Disparities and Resiliency in Adolescent Health
The experience of adolescence can vary greatly depending on several factors such as family and community, race/ethnicity, and poverty. Adolescents who face multiple adversities over time can experience negative effects on their learning, behavior, social interactions, and health into adulthood.1 Therefore, understanding the lifelong effects of adversities and the differences across adolescent groups means youth can benefit from tailored resources and services that match their unique needs during the transition from adolescence to adulthood.
Resilience is the ability to appropriately adapt to adversity despite the conditions.2 Resiliency can be learned and is an important part of adolescent development that can help promote a positive sense of identity, efficacy, and well-being. It is important to understand and utilize interpersonal, structural, and community strengths within an adolescent’s environment to help promote resiliency for those who have experienced chronic stress and/or trauma. Research and practice have found effective ways to promote resiliency in adolescents, particularly for those who have experienced social, economic, and health disparities. The following describes the more prevalent types of disparities that adolescents in the U.S. face along with how to promote resilience.
Toxic Stress & Adverse Childhood Experiences
Continuously experiencing adversity or having multiple risk factors can create toxic stress, which is when the body experiences “prolonged activation of the stress response systems in the brain and body.”3 Adverse Childhood Experiences (ACEs) can include neglect, abuse, poverty, and witnessing and/or experiencing violence. Experiencing multiple ACEs has been shown to negatively affect a person’s health over the life course and can even affect multiple generations.4
Additionally, allostatic load is a measure of “wear and tear on the body caused by [a] constant adaptation to stress.” Research on high allostatic load has found that there is a tipping point at which the body’s ability to self-regulate is overburdened and can no longer function properly. This can have cumulative and harmful long-term effects for youth who are simultaneously dealing with toxic stress and the normal stressors related to adolescent physical and cognitive development.5
Resilience to Toxic Stress & ACEs
There are many resources available on ACEs that provide background information, approaches, and success stories. Additionally, The Center on the Developing Child at Harvard University has found four key “counterbalancing factors” that can lead to resilience in the face of toxic stress and adverse childhood experiences. The purpose of these factors is to help a child or adolescent be able to develop skills such as planning, monitoring, and regulating behavior. These skills can help an individual have positive experiences and be able to better adapt to their circumstances. These key factors include:
- Promoting supportive adult-child relationships.
- Building a sense of self-efficacy and perceived control.
- Providing opportunities to strengthen adaptive skills and self-regulatory capabilities (for middle-school youth and high school youth).
- Encouraging and supporting involvement with sources of faith and/or cultural traditions.6
Socioeconomic Status & Neighborhood
Research has found that living in a neighborhood that has little to no economic viability in childhood and adolescence was the “single strongest predictor of biological risk” for having chronic health issues in adulthood, such as cardiovascular disease, diabetes, and depression.7 Furthermore, in the same study it was found that youth who lived in low-income areas that had higher unemployment and poverty rates showed higher levels of allostatic load in adulthood.8
Resiliency in Neighborhoods
Resiliency factors within neighborhoods can be utilized to help lessen the effects of a neighborhood’s economic status and promote positive outcomes for adolescents. Strong family and community relationships can help promote a sense of safety in the home and at school, a sharing of ideas in how to respond to problems in the community, and a network of support in times of need.9 There is also the approach of working with local businesses to help prevent child abuse and neglect.
Marginalized Youth and Health Disparities
It is important to understand the challenges that marginalized youth (e.g., racial minorities, LGBT, AI/AN) face in the U.S., such as prejudice, discrimination, and historical trauma, which can contribute to health disparities among marginalized groups of adolescents. These stressful experiences can contribute to a youth’s allostatic load, increasing their risk of developing physical and behavioral health issues. Additionally, members of minority groups typically “have less access to healthcare, receive worse healthcare, experience more serious health conditions, and have higher mortality than whites.”10
For instance, Native American/Alaskan Native youth disproportionately suffer from the burden of mental health disorders, among other health issues. Similarly, LGBT youth face multiple adversities because of how others respond to their sexual orientation or gender identity/expression, such as experiencing discrimination at school or rejection from family members. This discriminatory stress places LGBT youth at higher risk for mental health issues such as depression and suicide. Youth with physical, mental, intellectual, and/or sensory disabilities often face environmental and attitudinal barriers to access and fully participate in home, school, work, and social activities, which can adversely affect their physical and mental health.
Resiliency in Marginalized Youth
Resources for marginalized youth are similar to other resiliency approaches in that self-regulation, positive relationships, and a connection to one’s culture can all contribute to building resiliency. This includes promoting behavioral skills such as self-regulation for Native communities, emotional support for LGBT transitional age youth, and using trauma-informed care in treatment settings and teaching practices.
This program, from The National Alliance to Advance Adolescent Health, is funded through a cooperative agreement from the federal Maternal and Child Health Bureau, Health Resources and Services Administration. Its aim is to improve the transition from pediatric to adult health care through the use of evidence-driven strategies for clinicians and other health care professionals; public health programs; payers and plans; youth and young adults; and parents and caregivers.
The Promise of Adolescence: Realizing Opportunity for All Youth
This report examines the neurobiological and socio-behavioral science of adolescent development and outlines how this knowledge can be applied, both to promote adolescent well-being, resilience, and development, and to rectify structural barriers and inequalities in opportunity, enabling all adolescents to flourish. The report focuses on leveraging the developmental opportunities to harness the promise of adolescence—rather than focusing myopically on containing its risks. In addition to discussing adolescent development and the impact of inequality and injustice, accompanying resources include a communication toolkit, commissioned papers, and a video series in English and Spanish with recommendations for the education, justice, child welfare, and health care systems.
The Center on the Developing Child at Harvard University provides instructional information on the science and social causes behind toxic stress, ACEs, and other relevant topics while also providing information on how to prevent and address toxic stress.
Action Steps to Address Health and Educational Disparities
This webpage from the Centers for Disease Control and Prevention (CDC) provides proposed action steps for state and local education and health agencies to address health and educational disparities among students.
The Changing Face of America’s Adolescents
This webpage from the Office of Population affairs gives a comprehensive overview of adolescent health topics such as health outcomes, health disparities, and regional differences.
Youth Risk Behavior Survey: Data Summary and Trends Report 2007-2017
This report from the Centers for Disease Control and Prevention’s (CDC) Division of Adolescent and School Health (DASH) provides data summary and trend information on varying topics, including sexual behavior, high-risk substance use, violence victimization, mental health and suicide, and minority youth.
Bullying as an ACE
Bullying is a potentially traumatic adverse childhood experience or ACE that can have negative, lasting effects on a person. This fact sheet describes strategies used by schools to address ACEs and prevent bullying, which can also be applied in other areas.
1 Center on the Developing Child, n.d.
2 Franke, 2014
3 Center on the Developing Child, n.d.
4 Metzler et al., 2017
5 Troxel & Hastings, n.d.
6 Center on the Developing Child, n.d.
7 Troxel & Hastings, n.d.
8 Troxel & Hastings, n.d.
9 Valladares, & Anderson Moore, 2009
103 Office of Population Affairs, 2019; Agency for Healthcare Research, 2017; CDC, 2018; Richardson et al., 2012