Adolescent Enrollment in Psychosocial Care:Do Parents Make a Difference?

Care for adolescents with emotional and behavioral problems (EBP) is frequently unequally distributed. Parents may play a role in the access to this care. Therefore, the aim was to explore the association between parental characteristics and their adolescent's enrollment in psychosocial care. We used data from the Care4Youth cohort study. Our sample consisted of 446 adolescents (mean age 13.22 years, 48% boys) and 382 parents (mean age 42.95 years, 14% males). EBP combined with enrollment created four groups: 1, no EBP/no care; 2, no EBP/care; 3, EBP/no care; 4, EBP/care. We assessed differences in parental characteristics among the groups. Group 2 had a significantly lower socioeconomic position (p < 0.01), more psychological distress (p < 0.001), poorer supervision (p < 0.001) and lower family social support (p < 0.05) than Group 1. Group 4 had a significantly lower socioeconomic position (p < 0.01) and poorer supervision (p < 0.001) than Group 1. Group 3 had significantly poorer supervision (p < 0.001) than Group 4. The poor supervision in Group 3 requires attention, as these adolescents receive no care. The quality of parental supervision should be addressed generally, e.g., by providing better parenting support and more parental training

"I could do almost nothing without digital technology":a qualitative exploration of adolescents' perception of the risks and challenges of digital technology

BACKGROUND: The fast development of digital technology and of its use at even younger ages is significantly shaping the current generation of adolescents. This is leading to an almost unlimited accessibility that provides a large number of opportunities, but also to many challenges that adolescents have to face. The aim of our study was to explore the perceptions adolescents have of the risks of digital technology.METHODS: We conducted online semi-structured interviews as a part of the international Health Behaviour in School-aged Children study. The sample consisted of 15 Slovak adolescents (mean age: 15.33; 20% boys). To analyse our data, we used consensual qualitative research and thematic analysis.FINDINGS: Our findings confirmed that adolescents are aware of the risks associated with the use of digital technology. Regarding their specific types of the perceived risks, we identified four main themes: 1. dependence on the functionality of technology; 2. problematic control; 3. vulnerability in the virtual environment; 4. health risks. Adolescents thus want technology that is functional, safe and does not endanger their health.CONCLUSION: Despite the fact that adolescents know of the risks they may experience due the digital technology, they still use it. Preventive strategies should focus on functionality, safety and healthiness; furthermore, they should support the constant development of adolescents' digital awareness and raising their awareness about effective and non-threating use of technology.</p

The Association of Family-Related Adversity With Fighting in Adolescents:Does Hopelessness Mediate This Association?

Objectives: To explore the association of family-related adversities with physical fighting, and whether this association is mediated by hopelessness. Methods: The sample consisted of 3712 Slovak adolescents (mean age: 13.9, 50.7% girls). Participants answered questions regarding experienced family-related adversities, involvement in physical fighting in the last 12 months and the Hopelessness Questionnaire. First, the association of family adversities in general with fighting and of each of family-related adversity separately was assessed using linear regression models and second, mediation was assessed using the a*b product method with bootstrapped 95% confidence intervals Results: Adolescents who had experienced at least one family adversity reported more frequent fighting. Similarly, each of reported family adversities (death of a parent, substance abuse problems of a parent, conflicts/physical fights, divorce) was associated with more frequent fighting among adolescents. The mediation effect of hopelessness was found in each association of family-related adversity with fighting. Conclusion: These findings suggest that interventions to support adolescents who had experienced family adversities could among other things be directed at better coping with hopelessness

"I could do almost nothing without digital technology":a qualitative exploration of adolescents' perception of the risks and challenges of digital technology

BACKGROUND: The fast development of digital technology and of its use at even younger ages is significantly shaping the current generation of adolescents. This is leading to an almost unlimited accessibility that provides a large number of opportunities, but also to many challenges that adolescents have to face. The aim of our study was to explore the perceptions adolescents have of the risks of digital technology.METHODS: We conducted online semi-structured interviews as a part of the international Health Behaviour in School-aged Children study. The sample consisted of 15 Slovak adolescents (mean age: 15.33; 20% boys). To analyse our data, we used consensual qualitative research and thematic analysis.FINDINGS: Our findings confirmed that adolescents are aware of the risks associated with the use of digital technology. Regarding their specific types of the perceived risks, we identified four main themes: 1. dependence on the functionality of technology; 2. problematic control; 3. vulnerability in the virtual environment; 4. health risks. Adolescents thus want technology that is functional, safe and does not endanger their health.CONCLUSION: Despite the fact that adolescents know of the risks they may experience due the digital technology, they still use it. Preventive strategies should focus on functionality, safety and healthiness; furthermore, they should support the constant development of adolescents' digital awareness and raising their awareness about effective and non-threating use of technology.</p

Desirable but not feasible:Measures and interventions to promote early childhood health and development in marginalized Roma communities in Slovakia

Roma are the largest and most disadvantaged ethnic minority in Europe often facing generational poverty, and limited access to education, employment, housing, and various types of services. Despite many international and national initiatives, children from marginalized Roma communities face multiple risks and are being disadvantaged as early as from conception onward. We, therefore, aimed to identify measures and/or interventions targeting equity in early childhood health and development in marginalized Roma communities which implementation is considered to be urgent but not feasible. We used a group concept mapping approach-a participatory mixed research method-and involved 40 experts and professionals from research, policy and practice. From 90 measures and interventions proposed to achieve early childhood equity for children from marginalized Roma communities, 23 measures were identified as urgent but not feasible. These concerned particularly measures and interventions targeting living conditions (including access to income, access to housing, and basic infrastructure for families) and public resources for instrumental support (covering mainly topics related to financial and institutional frameworks). Our results reflect the most pressing issues in the area of equality, inclusion and participation of Roma and expose barriers to implementation which are likely to arise from public and political discourses perpetrating a negative image of Roma, constructing them as less deserving. Measures to overcome persistent prejudices against Roma need to be implemented along with the measures targeting equity in early childhood health and development

"I could do almost nothing without digital technology":a qualitative exploration of adolescents' perception of the risks and challenges of digital technology

BACKGROUND: The fast development of digital technology and of its use at even younger ages is significantly shaping the current generation of adolescents. This is leading to an almost unlimited accessibility that provides a large number of opportunities, but also to many challenges that adolescents have to face. The aim of our study was to explore the perceptions adolescents have of the risks of digital technology.METHODS: We conducted online semi-structured interviews as a part of the international Health Behaviour in School-aged Children study. The sample consisted of 15 Slovak adolescents (mean age: 15.33; 20% boys). To analyse our data, we used consensual qualitative research and thematic analysis.FINDINGS: Our findings confirmed that adolescents are aware of the risks associated with the use of digital technology. Regarding their specific types of the perceived risks, we identified four main themes: 1. dependence on the functionality of technology; 2. problematic control; 3. vulnerability in the virtual environment; 4. health risks. Adolescents thus want technology that is functional, safe and does not endanger their health.CONCLUSION: Despite the fact that adolescents know of the risks they may experience due the digital technology, they still use it. Preventive strategies should focus on functionality, safety and healthiness; furthermore, they should support the constant development of adolescents' digital awareness and raising their awareness about effective and non-threating use of technology.</p

Barriers to HPV vaccination in marginalized Roma communities in Slovakia

IntroductionLimited access to healthcare services leads to lower vaccination rates in marginalized Roma communities (MRCs). This study aimed to explore health system barriers to HPV vaccination faced by people from MRCs from multiple perspectives.MethodsThe qualitative study was conducted in Slovakia in 2021/22 with 43 community members and health professionals. Data were analyzed using a combination of content analysis and consensual qualitative research.ResultsA substantial barrier to vaccination is limited coverage of vaccination expenses for certain age categories by health insurance. Moreover, Slovakia faces a significant shortage of healthcare personnel, leading to work overload and a lack of capacity and motivation to address HPV vaccination. Impaired relationships between health care providers and people from MRCs lead to the avoidance of healthcare services, which contributes to insufficient delivery of information and a lack of awareness regarding HPV-related diseases and vaccination.ConclusionStrengthening the capacities of health care providers, expanding the age group covered by health insurance and providing tailored information to people from MRCs are necessary prerequisites to increase the availability of HPV vaccination and enable people to make informed decisions about HPV vaccination

How Well Do Health-Mediation Programs Address the Determinants of the Poor Health Status of Roma? A Longitudinal Case Study

In Central and Eastern Europe (CEE), health-mediation programs (HMPs) have become central policy instruments targeting health inequities between segregated Roma and general populations. Social determinants of health (SDH) represent the root causes behind health inequities. We therefore evaluated how an HMP based in Slovakia addressed known SDH in its agenda and its everyday implementation. To produce descriptive data on the HMP's agenda and everyday implementation we observed and consulted 70 program participants across organizational levels and 30 program recipients over the long-term. We used a World Health Organization framework on SDH to direct data acquisition and consequent data content analysis, to structure the reporting of results, and to evaluate the program's merits. In its agenda, the HMP did not address most known SDH, except for healthcare access and health-related behaviours. In the HMP's everyday implementation, healthcare access facilitation activities were well received, performed as set out and effective. The opposite was true for most educational activities targeting health-related behaviours. The HMP fieldworkers were proactive and sometimes effective at addressing most other SDH domains beyond the HMP agenda, especially material conditions and psychosocial factors, but also selected local structural aspects. The HMP leaders supported such deliberate engagement only informally, considering the program inappropriate by definition and too unstable institutionally to handle such extensions. Reports indicate that the situation in other CEE HMPs is similar. To increase the HMPs' impact on SDH, their theories and procedures should be adapted according to the programs' more promising actual practice regarding SDH

Does family communication moderate the association between adverse childhood experiences and emotional and behavioural problems?

BACKGROUND: Adverse childhood experiences (ACEs) and poor family support and communication can increase emotional and behavioural problems (EBP). Therefore, we assessed the association of difficult communication with mother and with father separately with both emotional and behavioural problems (EBP), and whether adolescents' communication with mother and with father moderates the association of adverse childhood experiences (ACE) with the EBP of adolescents. METHODS: We used data from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia, comprising 5202 adolescents aged from 11 to 15 (mean age 13.53; 49.3% boys). EBP were measured using the Strengths and Difficulties Questionnaire. We used generalized linear regression adjusted for age, gender and family affluence to explore the modification of the associations between ACE and EBP by communication (easy vs. difficult communication) with mother and father. RESULTS: Difficult communication or a complete lack of communication due to the absence of mother and father increased the probability of emotional (exp (b): 0.96, 95% CI: 0.92|1.00; and 0.95, 95% CI: 0.91|0.99, respectively) and also of behavioural problems (exp (b): 0.96, 95% CI: 0.92|1.00; and 0.94, 95% CI: 0.90|0.97, respectively). We found a statistically significant interaction of communication with father on the association of ACE with EBP, showing that the joint effects were less than multiplicative. CONCLUSION: Difficult communication with mother and father is related to EBP among adolescents, and adolescents' communication with father moderates the association of ACE with both emotional and behavioural problems among adolescents

Are Adverse Childhood Experiences Associated With Being in the System of Care?

Background: Adverse childhood experiences (ACEs) can cause serious mental problems in adolescents and therefore may expected to be associated with higher use of psychosocial care, potentially varying by type of specific ACE. The aim of our study is to explore the association of the number of ACE and types of specific ACE with entering and using psychosocial care. Methods: We used data from the Slovak Care4Youth cohort study, comprising 509 adolescents from 10 to 16 years old (mean age 13.2 years, 48.6% boys). We used logistic regression models adjusted for age, gender, and family affluence to explore the associations of number and type of specific ACE with the use of psychosocial care. Results: Having three or more ACE as well as experiencing some specific ACE (death of a mother/father, death of somebody else you love, problems of a parent with alcohol or drugs, conflicts or physical fights between parents, and separation/divorce of parents) increased the likelihood of using psychosocial care. Regarding experience with the death of somebody else you love, we found a decreased likelihood of the use of psychosocial care. Conclusion: Experiencing ACE above a certain threshold (three or more) and parent-related ACE increase the likelihood of adolescent care use