Adolescent Health: Robert Wm. Blum, MD, MPH, PhD Center for Adolescent Health & Development WHO...

Adolescent Health:

Robert Wm. Blum, MD, MPH, PhDCenter for Adolescent Health & Development

WHO Collaborating Centre on Adolescent Health

University of Minnesota

New Directions for a New Millennium

Youth Support ConferenceLondon, England24 October 2002

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

A Picture of Youth Health

PhysicallyHealthy

A Picture of Youth Health

PhysicallyHealthy

MentallyHealthy

A Picture of Youth Health

PhysicallyHealthy

MentallyHealthy

SexuallyHealthy

A Picture of Youth Health

PhysicallyHealthy

MentallyHealthy

SexuallyHealthy

EducatedorLiterate

A Picture of Youth Health

PhysicallyHealthy

MentallyHealthy

SexuallyHealthy

EducatedorLiterate

Safe & free of abuse

A Picture of Youth Health

PhysicallyHealthy

MentallyHealthy

SexuallyHealthy

EducatedorLiterate

Safe & free of abuse

FullParticipation

A Picture of Youth Health

PhysicallyHealthy

MentallyHealthy

SexuallyHealthy

EducatedorLiterate

Safe & free of abuse

FullParticipation

SpirituallyHealthy

A Picture of Youth Health

PhysicallyHealthy

MentallyHealthy

SexuallyHealthy

EducatedorLiterate

Safe & free of abuse

FullParticipation

SpirituallyHealthy

Today, 30% of the world’s population is between the ages of 10-24 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.

0

200

400

600

800

1000

1200

1990 2000 2025

RuralUrban

Population of Young People in Developing Countries by Urban & Rural Areas 1990-2025

Social Trends

Global homogenization of youth culture and the impact of global media

The rise in religionChanges in traditional practices:

Female Genital Mutilation Abuse

Births before marriageAIDS orphansDivorceMultiple household families

The Changing Structure of the Family

Our Understanding of what InfluencesAdolescent Health has Changed

Deviance ModelClustering of risk behaviorsRisk and protective factorsAn ecological modelPositive youth development

Shifting Models/Shifting Approaches

TeenTeen

Knowledge(just know)

Shifting Models/Shifting Approaches

TeenPeer 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

Foster basic research; Understanding social contexts and

their impact on youth health and development;

Strengthen informal networks and parental supports;

Operationalize positive youth development;

Priorities for the Next Decade

Shift supports from social protection to social capital;

Broaden our framework from healthy people to healthy communities;

Establish new collaborations; Move from demonstration to

replication.

#1 Basic Research

Neurodevelopment through puberty and adolescence into adulthood;

Neuroendocrinology of puberty and adolescence;

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

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

5 10 15 20 25 30

PercentCrane, J. Am J. Soc. 1991, 96(5):1226-1259

— 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 AdolescentHealth and Development

www.allaboutkids.umn.edu