The burden of disease in adolescents worldwide is now much more centred on injuries and non-communicable disease, since infectious disease rates fell long ago in developed countries and are falling in most low-income and middle-income countries (LMIC). Problem behaviours implicated in most of this burden (alcohol, tobacco, drug misuse, mental health problems, unsafe sex, unsafe driving, and violence) are largely preventable. Evidence exists on a wide range of prevention policies and programmes, but as in other parts of health care, policy makers and parents are yet to embrace prevention programmes as useful and cost-effective. The challenges are discussed in the third paper in The Lancet Series on Adolescent Health, written by Professor Richard F Catalano, Director of the Social Development Research Group, School of Social Work, University of Washington, Seattle, WA, USA, and colleagues.
Ads by Google
For some disorders such as alcohol misuse and dependence and antisocial personality disorder, more than 50% of lifetime first diagnoses are by age 25 years. These are just two of the examples that underline why interventions earlier in life are vital to prevent problems in adolescence and into adulthood. And while prevention programmes in adolescents had a difficult and ineffective start in high-income countries (HIC), across the last 30 years a substantial body of evidence has been built identifying risk and protective factors, potential root causes of behaviour problems, and showing prevention programmes that address risk and protection are efficacious and cost-effective. Much of this work could, with the appropriate modifications, be transferred to LMIC where governments are only just beginning to recognise adolescent health as a distinct stage of life and where prevention efforts are few or absent. Today, globally, the focus remains on treatment rather than prevention.
Research suggests two clusters of risk across early life: one in infancy and early childhood, and one in early adolescence. Failing to prevent problem behaviours at one or both of these phases can result in issues cascading to cause health problems in adolescence and into adulthood. For example, a child neglected or abused in infancy could struggle to learn in primary school, then be rejected by peers due to these learning difficulties in secondary school, before progressing to alcohol, tobacco, and illicit drug use, violence, mental health problems, pregnancy or early school leaving.
The authors discuss a number of interventions tested in studies across the USA, Europe, Africa, Hong Kong, and Australia. Successful policies include providing minors (those under 18) with free or easily accessed contraception, raising taxes on alcohol (such as USA and UK general alcohol tax rises), and graduated licensing policies for driving, such as in the UK where those drivers who have just passed their driving test (mostly younger drivers) face tough sanctions if they commit driving offences within a 2 year period after qualifying. In Canada and the USA, driving laws require a minimum amount of driving time before qualifying, and also restrict the number of peer passengers and the amount of night driving. These policies have reduced unintended adolescent pregnancy, risky sex, harmful drinking, traffic crashes, and crime.