Access to healthcare for adolescents is often overlooked in the United States due to federal and state-sponsored insurance programs such as Medicaid and the Children’s Health Insurance Program. While these types of programs provide some relief, the issue of healthcare access goes beyond insurance coverage and includes an array of ecological factors that hinder youths from receiving services. The purpose of this scoping review was to identify social-ecological barriers to adolescents’ healthcare access and utilization in the United States. We followed the PRISMA and scoping review methodological framework to conduct a comprehensive literature search in eight electronic databases for peer-reviewed articles published between 2010 and 2020. An inductive content analysis was performed to thematize the categories identified in the data extraction based on the Social-Ecological Model (SEM). Fifty studies were identified. Barriers across the five SEM levels emerged as primary themes within the literature, including intrapersonal-limited knowledge of and poor previous experiences with healthcare services, interpersonal-cultural and linguistic barriers, organizational-structural barriers in healthcare systems, community-social stigma, and policy-inadequate insurance coverage. Healthcare access for adolescents is a systems-level problem requiring a multifaceted approach that considers complex and adaptive behaviors.

Background: Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of the internal barriers associated with physical activity. Objective: The primary aim of this study was to investigate the acceptability of an electronically delivered physical activity intervention for survivors of breast cancer, centered on ACT processes. Methods: This study used a 1-group pretest-posttest design. We recruited 80 insufficiently active female survivors of breast cancer using a web-based recruitment strategy. The 8-week intervention consisted of weekly modules that featured didactic lessons and experiential exercises targeting key ACT processes in the context of physical activity promotion (namely, values, committed action, acceptance, defusion, and contacting the present moment). We determined intervention acceptability according to study retention (≥70%), adherence rates (≥75% of the participants completing ≥50% of the modules), and posttest survey scores reflecting the perceived ease of use, perceived usefulness, and interest and enjoyment of the intervention (≥5 on a 7-point Likert-type scale). We also evaluated changes in self-reported aerobic and muscle strengthening–physical activity, physical activity acceptance, physical activity regulation, and health-related outcomes. Results: The retention rate (61/80, 76%), adherence rate (60/80, 75%), average perceived ease of use (6.17, SD 1.17), perceived usefulness (5.59, SD 1.40), and interest and enjoyment scores (5.43, SD 1.40) met the acceptability criteria. Participants increased their self-reported aerobic physical activity (Cohen d=1.04), muscle strengthening–physical activity (Cohen d=1.02), physical activity acceptance (cognitive acceptance: Cohen d=0.35; behavioral commitment: Cohen d=0.51), physical activity regulation (identified regulation: Cohen d=0.37; integrated regulation: Cohen d=0.66), increased their ability to participate in social roles and activities (Cohen d=0.18), and reported less fatigue (Cohen d=0.33) and sleep disturbance (Cohen d=0.53). Conclusions: Electronically delivered acceptance- and mindfulness-based interventions may be useful for promoting physical activity in survivors of breast cancer. Further research is needed to refine these approaches and evaluate their effectiveness.

Physical activity (PA) decreases during summer months, potentially leading to accelerated weight gain and increased depressive symptoms in adolescents. Summer care programs offer opportunities for PA promotion but understanding how different groups (based on initial perceived and objectively measured PA) respond to these programs is crucial for developing focused interventions. Adolescents (n = 47; mean age = 11.0 years; 51.1% female) who participated in an 8-week summer program wore ActiGraph GT9X accelerometers to measure moderate-to-vigorous physical activity (MVPA) at the beginning and end of the program. Self-reported PA was assessed using the Health Behavior in School-Aged Children survey. Both measures were then transformed into respective z-scores. K-means cluster analysis was performed to identify distinct groups based on device-measured and perceived PA at the beginning of summer. Changes in MVPA were compared across clusters using one-way ANOVA and post hoc Tukey’s HSD tests. Three clusters were identified: “High Accuracy Actives” (n = 17), “Underestimators” (n = 22), and “Overestimators” (n = 8). “Overestimators” showed the largest mean increase in MVPA (30.63 min/day), followed by “Underestimators” (17.76 min/day). “High Accuracy Actives” experienced a mean decrease in MVPA (−7.69 min/day). ANOVA revealed significant differences in MVPA change between clusters (F(2,44) = 4.93, p = 0.01). Summer care programs can positively impact adolescent PA, particularly for those who initially underestimate or overestimate their activity levels. However, strategies are needed to prevent declines among initially highly active participants. For example, adolescents who underestimate their activity levels may benefit from interventions focused on building self-efficacy and providing positive feedback, while those who overestimate might require educational components about PA guidelines and self-monitoring techniques.