Commentary Adolescent Health and Youth Development: Turning Social Policy Into Public Health Practice Richard E. Kreipe rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr The blueprint for improving the health of Americans, has demonstrated effectiveness in addressing public Healthy People 2010, contains eight measurable lead- health goals. Youth with more developmental assets ing health indicators for adolescents and young adults, have reduced morbidity and better health outcomes.3 with six targets directed at morbidity and mortality. In recognition of emerging data regarding the protec- These are reduction of (1) deaths caused by motor ve- tive value of YD approaches with respect to improving hicle crashes, (2) homicides, (3) proportion of youth the health of youth, Dr Karen Pittman, one of the au- engaging in binge drinking of alcoholic beverages, (4) thors of another commentary in this supplement, was past-month use of illicit substances, (5) tobacco use, and invited to be the keynote speaker at the Society for Ado- (6) proportion of youth who are overweight or obese. lescent Medicine annual meeting in 2000. Instead of fo- In addition, there are two targets directed at wellness, cusing on the prevention of illness, the YD approach increasing the proportion of youth who (1) abstain from that she and others have espoused takes a positive and sexual intercourse or use condoms if currently sexually affirming ecological perspective, emphasizing young active and (2) engage in vigorous physical activity.1 Al- people’s potential (not as problems) and the reciprocal though each of these targets is related to potentially interactions (positive or negative) that they have with modifiable adolescent behaviors, traditional medical their environment. As she and colleagues point out, a approaches have largely failed to reach them. Even pub- YD approach nurtures adolescents’ internal assets, in- lic health approaches have predominantly been deficit- cluding their emerging capacities for empathy and en- based, insofar as they tend to measure the reduction gagement, meaningful relationships, critical thinking, in morbidity or mortality, rather than improvements in and leadership, with a “downstream” effect of improv- health (including 75% of health indicators mentioned ing health-related behaviors. Adolescent health is not above). Moreover, an Institute of Medicine report re- framed as the absence of health problems or risky be- cently expressed concern about the crumbling infras- haviors but as the cultivation of internal and external tructure of public health in America and noted the need strengths resulting in the attainment of an individual’s to determine the best strategies to ensure the health of full human potential, which is associated with better the public in the 21st century.2 Thus, specialists in pub- health. A feature of YD that makes it equally attractive lic health and in adolescent healthcare have begun to to adolescent healthcare providers and to public health recognize the promise of a more positive, asset-based practitioners is its applicability across all levels of in- approach to improve the health of our youth by focus- tervention, from the individual youth to entire popula- ing on healthy youth development (YD). The details tions of young people. of the YD approach are explored by several articles in At the individual level, providers of adolescent this supplement of the Journal of Public Health Manage- healthcare, including private practitioners and school ment and Practice and offer innovative alternatives to approaches that have failed largely because they did not include the target population in their design or im- Corresponding author: Richard E. Kreipe, MD, Division of Adolescent Medicine, plementation in meaningful ways. Department of Pediatrics, University of Rochester, Golisano Children’s Hospital Although not intentionally designed as a public at Strong, 601 Elmwood Ave, Rochester, NY 14642 (e-mail: richard kreipe@ urmc.rochester.edu). health strategy, attention to positive YD nonetheless qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq Richard E. Kreipe, MD, is Professor of Pediatrics and Chief, Division of Adolescent J Public Health Management Practice, 2006, November(Suppl), S4–S6 Medicine, Department of Pediatrics, University of Rochester, Golisano Children’s C 2006 Lippincott Williams & Wilkins, Inc. Hospital at Strong, Rochester, New York. S4 Adolescent Health and Youth Development ❘ S5 health professionals, need to be involved in YD at the in- The public health implications of the YD approach dividual and family levels. For example, Bright Futures4 span from the county to the national level. As an ex- is a set of guidelines for health supervision that very ample, Monroe County (Rochester), New York, estab- clearly focuses on the development of youth assets. lished an initiative called HEALTH ACTION in which Health maintenance visits in the YD framework include the community would be considered “healthy” if it asking the adolescent about family, friends, academics, achieved optimal levels of objective measures of health and leisure activities. Likewise, health counseling ad- status and sustained a commitment to health to all age dresses not only high-risk behaviors but also issues groups. In this context, the two youth-oriented prior- such as community service and features related to char- ities for community action in 2001 were to reduce to- acter, confidence, competence, connectedness, and car- bacco use and to build youth competencies to promote ing. Parents are similarly included in a YD framework, healthy lives. These continue to frame public health ef- with appraisal of parenting style and practices and ex- forts in the community, with encouraging results. The pectations and supervision of adolescent activities. Re- rate of smoking among youth has been reduced by 50 gardless of the purpose of the visit, recommendations percent and a Community Asset Partner Network has to enhance an adolescent’s developmental assets can be been established6 to enhance ongoing YD activities in made at the individual and/or family level. For exam- the region, including a Youth Summit attended by more ple, during a “sports physical,” the practitioner can de- than 700 individuals. Overseen by the County Depart- termine the role that sports plays in the adolescent’s life, ment of Health, HEALTH ACTION is a public health as well as how sports is balanced against other creative intervention that not only measures youth assets but activities and academics. Nonparental adults, such as also makes enhancing youth assets a community prior- coaches, can function as important role models and ex- ity across all youth-serving agencies. ternal assets. The National Initiative to Improve Adolescent Two asset-based, autonomy-supportive YD tech- Health by the Year 2010 (NIIAH) is a broad-based niques in providing healthcare to individual adoles- effort to improve the health, safety, and well-being cents that can be used to address public health prob- of adolescents and young adults. Led by a federal lems listed in Healthy People 2010 include the use of partnership between the Centers for Disease Con- guided decision making and motivational interview- trol and Prevention’s Division of Adolescent and ing. For example, youth who smoke can be engaged School Health (CDC/DASH) and the Health Re- as active participants—with assistance from the health- sources and Services Administration’s Maternal and care professional using guided decision making—in de- Child Health Bureau/Office of Adolescent Health termining the strategies most likely to help them quit (HRSA/MCHB/OAH) working in collaboration, the using tobacco. This dynamic closely parallels youth goals of the NIIAH are to (1) elevate national, state, involvement in YD at the population level, in which and community focus and commitment to the health, youth are fully engaged, not just as recipients of ser- safety,and well-being of adolescents, young adults, and vices but as active participants. As discussed elsewhere their families; (2) increase access to quality healthcare, in this supplement, Assets Coming Together (ACT) for including comprehensive general health, oral health, Youth is a public health initiative funded by the New mental health, and substance abuse prevention and York State Department of Health to infuse YD through- treatment services; (3) improve health and safety out- out all youth services state-wide. Youth participants in comes in areas defined by the “21 Critical Health Ob- ACT for Youth have developed the motto “no decisions jectives” of Healthy People 2010; and (4) eliminate health about us, without us.” Similarly, motivational inter- disparities among adolescents and young adults. The viewing, grounded in the readiness-to-change model, NIIAH provides a unique opportunity for policy mak- is known to facilitate change in behavior by not only ers, health professionals, community members, adoles- acknowledging, respecting, and nurturing the emerg- cents, young adults, and their families to collectively ing autonomy in adolescents but also providing them address the issues that affect the health of our nation’s with direct feedback.5 At the individual level, this can youth. be focused on increasing the likelihood that a sexually With a focus on enhancing YD as a strategy to achieve active adolescent will decide to use condoms consis- its lofty goals, the NIIAH takes a positive and affirm- tently by exploring the various