title: How adolescents perceive their communities: a qualitative study that explores the relationship between health and the physical environment.
abstract: BACKGROUND
  The Well-Being of Adolescents in Vulnerable Environments (WAVE) study was conducted among adolescents aged 15-19 years in Baltimore, Ibadan, Johannesburg, New Delhi, and Shanghai to examine perceived factors related to their health. A preliminary analysis of the data, unexpectedly, revealed that the influence of the physical environment on adolescent health was a dominant theme across every site examined. To explore this further, this paper analyzed the specific components of the physical environment that were perceived to influence health, and how they contributed to various health outcomes across sites.
  
  
  METHODS
  Researchers in each site conducted in-depth interviews among adolescents; community mapping and focus groups among adolescents; a Photovoice methodology, in which adolescents were trained in photography and took photos of the meaning of 'health' in their communities; and key informant interviews among adults who work with young people. A total 529 participants from across the sites were included in the analysis.
  
  
  RESULTS
  Findings showed that while there was surprising uniformity in how adolescents characterized their physical environment, perceived health outcomes related to the physical environment varied by site and gender. In Baltimore and Johannesburg, vacant homes and the lack of recreation facilities were perceived to impact on sexual and reproductive health problems for girls, while among boys they contributed to drugs and violence. In Shanghai, New Delhi, and Ibadan, garbage and trash observed in their communities were perceived to have a higher impact on infectious and chronic diseases.
  
  
  CONCLUSIONS
  As the world continues to urbanize, our study points to a strong need to examine how the physical aspects of a living environment contribute to the health of adolescents. Specific aspects, such as housing, safety, garbage, and recreational spaces must all be examined as possible pathways for making improvements to health of adolescents, particularly among those living in poor urban environments.
authors.affiliation: Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N, Wolfe Street, Baltimore, MD 21205, USA. kmmari1@jhu.edu.
authors.forename: Kristin
authors.initials: K
authors.lastname: Mmari
authors.forename: Hannah
authors.initials: H
authors.lastname: Lantos
authors.forename: Heena
authors.initials: H
authors.lastname: Brahmbhatt
authors.forename: Sinead
authors.initials: S
authors.lastname: Delany-Moretlwe
authors.forename: Chaohua
authors.initials: C
authors.lastname: Lou
authors.forename: Rajib
authors.initials: R
authors.lastname: Acharya
authors.forename: Adesola
authors.initials: A
authors.lastname: Sangowawa
mesh_terms: D000293:Adolescent; D000328:Adult; D015142:Baltimore; D002681:China; D004777:Environment; D005260:Female; D017144:Focus Groups; D005735:Garbage; D006301:Health Services Needs and Demand; D006304:Health Status; D006798:Housing; D006801:Humans; D007194:India; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D009549:Nigeria; D010465:Perception; D036301:Qualitative Research; D011998:Recreation; D012111:Residence Characteristics; D012449:Safety; D012737:Sex Factors; D012959:Socioeconomic Factors; D013019:South Africa; D014504:Urban Health / Q000706:statistics & numerical data*; D014754:Violence; D055815:Young Adult
references.citation: J Urban Health. 2008 Sep;85(5):787-801
references.pmid: 18668367
references.citation: J Adolesc Health. 2015 Feb;56(2):188-96
references.pmid: 25620301
references.citation: Soc Sci Med. 2013 Jan;77:20-30
references.pmid: 23206559
references.citation: Int J Environ Res Public Health. 2012 Aug 24;9(9):3030-50
references.pmid: 23202669
references.citation: J Law Med Ethics. 2003 Winter;31(4):557-66
references.pmid: 14968658
references.citation: Int J Behav Nutr Phys Act. 2012 Jun 29;9:81
references.pmid: 22747523
references.citation: Annu Rev Public Health. 2005;26:341-65
references.pmid: 15760293
references.citation: J Nutr Educ Behav. 2002 Jul-Aug;34(4):224-30
references.pmid: 12217266
references.citation: Int J Health Geogr. 2012 Oct 17;11:46
references.pmid: 23075269
references.citation: Ann Behav Med. 2013 Feb;45 Suppl 1:S68-75
references.pmid: 23334761
references.citation: Int J Environ Res Public Health. 2011 Oct;8(10):3953-78
references.pmid: 22073022
references.citation: J Urban Health. 2007 May;84(3 Suppl):i16-26
references.pmid: 17356903
references.citation: Soc Sci Med. 2014 Mar;104:124-32
references.pmid: 24581070
references.citation: Health Place. 2012 Sep;18(5):1088-100
references.pmid: 22704913
references.citation: Clin Pediatr (Phila). 2012 Aug;51(8):750-8
references.pmid: 22563061
references.citation: Future Cardiol. 2012 Sep;8(5):677-9
references.pmid: 23013118
references.citation: Int J Health Geogr. 2012 Apr 26;11:11
references.pmid: 22537116
references.citation: Int J Behav Nutr Phys Act. 2012 May 23;9:59
references.pmid: 22620266