Determinants interact
The impact of determinants depends on an adolescent’s age and stage of development as well as on the mix of risk and protective factors in their social and physical environment. For example, with respect to adolescent violence, neighbourhood deprivation may reduce the protective effect of having supportive parents29 30 The interactions of determinants at different levels are critical to consider in developing interventions.31
Determinants may have different impact at different ages during adolescence. In terms of neurodevelopment, for example, alcohol use may be a much more serious cause for concern in early than late adolescence.32 The determinants of similar risk behaviours in adolescent boys and girls may also be different—for example, the factors that give rise to tobacco use.33
Many health problems and health-related behaviours have common risk and protective factors that are often rooted in adolescents’ immediate environments.34 For example, connectedness with parents and schools is protective against depression, unsafe sex and substance use.35
Adolescence itself might even be considered a determinant of health-related behaviours. The neurodevelopmental processes taking place during this period suggest that adolescents’ risk-taking may be more normative than pathological. These processes help explain the initiation of health-compromising behaviours during adolescence, when heightened reward-seeking and impulsivity interact with social determinants such as poverty, limited access to education and lack of a agency.
The interaction of determinants is complex. Some factors may be both outcomes and determinants—for example, the bi-directional links between health and education36-38 and between the use of psychoactive substances and mental health. Determinants may affect specific health outcomes differently depending on context. For example, the direction of the association between adolescent obesity and socioeconomic status is not consistent across countries.39 Similarly, some determinants may have different impacts on health-compromising behaviours. For example, adolescents’ tobacco use may be associated with lower socio-economic status, but alcohol use not.40 And some determinants may have the potential for both positive and negative effects—for example, globalization, migration and the Internet.
Caring for ‘gobile’ Video by Michael RichSome adolescents are resilient. Many adolescents who are potentially vulnerable—living in conflict situations or living with disability, for example—nonetheless develop positive trajectories into adulthood. They exhibit resilience, the ability of adolescents to overcome the negative effects of risk exposure and to cope with traumatic experiences. Interventions can take advantage of resiliency by drawing on individual-level characteristics—for example, the development of social skills and self-esteem—combined with aspects of the adolescent’s environment that foster coping—for example, having a relationship with a caring adult who provides guidance and support.41 The factors that strengthen resiliency are likely to have positive developmental effects for all adolescents, whether or not they have to cope with traumatic experiences.
Adolescents on what makes them sad: The situation in my country. To not have a way to get products that are very important like medicine, food and hygienic products. Injustices and unemployment.
female, 18-19, Venezuela
Adolescents on what makes them feel safe: Having confidence in myself and in my potential.
male, 15-17, Venezuela
I have a group of very close friends who looked out for me when I needed them most. I then talked to my parents and then saw a doctor about my situation. Since then I have been much happier and more content.
male, 15-17, United Kingdom
I am currently drinking water from the well and we share with animals, my mosquito net is torn and I do not have money to buy a new net and drought has hit our area and am not eating well balanced food.
male, 18–19, Uganda
I feel like I am safe when I am at school.
12-14, female, Malawi
I usually procrastinate homework, and I have gotten into an habit when I "need" to do something funny and relax on my iPhone 30 minutes before I sleep. This combined leads to a habit where I go to sleep late
female, 15–17, Norway
The support, presence, tenderness, trust and above all the love of those close to me make me feel safe.
female, 15-17, France
Adolescents on what can be done to improve their health: Intervene and inform us more, create a web site where we can talk online with a psychologist, nurse, doctor, etc. Especially on the Internet and Facebook, as we are young and we tend to use these technologies very often.
female, 15–17, country not specified
The conditions in my country are so unsafe that I couldn’t just take a leisurely walk or do any sort of exercise outside, like running.
female, 18–19, Venezuela
My culture/environment does not encourage exercise. For instance, housing areas are not fit/safe/appropriate for a morning jog.
female, 18–19, United Arab Emirates
My country is poor, especially in this post-conflict era, and there are many risks to my health. Daily life is costly, and health care is difficult to access
male, 18–19, Burundi
I often use websites that allow for anonymous communication.
male, 18–19, Canada
Adolescents on what makes them feel safe: Knowing that my family and friends are there supporting me and that their reasons for not letting me do something is because they care about me or feel like I can do better.
18-19, Female, Thailand
Adolescents on what makes them feel safe: To see that the results of my efforts are becoming reality for myself and for others.
female, 18-19, Peru
Adolescents on what makes them sad: To see the situation not only in my city but in my country. To know that in my city the government can’t finish a simple public transportation project. Not being able to walk the streets without being in fear.
female, 15–17, Mexico
Adolescents on what can be done to improve their health: To protect the development of my country.
male, 18–19, Democratic Republic of Congo
I get sad when I see indigenous people begging on the street, sick with skin diseases like vitiligo, breathing the dirty, smoggy air that they’re exposed to all day under the hot sun, to see other people begging for food, seeing that they’re dirty and sometimes mentally ill, begging to no avail and being exposed to the difficult life on the streets.
female, 18-19, Mexico
