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Background Adolescents experience a multitude of vulnerabilities which need to be addressed in order to achieve the Sustainable Development Goals (SDGs). In sub-Saharan Africa, adolescents experience high burden of HIV, violence exposure, poverty, and poor mental and physical health. This study aimed to identify interventions and circumstances associated with three or more targets ("accelerators") within multiple SDGs relating to HIV-affected adolescents and examine cumulative effects on outcomes. Methods Prospective longitudinal data from 3401 adolescents from randomly selected census enumeration areas in two provinces with > 30% HIV prevalence carried out in 2010/11 and 2011/12 were used to examine six hypothesized accelerators (positive parenting, parental monitoring, free schooling, teacher support, food sufficiency and HIV-negative/asymptomatic caregiver) targeting twelve outcomes across four SDGs, using a multivariate (multiple outcome) path model with correlated outcomes controlling for outcome at baseline and socio-demographics. The study corrected for multiple-hypothesis testing and tested measurement invariance across sex. Percentage predicted probabilities of occurrence of the outcome in the presence of the significant accelerators were also calculated. Results Sample mean age was 13.7 years at baseline, 56.6% were female. Positive parenting, parental monitoring, food sufficiency and AIDS-free caregiver were variously associated with reductions on ten outcomes. The model was gender invariant. AIDS-free caregiver was associated with the largest reductions. Combinations of accelerators resulted in a percentage reduction of risk of up to 40%. Conclusion Positive parenting, parental monitoring, food sufficiency and AIDS-free caregivers by themselves and in combination improve adolescent outcomes across ten SDG targets. These could translate to the corresponding real-world interventions parenting programmes, cash transfers and universal access to antiretroviral treatment, which when provided together, may help governments in sub-Saharan Africa more economically to reach their SDG targets.

AbstractIntroductionAdolescent girls are at high risk of HIV infection in sub‐Saharan Africa. Mental health distress, driven by adverse childhood experiences (ACEs) such as abuse, poverty and family HIV, may be an important driver of HIV risk behaviour among adolescent girls, while education may mitigate these risks. This study aimed to develop an empirically based theoretical model between ACEs, mental health distress and HIV risk behaviour among adolescent girls in South Africa and to investigate the potential moderating effects of free schooling provision.MethodsSelf‐report questionnaires using validated scales were completed by adolescent girls aged 12 to 17 at baseline in two provinces in South Africa in 2011, with a 99% one‐year follow‐up in 2012 (n = 1498). Sampling included every household in randomly selected census enumeration areas of four deprived health districts. Confirmatory factor analysis was employed to identify measurement models and a structural equation model was developed to test pathways of risk and protection.ResultsInternalizing and externalizing mental health distress fully mediated the positive relationship between ACEs at baseline and HIV risk behaviour at follow‐up among adolescent girls. Internalizing mental health distress was associated with increased sexual risk at follow‐up via higher externalizing problems. Free schooling provision at baseline and follow‐up eliminated the pathway from internalizing to externalizing mental health distress by moderating the pathway between ACEs and internalizing mental health distress. It also weakened the pathway from externalizing mental health distress to HIV risk behaviour at follow‐up through a direct negative effect on externalizing mental health distress.ConclusionsReducing ACEs and adolescent mental health distress is essential for reducing HIV risk behaviour among girls in South Africa. Free schooling provision may be an important tool for reducing these problems and mitigating negative pathways to HIV risk among vulnerable adolescent girls.

While existing studies have examined the effectiveness of school-based child sexual abuse (CSA) prevention programs in China, there is currently little qualitative evidence on how stakeholders view these programs and research on CSA in China more generally. To address this research gap, the aims of this study were to explore stakeholders' perspectives on: (a) school-based CSA prevention programs in China; (b) the components of these programs; (c) CSA research in China. Qualitative semi-structured interviews were conducted with 21 participants in Beijing and a county under Lanzhou City, China. Interview transcripts were systematically coded and emerging themes were developed from the codes. An inductive thematic analysis approach was utilized to analyze the interview data. Participants' perspectives on school-based CSA prevention programs included: (a) recognition of the importance of school-based CSA prevention programs; (b) fear about a possible negative impact on children participating in such programs; (c) assessment that school-based CSA prevention programs alone are not enough to prevent CSA. Components that participants thought needed to be part of Chinese school-based CSA prevention programs were: (a) content regarding online-facilitated CSA; (b) the use of a rights-based approach; and (c) greater parental and community involvement. Participants also identified factors that have both fostered the implementation of CSA research (e.g., the growing awareness of CSA in the central government) and prevented researchers from effectively conducting CSA research: (a) lack of national data; (b) inadequate government support; and (c) barriers to research collaboration among organizations. The findings indicate that while CSA prevention programs are on the whole regarded positively by key stakeholders in China, a number of important concerns were identified. Our study highlighted a number of ways in which future CSA prevention programs and research on CSA could be strengthened in the Chinese context.

AbstractIntroduction: Internalized HIV stigma is a key risk factor for negative outcomes amongst adolescents living with HIV (ALHIV), including non‐adherence to anti‐retroviral treatment, loss‐to‐follow‐up and morbidity. This study tested a theoretical model of multi‐level risk pathways to internalized HIV stigma among South African ALHIV.Methods: From 2013 to 2015, a survey using total population sampling of ALHIV who had ever initiated anti‐retroviral treatment (ART) in 53 public health facilities in the Eastern Cape, South Africa was conducted. Community‐tracing ensured inclusion of ALHIV who were defaulting from ART or lost to follow‐up. 90.1% of eligible ALHIV were interviewed (n = 1060, 55% female, mean age = 13.8, 21% living in rural locations). HIV stigma mechanisms (internalized, enacted, and anticipated), HIV‐related disability, violence victimization (physical, emotional, sexual abuse, bullying victimization) were assessed using well‐validated self‐report measures. Structural equation modelling was used to test a theoretically informed model of risk pathways from HIV‐related disability to internalized HIV stigma. The model controlled for age, gender and urban/rural address.Results: Prevalence of internalized HIV stigma was 26.5%. As hypothesized, significant associations between internalized stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV‐related disability, victimization, and enacted stigma were not directly associated with internalized stigma. Instead significant pathways were identified via anticipated HIV stigma and depression. The model fitted the data well (RMSEA = .023; CFI = .94; TLI = .95; WRMR = 1.070).Conclusions: These findings highlight the complicated nature of internalized HIV stigma. Whilst it is seemingly a psychological process, indirect pathways suggest multi‐level mechanisms leading to internalized HIV stigma. Findings suggest that protection from violence within homes, communities and schools may interrupt risk pathways from HIV‐related health problems to psychological distress and internalized HIV stigma. This highlights the potential for interventions that do not explicitly target adolescents living with HIV but are sensitive to their needs.

The study was funded by a Norway Innovation Grant [RO19.04] toward the Romanian Ministry of Health/National Institute of Public Health as part of the "Multilevel intervention to prevent non-communicable disease associated with the life style" (2014–2016). Franziska Meinck was supported by an Economic and Social Research Council (ESRC) Future Research Leader Award [ES/N017447/1], the European Research Council under the European Union's Seventh Framework Programme [FP7/2007-2013, grant agreement 313421], the Leverhulme Trust [PLP-2014-095] and the University of Oxford's ESRC Impact Acceleration Account [1602-KEA-189; 1311-KEA-004 & 1609-GCRF-227]. ; Child abuse is a major public health problem. In order to establish the prevalence of abuse exposure among children, measures need to be age-appropriate, sensitive, reliable and valid. This study aimed to investigate the psychometric properties of the Adverse Childhood Experiences Questionnaire Abuse Short Form (ACE-ASF). The ACE-ASF is an 8-item, retrospective self-report questionnaire measuring lifetime physical, emotional and sexual abuse. Data from a nationally representative sample of 15-year-old, school-going adolescents (n = 1733, 55.5% female) from the Romanian Health Behavior in School-Based Children Study 2014 (HBSC) were analyzed. The factorial structure of the ACE-ASF was tested with Exploratory factor analysis (EFA) and confirmed using Confirmatory factor analysis (CFA). Measurement invariance was examined across sex, and internal reliability and concurrent criterion validity were established. Violence exposure was high: 39.7% physical, 32.2% emotional and 13.1% sexual abuse. EFA established a two-factor structure: physical/emotional abuse and sexual abuse. CFA confirmed this model fitted the data well [χ2(df) = 60.526(19); RMSEA = 0.036; CFI/TLI = 0.990/0.986]. Metric invariance was supported across sexes. Internal consistency was good (0.83) for the sexual abuse scale and poor (0.57) for the physical/emotional abuse scale. Concurrent criterion validity confirmed hypothesized relationships between childhood abuse and health-related quality of life, life satisfaction, self-perceived health, bullying victimization and perpetration, externalizing and internalizing behaviors, and multiple health complaints. Results support the ACE-ASF as a valid measure of physical, emotional and sexual abuse in school-aged adolescents. However, the ACE-ASF combines spanking with other types of physical abuse when this should be assessed separately instead. Future research is needed to replicate findings in different youth populations and across age groups. ; Publisher PDF ; Peer reviewed

Purpose The purposes of this systematic review were to systematically summarize components in existing school-based child sexual abuse (CSA) prevention programs and identify predictors for program effectiveness. Method Building upon the most comprehensive systematic review on this topic, we conducted systematic searches in both English-language from September 2014 to October 2020 and Chinese-language from inception to October, 2020. Meta-regressions were performed to identify predictors for program effectiveness. Results Thirty-one studies were included with a total sample size of 9049 participants. Results from meta-analyses suggested that interventions are effective in increasing participants' CSA knowledge as assessed via questionnaires ( g = 0.72, 95% CI [0.52–0.93]) and vignette-based measures ( g = 0.55, 95% CI [0.35–0.74]). Results from meta-regression suggested that interventions with more than three sessions are more effective than interventions with fewer sessions. Interventions appear to be more effective with children who are 8 years and older than younger children. Discussion CSA is a global issue that has significant negative effects on victims' physical, psychological, and sexual well-being. Our findings also provide recommendations for future research, particularly in terms of optimizing the effectiveness of school-based CSA prevention programs, and the better reporting of intervention components as well as participant characteristics.

AbstractParenting stress has a range of effects on parents and their children. Despite existing evidence on the effectiveness of family‐based interventions on reducing parenting stress, little is known about the mechanism of change that contributes to its reduction. This study investigates the mechanism of change in a parenting programme (Parenting for Lifelong Health [PLH]) on reducing parenting stress among parents of adolescents in South Africa. A pragmatic cluster randomized controlled trial was conducted among a total sample of 552 parents and primary caregivers (aged, M = 49.37; SD = 14.69) who were recruited from 40 communities in South Africa's Eastern Cape Province. A mediation analysis was performed to investigate direct and indirect effects using PROCESS macrostatistical software. The findings of the study indicate that parenting stress reduction operates via three significant mediators: improved parent–child relationship (β = 0.058, P < 0.000), reduced parental depression (β = −0.103, P < 0.000) and reduced family financial strain (β = −0.049, P < 0.000). The findings of the study highlight the importance of considering child, parental and contextual factors in the design and development of interventions aimed at reducing parenting stress in families in low‐ and middle‐income settings.

The impact of violence on children's health and development has had growing attention in global and national politics. Research on children's experiences of violence has increased in recent years, and this article aims to add to this literature by highlighting key messages and learning points from the experiences of researchers who have worked with children and violence across the different contexts of the UK and South Africa. As qualitative and quantitative researchers, our concepts, aims, methods, resources and approaches were very different, but we all faced similar challenges in working with children and violence in contexts where adults' views about what violence counted predominated. We argue that children's participation in research and highlighting children's own understandings, agency and negotiations in relation to violence are crucial for challenging sometimes unhelpful taken-for-granted views about the impact of violence on children's lives.

The impact of violence on children's health and development has had growing attention in global and national politics. Research on children's experiences of violence has increased in recent years and this paper aims to add to this literature by highlighting key messages and learning points from the experiences of researchers who have worked with children and violence across the different contexts of the UK and South Africa. As qualitative and quantitative researchers, our concepts, aims, methods, resources and approaches were very different but we all faced similar challenges in working with children and violence in contexts were adults' views about what violence counted predominated. We argue that children's participation in research and highlighting children's own understandings, agency and negotiations in relation to violence are crucial for challenging sometimes unhelpful taken for granted views about the impact of violence on children's lives. Keywords: childhood; cross national research, child abuse, family violence, domestic violence