In their book Freakonomics, authors Steven Levitt and Stephen Dubner address unquestioned theories, seemingly logical explanations for changes in society, that became conventional wisdom. Specifically, such beliefs about economic causes and effects are analyzed and summarily dismissed as false.
At the risk of falling victim to a similar kind of logic, I've been wondering about a very different cause-and-effect scenario—namely, the repercussions of America's severely weakened economy on the emotional and physical health of our adolescent population.
Adolescents, of course, are not the breadwinners in families. Nevertheless, they can be seriously impacted by economic strain as they witness its effects on their parents and other family members and perhaps worry about their own future in the job market. And because adolescents are frequently more susceptible to external pressures than adults, they are more likely to pursue risky activities, for perceived benefits unique to their age-group, in order to relieve that stress.
Although the recent push by Congress to provide health insurance to millions of low-income children (including adolescents) is admirable, it is imperative that we go even further by putting a greater emphasis on healthy lifestyles and avoidance of risky behaviors when we see adolescent patients.
We know that adolescents are a particularly vulnerable population because they tend to think of themselves as immortal, due to their underdeveloped socioemotional and cognitive-control systems. The socioemotional system becomes very active during puberty and makes adolescents more susceptible to social influences, intense emotions, and physical arousal. The cognitive-control system is the part of the brain that regulates behavior and makes decisions, but it is still maturing during adolescence. Therefore, we need to pay attention to situations that challenge the adolescent's ability to refrain from engaging in risky behaviors.
Violence is one of the more risky behaviors that attract our youth. Fights involving weapons and fistfights that inflict serious injuries are obvious examples. Television, video games, and the Internet have all been cited as being causal risk factors in increasing the likelihood of violent behavior in adolescents. Add the exposure to violence via the media to the immaturity of their cognitive control system and you have a recipe for tragedy.
But violent activities aren't the only concern. Other behaviors that adolescents engage in can be just as destructive. Behaviors thought to be innocent communications or merely games can have devastating outcomes.
Posing sexually oriented questions on public Web sites such as "chat rooms," for example, can expose adolescents to sexual predators or unwanted conversations with adults pretending to be teenagers. Engaging in choking or asphyxial games or inhaling common substances in an attempt to get a momentary high can result in serious injury or even death.
Another important thing to keep in mind is that risk-taking behaviors tend to cluster—if an adolescent engages in one, he or she is more likely to engage in others. We need to keep ourselves apprised of what our youth are doing and be attuned to the subtle clues that suggest they are at risk.
The considerable energies of the adolescent must be creatively channeled into activities that mitigate involvement in risk-taking behaviors. Researchers from the University of Washington1 recently demonstrated that adolescents frequently display on public Web sites risk-taking behavior information, such as describing sexual behaviors or substance use.
The researchers found that intervention using social networking sites shows promise in reducing sexual references in the online profiles of at-risk adolescents. They also found that involvement in church activities, sports, or hobbies was associated with a decrease in references to violence and other such behaviors.
Involving youth in organized activities is a wonderful concept and ideal. But school and community programs that help engage youth in after-school activities have fallen victim to budget cuts over the past few years and are sure to be the target of further cuts. The decimation of such activities can put adolescents at risk to engage in unhealthy behaviors as the number of unsupervised hours in their lives increases.
We need to take every opportunity to reach out to our young patients and assist them in making healthy choices by teaching them how to improve and maintain their physical and mental health. Ask them what they do in their free time and what kind of relationships they have with friends and family. Open the door to discussions about what's going on in their life.
Keeping our future generations healthy is about more than insurance. It's about getting them involved in activities that keep them physically and emotionally healthy and teaching them to manage their lives creatively.