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[Thorpe] Welcome to Beyond the Data,
I'm Dr. Phoebe Thorpe here to talk about Adolescent Health
and with me today is Dr. Stephanie Zaza,
the Director of the Division of Adolescent and School Health.
Stephanie, thank you so much for joining us.
[Zaza] Thanks for having me.
[Thorpe] This is a very exciting session of
public health grand rounds about adolescents...teenagers.
Everybody knows that teenagers are at adolescence,
change, evolve, it can be day-to-day.
It seems like forever and then they get through it.
What is it about that time period in people's lives
that is so important for us to focus on from a
public health point of view?
[Zaza] Well, I'm glad you asked.
It's a really profound time of change.
Lots going on for these young people and there's
natural risk-taking that has to happen for them to
grow and mature and that's why it's so important that
we pay attention.
This is the time when all kinds of new behaviors are
being tried out, tested if you will,
and they're learning from those.
And so if we can really encourage healthy habits
and try to as much as possible, reduce the
risky habits that they could be forming it does two things
first, it prevents problems right now
when they're kids.
So for example, reducing risk behaviors right now.
But that it also sets up new habits for a lifetime
so that they'll have healthy nutrition for
example, throughout their whole life if they're
learning how to do that now.
It's a very important time because they're learning
so much so fast.
[Thorpe] And it's the habits now that they form,
that they carry through into adulthood and the
rest of their life.
[Zaza] Exactly.
[Thorpe] Sure.
So can you tell me some about the risks that we're
concerned about that adolescents take and
everybody knows the ones about like texting and
things, but what are some of the other ones?
[Zaza] Well I think you raise a really important one,
you know, ten years ago we didn't have to even
ask the question, have you ever
texted while you were driving?
We ask that question now and a very disturbing
number of young people admit that they text while
they're driving or use the phone.
And so that's a really important new risk.
We're also seeing some emerging things like the
use of e-cigarettes or other vapor products which
we didn't really have as a risk before.
So the things that are ongoing though, I think,
injury risks are huge so, bicycle helmets, learning
safe driving habits for example, those are really
important during this time.
And then the other side of habits, there are several,
using substances: alcohol, tobacco and other drugs,
very important.
If young people don't start in this time of life
they often won't ever.
So really trying to avoid some of these very risky
behaviors in adolescence can be very important.
And then the third area that I think I'd focus on
is sexual risk.
This is a normal time, this is puberty,
sexual maturation, it's unique to adolescence, and again,
this is how young people have to learn how to
manage these new feelings and new bodies that
they're inhabiting and so helping them through that time
to understand how to be safe with their sexual habits,
how to hopefully delay sexual initiation
until they're really ready and then once they do,
to be safe in their habits
with a smaller number of partners,
with using condoms, using contraception.
Really helping them learn what
those things are for a lifetime.
[Thorpe] Yeah, and that sounds really kind of like
the interventions that you're talking about are
both looking at risks that they're taking but also
addressing or looking at the good behaviors that
they have either we're wanting them to take or
that they're already doing.
I have through working with the session with you,
I have heard more about how the focus is also
not only kind of, "don't do that", but also,
"hey, you're doing this well".
Can you tell us some about that, that shift in the
in the concept of adolescence?
[Zaza] Really, really important area.
So we call it, you know, we often talk about
risk factors, but what we want to also focus on,
and maybe want to focus on even more are what we call
protective factors. Things that really help young people.
Things like youth development, parent engagement.
There's almost nothing more important than
the parent relationship with the young person.
Constant conversations and knowing that
the parent is there. These are important.
Connectedness to the school can be
very important for young people.
So that sense of belonging and having
safe places within that school.
So, for kids who feel like they're maybe
excluded from some things or bullied, to find allies
and to find places where they know teachers and to
know that the school supports them.
So these kind of protective factors are
really important for young people as well.
Not just focusing on the, you know,
sort of the scolding, "don't do that" kind of...
But providing that nurturing
and that youth development. Giving young people
responsibility for their health
and for setting that expectation,
but giving them the tools to do it.
The skills and the knowledge to do that.
[Thorpe] That's a very good example of it because
what I was, when you were saying, I was thinking of
you had mentioned that as children go into adolescence
that one of the things as clinicians that we can do
is try to encourage them to have alone time
with the physician while they're there for their visits.
That's an example of
what a clinician or an individual could do.
There's also more about what communities can do
and, can you tell us a little bit about how the
interventions run that whole gamut of individual
or clinician to community and where that's going?
[Zaza] So, you know, we've talked a lot about
young people and working with them individually.
We also look at things like health education and
physical education in school.
So schools can do lots of things.
Clinicians have a very important role.
So they provide a lot of anticipatory guidance.
They're actually providing some of that health
education, if you will, in that setting.
They're also teaching in the nature of that relationship
a young person how to be a good healthcare consumer.
How to take care, how to seek information and services
when they need them, very, very important.
And it's important for parents to understand why
that needs to happen so that they will either
absent themselves from the visit or allow that to happen
so that the young person can learn how to engage
with their physician.
And then, in the community, it's very
important that we think about the whole community
as supporting adolescents, their families, making
sure all those pieces are fitting together.
So we think about for example
the school can't do everything, but the school can have
good connections to clinical services or other
health services in the community and help the adolescent
actually activate those services and
get to those services. That's important.
Having good transportation to those services.
And then once the young person arrives there,
that those services are teen friendly, that they understand
how teenagers think and work and feel and
what they need so that the, when the teenager
gets to that place they feel comfortable and confident
and able to use that service.
[Thorpe] So, we talk about a lot of
different interventions in the session.
And they're like here and there and they're great examples
but I would really like to know
what's the next step?
How can we go from here and there to beyond to
what can we do to make it bigger?
And also like the whole child, you know, it sounds like
it's like everywhere we need to kind of work...
[Zaza] I think the most important thing we need to
do first is to set adolescence,
the stage of adolescence as a priority.
That we do a really good job with early childhood.
For example lots of energy, lots of attention
to early childhood development,
early childhood education, vaccines in childhood
and then we sort of expect our adolescents to kind of
go it on their own.
[Thorpe] (speaking over Zaza) They're almost there...
[Zaza] They're almost there, almost adults,
but they're not mini adults.
They are in a very unique developmental stage and so
first I think, as communities,
we have to prioritize acting during this time
to help nurture that development.
That very specific developmental stage.
I think that's the first thing we have to do.
Because you can't scale up these interventions to
create a community unless you're actually setting
that as a priority. So that's the first thing.
Not that you want to take anything away from the
early childhood piece at all, but we also have to
not ignore the adolescent time.
And then we have to have at a community level,
policies in place that support the
kind of interventions that need to happen.
So you have to have policies that
support health education in the school so
a school district policy for example.
And you have to have policies in the community
that can create a safe environment.
Policies like bike trails and crosswalks and,
you know, so it's sort of, again,
it's a whole community that is, you know,
the school is part of the community,
the families are part of the community.
So really bringing that all together is important.
[Thorpe] Thank you so much for coming today and for
putting on this session. It's very, very important.
[Zaza] Thank you.
[Thorpe] Very important to our adolescents
and to all their futures.
[Zaza] Thank you.
[Thorpe] And thank you for joining us.
See you next time for Beyond the Data.
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