Susan Margaret Sawyer

Introduction : Australian children of South Asian ethnicity are underrepresented in research on physical activity and sedentary behavior. Understanding the factors that shape these behaviors is essential for developing culturally responsive interventions. This Australian qualitative study explored South Asian children’s and mothers’ perceptions of these behaviors and their preferences for child-focused intervention programs. Methods : Online interviews were conducted with 10 mother–child dyads (children aged 10–12 y) and 14 additional mothers with children aged 2–12 years. Interviews were conducted in English and lasted between 15 and 60 minutes. Data were analyzed using reflexive thematic analysis in NVivo 15. Results : Children and mothers offered complementary perspectives that provided a nuanced understanding of children’s physical activity and sedentary behavior. Key themes related to physical activity included child-related factors (such as interest, perceived benefits), parental role as facilitators and gatekeepers, supportive home environment, role of school and peers, neighborhood environment and opportunities, and cultural norms. Key themes related to sedentary behavior included perceptions about screen use, access to personal digital devices, screen time practices at home, and the role of siblings and peers. Children and mothers preferred an in-person activity-oriented physical activity program, delivered in English by friendly instructors and involving parents, siblings, and school friends. Mothers emphasized tailoring programs by age and providing additional support for girls. Conclusion : A range of factors shape South Asian children’s physical activity and sedentary behavior. Barriers unique to this group stem from cultural and gender norms that influence parents’ (especially mothers’) confidence and skills to support children’s physical activity.

Adolescents in many countries face serious challenges in realizing the level of well-being that is their human right. Many factors—deep-seated inequality within and between countries, rapid change in skill requirements for employment, climate change, and social media—are driving these deepening challenges. This paper develops three points about the need for an urgent response to this situation. First, there is now evidence that a powerful suite of cost-effective investments is available to improve adolescent well-being. To support this claim, we draw on recent modelling of investments for many low- and middle-income countries (LMICs), as well as on detailed case studies of three countries (India, South Africa, and Colombia). In all these studies, most of the investments are highly cost-effective, with benefit-cost ratios over 6, and in many cases much higher. However, the cost of these investments is substantial, especially for those that involve the education system, raising major financing issues for most countries. Second, the case studies highlight, at least for South Africa and Colombia, the extent to which within-country inequality harms adolescent development. For example, if school quality is poor for low-income groups or regions, schooling can perpetuate rather than arrest inequality, which in turn can lead to disruptive violence for these groups or regions. Third, countries with limited fiscal space, high debt levels, and inequality and violence curtailing growth rates will find it hard to fund the investments needed to transform adolescent well-being. Major reforms to development finance are necessary, such as those outlined at the Fourth International Conference on Financing for Development at Seville in mid-2025, as well as changes to the priority given to domestic investments. Steps to reduce income inequality by new fiscal measures are also important, to fund the investments in adolescent well-being and to make them more effective.

Exploring how multidimensional social factors are linked with adolescent health could inform policies to achieve equitable and sustainable well-being. We aimed to examine the associations between adolescent health and three dimensions of social development globally. We conducted a global ecological analysis across 193 countries using data from the Global Burden of Disease 2021. We analysed age-standardised DALY rates (ASDR) for adolescents aged 10–24 years (2010–2035) in relation to well-being (human development index (HDI)), inclusion (gender inequality index (GII)), and sustainability (adjusted net savings (ANS)). We performed the main analyses using data from 2010 to 2021. We generated forecasts to 2035, presented as scenario analyses, using autoregressive integrated moving average models, and log-linear regressions were used to estimate associations and temporal trends. Global adolescent ASDR declined from 14 280.1 (95% uncertainty interval (UI) = 14 264.3, 14 296.0) in 2010 to 13 260.5 (95% UI = 13 245.2, 13 275.8) in 2021, and is forecasted to be 11 187.7 (95% UI = 11 173.8, 11 201.6) per 100 000 by 2035. HDI showed attenuating negative associations with all-cause ASDR (rate ratio (RR) = 0.79; 95% confidence interval (CI) = 0.74, 0.84 in 2010 vs. RR = 0.84; 95% CI = 0.79, 0.89 in 2021), with further attenuation in the scenario analysis to 2035 (RR = 0.92; 95% CI = 0.88, 0.96). GII demonstrated strengthening positive associations (RR = 1.09; 95% CI = 1.02, 1.15 in 2010 vs. RR = 1.11; 95% CI = 1.06, 1.17 in 2021), with further strengthening in the scenario analysis (RR = 1.15; 95% CI = 1.11, 1.20). ANS showed no significant associations in 2010 or 2021, but showed emerging associations with the adolescent health burden of non-communicable diseases (NCDs) in NCD-predominant countries. While gains in well-being were linked to reduced adolescent health burden, this relationship appeared to attenuate in our main analysis between 2010 and 2021 and the scenario analysis for 2035. Inclusion shows increasingly strong associations with the adolescent health burden across diseases, and sustainability is emerging in developed regions. Findings indicate the benefits of equity-focused, intersectoral policies that promote inclusive development and intergenerational justice.

Objective: This study aimed to assess the structural validity and readability of a brief 7‐item version of the Eating Disorder Examination Questionnaire (the EDE‐Q7) among adolescents. Method: Latent variable analysis was used in a sample of 263 adolescents (age range = 13–17.99y) diagnosed with an eating disorder and recruited from treatment centres in the United States of America and Australia. Several indices were used to provide different estimates of overall model fit. Results: The EDE‐Q7 showed good fit to the data, although absolute fit indices suggested some evidence of imperfect fit. Several other models (both brief and full‐item versions) failed to meet most criteria indicating good fit. The subscales of the EDE‐Q7 showed significant correlations with several disordered eating behaviors, suggesting convergent validity. Review of the EDE‐Q7 suggests ease of readability for adolescents from at least 11 years of age. Discussion: This is one of the first clinical studies to support the EDE‐Q7 as a brief, valid assessment of eating psychopathology that can be used with adolescents as well as adults. The results indicate that the EDE‐Q7 might be appropriate for assessing eating pathology among adolescents from the age of 13 years.

Objectives: To examine the effects of social media on future mental health problems (depressive symptoms, anxiety symptoms, poor well‐being and self‐harm) in adolescents aged 12–18 years, overall and stratified by sex and age periods (early, middle and late adolescence). Study Type: Prospective longitudinal study. Setting: Participants were recruited in 2012 through schools in Melbourne, selected using stratified random sampling. In wave 1 (2012), 1239 Grade 3 students participated and have since completed annual surveys. Participants: The analysis used data up to wave 11 (2022). Participants with no data on mental health, social media and confounders were excluded, leaving a sample of 1195 (552 [46%] male participants). Main Outcome Measures: Exposure was self‐reported duration of daily social media use at each wave, from waves 4 to 10 (ages 12–18 years). Outcomes (self‐reported depressive symptoms, anxiety symptoms, well‐being, self‐harm) were assessed at the subsequent annual wave, from waves 5 to 11 (ages 13–19 years). Results: Across adolescence, > 2 h versus < 1 h of daily social media use was associated with a small increase in risk of high depressive symptoms (risk difference [RD] per 100, 6.3 [95% CI, 2.7–9.9]) and poor well‐being (RD, 4.9 [95% CI, 1.1–8.6]) at the subsequent annual wave. Estimated risks for all mental health problems were greatest in early adolescence (12–13 years), with the largest effects observed for high depressive symptoms in female participants (> 2 h vs. < 1 h: RD, 10.8 [95% CI, 2.7–18.9]). Conclusions: Higher levels of social media use were associated with small increases in future risk of high depressive symptoms and poor well‐being across adolescence. The largest risks for all mental health problems were observed during early adolescence for both male and female participants, supporting the need to consider policies that mitigate the adverse effects of social media on the mental health of younger adolescents.

Objectives: To conduct a systematic review of studies assessing the accuracy of International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM) codes in administrative data for ascertaining health conditions when compared to a reference standard. Materials and Methods: We searched MEDLINE, Embase, and PsycINFO, and reported study characteristics and accuracy measures, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). We synthesized information about primary and validation sources of administrative data used in this literature and visually described accuracy measures by ICD chapter. Results: Our review included 280 studies; only two were conducted in low or middle-income countries. The majority of studies used hospital records as the primary administrative data source (52.1%; n = 146) and medical chart reviews as the data source for validation (53.6%; n = 150). The IQRs of accuracy measures across studies and ICD chapters were 44.0-91.4, 90.0-99.6, 59.4-91.1, and 90.0-99.5 for sensitivity, specificity, PPV, and NPV, respectively. Discussion: The assessed literature is heavily skewed towards data from high-income countries. The variance we observed in accuracy measures, particularly for sensitivity and PPV, indicates that we need more evidence on and ongoing monitoring of the accuracy of ICD/DSM codes in administrative data, which are now widely used in population-based epidemiologic studies and therefore highly relevant for public health policymaking. Conclusion: Health conditions ascertained using ICD/DSM have moderate to high accuracy in identifying true positives and high to very high accuracy in identifying true negatives.

Background: The relationships between the overlapping symptomology of physical and mental health concerns among young people with cerebral palsy (CP) requires greater clarity.,Objective: To examine the prevalence, correlates, and relationships between physical and mental health variables among young people with CP.,Method: This cross-sectional study involved participants or their proxy completing online questionnaires assessing pain, fatigue, sleep, anxiety, depression, and emotional functioning. Descriptive statistics and correlations (r) were computed to examine the relationships between the variables of interest.,Results: Participants were 72 young people with CP aged between 10-31 years (mean age = 21.81 years, SD = 5.94, 55.6% female) with representation from all levels of the CP functional classification systems. Pain, fatigue, and sleep disturbances were frequently reported (69%, 79%, and 65% respectively), along with anxiety (54%) and depression (35%). Strong positive associations were identified between most outcomes (r ≥ 0.50). The only statistically significant association between investigated conditions and age, gender or motor function was between age and proxy report pain (p <0.05).,Conclusion: Positive associations between physical and mental health outcomes exist for young people with CP. The nature of these relationships is complex, with these conditions having overlapping symptoms.

Objective: This study explored the flexible use of family‐based treatment (FBT) and the unified protocol for the transdiagnostic treatment of emotional disorders in adolescents (FBT + UP‐A) to address the diverse needs of those with avoidant/restrictive food intake disorder (ARFID). Method: Adolescents ( n = 13, age range 13–18 years) diagnosed with ARFID were sequentially recruited from a publicly funded eating disorder program and were offered 9 months of outpatient treatment. After achieving initial weight gain using FBT, adolescents were given the option to receive the UP‐A to work on self‐identified treatment goals. Results: The study enrolled 100% of eligible participants and all completed treatment. All participants received the minimum required dose of FBT and most chose to engage in UP‐A (84.62%). Completion of research measures was inconsistent across participants and those choosing FBT‐only were lost to research follow‐up. Exploratory analysis of treatment response pre‐to post‐treatment demonstrated moderate to large treatment effect sizes in terms of weight, ARFID symptoms, and depression, but only small effect sizes for anxiety. Discussion: The current study explored the sequential use of an eating disorder and a transdiagnostic emotional disorder intervention for the treatment of ARFID and co‐occurring emotional concerns identified by adolescents. These findings suggest that FBT + UP‐A has the potential to treat ARFID and depression but requires further testing in a larger controlled study.