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Bringing Adolescent Health to the Forefront

Ablorh-Odjidja, Angela MHS; Joseph, Jennifer PhD

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Journal of Public Health Management and Practice: January-February 2007 - Volume 13 - Issue 1 - p 83-85
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Abstract

Adolescence is a unique developmental stage confluent with tremendous possibility and risk. The transition from childhood to adolescence brings a 300 percent increase in morbidity and mortality, with most of the danger associated with preventable behaviors.1 At the same time, the establishment of healthy behaviors in adolescence can set positive patterns that can be conveyed into adulthood.

A national expert panel identified 21 critical objectives for adolescents and young adults from the Healthy People 2010 Goals. Theses objectives address a range of issues associated with adolescent morbidity, mortality, and related negative health outcomes, including alcohol- and drug-related driving, seatbelt use, physical fighting, weapon carrying, binge drinking, other forms of substance abuse, depression and suicide, pregnancy, human immunodeficiency virus (HIV) and sexually transmitted disease (STD) infection, condom use, tobacco abuse, obesity, and physical activity.2 Adolescent health, safety, and well-being indicators have not improved over the last several years, and this array of contemporary challenges and opportunities provide a strong case for intensifying the focus on this population.

Adolescent vaccines recently approved by the FDA, including acellular pertussis, meningococcal, and human papilloma virus (HPV), have the potential to change the nature of adolescent healthcare by providing the impetus for multiple adolescent health visits. These visits may provide practitioners with regular and ongoing opportunities to provide education and counseling on various health issues affecting adolescents. Likewise, these advances raise questions about how these potentially life-saving vaccines can be effectively linked to the healthcare that must accompany their administration.

Local health departments (LHDs) are charged with ensuring the health of their communities3 and, as such, addressing the wide array of preconditions for health. LHDs are also uniquely positioned to initiate or support community-based adolescent health initiatives. The LHD's role in the community and its partnerships with the institutions that influence the health of adolescents facilitate this role (eg, relationships with parents and families, schools, local policy makers, healthcare providers, community agencies that serve youth, faith-based organizations, media, postsecondary institutions, employers, and other government agencies4).

Furthermore, LHDs have actively addressed a wide spectrum of adolescent health issues. They have promoted graduated driver's licensing initiatives, whereby adolescents get restricted driver's licenses that become more permissive as driving experience is accumulated. In response to the obesity epidemic, they have (1) educated schools on land-use planning,* (2) worked with schools to establish related policies and activities associated with built-environment issues,5 (3) advocated for policies that reduce or eliminate access to snack foods and/or beverages that contain large amounts of empty calories, and (4) collaborated with community partners to develop tools and resources to assist youth-serving organizations in encouraging physical activity.6 LHDs have also promoted smoke-free ordinances in their communities, reducing adolescent exposure and access to cigarettes and other tobacco products.

In addition, LHDs have also responded to HIV and STD infection, and unintended pregnancy. They have (1) provided and promoted the availability of confidential services in local clinics; (2) conducted integrated education and outreach for HIV, STD, and teen pregnancy prevention; (3) advocated for comprehensive sexual health information in schools; and (4) have collaborated with school-based health centers to provide education and clinical services and work with youth-serving organizations, schools, and other societal institutions to reach adolescents and their parents with vital information.

However, LHDs are generally not structured in ways conducive to addressing health issues associated with a life stage. Problem-oriented and disease-specific categorical funding streams often make it difficult to identify and meet the broad, cross-cutting health needs of a given community. As a result, adolescent health promotion tends to be reactive, focused on individual risk behaviors, and performed within programmatic silos rather than as a coordinated, coherent, and systematic effort.

In response to recognizing some of those same sorts of shortcomings in itself, NACCHO is enhancing its infrastructure and undertaking its own efforts to help LHDs build capacity to promote adolescent health in their communities. NACCHO will conduct needs assessments to further identify activities that best serve its members and will implement numerous planned activities such as identifying and disseminating model programs and practices, providing technical and other capacity-building assistance, and sharing relevant information through a new adolescent health e-mail distribution list. These activities are supported by the Centers for Disease Control and Prevention, Division of Adolescent and School Health, and the Health Resources and Services Administration, Maternal and Child Health Bureau.

Leveraging financial and human resources provides the opportunity to address broadly the risk and protective factors that are related to a spectrum of both positive and negative health outcomes. The positive youth development (PYD) approach provides an evidence-based framework to guide both NACCHO and LHDs beyond the paradigm of preventing problems to addressing the underlying developmental and contextual issues that can provide resiliency against them.

It is well known that health problems are not evenly distributed among adolescents. Glaring inequities exist, with African American and Hispanic youth experiencing a greater burden of many adolescent health problems and white adolescents being more likely to engage in alcohol, tobacco, and other substance abuse.7 There must be a better understanding of how to address these inequities, including how to address the structural determinants of negative health outcomes.8 The PYD framework is an approach that holds such promise.

In particular, the PYD goes beyond traditional approaches to prevention. This paradigm provides an opportunity to pool resources traditionally dedicated to single issues to provide opportunities for all youth to avoid negative health outcomes and experience a long-lasting healthy transition to adulthood.

Inherent in the PYD approach, and a factor increasingly being embraced by those in the field of prevention, is a positive outcome focus, involving young people in its processes and reaching out to other sectors of the community. While the PYD approach is not widespread in local public health practice, LHDs are increasingly embracing its principles and philosophies.

San Mateo County, California, recently held a week-long celebration of its accomplishments associated with its collaborative Youth Development Initiative, supported by the health department and several community partners. Their community's goals include giving youth a voice in decisions that affect them, placing youth as representatives on county commissions and boards, educating adults on the importance of their involvement in the lives of young people, promoting positive asset development, and providing youth with resources that enable them to make healthy decisions.9

Likewise, the Bridgeport Health Department in Connecticut has collaborated with school-based health centers and a local high school with a PYD approach. Their FAMILIES and SCHOOLS Together (FAST) program brings together 10 to 12 families in a multifamily group facilitated by a team of school- and community-based providers. The FAST Night is an opportunity for families to learn to “enjoy” their time together, make new connections to other families, and improve relationships between parents and children. The FAST program provides tools for parents to take leadership of their families, their lives, and to support their child's educational progress. Early outcomes suggest that families' bonds to school and community improve following involvement in FAST.*

Moreover, local health departments are also involved in Nebraska's Health and Human Services Department's statewide youth development initiative “to build a network of providers who work for positive connections and opportunities for youth.” Members of the network share resources, training opportunities and expertise in community collaboration.*

Finally, the New York State Association of County Health Officials is a partner in the State Department of Health's ACT for Youth Initiative, which aims to strengthen community partnerships that promote positive youth development and prevent risky and unhealthy behaviors among young people, aged 10 to 19. This statewide initiative has resulted in an online Positive Youth Development Manual, which shares lessons learned over the 5-year duration of the initiative.

NACCHO will continue to identify and catalog successful adolescent health and youth development strategies. A compendium of programs highlighting collaborations around adolescent HIV and STD prevention is currently being developed and plans are in place to produce similar documents with a broader youth development focus. These resources will be promoted to LHDs through the adolescent health distribution list, NACCHO's Web site, and through our publications.

Furthermore, NACCHO believes that there is untapped potential for LHDs to enhance adolescent health and welcomes the opportunity to serve our members and move this agenda forward. LHDs can be involved in NACCHO's efforts by subscribing to the new adolescent health distribution list (e-mail: [email protected]), sharing their own success stories for adolescent health promotion through our model and promising practices program, responding to requests for proposals for demonstration site funding opportunities, submitting relevant tools and resources developed and/or used at the local level, and sharing with NACCHO areas of related expertise for our growing database of peer-to-peer referrals.

REFERENCES

1. Dahl RE, Spear LP, eds. Adolescent Brain Development: Vulnerabilities and Opportunities. New York: Academy of Sciences; 2004.
2. CDC, HRSA, and National Adolescent Health Information Center, University of California, San Francisco. Improving the Health of Adolescents & Young Adults: A Guide for States and Communities. Atlanta, GA: 2004.
3. National Association of County and City Health Officials. Operational Definition of Functional Local Health Department. 2005. Available at: www.naccho.org. Accessed October 18, 2006.
4. Centers for Disease Control and Prevention, Health Resources and Services Administration, and National Adolescent Health Information Center, University of California, San Francisco. Improving the Health of Adolescents & Young Adults: A Guide for States and Communities. Atlanta, GA: 2004.
5. National Association of County and City Health Officials. Building Healthier Schools: Local Collaborations to Promote Nutrition and Physical Activity. Available at: http://www.naccho.org/documents/Healthy_Schools.pdf. Accessed October 18, 2006.
6. National Association of County and City Health Officials. Building Healthier Communities: Local Nutrition and Physical Activity Programs. Available at: www.naccho.org/topics/HPDP/documents/Healthy_Community.pdf. Accessed October 18, 2006.
7. Centers for Disease Control and Prevention. Youth risk behavior surveillance. MMWR. Morb Mortal Wkly Rep. 2006;55(SS-5). Available at: http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf. Accessed October 18, 2006.
8. Blankenship KM, Friedman SR, Dworkin S, Mantell JE. Structural interventions: concepts, challenges and opportunities for research. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2006: doi:10.1007/s11524-005-9007-4. Available at: http://www.harmredux.org/HIVarticles/BlankenshipStruc06±.pdf. Accessed October 18, 2006.
9. San Mateo County. San Mateo County celebrates positive youth development and community support with week-long event. Available at: http://www.yfes.org/pdfs/YDIPress.pdf. Accessed October 18, 2006.

*See http://www.naccho.org/topics/hpdp/land_use_planning/LUP_Toolbox.cfm for additional information on how LHDs are involved.
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*For more information, visit http://modelprograms.samhsa.gov/matrix_all.cfm.
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*For more informatiion, visit http://www.hhs.state.ne.us/hew/fah/PositiveYouthDevelopment/partners.htm.
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†For more information, visit http://www.actforyouth.net.
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‡The manual can be accessed at: http://www.actforyouth.net?ydManual.
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© 2007 Lippincott Williams & Wilkins, Inc.