While adolescents’ access and utilization of health services is critical for ensuring their health, very few seek care, and if they do, it is primarily from family members, friends, or other non-formal sources of care. Examining the influence of the social context on adolescent health care seeking behaviors may provide us with a better understanding for how interventions can increase adolescents’ utilization of formal health care services. The study is based on qualitative and quantitative data collected as part of the Well Being of Adolescents in Vulnerable Environments (WAVE) study, one of the first global studies to focus on very disadvantaged urban adolescents (aged 15–19 years) across five diverse sites, which include: Baltimore (USA), Ibadan (Nigeria), Johannesburg (South Africa), New Delhi (India), and Shanghai (China). Qualitative data was based on numerous methodologies, including key informant interviews, a Photovoice exercise, community mapping, focus groups and in-depth interviews. Quantitative data was gathered from a cross-sectional Audio Computer Assisted Self Interview (ACASI) survey that was administered to approximately 450–500 adolescents per site, yielding a total of 2,393 adolescents. Respondent-driven sampling was used to ensure the sample include out-of-school youth and unstably housed youth who are often underrepresented in school-based or household-based samples. While adolescents in Baltimore, New Delhi, and Johannesburg were more likely to seek health services if they felt illness symptoms, a fairly large proportion of adolescents indicated that even when they needed health care, they didn’t seek it. In Johannesburg, more than 30 % of adolescents did not seek care even when they knew it was needed. Similarly, nearly a quarter of adolescents in Baltimore and in Shanghai indicated not seeking care when needed. Qualitative data indicated that adolescents exhibited a general lack of trust in providers and often felt embarrassed or stigmatized for seeking services. Multivariate analysis revealed that perceived fear and exposure to community violence was associated with a decreased likelihood of seeking care, while adult support from the home increased adolescents’ likelihood to seek care in Baltimore and Johannesburg. Adolescent health care seeking patterns vary substantially by setting and gender. Neighborhood and family environments are important contexts in which health seeking behaviors are shaped. Efforts to connect adolescents to health care will need to target neighborhood safety as well as trust and support among adults outside of provider settings.

Given the lack of attention on adolescent food insecurity, the primary objective of this study was to assess the association of household participation in federal food assistance programs with food security status among adolescents in Baltimore during the COVID-19 pandemic. Adolescents, ages 14–19 years, were invited to participate in two online surveys. The baseline was implemented between October 2020 and January 2021, while the follow-up took place one year later from November 2021 to January 2022 after schools had re-opened. We then matched survey participants with household participation in food nutrition assistance programs using data obtained from the Maryland Department of Social Services. We used logistic regression to examine the association between food assistance program participation status and food insecurity. Additionally, to examine whether the impact of program participation on food insecurity changed between the baseline survey and one year later at follow-up when schools re-opened, a difference-in-differences analysis was conducted. The results showed no significant associations between adolescent food security and participation in any of the federal nutrition assistance programs. Increased attention on how best to improve adolescent food security in low-income households that can respond to the unique needs of adolescents is clearly warranted.

The effects of online toxicity on children and adolescents permeate nearly every part of their lives. The harmful effects of online behavior and interactions increasingly impact not just students, but also teachers, school staff, and families, local education leaders, and even public confidence in education. Online toxicity is linked with serious mental health symptoms, school withdrawal and absenteeism, fighting and violence among students, and harassment of teachers, staff, and school board members. Increasingly, schools have looked to structural and policy interventions, including cell phone policies, to reduce the effects of negative online interactions on student behavior and learning during the school day; however, these approaches address only part of the problem. In this conceptual analysis, we begin by summarizing what is known about the impact of online toxicity on schools as organizations and the individuals who interact with them. We propose a conceptual framework illustrating how online behavior affects schools (e.g., peer–to–peer, student-to-teacher, family-to-staff, community-to-staff) to help explain this phenomenon. Finally, we discuss the strengths and limitations of current interventions and highlight opportunities to enhance interventions to support the health and well-being of students and school communities navigating online toxicity.