Understanding adolescent health risk behaviour and socioeconomic position:A grounded theory study of UK young adults

Health risk behaviours such as tobacco smoking, excessive alcohol consumption, drug use, unhealthy diet and unprotected sexual intercourse contribute to the global burden of non‐communicable diseases and are often initiated in adolescence. An individualistic focus on ‘health risk behaviours’ has resulted in behaviour change strategies that are potentially ineffective and increase inequalities. We conducted a grounded theory study of 25 young adults to increase the limited qualitative evidence base surrounding young people, health risk behaviours and socioeconomic inequalities. We found that health risk behaviours were perceived as class markers, manifesting as class stigma, leading some participants from lower socioeconomic backgrounds to employ strategies to avoid such behaviours. Peers and family were core constructs for understanding the relationship between health risk behaviours and socioeconomic life trajectories. However, individualism and choice were consistently expressed as the overriding narrative for understanding health risk behaviour and socioeconomic position during the transition to adulthood. The use of ‘personal responsibility’ discourse by young adults, we argue, highlights the need for a public health focus on achieving structural changes as opposed to individualised approaches to avoid reinforcing neoliberal ideologies that serve to marginalise and maintain social inequalities

Preconception exposures and adverse pregnancy, birth and postpartum outcomes:Umbrella review of systematic reviews

Background Preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes. However, the reports, statements and guidelines of national and international health organisations vary in what they recommend individuals should monitor, avoid, reduce or practise in the preconception period. Objectives To synthesise and evaluate the evidence across systematic reviews for associations between exposures before conception and adverse pregnancy, birth and postpartum outcomes. Data sources MEDLINE, Embase, Epistemonikos (to May 2020) and reference lists of included reviews, without language or date restrictions. Study selection, data extraction and synthesis Systematic literature reviews of observational and/or interventional studies reporting associations between preconception exposures in women and/or men of reproductive age and pregnancy, birth or postpartum health outcomes were included. The methodological quality of reviews and the certainty of the evidence underlying each exposure-outcome association were assessed using AMSTAR 2 and the GRADE approach. Results We identified 53 eligible reviews reporting 205 unique exposure-outcome associations. Methodological quality was generally low with only two reviews rated as ‘high’ quality and two as ‘moderate’. We found high-certainty, randomised trial evidence that maternal folate supplementation reduces the risk of neural tube defects and anomaly-related terminations. Moderate-certainty, observational evidence was found that maternal physical activity is associated with reduced risk of pre-eclampsia and gestational diabetes, and that paternal age of ≥40 years and maternal body mass index (BMI) and interpregnancy weight gain are associated with increased risk of various adverse pregnancy and birth outcomes. Low- and very low-certainty evidence was found for other associations. Conclusions Clinicians and policymakers can be confident that maternal folate supplementation should be encouraged during the preconception period. There is moderate certainty in the evidence base that maternal physical activity, BMI and interpregnancy weight gain and advanced paternal age are important preconception considerations. High-quality research is required to better understand other exposure-outcome associations

Reflections on the benefits and challenges of using co-produced artistic workshops to engage with young people in community settings

Background Despite increased focus on adolescence, young people’s voices are often undervalued and underrepresented in health inequalities research and policy. Through exploring young people’s priorities for their health and their community, we may begin to understand how public health interventions and policies can be more effective and equitable. Engaging with youth using art enables empowerment and self-expression on these complex topics. Methods Creative workshops, co-produced with a young artist, were delivered at three youth centres to participants aged 11-18 years (n=30) in disadvantaged areas of Bristol, UK. Participants engaged in art and were guided by a semi-structured topic guide through focus group discussion. Thematic analysis, supported by the young artist, was used to distil key policy priorities for young people to be delivered to the local authority.ResultsThe young people identified a list of key priorities. These were: (1) mental health, (2) feeling ‘forgotten’ as an age group and having safe city spaces to socialise, (3) the need for greater support for their education and career aspirations. I provide a brief summary of these priorities, but the focus of this article is on the critical reflections on this innovative way of engaging with young people about local policy. I provide key learning points for researchers looking to do creative public health work in community settings and involve marginalised young people. ConclusionsArt is a promising way of engaging with young people in community settings and elevating marginalised voices. Co-producing with a local young artist enriched the project and partially alleviated power imbalances. This approach has potential for involving different groups within local policymaking and priority setting around health inequalities.<br/

Discrimination and the impact on health: an intersectional qualitative study of young women in Scotland

Background Discrimination can affect health outcomes and increase health inequalities. There is also growing evidence to suggest that discrimination disproportionately affects women’s health, but qualitative and UK-specific research is sparse. Adolescence and young adulthood are critical periods for laying the foundations for improving health outcomes, with girls and young women experiencing specific inequalities. This qualitative research focuses on how young women in Scotland experience discrimination and the extent to which that impacts on their mental and physical health. It was developed to support evidence needs of the Scottish Government’s Women’s Health Plan.Methods Four online focus groups scoped out population groups. We then used semi-structured interviews with women aged 16–25 in Scotland, using a semi-structured topic guide. Transcripts were thematically analysed using NVivo. We practiced reflexivity using research diaries and reflecting on our positions as researchers.Results To date, we have generated four themes from our sample of young women (n=26). (1) Mental health is key to young women’s understanding of ‘health’. Many experienced sexism while seeking mental health support through school or health services, including their symptoms being invalidated (and dismissed) as wholly down to menstruation. (2) Several young women described their experiences of discrimination related to contraception. They experienced a lack of information about side effects, alternative options to hormonal technologies and felt the sole responsibility for contraception is placed on women. Participants faced resistance from practitioners when wanting to change contraception when experiencing poor mental health and other symptoms. They saw this as related to broader societal sexism and ageism. (3) Participants recognised that the intersection of age and gender led to a particular experience of gendered ageism. This intersection led to harmful stereotypes such as the ‘hormonal, overdramatic teenage girl’, resulting in disrespectful healthcare, and long waits for referrals and diagnosis. (4) Structural racism and ableism within and outside of the health system were highlighted as impacting some participants’ healthcare access, treatment and mental health. This research illuminates the embedded and interconnected experiences of sexism, ageism, ableism, racism and other forms of discrimination within the health system and wider society and the complex ways in which these impact on young women’s health.Conclusion Discriminatory experiences are often intersectional, but regularly relate to sexism, manifesting in specific ways for adolescents and young adults. Policies to reduce systemic and intersectional discrimination have the potential to improve young women’s health outcomes and reduce health inequalities

Community mobilisation approaches to preventing adolescent multiple risk behaviour:a realist review

BackgroundAdolescent multiple risk behaviour (MRB) is a global health issue. Most interventions have focused on the proximal causes of adolescent MRB such as peer or family influence, with systematic reviews reporting mixed evidence of effectiveness. There is increasing recognition that community mobilisation approaches could be beneficial for adolescent health. There are gaps in the current literature, theory and implementation that would benefit from a realist approach. We use a theory-driven evidence synthesis to assess how and why community mobilisation interventions work/do not work to prevent adolescent MRB and in what contexts.MethodsThis realist review used a six-stage iterative process, guided by the RAMESES framework. We systematically searched PubMed, MEDLINE, PsycINFO, Web of Science, CINAHL and Sociological Abstracts, from their inception to 2021. Studies were screened for relevance to the programme theory, assessed for rigour and included based on a priori criteria. Two independent reviewers selected, screened and extracted data from included studies. A realist logic of analysis was used to develop context-mechanism-outcome configurations that contributed to our programme theory.FindingsWe reviewed 35 documents describing 22 separate community mobilisation intervention studies. Most studies (n = 17) had a quality assessment score of three or four (out of four). We analysed the studies in relation to three middle range theories. To uphold our theory that these interventions work by creating a social environment where adolescents are less likely to engage in MRB, interventions should: (1) embed a framework of guiding principles throughout the community, (2) establish community readiness with population data and (3) ensure a diverse coalition with the support of intervention champions. Mechanisms such as empowerment through coalition ownership over the delivery of the intervention, cohesion across the community and motivation to work collaboratively to improve adolescent health are triggered to achieve social environment shifts. However, certain contexts (e.g. limited funding) restrict intervention success as these mechanisms are not fired.ConclusionsFor community mobilisation interventions to reduce adolescent MRB, the coalitions within them must seek to alter the social environment in which these behaviours occur. Mechanisms including empowerment, cohesion and motivation lead to this shift, but only under certain contexts.Systematic review registrationPROSPERO CRD4202020534

The first pterosaur 3-D egg: Implications for Pterodaustro guinazui nesting strategies, an Albian filter feeder pterosaur from central Argentina

The increasing number of fossil pterosaur eggs sheds light on nesting environments and breeding behaviors of these extinct flying reptiles. Here we report the first partial three-dimensional egg of the pterosaur, Pterodaustro guinazui, from central Argentina. The specimen was discovered from the same Albian deposits as the exceptional P. guinazui embryo described in 2004. Microscopic characterizations indicate a pristine preservation of the 50 μm thick calcium carbonate, which differs significantly from the soft shell of Chinese pterosaur eggs. Estimate of the eggshell conductance implies that the nest had a minimum moisture content of 75%. This moisture estimate, combined with geological and taphonomical data, suggests that P. guinazui may have adopted a nesting strategy similar to those of grebes and flamingos rather than being buried on land, as previously hypothesized. Moreover, our results demonstrate that the nesting paleoenvironment of this pterosaur species was closely linked to a mesohaline lacustrine ecosystem in a basin governed by regional tectonic subsidence, a setting characteristic for the feeding and reproduction of modern flamingos

Is adolescent multiple risk behaviour associated with reduced socioeconomic status in young adulthood and do those with low socioeconomic backgrounds experience greater negative impact? Findings from two UK birth cohorts

Abstract Background Adolescent multiple risk behaviour (MRB) is associated with negative outcomes such as police arrests, unemployment and premature mortality and morbidity. What is unknown is whether MRB is associated with socioeconomic status (SES) in adulthood. We test whether adolescent MRB is associated with socioeconomic status (SES) in young adulthood and whether it is moderated by early life SES variables. Methods Prospective cohort studies; British Cohort Study 1970 (BCS70) and Avon Longitudinal Study of Parents and Children (ALSPAC), born in 1991–1992, were used and two comparable MRB variables were derived. Logistic regression was used to determine the association between MRB and young adult SES. The moderating effect of three early life SES variables was assessed using logistic regression models with and without interaction parameters. Evidence to support the presence of moderation was determined by likelihood ratio tests ≤p = 0.05. Multiple imputation was used to account for missing data. Results Adolescents had a median of two risk behaviours in BCS70 and three in ALSPAC. Adolescent MRB was negatively associated with young adult SES (university degree attainment) in BCS70 (OR 0.81, 95% CI: 0.76, 0.86) and ALSPAC (OR 0.85, 95% CI: 0.82, 0.88). There was a dose response relationship, with each additional risk behaviour resulting in reduced odds of university degree attainment. MRB was associated occupational status at age 34 in BCS70 (OR 0.86 95% CI: 0.82, 0.90). In BCS70, there was evidence that maternal education (p = 0.03), parental occupational status (p = 0.009) and household income (p = 0.03) moderated the effect of adolescent MRB on young adult SES in that the negative effect of MRB is stronger for those with low socioeconomic backgrounds. No evidence of moderation was found in the ALSPAC cohort. Conclusions Adolescence appears to be a critical time in the life course to address risk behaviours, due to the likelihood that behaviours established here may have effects in adulthood. Intervening on adolescent MRB could improve later SES outcomes and thus affect health outcomes later in life. Evidence for a moderation effect in the BCS70 but not ALSPAC suggests that more detailed measures should be investigated to capture the nuance of contemporary young adult SES