January 25, 2020
The United States Department of Health and Human Services (HHS) Office of the Assistant Secretary for Health (OASH) should focus funding on holistic, evidence-based, population-wide adolescent health programs that consider adolescent risk-taking as normative, according to a new report from the National Academies of Sciences, Engineering, and Medicine.
The report was co-authored by Nicole Kahn, PhD, a program officer with the National Academies and an adjunct assistant professor of maternal and child health at the UNC Gillings School of Global Public Health.
OASH should ensure that its programs promote building-block skills — beginning in childhood and continuing through adolescence — that make healthy behaviors possible, and engage diverse communities in improving the social and environmental factors that disadvantage and stress youth and their families.
The report — Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century — offers promising approaches for adolescent health programs, explaining that they can benefit from implementing policies and practices that promote inclusiveness and equity so that all youth are able to thrive. Effective adolescent health research, policies and programs also can benefit from including youth of diverse ages, racial and ethnic backgrounds, socioeconomic status, rural and urban settings, sexual orientation, sex and gender, and disability status in decision-making processes.
Neurobiological changes lead young people to seek out new experiences and make sense of their environments through exploration, experimentation and risk-taking, the report says. Risk-taking helps young people become autonomous, explore their identities and forge social ties, and the report emphasizes that OASH programs should treat risk-taking and exploration as normal adolescent behavior.
The report recommends that HHS fund additional research aimed at identifying and evaluating the effectiveness of specific core components of programs that promote positive adolescent health behaviors and outcomes. It also suggests that the Centers for Disease Control and Prevention update its Youth Risk Behavior Survey to include youth who are not in school and to cover a more comprehensive set of sexual behaviors.
OASH requested that the National Academies identify core components of risk behavior prevention programs that can be used to improve a variety of adolescent health outcomes, with the parallel goal of discontinuing — rather than just reducing — risky behaviors among adolescents. The committee that wrote the report conducted a systematic review focused on programs that promote positive adolescent health behaviors and outcomes, with a particular focus on tobacco use, alcohol consumption and sexual behavior.
The review did not reveal consistent evidence of effectiveness for specific core components across all of the studies reviewed. The committee’s ability to identify these components was limited by the scope of studies currently available in the literature.
However, the review did reveal the strengths of social-emotional learning and positive youth development programs, which can equip children and adolescents with the foundational skills they need for effective impulse control and self-regulation and ultimately can help them make healthy decisions in a variety of situations. Programs that focus on specific health behaviors, such as substance use prevention or inclusive sex education, can then build on these foundational skills to promote positive health outcomes. Programs that involved youth, families and communities, and that targeted social determinants of health, were shown to effectively reduce health inequities tied to social and economic disadvantage.
The study — undertaken by the Committee on Applying Lessons of Optimal Adolescent Health to Improve Behavioral Outcomes for Youth — was sponsored by HHS.
The National Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, which was signed by President Lincoln. For more information, visit nationalacademies.org.
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