National Initiative to Improve Adolescent Health by the Year 2010: Linking Youth Development to Positive Health Outcomes in Adolescents

Practice Matters, March 2006

A publication of the ACT for Youth Center of Excellence

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by Dr. Richard Kreipe, Division of Adolescent Medicine, University of Rochester

Overview of NIIAH

The National Initiative to Improve Adolescent Health by the Year 2010 (NIIAH, National Initiative) was created to improve the health, safety and well-being of adolescents and young adults through collaborative action at community, state and national levels. Launched as a unique partnership between two federal agencies (the Centers for Disease Control and Prevention: Division of Adolescent and School Health, and the Health Services and Resources Administration: Maternal and Child Health Bureau's Office of Adolescent Health, the National Initiative provides a great opportunity for policy makers, health professionals, community members, adolescents and their families to collectively address the issues that affect the health of American youth ages 10 to 24. Anchored in Healthy People 2010, the National Initiative focuses on 21 objectives that were identified by a national expert consensus panel as being related to critical health outcomes or contributing behaviors, and for which state-level data are (or will soon be) available to measure progress. The 21 Critical Adolescent Health Objectives span six themes:

  1. Mortality
  2. Unintentional Injury
  3. Violence
  4. Mental Health & Substance Abuse
  5. Reproductive Health
  6. Chronic Diseases

For more information go to: http://www.healthypeople.gov/search/stat_21crobj.htm.

Achieving these objectives will require reducing existing disparities in health among different groups of adolescents, and a broader view of adolescent health, recognizing the role that positive youth development and safe, nurturing environments play in helping young people both make healthy decisions and positively influence their environment. In focusing on healthy youth development, the National Initiative takes a positive and affirming ecological perspective, emphasizing young people's potential and reciprocal interactions between them and their environment. This youth development approach nurtures young people's internal assets, including their emerging capacities for empathy and engagement, meaningful relationships, critical thinking and leadership. Parallel to the World Health Organization's definition of health ("the presence of complete physical, mental and social well-being and not merely the absence of disease or infirmity"), this approach views the hallmarks of adolescent health, not as the absence of health problems or risky behaviors, but the cultivation of internal and external strengths, and the achievement of one's full human potential. The National Initiative also recognizes that an adolescent's environment strongly shapes his or her choices and behaviors, and that addressing the health needs of youth is a complex enterprise. Families, schools, communities and public policies influence behavior. Although young people are responsible for their choices, adults also bear responsibility for the choices available to them. This requires a societal commitment to young people at the local, regional, state and national levels, and a different way in which we measure success in efforts to improve adolescent health.

Linking NIAAH to NYS DOH and ACT for Youth

In the youth development framework, success is measured by an adolescent's personal growth and achievements, not merely by problems averted. To create healthy environments, all members of society -- adults and youth -- have a role to play in improving adolescent health. Adolescents and their families need support from schools, faith-based organizations, businesses, policymakers, medical and health professionals, and many others. The National Initiative encourages all adults to empower adolescents to take greater leadership in creating healthy environments. This is an ambitious endeavor, but its advocates firmly believe that our young people deserve no less.

Does this sound familiar? It should because these are the very principles upon which the ACT for Youth Initiative was established more than six years ago. It is important to acknowledge that the New York State Department of Health was extremely progressive when they first established the positive youth development approach as a promising strategy to address public health issues. In its early phases, youth development work was often viewed as more relevant to social work, education, recreation or leisure activities than to health.

However, as data emerged that adolescents with more assets or more protective factors also had better health outcomes, the public health community started to pay attention to youth development as a potential strategy to address the most difficult challenges facing professionals with respect to adolescent health problems, such as those listed in the 21 critical objectives. A publication in June 2005 from the Forum for Youth Investment entitled "What's Health Got To Do With It?" made an excellent case for "connecting the dots" that link health and youth development.

For more information go to: http://www.forumfyi.org/Files/ForumFOCUS_May.June2005.pdf. This article makes a persuasive argument for seeing youth development as a public health measure.

The New York State Department of Health ensures the public health infrastructure, supports scientific and technical capabilities, and facilitates youth development program capacity and services through programs like ACT for Youth. The National Initiative also supports states by providing a range of practical resources focused on strategic action to improve the health of youth at state and community levels. All materials are available on-line at the National Adolescent Health Information Center (NAHIC) website. NAHIC is a wonderful resource -- supported by your federal tax dollars through a grant from the Maternal and Child Health Bureau in the Health Resources and Services Administration (HRSA/MCHB). Browsing their website will show you the full range of materials pertinent to your work.

Linking YD Concepts to Adolescent Health: Resources to Get You Started

To get started, if you are not familiar with Improving the Health of Adolescents & Young Adults: A Guide for States and Communities, I suggest that you become familiar with this core document, as it is designed to help guide state and local agencies and organizations, and local adolescent health leaders through public health processes and resources facilitating initiatives related to the 21 Critical Adolescent Health Objectives. The considerably briefer (1.3 mb, 11 page) Executive Summary is available on-line before reading the entire 257 page document. The executive summary (http://nahic.ucsf.edu//downloads/niiah/execsum.pdf) highlights things that can be done to improve adolescent health -- at a population rather than an individual level, by applying a youth development approach.

Another large (175 pages) document from NAHIC that may be helpful in planning can be found at http://nahic.ucsf.edu/index.php/niiah/article/niiah_brief_documents/. This document, entitled, Toward Meeting the Needs of Adolescents: An Assessment of Federally Funded Adolescent Health Programs and Initiatives Within the Department of Health and Human Services (2005) examines the federal-level focus on adolescent health and federal approaches to improving adolescent health, as well as evaluations of adolescent health programs. This review aims to help policymakers and program managers effectively use resources to meet the needs of adolescents, their families, and their communities. Although its focus is the federal level, it is important to note that much of the funding available at the local level represents federal "pass-through" that comes through various state agencies. Therefore, having an awareness of federal priorities and initiatives is very worthwhile even for those working in small communities.

Finally, there is an excellent brief that provides an overview of Best Practices and a comprehensive listing (http://nahic.ucsf.edu/index.php/publications/article/best_practices_brief/) of resources available in adolescent health. This provides the kind of evidence that practitioners may find useful as they prepare to implement youth development practices and improve the health of adolescents.

Spending some time becoming familiar with these materials can only assist you in your local youth development and community building efforts. The materials on the National Initiative are available on-line and free-of-charge through NAHIC. New products are coming out all the time, so check in regularly. In many ways, New York State was a national leader in employing youth development approaches to public health problems when ACT for Youth was started several years ago. Now that the rest of the nation has caught up with us, in the form of the National Inititive, we should take advantage of these wonderful resources to continually improve the health of adolescents in New York State.

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