Adolescent Health: Robert Wm. Blum, MD, MPH, PhD Center for Adolescent Health & Development WHO Collaborating Centre on Adolescent Health University of Minnesota New Directions for a New Millennium Youth Support Conference London, England 24 October 2002

When we talk about adolescent health, what is it that we picture?

A Picture of Youth Health Physically Healthy

A Picture of Youth Health Physically Healthy Mentally Healthy

A Picture of Youth Health Physically Healthy Mentally Healthy Sexually Healthy

A Picture of Youth Health Physically Healthy Mentally Healthy Sexually Healthy Educated or Literate

A Picture of Youth Health Physically Healthy Mentally Healthy Sexually Healthy Educated or Literate Safe & free of abuse

A Picture of Youth Health Physically Healthy Mentally Healthy Sexually Healthy Educated or Literate Safe & free of abuse Full Participation

A Picture of Youth Health Physically Healthy Mentally Healthy Sexually Healthy Educated or Literate Safe & free of abuse Full Participation Spiritually Healthy

A Picture of Youth Health Physically Healthy Mentally Healthy Sexually Healthy Educated or Literate Safe & free of abuse Full Participation Spiritually Healthy

Today, 30% of the world’s population is between the ages of years  1.5 billion young people;  Over the next decade the number will increase;  In industrialized countries young people represent 13% of the population;  In developing nations it is 20-25%.

There is a deepening North/South divide between economically rich & poor nations  85% of young people live in economically impoverished nations;  The changing opportunity structure for young people: away from agriculture toward the factory some will compete in the information age.  80% of young people are unemployed.

Population of Young People in Developing Countries by Urban & Rural Areas

Social Trends  Global homogenization of youth culture and the impact of global media  The rise in religion  Changes in traditional practices: Female Genital Mutilation Abuse

 Births before marriage  AIDS orphans  Divorce  Multiple household families The Changing Structure of the Family

Our Understanding of what Influences Adolescent Health has Changed  Deviance Model  Clustering of risk behaviors  Risk and protective factors  An ecological model  Positive youth development

Shifting Models/Shifting Approaches Teen Knowledge (just know)

Shifting Models/Shifting Approaches Teen Peer Influence (peer education ) Teen Knowledge (just know)

Shifting Models/Shifting Approaches Teen Risk Behaviors Linked (comprehensive strategy) Peer Influence (peer education ) Teen Knowledge (just know)

Shifting Models/Shifting Approaches Teen Resistance Skills (just say no) Risk Behaviors Linked (comprehensive strategy) Peer Influence (peer education ) Teen Knowledge (just know)

Shifting Models/Shifting Approaches Teen Environmental Factors (mentorship) Resistance Skills (just say no) Risk Behaviors Linked (comprehensive strategy) Peer Influence (peer education ) Teen Knowledge (just know)

Shifting Models/Shifting Approaches Teen Family Factors (family involvement) Environmental Factors (mentorship) Resistance Skills (just say no) Risk Behaviors Linked (comprehensive strategy) Peer Influence (peer education ) Teen Knowledge (just know)

Priorities for the Next Decade u Foster basic research; u Understanding social contexts and their impact on youth health and development; u Strengthen informal networks and parental supports; u Operationalize positive youth development;

Priorities for the Next Decade u Shift supports from social protection to social capital; u Broaden our framework from healthy people to healthy communities; u Establish new collaborations; u Move from demonstration to replication.

#1 Basic Research u Neurodevelopment through puberty and adolescence into adulthood; u Neuroendocrinology of puberty and adolescence; u The interface of genetics and behavior.

#2 Social Contexts The role of social contexts in the lives of young people

Do social epidemics work like infectious disease epidemics?

A non-linear relationship between a number of adolescent health problems and the environment in which young people live.

Probability of Black Teenagers Dropping Out of School as a Function of Percentage of High-Status Workers in Big-City Neighborhoods Crane, J. Am J. Soc. 1991, 96(5): — Males — Females

If this is true for other issues, other groups and other settings, it means that small environmental shifts can have big effects.

School Climate Research

School Environment Counts  School connectedness protects against every health risk studied;  School connectedness does not depend on: Class size; Years of teacher experience; Academic preparation of teachers.  School connectedness depends on: Caring adults; Social integration; School size; Classroom management.

#3 Strengthen Informal Networks and Parenting Supports  Resilience research consistently shows that informal social networks are highly protective in the lives of adolescents as well as adults: Neighbors Friendship networks Adults Teachers/coaches

Strengthening Families While we know that families are important, much less is known about policies or programs that most effectively support parents of adolescent children.

Strengthening Families How do we strengthen the human resources in a neighborhood so they can better support young people?

#4 Operationalize Positive Youth Development Positive youth development is defined as participation in prosocial behaviors and avoidance of health compromising and future jeopardizing behaviors.

Key Elements of Positive Youth Development

Successful Interventions  Build strong adult-youth relationships;  Have a clear, well articulated philosophy about youth;  Build interventions on a theory of youth development grounded in research;  Recognize the strengths of youth and build upon those strengths;

Successful Interventions  Recognize the human resources in the community;  Actively involve young people;  Link young people with pro-social adults;  Provide life skills;  Provide opportunities for young people to contribute.

 To identify the protective factors in the lives of young people that transcend culture and setting;  To identify successful interventions at the individual and community level that support and strengthen the protective factors in the lives of young people. The Challenges for the Next Decade

#5 Shift From Social Protection to Social Capitol

Social Capitol  Social capital: Environmental resources that are people specific (e.g., family stability) that support human development. These factors are also protective. These factors are sometimes viewed as assets. Others refer to them as components of resilience.

Factors Associated with Social Capital  Two parents;  Fewer siblings;  Fewer changes in schools attended;  Regular attendance at religious services;  Mother’s expectations for her children’s educational attainment.

#6 Broaden our Perspective from Healthy People to Healthy Communities  Social capital;  Positive youth development;  Informal networks;  Social contexts.

#7 Develop New Teams and Collaborations  Education, health and development as core, integrated elements;  Youth as a critical team player;  Link economic development and health domestically.

#8 Move from Demonstration to Replication then to Scale

Center for Adolescent Health and Development