SEE ALSO adulthood and later life; injury; overweight and obesity; peer education; risk factors; schools; sexual health
Definitions of youth, adolescents or young people vary according to age but are generally interpreted as being between the ages of 10 and 24 years (Patton et al., 2009).
Although adolescence is often referred to as the healthiest stage of life, young people are at substantial risk of morbidity and mortality, often due to risky behaviours and preventable conditions. Adolescence can be a confusing time in which many pressures are placed on the young person, such as employment or continued education, and this can lead to stress and conflict in their lives. A key consideration when working with adolescents is the age at which they begin to understand their world in a concrete and abstract way such that they can fully engage with concepts of a social and political nature. An approach to adolescence based on their right to participate as social actors accepts that they act on the world around them. Practitioners can then engage with them about their worlds and involve them in identifying their needs and in decision-making processes. Although there is not a definitive youngest age at which adolescents can be engaged to empower themselves, a guide of 14 years, give or take a year, depending on the individual, can be used in practice (Laverack, 2013a, p. 44).
In 2004, 2·6 million deaths occurred in people aged 10–24 years of which 97% were in low- and middle-income countries, where poor maternal conditions were a leading cause of female youth deaths. Traffic accidents, violence and suicide accounted for a large proportion of all youth deaths. However, non-communicable diseases also contribute to mortality because youths are being exposed to high-fat, high-sugar, high-salt, energy-dense, micronutrient-poor food sin conjunction with lower levels of physical activity. This is resulting in increased overweight and obesity which is likely to stay into adulthood and to develop into diseases such as diabetes and cardiovascular diseases (Patton et al., 2009).
Public health interventions place responsibility on the adolescent for their own behaviour and health and target issues such as substance abuse, mental illness and bullying. Successful strategies for working with adolescents in public health programmes include peer education, social media and social networking. Public health interventions for youth groups, such as tobacco use, sexually transmitted infections and physical inactivity, can have far-reaching benefits into adulthood. Schools are also seen as an important setting for adolescence because they can be used to reach a large audience for a long period of time to engage with adolescents in regard to relevant health issues.
In one American high school students formed a Students Against Drunk Driving (SADD) chapter when one of their friends was killed in a drink-related driving accident. Gradually the students began to take a leadership role and organized events to raise the issues of drug abuse and drink-driving in local meetings. The students in SADD had a statistically significant increase in self-reported perception of the risks involving drinking and drug abuse as compared to the control group, which showed a significant drop in perception (Wallerstein and Bernstein, 1988). Another adolescent health intervention used brief motivational interviews to reduce alcohol-related consequences among 18–19 year olds treated in an emergency room following an alcohol-related event. An assessment of their condition and future risk of harm and motivational interviews were conducted in the emergency room after the patient’s treatment. Follow-up assessments showed that youth who received the motivational interviews had a significantly lower incidence of drinking and driving, traffic violations, alcohol-related injuries and alcohol-related problems than youth who only received the standard care at the emergency room (Monti et al., 1999).
Monitoring health risks associated with youth groups is important to identify appropriate methods for the implementation and evaluation of public health interventions. The Centers for Disease Control and Prevention has developed a Youth Risk Behavior Surveillance System (YRBSS) to monitor six categories of priority health-risk behaviours among youth: behaviours that contribute to unintentional injuries and violence; tobacco, alcohol and other drug use; sexual behaviours that contribute to unintended pregnancy and sexually transmitted diseases; unhealthy dietary behaviours; and physical inactivity associated with overweight and obesity. The YRBSS includes a national school-based survey as well as state and local school-based surveys conducted by education and health agencies (Centers for Disease Control and Prevention, 2013a).
What distinguishes the causes of death of young people from other population age groups is that most deaths have behavioural causes that can be exacerbated by national policy or failures of health-service delivery systems. The reduction of risk in adolescence alone is therefore insufficient unless supportive environments and policy are available to help to protect young people. This includes prevention strategies such as safe abortion services and by providing social support, harm-reduction, peer education and self-help projects and policy on, for example, road safety and driving to use seat belts and to stop drunk-driving (World Bank, 2007).
KEY TEXTS
•DiClemente, R., Santelli, J. and Crosby, R. (eds) (2009) Adolescent Health: Understanding and Preventing Risk Behaviours (San Francisco: Jossey-Bass)
•Patton, G. et al. (2009) ‘Global Patterns of Mortality in Young People: A Systematic Analysis of Population Health Data’, The Lancet, 374: pp. 881–892
•World Bank (2007) ‘Development and the Next Generation’. World Development Report (Washington DC: The World Bank)