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The global adolescent population is larger than ever before and is rapidly urbanizing. Global surveillance systems to monitor youth health typically use household- and school-based recruitment methods. These systems risk not reaching the most marginalized youth made vulnerable by conditions of migration, civil conflict and other forms of individual and structural vulnerability. We describe the methodology of the Well Being of Adolescents in Vulnerable Environments (WAVE) survey, which used respondent-driven sampling (RDS) to recruit male and female youth aged 15 to 19 years and living in economically distressed urban settings in Baltimore, USA, Johannesburg, South Africa, Ibadan, Nigeria, Delhi, India and Shanghai, China (migrant youth only) for a cross-sectional study. We describe a shared recruitment and survey administration protocol across the five sites, present recruitment parameters, and illustrate challenges and necessary adaptations for use of RDS with youth in disadvantaged urban settings. We describe the reach of RDS into populations of youth who may be missed by traditional householdbased and school-based sampling. Across all sites, an estimated 9.6% were unstably housed; among those enrolled in school, absenteeism was pervasive with 29% having missed over 6 days of school in the past month. Overall findings confirm the feasibility, efficiency and utility of RDS in quickly reaching diverse samples of youth, including those both in and out of school and those unstably housed, and provide direction for optimizing RDS methods with this population. In our rapidly urbanizing global landscape with an unprecedented youth population, RDS may serve as a valuable tool in complementing existing household- and school-based methods for health-related surveillance that can guide policy.

BackgroundWhile 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.MethodsThe 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.ResultsWhile 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.ConclusionsAdolescent 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1597-x) contains supplementary material, which is available to authorized users.

Background Social capital is essential for the successful development of young people. The current study examines direct measures of social capital in young people in five urban global contexts. Methods The Well Being of Adolescents in Vulnerable Environments (WAVE) is a global study of young people aged 15 to 19 years living in disadvantaged, urban settings. Respondent Driven Sampling (RDS) was used to recruit approximately 500 participants from each site. The sample included 2339 young people (mean age 16.7 years; 47.5% female). We examined the associations between social capital in four domains -family, school, peers and neighborhood -and demographic characteristics using gender stratified Ordinary Least Squares regression. We also examined associations between self-reported health and the four social capital domains is minimal. School enrollment was positively associated with social capital for young women in Baltimore, Delhi, and Shanghai: the association was less consistent for young men. The same pattern is true for perceived wealth. Unstable housing was associated with low familial social capital in all groups except young women in Shanghai and young men in Ibadan and Johannesburg. Being raised outside a two-parent family has a widespread, negative association with social capital. Self-reported health had a mainly positive association with social capital with the most consistent association being neighborhood social capital, Conclusions Different types of social capital interact with social contexts and gender differently. Strategies that aim to build social capital as part of risk reduction and positive youth development programming need to recognize that social capital enhancement may work differently for different groups and in different settings.

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