It’s Time To Invest In Better Health And Well-Being For Teens – Health Affairs

Of the 25.1 million high-school aged teens, an estimated 60 percent, or 15 million, are languishing or only feeling moderately mentally healthy. Only an estimated 40 percent of teens are flourishing psychologically, socially, and emotionally. In addition to navigating academic pressures, bullying, and social media, teens are also concerned about mass shootings, rising suicide rates, climate change and global warming, the deportation of immigrants and migrant families, peers’ mental health and drug use, and, more recently, the social and economic consequences of the coronavirus pandemic and pervasive racism targeted at Black people.

According to experts in neurodevelopment, adolescent brain science shows that the teen years are a critical developmental period, likely to be as vital as early childhood. From the perspective of the colleges and workplaces that take on high school graduates, the teen years are an opportunity for early intervention. Teen brain plasticity means that investments at this age can make a difference for them today and for the rest of their lives. Further, our teens today are facing a myriad of challenges—many unique to their generation—and we are not doing enough to support teens. In the research, our funding, and our policy priorities, we ignore or discount the adolescent years too often.

According to a new report from AcademyHealth, Adolescents and Children [ACT] for Health, and Well Being TrustAdvancing Teen Flourishing: Moving Policy Upstream, many strategies hold promise for improving teens’ mental well-being. These interventions range across socio-ecological domains: from policies such as family income supplementation and changing school start times to direct interventions with teens such as increased interaction with nature, engaging in physical activity, and mindfulness-based stress reduction. Other strategies—such as improving teens’ family interactions; social and emotional learning; adopting the whole community, whole school, whole child approach; and youth leadership in policy change–are theoretically compelling but require more research involving actual engagement with teens.

Advancing Teen Flourishing provides a coherent set of evidence-informed action items based on a detailed and stepwise approach that included a systematic review of interventions and strategies, a global scan of policy recommendations, a set of key informant interviews, and a structured approach to identifying and prioritizing a unique set of action items for the US context, all guided by a National Expert Panel.

The report’s action items first recommend taking on broad cultural challenges such as changing public attitudes toward adolescence and adolescents, thinking more broadly about mental health, and, critically, in our current environment, finding evidence-based ways to eliminate structural inequities like racism, sexism, and homophobia.

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Next, the report suggests how a variety of “systems of caring” could do better to meet their responsibilities for advancing teen flourishing. Such systems can be seen, broadly, as spheres of contact for teens, such as the child welfare system, community and extracurricular activities, recreational sports, employment, digital life and social media, schools, families, and health care.

For example, a top action item for education is to pay as much attention to teens’ psychological well-being as to their academic achievement. Most teens do not encounter the child welfare and juvenile justice systems, but these systems, too, could be structured to advance teens’ subjective well-being in addition to their more traditional goals. Teens’ encounters with the health care system often go beyond pediatricians’ offices. Thus, providers across the board need to build capacity to work effectively with teens. Evidence-based resources should be developed to help coaches, employers, and other extracurricular leaders advance teen happiness. Cross-cutting recommendations address funding, governance, measurement and monitoring, and research.

High-priority solutions include the following.

Provide Greater Financial Resources To Parents And Families

Raising teens is more costly than raising younger children—averaging $900 a year more for teens than for younger children, but this is not reflected in tax and other federal policy. Today, 52 percent of adolescents ages 10 to 19 live in or near poverty. Economic disparities among peers are also a major source of concern among teens. Evidence suggests that providing families with resources like supplemental income, food, housing, or money for education or extracurricular activities could help bridge gaps in care and improve well-being among teens.

Similarly, strengthening specialized services to families of teens undergoing stressful situations, as defined by the families, will also help ensure that families can best provide for their teens.

Prioritize Well-Being In The Education System

School environments contribute to many sources of stress for teens—such as heavy workloads, poor sleep schedules, and social conflict taking place both online and offline—that impact their ability to flourish across the board. Local and state education jurisdictions must shift their focus from academic achievement alone to an equal and integrated focus on teens’ social, emotional, and psychological well-being. This includes creating positive environments in high schools that foster caring and supportive relationships. Such schools work with teens, families, and school staff to create opportunities for peer-driven school activities (for example, teens might work with each other on issues like depression), include teens in decision making, and take a holistic approach to learning and development.  

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Education agencies at all levels should also consider ways to lift the burden of improving teen well-being away from students and, instead, hold the education system accountable for these outcomes. In the same vein, providing strong incentives to education agencies to change school start times to a later time—one suggested start time is 8:30 a.m.—would also greatly benefit teen well-being by facilitating developmentally appropriate teen sleep patterns.

Protect Teens From Harmful Influences

Teens’ constant connection to the world through technology—on average, more than seven hours a day—has raised concerns about its impact on their well-being. The possible effects include cyberbullying, unrealistic body expectations because of the proliferation of manipulated Instagram photos, and exposure to teen “drama” and a culture of online shaming.

On the flip side, the digital world is also supporting well-being in different ways, including increased opportunities for social connections and improving health care delivery. For example, therapeutic services delivered through mobile devices or online platforms offer another way to bring care to students. To maximize the positive outcomes of this digital environment, social media platforms—and the influencers and advertisers who use them—must be held accountable for producing and sharing harmful content.

This can be done by establishing expectations and accountability mechanisms to which social media companies, technology firms, influencers, and advertisers will be required to adhere. These same groups should also engage with researchers, teens, and community stakeholders to understand how they can better support teen well-being through prosocial content—that is, content that encourages empathy and helping others. In addition, adults who come in close contact with teens—such as clinicians, educators, family members, employers—could partner with youth to support media use that promotes positive psychological, social, and emotional outcomes, such as self-care and care for peers and communities online.

Develop And Test Interventions To Reduce Structural Inequities

Teens in the United States experience and are sensitive to racism, sexism, heterosexism, and socio-economic discrimination. These experiences affect all teens’ psychological, social, and emotional well-being. When teens believe that their families are not economically successful, they have more mental health symptoms. Beliefs about school safety affect the psychological well-being of gender-nonconforming youth. Teen girls are more likely than teen boys to feel pressure to always be positive and make sure they do not disappoint others. Girls also have higher levels of psychological distress. White teens also suffer negative effects from racism.

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With the events of 2020 and their disparate impacts seen in the news, many entities, such as AcademyHealth, are searching for strategies that will work across the multiple levels of society that embed racism and other “isms” and thus affect the health and mental well-being of the US population. Within these efforts, focusing on the unique needs of teens is of paramount importance.

Include Teens In Relevant Policy Making

For so long, teens have been overlooked when it comes to making policy decisions. Government at all levels should work to collaborate with teens to better serve their needs. This could start with the announcement of a Decade of Teen Flourishing, in which teens serve in leadership positions to promote efforts to improve teen well-being across the board. Implementing “teen impact” reviews of government policies and programs could also ensure that every government contact with teens advances, rather than hinders, teen flourishing. Importantly, fostering these relationships will provide teens with the valuable opportunity to bring their greatest concerns to the table for consideration in policy decisions that will affect their generation in the years to come.

Without either a dedicated child and adolescent federal budget or an adolescent impact statement developed for the federal budget, it seems unlikely that more funding would be available from the federal government.

However, a Well Being Fund combining multiple sources of revenue from public and commercial entities is a high-priority policy recommendation in the Advancing Teen Flourishing report. Additional philanthropic dollars could also help elevate adolescent investments to the level they deserve.

Our nation’s teens are not a bundle of risk factors to be addressed and problems to be solved, despite the numbers indicating the large scale problems and the headlines emphasizing the issues. Young people should feel as if they are at the peak of their lives, and we should all realize that teens are an incredible resource for our nation.

Our teens are taking up the mantle of social change and actively creating a better future for all of us. Let’s give them the respect they deserve and invest in their well-being accordingly. Our future depends on it. 

Related Reading

“We’re Failing Adolescents And Families Coping With Behavioral Health Issues,” by Karen Wolk Feinstein of the Jewish Healthcare Foundation, GrantWatch section of Health Affairs Blog, May 31, 2016.



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