BACKGROUND: Engaging youth in mental health research and intervention design has the potential to improve their relevance and effectiveness. Frameworks like Roger Hart\'s ladder of participation, Shier\'s pathways to participation and Lundy\'s voice and influence model aim to balance power between youth and adults. Hart\'s Ladder, specifically, is underutilized in global mental health research, presenting new opportunities to examine power dynamics across various contexts. Drawing on Hart\'s ladder, our study examined youth engagement in mental health research across high- and middle-income countries using Internet-based technologies, evaluating youth involvement in decision-making and presenting research stages that illustrate these engagements.
METHODS: We conducted a directed content analysis of youth engagement in the study using primary data from project documents, weekly AirTable updates and discussions and interviews with youth and the research consortium. Using Hart\'s Ladder as a framework, we describe youth engagement along rungs throughout different research stages: cross-cutting research process, onboarding, formative research and quantitative and qualitative study designs.
RESULTS: Youth engagement in the MindKind study fluctuated between Rung 4 (\'Assign, but informed\') and Rung 7 (\'Youth initiated and directed\') on Hart\'s Ladder. Engagement was minimal in the early project stages as project structures and goals were defined, with some youth feeling that their experiences were underutilized and many decisions being adult-led. Communication challenges and structural constraints, like tight timelines and limited budget, hindered youth engagement in highest ladder rungs. Despite these obstacles, youth engagement increased, particularly in developing recruitment strategies and in shaping data governance models and the qualitative study design. Youth helped refine research tools and protocols, resulting in moderate to substantial engagement in the later research stages.
CONCLUSIONS: Our findings emphasize the value of youth-adult partnerships, which offer promise in amplifying voices and nurturing skills, leadership and inclusiveness of young people. Youth engagement in project decision-making progressed from lower to higher rungs on Hart\'s Ladder over time; however, this was not linear. Effective youth engagement requires dynamic strategies, transparent communication and mutual respect, shaping outcomes that authentically reflect diverse perspectives and mental health experiences.
UNASSIGNED: There was substantial patient and public involvement in this study. This paper reports findings on youth engagement conducted with 35 young people from India, South Africa and the United Kingdom, all of whom had lived experience of mental health challenges. Youth engagement in the MindKind study was coordinated and led by three professional youth advisors (PYAs) in these contexts, who were also young people with lived experience of mental health challenges. Each of the three study sites embedded a full-time, community-based PYA within their study team to inform all aspects of the research project, including the development of informational materials and the facilitation of Young People\'s Advisory Group (YPAG) sessions referenced in this paper. Each PYA also consulted with a site-specific YPAG that met bi-monthly throughout the project, shaping the formation of study materials and serving as a test group in both the quantitative and qualitative studies. Youth participants in this study also contributed extensively, engaging in data collection and manuscript writing. The following youth advisory panels members (J.B., L.B., D.O.J., M.V.) and all PYAs (E.B., S.R., R.S.) in the MindKind study contributed to the writing of this manuscript and are acknowledged as co-authors.

Addressing the intersection of food insecurity, malnutrition and climate change in Sub-Saharan Africa requires meaningful adolescent and youth engagement to drive sustainable change. Drawing on empirical evidence and collective experiences from youth-led initiatives and coalitions, four gaps and opportunities to better involve youth in programmes are discussed, including, the need to: (1) standardise the definition of youth to improve programme design and data harmonisation, (2) provide capacity building and mentorship for youth leadership in health service delivery, (3) foster youth leadership and multisectoral collaboration in food and health systems and (4) enhance capacity development for non-youth actors to support genuine youth participation. This viewpoint underscores the importance of involving African youth in public health nutrition, climate change and food security programmes design and implementation-as drivers of change to addressing hunger and climate crises. By centering youth voices and experiences, programmes and policies can better address African communities\' complex challenges, fostering inclusivity, sustainability and resilience in achieving better nutrition and public health programmes and outcomes.

BACKGROUND: Youth engagement refers to the collaboration between researchers and youth to produce research. Youth engagement in health research has been shown to inform effective interventions aimed at improving health outcomes. However, limited evidence has identified promising practices to meaningfully engage youth. This synthesis aims to describe youth engagement approaches, frameworks, and barriers, as well as provide both evidence-based and youth-generated recommendations for meaningful engagement.
METHODS: This review occurred in two stages: 1) a narrative review of existing literature on youth engagement and 2) a Youth Advisory Council (YAC) to review and supplement findings with their perspectives, experiences, and recommendations. The terms \'youth engagement\' and \'health research\' were searched in Google Scholar, PubMed, Web of Science, Scopus, and PsycINFO. Articles and non-peer reviewed research works related to youth engagement in health research were included, reviewed, and summarized. The YAC met with research team members and in separate youth-only forums to complement the narrative review with their perspectives. Types of youth engagement include participation as research participants, advisors, partners, and co-investigators. Barriers to youth engagement were organized into youth- (e.g., time commitments), researcher- (e.g., attitudes towards youth engagement), organizational- (e.g., inadequate infrastructure to support youth engagement), and system-level (e.g., systemic discrimination and exclusion from research). To enhance youth engagement, recommendations focus on preparing and supporting youth by offering flexible communication approaches, mentorship opportunities, diverse and inclusive recruitment, and ensuring youth understand the commitment and benefits involved.
CONCLUSIONS: To harness the potential of youth engagement, researchers need to establish an inclusive and enabling environment that fosters collaboration, trust, and valuable contributions from youth. Future research endeavors should prioritize investigating the dynamics of power-sharing between researchers and youth, assessing the impact of youth engagement on young participants, and youth-specific evaluation frameworks.
Engaging and partnering with youth in research related to healthcare is important, but often not done well. As researchers, we recognize that youth perspectives are needed to make sure we are asking the right questions, using appropriate research methods, and interpreting the results correctly. We searched the literature to identify challenges researchers have faced engaging youth in health research, as well as strategies to partner with youth in a meaningful way. We worked closely with 11 youth from across Canada with experience in healthcare, who formed a Youth Advisory Council. The youth advisors reviewed the literature we found and discussed how it fit with their own experiences and perspectives through group meetings with the research team. Youth advisors divided into four groups to co-author parts of this paper, including identifying the importance, benefits, and challenges of engaging in research and providing reflections on their positive and negative previous experiences as youth advisors. This paper provides an overview of recommendations for researchers to engage with youth in a meaningful way, including how they communicate and meet with youth, recognize their contributions, and implement feedback to improve the experiences of youth partners.

BACKGROUND: Youth engagement in research, wherein youth are involved in the research beyond mere participation as human subjects, is growing and becoming more popular as an approach to research. However, systematic and deliberate theory-building has been limited. We conducted a systematic review to identify and synthesize theories, models and frameworks that have been applied in the engagement of youth in health research, including mental health.
METHODS: Six academic databases (MEDLINE, PsycINFO, Embase, PubMed, Scopus, CINAHL) and the grey literature were searched for relevant studies. Citation tracking was conducted through ancestry and descendancy searches. The final search was completed on 7 February 2023. Findings were summarized in a narrative synthesis informed by principles of hermeneutic analysis and interpretation. Reporting of results is in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 Statement.
RESULTS: Of the 1156 records identified, 16 papers were included, from which we extracted named theories (n = 6), implicit theories (n = 5) and models and frameworks (n = 20) used for youth engagement in health research. We identified theories that were explicitly stated and surfaced theories that were more implicitly suggested. Models and frameworks were organized into four categories based on their principal features: power-focused (n = 8), process-focused (n = 7), impact-focused (n = 3) and equity-focused (n = 2). Few frameworks (n = 5) were empirically tested in health-related research.
CONCLUSIONS: The state of theoretical development in youth engagement in research is still evolving. In this systematic review, we identified theories, models and frameworks used for youth engagement in health research. Findings from this systematic review offer a range of resources to those who seek to develop and strengthen youth engagement in their own research.
UNASSIGNED: Youth engaged as patients in the research were not involved in planning or conducting the systematic review. However, youth researchers in their early to mid-20s led the planning, implementation and interpretation of the review. As part of subsequent work, we formed a youth advisory board to develop a youth-led knowledge mobilization intended for an audience of youth with lived experience of being engaged as patients in research.

BACKGROUND: Marketing has a significant impact on the normalisation of gambling for youth across the globe. This has included shaping positive attitudes towards gambling, as well as increasing the social and cultural acceptance of gambling - particularly aligned with valued activities such as sport. Because of this, public health experts argue that gambling marketing poses a significant risk to the health and wellbeing of youth. While young people are increasingly exposed to, and impacted by marketing for gambling products, they are rarely consulted about policy issues and options. This study aimed to explore young Australians\' perceptions of current policy responses to gambling advertising, whether they thought young people should be involved in discussions and decisions about gambling marketing regulations, and their perceptions of the duty of governments to protect young people from gambling industry marketing strategies.
METHODS: Qualitative focus groups (n = 22) were held with n = 64, 12-17 year olds in the Australian states of Victoria and New South Wales. Participants were asked to reflect on current gambling policies, particularly relating to marketing, what they thought should be done about gambling marketing, and if and how young people should be included in public health responses to gambling. An interpretivist \'Big Q\' approach to reflexive thematic analysis was used.
RESULTS: Young people highlighted the need for more effective regulations around the content and frequency of gambling marketing. They also wanted to see more realistic representations of the negative impacts of gambling to counter persistent positive commercial marketing messages. Most thought that young people should be given an opportunity to have a say about responses to gambling due to their unique experiences. Participants identified mechanisms to increase young people\'s engagement in decision making, such as direct lines of communication to different levels of government, involvement in research, and diversifying ways of engagement. Specific recommendations included more regulatory action such as bans on gambling advertising.
CONCLUSIONS: Creating formal structures that facilitate the inclusion of young people\'s perspectives in decisions made about gambling can result in more innovative and effective strategies to prevent the harms from gambling industry products, promotions, and practices.

More young people are living in the world than ever before, 90% of whom reside in low and middle income countries (LMICs). To address their needs, it is critical to have sustainable youth engagement when determining policy and to advance effective implementation of youth-focused interventions. Youth Community Advisory Boards (CABs) are a sustainable mechanism to achieve this goal. This paper describes engagement with youth CAB members across four locations in Tanzania. To set youth CAB meeting agendas and priorities, we asked youth CAB members to write (using free text) the top five challenges faced by young people in their communities (highest to lower priority). The Google Forms survey link was presented at the May 2023 youth CAB meeting and disseminated through WhatsApp. The survey was completed by smartphone, tablet, or paper provided to the youth liaison for data entry. Results were translated from Swahili to English and coded using excel. Findings were then presented back to the youth CABs at the September 2023 meeting. At that meeting, youth CAB members were then asked to write (free text) potential solutions to the most commonly described challenges. The surveys had response rates of 90% (84/93) for challenges and 78% (71/93) for solutions. The number one reported challenge was unemployment and financial instability (45%). Gender based violence (13%), sexual reproductive health issues (8%), and alcohol and drug use (8%) were in the top four both by priority and frequency of report. Other important challenges included physical and mental health, malnutrition, relationships, education, and societal and environmental norms, among others. Solutions included job creation, improved education, expanded legal systems, youth-friendly health care services, and increased social support through peer networks and community support. The National Accelerated Action and Investment Agenda for Adolescent Health and Wellbeing (NAIA-AHW) 2021/22-2024/25 includes most, but not all, of these top challenges and solutions. Ensuring young people have a seat at the policy table is critical to effective youth-empowerment in health and other related programs. Including a youth CAB member to represent this collective in youth-related government activities is a sustainable model to achieve this goal.

OBJECTIVE: There are various ways to integrate the lived experiences and perspectives of youth and young adults into Maternal Child Health (MCH) goals, initiatives, and programs. This article describes the history, evolution, and current strategy of a program that engages youth from across the state of Wisconsin. It serves as an example for others who may be interested in building capacity for youth leadership and engagement.
METHODS: The Providers and Teens Communicating for Health (PATCH) Program started as a community-based pilot project and evolved into a robust statewide youth engagement infrastructure.
CONCLUSIONS: Meaningful youth engagement requires capacity, adaptability, and expertise. Thus, in this case, it has proven advantageous to develop complementary and mutually beneficial partnerships to support adolescent health more effectively and efficiently in Wisconsin.

Engagement in youth programs is a potential means to promote health and well-being across populations of young people. Safer spaces in these youth programs are likely critical in fostering positive health outcomes, but current research on the links between safer spaces and health is limited. In this exploratory study, we examined links between program safety in youth development programs and minoritized status, and health-related quality of life (HRQoL) and psychosomatic health complaints. Participants (N = 282; Mean age = 16.97 years; SD = 2.97) self-identified across various minority status groups, including LGBTQ (30%) and a range of perceived income levels. We tested a statistical model in which safer spaces, LGBTQ status and perceived income predicted HRQoL and health complaints in youth development program participants. LGBTQ status and lower perceived income were related to lower HRQoL and more health complaints, and safer space in youth development programs was related to better HRQoL. We also found an interaction effect, such that safer spaces in youth programs appeared to be especially beneficial for HRQoL for youth with higher incomes. Findings reinforce past research on LGBTQ status and income as factors for youth wellness and mental health. Findings also suggest that perceived safer spaces in youth development programs support better HRQoL and lower health complaints, across populations of participating youth.

Young adults of color with foster care experience are disproportionately represented in foster care in the United States. Developing meaningful connections with child welfare professionals can help young adults develop healthy relationships in emerging adulthood.
This exploratory qualitative study addressed how young adults with foster care experience described their relationships with child welfare professionals and the impact of these relationships on their overall mental health and well-being in young adulthood.
A sample of young adults of color, (ages 18-29) with lived experience in foster care from a performing arts program in New York City.
Reflexive thematic analysis was conducted on 14 semi-structured interviews with young adults of color with prior or ongoing foster care experience.
The following themes were identified: safe space to be myself, listen to more than words, and understand my trauma. Child welfare professionals were dropped from support networks if they were disingenuous or did not attend to their own self-care needs.
The study underscores the importance of promoting positive mental health outcomes for young adults through building stronger connections with child welfare professionals. Future research should explore the incorporation of individualized approaches to better serve this population of young adults.

Little is known about the experience and impact of intersectional stigma experienced by rural young people (15-25 years) who have a parent with mental health challenges. The StigmaBeat project employed a co-design approach to create short films to identify and challenge mental health stigma from the perspective of young people who have experienced this phenomenon. The aim of this paper is to describe the co-design methodological approach used in StigmaBeat, as an example of a novel participatory project. We describe one way that co-design can be employed by researchers in collaboration with marginalised young people to produce films aimed at reducing mental health stigma in the community. Through describing the processes undertaken in this project, the opportunities, challenges, and tensions of combining community development methods with research methods will be explored. Co-design with young people is a dynamic and engaging method of collaborative research practice capable of harnessing lived experience expertise to intervene in social issues and redesign or redevelop health services and policies. The participatory approach involved trusting and implementing the suggestions of young people in designing and developing the films and involved creating the physical and social environment to enable this, including embedding creativity, a critical element to the project\'s methodological success. Intensive time and resource investment are needed to engage a population that is often marginalised in relation to stigma discourse.