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The dual crises of COVID-19 and climate change are impacting the lives of adolescents and young people as they transition to adulthood in an uncertain world, yet they are often excluded from research and political discourse. We surveyed young people about their needs and experiences, critical to engaging them and designing effective programs and policies to address these intersecting harms. The 2022 round of a national online survey through the Violence Outcomes in COVID-19 Epoch (VoCes) Study surveyed 152,088 Mexican youth (15-24 years). Logistic regressions were implemented to identify characteristics associated with four climate responses (economic, work-related, receiving government support, or social network support). Overall, 8.1% of participants experienced a recent climate hazard, with major impacts including housing damage from floods, and crop/livestock losses from drought. Participants who experienced a climate hazard were more likely to have experienced a pandemic-related harm, suggesting a dual impact. Poor youth were more likely to report economic losses from both the pandemic and a climate event but least likely to receive government support. Economic effects from the pandemic are exacerbating climate-related harms, unequally threatening the poorest youth. Engaging young people in decision-making and supporting the most vulnerable youth is critical for the next generation to thrive.

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PURPOSE: Studies have documented diverse adverse effects of the COVID-19 pandemic on young people's lives-for instance on mental health, education/employment prospects, and intrafamily violence. We sought to generate much-needed evidence regarding whether, and which, young people are experiencing multiple intersecting effects. METHODS: Data come from cross-sectional surveys with young people ages 15-25 years in Mexico (nationwide, n = 55,692), Kenya (four counties, n = 2,750), and India (two states, n = 3,537), collected from late 2020 to early 2022. We used latent class analysis to identify subgroups based on multiple adverse effects, then examined associations between these subgroups and COVID-19 infections/family deaths, and sociodemographic characteristics. RESULTS: We found prevalent adverse impacts overall and two distinct subgroups in each country-one experiencing higher levels of all impacts, such as on mental health (44%-78% across countries), education/employment (22%-84%), intrafamily violence (22%-49%), and friendships (66%-86%). This subgroup comprised 40% of the sample in Mexico, 25% in Kenya, and 35% in India. In multivariate analyses, this group consistently had greater odds of experiencing COVID-19-related infections and deaths of loved ones. They were more likely socioeconomically disadvantaged, older, urban residents. Associations with other characteristics were country-specific. DISCUSSION: This study provides novel cross-country evidence that a subgroup of young people has experienced intersecting adverse impacts of COVID-19 on their lives. Findings also confirm prior evidence of multiple elevated vulnerabilities in general. Expanded provision of multiple layers of support is required, particularly for the most vulnerable subgroup, as are multi-sectoral policies and interventions to prevent intersectional effects in future times of crisis.

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OBJECTIVE: Limited evidence exists on interventions aimed at enabling reproductive health (RH) services access for undocumented female migrants and refugee women. We aimed to identify intervention characteristics and impacts on RH outcomes among migrants and refugee women in protracted situations. METHODS: We conducted a systematic literature review of RH intervention studies that reported on migrants and refugee women in protracted situations. We applied 2 search strategies across 6 databases to identify peer-reviewed articles in English, Spanish, and Portuguese. Eligible studies were assessed for content and quality. RESULTS: Of the 21,453 screened studies, we included 10 (all observational) for final data extraction. Interventions implemented among migrant and refugee women included financial support (n=2), health service delivery structure strengthening (n=4), and educational interventions (n=4). Financial support intervention studies showed that enabling women to obtain RH services for free or at a low cost promoted utilization (e.g., increased use of contraception). Interventions that established or strengthened health service delivery structures and linkage demonstrated increased prenatal visits, decreased maternal mortality, and facilitated access to safe abortion through referral services or access to medical abortion. Educational interventions indicated positive effects on RH knowledge and the importance of involving peers and meeting the unique needs of a mobile population. All intervention studies emphasized the need to accommodate migrant security concerns and cultural and linguistic needs. CONCLUSION: Interventions in protracted situations reported positive outcomes when they were migrant or refugee-centered and complementary, culturally acceptable, geographically proximate, and cost-sensitive, as well as recognized the concerns around legality and involved opportunities for peer learning. Free or low-cost RH services and greater availability of basic and emergency maternal and neonatal care showed the most promise but required further community outreach, education, and stronger referral mechanisms. We recommend further participatory implementation research linked to policy and programming.

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Objective. To investigate whether stature is associated with two highly prevalent cardiometabolic disorders—diabetes mellitus (DM) and high blood pressure (HBP) —in middle-aged Mexican women. Methods. We conducted a cross-sectional analysis of a sample of 93 481 middle-aged Mexican female teachers, all participating in the Mexican Teachers Cohort (MTC, or ESMaestras) study. We used a multivariable regression model to investigate the association of stature quintiles with the self-reported outcomes of DM and HBP. Results. After adjusting for birth cohort, ethnicity, family history, birthweight, occupation of household’s head during participant’s childhood, menopausal status, and geographical region of birthplace, stature was inversely associated with DM, with the odds for DM being 9% higher in the lowest stature quintile when compared to the highest stature quintile. Stratification for location of residence resulted in confirmation of the above-mentioned findings only in participants living in urban environments. Conclusions. We found an inverse association of stature with DM but not with HBP. Our data suggest that urban setting might be an important effect modifier of this association, which merits further investigation since it might provide valuable insights into the epidemiological transition occurring in developing countries.

Objetivo. Investigar si la estatura está asociada a dos trastornos cardiometabólicos — diabetes sacarina e hipertensión arterial— muy prevalentes en las mujeres mexicanas de mediana edad. Métodos. Realizamos un análisis transversal de una muestra de 93 481 maestras mexicanas de mediana edad que participaban en el Estudio de la Salud de las Maestras (ESMaestras). Utilizamos un modelo de regresión multivariante para investigar la relación entre los quintiles de estatura y los resultados autonotificados de diabetes sacarina e hipertensión arterial. Resultados. Después de ajustar los datos en función de la cohorte de nacimiento, la etnicidad, los antecedentes familiares, el peso al nacer, la ocupación del jefe del hogar durante la niñez de la participante, el estado menopáusico y la zona geográfica del lugar de nacimiento, se observó una relación inversa entre la estatura y la diabetes sacarina, dado que las probabilidades de aparición de esta última fue un 9 % mayor en el quintil más bajo de estatura que en el quintil más alto. La estratificación en función de la residencia permitió confirmar los resultados mencionados solo respecto de aquellas participantes que vivían en entornos urbanos. Conclusiones. Encontramos una relación inversa entre la estatura y la diabetes sacarina, pero no entre la estatura y la hipertensión arterial. Nuestros datos indican que el entorno urbano podría modificar considerablemente el efecto de esta relación, lo que amerita continuar con las investigaciones dado que podrían arrojar una luz valiosa sobre la transición epidemiológica en los países en desarrollo.

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OBJECTIVE: To investigate whether stature is associated with two highly prevalent cardiom- etabolic disorders-diabetes mellitus (DM) and high blood pressure (HBP) -in middle-aged Mexican women. METHODS: We conducted a cross-sectional analysis of a sample of 93 481 middle-aged Mexican female teachers, all participating in the Mexican Teachers Cohort (MTC, or ESMaestras) study. We used a multivariable regression model to investigate the association of stature quintiles with the self-reported outcomes of DM and HBP. RESULTS: After adjusting for birth cohort, ethnicity, family history, birthweight, occupation of household's head during participant's childhood, menopausal status, and geographical region of birthplace, stature was inversely associated with DM, with the odds for DM being 9% higher in the lowest stature quintile when compared to the highest stature quintile. Stratification for location of residence resulted in confirmation of the above-mentioned findings only in partici- pants living in urban environments. CONCLUSIONS: We found an inverse association of stature with DM but not with HBP. Our data suggest that urban setting might be an important effect modifier of this association, which merits further investigation since it might provide valuable insights into the epidemiological transition occurring in developing countries.

OBJETIVO: Investigar si la estatura está asociada a dos trastornos cardiometabólicos ­ diabetes sacarina e hipertensión arterial­ muy prevalentes en las mujeres mexicanas de mediana edad. MÉTODOS: Realizamos un análisis transversal de una muestra de 93 481 maestras mexicanas de mediana edad que participaban en el Estudio de la Salud de las Maestras (ESMaestras). Utilizamos un modelo de regresión multivariante para investigar la relación entre los quintiles de estatura y los resultados autonotificados de diabetes sacarina e hipertensión arterial. RESULTADOS: Después de ajustar los datos en función de la cohorte de nacimiento, la etnicidad, los antecedentes familiares, el peso al nacer, la ocupación del jefe del hogar durante la niñez de la participante, el estado menopáusico y la zona geográfica del lugar de nacimiento, se observó una relación inversa entre la estatura y la diabetes sacarina, dado que las probabilidades de aparición de esta última fue un 9 % mayor en el quintil más bajo de estatura que en el quintil más alto. La estratificación en función de la residencia permitió confirmar los resultados mencionados solo respecto de aque- llas participantes que vivían en entornos urbanos. CONCLUSIONES: Encontramos una relación inversa entre la estatura y la diabetes saca- rina, pero no entre la estatura y la hipertensión arterial. Nuestros datos indican que el entorno urbano podría modificar considerablemente el efecto de esta relación, lo que amerita continuar con las investigaciones dado que podrían arrojar una luz valiosa sobre la transición epidemiológica en los países en desarrollo.

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ABSTRACT Objective To investigate whether stature is associated with two highly prevalent cardiometabolic disorders—diabetes mellitus (DM) and high blood pressure (HBP) —in middle-aged Mexican women. Methods We conducted a cross-sectional analysis of a sample of 93 481 middle-aged Mexican female teachers, all participating in the Mexican Teachers Cohort (MTC, or ESMaestras) study. We used a multivariable regression model to investigate the association of stature quintiles with the self-reported outcomes of DM and HBP. Results After adjusting for birth cohort, ethnicity, family history, birthweight, occupation of household's head during participant's childhood, menopausal status, and geographical region of birthplace, stature was inversely associated with DM, with the odds for DM being 9% higher in the lowest stature quintile when compared to the highest stature quintile. Stratification for location of residence resulted in confirmation of the above-mentioned findings only in participants living in urban environments. Conclusions We found an inverse association of stature with DM but not with HBP. Our data suggest that urban setting might be an important effect modifier of this association, which merits further investigation since it might provide valuable insights into the epidemiological transition occurring in developing countries.

RESUMEN Objetivo Investigar si la estatura está asociada a dos trastornos cardiometabólicos —diabetes sacarina e hipertensión arterial— muy prevalentes en las mujeres mexicanas de mediana edad. Métodos Realizamos un análisis transversal de una muestra de 93 481 maestras mexicanas de mediana edad que participaban en el Estudio de la Salud de las Maestras (ESMaestras). Utilizamos un modelo de regresión multivariante para investigar la relación entre los quintiles de estatura y los resultados autonotificados de diabetes sacarina e hipertensión arterial. Resultados Después de ajustar los datos en función de la cohorte de nacimiento, la etnicidad, los antecedentes familiares, el peso al nacer, la ocupación del jefe del hogar durante la niñez de la participante, el estado menopáusico y la zona geográfica del lugar de nacimiento, se observó una relación inversa entre la estatura y la diabetes sacarina, dado que las probabilidades de aparición de esta última fue un 9 % mayor en el quintil más bajo de estatura que en el quintil más alto. La estratificación en función de la residencia permitió confirmar los resultados mencionados solo respecto de aquellas participantes que vivían en entornos urbanos. Conclusiones Encontramos una relación inversa entre la estatura y la diabetes sacarina, pero no entre la estatura y la hipertensión arterial. Nuestros datos indican que el entorno urbano podría modificar considerablemente el efecto de esta relación, lo que amerita continuar con las investigaciones dado que podrían arrojar una luz valiosa sobre la transición epidemiológica en los países en desarrollo.

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Structure of the Spanish version of the nine-item Patient Health Questionnaire (PHQ-9) has been inconclusive. We report the factor structure of the PHQ-9 in 55,555 women from the Mexican Teachers' Cohort (MTC). Factor structure of the PHQ-9 was assessed by exploratory and confirmatory factor analyses in two sub-samples (n = 27,778 and 27,777 respectively). A one-factor model of the PHQ-9 was the solution with the best fit to the data, exhibiting strong factor loadings (0.71 to 0.90) and high internal consistency (Cronbach's alpha = 0.89). A prevalence rate of moderate to high severity of depressive symptoms of 12.6% was identified. Results suggest that a global score is an appropriate measure of depressive symptoms and commend the use of the Spanish PHQ-9 as a measure of depression for research and clinical purposes.

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