An International Comparison of Risk and Protective Factors in the Lives of Young People Robert Wm. Blum, M.D. M.P.H. Ph.D. Professor & Director Center for Adol,escent Health and Development WHO Collaborating Centre for Adolescent Health University of Minnesota Prepared for: Youth Support Conference London, England 24 October 2002

Why do some who are raised in adverse circumstances appear to live healthy and productive lives?

Resilience The capacity to recover and maintain adaptive behavior after insult. Garmezy

An Ecological Model of Resilience Macro-level Environment Political Realities Youth Laws/Policies Macrolevel Economics Historical Events

An Ecological Model of Resilience Community Environment arrests by age, type community fertility rates by age poverty single parent female head of household age of migration Medicaid (proportion & payment) exposure to violent media exposure to youth-oriented advertising access to tobacco, alcohol, drugs, firearms educational attainment by age school enrollment for health care facilities health care utilization employment rates of adults informal support systems religious institutions access to role models pro-social media Macro-level Environment RiskProtection

Family low parental education family mental illness maternal stress large family size overcrowding poverty access to weapons engaging in health compromising behaviors authoritarian parenting style exposure to family violence connectedness parental presence parental values - towards school - toward risk taking two parents fewer siblings family cohesion authoritative parenting style Community Environment Macro-level Environment An Ecological Model of Resilience RiskProtection

prejudice from peers perception of threat social isolation participation in deviant culture being treated fairly by peers having low-risk friends peers with pro- social norms An Ecological Model of Resilience Family Community Environment Macro-level Environment Peers Risk Protection

retention size of school absenteeism suspension connectedness to school improved academic performance number of schools attended school policies An Ecological Model of Resilience Family Community Environment Macro-level Environment Peers School Risk Protection

biological vulnerability intellectual impairment dyssynchronous maturation aggressive temperament impulsivity affective disorder ADHD aggressive behavior stress reactivity spirituality/religiosity social skills average intelligence late maturation positive self-image positive self-efficacy perceived importance of parents An Ecological Model of Resilience RiskProtection Individual School Community Environment Macro-level Environment Family Individual Peers

Macrolevel Environment An Ecological Model of Resilience Health Risk Behaviors - tobacco - alcohol - marijuana - other Substance Use -inactivity -disordered eating -eating disorders -over-consumption Diet & Exercise - weapon carrying - interpersonal violence -seat belt use -helmet use -motorcycle use -drinking & driving -sexual assault Injury & Violence - non contraception - condom avoidance - early sexual debut - multiple sexual partners Sexual Reproductive School Community Environment Macro-level Environment Family Individual Peers

The empirical evidence for resilience in adolescent health.

Caribbean Participating Countries

Ever Had Intercourse Countries of Caribbean l = protective, statistically significant m = protective, trend s = risk, statistically significant

Suicide Attempt l = protective, statistically significant m = protective, trend s = risk, statistically significant Countries of Caribbean

Violence l = protective, statistically significant m = protective, trend s = risk, statistically significant Countries of Caribbean

Problems Due to Substance Use l = protective, statistically significant m = protective, trend s = risk, statistically significant Countries of Caribbean

Global Research on Risk and Protective Factors (WHO)

Early Sexual Initiation l = protective, statistically significant = not measured s = risk, statistically significant NS = not significant Risk or Protective factors for Adolescents

Substance Use (tobacco, alcohol and other psychoactive substances) Risk or Protective factors for Adolescents l = protective, statistically significant = not measured s = risk, statistically significant NS = not significant

Depression Risk or Protective factors for Adolescents l = protective, statistically significant = not measured s = risk, statistically significant NS = not significant

What Can We Conclude Across Cultures? Risk or Protective factors for Adolescents l = protective, statistically significant s = risk, statistically significant

What works? What doesn’t work? What doesn’t work?

Evaluation research has repeatedly shown that problem reduction interventions alone directed at youth are rarely effective.

l Providing information alone; l Scare tactics; l Short-term interventions; l Abstinence only; l Contraception only; l School-based services. Ineffective Strategies for Teen Pregnancy Prevention

Caring and Compassion; Character; Competence in academic, social and vocational arenas; Confidence; Connection. The 5 Assets of Youth

CONTRIBUTION The 5 Assets of Youth Lead to a 6th Asset

Programs that incorporate more elements of positive youth development appear to be more effective in achieving their goals; Programs that strengthen adult-adolescent relationships appear to have better outcomes; Long-term programs with a strong youth participation component are most effective. Program Elements that Promote Youth Assets

Positive youth development has as a basic tenet that youth are resources to be developed not problems to be fixed. Pittman

both an outcome and an intervention. Development is...

Positive youth development is defined as participation in pro- social behaviors and avoidance of health compromising and future jeopardizing behaviors. As An Outcome

P C A A P Activities School and community activities that develop a sense of connection/belonging Contributions The opportunities to contribute to family, neighborhood, community, youth involvement. People An adult who cares, who is connected; a network of adults who are involved in the life of the adolescent. Place A safe place for youth to congregate, to recreate with adult supervision, to develop friendships The Adolescent PCAP Model