HEALTH FOR THE WORLD'S ADOLESCENTS

Social norms are crucial. Adolescence is a time of progressively heightened autonomy in decisions and behaviours. Social norms play a critical role in defining adolescents’ expectations and behaviours. Norms are communicated by multiple sources: families, friends, teachers, religious leaders and the media. The social norms surrounding adolescents are often inconsistent (for example, differing between peers and parents). They are reinforced and sanctioned in a number of ways, both formal (e.g. laws and regulations) and informal (e.g. shame, ridicule and ostracism, or admiration and praise). Efforts to change norms need to help people appreciate the reasons to change a specific behaviour and the benefits of departing from the current norm

The mass media have been widely used both to reinforce and to change social norms that affect the health of adolescents, both for good (e.g. condom use) and for ill (e.g. tobacco and alcohol use). Adolescents’ widespread use of interactive media and social networks has opened up new opportunities to influence norms. In the WHO global consultation with adolescents, these were considered as important and influential sources of information after their parents and health workers.

Influencing gender norms. Particularly important during adolescence are social norms regarding gender roles—expectations of femininity and masculinity. A growing number of interventions, supported by many sectors, aim to influence gender norms both at a societal level and among adolescents themselves. These programmes mostly focus on adolescent girls. However, the need to address adolescent boys is increasingly recognized. Growing evidence suggests that changing gender norms can influence health outcomes, for example intimate partner violence.₇

Sports promote health. Efforts by communities to engage adolescent boys (and, increasingly, girls) in health-promoting activities have often centred on sports—to increase physical activity, to provide opportunities to expand and strengthen social ties and networks and to strengthen adolescents’ sense of belonging. Sports coaches can serve as mentors and educators and provide links to health services such as HIV testing and counselling.₈ In addition, spectator sports are being used as a platform for communication, education and social mobilization for health, although they may equally be used to advertise and promote commercial products that undermine adolescents’ health, for example tobacco, alcohol and other substances.

Facilitating adolescents’ participation. Adolescents contribute in many ways to their families and communities, for example by taking responsibility for domestic chores and caring for elder and younger family members. This engagement gives them both a stake in their communities and important first-hand perspectives on a range of life issues. Community organizations can also make opportunities for adolescents to participate in civic activities. Both families and communities thus create environments in which adolescents are able to develop abilities and skills that contribute positively to their health and interpersonal relationships.

Adolescent participation is a hallmark of programming for adolescent health, from a rights perspective as well as for improving implementation and effectiveness. National, regional and international networks of young people abound, and young people’s voices are being solicited and are reaching influential platforms, earning respect and appreciation.

The impact of adolescent participation. Unfortunately, research has found little effect of adolescents’ participation in programming for health.₉ Even the very common strategy of adolescent peer education has little strong evidence to support it, although improvements in knowledge, attitudes and behaviours have been shown, particularly for sexual and reproductive health.₁₀ Increasing commitment to improve the quality of adolescent participation (e.g. the standards of the International Planned Parenthood Federation₁₁) may lead to better documentation and evaluation of these participatory strategies, and potentially to greater impact.