Being, Belonging, Becoming: Minnesota's Adolescent Health Action Plan
2002 Executive Summary
|Minnesota Department of Health
P.O. Box 64975
St. Paul, MN 55164-0882
800-627-3529 MINNESOTA RELAY SERVICE TTY
Table of Contents
Adolescence...a formative time for being, belonging, becoming.
This period of life is characterized by significant change and transition. The health and well-being of adolescents is shaped by the world in which they grow and the people that surround them.
As young people navigate the changes of adolescence, it is critical that they receive the guidance, support and encouragement that fosters healthy development. Choosing the right course of action is daunting because health is a complex issue. Therefore, it is important first to clearly identify the factors that affect the health of adolescents and define what teens need to develop in healthy ways.
This information can be used to guide decisions about the best strategies and actions to support healthy youth in Minnesota.
Adolescence provides a unique opportunity to invest in the health and well-being of youth. Good health (physical, emotional, social and spiritual) enables young people to make the most of their teenage years while laying a strong foundation for adult life. Lifestyle behaviors developed during adolescence often continue into adulthood and influence long-term prospects for health and risk of chronic disease. Thus, investment in health during adolescence has long-term benefits.
Adolescence is defined by the World Health Organization as the period of life between the ages of 10 to 19 . It is a time characterized by distinct and dramatic developmental changes such as physical changes due to puberty; social changes related to social roles and expectations, and changing roles in relationships; and emotional and intellectual changes in a transition from concrete to abstract thought and reasoning. The rate of these developmental changes is second only to infancy. Experimentation and exploration are hallmarks of adolescence as young people seek to find their fit in society. This is a time of redefining and developing relationships, with parents, family and peers. It is important to understand adolescence in the continuum of the lifespan. The experiences of childhood have a significant impact on adolescence, while adolescence lays a foundation for the experiences of adulthood.
The Cost of Not Investing in Health of Adolescents
The cost of not investing in Minnesota youth is staggering in economic, social and humanitarian terms. At the same time, there are significant benefits of investing in the health of Minnesota adolescents. Young people who are well-educated and healthy are more likely to become contributing members of society and contributors to our economic prosperity. It is also more effective to prevent problems before they start, especially in childhood and adolescence. How Minnesota collectively invests in their success and well-being reflects who we are as a society.
Definition of Health
Health is an optimal state of well being in all areas of life physical, emotional, social and spiritual. By using this broad definition of health, adolescents are healthy when they:
1) engage in healthy behaviors that contribute to a healthy lifestyle;
2) have the capacity to thrive in spite of stressors in life (resiliency);
3) successfully engage in the developmental tasks of adolescence; and
4) experience a sense of wholeness and well-being.
Minnesota youth have defined health in a similar manner:
1. feeling confident in oneself;
2. feeling comfortable with oneself;
3. support of caring family, other adults and peers;
4. being strong in ones individuality;
5. having personal goals and dreams;
6. enjoyment of being with others and development of close, positive relationships;
Factors That Affect the Health of Adolescents
The health of adolescents is affected by a complex interplay of factors between the young person and their social environment. Their health is shaped by parents and families, peers, neighborhoods and communities, schools, community organizations, faith communities, health care systems, media, employers, and social norms, policies and laws. These factors impact young peoples sense of health and well-being by affecting their capacity to withstand life stressors, their ability to transition in developmentally appropriate ways, and their ability to make decisions about health behaviors.
There are a small number of behaviors that negatively affect the health of adolescents. In fact, 70% of adolescent death and illness are caused by six categories of risk behavior, listed in the table below.
BEHAVIORS THAT RESULT IN
UNINTENTIONAL AND INTENTIONAL INJURY
(including violence and suicidal behaviors)
ALCOHOL AND OTHER DRUG ABUSE
that result in unintended pregnancy, HIV infection
and other sexually transmitted infections
UNHEALTHY DIETARY BEHAVIORS
INADEQUATE PHYSICAL ACTIVITY
There are a multitude of factors, both positive and negative, that influence the health and well-being of adolescents.
Risk factors are elements that raise the odds that a poor outcome will occur and diminish the likelihood of successful development. While they do not predict or guarantee an outcome, risk factors threaten the health and well-being of youth.
Protective factors have a positive influence. They are elements that moderate or buffer against hazards and stressors. Protective factors do not eliminate risk but moderate it. Risk and protective factors interact together to influence the health of youth.
It is not just the presence of factors but more importantly the complex balance and interplay between them that affects health.
Spheres of Influence
To better understand the affect of risk and protective factors, they can be organized within spheres of influence:
Individual Adolescent (Youth)
There are factors within the individual adolescent that affect the young persons health and well-being. Some factors are biologically determined while others are social in nature, including a young persons view of self, their attitudes and beliefs, their sense of future and their ability to interact socially with others.
Family plays a critical role in the health and well-being of adolescents. Teens supported by a caring family are most likely to develop in healthy ways and less likely to engage in problem behaviors. Young people who grow up surrounded by family discord, conflict, instability and lack of supervision are at higher risk for poor health outcomes.
The influence of peers on health can be direct (attitudes and behaviors of peers) or indirect (a young persons perception of their peer groups attitudes and behaviors).
School has a powerful influence on the health and well-being of adolescents. Young people who feel connected to school are less likely to be involved in problem behaviors. Adolescents who struggle in school (being old for grade, being retained in grade, failing in school, dropping out) tend to be at higher risk for problem behaviors.
Young people who feel a sense of belonging to a community that offers support and opportunity are fostered to grow and develop in healthy ways. This support can be provided through caring adults, community organizations, faith communities, other community institutions, and opportunities for authentic involvement. Youth surrounded by communities characterized by poverty, chaos, disconnection and violence tend to be at higher risk for problem behaviors and poor outcomes.
The Connection Between Healthy Development and Adolescent Health
There are specific developmental tasks that all youth need to accomplish in order to enter adulthood well prepared. These tasks are best described by the theme of being, belonging and becoming.
Being refers to defining who I am and has to do with personal values, attitudes, knowledge and behaviors. These developmental tasks revolve around defining a clear sense of identity, a positive sense of self worth and control over ones life.
Belonging refers to finding my place in the world and has to do with a young persons fit with their environment. These developmental tasks focus on the ability to form healthy relationships with others, using available support systems, finding a valued place in their world and finding ways to be useful to others.
Becoming refers to achieving my personal goals, hopes and aspirations. These developmental tasks include mastering social skills, developing lifelong learning habits, developing a sense of curiosity and exploration, seeing a promising future with real opportunities, acquiring skills to participate in our economy and establishing a respect for diversity.
Young people who are supported to complete these developmental tasks are better prepared to make a successful transition from adolescence into adulthood while young people who are not given healthy outlets for growth are likely to find potentially harmful alternatives. In general, adolescents need to be surrounded by safe places, challenging experiences and caring people to develop in healthy ways.
The Current Health Status of Minnesota Adolescents
Developing effective strategies starts by assessing the current health status of youth. This assessment includes examination of the key factors that affect youth health.
Population of Adolescents
The number of adolescents age 10-19 and their percentage of the total population in Minnesota is expected to decline from 1995 to 2025. At the same time, adolescents will become more racially and ethnically diverse. In 1995, youth of color (age 10-19) represented 9% of all adolescents in Minnesota they are expected to comprise 16% in 2025 .
Challenges to Health
In conversations with Minnesota youth age 12 to 21, they identified the following as the most significant challenges to their health:
1. TRADITIONAL PROBLEMS
Alcohol and other drug use; Sexual activity, pregnancy and issues of sexuality; Depression and suicide
2. STRESS AND DISTRESS
3. INADEQUATE RESOURCES FOR YOUTH:
Inadequate fit between schools and youth; Inadequate recreational opportunities for youth
4. YOUTH DISCONNECTION FROM ADULTS:
Adult stereotypes about youth and lack of respect for youth; Problems with parents and families; Problems with adults
5. SOCIETAL PROBLEMS
Violence, racism, poverty, homelessness, unhealthy neighborhoods, people who are disconnected
Factors that Affect the Health of Minnesota Adolescents:
Too few adolescents have access to appropriately designed and delivered health care services. Challenges include:
1) lack of health care providers who understand adolescent health and enjoy working with teens;
2) lack of coordination of health care services;
3) lack of access to services at convenient times and locations;
4) lack of confidentiality for sensitive services; and
5) difficulties in financing of health care services when youth seek services outside of the traditional health service system.
A large proportion of teens believe that their family cares about them and are able to talk with their parents about problems .
Youth in grades 6, 9 and 12 generally have positive feelings about themselves .
Peers can have a strong impact on the health of teens. In Minnesota, friends are the number one source of happiness for adolescents in public schools . Nationally, teens who spend significant amounts of time hanging out with friends, especially those who are involved in specific risk behaviors, are more likely to be involved in these behaviors themselves .
School has a powerful influence on the health and well-being of adolescents. Yet an alarming percentage of students report cutting or skipping school and there are significant disparities in school completion by race and ethnicity [3,5].
In a 1999 national public opinion poll of Americans, a strong majority of adults describe teens negatively, using words such as rude, irresponsible and wild. Only 38% believe that todays youth, once grown, will make the United States a better place. Despite their pessimism about teens, adults believe that helping youth get a good start in life is one of the most important issues facing the country, even more important than creating jobs or reducing crime .
Minnesota Adolescent Health Behaviors and Outcomes
INJURY AND VIOLENCE
Youth age 10-19 represented 16% of all motor vehicle crash deaths and 23% of all motor vehicle crash injuries in 1999 . An alarming percentage of high school students report driving after use of alcohol or other drugs and riding with others who have used these chemicals .
For 15-19 year old youth, homicide and suicide combined accounted for one quarter of deaths in this age group in 1998 .
On average, a classroom of 30 high school students will have at least 2 or 3 youths who have been sexually abused .
Nationally, adolescents experienced the highest rates of violent crime in 1999 .
CAUSES OF DEATH
Unintentional and intentional injuries are leading causes of death among Minnesota adolescents age 10-19, especially older teens. Deaths due to motor vehicle injuries represent the largest proportion of all unintentional injury deaths among this age group .
TOBACCO, ALCOHOL AND OTHER DRUGS
More than 1 out of 3 high school students and 1 out of 8 middle school students are current tobacco users. Most young smokers say they would like to quit and many have tried to quit unsuccessfully .
Alcohol is a commonly used chemical among Minnesota adolescents. Between 1992-1998, marijuana use increased while alcohol and other drug use decreased slightly among 9th and 12th graders .
SEXUAL BEHAVIOR, PREGNANCY, STDS & HIV
The percent of students in 9th and 12th grades who have ever had sexual intercourse decreased from 1989 to 1998 .
The overall teen pregnancy and birth rates decreased from 1990 to 1998, yet the rates for Hispanic and Asian youth increased. Also, Minnesota youth of color face teen pregnancy and birth rates that are 2-51/2 times higher than white teens with African American and Hispanic young women most likely to experience a pregnancy and give birth . Nationally, teen pregnancy rates have declined because:
1) fewer teens are having sex; and
2) more sexually active teens are using contraceptives effectively .
Adolescents and young adults (age 15-24) have the highest rates of Chlamydia and Gonorrhea in Minnesota . Youth of color are disproportionately represented among youth diagnosed with STD and HIV infection [12,13].
Factors that contribute to this disparity require careful attention and focus.
NUTRITION AND PHYSICAL ACTIVITY
There are limited data about nutrition and physical activity among Minnesota adolescents. Only a small percentage of 6th, 9th and 12th grade students participate in physical activity on a regular basis and eat adequate amounts of fruits and vegetables every day. Weight and appearance are a source of worry for a large percentage of high school students .
MENTAL HEALTH & SUICIDE
An alarming percentage of Minnesota teens report feeling pervasive sadness, high levels of stress, feelings of hopelessness/discouragement, and having thought about or having tried to kill themselves . Between 1996 and 1998, the suicide rate among young people age 15-19 decreased slightly .
Action Steps That Effectively Support the Health of Adolescents
Extensive work in the field of adolescent health over the past 30 years provides a wealth of information about strategies that effectively support the health and wellbeing of youth. Analyzing and applying the lessons learned from this research can assist in making informed decisions about those strategies that most likely have a positive effect on the health of Minnesota adolescents.
Types of Strategies
Four types of strategies have been shown to effectively support the health and well-being of adolescents:
1. DECREASING THE RISK FACTORS that contribute to risky behaviors and poor health outcomes.
2. INCREASING THE PROTECTIVE FACTORS that contribute to resiliency and healthy outcomes.
3. PROVIDING OPPORTUNITIES for young people to successfully meet the developmental needs of adolescence.
4. BUILDING HEALTHY COMMUNITIES that support and nurture adolescents.
There are a number of characteristics shared by effective adolescent health strategies. These characteristics play out differently depending on whether strategies intervene directly with adolescents and their families or build systems that support healthy youth. But at their core, effective strategies incorporate many of these characteristics:
1. Adolescents are viewed as resources to be nurtured and supported, not problems to be fixed.
2. Strategies are integrated and coordinated.
- There is a diversity of strategies that focus not only on adolescents, but also on their social environment including families, peers, schools, and communities.
- A combination of prevention, health promotion and healthy youth development (asset-building) strategies are used.
3. Youth are involved and engaged as active partners in the design, implementation and evaluation of strategies.
4. There is a good fit between strategies and the adolescents on which they focus.
- They are responsive to cultural, ethnic and other forms of diversity.
- They are developmentally appropriate.
5. The people involved understand adolescent health and well-being.
6. There is a focus on building and strengthening relationships.
- They purposefully focus on building supportive adult-youth relationships.
- They focus on strengthening families.
7. Young people are supported to make successful transitions.
- They help youth to develop basic life skills.
- They help young people find and become involved in meaningful roles in their communities.
- They strengthen the social supports available to adolescents and their families.
8. They provide an array of opportunities for young people so that risk behaviors are not the best option open to youth.
A Minnesota Vision for Healthy Adolescence
Our responsibility as the community of Minnesota is to support and guide Minnesota youth in the healthy development of being, belonging and becoming. This requires a focus on wholeness and wellness, and seeing Minnesota youth as at promise rather than at risk. Minnesota youth can achieve health and well-being when they have the following:
- The basic needs of adolescents are met (including food, shelter and safety).
- Communities that embrace, respect and value adolescents.
- Caring adults of all ages support adolescents through nurturing relationships.
- Education is individualized to meet the needs of adolescents and the needs of society.
- Social and recreational opportunities that are interesting and challenging are available to adolescents.
- An opportunity to provide leadership and play an active role in their community, including policy-making.
- Universal access to holistic physical and mental health services.
- Support to reduce their risk for poor health outcomes.
- Resources that are adequately funded, continuous and flexible to effectively meet the health needs of adolescents.
- Participation in decision making is equal among all groups.
Recommendations for Action
These recommendations for action provide the means to build a nurturing and supportive environment for all teens in Minnesota. They focus on:
- building the capacity of youth by providing caring relationships, positive expectations, opportunities to participate and contribute, and support for healthy behavior;
- developing a comprehensive set of resources that address adolescent health issues;
- strengthening the infrastructure of resources that support healthy
youth, families and communities.
The action steps following each recommendation provide more detailed information on ways to act on the recommendation. These steps are intended to be implemented at a variety of different levels:
INDIVIDUALAND FAMILY-FOCUSED ACTIONS that change the knowledge, attitudes, beliefs, skills, practices and behaviors among individuals, either singly or in families, classes or groups.
COMMUNITY-FOCUSED ACTIONS that change community norms, attitudes, practices and behaviors among a population-of-interest (e.g., target group).
SYSTEMS-FOCUSED ACTIONS that change organizations, policies, laws, and structures.
Change societys view of adolescents to see youth as resources to be nurtured rather than as problems to be fixed
The goal of this recommendation is to develop a positive view of adolescents among the general public. The action steps promote a view of adolescence focused on the strength and capacity of youth. This view will contribute to an environment that nurtures the health and well-being of Minnesota adolescents.
Educate adults about adolescent health and development
The goal of this recommendation is to increase adult knowledge and skills about adolescence in order to strengthen their capacity to support healthy youth. The action steps focus on training both adults who work formally and informally with teens, and adults who influence policy and funding decisions.
Routinely partner with adolescents to address the issues that affect their health and development
The goal of this recommendation is to engage youth authentically in addressing their issues. Partnership with youth increases the effectiveness of actions because teens understand youth issues in ways that adults do not. It also provides opportunity for youth to be involved in meaningful roles in their communities. The action steps strive to engage the insight, creative ideas, enthusiasm and commitment of adolescents in all areas of adolescent health and well-being.
Build the capacity of families to support healthy adolescents
The family plays a significant role in nurturing the health and well-being of teens. The goal of this recommendation is to support strong, stable families that have the capacity to nurture healthy children and adolescents. The action steps focus on strategies that reach out to parents and other caregivers to develop strong families from birth through adolescence.
Build the capacity of adolescents to become productive adults
Strengthen schools for students of all ages
Strengthen opportunities that connect teens to the world of work
The goal of this recommendation is to provide adolescents with the opportunities that build a promising future and pathways towards a successful transition into adult roles. The action steps focus on strengthening schools for students of all ages and improving opportunities that connect youth to the world of work.
Develop activities that provide youth with healthy outlets and connections to caring adults
Develop a wide variety of recreational activities for teens
Develop opportunities for teens to give back to their community
Develop opportunities for adults to build supportive relationships with youth, especially those who are struggling
The goal of this recommendation is to involve young people in activities that provide opportunity for:
1) healthy experimentation;
2) development of critical social skills;
3) connections to caring adults;
4) involvement in meaningful activities within the community; and
5) experience of success.
The action steps focus on opportunities for recreation, community service and civic engagement. They include activities that connect youth with supportive adults.
Improve the responsiveness of physical and mental health care services to adolescent health needs
Strengthen health care services for adolescents and their families
Improve mental health services for adolescents
The goal of this recommendation is to strengthen the health care system to better meet the mental and physical health needs of adolescents. The action steps focus on access to services, increasing the capacity of health care providers to effectively address adolescent health needs, and providing services confidentially while balancing the need to reach out to parents of teens.
Use strategies that are effective in meeting the needs of Minnesota adolescents
Increase the responsiveness of youth programs to the cultural and ethnic diversity of Minnesota youth
Promote the use of best practices and promising strategies to build the capacities of all Minnesota youth
The goal of this recommendation is to promote use of actions proven effective to meet the needs of youth. The action steps focus on improving the fit between a diverse group of Minnesota teens and the strategies used to address their health needs. They focus on increasing the use of information from research and program evaluation to guide decisions on adolescent health activities, programs and services.
Strengthen the infrastructure of adolescent health resources in Minnesota
Develop commitment to a unified adolescent health agenda focused on building the capacities of all Minnesota youth
Strengthen the connections and relationships between organizations that address adolescent health and healthy development
Improve data on adolescent health and development
Strengthen the evaluation of adolescent health and healthy development activities
Strengthen funding for effective adolescent health and healthy development activities
The goal of this recommendation is to ensure that Minnesota has a structure that supports a comprehensive network of adolescent health resources. These actions steps focus on:
1) strengthening commitment to a common adolescent health agenda;
2) building relationships between adolescent focused agencies at the state and local levels;
3) strengthening adolescent health data and program evaluation; and
4) developing stable funding.
Together, these actions move Minnesota from systems that foster a piecemeal approach to adolescent health to one that is coordinated and comprehensive.
Address the social conditions that affect the health of youth, especially racism
The goal of this recommendation is to improve the social conditions that negatively affect the health and well-being of youth and their families. These action steps are based on an understanding that the fundamental conditions and resources for health are peace, shelter, education, food, income, a stable ecosystem, sustainable
resources, social justice and equity .
Resources for Action
Addressing adolescent health issues is a complex endeavor, one that requires sharing resources and expertise across communities. While it is often overwhelming to put effective strategies in place, there is a vast array of resources available to help in planning, implementing and evaluating these strategies. The following is an abbreviated list of resources that touch on aspects of adolescent health and development.
Center for 4-H Youth Development
This is the largest youth organization in Minnesota, one focused on youth development. 4-H is a part of the University of Minnesota Extension Services, an educational outreach arm of the University with offices in every county of the state. It includes a wide variety of activities and programs for youth, including a Minnesota Multicultural Youth Corps which seeks to educate youth about cultural issues and diversity, and helps build relationships among its participants.
University of Minnesota
200 Oak Street Southeast, Suite 270B
Minneapolis, MN 55455
(612) 624-2116 or (800) 444-4238
Center for Youth Development and Policy Research (CYD)
This organization is dedicated to contributing to better futures for all youth, particularly disadvantaged youth in the United States. Its goal is to transform concern about youth problems into public and private commitment to youth development. It produces a series of papers on youth risk and development available from their website or ordered in print copy. Topics include violence prevention, drug abuse and building supportive communities for youth.
Center for Youth Development & Policy Research
Academy for Educational Development
1825 Connecticut Avenue Northwest, Suite 700
Washington D.C. 20009
Healthy Youth Funding Database
A website that provides access to a database of information about funding resources that support school health and adolescent health programs. It includes information on federal and private funding and is updated frequently and easy to use. It provides links to the website of funders as they become available.
Centers for Disease Control and Prevention
Division of Adolescent and School Health (DASH)
4770 Buford Highway, N.E.
Atlanta, GA 30341-3724
Konopka Institute for Best Practices in Adolescent Health
The Konopka Institute is a special initiative of the Schools of Medicine, Nursing and Public Health at the University of Minnesota. Their mission is to promote the adoption and adaptation of strategies, policies and systems that show the greatest promise of supporting healthy youth development. This is done through 1) dissemination of cutting edge information on a range of adolescent health-related issues; 2) convening and creating opportunities for discussion around specific policy, programmatic or systems issues; 3) education about adolescent health best practices and tools to adapt these practices for application at state and local levels; and 4) translating research into everyday language and in formats accessible to a wide variety of audiences. Their publications include Growing absolutely fantastic youth: A guide to best practices in healthy youth development and Best Bet policy briefs.
University of Minnesota
200 Oak Street SE, Suite 260
Minneapolis, MN 55455-2002
National Adolescent Health Information Center
An organization that disseminates a wide array of practical information about adolescent health that is grounded in research.
National Adolescent Health Information Center
3333 California Street, Box 0503
San Francisco, CA 94143
Strategies for public health: A compendium of ideas, experiences, and
research from Minnesotas public health professionals
A guide to best practices and promising strategies to address a wide range of health concerns, including adolescent health issues.
Minnesota Department of Health
Health Systems Development Section
P.O. Box 64975
St. Paul, MN 55164-0975
A non-profit policy research organization whose goals are to sharpen thinking about societys problems and efforts to solve them, improve government decisions and their implementation, and increase citizens awareness about important public choices. As part of their work, they have developed a number of adolescent-focused publications such as Teen risk-taking: Promising prevention programs and approaches; Why should we invest in adolescents?; Helping at-risk youth: Lessons from community-based initiatives. Many of these reports are available on-line.
2100 M Street NW
Washington D.C. 20037
Whats Up? Adolescent Health Fact Sheets
Factsheets on a wide variety of adolescent health issues including drug and alcohol use, tobacco use, eating disorders, nutrition, physical activity, physical growth and development, emotional growth and development, STDs, teen pregnancy, sexual behavior, intentional and unintentional injury, sexual identity, suicide, and talking to your teen. Available on-line or in print version (the order form is available on-line). Up to 25 copies of each fact sheet are available at no cost. being,
Washington State Department of Health
P.O. Box 47890
Olympia, WA 98504-7890
|NOW IS THE TIME FOR ACTION|
The health and well-being of Minnesota youth is in our hands. Being, Belonging, Becoming: Minnesotas Adolescent Health Action Plan provides an array of tools for use by advocates to strengthen Minnesotas investment in healthy youth. While the magnitude of work is great, each of us has an important role to play. Take time to think about how the information in the Action Plan fits with your work, whether personal or professional. Then decide on what area or areas you can take action. No action is too small!
14. WHO Collaborating Centre on Supportive Environments for Health (1986). Ottawa Charter for Health Promotion (on-line). Available: http://www.phs.ki.se/whoccse/ottawa.htm
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