SETTING: Nine high-burden public tuberculosis (TB) clinics in Gaborone, Botswana.OBJECTIVE: To evaluate the challenges encountered, healthcare worker (HCW) approaches, and supported interventions in TB and TB-HIV (human immunodeficiency virus) care for adolescents and young adults (AYA, aged 10–24 years).DESIGN: Semi-structured interviews with HCW in TB clinics, analyzed using thematic analysis.RESULTS: Sixteen HCWs were interviewed. AYA developmental needs included reliance on family support for care, increasing autonomy, attending school or work, building trust in HCWs, and intensive TB education and adherence support. Stigma strongly influenced care engagement, including clinic attendance and HIV testing. Health system barriers to optimal AYA TB care included limited staffing and resources to follow-up or support. HCWs utilized intensive education and counseling, and transitioned AYA to community-based directly observed therapy whenever feasible. HCWs supported implementation of youth-friendly services, such as AYA-friendly spaces or clinic days, training in AYA care, use of mobile applications, and peer support interventions, in addition to health system strengthening.CONCLUSION: HCWs utilize dedicated approaches for AYA with TB, but have limited time and resources for optimal care. They identified several strategies likely to improve care and better retain AYAs in TB treatment. Further work is needed to study interventions to improve AYA TB care and outcomes.

Environment is key to human development, yet the complex network structure of exposures (i.e., exposome) makes it challenging to investigate. Here, we analyzed data from the Adolescent Brain and Cognitive Development (ABCD) Study , a large, diverse sample of US adolescents (N=11,235, mean age=10.9, 52% male) with phenotyping at multiple levels of environmental exposure. Applying data-driven iterative factor analyses and bifactor modeling, we reduced dimensionality from hundreds of exposures to six exposome subfactors and a general (adverse) exposome factor. These factors revealed quantitative differences among racial and ethnic groups. Exposome factors increased variance explained in mental health by 10-fold (from <4% to >38%), over and above other commonly used sociodemographic factors. The general exposome factor was associated with psychopathology (Beta=0.27) and key health-related outcomes: obesity (OR=1.4) and advanced pubertal development (OR=1.3). Findings highlight the exposome role in adolescent health and demonstrate the critical need to study environment using the exposome framework.

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Exposures to perinatal, familial, social, and physical environmental stimuli can have substantial effects on human development. We aimed to generate a single measure that capture’s the complex network structure of the environment (i.e., exposome) using multi-level data (participant’s report, parent report and geocoded measures) of environmental exposures (primarily from the psychosocial environment) in two independent adolescent cohorts: The Adolescent Brain Cognitive Development Study (ABCD Study, N = 11,235, mean age 10.9 years, 47.7% females) and an age- and sex-matched sample from the Philadelphia Neurodevelopmental Cohort (PNC, N = 4,993). We conducted a series of data-driven iterative factor analyses and bifactor modeling in the ABCD Study, reducing dimensionality from 348 variables tapping to environment to six orthogonal exposome subfactors and a general (adverse) exposome factor. The general exposome factor was associated with overall psychopathology (B = 0.28, 95%CI 0.26-0.3) and key health-related outcomes: obesity (OR = 1.4, 95%CI 1.3-1.5) and advanced pubertal development (OR = 1.3, 95%CI 1.2-1.5). A similar approach in PNC reduced dimensionality of environment from 29 variables to four exposome subfactors and a general exposome factor. PNC analyses yielded consistent associations of the general exposome factor with psychopathology (B = 0.15, 95%CI 0.13-0.17), obesity (OR = 1.4, 95%CI 1.3-1.6) and advanced pubertal development (OR = 1.3, 95%CI 1-1.6). In both cohorts, inclusion of exposome factors greatly increased variance explained in overall psychopathology compared to models relying solely on demographics and parental education (from &lt;4% to &gt; 38% in ABCD; from &lt;4% to &gt; 18.5% in PNC). Findings suggest that a general exposome factor capturing multi-level environmental exposures can be derived and can consistently explain variance in youth’s mental and general health.

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IMPORTANCE Childhood suicidality (ie, suicidal ideation or attempts) rates are increasing, and attention-deficit/hyperactivity disorder (ADHD) and externalizing symptoms are common risk factors associated with suicidality. More data are needed to describe associations of ADHD pharmacotherapy with childhood suicidality. OBJECTIVE To investigate the associations of ADHD pharmacotherapy with externalizing symptoms and childhood suicidality. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, cross-sectional and 1-year-longitudinal associations were examined using data (collected during 2016-2019) from the Adolescent Brain Cognitive Development (ABCD) Study, a large, diverse US sample of children aged 9 to 11 years. Data analysis was performed from November to December 2020.EXPOSURES Main and interaction associations of externalizing symptoms (hyperactivity ADHD symptoms, oppositional defiant, and conduct disorder symptoms) and ADHD medication treatment (methylphenidate and amphetamine derivatives, α-2-agonists, and atomoxetine) at baseline assessment. MAIN OUTCOMES AND MEASURESChild-reported suicidality (past and present at baseline; current at longitudinal assessment). Covariates were age, sex, race/ethnicity, parents' education, marital status, and concomitant child psychiatric pharmacotherapy (antidepressants and antipsychotics). RESULTS Among 11 878 children at baseline assessment (mean [SD] age, 9.9 [0.6] years; 6196 boys [52.2%]; 8805 White [74.1%]), 1006 (8.5%) were treated with ADHD medication and 1040 (8.8%) reported past or current suicidality. Externalizing symptoms (median [range], 1 [0-29] symptom count) were associated with suicidality (for a change of 1 SD in symptoms, odds ratio [OR], 1.34; 95%