1. John Coleman University of Oxford

2. Thinking a bit more broadly The family The school The peer group The digital world

3. The family The Cheltenham study of drug users Various studies of smoking in young people Sexual health International studies showing the more parents talk, the less sexual risk-taking The FPA and Speakeasy

4. Where else might the family be influential? Exercise? Eating behaviour? Attendance at primary care? Transition?

5. The school The health-promoting school Chris Bonell and others “Improving school ethos may reduce substance abuse and teenage pregnancy” The Gatehouse project in Australia The Healthy Schools initiative in the UK Why schools can make a difference

6. The peer group It seems obvious, yet very little research has highlighted the role of the peer group. One exception - studies of smoking We know from studies of anti-social behaviour that there is a reciprocal influence between behaviour and membership of a peer group But we know little about how this works where health is concerned MORE RESEARCH!

7. The digital world The positives: access to information, staying in touch with services, highlighting issues on social media (e.g. prostitution) The negatives: pornography, internet addiction, grooming, cyber-bullying. Where is the balance? As health professionals we have to become engaged But MORE RESEARCH!

8. Conclusion All four factors clearly impact on young people’s health Yet, to a large extent, these factors are not linked to health outcomes and to the delivery of services An opportunity for some exciting new thinking Let’s expand the notion of social determinants of health to include some of the things I have discussed this morning.