The health and well-being of adolescents have a major impact on the overall health of society: today's adolescents are tomorrow's workforce, parents, and leaders. In the past, approaches to working with youth to improve health often focused solely on problem behaviors in an effort to change them. As detailed in the series of articles that make up this supplement, "youth development" emphasizes the many positive attributes of young people and focuses on working to develop inherent strengths and assets in youth to promote healthy behavioral development. The youth development model mirrors a public health approach; many of the principles that comprise youth development strategies-prevention, specific population focus, mobilization of affected communities-also guide public health activities.
This supplement to the Journal of Public Health Management andPractice presents and discusses youth development approaches in the context of public health programs. The overarching purpose of the supplement is to acquaint public health practitioners with the basic concepts of youth development and to provide guidance about how to put them into practice. Articles in this supplement address related topics, including how to mount a successful public health program based on youth development principles, what partnerships are important for successful outcomes, and how to evaluate the impact of such programs. Supplement articles highlight the underlying theory of youth development, provide case studies from actual practice, and suggest ways that public health practitioners can incorporate youth development concepts into practice.
The supplement is presented in three parts. First, there is a general section giving background information on youth development as an approach for public health practitioners in what might be termed "youth development 101." The second section details specific experiences of the New York ACT (Assets Coming Together) for Youth program and its funded projects. The final section covers evaluation of youth development projects, including those in New York State.
The mission of public health has been defined as "fulfilling society's interest in assuring conditions in which people can be healthy."1 Public health pursues this mission in conjunction with a vast array of governmental, academic, and community partners. With an increasingly diverse society and underlying disparities that impair the health and well-being of a number of populations, youth development can create the conditions by which young people from all populations have opportunities to develop skills and habits that lead to long-term good health.
Adolescents face many health challenges related to both behavior and development, some of which public health agencies, among others, seek to address. These include sexually transmitted diseases and HIV, drug and cigarette use, pregnancy, violence, and injuries.2 Seventy-five percent of deaths in adolescents are related to social and behavioral factors.3 Lifestyle behaviors developed during adolescence often continue into adulthood and influence long-term health and risk for chronic disease. Good health enables youth to make the most of their teenage years, while preparing a strong foundation for adult life. Thus, adolescence provides an opportunity for public health intervention and promoting positive outcomes for the future. For all of these reasons, public health agencies and programs must focus on, and have a critical role in promoting, the health of adolescents.
On the other hand, many adolescent health issues are different from the usual public health concerns of acute illness and chronic disease. Youth development differs from traditional risk-factor-based public health approaches by focusing on developing strengths and assets in youth. As others have noted, "Problem-free is not fully prepared." However, in reality, the best models may include elements of both approaches (public health and youth development) working hand-in-hand.5
Rather than focusing solely on reducing risk factors for morbidity and mortality, youth development approaches look at strengthening resilience, as detailed by Bernat and Resnick elsewhere in this supplement. Resiliency is the ability of youth to overcome obstacles and risk factors in their environment to meet the social demands of adolescence and to build the competencies necessary for success as adults. Resilient adolescents have usually benefited from supportive relationships and positive experiential opportunities that enable them to move successfully into adulthood. In many cases, the factors that make adolescents resilient enable them to be successful even when the odds are stacked against them as a result of risk factors in their environment.6
Research has demonstrated that facilitating social connectedness influences health and well-being in many ways and that social connectedness can promote multiple health objectives, as well as lead to broader community and societal benefits.7,8 Social connectedness and a sense of belonging especially benefit vulnerable youth (eg, sexual minorities and youth with disabilities) and youth struggling with cultural identities in a multicultural society. To reap the full benefits of youth development, multiple stakeholders need to be mobilized. These include clinicians, nurses, educators, community groups, elected officials, and youth themselves.
In 1999, the New York State Department of Health (NYSDOH) undertook a new program using a youth development approach. The program, called "ACT for Youth," was innovative for a public health program in that it was based on youth development principles, which were being developed at the time. ACT for Youth provided state funding to 11 community-based and public health agencies to form local programs for youth based on youth development principles to combat the root causes of the public health problems mentioned above. The grantees, selected competitively through a request for proposals mechanism, were diverse in terms of geography, population served, host agency, and specific activities undertaken. Two academic centers for excellence (Cornell University and Mt. Sinai Medical Center) were also funded to assist the community grantees work through a planning and program development process.
ACT for Youth was developed at a time when similar approaches were being piloted by other New York State agencies, including the Office for Children and Family Services and the Office of Alcohol and Substance Abuse Services. Taking advantage of the expertise of other state agencies and NYSDOH staff from a variety of programs (child and adolescent health, pregnancy prevention, tobacco control, HIV/AIDS), an interdisciplinary approach informed the development of the ACT for Youth Request for Proposals. This was the foundation of a cross-program team that continues to inform program and policy in New York State. The importance of this is discussed elsewhere in this supplement by Carter et al and by Riser et al. Funding from several categorical funding streams was merged for the program.
Addressing the public health problems facing youth is challenging. It is hoped that this supplement to the journal provides public health professionals with the tools to begin to incorporate youth development principles into their work and assess their effectiveness. Adolescence represents a unique period in the life cycle that brings both challenges and opportunities. No longer children and not yet adults, adolescents make significant choices about their health and develop attitudes and health practices that continue into adulthood. In this period of exploration, adolescents also start to make conscious choices about their future and develop ideas about their roles in society. Adolescence therefore represents an opportunity to encourage health choices and prosocial behaviors. Creating safe and nurturing environments for today's adolescents-environments that build assets while minimizing opportunities for behaviors that endanger health and safety-ensures that tomorrow's adults will be healthy and productive.9
The approach of focusing on assets and positive attributes in addition to risk may also be beneficial in addressing other public health problems in other population groups. It will hopefully allow public health practitioners to see beyond a primary risk factor prevention approach because prevention of risk factors is not always the only goal.
This supplement shows how youth development offers public health practitioners, and others, tools for "turning deadly health crises into youth development opportunities."10(p121),11(p416)
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