SUPPLEMENT ARTICLE
Encou aging g ea e empowe men o adolescen s in consen
p ocedu es in social science esea ch and policy p ojec s
Odd un Samdal
1
| Isabelle Budin-Ljøsne
2
| Ellen Haug
1
| T ond Helland
1
|
Lina Kjos a o a-Unko ska
3
| Clai e Bouillon
4
| Ch is ian B öe
5
|
Ma ia Co ell
6
| Alina Cosma
7
| Do o hy Cu ie
8
| Cha li E iksson
9
|
Rosema ie Felde -Puig
10
| Tania Gaspa
11
| Cu Hagquis
12
| Jane a Ha b on
13
|
A le Jås ad
14
| Cole e Kelly
15
| Cecile Knai
16
| Do o a Kleszczewska
17
|
Bja e Bi keland Kysnes
1
| Nanna Lien
18
| Aleksand a Luszczynska
19
|
Ge ben Moe man
5
| Concepcion Mo eno-Maldonado
20
| Saoi se NicGabhainn
15
|
I e a Pudule
21
| Jelena Gudelj Rakic
22
| Ana Ri o
23
|
Al ed Mes ad Rønnes ad
24
| Madeleine Uls ein
24
| Ha y Ru e
25
|
Knu -Inge Klepp
26
Co espondence
Odd un Samdal, Depa men o Heal h
P omo ion and De elopmen , Uni e si y o
Be gen, Be gen, No way.
Email: [email p o ec ed]
Funding in o ma ion
Eu opean Union's Ho izon 2020 esea ch and
inno a ion p og amme, G an /Awa d Numbe :
774210
Summa y
The Uni ed Na ions Con en ion on he Righ s o he Child emphasizes he impo -
ance o allowing child en and adolescen s o in luence decisions ha a e impo an
o hem ollowing hei age and ma u i y. This pape explo es he p inciples, p ac-
ices, and implica ions a ound using pa en al e sus child/adolescen consen when
pa icipa ing in social science esea ch and policy de elopmen . Expe iences om
wo s udies a e p esen ed: The Con on ing Obesi y: Co-c ea ing policy wi h you h
(CO-CREATE) and he Heal h Beha iou in School-aged Child en (HBSC) s udy, aWo ld
Heal h O ganiza ion (WHO) Collabo a i e C oss-Na ional s udy. Al hough pa en al con-
sen may be an impo an ga ekeepe o p o ec ing child en and adolescen s om
po en ially ha m ul esea ch pa icipa ion, i may also be conside ed an obs acle o
he empowe men o child en and adolescen s in case hey wan o sha e hei iews
and expe iences di ec ly. This pape a gues ha e alua ion o possible ha m should
be le o e hics commi ees and ha , i no ha m ela ed o he esea ch pa icipa ion
p ocesses is iden i ied and he p ojec has a clea pe spec i e on collabo a ing wi h
he a ge g oup, adolescen s om he age o 12 yea s should be g an ed he legal
capaci y o gi e consen o pa icipa e in he esea ch p ojec . Collabo a ion wi h
adolescen s in he de elopmen o he esea ch p ojec is encou aged.
Fo a ilia ions e e o page 9
Recei ed: 15 June 2023 Re ised: 23 July 2023 Accep ed: 25 July 2023
DOI: 10.1111/ob .13636
This is an open access a icle unde he e ms o he C ea i e Commons A ibu ion-NonComme cial License, which pe mi s use, dis ibu ion and ep oduc ion in any
medium, p o ided he o iginal wo k is p ope ly ci ed and is no used o comme cial pu poses.
© 2023 The Au ho s. Obesi y Re iews published by John Wiley & Sons L d on behal o Wo ld Obesi y Fede a ion.
Obesi y Re iews. 2023;24(S2):e13636. wileyonlinelib a y.com/jou nal/ob 1o 11
h ps://doi.o g/10.1111/ob .13636
KEYWORDS
adolescen consen , CO-CREATE s udy, HBSC s udy, pa en al consen
1|INTRODUCTION
Child and adolescen pa icipa ion in esea ch is aluable, and i is
impo an o unde s and and in eg a e his age g oup's pe spec i es in
policy and in e en ion de elopmen .
1–3
The Uni ed Na ions Con en-
ion on he Righ s o he Child (UNCRC)
4,5
and guidelines de eloped by
he Eu opean Commission and UNICEF
6
unde sco e he impo ance o
child en's and adolescen s' pa icipa ion in ma e s ha a ec hem,
including esea ch, and uphold hei igh o exp ess hei iews eely.
7
The UNCRC emphasizes ha child en's and adolescen s' iews should
be gi en weigh acco ding o hei e ol ing capaci ies and di e en ia e
be ween young child en and adolescen s nea e adul hood.
By allowing his age g oup o sha e hei li ed expe iences, he
inclusion o child en and adolescen s in social science esea ch ha
in es iga es a ious aspec s o hei social li e, beha io , and in e ac-
ions p o ides mo e comp ehensi e and nuanced esea ch indings o
use in a ge ed policy de elopmen . Conside ing he expe iences o
child en and adolescen s om di e en backg ounds, including hose
who may be mo e ulne able o ma ginalized, may educe dispa i ies
and p omo e equi y in in e en ions and policy. Howe e , i is c ucial o
ensu e ha e hical conside a ions, such as in o med consen , p i acy,
con iden iali y, and p o ec ion om ha m, a e add essed ca e ully when
in ol ing young people in esea ch.
3
I espec i e o hei age and gi en
hei psychological e ol ing ma u i y and incomple e abili y o unde -
s and he consequences o hei ac ions o choices, child en and adoles-
cen s should ecei e special p o ec ion om mal ea men , neglec
(UNCRC a icle 19), and economic exploi a ion (UNCRC a icle 32).
Pa en al consen is he p ocess o ob aining pe mission om a
leas one pa en o legal gua dian o mino s o in ol e hem in
esea ch s udies. In mos coun ies, i is an e hical and legal equi e-
men o ensu e he well-being and p o ec ion o child en and hei
igh s. The equi emen o pa en al consen ela es p ima ily o bio-
medical esea ch bu also applies o social science esea ch.
2,8
Ob ain-
ing pa en al consen assumes ha pa en s o legal gua dians
(he ea e e e ed o as “pa en s”) a e in he bes posi ion o make
decisions on behal o hei child en by conside ing hei bes in e -
es s, sa e y, and wel a e. Consen helps ensu e ha mino s a e no
subjec ed o esea ch ha could ha m hem physically, psychologi-
cally, o emo ionally. The consen p ocess ypically in ol es p o iding
pa en s wi h de ailed in o ma ion abou he esea ch s udy, including
i s pu pose, p ocedu es, po en ial isks and bene i s, and any mea-
su es aken o p o ec pa icipan s' p i acy and he con iden iali y o
hei da a. The pa en s a e hen asked o p o ide hei olun a y and
in o med consen on behal o he mino . Pa en al consen aims o
ensu e ha pa en s a e ully in o med abou he na u e o he
esea ch and can make decisions in he bes in e es o hei child by
weighing he po en ial isks and bene i s in ol ed.
Pa en al consen is usually p o ided in an ac i e o passi e o m.
Ac i e pa en al consen means ha he pa en s app o e hei child's pa -
icipa ion in a esea ch p ojec by p o iding ac i e con i ma ion, o
ins ance, by signing an in o med consen o m. By con as , passi e con-
sen means ha pa en s ecei e in o ma ion and espond only i hey do
no wan hei child o pa icipa e in he esea ch ac i i y. Collec ion o
he ac i e consen o pa en s emains a widesp ead equi emen o
e hics commi ees e iewing esea ch p ojec s. Howe e , he ideal o m
o consen (ac i e o passi e) has been deba ed o decades.
9–11
Depending on he na u e o he esea ch, addi ional assen om
he mino may also be equi ed. Assen is he child's o adolescen 's
ag eemen o a i ma i e esponse o pa icipa e in he esea ch,
which is sepa a e om pa en al consen . I ecognizes young people's
e ol ing capaci y o decision-making and allows hem o exp ess
hei willingness o pa icipa e.
2
Assen ypically in ol es p o iding
age-app op ia e in o ma ion abou he esea ch s udy o he child o
adolescen , explaining he pu pose, p ocedu es, po en ial isks and
bene i s, and any measu es o p o ec hei p i acy and con iden ial-
i y. The in o ma ion should be p esen ed in a manne ha he young
pe son can unde s and by using language and concep s ailo ed o
hei age and cogni i e de elopmen .
12
Pa en al consen aims o uphold p inciples such as espec o
au onomy, bene icence, and non-male icence. Howe e , he equi e-
men s o ob ain pa en al consen o he pa icipa ion o child en and
adolescen s in social science esea ch may ha e un o una e side
e ec s in some cases.
2,13
Fi s , mino s willing o pa icipa e in
esea ch may be p e en ed om doing so i hei pa en s disapp o e.
This may in e e e wi h he p inciples in a icle 12 o he UNCRC ou -
lining he child's igh o be hea d and may also be con adic o y o
cu en esea ch de elopmen s ha acknowledge he impo ance o
you h-led in ol emen in esea ch.
2,14,15
Ma hews
2
emphasizes ha
his is bo h an indi idual igh and a collec i e alue ega ding he
impac child en and adolescen s can and should be able o ha e in
e ms o ha ing hei li ed expe iences alida ed and included in pol-
icy de elopmen o he be e men o socie y. While in ol emen o
child en and adolescen s in esea ch and policymaking has been
inc easing o e he las decades, i migh come unde p essu e and
sc u iny soon. In an inc easing numbe o coun ies, an i- eminis
and an i-gende mo emen s a e g owing and in luencing poli ics.
16
This o en goes hand in hand wi h ede ining child en and adolescen s
as being in dange and in need o adul p o ec ion. Mo e b oadly,
he e is a educed emphasis on ci il socie y pa icipa ion in policy dis-
cussions and decision, whe e child en and ma ginalized g oups a e
especially a ec ed. Pa a ini e al.
17
highligh he impo ance o bo h
ea ing child en and adolescen s as objec s o esea ch s udies and
in i ing hem o become ac i e pa icipan s in he design o he
esea ch and la e in e p e a ion and dissemina ion o indings.
2o 11 SAMDAL ET AL.
1467789x, 2023, S2, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/ob .13636 by Readcube (Lab i a Inc.), Wiley Online Lib a y on [10/12/2024]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License
The second po en ial side e ec is ha collec ing he ac i e con-
sen o pa en s is mo e challenging han collec ing hei passi e
consen , despi e he de elopmen o digi al solu ions o pa en al con-
sen .
13
Ob aining consen om pa en s o low socioeconomic s a us
can be di icul because hey may no pe cei e he esea ch as ele-
an o may ind pa icipa ion di icul gi en logis ical issues such as
lack o anspo a ion, limi ed a ailabili y o ime, o language
ba ie s.
13,18,19
The lack o esponse om pa en s may lead o
biased ep esen a ion in esea ch p ojec s. Howe e , educed ep e-
sen a i eness in social science esea ch aiming o guide policy and
p ac ice de elopmen is p oblema ic because he needs o all socie al
g oups may no be conside ed.
2
The e a e also ci cums ances in which he equi emen s o collec
pa en al consen is p oblema ic o inapp op ia e (e.g., esea ch on
pa en al iolence). In in e na ional esea ch p ojec s, collec ing pa en al
consen may be challenging as consen equi emen s a y ac oss coun-
ies. Fo ins ance, pa en al consen is equi ed o adolescen s up o
he age o 18 yea s in Poland and Po ugal, whe eas adolescen s can
consen o pa icipa e in esea ch hemsel es om he age o 16 yea s
in Hunga y and he Ne he lands and om he age o 12 yea s in
C oa ia and he Czech Republic.
20
Such a ia ions in consen equi e-
men make i di icul o esea ch p ojec s o ha monize consen col-
lec ion p ocedu es when he esea ch akes place in a ious coun ies.
A gumen s ha e been made ha equi ing pa en al consen o
adolescen s aged 16 yea s o olde is an exp ession o o e p o ec-
ion
2,21–23
and may no be legally jus i ied in social science esea ch.
2
Pe haps, he same claim can be made o adolescen s as young as
12 yea s gi en ha adolescen s ha e been shown o ha e a g ea e
capaci y and ma u i y o unde s and he signi icance o esea ch and
he implica ions o he isk and bene i s o hemsel es han
expec ed.
2,17,24
A ecen s udy ac oss a wide ange o coun ies indi-
ca ed ha a sha p ad ance in he abili y o cogni i e app aisal occu s
om he age o 10 yea s and pla eaus a he age o 16 yea s, whe eas
psychological ma u i y con inues o de elop in o he 20s.
25
In mos o
he coun ies included in ha s udy, he cogni i e de elopmen was
conside ed o be ad anced a he age o 12 yea s.
In he UNCRC, he age o 12 yea s is speci ied as he age om
which he iew o he child should be gi en special weigh and consid-
e a ion. Re iew s udies ha e epo ed ha child en pa icipa ing in
esea ch in es iga ing sensi i e opics, such as iolence and heal h-
isk beha io s, see hei pa icipa ion as impo an and wo hwhile
e en i some sho - e m s ess is expe ienced.
2,26,27
The Gene al Da a
P o ec ion Regula ion in oduced in he Eu opean Union in 2016
28
acknowledges adolescen s' abili y o consen hemsel es o he use o
hei da a, o ins ance, om social media pla o ms and online appli-
ca ions, om he age o 13 yea s.
29
This highligh s ha young people
a e ecognized as ha ing he abili y o assess isks and bene i s associ-
a ed wi h da a use. Howe e , i is impo an o acknowledge ha pe -
sonal pa icipa ion in esea ch may di e om he use o one's da a
and may ha e o he impac s on pa icipan s.
This pape a gues ha adolescen s as young as 12 yea s should be
g an ed legal consen in social science esea ch p o ided ha i is iden i-
ied as nonha m ul by a compe en esea ch e hics commi ee. We build
ou a gumen on he expe iences om wo esea ch s udies. The i s
s udy is he CO-CREATE p ojec (“Con on ing Obesi y: Co-c ea ing
policy wi h you h”), in which young people aged 16–18 yea s we e
in i ed o coc ea e esea ch and policy de elopmen . The second is he
“Heal h Beha iou in School-aged Child en (HBSC). A Wo ld Heal h
O ganiza ion (WHO) Collabo a i e C oss-Na ional s udy,”in which su -
ey da a a e collec ed e e y 4 yea s om 11-, 13-, and 15-yea -olds.
We demons a e how you h in ol emen ha e con ibu ed o he
su ey de elopmen and also how a ying equi emen in e ms o
ac i e o passi e pa en al consen may impac he esea ch conduc ed.
2|EXPERIENCES FROM TWO RESEARCH
STUDIES
2.1 |Con on ing Obesi y: Co-c ea ing policy wi h
you h (CO-CREATE)
2.1.1 | Objec i es and you h pe spec i es
The objec i e o he Ho izon 2020 p ojec CO-CREATE was o collab-
o a e wi h young people h ough a you h-led pa icipa o y ac ion
app oach o iden i y he policy- ele an ac o s d i ing adolescen
obesi y and o e weigh and o sugges policy ac ions in collabo a ion
wi h adolescen s.
30–33
The p ojec aimed o gi e young people a oice
h oughou he esea ch p ocess, om he design o he s udy o he
dissemina ion o he esul s. You h ep esen a i es om P ess—Sa e
he Child en you h o ganiza ion in No way (h ps://p ess.no/) we e
in i ed o pa icipa e in he execu i e boa d o he p ojec a he ime
o he es ablishmen o he p ojec conso ium, which join ly de el-
oped he p ojec and he p ojec applica ion. The ole o P ess on he
execu i e boa d was o oice he in e es and conce ns o young peo-
ple h oughou he p ojec du a ion.
2.1.2 | Rec ui men , consen , and e hics app o al
The p ojec ec ui ed adolescen s in he Uni ed Kingdom, Poland,
Po ugal, he Ne he lands, No way, and Sou h A ica. Main channels o
ec ui men included schools, you h policy o ganiza ions (e.g., you h
councils), and you h ac i i y o ganiza ions (e.g., scou s). A snowball
app oach o ec ui men was also applied, and ec ui ed you h we e
encou aged o in i e iends and colleagues o pa icipa e in he p ojec .
A co e pa o he ini ial discussions among he execu i e boa d
was he age o he pa icipan s o be ec ui ed. Ini ially, he p ojec
wan ed o ec ui 10–18-yea -olds because, by his age, hey ha e
become mo e independen o hei pa en s and s a es ablishing hei
own li es yle pa e ns. The in en ion o each child en and adolescen s
du ing he age pe iod whe e o e weigh and obesi y, in p inciple, s ill
canbep e en edwasseenasimpo an .
34
The p ojec 's execu i e
boa d howe e ea ed ha ob aining pa en al consen ac oss se e al
pa icipa ing coun ies o his age g oup would be challenging. Ins ead,
i was decided o app oach 16–18-yea -olds because hey could s ill be
ec ui ed h ough he school sys em o o ganized you h ac i i ies and
SAMDAL ET AL.3o 11
1467789x, 2023, S2, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/ob .13636 by Readcube (Lab i a Inc.), Wiley Online Lib a y on [10/12/2024]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License
hey would ha e he legal capaci y o p o ide hei indi idual consen
o pa icipa e in he p ojec in mos Eu opean coun ies. Pa en al con-
sen howe e had o be ob ained in h ee coun ies (Poland, Po ugal,
and Sou h A ica)
35–37
o child en unde he age o 18 yea s. In he
Ne he lands, some young people unde he age o 16 yea s exp essed
in e es in pa icipa ing in he p ojec , and p ocedu es we e es ablished
o include hem in he p ojec , collec ing hei assen and hei pa en s'
consen . Pa icipan s could wi hd aw a any ime om all ac i i ies o
could decide o no pa icipa e in indi idual ac i i ies.
In hese coun ies, adolescen assen was also collec ed. Each
p ojec pa ne collec ing da a ob ained e hical app o al in acco dance
wi h he egula ions in hei ins i u ion and coun y, and Gene al Da a
P o ec ion Regula ion on s o age o pe sonal con ac in o ma ion
(such as email and mobile phone numbe ) we e ollowed.
2.1.3 | CO-CREATE ac i i ies
In he p ojec , he young people we e in i ed o pa icipa e in h ee
consecu i e ac i i ies: sys em mapping wo kshops, you h alliances,
and dialog o ums. In addi ion, su eys we e egula ly o ganized. The
ac i i ies aimed o acili a e collabo a ion be ween he adolescen s,
esea che s, and o he s akeholde s o iden i y challenges ela ed o
adolescen obesi y and ways o o e come hese challenges h ough
policy de elopmen .
32,33
The ac i i ies also enabled da a collec ion o
esea ch pu poses. Adolescen consen was ob ained sepa a ely o
pa icipa e in each ac i i y, and g oups o adolescen s could a y om
one ac i i y o he o he .
In he sys em mapping wo kshops, he adolescen s wo ked in
g oups o iden i y ac o s hey belie ed o in luence o e weigh and
obesi y in child en and adolescen s. In e es ingly, he young people
aised no el aspec s ha had no p e iously been iden i ied h ough
esea ch, namely, social media and men al heal h as d i e s o adoles-
cen o e weigh and obesi y.
38,39
In he you h alliances, which mainly
consis ed o g oups o 5–15 adolescen s, he young people wo ked
oge he o de elop policy ideas o educe childhood obesi y. The dis-
cussions we e acili a ed by one young adul and ield no es we e
aken by a co acili a o . The ocus o he discussions was a socie al
a he han indi idual le el o p o ec he p i acy o alliance pa ici-
pan s, o hei amilies and iends, om po en ial s igma iza ion. As
pa o he p ocess, a numbe o ac i i ies we e in oduced and lexi-
bly implemen ed, al e ed, and expanded in line wi h you h and s a
goals.
32,33
Policy ideas we e de eloped, es ed, and changed o e a
pe iod o se e al mon hs up o a yea . Di e en app oaches we e
used o conduc he wo k, including Pho o oice, a ool commonly
used in quali a i e esea ch, o documen issues ela ed o o e weigh
and obesi y in he local communi ies o he you h and o la e in o m
he de elopmen o policy ideas
32,33,40
and ad oca e o change in
hei communi ies.
15,41
The pa icipan s and, when equi ed, hei pa -
en s we e in o med abou he use and pu pose o Pho o oice. Only
Poland asked o consen o use pho os o esea ch pu poses.
40
Pho os ha would no iden i y indi iduals we e encou aged.
Finally, he young people we e in i ed o pa icipa e in dialog
o ums o discuss hei policy ideas wi h policymake s and o he
ele an s akeholde s. Making he you h eel com o able and
empowe ed o sha e hei opinions and expe iences wi h he policy-
make s and o en e in o discussions wi h hem on equal e ms we e
emphasized. A Dialog Fo um Tool Ki was de eloped wi h he you h
and used o secu e a clima e o dialog and equi y be ween he you h
and he adul s akeholde s ep esen ing policymake s and ood busi-
nesses.
42
In addi ion o sys em mapping wo kshops, you h alliances,
and dialog o ums, egula anonymous su eys we e o ganized o
in es iga e he you h's poli ical and ci ic engagemen , eadiness o
ac ion, and a i udes owa d obesi y p e en ion.
43,44
The adolescen s engaged in he p ojec o mo e han a yea . As
he p ojec de eloped and policy ideas lou ished, in 2020, he you h
o ganiza ion P ess—Sa e he Child en You h No way ook he ini ia-
i e o es ablish a You h Task Fo ce ga he ing six young ep esen a-
i es om he You h Alliances in No way, Poland, and Po ugal. The
g oup de eloped a You h Decla a ion on adolescen obesi y and
helped o ganize he CO-CREATE you h con e ence in Ma ch 2022. In
addi ion, P ess de eloped a new You h Ad ocacy Toolki (You h-Led
Change: A Sys ems Thinking Ac i i y Toolki ). I was designed by
Wo ld Obesi y Fede a ion and builds on he ac i i ies in he you h alli-
ances and he dialog o ums. The oolki can be used o de elop inno-
a i e policy ideas and ad oca e o policy change wi hin any a ea o
in e es . The You h Task Fo ce has p esen ed he oolki a a ious
na ional and in e na ional con e ences.
2.1.4 | Expe iences o he consen p ocess in
CO-CREATE
O e all, we expe ienced ha he consen p ocess was well unde s ood
by he you h and ha hei pa icipa ion in he p ojec was on hei
own will.
31
The you h alliance co acili a o s coo dina ing mee ings
had he possibili y o epo in hei ield no es on any beha io o
commen om he you h indica ing discon en o eluc ance o pa ici-
pa e in ac i i ies. Ou o 135 adolescen s ac oss i e coun ies
(Uni ed Kingdom, Poland, Po ugal, he Ne he lands, and No way) pa -
icipa ing in he you h alliances, only 24 had aised issues. Some adoles-
cen s did no wan o pa icipa e in a speci ic ac i i y, o example, did
no wan o be pho og aphed. In case o disag eemen , he acili a o s
and co acili a o s discussed wi h he you h and eminded hem o he
possibili y o wi hd aw. Emphasis was pu on le ing he young people
exp ess hei iews and conce ns and es ablish a dialog o equals.
In mos cases, he adolescen s decided o con inue pa icipa ion. O he
adolescen s simply did no show up a mee ings anymo e, o unknown
easons. Fieldno es om a Du ch acili a o exempli y u he :
A lo o pa icipan s did no ake pa in an online
mee ing. The easons a e no known. A e a lockdown
o he schools, we c ea ed a poll a Fb g oup o ask
who o he pa icipan s would like o mee online, and
only six esponded “yes.”Mos o he pa icipan s ak-
ing pa in he online mee ing ejec ed he i s ac ion
planned o be ca ied ou wi hin he policy idea con-
ce ning he ee choice o PE lessons because hey
4o 11 SAMDAL ET AL.
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decided ha hey don' wan o engage in ac ion i hey
don' belie e in he policy connec ed o his ac ion.
In sho , we can say ha issues ela ed o consen we e dynami-
cally managed whe e adul s and adolescen s con inuously enego-
ia ed he e ms o collabo a ion.
33
2.1.5 | Policy ele ance
CO-CREATE is one o he ew p ojec s whe e adolescen s ha e been
con ibu ing ac i ely and ha e sha ed hei iews ega ding policy
ac ions ha can be implemen ed o p e en o e weigh and obesi y in
hei age g oup, add essing challenges a a sys emic a he han indi-
idual le el.
2.2 |Heal h Beha iou in School-aged Child en. A
WHO Collabo a i e C oss-Na ional s udy
2.2.1 | Objec i es and you h pe spec i es
The HBSC (www.hbsc.o g) aims o moni o and unde s and he de el-
opmen o adolescen heal h and heal h beha io s.
45
I unde ook i s
i s na ionally ep esen a i e su ey among 11-, 13-, and 15-yea -
olds in ou membe coun ies in 1983 and, since 1985, has collec ed
da a e e y 4 yea s om he sampled age g oups in an inc easing num-
be o membe coun ies.
46,47
Today, 52 coun ies a e membe s o
he ne wo k. In all he pa icipa ing coun ies, he su ey add esses
heal h beha io s, heal h pe cep ions such as heal h complain s, li e
sa is ac ion, and hei social con ex co ela es ela ed o expe iences
in school, leisu e, wi h iends, and in he amily con ex . In addi ion,
coun ies may choose o include op ional packages ha p o ide mo e
in-dep h s udies o he abo emen ioned o complemen a y a eas such
as iolence and inju ies o men al well-being.
The pe spec i e o young people has been emphasized om he
beginning o he ne wo k's ac i i ies. In he i s su eys, his occu ed
h ough sys ema ic pilo s udies o all ques ionnai e i ems and ocus
g oup in e iews wi h child en and adolescen s when new opic a eas
we e o be iden i ied and de eloped. Young people we e in i ed o
commen on he pe spec i es p esen ed in he in e na ional epo s
om he s udy. A you h- iendly o ma and allowing you h o sha e
hei iews and pe spec i es on he indings we e emphasized. Du ing
he pas wo decades, a mo e p oac i e ole o you h in ol emen has
been acili a ed by in i ing young people o pa icipa e in you h boa ds
in se e al o he pa icipa ing coun ies. These boa ds ha e p o ided
inpu s on opics impo an o you h and wha hey ind impe a i e o
include in su eys whose aims a e o imp o e adolescen heal h.
A You h Engagemen Ad iso y G oup was in oduced in he in e -
na ional HBSC s udy om he ea ly 2000s. In his g oup, young peo-
ple a e in ol ed as equal s akeholde s p esen ing hei pe spec i es
on HBSC esea ch, u u e p io i ies, and policy and p og am ac ions.
When con e ences a e o ganized by he HBSC ne wo k, young people
pa icipa e in he planning p ocess and ha e oles du ing he
con e ence e en , which emphasizes adolescen s sha ing hei pe -
spec i e on he esea ch unde aken in he HBSC ne wo k.
2.2.2 | E hics app o al, ec ui men , and consen
p ac ices
Each HBSC coun y ollows hei coun y's egula ions o e hics
app o al o esea ch in ol ing child en and adolescen s. Mos o he
HBSC coun ies equi e and ecei e e hics app o al om one o h ee
le els (ins i u ional, egional, o a na ional body), whe eas only
h ee coun ies do no need e hics app o al o unde ake he na ional
su ey. Some coun ies also equi e he app o al o hei minis y o
heal h o minis y o educa ion o unde ake he su ey. In some
cases, he minis y equi es o app o e he i ems o be included in he
su ey. The HBSC eam in Tu key has no been g an ed pe mission
om hei minis y o unde ake he su ey in he las wo cycles.
Pa icipa ing you h a e ec ui ed h ough in i a ions sen o
schools whe e he equi alen o one class (abou 25 s uden s) is
ec ui ed o each o he ele an age g oups. In some coun ies
(e.g., whe e he school s a ing age is b oad), HBSC eams ec ui all
classes wi hin he age ange o 11–18 yea s and la e selec hose ha
mee he age c i e ia (whe e he aim is o ha e a mean age o 11.5,
13.5, o 15.5 yea s o each age g oup).
45
Six coun ies (Ge many, G eece, Poland, Po ugal, Se bia, and
Slo enia) in he 2021/2022 su ey we e equi ed o ob ain ac i e
consen om he pa en s o he pa icipa ing child en, whe eas he
o he s we e g an ed use o passi e pa en al consen ( o a comple e
lis o HBSC membe coun ies, see h ps://hbsc.o g/ne wo k/
coun ies/). These numbe s ha e been ela i ely s able o e he su -
ey yea s. Fo bo h modes o pa en al consen , w i en in o ma ion is
ypically sen home o pa en s in hei child's backpack o sha ed on a
digi al pla o m o communica ion be ween he school and he pa -
en s. When ac i e consen is equi ed, pa en s ei he espond h ough
digi al means o e u n a pape slip o school con i ming ha hei
child can pa icipa e. Fo passi e consen , pa en s can wi hhold con-
sen o hei child o pa icipa e by epo ing o he school ha hey
do no wan hei child o pa icipa e. The h ee coun ies ha did no
equi e pa en al e hics app o al did no ha e any p ocedu es o
eques ing pa en al app o al o hei child o pa icipa e.
Du ing he pas wo decades, in many coun ies, i has become
inc easingly di icul o ec ui schools o pa icipa e in he HBSC
s udy. The p incipal in es iga o s in he pa icipa ing coun ies epo
ha his ela es o he inc easing demands on schools o unde ake
na ional epo ing o au ho i ies in combina ion wi h a g owing num-
be o esea ch s udies wishing o collec da a in class ooms, including
empi ical wo k by mas e 's and PhD s uden s. In coun ies whe e
ac i e pa en al consen is equi ed, i is expec ed ha schools a e
mo e eluc an o accep he eques o pa icipa e in esea ch
because i equi es a subs an ial amoun o ime o eache s o
ollow-up on he dialog wi h he pa en s.
An inc easing numbe o schools a e declining o pa icipa e
because o hei o al wo kload, which adds o he bias ela ed o he
low pa icipa ion o child en wi h a low socioeconomic s a us whose
SAMDAL ET AL.5o 11
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pa en s a e less likely o con i m hei child's pa icipa ion. When schools
decline o pa icipa e, he ep esen a i eness o he sample mus be
main ained ei he h ough o e sampling o by inding a ma ching school
in e ms o size, u al/u ban placing, p i a e/public unding, and socio-
economic p o ile in he same geog aphical egion. In addi ion, he
equi emen o pa en al consen is some imes epo ed by eache s as
an addi ional bu den because i equi es communica ion wi h he pa -
en s on a opic ha is no di ec ly ela ed o he eaching obliga ions.
No way is one o he ew HBSC coun ies in which he equi e-
men s o ac i e o passi e consen ha e been changed by he P i acy
Ombudsman o he Regional E hics Commi ee du ing he di e en
su ey yea s. In 2017/2018, he No wegian s udy was equi ed by
he Regional E hics Commi ee o ob ain ac i e consen om pa en s
o 11- and 13-yea -olds o hei child o be able o pa icipa e,
whe eas he 15-yea -olds we e conside ed o be su icien ly ma u e
o e alua e hei own pa icipa ion. In 2021/2022, his was changed
back o he p e ious equi emen and only passi e consen was
equi ed o he 11- and 13-yea -olds based on he a gumen ha he
indings om he s udy a e being used o de elop policy and p ac ice
ini ia i es. The Regional E hics Commi ee s a ed ha he indings
would be biased i ewe s uden s om lowe socioeconomic g oups
pa icipa ed compa ed wi h hei coun e pa s om highe socioeco-
nomic g oups, as shown by o he s udies ha equi ed ac i e pa en al
consen .
13,18,19
The pa icipa ion a e om di e en socioeconomic
g oups o No way in he su ey yea s 2013/2014, 2017/2018, and
2021/2022 declined se e ely du ing he su ey yea equi ing ac i e
pa en al consen (2017/2018) o he g oup wi h he lowes socioeco-
nomic s a us. Based on in o ma ion abou he a he 's occupa ion, he
pe cen ages o pa icipa ion by he lowes socioeconomic g oups
we e 12.1%, 5.1%, and 9.7% o he su ey yea s 2013/2014,
2017/2018, and 2021/2022, espec i ely. The equi alen pe cen -
ages based on he mo he 's occupa ion we e 10.6%, 2.9%, and 6.1%,
espec i ely. The e we e no signi ican gende di e ences o pa ici-
pa ion a es in he lowes socioeconomic g oups based on a he 's
occupa ion in any o he su ey yea s, whe eas he e we e small sig-
ni ican gende di e ences o all he su ey yea s o pa icipa ion
a es in he lowes socioeconomic by mo he 's occupa ion. Fo he
2013/2014 su ey, he e we e sligh ly mo e boys (11.3%) han gi ls
(9.9%) in he lowe socioeconomic g oup based on mo he 's occupa-
ion (p=0.016). Fo he 2017/2018 (p=0.004) and he 2021/2022
(p=0.031) su eys, he e we e sligh ly mo e gi ls, 3.4% and 6.6%,
espec i ely, han boys, 2.5% and 5.6%, espec i ely, in he lowes
socioeconomic g oup based on mo he 's occupa ion.
2.2.3 | Policy ele ance
In many o he HBSC coun ies, he HBSC su ey p o ides he only
na ionally a ailable da a on adolescen heal h and heal h beha io s
and hei co ela es. In he en i e HBSC, he esul s om he s udy a e
p esen ed sys ema ically o na ional heal h and educa ion au ho i ies
p ima ily by sha ing he in e na ional epo de eloped in collabo a-
ion wi h he WHO. In addi ion, in many o he HBSC coun ies,
na ional epo s a e p oduced ha p o ide mo e de ails om he
na ional indings. Se e al o he p incipal in es iga o s in he HBSC
coun ies pa icipa e in a sys ema ic dialog wi h he na ional heal h
and educa ion au ho i ies and si on commi ees ha a e esponsible
o de eloping policy sugges ions o imp o e adolescen heal h o e a
ange o ele an opic a eas, such as ea ing beha io s, physical ac i i-
ies, smoking beha io s, and men al heal h.
3|DISCUSSION
The expe iences om bo h he CO-CREATE p ojec and he HBSC
s udy demons a e ha pa en al consen p ac ices a y subs an ially
ac oss Eu ope, No h Ame ica, and wes e n Asia bo h in e ms o
modes equi ed (ac i e o passi e) and he minimum age o he adoles-
cen s o whom pa en al consen is equi ed. This a ia ion cons i u es
a clea obs acle when doing in e na ional esea ch as he possibili y o
achie ing a ep esen a i e sample a ies subs an ially and he eby
challenges he compa abili y o he samples ac oss coun ies. I would
be bene icial o w i ing policy ecommenda ions based on in e na ional
esea ch i coun ies would apply he same minimum age o when
adolescen s hemsel es can p o ide hei own legal consen , ha is,
independen o hei pa en s. P e ious esea ch and expe iences om
he HBSC s udy show ha he equi emen o ac i e pa en al consen
o child en and adolescen pa icipa ion in esea ch p ojec s can
dec ease gene al pa icipa ion and, in pa icula , pa icipa ion o hose
om he lowes socioeconomic g oup.
13,18,19
The la e ep esen s
a challenge o achie ing a ep esen a i e sample and he eby an
adequa e basis o he de elopmen o policies and in e en ions o
mee challenges o ecommenda ions iden i ied by he esea ch
p ojec s.
2
The equi emen o pa en al consen o adolescen s' pa icipa-
ion can limi no only he ep esen a i eness o he expe iences
sha ed by adolescen s bu also hei igh o sha e hei iews and
expe iences ega dless o pa en al consen .
2
Thus, he gene ic
equi emen o pa en al consen up o age 15 o 18 yea s means ha
a la ge g oup o adolescen s is dep i ed o hei igh s and he oppo -
uni ies o sha e hei iews and con ibu e o esea ch and policy
de elopmen o ele ance o hei age g oup independen o he
app o al o hei pa en s. Gi en hei le el o cogni i e capaci y, ado-
lescen s could be g an ed au onomy on he decision o consen o
pa icipa e in esea ch om a younge age han 15–18 yea s o age
which is he cu en p ac ice.
2,17,24,25,48
Resea ch on sensi i e opics, such as sexual abuse o home io-
lence, may no ecei e consen om pa en s in ol ed in his abuse,
and he adolescen s a ec ed would be p e en ed om sha ing hei
expe iences. In such cases, he ep esen a i eness o he indings may
be limi ed. I is he e o e pe inen o discuss whe he he equi e-
men o pa en al consen could be conside ed a iola ion o he igh s
o child en and adolescen s se ou in he UNCRC,
4
in pa icula a i-
cle 13.
2
Ano he issue o conside is he p i acy o adolescen s
in ol ed in esea ch.
2
P i acy is pa icula ly ele an when he
esea ch opics a e sensi i e, such as adolescen sexual beha io o
sexual o ien a ion. Adolescen s may wish o sha e his in o ma ion o
6o 11 SAMDAL ET AL.
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esea ch and policy pu poses bu may be a e se o pa icipa e i i led
o ques ioning by hei pa en s because o he esea ch opic.
The p o ec ion o he igh s o child en and adolescen s o sha e
hei expe iences while e aining p i acy om hei pa en s should
howe e be e alua ed agains he po en ial isk o ha m in ol ed in
pa icipa ing in a esea ch p ojec . His o ically and in he UNCRC, pa -
en s a e gi en he esponsibili y o p o ec ing hei child om becom-
ing in ol ed in ac i i ies ha a e no bene icial o may be ha m ul.
2
Resea ch demons a es ha pa en s gene ally wan o decide which
esea ch ac i i ies hei child pa icipa es in and end o p e e ac i e
o e passi e pa en al consen . Howe e , pa en s inc easingly accep
passi e consen o ocus g oup in e iews and su eys om he age
o en e ing seconda y school, which is ypically om he age o 12–
13 yea s o age.
49
Gi en his poin o iew, hey migh also ag ee o
le ing hei child ha e he igh o legal consen om a lowe age han
cu en esea ch p ac ices p o ided ha p ocedu es a e in place o
p o ec hei child om expe iencing ha m in esea ch pa icipa ion.
Lowe ing he age o child and adolescen consen may esol e
some o he issues desc ibed abo e. Howe e , a balance is needed
be ween he empowe men o child en and adolescen s o pa icipa e
and he p o ec ion o hese young people when needed. In o he
wo ds, i may be a iola ion o he UNCRC i child en we e allowed o
eely oice hei opinion be o e hey eached a le el o ma u i y when
hey ully unde s ood he consequences o wha hey we e saying.
Simila ly, i may be a iola ion o he UNCRC i child en a e no able o
oice hei opinion a e hey ha e eached a su icien le el o ma u-
i y.
7,50
This need o balance may depend on he sensi i i y o wha
child en and adolescen s a e asked o exp ess hei opinion abou , ha
is, he mo e sensi i e he opic, he g ea e he need o p o ec ion.
Respec ing he igh s o he child en and adolescen s o ha e
hei oice hea d and simul aneously p o ec ing hem om ha m a e
key o e hical esea ch p ac ice. The e alua ion o a s udy's po en ial
ha m ulness should be unde aken by e hics commi ees. These com-
mi ees e alua e whe he he esea ch p ojec ollows es ablished
codes o conduc in esea ch (see, e.g., The Eu opean Code o Con-
duc o Resea ch In eg i y
51
). Be o e app o ing a esea ch p ojec , an
e hics commi ee will e alua e i e e hical p inciples o da a collec-
ion
52
: (1) olun a y pa icipa ion, (2) in o med consen , (3) anonymi y,
(4) con iden iali y, and (5) po en ial o a ious ypes o ha m. In pa -
icula , he po en ial o psychological ha m ela es o p o ec ion o
he pa icipan 's p i acy, he sensi i i y o he opic esea ched, he
ques ions asked o he ac i i ies in i ed o pa icipa e in, and o wha
ex en hese may igge nega i e esponses such as emo ions o
shame o anxie y. Social ha m ela es o any pe cei ed isk, emba -
assmen , o s igma. Physical ha m ela es o pain o inju y ha may
esul om he s udy ac i i ies. Legal ha m ela es o he conse-
quences o epo ing sensi i e da a ha could lead o legal isk o io-
la ion o p i acy. How he p ojec deals wi h he in o ma ion, p i acy,
and sensi i i y o he opic and, he e o e, he po en ial ha m o
pa icipa ion in e ms o psychological, social, physical, and legal
issues will de e mine whe he he e hics commi ee will equi e
consen om he pa en s o only om he pa icipa ing child/
adolescen .
Gi en he e lec ions desc ibed abo e, we sugges ha esea ch
p ojec s ha a e iden i ied by an e hics commi ee as no being ha m-
ul o child en and adolescen s could be opened o child en olde
han age 12 yea s o gi e hei legal consen o pa icipa e. This would
be consis en wi h he UNCRC's iden i ica ion o age 12 yea s as an
app op ia e age o gi ing weigh o child en's own pe spec i es
abou a decision ha ela es o hem.
4,5
Such an app oach is also con-
sis en wi h a sugges ion by Hein e al.,
53
who sugges , based on he
applica ion o an assessmen ool, ha child en as young as 12 yea s
should be allowed o decide on hei pa icipa ion in clinical esea ch.
Pe spec i es om de elopmen al psychology also unde sco e ha
child en and adolescen s a e mo e ma u e in e ms o hei cogni i e
capaci y, which is needed o e alua e hei pa icipa ion in esea ch,
han many o oday's consen es ic ions indica e. Howe e , despi e
some a ia ion, he cu en age o adolescen app o al is a conse a-
i e measu e o 15/16 yea s o age.
2,25,48,54
Ma hews
2
has iden i ied
ha he e is no equi emen in law equi ing a pa en o gi e consen
o an adolescen 's pa icipa ion in esea ch wi hin he opics ypically
co e ed by he disciplines o social science, including heal h s udies
based on li ed expe iences.
We he e o e sugges ha in e na ional p inciples on he age o
legal consen o adolescen s ha can be applied by all coun ies in
Eu ope and beyond should be es ablished. Fu he , p inciples on how
o p e en ha m om esea ch pa icipa ion should be included. These
p inciples migh become pa o he UNCRC o iden i ying he equi e-
men s o child en and adolescen s o be able o consen hei pa ici-
pa ion in esea ch om he age o 12 yea s. In gene al, he UNCRC
should p e e ably add ess he igh s o child en and adolescen s o
sha e hei iews h ough esea ch pa icipa ion as a way o p o iding
in luence o he socie al good h ough na ional and in e na ional de el-
opmen o policy and in e en ions. In some coun ies, he na ional
UNCRC commi ee has commen ed on he impo ance o de eloping
oolki s o consul ing child en on policy de elopmen s ha a ec
hem.
55,56
Consul a ion p ocesses ypically in ol e ew child en, and
we belie e ha he gene al popula ion o child en and adolescen s
should be allowed o in luence who ep esen s hem, o example,
h ough you h pa liamen s. To p o ide ull ep esen a ion o he child
and adolescen popula ion, we ecommend ha he UNCRC should
no e he impo ance o consul a ion and esea ch p ocesses ha in i e
la ge g oups o child en and adolescen s o sha e hei expe iences,
including ep esen a i e samples on he egional o na ional le el,
a he han a ew indi iduals selec ed o ep esen hei age g oup.
2,17
I lowe ing he age o child and adolescen consen o 12 yea s,
we ecommend ha , in addi ion o he condi ion o compe en e hics
e alua ion, a sys ema ic child and adolescen pe spec i e on esea ch
should be equi ed when de eloping esea ch p ojec s.
15,33,57
Based
on he expe iences om he CO-CREATE p ojec and he HBSC
s udy, we s ongly ecommend ha adolescen ep esen a i es si on
he boa d o he s udy and a e in i ed o in luence on bo h he con-
en o he s udy and he da a collec ion p ocedu es. This way, we can
wo k o ensu e ha adolescen s' needs and in e es s a e conside ed
in he esea ch p ojec . Fu he , bo h he e hics commi ees and he
esea che s should emphasize ha ing p ocedu es in place when
SAMDAL ET AL.7o 11
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unexpec ed expe iences om pa icipa ion in a esea ch p ojec o
ac i i y occu .
58
This could include se ing up a call line o a ele an
heal h se ice o alk o a p o essional abou hei expe ience and
aining esea che s as well as adul s akeholde s who pa icipa e in
dialog wi h adolescen s on how o achie e powe balance and pe -
cei ed equi y on pa o he adolescen pa icipan s. F om he CO-
CREATE p ojec , we expe ienced ha close collabo a ion and con inu-
ous dialog wi h he adolescen esea ch pa icipan s is i al o hem
o eel empowe ed and secu e in he se ing.
31,33
Compe en e hics e alua ion u he equi es ha he e hics com-
mi ee is ained in de elopmen al psychology in e ms o child en's
and adolescen s' cogni i e capaci y and whe e he limi o dis ess
needs o be se .
59
This aining should also add ess ele an adoles-
cen pa icipa o y p ocesses and pa icipan pe spec i es in a s udy.
P e e ably all e hics commi ees should also include ep esen a i es
wi h expe ise in he de elopmen al capaci y o child en and adoles-
cen s as well as ep esen a i es om adolescence when p ojec s a e
a ge ing hei age g oup. A esea ch s udy ha clea ly communica es
awa eness o child en's and adolescen s' pe spec i es and how hese
ha e been conside ed in he s udy, p e e ably by collabo a ing wi h
he a ge g oup, is also mo e likely o no ep esen a h ea . This
would be consis en wi h p inciples es ablished o collabo a i e
esea ch in ol ing young people, and which we e also applied in bo h
he CO-CREATE and HBSC s udies.
14,15,57
In esea ch p ojec s in which child en and adolescen s hemsel es
can decide o pa icipa e wi hou equi ing pe mission om hei
pa en s, i is i al ha he in o ma ion abou he esea ch p ojec 's
pu pose, ocus, implica ions o pa icipa ion, and inancial amewo k
is clea and accessible o he child o adolescen so ha hey can make
an in o med choice when deciding whe he o pa icipa e. Expe i-
ences om esea che s wo king wi h younge child en
12,54,60
may be
help ul in his ega d. These esea che s can p o ide excellen
guidance on suppo ing child en and adolescen s in hei decision by
using pho os, d awings, and na a i es ha a e mo e accessible o
child en han plain desc ip i e ex , which cu en ly is equen ly used
o in o m pa icipan s in esea ch s udies, including child en and
adolescen s.
Bo h he CO-CREATE and HBSC s udies sough collabo a ion wi h
young people in he design o he s udy. Bo h s udies ha e emphasized
he p o ision o clea in o ma ion o he pa icipan s on wha he p ojec
is abou , wha pa icipa ion implies, and a oidance o a ocus o ques-
ions ha could lead o psychological, social, o legal ha m. No po en ial
physical ha ms we e iden i ied in any o he p ojec s. We he e o e
belie e ha he CO-CREATE p ojec could ha e app oached age g oups
younge han 16–18 yea s as ini ially desi ed and applied adolescen
consen o hese younge age g oups. Fo example, in he CO-CREATE
p ojec , no ques ions on a pa icipan 's heigh o weigh we e included
o a oid pe cei ed s igma ela ed o he p ojec 's opic o p e en ing
o e weigh in adolescen s. Ins ead, he ques ions ocused on he adoles-
cen s' sense o hei capabili y o achie e change a he socie al le el
h ough own ini ia i es o in luence policy de elopmen .
43,44
The s ong ocus on you h-led pa icipa o y esea ch in he
CO-CREATE s udy is ano he a gumen o allowing pa icipan s as
young as 12 yea s ha could ha e been g an ed legal consen o pa -
icipa e in he p ojec . Gi en CO-CREATE's con en and close collabo-
a ion wi h you h h oughou all s eps o he design de elopmen and
he s udy's ac i i ies and he sensi i i y gi en o he pa icipan s'
esponses, we a gue ha he e was no po en ial ha m o he pa ici-
pan s. To he con a y, we ound ha hey expe ienced he pa icipa-
ion as s imula ing hei agency and in luence on policy de elopmen
ele an o hei age g oup in a way ha was consis en wi h he
p inciples o you h-led esea ch and he igh o ha e hei oice
hea d.
2,14,15,32,33,57
Ou ieldno e da a showed ha he adolescen s'
abili y o wi hd aw a any ime and o nego ia e pa ial pa icipa ion in
a coc ea i e se ing wo ked.
Mo e esea ch is needed in o how child en and adolescen s om
he age o 12 yea s expe ience hei pa icipa ion in esea ch and
wha can be done o ensu e ha esea ch becomes a way o young
people o in luence he de elopmen o policy and in e en ion
h ough hei esea ch pa icipa ion and whe e hey eel empowe ed
o no pa icipa e o wi hd aw should hey wan o. Fo such esea ch
o be success ul in iden i ying young people's expe iences, he adoles-
cen s should be in i ed as s akeholde s when designing he esea ch
p ojec as well as dissemina ing he indings. We ecommend ha he
design p ocess includes bo h he esea che s' and pa icipan s' pe -
spec i es so ha he ep esen a ion o young people ensu es he in e-
g a ion o hei in e es s as well as hose o he esea che s and ha
his ex ends o he ec ui men p ocesses, including who is ec ui ed
and how. Respec ing child en's and adolescen s' needs and in e es s
in hese p ocesses is i al o mee ing he objec i es o e hical esea ch
and he UNCRC, whe e he bes in e es o child en and adolescen s
should always guide decisions and he e is a clea emphasis on he
managemen o he powe imbalance be ween child and adolescen
s akeholde s/pa icipan s and adul esea che s.
7,15,31–33,42,57,61
4|CONCLUSIONS
Today's esea ch p ac ices a y widely ac oss na ions in e ms o he
age limi and e hical condi ions equi ed o child en and adolescen s
o p o ide hei consen o pa icipa ion in esea ch independen o
hei pa en s. Consis en wi h he UNCRC, a balance is needed
be ween child en's and adolescen s' igh s o ha e hei oice hea d
h ough pa icipa ion in esea ch and policy de elopmen and he
need o p o ec hem om ha m. The CO-CREATE p ojec and HBSC
s udy ha e demons a ed he impo ance o adolescen pa icipa ion
because bo h p ojec s ha e been a key o policy de elopmen o
adolescen heal h and well-being. Looking a he expe iences wi hin
CO-CREATE, we also see ha adolescen s a e pe ec ly able o oice
hei conce ns and enego ia e pa icipa ion and consen in he
p ocess. We p opose ha child en and adolescen s om he age o
12 yea s should be able o gi e hei legal consen o pa icipa e in
esea ch s udies in social and beha io al sciences p o ided ha
he e hics commi ees canno iden i y any ha m o hem in hei pa -
icipa ion and ha he esea ch app oach has a clea in eg a ion o
child en's and adolescen s' pe spec i es and needs, p e e ably as a
collabo a ion wi h ep esen a i es om he a ge g oup. Fo his o
8o 11 SAMDAL ET AL.
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be a iable app oach, e hics commi ees should be ained in he
needs, pe spec i es, and cogni i e capaci y o child en and adoles-
cen s. A ep esen a i e wi h compe ence in his a ea should be
included in he e hics e iew p ocess whe e possible. We also
ecommend ha young people a e ep esen ed on e hics commi ees.
In e na ional p inciples should be se o bo h minimum age o
consen and he e alua ion o po en ial ha m.
AFFILIATIONS
1
Depa men o Heal h P omo ion and De elopmen , Uni e si y o
Be gen, Be gen, No way
2
Depa men o Food Sa e y, Di ision o Clima e and En i onmen al
Heal h, No wegian Ins i u e o Public Heal h, Oslo, No way
3
Cen e o Psychosocial & C isis Ac ion—Malinska, Skopje, Republic
o Macedonia
4
EAT, Oslo, No way
5
Depa men o Sociology, Uni e si y o Ams e dam, Ams e dam, The
Ne he lands
6
Uni o Men al Heal h, Child en and You h, Public Heal h Agency o
Sweden, S ockholm, Sweden
7
Depa men o Sociology, T ini y College Dublin, Dublin, I eland
8
School o Medicine, S . And ews Uni e si y, S . And ews, UK
9
Depa men o Lea ning, In o ma ics, Managemen and E hics,
Ka olinska Ins i u e, Solna, Sweden
10
Depa men o E idence and Quali y S anda ds, Aus ian Na ional
Public Heal h Ins i u e, Vienna, Aus ia
11
Psychology and heal h Sciences Depa men , Luso ona Uni e si y,
Lisbon, Po ugal
12
Depa men o Educa ion and Special Educa ion, Uni e si y o
Go henbu g, Go henbu g, Sweden
13
Resea ch Cen e o Heal h Th ough Physical Ac i i y, Li es yle and
Spo (HPALS), Depa men o Human Biology, Uni e si y o
Cape Town, Cape Town, Sou h A ica
14
Facul y o Psychology, Uni e si y o Be gen, Be gen, No way
15
Heal h P omo ion Resea ch Cen e, Uni e si y o Galway, Galway,
I eland
16
Facul y o Public Heal h and Policy, London School o Hygiene &
T opical Medicine, London, UK
17
Ins i u e o Mo he and Child Founda ion, Wa saw, Poland
18
Depa men o Nu i ion, Uni e si y o Oslo, Oslo, No way
19
Ins i u e o Psychology, SWPS Uni e si y, W oclaw, Poland
20
Depa men o De elopmen al and Educa ional Psychology,
Uni e si y o Se illa, Se ille, Spain
21
Cen e o Disease P e en ion and Con ol, Riga, La ia
22
Cen e o Heal h P omo ion, Ins i u e o Public Heal h o Se bia,
Beog ad, Se bia
23
Cen e o S udies and Resea ch in Social Dynamics and Heal h,
Lisbon, Po ugal
24
P ess - Redd Ba na Ungdom, Oslo, No way
25
Depa men o Social and Policy Sciences, Uni e si y o Ba h, Ba h,
UK
26
Di ision o Men al and Physical Heal h, No wegian Ins i u e o
Public Heal h, Oslo, No way
ACKNOWLEDGMENTS
We acknowledge and hank all he young people who pa icipa ed in
his s udy. The CO-CREATE p ojec has ecei ed unding om he
Eu opean Union's Ho izon 2020 esea ch and inno a ion p og amme
unde g an ag eemen No. 774210. The con en o his pape e lec s
only he au ho s' iews, and he Eu opean Commission is no liable
o any use ha may be made o he in o ma ion i con ains. HBSC is
an in e na ional s udy pe o med in collabo a ion wi h he Wo ld
Heal h O ganiza ion/Eu ope, WHO/EURO. The au ho s acknowledge
he In e na ional Coo dina o o he s udy, Joanna Inchley, and he
eam om he Uni e si y o Glasgow, Sco land, and he In e na ional
Da a Cen e Manage , Odd un Samdal, and he eam a he Uni e si y
o Be gen, No way.
CONFLICT OF INTEREST STATEMENT
No con lic o in e es s a emen .
ORCID
Odd un Samdal h ps://o cid.o g/0000-0003-1776-9273
Isabelle Budin-Ljøsne h ps://o cid.o g/0000-0002-4610-1662
Clai e Bouillon h ps://o cid.o g/0000-0003-0956-2352
Cecile Knai h ps://o cid.o g/0000-0001-6663-7379
Do o a Kleszczewska h ps://o cid.o g/0000-0001-7523-8628
Nanna Lien h ps://o cid.o g/0000-0003-1486-4769
Knu -Inge Klepp h ps://o cid.o g/0000-0002-3181-6841
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1467789x, 2023, S2, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/ob .13636 by Readcube (Lab i a Inc.), Wiley Online Lib a y on [10/12/2024]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License