Adolescent Health Psychology
Unit Objectives
Understand the challenges faced in the field of adolescent health psychology.
Differentiate types of stress.
Describe why adequate sleep is essential for adolescents.
Discuss the effects of diet on behavior
Health Psychology is a field that examines psychological factors critical to maintaining health. Adolescent Health Psychology is a subfield that recognizes that this group may have specific vulnerabilities, risks, and strengths that warrant particular study.
Stress
Most adolescents will state that their lives are stressful. Many factors can cause adolescent stress. In one survey, at least half of adolescents reported that they were highly stressed.
But what stress actually is may be hard to define. There are many definitions.
Many psychologists define stress as a change in which the organism has to cope. With this definition, stress can be positive. However, it can also be harmful and overwhelming. Most people realize that stress can be positive, at least at times. Exercise, for example, stresses the heart or muscles but adds to the strength. Studying is stressful but builds knowledge. Psychologists and other behavioral scientists have worked to clarify when stress is likely to be helpful and likely to be too much (Hagger, 2009).
The theory guiding much research in psychology was presented by Canadian physician Hans Seyle during the last century. It is called the General Adaption Model. It attempts to define the conditions under which we adapt to stress (Groër, Meagher, & Kendall-Tackett, 2010). Seyle began his research with rats, trying to find appropriate models for human physical diseases. His findings led to the belief that the General Adaptation Syndrome existed across all mammals, including humans.
In this model, the animal or human experiences change. Stress, as above, is defined as change. Stress can be tolerated by the animal or person experiencing it, based on resources and the stress amount. Tolerable stress is called eustress. Stress approaching its limits is called distress. Ultimately distress may become overwhelming and causes a failure (Luria & Torjman, 2009).
Stress, particularly distress, has several harmful properties (Maria Katarzyna, 2007). For example, it is known to weaken the immune system. It does this by suppressing the cells that fight infection. Therefore, it makes people more susceptible to bacteria and viruses. It also makes people more susceptible to many types of psychological disorders, discussed in Unit Nine. Many incidents of depression and anxiety are initially triggered by stress. Stress also can be a factor in addiction and suicide (Wright, 2012).
Psychologists have studied the situations in which stress becomes distress. These include whether the stress is predictable or not. Unpredictable stress is much more likely to hurt the organism, especially if it is chronic and not escapable (Abelson, Khan, Young, & Liberzon, 2010; Denson, Spanovic, & Miller, 2009).
Somewhat related, uncontrollable stress is also much more damaging. In fact, the perception that we control the stressor is important. Feeling in control helps reduce stress and its severity.
Since perception and control of stress are essential, psychologists have spent considerable effort studying how people perceive stress and events that stress us. Findings indicate that it may be much less harmful if we feel a stressor is under our control. This is the locus of control discussed previously. People who think they have substantial control over events in their environment have an internal locus of control. People who think events are out of their power and happen to them are labeled as external locus of control (Denson et al., 2009; Groër et al., 2010)
Racism, homophobia, sexism, and poverty can cause people to shift their locus of control to a more external direction, feeling that life is less in their possession. This increases stress by making it less predictable (Kuhlman, Horn, Chiang, & Bower, 2020).
People who have more resources are at a more significant advantage in coping with stressors. This makes sense. The stress is more in their control and is less disruptive. For example, suppose an adolescent loses her wallet. In that case, it is not a catastrophe if she has money to buy another and can access money to make up for her immediate loss. However, if she does not have these resources, the situation can be immensely challenging.
Psychological evidence indicates that when people have someone they can confide in, their immune responses are improved. Stressors are less stressful. This is called social support (Carver & Connor-Smith, 2010). This process of confiding may be difficult for many adolescent people because social interactions are often uncertain, intense, somewhat competitive, and changeable. Often, people in their adolescent years find that they do not know whom to trust, especially about intimate secrets.
Sometimes people think they can find meaningful support from social media. Unfortunately, this has not proven to be the case, at least for younger people. So far, there is no good evidence that social media contact can meet social support in everyday situations. Often, people disclose too much information on social media and later are regretful. However, social media may serve as social support for older adults, including those with mobility problems.
Regardless of its causes, chronic stress is so severe that many researchers believe it is a serious public health problem. Unfortunately, it has proven challenging to curb, including in adolescent people. The effects of chronic stress during adolescence may endure for years. Many researchers believe that we should invest in programs to help prevent it and enhance people’s wellbeing during this critical period (Lane, Brundage, & Kreinin, 2017).
Programs to reduce teenage stress have become popular. Many are based in schools, although an increasing number are app-based. They tend to work, providing they are followed consistently. However, adherence to them remains the critical component often missing (van Loon et al., 2020). Compliance with many issues is complex for many adolescents, particularly those already highly stressed.
Vignette 8.1. Brandon: The Effects of Stress
Brandon is a 19-year-old Health Sciences major. When he was in his early teens, his family relocated to a larger town from a smaller one. This transition is often stressful. However, all seemed well for a while. Unfortunately, within a year of his move, his new town was hit by a hurricane.
“After the hurricane, people seemed okay, “ He noted. “: For a few months after, everyone pretended things were normal. But I don’t think they ever were, though. ”
In the months after the hurricane, many students, teachers, and parents complained of stress and experienced various illnesses. School absences increased. People seemed to be moody and constantly on edge.
To reduce the amount of stress that students were experiencing, the school implemented a program to increase coping and to help people deal with the anxiety and loss regarding the hurricane. The program emphasized teaching people to identify their feelings, reduce stress, and avoid overreacting when stressed. Brandon began exercising as a method of dealing with his worries. He believes that the program was successful because he and his friends reported feeling more positive once the program began.
Exercise
Exercise can reduce stress. Exercise also improves overall health. This is true for every age, from children through very old seniors(Luria & Torjman, 2009). More specifically, as we age and while we are younger, exercise profoundly affects disease prevention. It also affects longevity. Regardless of a person’s age, exercise reduces stress and enhances the immune system. Research suggests a strong association between exercise habits in teen years and later in life. What is learned in the adolescent years may well become a lifelong habit.
The mental health benefits of exercise can be quite positive. For some people, it helps control anxiety, depression and can help curb impulsive behaviors. In adults, exercise can be as effective as antidepressants for some types of depression. This truly remarkable finding has emerged in many studies. Exercise also appears to make psychotherapy more effective. (Do not discontinue any medication without consulting with your health care provider.)
There is evidence that exercise may help executive functioning (W. J. Hall & Rounds, 2013). For example, people who exercise sometimes report that they can think clearer, have better recall, and often report having more self-control.
Many adolescents in the United States, Canada, and Europe do not get enough exercise. Unfortunately, this trend seems to be increasing. There are several reasons for this.
First, adolescents are busy. There never seems to be enough time.
Secondly, the amount of time available in schools allotted to exercise has been reduced in many locations. Partly this is due to constant budget cuts. This is also due to a philosophical orientation that students need to preserve school time to master “essential” subjects. Some schools are also concerned about safety. Regardless of the causes, some schools no longer have time for physical activities in their days.
Physical education for adolescents in many schools is often linked primarily with organized high school sports. This may discourage students who do not see themselves as athletic or who choose not to participate competitively. Rather than encourage students to find exercises that are fun and motivate them for life, students are trained to compete against each other, whether they choose to or not. The results are that high school physical education classes are often successful for a small group of athletically included students. However, they may fail many students who need help the most.
There are different types of exercises with different goals. Aerobic exercise boosts the heart and lungs and increases endurance. Examples are running, swimming, walking, and tasks involving endurance. Anaerobic exercises are associated with strength training and shorter duration exercises. They boost muscle mass. While both are important, conditioning for endurance is often more difficult for adolescents to maintain because of the time commitment, convenience, opportunity, and even the social stigma of exercising. For example, in many places, a group of students might not be able to jog or walk without being sexually harassed or bullied. Aerobic exercises like biking or swimming may also involve special equipment or locations, much less likely for marginalized groups.
There is often little social encouragement from peers to engage in exercises. While this is not always true, adolescents who exercise may be doing so alone and risk stigmatization, especially if they are not training for a popular sport.
Sleep
Sleep is essential. We intuitively recognize this. The more scientists understand sleep, the more vital it is recognized to be. Yet, the more we study it, the more mysterious it becomes.
Sleep is so important that every animal sleeps. Fish, including sharks, sleep. Even dolphins and whales, who stay submerged for long periods but breathe above water, have found a way to sleep. They do so by sleeping with half of their brain at any time.
There are many theories about why we sleep. However, they all may be true. Sleep may have several vital functions. For example, bodily changes occur during sleep that does not happen while we are awake.
Sleep appears to be necessary for heart and muscle functioning and for preventing many diseases later in life. Furthermore, sleep seems especially important for making sure that memory works efficiently.
Sleep deprivation can cause problems in thinking and anxiety. For example, a recent meta-analysis of over 360,000 adolescents indicated that a lack of sleep is strongly associated with anxiety, depression, and mood swings (Short, Booth, Omar, Ostlundh, & Arora, 2020). Conversely, if people get in the optimal range of sleep, they feel better and function better.
Most people sleep seven to nine hours, with adolescents often sleeping much more. However, there are substantial variations in this number, and many people do not get enough sleep. The first symptom of a lack of sleep is moodiness, with the second being deficits in executive function (Short et al., 2020). A sleep-deprived person for a night drives like a person who is under the influence of alcohol.
Some adolescents are early risers, but most are more night owls, preferring to go to bed and sleep later. This is natural, and scientists are not quite sure of why it occurs. Whether we are night or morning people is partly determined by our environment, partly by our hormones and age, partly by our inborn genetic tendencies. For almost everyone, it is tough to stay up all night, at least consistently. In general, the hours between 3 AM and 5 AM are challenging. However, there is some variation depending on a person’s age and habits.
Adolescents may find that their waking and sleeping schedule is often at odds with society. They may feel most alert in the evening and into the night. Conversely, they feel the most sluggish in the morning. As they get into adulthood, their sleep rhythms will merge more towards daytime hours though many people will still remain night owls.
Many neurotransmitters and hormones are involved in the systems that regulate our sleep. One is melatonin. Some researchers suspect that electronic device screens and the blue light from phones and computers may disrupt the melatonin cycle. Therefore, it is not recommended that people use any video device with screens before bed, even with blue or other light filters.
The use of social media may also hurt sleep. Social media is often emotional, and the contents may be disruptive (Qi, 2019). It is often difficult to sleep when thinking about sending a text or posting. It may be even more difficult to sleep when thinking about what a person said to you if it makes you unhappy or stressed.
Unfortunately, people from urban areas, including the poor, are at high risk of impaired sleep. In less affluent urban areas, there are more disruptions, especially at night. Disruptors include noise as well as light. In some urban areas, noise is a danger signal, and children and adolescents sleep especially fitfully. These disruptors can be substantial for the teenage brain and significantly affect (Hale, James, Xiao, Billings, & Johnson, 2019).
Substance use, particularly alcohol, depresses Rapid Eye Movement (REM) sleep, which means that there is not much of it. As is recalled from other psychology classes, REM sleep is when we dream. When REM is disrupted, a person can sleep for nine hours and feel terrible, separate from the hangover effects of alcohol. REM rebound, which means catching up on REM the next night does occur. However, it is inefficient and is often associated with bizarre and unpleasant dreams.
Vignette 8.2 Shondra: SLEEP PROBLEMS
Shondra was 20 when she recounted sleep problems that occurred to her at 16. These started after the breakup with a boyfriend.
“I was staying up too late. I was getting up too early. I would wake up and watch videos at night. My grades dropped. I couldn’t concentrate. I was avoiding things. I thought I was depressed because of the relationship thing.”
Some nights she could not sleep. Other nights she had problems staying awake and fell asleep on the family couch.
The nurse practitioner that she saw as a primary health provider suggested that Shondra monitor her sleep.
“Some nights, I would only get a few hours. I thought I was sleeping fine, but I really wasn’t.”
Shondra followed a few tips recommended by her nurse practitioner. These included avoiding all electronic devices near bedtime and keeping a consistent schedule. After a few weeks of this new routine, she noted that she felt “like my usual self.”
Many adolescents report that during this period of their lives, they experience very vivid dreams at night. “It’s like I was watching constant television,” one fourteen-year-old reported.
Everyone dreams, as do almost every animal. Yet like sleep, dreaming is still a mystery that is being unpacked. In fact, psychologists still do not know the precise reason we-and other animals-dream. We have many theories, and perhaps all of them are partially true.
Some evidence suggests that we dream to reset our brains. Our nightly dreams are also influenced by our surroundings. For example, people who sleep without covers on a cold night are more likely to dream of being in a place with a colder temperature.
Freud’s notion that dreams typically represent unconscious motives is not supported by current research. The content of dreams is, for the most part, composed mainly of everyday experiences. Most people dream about trivial topics. We generally do not remember these dreams. However, Freud is perhaps correct that sometimes we use symbols to camouflage ideas we do not wish to discuss. For example, people who have been traumatized may dream about aspects of the trauma.
The psychiatrist Carl Jung’s notion that dreams are part of a “collective unconscious” has not been successfully tested by science(Carducci, 2009; Crellin, 2014). Its mystical and almost spiritual concepts continue to attract adherents in each generation. This now includes many teenagers who have been attracted to this theorist through the Internet.
Alfred Adler and subsequent clinicians have suggested that dreams may indicate essential topics that have significance for a person. Sometimes people can solve problems in their dreams. While this seemed far-fetched, there are enough cases to suggest that it is valid for some people. Suppose a person has a recurrent dream or is troubled by a dream. In that case, it is often helpful to discuss this with a mental health professional.
Adolescents seem to dream more. They also remember their dreams more than younger children. Some neuroscientists suggest that increased dreaming of adolescents may be partly due to the widening of the corpus callosum in the brain (Semple & Smyth, 2019). This allows for increasing interconnectivity between the brain’s sides. This is an area where more research is needed.
Dream content of adolescents usually involves more social interaction, not surprising since adolescents are more social. There may also be more romantic content, again no surprise since this reflects their waking interests.
Sleep talking or sleepwalking, despite what most people think, is not a part of dreaming. These activities occur at different parts of the sleep cycle and not during REM sleep. People worry that what they say reflects deep motivation, but this is not true. Sleepwalking, talking, and other disturbances are much more common when people are exhausted, sleep-deprived, or under stress and become much rarer as we age. If a person feels they have problems, it is appropriate to discuss this with a health care provider.
If someone you know is in crisis:Call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency. at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency. Learn more on Lifeline’s website or the Crisis Text Line’s website.. [Cite your source here.]
Suicide by adolescents and others is a significant public health concern. Suicide is the 10th leading cause of death. Not every suicide is preventable. However, each suicide is tragic.
There are many causes of suicide. Unfortunately, in many cases, we will never know the causes. However, in many other instances, warning signs can help identify people who are at risk.
According to the National Institute of Mental Health (2021), the behaviors listed below may indicate that someone, including an adolescent, is thinking about suicide.
Talking about wanting to die or wanting to kill themselves.
Talking about feeling empty, hopeless, or having no reason to live.
Planning or looking for a way to kill themselves, such as searching for lethal methods online, stockpiling pills, or looking at guns.
Talking about guilt or shame
Speaking of feeling trapped or feeling that there are no solutions.
Feeling unbearable pain (emotional pain or physical pain).
Talking about being a burden to others.
Using alcohol or drugs more often than before.
Acting anxious or agitated, or otherwise unusual.
Withdrawing from family and friends.
Changing in eating and/or sleeping habits.
Showing extreme anger or talking about seeking revenge.
Taking significant risks that could lead to death, such as driving extremely fast or recklessly.
Talking or thinking about death often.
Displaying extreme mood swings, suddenly changing from very sad to very calm or happy.
Giving away important possessions.
Saying goodbye to friends and family.
According to the National Institute of Mental Health, if these warning signs apply to someone you know, you should get help as soon as possible.
The National Institute of Mental Health notes that these are useful steps to help someone:
Here are five steps you can take to #BeThe1To help someone in emotional pain:
ASK: “Are you thinking about killing yourself?” It is not an easy question, but studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts.
KEEP THEM SAFE: Reducing a suicidal person’s access to highly lethal items or places is an integral part of suicide prevention. While this is not always easy, asking if the at-risk person has a plan and removing or disabling the lethal means can make a difference.
BE THERE: Listen carefully and learn what the individual is thinking and feeling. Research suggests acknowledging and talking about suicide may reduce rather than increase suicidal thoughts.
HELP THEM CONNECT: Save the National Suicide Prevention Lifeline’s (1-800-273-TALK (8255)) and the Crisis Text Line’s number (741741) in your phone, so it is there when you need it. You can also help connect with a trusted individual like a family member, friend, spiritual advisor, or mental health professional.
STAY CONNECTED: Staying in touch after a crisis or after being discharged from care can make a difference.
Risk Factors for Suicide
In addition to specific behaviors, there are also known risk factors for suicide. The National Institute of Mental Health (2021) notes that many people have some of these risk factors but do not attempt suicide. It is important to note that suicide is not a normal stress response. Suicidal thoughts or actions are signs of extreme distress, not a harmless bid for attention, and should not be ignored.
Depression or extreme anxiety.
Other mental disorders, or a substance abuse disorder.
Certain medical conditions.
Chronic pain.
A prior suicide attempt.
Family history of a mental illness or substance abuse.
Family history of suicide.
Family violence, including physical or sexual abuse.
Having guns or other firearms in the home.
Being exposed to others’ suicidal behavior, such as family members, peers, or celebrities.
Family and friends are often the first to recognize these warning signs. As a result, they can often take the first steps toward helping an at-risk individual find someone specializing in diagnosing and treating mental health conditions.
Treatments and Therapies For SUICIDAL BEHAVIORS
Suicide is complex. Treatments and therapies for people with suicidal thoughts or actions will differ based on a person’s age, gender, physical and mental well-being, and experiences. However, the National Institute of Mental Health notes several treatments that appear to be very helpful in many situations.
Personalized safety planning has been shown to help reduce suicidal thoughts and actions. In this treatment method, clients work with a caregiver to develop a plan that describes ways to limit access to lethal means such as firearms, pills, or poisons.
Follow-up phone calls: Research has shown that phone calls to clients by professionals can reduce suicidal behavior. Often professionals will involve family or friends in helping support a person.
Psychotherapies: Different types of psychosocial interventions are helpful for people who have attempted suicide. The National Institute of Mental Health notes that Cognitive Behavioral Therapy (CBT), for example, can help people learn new ways of dealing with stressful experiences through training.
In conclusion, if you know someone experiencing suicidal thoughts or showing suicidal behaviors, refer them to professional help. Listen to them with empathy and understanding. Give them support. Talk with them as a friend. But do not attempt to be their counselor or therapist.
Vignette 8.3 Juan: SUICIDE
Juan was 13 when he began to think of suicide. He kept these thoughts to himself until he was 16; however, following a sports injury, Juan became increasingly sad.
“I was going to kill myself. I started to give away my baseball card collection. It was something that my grandfather had given me when I was younger. A friend of mine thought that was not like me since I really cherished those cards. She talked to me and asked me if I would hurt myself… but I wasn’t honest with her.
“She told a teacher I wasn’t myself. I don’t know what happened, but there was some delay. Finally, the teacher was able to help me find someone to talk with, a counselor. To me, it was a really strange thing talking about your feelings! It took me a few months, but I started to open up.”
“I am still in counseling (at age 19), but I haven’t felt like hurting myself in months, years even. Talking about feelings really helps me. I took medicine for a while, but I don’t know. I know I can take it if I need it. It takes a while to work, but it does help, in my experience…
“I don’t let things bother me like I used to…. I learned how to cope with some of the bad situations in my life, things I can’t control. My counselor also brought in my mom and brothers to work with them.
“Looking back, I think no, I know- counseling saved my life. But so did everyone else who stepped up for me.”
Reproductive Health
Despite stereotypes of sexuality by the media, the trend over the last 20 years has been towards decreased sexual activity among adolescents in every age, ethnic group, and gender.
Notably, birth by teenagers has decreased. They are about one-half what they were ten years earlier.
The use of protection contraception, particularly condom use, has also increased. As a result, the rates of teen abortion are also down. They are approximately one-half of what they were about 20 years ago.
There is some evidence that sexual experiences are starting later for males and females. This is desirable because data suggests that early intercourse seems to increase vulnerability to some psychological problems. For example, a study of adults who voluntarily had early intercourse was more likely to report marital problems later in life.
We do not have a clear picture regarding trends in sexual exploitation. We do not know if the incidents are increasing or decreasing. Yet, any amount of exploitation is too much. Forced sexual experiences occurring to underage adolescents is child abuse. This criminal behavior can have devastating consequences to its victims. Girls are particularly vulnerable are though boys are also at risk. In addition, individuals from sexually marginalized communities may be at exceptionally high risk.
Adolescents who are sexually exploited often tend to devalue themselves. They report high rates of depression, anxiety, impulsive behavior, and other problems. Most perpetrators are people known to the child and not anonymous, as the media often portrays. After puberty, abusers may likely include other adolescents as well.
Unlike teen pregnancies, however, sexually transmitted infections (STIs) are on the increase. Sexually active adolescents have the highest rates of common STIs than sexually active people of any group. In addition, rates are exceptionally high among sexually active adolescents ages 15-19.
There are hundreds of different STIs. Chlamydia is the most frequently reported. If untreated can cause infertility. Fortunately, it can be successfully treated if the patient is aware of its presence.
HPV stands for human papillomavirus. According to the Center for Disease Control, this is actually the most common sexually transmitted infection. However, it is almost always not reported. HPV is not one virus but a family of viruses. They are usually harmless. These viruses can lead to genital warts or certain cancers, including cancer of the reproductive organs. A vaccine is available and is quite effective if administered during the adolescent years. The concerned patient should always discuss their questions with a health care provider.
Gonorrhea is a bacterial disease spread through sexual contact, including oral and vaginal sex. It is not spread casually through toilet seats or kissing. Sometimes there are few initial symptoms in the infected person. This is why sexually active people should receive routine health care. It is treatable through antibiotics, although antibiotic-resistant strains have arisen and remain a concern. If untreated, it can cause sterility.
Syphilis is generally harder to transmit but can be more devastating if not treated. As with gonorrhea, there may be few initial symptoms. However, if untreated, it can cause blindness and a type of mental illness that is difficult to distinguish from schizophrenia. It responds well to antibiotics but must be diagnosed and treated only by a medical professional.
Human Immunodeficiency Virus (HIV) is a fatal disorder if it is not treated. It is spread only through sexual contact or through blood and not through informal contact or saliva. The virus that causes the disorder attacks the immune system and constantly mutates, making it especially deadly and, so far, impossible to develop a vaccine for.
The disorder first appeared in gay communities in the early 1980s, adding to the stigma. It also existed in other communities, although it was often undetected. By 1988 there was one treatment, and by 1996 a second treatment was developed. Currently, there are several treatment options. Treatment is difficult because once a person is infected, the virus changes. This makes it necessary to obtain regular and frequent medical care. Although there is no cure, many people with the virus can live everyday lives if they receive treatment and follow medical advice.
In the last ten years, two innovations in HIV prevention have occurred. One is a drug that is administered to people that believe they have been exposed to the virus. This drug virtually blocks the virus from taking hold if it is administered in time. A healthcare provider must prescribe this drug. It should not be purchased on the internet or from friends.
The second innovation is a preventative drug taken in advance of sexual activity. Research has shown that this drug is largely effective. However, it is not a substitute for unsafe sexual practices. The hope is to develop a vaccine for this virus, although this has not yet been possible.
Adolescents need to be able to discuss sexual health with a qualified health care provider. Yet, often, they feel that they cannot. Sometimes this is because their health provider is their longtime pediatrician whom their parents know. As a result, their knowledge regarding sexual health may be material they have learned from friends or the internet. Needless to say, that information may be incomplete or simply incorrect.
People will often feel that if they are honest, their healthcare provider will criticize or shame them. If they think this, they need to have a discussion with the provider. If necessary, they should consider finding another provider they are comfortable with. Thus, they will not “hurt the provider’s feelings.” Health providers typically have training in these matters, and conversations about intimate and private issues are quite routine.
Accidents
The number one cause of adolescent death is accidents. It far surpasses death from disease. Many accidents are because adolescents take risks or are careless. Many of these accidents are preventable.
Accident prevention in adolescents has long been a topic of psychologists as well as law enforcement. Whether interventions have been successful is debatable. Seatbelt usage is now the norm for adolescents. Driving under the influence of substances has also decreased. Behavior scientists may have had a part in this. However, the death rate in automobile accidents is still stubbornly high, and more research is needed.
Vignette 8.4 MarcellIna
“When I was 16 my friends, and I almost killed someone,” said Marcellina, a junior in college. “We were driving. And we weren’t drinking or anything. It was just a stupid accident.
“In fact, we had been up all night at a Bible study. That was the problem. We were driving home and sleepy. I don’t think any of us knew you could fall asleep at the wheel. I mean, they don’t teach you that. None of us were experienced enough to know you don’t drive well when you are sleepy.”
“My friend was driving. We were laughing and having fun, making jokes and singing. The next thing I remember, I must have fallen asleep; then we wound up in a ditch by the side of the road. It gets a bit blurry after that.”
“My friend said we all drifted off. She woke up, and there was a big SUV aimed right at us. She was in their lane. I think she oversteered, and then we wound up on the other side of the road. We could have hit a tree. ”
“No one got hurt, but it was pretty embarrassing. The police came, and we all got in trouble. Not as much as we should have, I guess. But, really, the car wasn’t damaged too much.
“Later, I learned there was an entire family in that SUV. We were going 60 miles an hour, and we missed hitting them by a few feet. The whole family. Four kids and a grandparent, a mom.”
“I won’t drive anywhere now when I am the least bit sleepy. It isn’t worth it.”
Gang Violence
Many adolescents and young people in the US and elsewhere are gang-affiliated. This is a potential public health problem because gangs are often associated with violence and addictions. Gang activities, once confined to urban areas, have become more common. Racist and supremacist gangs may be recruiting younger members.
Gang affiliation often starts around ages 10-12. It is typically associated with a desire to be independent of parents or parent figures. In more middle-class areas, the same sentiment may be channeled into a drive to join a club, participate in a team sport, or take a trip with friends (Osman & Wood, 2018).
Gangs are usually organized on gender lines. They are also organized on geography and usually also by race and ethnicity. Gang affiliation provides the member with some protection. However, the experience of the gang member may be very hazardous.
In some neighborhoods, gang membership is seen by some as a right-of-passage. But, unfortunately, the experience is almost always abusive, sometimes exceptionally so. In North, America gangs are associated with drug traffic, intimidation, and street crime. Serious violence, including murder involving rival gangs, is a real possibility in some groups.
The lifestyle of gang members or their associates is occasionally romanticized by the media or in popular accounts. However, almost no one who emerges from this culture looks back on it positively. Many people enter into gangs because of social reasons and mental health problems. This indicates that adolescents could benefit from mental health treatment to prevent gang initiation. Furthermore, after gang activity, they could benefit from mental health treatment to undo the damage that gang affiliation may cause to their development (Osman & Wood, 2018).
Methods to prevent gang affiliation have been mixed. Strategies to avoid gang violence have occasionally had positive results. Still, they depend on the consistency of training and funding, as well as a long-term commitment.
Character development is a model that has been used to prevent gang affiliation. Character in adolescence is gaining increasing attention (Seider, Jayawickreme, & Lerner, 2017). Character development seems to be associated with positive role models and is generally resistant to adverse events. Thus, the introduction of positive role models into the community to develop adolescents’ character development may one day prove a successful strategy to prevent gang activity.
Some researchers believe that gang activities may be more likely because of the cognitive features associated with teenage development. Adolescents experience changes in effortful control. This is defined as the ability to self-regulate (Eisenberg, 2021). Effortful control typically increases throughout childhood. It is high at age ten, only to dip somewhat sharply around 14 and slowly increase again (Atherton et al., 2020). Furthermore, youths from more violent homes who are punished harshly are likely to experience a more profound dip. This might be one factor related to gang affiliation and perhaps also to crime in poor communities.
Vignette 8.4 Jake: a sUPREMACIST gAng member
Jake was 15 when he joined a small high school group that he thought was a religious fellowship. As he became involved in the group, he found out that many of their beliefs were based on hate for minority communities, gays, lesbians, and people of different faiths.
“It really was just a gang of kids who wanted to be tough. Despite all the things they recruited me with, they preached hate for everyone but themselves. I never saw anyone get violent, but they always talked about threatening people and what they would do if they had a chance.”
“It really was just a small wanna-be supremacist gang. A few people in charge were really racists, and that is what is so disturbing.”
Jake did not want to discuss his own drug history. However, he noted that some of the older group members were open about their drug problems and their experiences dealing with various illegal substances. “It was pretty clear these people were heavy users, and I was being initiated into something I didn’t really want. But I felt I couldn’t leave. Anyhow, they were my friends, like brothers by this point.”
Jake noted that his family grew suspicious of his behavior when he began making money running errands for the gang. The errors included minor drug dealing under the supervision of another gang member. Eventually, he was allowed to work independently.
He recalls laughing at his family when they told him to stop associating with his new friends. He also laughed at his pastor, who had tried to intervene.
“I told him that he was an idiot and that God was on my side. I was on the right side of history. I really believed that.”
“I got out of it (the gang) only because of someone my brother knew. I was 17. There was a guy from my old church who I really respected. He was a few years older than me. He was someone I had always looked up to. He lived out of town, but he came back just to talk to me. He made me realize that the group was really nothing more than, well, a group of criminals. Not Christian at all. They were like criminals with a cult belief. They believed in hate, heavy drugs, things that I know are wrong.”
Jake believes had he stayed longer in the gang, he might even be dead. However, he was able to eventually finish high school and eventually went to college. He hopes to one day work with adolescents like himself.
MAKING HealthY Choices
Adolescents make hundreds of choices each day that affect their health. Some of these choices have immediate consequences, for example, when they choose to avoid or engage in risky behaviors (Ewen, 2010). However, some may have longer-term effects, such as when they decide to eat incorrectly or always turn up their earbuds to very high levels.
Adolescents typically have several problems that may impede making healthy choices. One is that they may lack appropriate information. This is because their life experiences are often lacking. They rely on other people, such as friends, who also lack experience and knowledge. Although the internet may have helped this situation by providing more information, it has not solved it. The adolescent has not a way to determine whether the information they have learned is accurate.
A second problem area is that adolescents may succumb to immediate and irresponsible peer influences. This causes them to do things they otherwise would not do in more reasonable circumstances or with different peers. Just about everyone can recall episodes in life when peer influences in our teen years have been negative. This might have been times when we could have reflected more if we had just a bit more time.
A third involves the assessment of risk. Because adolescents lack experience, they may underestimate the risks of some behaviors. This is especially true for social risks or risks that occur in novel situations. The adolescent brain is also biased towards shorter-term solutions. As a result, it may not be as accurate at solving longer-term problems.
Fourth is that venturesomeness and risk-taking are highest among this age group (Reniers et al., 2016). Finally, males tend to be somewhat more impulsive, especially in social situations with peers. However, impulsiveness in females is also elevated and is most notable in group situations.
The fifth problem is that they thorough lack time perspective. The immediacy of joy-fun- overcomes potential risk. One example is loud music. It sounds excellent on earphones while working out. Never mind that it might be causing damage that will make it harder to listen to a persons’ children 20 years from now. Music is immediate and does not encourage people to think of the future.
Several programs have been designed to help adolescents make healthy choices (W. J. Hall & Rounds, 2013). A few have been successful. Others need to be thoroughly tested. Some have failed because they were created poorly with no understanding of what problems need to be considered. Others lacked authenticity or credibility. Some are of an inappropriate developmental or literacy level, either too high or too low for participants. Others may be culturally inappropriate, for example, programs developed for suburban youths and implemented in Latinx or American Indian communities (Blum, Mmari, & Moreau, 2017).
Critical THinking
Design a program that you believe could be helpful to prevent each of the following:
- Teenage alcohol problems.
- Excessive social media usage by young people.
- A program to combat racism and sexism in schools.
- A “no-bullying” program for middle schools.
- Poor driving behavior by adolescents.