Meaningful inclusion of young people’s perceptions and experiences of inequalities is argued to be critical in the development of pro-equity policies. Our study explored young people’s perceptions of what influences their opportunities to be healthy within their local area and their understandings of health inequalities. Three interlinked qualitative focus group discussions, each lasting 90 to 100 minutes, with the same six groups of young people (n = 42) aged 13–21, were conducted between February and June 2021. Participants were recruited from six youth groups in areas of high deprivation across three geographical locations in England (South Yorkshire, the North East and London). Our study demonstrates that young people understand that health inequalities are generated by social determinants of health, which in turn influence behaviours. They highlight a complex interweaving of pathways between social determinants and health outcomes. However, they do not tend to think in terms of the social determinants and their distribution as resulting from the power and influence of those who create and benefit from health and social inequalities. An informed understanding of the causes of health inequalities, influenced by their own unique generational experiences, is important to help young people contribute to the development of pro-equity policies of the future.

Background Across England, inequalities in health are worsening. They have been exacerbated by the COVID-19 pandemic and are particularly acute for some ethnic and socioeconomic groups, and some regions. Exploration of the public's understanding of health inequalities has increased, but few studies have looked at the views of young people. Our study seeks to redress this gap by exploring young people's perspectives of inequalities in health. MethodsWe did a qualitative study consisting of three interlinked focus groups (online and face-to-face) with young people from six youth organisations. Focus groups took place from Feb 10 to June 28, 2021. They were co-delivered with partnering youth organisations and involved participatory concept mapping activities and the discussion of health-related news articles. Working with youth organisations, we recruited young people (aged 13-21 years) from six youth groups in areas of high and mixed deprivation across three geographical locations in England (the North East, South Yorkshire, and London). Data were analysed using thematic analysis. The data management software NVivo 12 was used to facilitate coding. All participants provided written informed consent, following acquisition of verbal informed consent from parents or guardians. Ethical approval for the study was granted by the University of Sheffield, Durham University, and London School of Hygiene & Tropical Medicine ethics committees. Findings We ran 15 focus groups online and three face-to-face with 42 young people (19 male, 18 female, two nonbinary, and three trans-male). Numbers ranged from two to ten participants in each group. Young people described a variety of different factors that shaped their health, including individual behaviours, personal or household resources, relationships and community, local services, the physical environment (particularly reputation and safety), psychosocial factors (including sense of belonging), and the socioeconomic context of the area (eg, quality and quantity of local jobs). However, throughout their discussions they foregrounded the importance of interrelationships between factors. Young people's understanding of inequalities in health were often rooted in their own experience and focused on an awareness of advantage and disadvantage. Young people articulated several different pathways through which they perceived health inequalities to be created, and consistently emphasised the importance of poverty as a root cause of inequality. Priorities for change included improving mental health support, access to safe and healthy local spaces, affordability of activities, healthy food availability, and youth group funding. Interpretation Our study highlights that young people have nuanced, experiential understandings of factors influencing their and other people's health within their local areas. Exploring young people's perspectives of inequalities is crucial in designing policies that are relevant to, and informed by, the people and places they affect.

PurposeThe use of online focus groups to explore children and young people's (CYP) perspectives of inequalities in health and associated “sensitive” topics raises important ethical and methodological issues to consider. The purpose of the paper is to discuss lessons learnt from navigating the authors' way through some of the key challenges the authors encountered when researching inequalities in health with CYP through online focus groups.Design/methodology/approachIn the paper, the authors draw on reflections and notes from the fieldwork design, public involvement and engagement (PIE) activities and data collection for their research project.FindingsCollecting data online influenced the authors' ability to develop rapport and relationships with CYP and to provide effective support when discussing sensitive topics. The authors note that building activities to develop rapport with participants during recruitment and data collection and establishing clear support and safeguarding protocols helped navigate challenges of online approaches around effective and supportive participant engagement.Originality/valueThe paper highlights that despite ethical and methodological challenges of conducting online focus groups with CYP on potentially sensitive topics, the adoption of practical steps and strategies before, during and following data collection can facilitate the safe participation of CYP and generate useful and valid data in meaningful and appropriate ways.

The global COVID-19 pandemic has created, exposed and exacerbated inequalities and differences around access to—and experiences and representations of—the physical and virtual spaces of young people’s leisure cultures and practices. Drawing on longstanding themes of continuity and change in youth leisure scholarship, this paper contributes to our understandings of ‘liminal leisure’ as experienced by some young people in the UK before and during the COVID-19 pandemic. To do this, we place primary pre-pandemic research on disadvantaged young people’s leisure spaces and practices in dialogue with secondary data on lockdown and post-lockdown leisure. Subsequently, we argue that existing and emergent forms of youth ‘leisure liminality’ are best understood through the lens of intersectional disadvantages. Specifically, pre-existing intersectional disadvantages are being compounded by disruptions to youth leisure, as the upheaval of the pandemic continues to be differentially experienced. To understand this process, we deploy the concept of liminal leisure spaces used by Swaine et al Leisure Studies 37:4,440-451, (2018) in their ethnography of Khat-chewing among young British Somali urban youth ‘on the margins’. Similarly, our focus is on young people’s management and negotiation of substance use ‘risks’, harms and pleasures when in ‘private-in-public’ leisure spaces. We note that the UK government responses to the pandemic, such as national and regional lockdowns, meant that the leisure liminality of disadvantaged young people pre-pandemic became the experience of young people more generally, with for example the closure of night-time economies (NTEs). Yet despite some temporary convergence, intersectionally disadvantaged young people ‘at leisure’ have been subject to a particularly problematic confluence of criminalisation, exclusion and stigmatisation in COVID-19 times, which will most likely continue into the post-pandemic future.

Background Supporting children and young people’s (CYP) mental and physical health is a global policy priority but detecting need and facilitating access to health services and support is challenging. This paper explores professional stakeholders’ perspectives of the acceptability, utility and effectiveness of a school-based online health and wellbeing screening tool, the Digital Health Contact (DHC). The DHC, delivered by Public Health School Nurses (PHSN), aims to identify, and put in place strategies to support, unmet health needs among CYP. Methods We employed a qualitative study design, using semi-structured interviews. Fourteen key stakeholders involved in the design and implementation of the DHC (commissioners, providers, PHSN and healthcare staff, school leaders) were purposively sampled. Data were analysed thematically. Results Our analysis generated two key themes: the perceived benefits of the DHC; and challenges in delivering the DHC. Stakeholders perceived the universal application of the DHC with linked follow-up intervention as an effective means of identifying and supporting CYP with unmet needs, and an efficient way to target limited service resources. There were barriers around enabling school engagement in the DHC, typically in terms of logistics, school infrastructure, and perspectives of fit with schools. These barriers were seen as being negated through developing effective working relationships between schools and PHSN. Effective relationships could highlight the potential benefits of participation. Overall, the DHC was seen as a valuable and effective use of resources, with a low burden on school staff. Conclusions The DHC, as a universal school-based health and wellbeing screening tool with linked follow-up intervention, has great potential in identifying and supporting unmet health needs among CYP. The perspectives and experiences of those involved in delivering the DHC highlight important considerations which may enable effective implementation and delivery of school screening programmes across other areas.