government organisation in combating risky behaviour
Answers
Adolescence has long been considered a period of increased risk behaviour. This supposition has been supported by a wealth of empirical evidence and recently, health risk behaviours have been identified as a key mechanism for the general deterioration of adolescent health relative to other age groups. Research regarding adolescent risk behaviour suggests that there are often strong links between individual risk behaviours. The mechanisms for these associations have been attributed to common risk and protective factors, as well as gateway effects stemming from increased accessibility to additional risk behaviours. This has important implications for policy interventions designed to reduce risk behaviours in adolescence. Not only does a multiple risk behaviour approach increase the effectiveness of individual risk behaviour policy, but it is also conducive to a more cohesive, coherent and efficient approach to adolescent risk in general. Several examples of cohesive policy responses to multiple risk behaviours have emerged, but generally, policy remains segregated into individual risk domains. With increasing evidence for the effectiveness of integrated approaches, multiple risk behaviours require consideration to design and implement effective and efficient policy responses.
Concerns about risk behaviours amongst youth have a very long history. Characterizations of adolescence as a time of difficult or rowdy behaviour abound throughout the literature since classical times. Late nineteenth century social reformers regarded adolescents, particularly violent or criminal males and pregnant females, as posing significant threats to the social order. In the USA this focused largely on immigrant youth, while in the UK the lower social classes were the recipients of attention.
Early twentieth century developmental theorists reiterated concerns about adolescent risk behaviour. G. Stanley Hall characterized adolescence as a period of ‘sturm und drang’ (storm and stress) in which adolescence represented the later animal phases as human ontogeny recapitulated phylogenetic evolution in each individual. Freud saw adolescence as a period in which earlier developmental dilemmas, particularly sexual ones, are re-enacted and later Freudians suggested that an adolescence devoid of characteristic difficulties was in fact a marker for psychological problems; ‘to be normal during adolescence is itself abnormal’ (p. 267). In the first half of the twentieth century, adolescence was of little interest to legislators and policy-makers, largely because adolescence was the healthiest time of life, when morbidity and mortality were lowest across the lifecycle. However, the epidemiological transition occurring in high-income countries since the mid-twentieth century has dramatically shifted the burden of disease away from children and towards adolescence. Morbidity rises year on year from childhood into adolescence. Mortality is now higher amongst adolescents than amongst children after the first year of life, largely due to increases in the relative importance of injuries and non-communicable diseases, compared with non-communicable diseases as causes of death. This constitutes the new paradox of adolescent health—that while we become fitter, stronger, faster and cleverer during adolescence, mortality and morbidity rise through the adolescent years. This shift makes adolescent lifestyle choices, particularly those relating to risk-taking behaviour, a fruitful area for policy intervention. From the last quarter of the twentieth century, health problems relating to risk behaviours rose amongst adolescents to the extent that they began to constitute a key area of policy concern in many countries. Indeed, for some behaviours, such as smoking, binge drinking and cannabis use, their prevalence is now such that they can be considered normative, despite being to some extent illicit in many jurisdictions. Because of this, adolescence now occupies an ambivalent position for legislators and other policy-makers. On the one hand they remain mobilized by fear of anti-social behaviour, the promiscuousness denoted by sexual risk behaviours and disruption of the social order by substance users. On the other hand they recognize the normative nature of some behaviours in adolescence, the great potential of intervention during adolescence to protect young people from harm both in adolescence and later life, and the potential for a ‘good’ adolescence to contribute to forming later healthy and economically and socially productive citizens.