverse Childhood Experiences and Risk of Subsequently Engaging in Self-Harm and Violence towards Other People—“Dual Harm”

The etiology of “dual harm” (the co-occurrence of self-harm and externalized violence in the same individual) is under-researched. Risk factors have mostly been investigated for each behavior separately. We aimed to examine adversities experienced between birth and age 15 years among adolescents and young adults with histories of self-harm and violent criminality, with a specific focus on dual harm. Three nested case-control studies were delineated using national interlinked Danish registers; 58,409 cases in total aged 15–35 were identified: 28,956 with a history of violent criminality (but not self-harm), 25,826 with a history of self-harm (but not violent criminality), and 3987 with dual-harm history. Each case was matched by date of birth and gender to 20 controls who had not engaged in either behavior. We estimated exposure prevalence for cases versus controls for each of the three behavior groups, and incidence rate ratios (IRRs). Experiencing five or more childhood adversities was more prevalent among individuals with dual-harm history (19.3%; 95% CI 18.0, 20.8%) versus self-harm (10.9%; 10.5, 11.3%) and violence (11.4%; 11.0%, 11.8%) histories. The highest IRRs for dual harm were linked with parental unemployment (5.15; 95% CI 4.71, 5.64), parental hospitalization following self-harm (4.91; 4.40, 5.48) or assault (5.90; 5.07, 6.86), and parental violent criminality (6.11; 5.57, 6.70). Growing up in environments that are characterized by poverty, violence, and substance misuse, and experiencing multiple adversities in childhood, appear to be especially strongly linked with elevated dual-harm risk. These novel findings indicate potential etiologic pathways to dual harm.

Changes in cannabis use according to socioeconomic status among Finnish adolescents from 2000 to 2015

Background Despite reduced sanctions and more permissive attitudes toward cannabis use in the USA and Europe, the prevalences of adolescent cannabis use have remained rather stable in the twenty-first century. However, whether trends in adolescent cannabis use differ between socioeconomic groups is not known. The aim of this study was to examine trends in cannabis use according to socioeconomic status among Finnish adolescents from 2000 to 2015. Methods A population-based school survey was conducted biennially among 14–16-year-old Finns between 2000 and 2015 (n = 761,278). Distributions for any and frequent cannabis use over time according to socioeconomic adversities were calculated using crosstabs and chi-square test. Associations between any and frequent cannabis use, time, and socioeconomic adversities were studied using binomial logistic regression results shown by odds ratios with 95% confidence intervals. Results At the overall level, the prevalences of lifetime and frequent cannabis use varied only slightly between 2000 and 2015. Cannabis use was associated with socioeconomic adversities (parental unemployment in the past year, low parental education, and not living with both parents). The differences in any and frequent cannabis use between socioeconomic groups increased significantly over the study period. Conclusions Although the overall changes in the prevalence of adolescent cannabis use were modest, cannabis use increased markedly among adolescents with the most socioeconomic adversities. Socioeconomic adversities should be considered in the prevention of adolescent cannabis use.

Adverse Childhood Experiences and Risk of Subsequently Engaging in Self-Harm and Violence Towards Other People – ‘Dual Harm’

The etiology of &lsquo;dual harm&rsquo; (the co-occurrence of self-harm and externalized violence in the same individual) is under-researched. Risk factors have mostly been investigated for each behavior separately. We aimed to examine adversities experienced between birth and age 15 years among adolescents and young adults with histories of self-harm and violent criminality, with a specific focus on dual harm. Three nested case-control studies were delineated using national interlinked Danish registers; 58,409 cases in total aged 15-35 were identified: 28,956 with a history of violent criminality (but not self-harm), 25,826 with a history of self-harm (but not violent criminality), and 3987 with dual harm history. Each case was matched by date of birth and gender to 20 controls who had not engaged in either behavior. We estimated exposure prevalence for cases vs. controls for each of the three behavior groups, and incidence rate ratios (IRRs). Experiencing 5 or more childhood adversities was more prevalent among individuals with dual harm history (19.3%; 95% CI 18.0, 20.8%) versus self-harm (10.9%; 10.5, 11.3%) and violence (11.4%; 11.0%, 11.8%) histories. The highest IRRs for dual harm were linked with parental unemployment (5.15; 95% CI 4.71, 5.64), parental hospitalization following self-harm (4.91; 4.40, 5.48) or assault (5.90; 5.07, 6.86), and parental violent criminality (6.11; 5.57, 6.70). Growing up in environments that are characterized by poverty, violence and substance misuse, and experiencing multiple adversities in childhood, appear to be especially strongly linked with elevated dual harm risk. These novel findings indicate potential etiologic pathways to dual harm.

Resilience factors associated with physical function in vulnerable older adults from four countries

Background Adverse childhood experiences (ACEs) include an array of maltreatment and they have been shown to confer higher risks of early mobility loss and ultimately disablement in older ages. This study aims to identify resilience factors associated with physical function in a diverse sample of older adults (65-74 years) from the 2012 International Mobility in Aging Study (IMIAS) who reported ACEs. Methods 2002 participants were recruited from Kingston, Ontario; St. Hyacinthe, Quebec; Tirana, Albania; Manizales, Colombia; and Natal, Brazil. Economic ACEs were classified by self-report of at least one-poor childhood economic status, childhood hunger, parental unemployment-before the age of 15 years. The Short Physical Performance Battery was used to measure physical function; a score of &lt; 8 was considered poor. Associations between hypothesized resilience factors (education, social support, expressed gender roles) and physical function were identified via bivariate analysis and logistic regression; after adjusting for sex, age, and sample site. Results Nearly half (46%) the participants reported economic ACES. High levels of education (OR 0.39; CI: 0.22-0.66) and social support from family (OR: 0.52; CI: 0.36-0.76), partners (OR: 0.47; CI: 0.29-0.74), and friends (OR: 0.59; CI: 0.38-0.92), as well as masculine (OR:0.49; CI: 0.29-0.83) and androgynous (0.48; CI: 0.30-0.77) gender roles, protected against poor physical function for those reporting childhood economic ACEs. Conclusions Despite encountering economic ACEs, those who achieved high relative levels of education, greater levels of support, as well as those characterized by masculine or androgynous gender roles, were more likely to maintain good physical performance in older ages compared to those with low education, no social support, and those classified as undifferentiated gender roles. Findings highlight critical points of intervention for those who experienced ACES. Key messages These findings imply that the associated negative physical health outcomes of ACEs can be delayed or eliminated via exposure to certain protective factors. Economic ACE exposure may be unavoidable, but there are resilience factors that could be promoted to foster the better health across the life course.

Experience of Delinquent Adolescents in Juvenile Detention Center of Tehran With Emphasis on Crime Repetition Prevention

Objectives: Juvenile delinquents are a group of people that is in dire need of psychosocial rehabilitation. In this research, we seek to assess the lived experience in two groups of delinquent adolescents: one group is repetitive delinquents, the second group successfully returned to society. We tried to understand the relevant and essential factors in making this difference. Methods: This study is a qualitative research based on Grounded Theory. In this study, samples of adolescents with recurrent crimes and samples that have successfully returned to society without recidivism were reviewed. To do this, we should have investigated each case separately and the whole process that led to the recurrence of the crime. However, because the size of the statistical population is not sufficient to use quantitative and generalized methods, a case-experienced study has been conducted. This method assesses current phenomena in their real-life context, especially when the boundaries between a phenomenon and the context in which it occurs are not clearly defined. Several sources of evidence were used. After the coding of the gathered data and the formulation of the interviews in the form of concepts, the next step was to increase the level of abstraction of these concepts and propositions in the form of subcategories. Results: Finally, of 222 propositions, we reached 100 concepts that were mainly associated with recurrent delinquency or regret and return to society. Some of the most important ones were family problems (such as parental quarrels, parental addiction, parental unemployment, and a history of a criminal conviction and parental imprisonment). Discussion: Undoubtedly, one of the essential factors in the occurrence of crime is the environments in which the perpetrators deal with them. They are influenced by these environments whose personalities are shaped. Family, school, neighborhood, dropout, peer group, and general social determinants are influential in juvenile delinquency and its continuation or abandonment.

Youth injury and parents’ unemployment—the importance of socio-economic status and ethnicity context

Background Youth whose parents are unemployed have poorer health and well-being, including more injuries that result in hospitalization. The current study examined the possibility of an association of parents’ employment status with youth injury and the interaction of this status with other socio-economic factors and ethnicity. Methods We distributed to adolescents aged 11–15 years, in class, the Israel Health Behavior in School-Aged Children Survey. We distinguished between any injury and severe injury, defining the latter as one necessitating the use of a cast, stitches and crutches or overnight hospitalization. Results Of 13 705 respondents, 6224 (45%) had an injury in the past year that required medical treatment and 1827 pupils (13.5%) reported severe injuries. The odds of any injury were 1.86 for boys as against girls (95% confidence interval [CI] 1.73–1.99), 0.80 for school grade (95% CI 0.78–0.82), 1.56 for Arabs vs. Jews (95% CI 1.43–1.70) and 1.10 for high Family Affluence Scale (FAS) vs. medium FAS (95% CI 1.01–1.21). Only in the low FAS group, when two parents were unemployed, the odds for severe injury was 1.36 (95% CI 1.03–1.78); when one or two parents were employed, the odds of severe child injury were the same (OR 1.13 and 95% CI 0.92–1.40). Conclusion Factors that were found to increase the risk of injury among youth were parental unemployment, low socio-economic status and Arab ethnicity. The home environment was the most common place for injury.

Accumulated Disadvantage over the Lower Secondary School Years in Helsinki Metropolitan Area, Finland

Accumulated disadvantage (AD) is conceptualised here as an agglomeration of unfavourable or prejudicial conditions which in adolescence may compromise the progress to further education or future life chances. There are several theories on AD, suggesting, e.g., (1) an increase of AD by age and (2) trajectories (previous disadvantage predicts later disadvantage). Social pathways theory suggests that (3) a third factor (e.g., socioeconomic position, SEP) mediates or moderates the association between early and later disadvantage, while other theories imply (4) polarisation (a strengthening association between AD and SEP by age) or (5) equalisation (a weakening of association between AD and SEP). We apply these theories to longitudinal data of 7th graders (13 years, N = 5742), followed until the end of the 9th grade. Five dimensions of disadvantage were health (poor self-rated health), social behaviour (poor prosocial behaviour), normative (conduct disorders), educational (poor academic achievement), and economic (parental unemployment). The results show that the prevalence of AD increased over the follow-up as most indicators of disadvantage elevated. AD at the 7th grade predicted later AD, as did the SEP of the students. Moderation of AD by SEP was also observed. The study corroborates with hypotheses on increase of AD, trajectory, and social pathways but no signs of polarisation or equalisation were observed.