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Emerging issues that could trouble teens

Stanford Medicine’s Vicki Harrison explains the forces impacting youth mental health today, and why it’s so important to involve teens in solutions.

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One of the most alarming developments across the United States in recent years has been the growing mental health crisis among children and adolescents.

The already dire situation is evolving 2024 already presenting a new set of challenges that Vicki Harrison, the program director at the Stanford Center for Youth Mental Health & Wellbeing , is closely monitoring and responding to.

Stanford Report sat down with Harrison to find out what concerns her the most about the upcoming year. Harrison also talked about some of the promising ways she and her colleagues are responding to the national crisis and the importance of bringing the youth perspective into that response.

Challenging current events

From the 2024 general election to evolving, international conflicts, today’s dialed-in youth have a lot to process. As teens turn to digital and social media sources to learn about current events and figure out where they stand on particular issues, the sheer volume of news online can feel overwhelming, stressful, and confusing.

One way Harrison is helping teens navigate the information they consume online is through Good for Media , a youth-led initiative that grew out of the Stanford Center for Youth Mental Health & Wellbeing to bring teens and young adults together to discuss using social media in a safe and healthy way. In addition to numerous youth-developed tools and videos, the team has a guide with tips to deal with the volume of news online and how to process the emotions that come with it.

Harrison points out that the tone of political discourse today – particularly discussions about reining in the rights a person has based on aspects of their identity, such as their religion, race, national origin, or gender – affects adolescents at a crucial time in their development, a period when they are exploring who they are and what they believe in.

“If their identity is being othered, criticized, or punished in some way, what messages is that sending to young people and how do they feel good about themselves?” Harrison said. “We can’t divorce these political and cultural debates from the mental health of young people.”

Harrison believes that any calls for solving the mental health crisis must acknowledge the critical importance of inclusion, dignity, and respect in supporting the mental health of young people.

Talking about mental health

Adolescence is a crucial time to develop coping skills to respond to stressful situations that arise – a skill not all teens and youth learn.

“It hasn’t always been normalized to talk about mental health and how to address feeling sad or worried about things,” Harrison said. “It’s not something that all of us have been taught to really understand and how to cope with. A lot of young people aren’t comfortable seeking professional services.”

The Stanford Center for Youth Mental Health & Wellbeing is helping young people get that extra bit of support to deal with problems before they get worse.

This year, they are rolling out stand-alone “one-stop-shop” health centers that offer youth 12-25 years old access to a range of clinical and counseling services with both trained professionals and peers. Called allcove , there are three locations open so far – Palo Alto, Redondo Beach, and San Mateo. More are set to open across the state in 2024.

“If we can normalize young people having an access point – and feeling comfortable accessing it – we can put them on a healthier track and get them any help they may need,” Harrison said.

Another emerging issue Harrison is monitoring is the growing role of social media influencers who talk openly about their struggles with mental health and well-being.

While this is helping bring awareness to mental health – which Harrison wants to see more of – she is also concerned about how it could lead some teens to mistake a normal, stressful life experience for a mental disorder and incorrectly self-diagnose themselves or to overgeneralize or misunderstand symptoms of mental health conditions. Says Harrison, “We want to see mental health destigmatized, but not oversimplified or minimized.”

“We can’t divorce these political and cultural debates from the mental health of young people.” —Vicki Harrison Program Director at the Stanford Center for Youth Mental Health & Wellbeing

Eyes on new technologies

Advances in technology – particularly generative AI – offer new approaches to improving teen well-being, such as therapeutic chatbots or detecting symptoms through keywords or patterns in speech.

“Digital solutions are a promising part of the continuum of care, but there’s the risk of rolling out things without the research backing them,” Harrison said.

Social media companies have come under scrutiny in recent years for inadequately safeguarding young adult mental health. Harrison hopes those mishaps serve as a cautionary tale for those applying AI tools more broadly.

There’s an opportunity, she says, to involve adolescents directly in making AI applications safe and effective. She and her team hope to engage young people with policy and industry and involve them in the design process, rather than as an afterthought.

“Can we listen to their ideas for how to make it better and how to make it work for them?” Harrison asks. “Giving them that agency is going to give us great ideas and make a better experience for them and for everyone using it.”

Harrison said she and her team are hoping to engage young people with policy and industry to elevate their ideas into the design process, rather than have it be an afterthought.

“There’s a lot of really motivated young people who see potential to do things differently and want to improve the world they inhabit,” Harrison said. “That’s why I always want to find opportunities to pass them the microphone and listen.”

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The concerns and challenges of being a U.S. teen: What the data show

American teens have a lot on their minds. Substantial shares point to anxiety and depression, bullying, and drug and alcohol use (and abuse) as major problems among people their age, according to a new Pew Research Center survey of youth ages 13 to 17.

How common are these and other experiences among U.S. teens? We reviewed the most recent available data from government and academic researchers to find out:

Anxiety and depression

Serious mental stress is a fact of life for many American teens. In the new survey, seven-in-ten teens say anxiety and depression are major problems among their peers – a concern that’s shared by mental health researchers and clinicians .

Data on the prevalence of anxiety disorders is hard to come by among teens specifically. But 7% of youths ages 3 to 17  had such a condition in 2016-17, according to the National Survey of Children’s Health. Serious depression, meanwhile, has been on the rise among teens for the past several years, according to the National Survey on Drug Use and Health , an ongoing project of the federal Department of Health and Human Services. In 2016, 12.8% of youths ages 12 to 17 had experienced a major depressive episode in the past year, up from 8% as recently as 2010. For 9% of youths in 2016, their depression caused severe impairment. Fewer than half of youths with major depression said they’d been treated for it in the past year.

Alcohol and drugs

Anxiety and depression aren’t the only concerns for U.S. teens. Smaller though still substantial shares of teens in the Pew Research Center survey say drug addiction (51%) and alcohol consumption (45%) are major problems among their peers.

Fewer teens these days are drinking alcohol, according to the University of Michigan’s long-running Monitoring the Future survey, which tracks attitudes, values and behaviors of American youths, including their use of various legal and illicit substances. Last year, 30.2% of 12th-graders and 18.6% of 10th-graders had consumed alcohol in the past 30 days. Two decades earlier, those figures were 52% and 38.8%, respectively. (In the Center’s new survey, 16% of teens said they felt “a lot” or “some” pressure to drink alcohol.)

But the Michigan survey also found that, despite some ups and downs, use of marijuana (or its derivative, hashish) among 12th-graders is nearly as high as it was two decades ago. Last year, 22.2% reported using marijuana in the past 30 days, versus 22.8% in 1998. Past-month marijuana use among 10th-graders has declined a bit over that same period, from 18.7% to 16.7%, but is up from 14% in 2016.

Marijuana was by far the most commonly used drug among teens last year, as it has been for decades.  While more than 10% of 12th-graders reported using some illicit drug other than marijuana in the late 1990s and early 2000s, that figure had fallen to 6% by last year.

The Michigan researchers noted that vaping, of both nicotine and marijuana, has jumped in popularity in the past few years. In 2018, 20.9% of 12th-graders and 16.1% of 10th-graders reported vaping nicotine in the past 30 days, about double the 2017 levels. By comparison, only 7.6% of 12th-graders and 4.2% of 10th-graders had smoked a cigarette in that time. And 7.5% of 12-graders and 7% of 10th-graders said they’d vaped marijuana within the past month, up from 4.9% and 4.3%, respectively, in 2017.

Bullying and cyberbullying

Issues of personal safety also are on U.S. teens’ minds. The Center’s survey found that 55% of teens said bullying was a major problem among their peers, while a third called gangs a major problem.

Bullying rates have held steady in recent years, according to a survey of youth risk behaviors by the Centers for Disease Control and Prevention. About a fifth of high school students (19% in 2017) reported being bullied on school property in the past 12 months, and 14.9% said they’d experienced cyberbullying (via texts, social media or other digital means) in the previous year. In both cases, girls, younger students, and students who identified as gay, lesbian or bisexual were more likely to say they’d been bullied.

As for gangs, the share of students ages 12 to 18 who said gangs were present at their school fell from 20.1% in 2001 to 10.7% in 2015, according to a report on school safety from the federal departments of Education and Justice. Black and Hispanic students, as well as students in urban schools, were most likely to report the presence of gangs at school, but even for those groups the shares reporting this fell sharply between 2001 and 2015, the most recent year for which data are available.

Four-in-ten teens say poverty is a major problem among their peers, according to the Center’s new report. In 2017, about 2.2 million 15- to 17-year-olds (17.6%) were living in households with incomes below the poverty level – up from 16.3% in 2009, but down from 18.9% in 2014, based on our analysis of Census data. Black teens were more than twice as likely as white teens to live in households below the poverty level (30.4% versus 14%); however, the share of white teens in below-poverty-level households had risen from 2009 (when it was 12.1%), while the share of black teens in below-poverty-level households was almost unchanged.

Teen pregnancy

Far fewer U.S. teens are having to juggle adolescence and parenthood, as teen births continue their long-term decline . Among 15- to 19-year-olds, the overall birthrate has fallen by two-thirds since 1991 – from 61.8 live births per 1,000 women to 20.3 in 2016 , according to the CDC. All racial and ethnic groups have witnessed teen-birthrate declines of varying degrees: Among non-Hispanic blacks, for example, the rate fell from 118.2 live births per 1,000 in 1991 to 29.3 in 2016 .

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Drew DeSilver is a senior writer at Pew Research Center

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Science News

Social media harms teens’ mental health, mounting evidence shows. what now.

Understanding what is going on in teens’ minds is necessary for targeted policy suggestions

Most teens use social media, often for hours on end. Some social scientists are confident that such use is harming their mental health. Now they want to pinpoint what explains the link.

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By Sujata Gupta

February 20, 2024 at 7:30 am

In January, Mark Zuckerberg, CEO of Facebook’s parent company Meta, appeared at a congressional hearing to answer questions about how social media potentially harms children. Zuckerberg opened by saying: “The existing body of scientific work has not shown a causal link between using social media and young people having worse mental health.”

But many social scientists would disagree with that statement. In recent years, studies have started to show a causal link between teen social media use and reduced well-being or mood disorders, chiefly depression and anxiety.

Ironically, one of the most cited studies into this link focused on Facebook.

Researchers delved into whether the platform’s introduction across college campuses in the mid 2000s increased symptoms associated with depression and anxiety. The answer was a clear yes , says MIT economist Alexey Makarin, a coauthor of the study, which appeared in the November 2022 American Economic Review . “There is still a lot to be explored,” Makarin says, but “[to say] there is no causal evidence that social media causes mental health issues, to that I definitely object.”

The concern, and the studies, come from statistics showing that social media use in teens ages 13 to 17 is now almost ubiquitous. Two-thirds of teens report using TikTok, and some 60 percent of teens report using Instagram or Snapchat, a 2022 survey found. (Only 30 percent said they used Facebook.) Another survey showed that girls, on average, allot roughly 3.4 hours per day to TikTok, Instagram and Facebook, compared with roughly 2.1 hours among boys. At the same time, more teens are showing signs of depression than ever, especially girls ( SN: 6/30/23 ).

As more studies show a strong link between these phenomena, some researchers are starting to shift their attention to possible mechanisms. Why does social media use seem to trigger mental health problems? Why are those effects unevenly distributed among different groups, such as girls or young adults? And can the positives of social media be teased out from the negatives to provide more targeted guidance to teens, their caregivers and policymakers?

“You can’t design good public policy if you don’t know why things are happening,” says Scott Cunningham, an economist at Baylor University in Waco, Texas.

Increasing rigor

Concerns over the effects of social media use in children have been circulating for years, resulting in a massive body of scientific literature. But those mostly correlational studies could not show if teen social media use was harming mental health or if teens with mental health problems were using more social media.

Moreover, the findings from such studies were often inconclusive, or the effects on mental health so small as to be inconsequential. In one study that received considerable media attention, psychologists Amy Orben and Andrew Przybylski combined data from three surveys to see if they could find a link between technology use, including social media, and reduced well-being. The duo gauged the well-being of over 355,000 teenagers by focusing on questions around depression, suicidal thinking and self-esteem.

Digital technology use was associated with a slight decrease in adolescent well-being , Orben, now of the University of Cambridge, and Przybylski, of the University of Oxford, reported in 2019 in Nature Human Behaviour . But the duo downplayed that finding, noting that researchers have observed similar drops in adolescent well-being associated with drinking milk, going to the movies or eating potatoes.

Holes have begun to appear in that narrative thanks to newer, more rigorous studies.

In one longitudinal study, researchers — including Orben and Przybylski — used survey data on social media use and well-being from over 17,400 teens and young adults to look at how individuals’ responses to a question gauging life satisfaction changed between 2011 and 2018. And they dug into how the responses varied by gender, age and time spent on social media.

Social media use was associated with a drop in well-being among teens during certain developmental periods, chiefly puberty and young adulthood, the team reported in 2022 in Nature Communications . That translated to lower well-being scores around ages 11 to 13 for girls and ages 14 to 15 for boys. Both groups also reported a drop in well-being around age 19. Moreover, among the older teens, the team found evidence for the Goldilocks Hypothesis: the idea that both too much and too little time spent on social media can harm mental health.

“There’s hardly any effect if you look over everybody. But if you look at specific age groups, at particularly what [Orben] calls ‘windows of sensitivity’ … you see these clear effects,” says L.J. Shrum, a consumer psychologist at HEC Paris who was not involved with this research. His review of studies related to teen social media use and mental health is forthcoming in the Journal of the Association for Consumer Research.

Cause and effect

That longitudinal study hints at causation, researchers say. But one of the clearest ways to pin down cause and effect is through natural or quasi-experiments. For these in-the-wild experiments, researchers must identify situations where the rollout of a societal “treatment” is staggered across space and time. They can then compare outcomes among members of the group who received the treatment to those still in the queue — the control group.

That was the approach Makarin and his team used in their study of Facebook. The researchers homed in on the staggered rollout of Facebook across 775 college campuses from 2004 to 2006. They combined that rollout data with student responses to the National College Health Assessment, a widely used survey of college students’ mental and physical health.

The team then sought to understand if those survey questions captured diagnosable mental health problems. Specifically, they had roughly 500 undergraduate students respond to questions both in the National College Health Assessment and in validated screening tools for depression and anxiety. They found that mental health scores on the assessment predicted scores on the screenings. That suggested that a drop in well-being on the college survey was a good proxy for a corresponding increase in diagnosable mental health disorders. 

Compared with campuses that had not yet gained access to Facebook, college campuses with Facebook experienced a 2 percentage point increase in the number of students who met the diagnostic criteria for anxiety or depression, the team found.

When it comes to showing a causal link between social media use in teens and worse mental health, “that study really is the crown jewel right now,” says Cunningham, who was not involved in that research.

A need for nuance

The social media landscape today is vastly different than the landscape of 20 years ago. Facebook is now optimized for maximum addiction, Shrum says, and other newer platforms, such as Snapchat, Instagram and TikTok, have since copied and built on those features. Paired with the ubiquity of social media in general, the negative effects on mental health may well be larger now.

Moreover, social media research tends to focus on young adults — an easier cohort to study than minors. That needs to change, Cunningham says. “Most of us are worried about our high school kids and younger.” 

And so, researchers must pivot accordingly. Crucially, simple comparisons of social media users and nonusers no longer make sense. As Orben and Przybylski’s 2022 work suggested, a teen not on social media might well feel worse than one who briefly logs on. 

Researchers must also dig into why, and under what circumstances, social media use can harm mental health, Cunningham says. Explanations for this link abound. For instance, social media is thought to crowd out other activities or increase people’s likelihood of comparing themselves unfavorably with others. But big data studies, with their reliance on existing surveys and statistical analyses, cannot address those deeper questions. “These kinds of papers, there’s nothing you can really ask … to find these plausible mechanisms,” Cunningham says.

One ongoing effort to understand social media use from this more nuanced vantage point is the SMART Schools project out of the University of Birmingham in England. Pedagogical expert Victoria Goodyear and her team are comparing mental and physical health outcomes among children who attend schools that have restricted cell phone use to those attending schools without such a policy. The researchers described the protocol of that study of 30 schools and over 1,000 students in the July BMJ Open.

Goodyear and colleagues are also combining that natural experiment with qualitative research. They met with 36 five-person focus groups each consisting of all students, all parents or all educators at six of those schools. The team hopes to learn how students use their phones during the day, how usage practices make students feel, and what the various parties think of restrictions on cell phone use during the school day.

Talking to teens and those in their orbit is the best way to get at the mechanisms by which social media influences well-being — for better or worse, Goodyear says. Moving beyond big data to this more personal approach, however, takes considerable time and effort. “Social media has increased in pace and momentum very, very quickly,” she says. “And research takes a long time to catch up with that process.”

Until that catch-up occurs, though, researchers cannot dole out much advice. “What guidance could we provide to young people, parents and schools to help maintain the positives of social media use?” Goodyear asks. “There’s not concrete evidence yet.”

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• 07 October 2021

Young people’s mental health is finally getting the attention it needs

You have full access to this article via your institution.

A kite-flying festival in a refugee camp near Syria’s border with Turkey. The event was organized in July 2020 to support the health and well-being of children fleeing violence in Syria. Credit: Muhammed Said/Anadolu Agency/Getty

Worldwide, at least 13% of people between the ages of 10 and 19 live with a diagnosed mental-health disorder, according to the latest State of the World’s Children report , published this week by the United Nations children’s charity UNICEF. It’s the first time in the organization’s history that this flagship report has tackled the challenges in and opportunities for preventing and treating mental-health problems among young people. It reveals that adolescent mental health is highly complex, understudied — and underfunded. These findings are echoed in a parallel collection of review articles published this week in a number of Springer Nature journals.

Anxiety and depression constitute more than 40% of mental-health disorders among young people (those aged 10–19). UNICEF also reports that, worldwide, suicide is the fourth most-common cause of death (after road injuries, tuberculosis and interpersonal violence) among adolescents (aged 15–19). In eastern Europe and central Asia, suicide is the leading cause of death for young people in that age group — and it’s the second-highest cause in western Europe and North America.

Collection: Promoting youth mental health

Sadly, psychological distress among young people seems to be rising. One study found that rates of depression among a nationally representative sample of US adolescents (aged 12 to 17) increased from 8.5% of young adults to 13.2% between 2005 and 2017 1 . There’s also initial evidence that the coronavirus pandemic is exacerbating this trend in some countries. For example, in a nationwide study 2 from Iceland, adolescents (aged 13–18) reported significantly more symptoms of mental ill health during the pandemic than did their peers before it. And girls were more likely to experience these symptoms than were boys.

Although most mental-health disorders arise during adolescence, UNICEF says that only one-third of investment in mental-health research is targeted towards young people. Moreover, the research itself suffers from fragmentation — scientists involved tend to work inside some key disciplines, such as psychiatry, paediatrics, psychology and epidemiology, and the links between research and health-care services are often poor. This means that effective forms of prevention and treatment are limited, and lack a solid understanding of what works, in which context and why.

This week’s collection of review articles dives deep into the state of knowledge of interventions — those that work and those that don’t — for preventing and treating anxiety and depression in young people aged 14–24. In some of the projects, young people with lived experience of anxiety and depression were co-investigators, involved in both the design and implementation of the reviews, as well as in interpretation of the findings.

Quest for new therapies

Worldwide, the most common treatment for anxiety and depression is a class of drug called selective serotonin reuptake inhibitors, which increase serotonin levels in the brain and are intended to enhance emotion and mood. But their modest efficacy and substantial side effects 3 have spurred the study of alternative physiological mechanisms that could be involved in youth depression and anxiety, so that new therapeutics can be developed.

Mental health: build predictive models to steer policy

For example, researchers have been investigating potential links between depression and inflammatory disorders — such as asthma, cardiovascular disease and inflammatory bowel disease. This is because, in many cases, adults with depression also experience such disorders. Moreover, there’s evidence that, in mice, changes to the gut microbiota during development reduce behaviours similar to those linked to anxiety and depression in people 4 . That suggests that targeting the gut microbiome during adolescence could be a promising avenue for reducing anxiety in young people. Kathrin Cohen Kadosh at the University of Surrey in Guildford, UK, and colleagues reviewed existing reports of interventions in which diets were changed to target the gut microbiome. These were found to have had minimal effect on youth anxiety 5 . However, the authors urge caution before such a conclusion can be confirmed, citing methodological limitations (including small sample sizes) among the studies they reviewed. They say the next crop of studies will need to involve larger-scale clinical trials.

By contrast, researchers have found that improving young people’s cognitive and interpersonal skills can be more effective in preventing and treating anxiety and depression under certain circumstances — although the reason for this is not known. For instance, a concept known as ‘decentring’ or ‘psychological distancing’ (that is, encouraging a person to adopt an objective perspective on negative thoughts and feelings) can help both to prevent and to alleviate depression and anxiety, report Marc Bennett at the University of Cambridge, UK, and colleagues 6 , although the underlying neurobiological mechanisms are unclear.

In addition, Alexander Daros at the Campbell Family Mental Health Institute in Toronto, Canada, and colleagues report a meta-analysis of 90 randomized controlled trials. They found that helping young people to improve their emotion-regulation skills, which are needed to control emotional responses to difficult situations, enables them to cope better with anxiety and depression 7 . However, it is still unclear whether better regulation of emotions is the cause or the effect of these improvements.

Co-production is essential

It’s uncommon — but increasingly seen as essential — that researchers working on treatments and interventions are directly involving young people who’ve experienced mental ill health. These young people need to be involved in all aspects of the research process, from conceptualizing to and designing a study, to conducting it and interpreting the results. Such an approach will lead to more-useful science, and will lessen the risk of developing irrelevant or inappropriate interventions.

Science careers and mental health

Two such young people are co-authors in a review from Karolin Krause at the Centre for Addiction and Mental Health in Toronto, Canada, and colleagues. The review explored whether training in problem solving helps to alleviate depressive symptoms 8 . The two youth partners, in turn, convened a panel of 12 other youth advisers, and together they provided input on shaping how the review of the evidence was carried out and on interpreting and contextualizing the findings. The study concluded that, although problem-solving training could help with personal challenges when combined with other treatments, it doesn’t on its own measurably reduce depressive symptoms.

The overarching message that emerges from these reviews is that there is no ‘silver bullet’ for preventing and treating anxiety and depression in young people — rather, prevention and treatment will need to rely on a combination of interventions that take into account individual needs and circumstances. Higher-quality evidence is also needed, such as large-scale trials using established protocols.

Along with the UNICEF report, the studies underscore the transformational part that funders must urgently play, and why researchers, clinicians and communities must work together on more studies that genuinely involve young people as co-investigators. Together, we can all do better to create a brighter, healthier future for a generation of young people facing more challenges than ever before.

Nature 598 , 235-236 (2021)

doi: https://doi.org/10.1038/d41586-021-02690-5

Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E. & Binau, S. G. J. Abnorm. Psychol. 128 , 185–199 (2019).

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Murray, E. et al. Brain Behav. Immun. 81 , 198–212 (2019).

Cohen Kadosh, K. et al. Transl. Psychiatr. 11 , 352 (2021).

Bennett, M. P. et al. Transl Psychiatr. 11 , 288 (2021).

Daros, A. R. et al. Nature Hum. Behav . https://doi.org/10.1038/s41562-021-01191-9 (2021).

Krause, K. R. et al. BMC Psychiatr. 21 , 397 (2021).

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A Mental Health Crisis Among the Young

More from our inbox:, ‘i have an emergency alert for democrats’, ‘an endlessly increasing pentagon budget’, move away from coal.

To the Editor:

Re “ Alarm Sounded on Youth Mental Health ” (news article, Dec. 8):

There is a serious mental health crisis for the youth of America, according to Dr. Vivek Murthy, surgeon general of the United States. There is a mountain of evidence supporting this.

Pediatric hospitals are overrun with mental health cases. There is a lot of hand-wringing but little more. A thorough analysis of our cultural flaws is seriously lacking.

These children and adolescents are bombarded with a toxic mix of vicious social media and harmful violent video games, television shows and films. In addition, this is the only advanced nation in the world where going to school has turned into a form of Russian roulette.

The discordant state of politics guarantees that nothing will change for these unfortunate youth. Our culture, which emphasizes winning at sports, egotism and accumulation of wealth, creates a weakened society unable to comprehend and deal with its most serious problems. The Covid pandemic is exhibit A.

The mental health crisis of American youth is a function of a culture that promotes ignorance, self-indulgence and self-aggrandizement with little sense of decency, mutual respect or self-reflection. How do you repair a defective culture? I am not sure, but it needs to start with a serious examination of its substantial flaws.

Arnold R. Eiser Philadelphia The writer, a doctor, is a senior adjunct fellow at the Leonard Davis Institute of Health Economics and an adjunct fellow at the Center for Public Health Initiatives at the University of Pennsylvania.

Re “ Schools in Bind as Bitter Feuds Cripple Board ” (front page, Dec. 2):

As schools across the country confront “an array of urgent challenges,” we’re failing to address the most systemic, the most alarming and the most dangerous crisis of all: a youth mental health emergency. The lack of a significant national response is stunning.

Not only do we need to shift our collective focus, but we also need to shift the culture of our schools if we are to meaningfully address this mental health crisis that is exhausting and overstretching entire school communities.

That means putting an end to toxic school stressors that have long caused anxiety and depression in young people, and starting to create environments that are humane for students, teachers and families. Instead of being driven by a narrow vision of achievement and success, our schools must prioritize the experiences that support health — like connection, agency and meaningful learning.

If we finally bring humanity to our schools, maybe then not only will our kids be healthier, but also we as a society can start to heal together.

Vicki Abeles Lafayette, Calif. The writer is the author of “Beyond Measure: Rescuing an Overscheduled, Overtested, Underestimated Generation,” and director of the documentaries “Race to Nowhere” and “Beyond Measure.”

Re “ Democrats’ Dangerous Appetite for Eating Their Own ,” by Frank Bruni (newsletter, nytimes.com, Dec. 9):

I have an Emergency Alert for Democrats. Our nation’s democratic form of government is in the cross hairs. The political moment is grave. It is not clear if our remarkable democracy will survive the vicious and organized assault from the right, nor is it clear if the Dems have the clarity and stamina to save it.

Remember that you are politicians, elected to meet the political moment, equipped and focused on what is now the greatest threat to our country since the Civil War. Critical issues of climate change, equality and health care must be addressed.

But if we lose the country as we have known it, how will it be possible to fight for those things? It is a terrifying prospect.

Susan Teicher Urbana, Ill.

“ Houses Passes Defense Bill in Rare Display of Unity to Salvage Shared Priority ” (news article, Dec. 8) didn’t do justice to the sheer size of the Pentagon budget. After months of intense debate over the president’s Build Back Better, at $1.8 trillion over 10 years, a Pentagon budget with annual spending ($768 billion) four times as much as those domestic investments is astounding.

The U.S. military budget is larger than that of the next 11 countries combined, and more than twice that of China, a constantly cited justification for more spending. After 20 years, the end of the war in Afghanistan resulted not in a budget decrease, but more increases. And Congress cut Build Back Better in half, but added to the president’s defense budget request.

The majority of Americans don’t support an endlessly increasing Pentagon budget. But double standards in Congress combined with low media coverage tip the scales toward that outcome, time and again.

Lindsay Koshgarian Northampton, Mass. The writer is program director for the National Priorities Project at the Institute for Policy Studies.

Re “ A Sticking Point in Climate Plan ” (Business, Dec. 13):

The proper function of Republicans (and of Senator Joe Manchin, a Democrat) is to jump right in on clean energy plans from the get-go, ensuring not just benefits and transition pay, but also a robust retraining program for displaced workers — a program conceived and monitored in cooperation with those workers and their advocates.

In the current polarized era of dysfunction, coal miners’ political advocates have abdicated this vital responsibility. By denying, obfuscating, obstructing and slow-walking the necessary decarbonization of the economy, they have fostered a double disaster.

Coal miners will be shortchanged by poorly thought out Democratic policies, while climate catastrophe will proceed apace.

Jeff Freeman Rahway, N.J.

Being a teen comes with exciting milestones that double as challenges – like becoming independent, navigating high school and forming new relationships. For all the highs that come with getting a driver’s license or acing that difficult test, there are lows that come with growing up in a rapidly changing world being shaped by the COVID-19 pandemic, social media and distance learning.

Teens’ brains are growing and developing, and the ways they process their experiences and spend their time are crucial to their development. Each great experience and every embarrassing moment can impact their mental health.

Sometimes a mood is about more than just being lonely or angry or frustrated.

Mental health challenges are different than situational sadness or fatigue. They’re more severe and longer-lasting, and they can have a large impact on daily life. Some common mental health challenges are anxiety, depression, eating disorders, substance use, and experiencing trauma. They can affect a teen’s usual way of thinking, feeling or acting, and interfere with daily life.

Adding to the urgency: Mental health challenges among teens are not uncommon. Up to 75% of mental health challenges emerge during adolescence, and according to the Mental Health First Aid (MHFA) curriculum, one in five teens has had a serious mental health disorder at some point in their life.

Not every mental health challenge will be diagnosed as a mental disorder, but every challenge should be taken seriously.

A mental health challenge left unchecked can become a more serious problem that also impacts physical health — think of how substance use, and changes in sleep patterns and eating habits affect the body as well as the mind. Signs of fatigue, withdrawing socially or changes in mood may point to an emerging mental health challenge like a depressive or substance use disorder.

As teens mature, they begin spending more time with their friends, gain a sense of identity and purpose, and become more independent. All of these experiences are crucial for their development, and a mental health challenge can disrupt or complicate that development. Depending on the severity of the mental health challenge, the effects can last long into adulthood if left unaddressed.

How do we address teens’ mental health?

Teens need tools to talk about what’s going on with them, and they need tools for when their friends reach out to them. Research shows that teens are more likely to talk to their friends than an adult about troubles they’re facing.

That’s why it’s important to talk to teens about the challenges they may deal with as they grow up and navigate young adulthood. They need to know it’s OK to sometimes feel sad, angry, alone, and frustrated. But persistent problems may be pointing to something else, and it is crucial to be able to recognize early warning signs so teens can get appropriate help in a timely manner. teen Mental Health First Aid teaches high school students in grades 10-12 how to identify, understand and respond to signs of a mental health problem or crisis among their friends — and how to bring in a trusted adult when it’s appropriate and necessary. With proper care and treatment, many teens with mental health or substance use challenges can recover. The first step is getting help.

Learn more about teen Mental Health First Aid by watching this video and checking out our blog . Your school or youth-serving organization can also apply to bring this training to your community.

teen Mental Health First Aid is run by the National Council for Mental Wellbeing and supported by Lady Gaga’s Born This Way Foundation.

Resource Guide:

• Mental Health First Aid USA. (2020). teen Mental Health First Aid USA: A manual for young people in 10 th -12 th grade helping their friends. Washington, DC: National Council for Mental Wellbeing.

National Institute of Mental Health. (2020). The Teen Brain: 7 Things to Know. U.S. Department of Health and Human Services, https://www.nimh.nih.gov/health/publications/the-teen-brain-7-things-to-know/index.shtml.

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Adolescent Health and Well-Being: Issues, Challenges, and Current Status in India

• First Online: 08 March 2022

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• Nandita Babu 3 &
• Mehreen Fatima 3  

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Adolescence is the developmental stage between childhood and adulthood marked by considerable growth in physical, cognitive, and socio-emotional domains. It is considered as a preparatory phase for adulthood, and therefore, well-being during adolescence would predict well-being during adulthood and age ahead. During this stage of life, children have specific needs that vary based upon gender, socio-economic status, and overall cultural belief system of the community. In order to understand the process of development during adolescence, it is extremely important to study the systems like family, school neighborhood, and community in which the adolescents live. Few researches in India have studied these processes to understand the adolescent’s need at large. With about 373 million persons between the ages of 10 and 24 years, India has the largest number of young people of any country in the world and that makes it a more viable area for research, intervention, and policy implementation. To meet the 2030 Agenda for Sustainable Development and its Global Strategy for Women’s, Children’s, and Adolescents’ health, the Government of India have prioritized adolescent health in various programs and policies. However, in spite of all the attempts by researchers, practitioners, and policymakers, there is still a major gap which needs to be filled up to reach the 2030 SDG goals. Therefore, the need of the hour is to follow a multidisciplinary approach toward research, policy formulation, and intervention for psychosocial and physical health of adolescents. This chapter is an attempt to discuss the major issues of adolescent development in the socio-cultural context of India, identify the research gaps, and analyze the policies and programs for positive developmental outcomes for the young people in India.

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Babu, N., Fatima, M. (2022). Adolescent Health and Well-Being: Issues, Challenges, and Current Status in India. In: Deb, S., Gerrard, B.A. (eds) Handbook of Health and Well-Being. Springer, Singapore. https://doi.org/10.1007/978-981-16-8263-6_7

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Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.

A series of FT View editorials and daily online debates will make the case for a new deal for the young. Beginning on Monday 26 April, they will address housing, pensions, jobs, education, the climate and tax over the course of the week.  Click to register for the events and see all the other articles

Growing inequality between generations has been exacerbated by the pandemic and has left many people in their teens, twenties and thirties feeling like they have got a raw deal.

The Financial Times wanted to bring those young people into a discussion about shifts in asset prices, pensions, education and the world of work so we launched a global survey. We asked people aged between 16 and 35 to tell us what life has been like for them in the pandemic, and which problems need fixing most urgently.

The survey was only open for one week but we had a record number of responses, with 1,700 people replying to the callout and spending an average of 30 minutes each on their responses.

While the majority of respondents were from the UK and US, others who shared their views were from Europe, Brazil, Egypt, and Asia-Pacific. Many of the respondents, though not all, were graduates who worked in sectors such as law, banking, media, education, science and technology. Many did not want to share their full names or personal details for fear of professional and personal repercussions.

People spoke of the difficulties — and benefits — of being young in today’s difficult economic times compared with their parents’ generation, and about issues relating to housing, education, jobs, pensions and the environment.

The responses formed the starting point for an in-depth analysis of the problems faced by young people today by Sarah O’Connor, our employment columnist. It is the first article in an FT series on what policies would make the economy work better for today’s youth.

Here we highlight some of the many hundreds of comments we received from readers:

Cramped housing

I absolutely cannot relate to mid career professionals being glad to be at home in their leafy three bedroom houses with gardens, when I have to have mid afternoon calls with the sound of my flatmates frying fish for lunch in the background. — A 20-year-old female reader living in London

The burden of student loans

Student loans feel like a unique problem for our generation. I can’t think of a similarity in the past when youth had such large financial burdens that can’t be discharged in most cases. Not that cancellation is necessarily the right choice. I knew what I signed up for, but what was the alternative, work in a coffee shop while the rest of my generation bettered themselves?

Mortgages and car payments just aren’t comparable to the $100k in loans I’ve been forced to deal with since I was 22. The rest seems similar. We have climate change and equality, my parents generations had communist totalitarian governments, nuclear war and . . . equality. — Matt, who works in Chicago, US

Mismatched ideas

The older generation has never understood that while our pay has increased it has been wiped out by extortionate rise in property prices. The older generation also thinks young people only enjoy spending money on experiences rather than saving money, which is not true. — A 30-year-old engineer living in the UK

Living with uncertainty

Older generations don’t feel the uncertainty we younger generation live with. Now it is more common for us to have more temporary jobs, for example, the gig economy. This uncertainty makes planning for future harder and makes taking risks impossible. — Ahmed, a lecturer living in Egypt

Scrap stamp duty on housing

The government needs to sort out house prices and stop inflating them. It should also scrap stamp duty and introduce annual property taxes instead. — A 25-year-old investment banker living in London

Emotionally better off than my parents

I know I’ll be better off than my parents. My mom came from an Italian immigrant family with seven siblings. I’m one of the first people to graduate from college with a four-year degree and one of the only people employed. Neither of my parents really ‘did’ therapy through their adult lives despite needing it, whereas I’ve had a therapist since my second year in college.

I think a common misperception about being better off is the focus on wealth — being better off also means being more emotionally and mentally healthy, which I know I am already better off than many of my family members. — Alicia, a financial analyst living in America

London feels increasingly full of anxious, burnt out 20- and 30-something-year-olds who spend half their income on a cramped flat with a damp problem and spend their weekends in the foetal position on their landlord’s Ikea sofa, endlessly scrolling through the latest app.

We have so much more than our parents did at our age, but also so much less. — A 25-year-old woman from the UK

Artificially high property prices

Current policies like Help to Buy are making things worse for young people in Britain. The prices of new builds are artificially inflated as builders know HTB can only be used on new builds! £450,000 for a one bed flat in London? Jog on. It’s insane. — Chris, in his late twenties living in London

Gen X doesn’t understand Gen Y

Generation X, doesn’t understand Generation Y, who doesn’t understand Generation Z — Andreas, a young doctor from Bulgaria

Regulate financial markets

I also have a feeling that regulating the financial markets would create more stability which would reduce the constant fear of a market meltdown — Kasper from Finland

Who is accountable?

Sustainability (renewable energy, mindful meat consumption, plastic usage awareness, social responsibility, ESG) are utmost key, and older generations seem to miss this. It feels they have put us in a stage where there is no going back, and there is no accountability whatsoever. — Renato, a risk manager from Brazil

Soaring rents

Many items that are considered a luxury to older generations, holidays, clothes, going out to eat, for example, are cheaper these days, but buying a house or renting is so much more expensive compared to when my parents were young. A lot of young people can afford the former not the latter, but for many older generations it seems the opposite was true, which creates contrasting views from each side about who has it worse. — Sophie, in her mid-twenties, from London

Young vs old

A number of older people I know are relatively sympathetic to a lot of the issues we face. There is a young versus old narrative pushed by certain sections of the media which, at least for many older people with families, has rung hollow with me. Generally they do recognise that we live in a more competitive world than they grew up in, for university places, jobs, housing etc. If anything I feel older generations probably understand younger people better than we understand them — Alex, a student solicitor in London

Cannot afford to buy a house

There is no acceptance that working from home is not feasible for younger people where you’re in significantly smaller accommodation. My company released an internal communication informing us how to be more efficient working in shared accommodation or working from your bedroom at the same time as starting consultation on closing all offices and homeworking permanently. — Lewis, who is working and studying in Bristol, UK

I have a mildly dystopian view

I feel older generations don’t understand the value of money, and it feels strange because my parents have lived a frugal life and I am doing well enough for myself, yet, given the economy, I feel compelled to save, while they don’t understand why I think thrice before every purchase.

On the issue of non-renewable resources, I feel that my parents have a particularly different mindset compared to mine; I have a mild compulsion to turn off any running tap or switch if it’s not being used. They have this comfort and faith that there will be enough for the coming generations, while I have a mildly dystopian view of the future Water/Resource Wars — Pia, a woman in her twenties in India

Steep housing costs

At my age on an apprentice’s salary my dad owned his own house and was buying and flipping more houses. I’ve got a masters degree, earning about 40 per cent more than the national average and I’m still struggling to find anywhere. They just don’t seem to understand, my dad refused to believe me until I showed him the tiny studio flats selling in my area for almost £300k — A data scientist in his late twenties, working in the UK

My generation is worn out

In many ways I think I am better off than my parents were. I’ve been able to travel and live in different countries. I had more choices than women before me. Where I live, I can love whomever I want to love. I do not have a physical job that wears down my body. But I guess each generation faces different challenges.

My generation is perhaps more likely to be mentally worn out. Housing is less affordable and returns are relatively less certain and I don’t have a pension or a pensions saving account that is protected from double taxation. — Deborah from the Netherlands

Change the voting system

It is probably an unrealistic policy change, but I would like to see some kind of weighting system applied to future voting (be it elections or referendums). The older you are, the fewer years you have left to live and the less you will have to suffer from poor long-term choices.

Brexit is a good example of this. Foolish and impressionable members of the older generation selfishly voted to leave the EU — a decision which will cause long-term damage for my generation well after they are deceased. Older people’s votes should have counted for less in the referendum. — David, working in fintech in London

Introduce a ‘meat licence’

I would introduce a “meat license” which every adult in the UK would require before they purchase/consume meat. To get this license, once a year they would have to go to an abattoir and slaughter a cow or pig. Once they have done this, they are allowed to consume as much meat as they want during the year.

This would encourage others to switch to alternatives that are available or at least reduce meat waste which is a tragically growing issue in the rich world. — Dan, working in London, UK

Replace student fees

Instead of tuition fee loans and maintenance loans I would give all young people a lump sum at regular intervals for their first several years post 18. They could use this towards going to uni, getting training, buying a house, etc. It would help diversify the paths people take post 18 whilst redistributing wealth. — A man in his mid-twenties living in Sheffield, UK

*Comments have been edited for length, style and clarity

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Parenting & Family Articles & More

How teens today are different from past generations, a psychologist mines big data on teens and finds many ways this generation—the “igens"—is different from boomers, gen xers, and millennials..

Every generation of teens is shaped by the social, political, and economic events of the day. Today’s teenagers are no different—and they’re the first generation whose lives are saturated by mobile technology and social media.

In her new book, psychologist Jean Twenge uses large-scale surveys to draw a detailed portrait of ten qualities that make today’s teens unique and the cultural forces shaping them. Her findings are by turn alarming, informative, surprising, and insightful, making the book— iGen:Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy—and Completely Unprepared for Adulthood—and What That Means for the Rest of Us —an important read for anyone interested in teens’ lives.

Who are the iGens?

Twenge names the generation born between 1995 and 2012 “iGens” for their ubiquitous use of the iPhone, their valuing of individualism, their economic context of income inequality, their inclusiveness, and more.

She identifies their unique qualities by analyzing four nationally representative surveys of 11 million teens since the 1960s. Those surveys, which have asked the same questions (and some new ones) of teens year after year, allow comparisons among Boomers, Gen Xers, Millennials, and iGens at exactly the same ages. In addition to identifying cross-generational trends in these surveys, Twenge tests her inferences against her own follow-up surveys, interviews with teens, and findings from smaller experimental studies. Here are just a few of her conclusions.

iGens have poorer emotional health thanks to new media. Twenge finds that new media is making teens more lonely, anxious, and depressed, and is undermining their social skills and even their sleep.

iGens “grew up with cell phones, had an Instagram page before they started high school, and do not remember a time before the Internet,” writes Twenge. They spend five to six hours a day texting, chatting, gaming, web surfing, streaming and sharing videos, and hanging out online. While other observers have equivocated about the impact, Twenge is clear: More than two hours a day raises the risk for serious mental health problems.

She draws these conclusions by showing how the national rise in teen mental health problems mirrors the market penetration of iPhones—both take an upswing around 2012. This is correlational data, but competing explanations like rising academic pressure or the Great Recession don’t seem to explain teens’ mental health issues. And experimental studies suggest that when teens give up Facebook for a period or spend time in nature without their phones, for example, they become happier.

The mental health consequences are especially acute for younger teens, she writes. This makes sense developmentally, since the onset of puberty triggers a cascade of changes in the brain that make teens more emotional and more sensitive to their social world.

Social media use, Twenge explains, means teens are spending less time with their friends in person. At the same time, online content creates unrealistic expectations (about happiness, body image, and more) and more opportunities for feeling left out—which scientists now know has similar effects as physical pain . Girls may be especially vulnerable, since they use social media more, report feeling left out more often than boys, and report twice the rate of cyberbullying as boys do.

Social media is creating an “epidemic of anguish,” Twenge says.

iGens grow up more slowly. iGens also appear more reluctant to grow up. They are more likely than previous generations to hang out with their parents, postpone sex, and decline driver’s licenses.

More on Teens

Discover five ways parents can help prevent teen depression .

Learn how the adolescent brain transforms relationships .

Understand the purpose of the teenage brain .

Explore how to help teens find purpose .

Twenge floats a fascinating hypothesis to explain this—one that is well-known in social science but seldom discussed outside academia. Life history theory argues that how fast teens grow up depends on their perceptions of their environment: When the environment is perceived as hostile and competitive, teens take a “fast life strategy,” growing up quickly, making larger families earlier, and focusing on survival. A “slow life strategy,” in contrast, occurs in safer environments and allows a greater investment in fewer children—more time for preschool soccer and kindergarten violin lessons.

“Youths of every racial group, region, and class are growing up more slowly,” says Twenge—a phenomenon she neither champions nor judges. However, employers and college administrators have complained about today’s teens’ lack of preparation for adulthood. In her popular book, How to Raise an Adult , Julie Lythcott-Haims writes that students entering college have been over-parented and as a result are timid about exploration, afraid to make mistakes, and unable to advocate for themselves.

Twenge suggests that the reality is more complicated. Today’s teens are legitimately closer to their parents than previous generations, but their life course has also been shaped by income inequality that demoralizes their hopes for the future. Compared to previous generations, iGens believe they have less control over how their lives turn out. Instead, they think that the system is already rigged against them—a dispiriting finding about a segment of the lifespan that is designed for creatively reimagining the future .

iGens exhibit more care for others. iGens, more than other generations, are respectful and inclusive of diversity of many kinds. Yet as a result, they reject offensive speech more than any earlier generation, and they are derided for their “fragility” and need for “ trigger warnings ” and “safe spaces.” (Trigger warnings are notifications that material to be covered may be distressing to some. A safe space is a zone that is absent of triggering rhetoric.)

Today’s colleges are tied in knots trying to reconcile their students’ increasing care for others with the importance of having open dialogue about difficult subjects. Dis-invitations to campus speakers are at an all-time high, more students believe the First Amendment is “outdated,” and some faculty have been fired for discussing race in their classrooms. Comedians are steering clear of college campuses, Twenge reports, afraid to offend.

The future of teen well-being

Social scientists will discuss Twenge’s data and conclusions for some time to come, and there is so much information—much of it correlational—there is bound to be a dropped stitch somewhere. For example, life history theory is a useful macro explanation for teens’ slow growth, but I wonder how income inequality or rising rates of insecure attachments among teens and their parents are contributing to this phenomenon. And Twenge claims that childhood has lengthened, but that runs counter to data showing earlier onset of puberty.

So what can we take away from Twenge’s thoughtful macro-analysis? The implicit lesson for parents is that we need more nuanced parenting. We can be close to our children and still foster self-reliance. We can allow some screen time for our teens and make sure the priority is still on in-person relationships. We can teach empathy and respect but also how to engage in hard discussions with people who disagree with us. We should not shirk from teaching skills for adulthood, or we risk raising unprepared children. And we can—and must—teach teens that marketing of new media is always to the benefit of the seller, not necessarily the buyer.

Yet it’s not all about parenting. The cross-generational analysis that Twenge offers is an important reminder that lives are shaped by historical shifts in culture, economy, and technology. Therefore, if we as a society truly care about human outcomes, we must carefully nurture the conditions in which the next generation can flourish.

We can’t market technologies that capture dopamine, hijack attention, and tether people to a screen, and then wonder why they are lonely and hurting. We can’t promote social movements that improve empathy, respect, and kindness toward others and then become frustrated that our kids are so sensitive. We can’t vote for politicians who stall upward mobility and then wonder why teens are not motivated. Society challenges teens and parents to improve; but can society take on the tough responsibility of making decisions with teens’ well-being in mind?

The good news is that iGens are less entitled, narcissistic, and over-confident than earlier generations, and they are ready to work hard. They are inclusive and concerned about social justice. And they are increasingly more diverse and less partisan, which means they may eventually insist on more cooperative, more just, and more egalitarian systems.

Social media will likely play a role in that revolution—if it doesn’t sink our kids with anxiety and depression first.

About the Author

Diana Divecha

Diana Divecha, Ph.D. , is a developmental psychologist, an assistant clinical professor at the Yale Child Study Center and Yale Center for Emotional Intelligence, and on the advisory board of the Greater Good Science Center. Her blog is developmentalscience.com .

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• Open access
• Published: 14 September 2023

Children and youth’s perceptions of mental health—a scoping review of qualitative studies

• Linda Beckman 1 , 2 ,
• Sven Hassler 1 &
• Lisa Hellström 3  

BMC Psychiatry volume  23 , Article number:  669 ( 2023 ) Cite this article

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Recent research indicates that understanding how children and youth perceive mental health, how it is manifests, and where the line between mental health issues and everyday challenges should be drawn, is complex and varied. Consequently, it is important to investigate how children and youth perceive and communicate about mental health. With this in mind, our goal is to synthesize the literature on how children and youth (ages 10—25) perceive and conceptualize mental health.

We conducted a preliminary search to identify the keywords, employing a search strategy across electronic databases including Medline, Scopus, CINAHL, PsychInfo, Sociological abstracts and Google Scholar. The search encompassed the period from September 20, 2021, to September 30, 2021. This effort yielded 11 eligible studies. Our scoping review was conducted in accordance with the PRISMA-ScR Checklist.

As various aspects of uncertainty in understanding of mental health have emerged, the results indicate the importance of establishing a shared language concerning mental health. This is essential for clarifying the distinctions between everyday challenges and issues that require treatment.

We require a language that can direct children, parents, school personnel and professionals toward appropriate support and aid in formulating health interventions. Additionally, it holds significance to promote an understanding of the positive aspects of mental health. This emphasis should extend to the competence development of school personnel, enabling them to integrate insights about mental well-being into routine interactions with young individuals. This approach could empower children and youth to acquire the understanding that mental health is not a static condition but rather something that can be enhanced or, at the very least, maintained.

Peer Review reports

Introduction

In Western society, the prevalence of mental health issues, such as depression and anxiety [ 1 ], as well as recurring psychosomatic health complaints [ 2 ], has increased from the 1980s and 2000s. However, whether these changes in adolescent mental health are actual trends or influenced by alterations in how adolescents perceive, talk about, and report their mental well-being remains ambiguous [ 1 ]. Despite an increase in self-reported mental health problems, levels of mental well-being have remained stable, and severe psychiatric diagnoses have not significantly risen [ 3 , 4 ]. Recent research indicates that understanding how children and youth grasp mental health, its manifestations, and the demarcation between mental health issues and everyday challenges is intricate and diverse. Wickström and Kvist Lindholm [ 5 ] show that problems such as feeling low and nervous are considered deep-seated issues among some adolescents, while others refer to them as everyday challenges. Meanwhile, adolescents in Hellström and Beckman [ 6 ] describe mental health problems as something mainstream, experienced by everyone at some point. Furthermore, Hermann et al. [ 7 ] point out that adolescents can distinguish between positive health and mental health problems. This indicates their understanding of the complexity and holistic nature of mental health and mental health issues. It is plausible that misunderstandings and devaluations of mental health and illness concepts may increase self-reported mental health problems and provide contradictory results when the understanding of mental health is studied. In a previous review on how children and young people perceive the concept of “health,” four major themes have been suggested: health practices, not being sick, feeling good, and being able to do the desired and required activities [ 8 ]. In a study involving 8–11 year olds, children framed both biomedical and holistic perspectives of health [ 9 ]. Regarding the concept of “illness,” themes such as somatic feeling states, functional and affective states [ 10 , 11 ], as well as processes of contagion and contamination, have emerged [ 9 ]. Older age strongly predicts nuances in conceptualizations of health and illness [ 10 , 11 , 12 ].

As the current definitions of mental health and mental illness do not seem to have been successful in guiding how these concepts are perceived, literature has emphasized the importance of understanding individuals’ ideas of health and illness [ 9 , 13 ]. The World Health Organization (WHO) broadly defines mental health as a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, work productively and fruitfully and make a contribution to his or her community [ 14 ] capturing only positive aspects. According to The American Psychology Association [ 15 ], mental illness includes several conditions with varying severity and duration, from milder and transient disorders to long-term conditions affecting daily function. The term can thus cover everything from mild anxiety or depression to severe psychiatric conditions that should be treated by healthcare professionals. As a guide for individual experience, such a definition becomes insufficient in distinguishing mental illness from ordinary emotional expressions. According to the Swedish National Board of Health and Welfare et al. [ 16 ], mental health works as an umbrella term for both mental well-being and mental illness : Mental well-being is about being able to handle life's difficulties, feeling satisfied with life, having good social relationships, as well as being able to feel pleasure, desire, and happiness. Mental illness includes both mild to moderate mental health problems and psychiatric conditions . Mild to moderate mental health problems are common and are often reactions to events or situations in life, e.g., worry, feeling low, and sleep difficulties.

It has been argued that increased knowledge of the nature of mental illness can help individuals to cope with the situation and improve their well-being. Increased knowledge about mental illness, how to prevent mental illness and help-seeking behavior has been conceptualized as “mental health literacy” (MHL) [ 17 ], a construct that has emerged from “health literacy” [ 18 ]. Previous literature supports the idea that positive MHL is associated with mental well-being among adolescents [ 19 ]. Conversely, studies point out that low levels of MHL are associated with depression [ 20 ]. Some gender differences have been acknowledged in adolescents, with boys scoring lower than girls on MHL measures [ 20 ] and a social gradient including a positive relationship between MHL and perceived good financial position [ 19 ] or a higher socio-economic status [ 21 ].

While MHL stresses knowledge about signs and treatment of mental illness [ 22 ], the concern from a social constructivist approach would be the conceptualization of mental illness and how it is shaped by society and the thoughts, feelings, and actions of its members [ 23 ]. Studies on the social construction of anxiety and depression through media discourses have shown that language is at the heart of these processes, and that language both constructs the world as people perceive it but also forms the conditions under which an experience is likely to be construed [ 24 , 25 ]. Considering experience as linguistically inflected, the constructionist approach offers an analytical tool to understand the conceptualization of mental illness and to distinguish mental illness from everyday challenges. The essence of mental health is therefore suggested to be psychological constructions identified through how adolescents and society at large perceive, talk about, and report mental health and how that, in turn, feeds a continuous process of conceptual re-construction or adaptation [ 26 ]. Considering experience as linguistically inflected, the constructionist approach could then offer an analytical tool to understand the potential influence of everyday challenges in the conceptualization of mental health.

Research investigating how children and youth perceive and communicate mental health is essential to understand the current rise of reported mental health problems [ 5 ]. Health promotion initiatives are more likely to be successful if they take people’s understanding, beliefs, and concerns into account [ 27 , 28 ]. As far as we know, no review has mapped the literature to explore children’s and youths’ perceptions of mental health and mental illness. Based on previous literature, age, gender, and socioeconomic status seem to influence children's and youths’ knowledge and experiences of mental health [ 10 , 11 , 12 ]; therefore, we aim to analyze these perspectives too. From a social constructivist perspective, experience is linguistically inflected [ 26 ]; hence illuminating the conditions under which a perception of health is formed is of interest.

Therefore, we aim to study the literature on how children and youth (ages 10—25) perceive and conceptualize mental health, and the specific research questions are:

What aspects are most salient in children’s and youths’ perceptions of mental health?

What concepts do children and youth associate with mental health?

In what way are children's and youth’s perceptions of mental health dependent on gender, age, and socioeconomic factors?

Literature search

A scoping review is a review that aims to provide a snapshot of the research that is published within a specific subject area. The purpose is to offer an overview and, on a more comprehensive level, to distinguish central themes compared to a systematic review. We chose to conduct a scoping review since our aim was to clarify the key concepts of mental health in the literature and to identify specific characteristics and concepts surrounding mental health [ 29 , 30 ]. Our scoping review was conducted following the PRISMA-ScR Checklist [ 31 ]. Two authors (L.B and L.H) searched and screened the eligible articles. In the first step, titles and abstracts were screened. If the study included relevant data, the full article was read to determine if it met the eligibility criteria. Articles were excluded if they did not fulfill all the eligibility criteria. Any uncertainties were discussed among L.B. and L.H., and the third author, S.H., and were carefully assessed before making an inclusion or exclusion decision. The software Picoportal was employed for data management. Figure  1 illustrates a flowchart of data inclusion.

PRISMA flow diagram outlining the search process

Eligibility criteria

We incorporated studies involving children and youth aged 10 to 25 years. This age range was chosen to encompass early puberty through young adulthood, a significant developmental period for young individuals in terms of comprehending mental health. Participants were required not to have undergone interviews due to chronic illness, learning disabilities (e.g., mental health linked to a cancer diagnosis), or immigrant status.

Studies conducted in clinical settings were excluded. For the purpose of comparing results under similar conditions, we specifically opted for studies carried out in Western countries .

Given that this review adopts a moderately constructionist approach, intentionally allowing for the exploration of how both young participants and society in general perceive and discuss mental health and how this process contributes to ongoing conceptual re-construction, the emphasis was placed on identifying articles in which participants themselves defined or attributed meaning to mental health and related concepts like mental illness. The criterion of selecting studies adopting an inductive approach to capture the perspectives of the young participants resulted in the exclusion of numerous studies that more overtly applied established concepts to young respondents [ 32 ].

Information sources

We utilized electronic databases and reached out to study authors if the article was not accessible online. Peer-reviewed articles were exclusively included, thereby excluding conference abstracts due to their perceived lack of relevance in addressing the review questions. Only research in English was taken into account. Publication years across all periods were encompassed in the search.

Search strategy

Studies concerning children’s and youths’ perceptions of mental health were published across a range of scientific journals, such as those within psychiatry, psychology, social work, education, and mental health. Therefore, several databases were taken into account, including Medline, Scopus, CINAHL, PsychInfo, Sociological abstracts, and Google Scholar, spanning from inception on September 20, 2021 to September 30, 2021. We involved a university librarian from the start in the search process. The combinations of search terms are displayed in Table 1 .

Quality assessment

We employed the Quality methods for the development of National Institute for Health Care Excellence (NICE) public health guidance [ 33 ] to evaluate the quality of the studies included. The checklist is based on checklists from Spencer et al. [ 34 ], Public Health Resource Unit (PHRU) [ 26 , 35 ], and the North Thames Research Appraisal Group (NTRAG) [ 36 ] (Refer to S2 for checklist). Eight studies were assigned two plusses, and three studies received one plus. The studies with lower grades generally lacked sufficient descriptions of the researcher’s role, context reporting, and ethical reporting. No study was excluded in this stage.

Data extraction and analysis

We employed a data extraction form that encompassed several key characteristics, including author(s), year, journal, country, details about method/design, participants and socioeconomics, aim, and main results (Table 2 ). The collected data were analyzed and synthesized using the thematic synthesis approach of Thomas and Harden [ 37 ]. This approach encompassed all text categorized as 'results' or 'findings' in study reports – which sometimes included abstracts, although the presentation wasn’t always consistent throughout the text. The size of the study reports ranged from a few sentences to a single page. The synthesis occurred through three interrelated stages that partially overlapped: coding of the findings from primary studies on a line-by-line basis, organization of these 'free codes' into interconnected areas to construct 'descriptive' themes, and the formation of 'analytical' themes.

The objective of this scoping review has been to investigate the literature concerning how children and youth (ages 10—25) conceptualize and perceive mental health. Based on the established inclusion- and exclusion criteria, a total of 11 articles were included representing the United Kingdom ( n  = 6), Australia ( n  = 3), and Sweden ( n  = 2) and were published between 2002 and 2020. Among these, two studies involved university students, while nine incorporated students from compulsory schools.

Salient aspects of children and youth’ perceptions of mental health

Based on the results of the included articles, salient aspects of children’s and youths’ understandings revealed uncertainties about mental health in various ways. This uncertainty emerged as conflicting perceptions, uncertainty about the concept of mental health, and uncertainty regarding where to distinguish between mild to moderate mental health problems and everyday stressors or challenges.

One uncertainty was associated with conflicting perceptions that mental health might be interpreted differently among children and youths, depending on whether it relates to their own mental health or someone else's mental health status. Chisholm et al. [ 42 ] presented this as distinctions being made between ‘them and us’ and between ‘being born with it’. Mental health and mental illness were perceived as a continuum that rather developed’, and distinctions were drawn between ‘crazy’ and ‘diagnosed.’ Participants established strong associations between the term mental illness and derogatory terms like ‘crazy,’ linking extreme symptoms of mental illness with others. However, their attitude was less stigmatizing when it came to individual diagnoses, reflecting a more insightful and empathetic understanding of the adverse impacts of stress based on their personal realities and experiences. Despite the initial reactions reflecting negative stereotypes, further discussion revealed that this did not accurately represent a deeper comprehension of mental health and mental illness.

There was also uncertainty about the concept of mental health , as it was not always clearly understood among the participating youth. Some participants were unable to define mental health, often confusing it with mental illness [ 28 ]. Others simply stated that they did not understand the term, as in O’Reilly [ 44 ]. Additionally, uncertainty was expressed regarding whether mental health was a positive or negative concept [ 27 , 28 , 40 , 44 ], and participants associated mental health with mental illness despite being asked about mental health [ 28 ]. One quote from a grade 9 student illustrates this: “ Interviewer: Can mental health be positive as well? Informant: No, it’s mental” [ 44 ]. In Laidlaw et al. [ 46 ], with participants ranging from 18—22 years of age, most considered mental health distinctly different from and more clinical than mental well-being. However, Roose et al. [ 38 ], for example, the authors discovered a more multifaceted understanding of mental health, encompassing emotions, thoughts, and behavior. In Molenaar et al.[ 45 ], mental health was highlighted as a crucial aspect of health overall. In Chisholm et al. [ 42 ], the older age groups discussed mental health in a more positive sense when they considered themselves or people they knew, relating mental health to emotional well-being. Connected to the uncertainty in defining the concept of mental health was the uncertainty in identifying those with good or poor mental health. Due to the lack of visible proof, children and youths might doubt their peers’ reports of mental illness, wondering if they were pretending or exaggerating their symptoms [ 27 ].

A final uncertainty that emerged was difficulties in drawing the line between psychiatric conditions and mild to moderate mental health problems and everyday stressors or challenges . Perre et al. [ 43 ] described how the participants in their study were uncertain about the meaning of mental illness and mental health issues. While some linked depression to psychosis, others related it to simply ‘feeling down.’ However, most participants indicated that, in contrast to transient feelings of sadness, depression is a recurring concern. Furthermore, the duration of feeling depressed and particularly a loss of interest in socializing was seen as appropriate criteria for distinguishing between ‘feeling down’ and ‘clinical depression.’ Since feelings of anxiety, nervousness, and apprehension are common experiences among children and youth, defining anxiety as an illness as opposed to an everyday stressor was more challenging [ 43 ].

Terms used to conceptualize mental health

When children and youth were asked about mental health, they sometimes used neutral terms such as thoughts and emotions or a general ‘vibe’ [ 27 ], and some described it as ‘peace of mind’ and being able to balance your emotions [ 38 ]. The notion of mental health was also found to be closely linked with rationality and the idea of normality, although, according to the young people, Armstrong et al. [ 28 ], there was no consensus about what ‘normal’ meant. Positive aspects of mental health were described by the participants as good self-esteem, confidence [ 40 ], happiness [ 39 , 43 ], optimism, resilience, extraversion and intelligence [ 27 ], energy [ 43 ], balance, harmony [ 39 , 43 ], good brain, emotional and physical functioning and development, and a clear idea of who they are [ 27 , 41 ]. It also included a feeling of being a good person, feeling liked and loved by your parents, social support, and having people to talk with [ 27 , 39 ], as well as being able to fit in with the world socially and positive peer relationships [ 41 ], according to the children and youths, mental health includes aspects related to individuals (individual factors) as well as to people in their surroundings (relationships). Regarding mental illness, participants defined it as stress and humiliation [ 40 ], psychological distress, traumatic experiences, mental disorders, pessimism, and learning disabilities [ 27 ]. Also, in contrast to the normality concept describing mental health, mental illness was described as somehow ‘not normal’ or ‘different’ in Chisholm et al. [ 42 ].

Depression and bipolar disorder were the most often mentioned mental illnesses [ 27 ]. The inability to balance emotions was seen as negative for mental health, for example, not being able to set aside unhappiness, lying to cover up sadness, and being unable to concentrate on schoolwork [ 38 ]. The understanding of mental illness also included feelings of fear and anxiety [ 42 ]. Other participants [ 46 ] indicated that mental health is distinctly different from, and more clinical than, mental well-being. In that sense, mental health was described using reinforcing terms such as ‘serious’ and ‘clinical,’ being more closely connected to mental illness, whereas mental well-being was described as the absence of illness, feeling happy, confident, being able to function and cope with life’s demands and feeling secure. Among younger participants, a more varied and vague understanding of mental health was shown, framing it as things happening in the brain or in terms of specific conditions like schizophrenia [ 44 ].

Gender, age, socioeconomic status

Only one study had a gender theoretical perspective [ 40 ], but the focus of this perspective concerned gender differences in what influences mental health more than the conceptualization of mental health. According to Johansson et al.[ 39 ], older girls expressed deeper negative emotions (e.g., described feelings of lack of meaning and hope in various ways) than older boys and younger children.

Several of the included studies noticed differences in age, where younger participants had difficulty understanding the concept of mental health [ 39 , 44 ], while older participants used more words to explain it [ 39 ]. Furthermore, older participants seemed to view mental health and mental illness as a continuum, with mental illness at one end of the continuum and mental well-being at the other end [ 42 , 46 ].

Socioeconomic status

The role of socioeconomic status was only discussed by Armstrong et al. [ 28 ], finding that young people from schools in the most deprived and rural areas experienced more difficulties defining the term mental health compared to those from a less deprived area.

This scoping review aimed to map children's and youth’s perceptions and conceptualizations of mental health. Our main findings indicate that the concept of mental health is surrounded by uncertainty. This raises the question of where this uncertainty stems from and what it symbolizes. From our perspective, this uncertainty can be understood from two angles. Firstly, the young participants in the different studies show no clear and common understanding of mental health; they express uncertainty about the meaning of the concept and where to draw the line between life experiences and psychiatric conditions. Secondly, uncertainty exists regarding how to apply these concepts in research, making it challenging to interpret and compare research results. The shift from a positivistic understanding of mental health as an objective condition to a more subjective inner experience has left the conceptualization open ranging from a pathological phenomenon to a normal and common human experience [ 47 ]. A dilemma that results in a lack of reliability that mirrors the elusive nature of the concept of mental health from both a respondent and a scientific perspective.

“Happy” was commonly used to describe mental health, whereas "unhappy" was used to describe mental illness. The meaning of happiness for mental health has been acknowledged in the literature, and according to Layard et al. [ 48 ], mental illness is one of the main causes of unhappiness, and happiness is the ultimate goal in human life. Layard et al. [ 48 ] suggest that schools and workplaces need to raise more awareness of mental health and strive to improve happiness to promote mental health and prevent mental illness. On the other hand, being able to experience and express different emotions could also be considered a part of mental health. The notion of normality also surfaced in some studies [ 38 ], understanding mental health as being emotionally balanced or normal or that mental illness was not normal [ 42 ]. To consider mental illness in terms of social norms and behavior followed with the sociological alternative to the medical model that was introduced in the sixties portraying mental illness more as socially unacceptable behavior that is successfully labeled by others as being deviant. Although our results did not indicate any perceptions of what ‘normal’ meant [ 28 ], one crucial starting point to the understanding of mental health among adolescents should be to delineate what constitutes normal functioning [ 23 ]. Children and youths’ understanding of mental illness seems to a large extent, to be on the same continuum as a normality rather than representing a medicalization of deviant behavior and a disjuncture with normality [ 49 ].

Concerning gender, it seemed that girls had an easier time conceptualizing mental health than boys. This could be due to the fact that girls mature verbally faster than boys [ 50 ], but also that girls, to a larger extent, share feelings and problems together compared to boys [ 51 ]. However, according to Johansson et al. [ 39 ], the differences in conceptualizations of mental health seem to be more age-related than gender-related. This could be due to the fact that older children have a more complex view of mental health compared to younger children.. Not surprisingly, the older the children and youth were, the more complex the ability to conceptualize mental health becomes. Only one study reported socioeconomic differences in conceptualizations of mental health [ 28 ]. This could be linked to mental health literacy (MHL) [ 18 ], i.e., knowledge about mental illness, how to prevent mental illness, and help-seeking behavior. Research has shown that disadvantaged social and socioeconomic conditions are associated with low MHL, that is, people with low SES tends to know less about symptoms and prevalence of different mental health problems [ 19 , 21 ]. The perception and conceptualizations of mental health are, as we consider, strongly related to knowledge and beliefs about mental health, and according to von dem Knesebeck et al. [ 52 ] linked primarily to SES through level of education.

Chisholm et al. [ 42 ] found that the initial reactions from participants related to negative stereotypes, but further discussion revealed that the participants had more refined knowledge than at first glance. This illuminates the importance of talking to children and helping them verbalize their feelings, in many respects complex and diversified understanding of mental health. It is plausible that misunderstandings and devaluations of mental health and mental illness may increase self-reported mental health problems [ 5 ], as well as decrease them, preventing children and youth from seeking help. Therefore, increased knowledge of the nature of mental health can help individual cope with the situations and improve their mental well-being. Finding ways to incorporate discussions about mental well-being, mental health, and mental illness in schools could be the first step to decreasing the existing uncertainties about mental health. Experiencing feelings of sadness, anger, or upset from time to time is a natural part of life, and these emotions are not harmful and do not necessarily indicate mental illness [ 5 , 6 ]. Adolescents may have an understanding of the complexity of mental health despite using simplified language but may need guidance on how to communicate their feelings and how to manage everyday challenges and normal strains in life [ 7 ].

With the aim of gaining a better understanding of how mental health is perceived among children and youth, this study has highlighted the concept’s uncertainty. Children and youth reveal a variety of understandings, from diagnoses of serious mental illnesses such as schizophrenia to moods and different types of behaviors. Is there only one way of understanding mental health, and is it reasonable to believe that we can reach a consensus? Judging by the questions asked, researchers also seem to have different ideas on what to incorporate into the concept of mental health — the researchers behind the present study included. The difficulties in differentiating challenges being part of everyday life with mental health issues need to be paid closer attention to and seems to be symptomatic with the lack of clarity of the concepts.

A constructivist approach would argue that the language of mental health has changed over time and thus influence how adolescents, as well as society at large, perceive, talk about, and report their mental health [ 26 ]. The re-construction or adaptation of concepts could explain why children and youth re struggling with the meaning of mental health and that mental health often is used interchangeably with mental illness. Mental health, rather than being an umbrella term, then represents a continuum with a positive and a negative end, at least among older adolescents. But as mental health according to this review also incorporates subjective expressions of moods and feelings, the reconstruction seems to have shaped it into a multidimensional concept, representing a horizontal continuum of positive and negative mental health and a vertical continuum of positive and negative well-being, similar to the health cross by Tudor [ 53 ] referred to in Laidlaw et al. [ 46 ] A multidimensional understanding of mental health constructs also incorporates evidence from interventions aimed at reducing mental health stigma among adolescents, where attitudes and beliefs as well as emotional responses towards mental health are targeted [ 54 ].

The contextual understanding of mental health, whether it is perceived in positive terms or negative, started with doctors and psychiatrists viewing it as representing a deviation from the normal. A perspective that has long been challenged by health workers, academics and professionals wanting to communicate mental health as a positive concept, as a resource to be promoted and supported. In order to find a common ground for communicating all aspects and dimensions of mental health and its conceptual constituents, it is suggested that we first must understand the subjective meaning ascribed to the use of the term [ 26 ]. This line of thought follows a social-constructionist approach viewing mental health as a concept that has transitioned from representing objective mental descriptions of conditions to personal subjective experiences. Shifting from being conceptualized as a pathological phenomenon to a normal and common human experience [ 47 ]. That a common understanding of mental health can be challenged by the healthcare services tradition and regulation for using diagnosis has been shown in a study of adolescents’ perspectives on shared decision-making in mental healthcare [ 55 ]. A practice perceived as labeling by the adolescents, indicating that steps towards a common understanding of mental health needs to be taken from several directions [ 55 ]. In a constructionist investigation to distinguish everyday challenges from mental health problems, instead of asking the question, “What is mental health?” we should perhaps ask, “How is the word ‘mental health’ used, and in what context and type of mental health episode?” [ 26 ]. This is an area for future studies to explore.

Methodological considerations

The first limitation we want to acknowledge, as for any scoping review, is that the results are limited by the search terms included in the database searches. However, by conducting the searches with the help of an experienced librarian we have taken precautions to make the searches as inclusive as possible. The second limitation concerns the lack of homogeneous, or any results at all, according to different age groups, gender, socioeconomic status, and year when the study was conducted. It is well understood that age is a significant determinant in an individual’s conceptualization of more abstract phenomena such as mental health. Some of the studies approached only one age group but most included a wide age range, making it difficult to say anything specific about a particular age. Similar concerns are valid for gender. Regarding socioeconomic status, only one study reported this as a finding. However, this could be an outcome of the choice of methods we had — i.e., qualitative methods, where the aim seldom is to investigate differences between groups and the sample is often supposed to be a variety. It could also depend on the relatively small number of participants that are often used in focus groups of individual interviews- there are not enough participants to compare groups based on gender or socioeconomic status. Finally, we chose studies from countries that could be viewed as having similar development and perspective on mental health among adolescents. Despite this, cultural differences likely account for many youths’ conceptualizations of mental health. According to Meldahl et al. [ 56 ], adolescents’ perspectives on mental health are affected by a range of factors related to cultural identity, such as ethnicity, race, peer and family influence, religious and political views, for example. We would also like to add organizational cultures, such as the culture of the school and how schools work with mental health and related concepts [ 56 ].

Conclusions and implications

Based on our results, we argue that there is a need to establish a common language for discussing mental health. This common language would enable better communication between adults and children and youth, ensuring that the content of the words used to describe mental health is unambiguous and clear. In this endeavor, it is essential to actively listen to the voices of children and youth, as their perspectives will provide us with clearer understanding of the experiences of being young in today’s world. Another way to develop a common language around mental health is through mental health education. A common language based on children’s and youth’s perspectives can guide school personnel, professionals, and parents when discussing and planning health interventions and mental health education. Achieving a common understanding through mental health education of adults and youth could also help clarify the boundaries between everyday challenges and problems needing treatment. It is further important to raise awareness of the positive aspect of mental health—that is, knowledge of what makes us flourish mentally should be more clearly emphasized in teaching our children and youth about life. It should also be emphasized in competence development for school personnel so that we can incorporate knowledge about mental well-being in everyday meetings with children and youth. In that way, we could help children and youth develop knowledge that mental health could be improved or at least maintained and not a static condition.

Availability of data and materials

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

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Beckman, L., Hassler, S. & Hellström, L. Children and youth’s perceptions of mental health—a scoping review of qualitative studies. BMC Psychiatry 23 , 669 (2023). https://doi.org/10.1186/s12888-023-05169-x

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The 10 Biggest Teen Health Risks

Automobile accidents, gun violence.

• Sexual Risks

Tobacco Use

Recreational drugs, eating disorders.

Teenagers today are exposed to more risks than ever before. From online bullying and school shootings to alcohol and opioid abuse , teens have higher levels of stress than in years past and increasing rates of suicide.

For parents and caregivers, this means having difficult conversations with their increasingly independent children about making smart choices about health and safety. If you're one of those caregivers, arm yourself with facts about the top 10 teen health issues as well as resources to help navigate the stormy waters of adolescence.

Motor vehicle accidents are the leading cause of teen deaths in the United States. The Centers for Disease Control and Prevention (CDC) estimates that every day seven teens between the ages of 16 and 19 die from motor vehicle injuries and even more are treated in emergency rooms for serious injuries.

Teens 16–19 have a greater risk of death or injury in a car crash than any other age group.

Before your teen gets behind the wheel, it is important to understand the factors that contribute to teen car accidents. These include:

• Inexperience: Teens are less able to recognize dangerous situations and have less-developed driving reflexes than more experienced drivers. 
• Speeding: Teens are more likely to speed and to drive too closely to the car in front of them.
• Seat-belt use: Fewer than 60% of high school students wear seat belts every time they get in a car. In fact, among young drivers who died in car accidents in 2017, about half were not wearing a seat belt.
• Drunk driving: Statistics show one in six teens have ridden in a car with a driver who is under the influence of alcohol and that 1 in 20 admits to getting behind the wheel after drinking.

Suicide is the second-leading cause of death among adolescents. Between 2007 and 2017, rates of teen suicide increased by 56%. Statistics show that roughly 1 in 11 high school students attempt suicide.

Contributing factors for suicide include loneliness, depression, family problems, and substance use disorder . The issues are complex and aren’t usually a result of one or two factors. Teens who have good communication with at least one adult are less likely to engage in risky behaviors and less likely to become depressed.

Learn to recognize the warning signs of suicidal thoughts in teens, which include:

• Feeling like a burden
• Being isolated
• Increasing anxiety
• Feeling trapped or in unbearable pain
• Increased substance use
• Looking for a way to access lethal means
• Increasing anger or rage
• Extreme mood swings
• Expressing hopelessness
• Sleeping too little or too much
• Talking or posting about wanting to die
• Making plans for suicide

If you suspect your child may be thinking of harming themself, ask if they are having thoughts of suicide, express your concerns about their behavior, listen attentively without judgment, let them know they have been heard and are not alone, and guide them to professional help.

If you are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one are in immediate danger, call 911 .

While school shootings get ta lot of news attention, they make up just 1.2% of firearm fatalities in school-aged children. Gang violence and drive-by shootings are a problem in many cities in the United States. Black children and teens are more than 8 times more likely to die from firearm homicide than their white counterparts.

Regardless of your personal stance on guns, it is important to talk to your children about gun safety. If you keep firearms in your home, be sure to keep them locked up and unloaded.

Research shows roughly 1 in 3 handguns is kept loaded and unlocked in the home and most children know where their parents keep their guns. The majority of firearm injuries and deaths in children and adolescents are related to guns in the home.

Homicide by firearm is the third leading cause of accidental death for young adults aged 15–24.

Whether a child has had firsthand experience with gun violence or learns about a mass shooting on the news, the opportunity to discuss this important topic with your teen will likely arise. The American Psychological Association offers the following tips for families:

• Limit news coverage of traumatic events.
• Listen to your child's concerns.
• Try to put their fears into proportion to the real risk, which is small.
• Reassure your teen that adults are doing everything they can to make their school, home, and neighborhood safe.

Roughly 1 in 3 adolescents are impacted by bullying—a form of aggressive behavior in which someone intentionally and repeatedly causes another person injury or discomfort. Bullying can be verbal, social, physical, or done online in the form of cyberbullying . It most commonly occurs at school. Approximately 30% of teens admit to bullying others.

Persistent bullying can cause feelings of isolation, rejection, exclusion, and despair, as well as depression and anxiety , which can contribute to suicidal behavior. However, the majority of teens who are bullied do not attempt suicide. While any teen can be a victim of bullying, LGBTQ youth are at a heightened risk of being targeted.

Despite many teens experiencing bullying, only 20%–30% of teens who are bullied report it to an adult.

Signs that your teen may be experiencing bullying include:

• Coming home with unexplained cuts, bruises, or scratches
• Making excuses to avoid school or resisting going to school or riding the school bus
• Complaining of frequent headaches, stomachaches, or other physical ailments, having trouble sleeping, or having frequent bad dreams
• Losing interest in schoolwork or suddenly doing poorly in school
• Appearing sad, moody, teary, anxious, or depressed when they come home from school

If you suspect your teen is being bullied, it can help to broach the subject indirectly by asking about friends or discussing bullying in the news. Most important is to keep the lines of communication open and provide a supportive environment. Don't downplay the situation by telling your teen to just get over it or toughen up.

Sex, Pregnancy, and STIs

Having the sex talk with your child can be uncomfortable, but it is important to make sure your teen understands the risks of sexual activity, how to practice safe sex, and the importance of consent. The health consequences of teen sex—namely pregnancy and sexually transmitted infections (STIs) —can have lifelong impacts. Arming yourself with facts can help facilitate a productive conversation.

Teens are at an increased risk of contracting a sexually transmitted infection than older adults, with studies showing that 46% of sexually active teens did not use a condom the last time they had sex.

In the United States, an estimated one-fifth of new human immunodeficiency virus ( HIV ) diagnoses each year are among people between the ages of 13 and 24, while half of all reported STIs occur in those 15–24.

On the bright side, the teen pregnancy rate has declined in recent years from its high in the 1980s and 1990s. In 2012, only about 29 per 1,000 women between 15 and 19 became pregnant. By 2016, that figure dropped even further to 18 per 1,000, according to the CDC. This decline is due to an increase in teens using birth control and practicing abstinence .

Another important sex topic to discuss with your teen is consent —the agreement between two parties regarding sexual activity. Failure to get consent from a partner can lead to legal consequences. Explain to your child the importance of communication, setting boundaries, and respecting their partners.

Make sure your child understands that pressuring someone to engage in activities they are not ready for or taking advantage of someone who is drunk or drugged is never OK. Likewise, if a teen is feeling pressured or uncomfortable in a situation, it is important to speak up and leave if necessary.

Tobacco use is the leading cause of preventable death in the United States, and nearly all nicotine addictions start in young adults. By their senior year of high school, more than two-thirds of kids have tried or are regularly using tobacco products.

While the use of cigarettes and smokeless tobacco products has been in sharp decline over the past 25 years, vaping (the use of electronic nicotine delivery systems) has grown exponentially.

Initially, vaping was believed to be safer than smoking cigarettes; however, a new lung disease known as EVALI (e-cigarette, or vaping, product use-associated lung injury) was identified in 2019.

According to data from the 2018 National Youth Tobacco Survey, 27.1% of high school students and 7.2% of middle school students reported using any tobacco product in the past 30 days, representing an increase over the previous year. During that period, the use of e-cigarettes by youth increased by 77.8% with 1 in 5 high schoolers admitting to vaping regularly .

The American Lung Association offers the following tips for talking to your kids about smoking and vaping: 

• Tell your teen honestly and directly that you do not want them to smoke cigarettes, vape, or chew tobacco .
• Educate yourself and your teen on the harm of tobacco products.
• Set a good example by not smoking or using tobacco. If you currently smoke, quit .

If you catch your teen smoking or vaping, avoid threats and ultimatums, and instead talk with them to find out why they are using nicotine and help them to find healthier ways to cope. 

Underage drinking can lead to many problems, including difficulty at school, poor judgment and impulse control, legal troubles, and health problems . According to a 2019 survey, 30% of high school seniors reported drinking alcohol in the last month and 14% admitted to binge drinking (defined as consuming four or more alcoholic beverages per occasion for women, five or more drinks per occasion for men).

The CDC reports more than 4,000 underage teens die from excessive drinking each year and there are close to 120,000 emergency room visits among 12- to 21-year-olds related to alcohol use.

Having an ongoing discussion with your teen about underage drinking is important. Encourage a two-way conversation with your teen and clearly state your expectations. Ask open-ended questions that encourage your child to tell you how they feel without lecturing.

The National Institute on Alcohol Abuse and Alcoholism advises keeping the lines of communication open and emphasizing some key points, including:

• Alcohol is a depressant that slows the body and mind.
• Being under the influence of alcohol impairs coordination and slows reaction time.
• Drinking impairs vision, thinking, and judgment, which can lead you to do something you would not do sober.
• People often misjudge how impaired they are after drinking alcohol.
• It takes between two and three hours for a single drink to leave your system. 
• Alcohol affects young people differently than adults and may lead to long-lasting intellectual effects in still-maturing brains.

While most parents do not want their teens to drink, it is important to keep lines of communication open, especially when it comes to drunk driving .

Emphasize to your teen that they should never get behind a wheel after drinking or get into a car with a driver who has been drinking. Let them know they can always call you if they need a ride, no questions asked.

Recreational drug use is a serious health risk for teens. Roughly half of all high school students report having tried cannabis, one-fifth have taken prescription medication that was not prescribed to them, 6% have tried cocaine , and 3% of teen males have used performance-enhancing steroids.

Opioids present the largest drug-related health risk for teens, with more than 4,000 young adults ages 15–25 overdosing and dying each year. A highly addictive group of drugs, opioids include both prescription pain medications and street drugs like:

• OxyContin (oxycodone)
• Percocet (oxycodone/acetaminophen)
• Vicodin (hydrocodone/acetaminophen)

Opioid addiction can have major life-threatening consequences. Many people start out taking prescription tablets, become addicted, and turn to heroin because it is less expensive.

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends talking with your teen often about the dangers of opioids and other drugs. Encourage your child to have an exit plan if they are offered drugs, such as texting a code word to a family member, and practice how to say no assertively.

If you suspect your child is addicted to opioids or abusing drugs, seek professional help. Talk to your child's doctor or school counselor or contact the SAMHSA National Helpline at  800-662-HELP (4357) .

Eating disorders frequently first appear during adolescence. Often misunderstood as a lifestyle choice, eating disorders such as anorexia nervosa , bulimia nervosa , and binge-eating disorder are serious and sometimes fatal illnesses that alter behaviors, thoughts, and emotions.

Both sexes can develop eating disorders, however, rates are higher in girls than boys. If your child seems preoccupied with food, their weight, and the shape of their body, they may have an eating disorder.

Other signs to watch for include:

• Frequently stepping on the scale or taking body measurements
• Restricting food intake
• Extreme weight loss or weight gain
• Spending extra time in the bathroom due to throwing up after meals or taking laxatives or diuretics
• Chronic sore throat, hoarse voice, or swollen lymph nodes on the neck from self-induced vomiting
• Sneaking food or eating in secret
• Eating large portions very quickly
• Anxiety, depression, and mood swings

If your teen is showing signs of having an eating disorder, it is important to seek treatment, which may include psychotherapy, medications, and nutritional classes. To find resources in your area, contact the National Association of Eating Disorders helpline at 800-931-2237 .

An estimated 20% of teens in the United States meet the medical definition of obesity , which is having a body mass index (BMI) at or above the 95th percentile for children of the same age and sex.

BMI is a dated, flawed measure. It does not take into account factors such as body composition, ethnicity, sex, race, and age.  Even though it is a biased measure, BMI is still widely used in the medical community because it’s an inexpensive and quick way to analyze a person’s potential health status and outcomes.

The health consequences of childhood obesity are serious and include type 2 diabetes , heart disease , asthma , and fatty liver disease . It also can lead to psychological problems including anxiety, depression, low self-esteem, and bullying. Childhood obesity also sets the stage for obesity and health problems in adulthood.

Factors associated with excessive weight gain in teens include:

• Consuming sugary, high-fat, and refined foods (including fast food )
• A lack of physical activity
• Sedentary activities such as watching television or playing video games
• Low self-esteem
• Family and peer problems
• Family history of obesity

In fact, about 87% of high school students do not eat the recommended five servings of fruits and vegetables a day, while more than 25% eat more than two servings of high-fat products a day. According to the CDC, around 33% of high school students do not get enough exercise and only 36% percent are enrolled in daily physical education programs.

Weight issues during the teenage years can be complicated to approach. Most teens go through growth spurts during these years, and teens often gain weight before they grow taller. Many teens feel uncomfortable in their new bodies and can be sensitive to discussions about weight.

If you are concerned that your teen is gaining too much weight, use the CDC's BMI Calculator for Child and Teen or ask for an assessment at your child's next physical. A BMI percentile of 85% is considered overweight, while 95% is obese.

The treatment of obesity involves weight loss and lifestyle changes, including an improved diet and routine exercise. It can help to see a nutritionist to develop a balanced eating plan. Healthy eating as a family can help support your teen without causing them to feel singled out.

A Word From Verywell

The teen years can be a challenge for many parents. As children grow more independent and form new friendships, it becomes more difficult to monitor their behavior than when they were younger.

At the same time, teens need guidance navigating peer pressure and making smart choices, so it is essential to keep the lines of communication open. Many parents find having these talks with their teens is more productive when the conversation flows naturally while doing something else, like playing a board game, taking a walk, or driving in the car.

Arming yourself with facts in advance can help facilitate a productive discussion. At the end of the day, the most important thing is for teens to know they are loved and that they always have someone to come to with their problems.

Centers for Disease Control and Prevention. Teen drivers: get the facts .

Curtin SC, Heron M. Death rates due to suicide and homicide among persons aged 10–24: United States, 2000–2017 . NCHS Data Brief . 2019;(352):1-8.

Cunningham RM, Walton MA, Carter PM. The major causes of death in children and adolescents in the United States . N Engl J Med . 2018;379(25):2468-2475. doi:10.1056/NEJMsr1804754

Centers for Disease Control and Prevention. Suicide rising across the US .

University of Michigan: Michigan Medical. The facts on the U.S. children and teens killed by firearms .

Children's Hospital of Philadelphia Research Institute. Gun violence: facts and statistics .

Centers for Disease Control and Prevention. 10 Leading causes of injury deaths by age group highlighting unintentional injury deaths, United States .

American Psychology Association. Talking to your children about the recent spate of school shootings .

U.S. Department of Health and Human Services. Facts about bullying . In: StopBullying.gov.

Shannon CL, Klausner JD. The growing epidemic of sexually transmitted infections in adolescents: a neglected population . Curr Opin Pediatr . 2018;30(1):137-143. doi:10.1097/MOP.0000000000000578

Centers for Disease Control and Prevention. Sexual risk behaviors can lead to HIV, STDs, & teen pregnancy .

Centers for Disease Control and Prevention. About teen pregnancy .

Gentzke AS, Creamer M, Cullen KA, et al. Vital signs: tobacco product use among middle and high school students – United States, 2011–2018 . MMWR Morb Mortal Wkly Rep . 2019;68(6):157-164. doi:10.15585/mmwr.mm6806e1

U.S. Department of Health and Human Services. Adolescents and tobacco: trends .

U.S. Food and Drug Administration. Lung injuries associated with use of vaping products .

American Lung Association. Tips for talking to kids about smoking .

Centers for Disease Control and Prevention. Underage drinking .

National Institute on Alcohol Abuse and Alcoholism. Make a difference: talk to your child about alcohol - parents .

Centers for Disease Control and Prevention. Teen substance use & risks .

Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose Deaths — United States, 2013–2017 . MMWR Morb Mortal Wkly Rep . 2019;67:1419–1427. doi:10.15585/mmwr.mm675152e1

Substance Abuse and Mental Health Services Administration. Talking with your child about opioids: Keeping your kids safe .

National Institute of Mental Health. Eating disorders .

Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015–2016 . NCHS Data Brief . 2017;(288):1-8.

U.S. Centers for Disease Control and Prevention. Childhood obesity causes & consequences .

American Academy of Child and Adolescent Psychiatry. Obesity in children and teens .

Moore LV, Thompson FE, Demissie Z. Percentage of youth meeting federal fruit and vegetable intake recommendations, youth risk behavior surveillance system, United States and 33 States, 2013 . J Acad Nutr Diet . 2017;117(4):545-553.e3. doi:10.1016/j.jand.2016.10.012

Centers for Disease Control and Prevention.  Adolescent health .

By Amy Morin, LCSW Amy Morin, LCSW, is a psychotherapist, author of the bestselling book "13 Things Mentally Strong People Don't Do," and a highly sought-after speaker.

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10 Social Issues and Problems That Trouble Today's Teens

Technology and social media can amplify the struggles teens face, but they aren't the only issues they encounter.

Social Media

Peer pressure, on-screen violence, sexual activity, alcohol use, academic problems, how to talk to your teen.

Just like adults, teens nowadays often face social problems. They may also be more susceptible to challenges because their brains are still developing and their bodies are changing quickly. Combine that with advances in technology, and today's teens are facing new and different social issues than their parents may have.

Not only has electronic media amplified some teenage troubles, but digital communication and social media have also changed the way teens interact with their peers and romantic interests. The end result is a group of young people who struggle with essential interpersonal communication skills like picking up on social cues.

Some of this dysfunction can be linked to technology—especially since the average teen spends more than eight hours each day using electronic devices.  That said, not all teen social issues are linked to the digital world. Teens also are at a higher risk for overdose, might not practice safe sex, and are facing increasing academic pressures.

Here's a closer look at the top 10 social issues teens nowadays struggle with.

Brianna Gilmartin 

Instagram, Twitter, and SnapChat  can be great ways for teens to connect, but social media can be problematic for several reasons. It can expose your teen to cyberbullying, slut-shaming, and so much more.  

Social media can hurt friendships, and it's changing the way teens date. Research shows it can impact their mental health.  And no matter what precautions you take, teens are likely to be exposed to unsavory people, unhealthy images, and sexual content online.

Help your teen learn to navigate social media in a healthy way by following these tips:

• Talk about ways to stay safe online.
• Ask what your teen is doing on social media.
• Educate yourself about the latest apps, websites, and social media pages teens are using.
• Consider  limiting your teen's screen time .

While peer pressure has affected teens for generations, social media brings it to a whole new level. Sexting, for example, is a major cause for concern. Many teens don't understand the lifelong consequences that sharing explicit photos can have. 

But sending inappropriate photos isn't the only thing kids are coerced into doing. Teens face pressure to have sex, use drugs or alcohol, and even bully others.  

To keep your kids from falling victim to peer pressure, consider these tips:

• Give them skills to make healthy choices and resist peer pressure.
• Talk to teens about what to do if they make a mistake.
• Let them know it's safe to come to you when they have problems or make poor choices.
• Demonstrate that you can listen without judging or overreacting.
• Help them find healthy ways to make amends and move on if they peer pressure others.

Teenagers are going to witness some violent media at one time or another. And it's not just TV, music, and movies that depict violence. Many of today's video games portray gory scenes and disturbing acts of aggression. Over the past couple of decades, studies have linked these violent images to a lack of empathy and aggressive behavior .

Other studies have shown the top factor in determining the way kids relate to media is how their parents think and act.  That means the more violence parents watch, the more likely their kids will think it's OK.  

To help limit exposure to on-screen violence, pay attention to your teen's media use and consider implementing these guidelines:

• Restrict or limit your teen from watching R-rated movies or playing M-rated video games. Consuming that material excessively (and unsupervised) is not healthy. 
• Talk about the dangers of being exposed to violent images and monitor your teen's mental state.
• Discuss sexual situations and racial stereotypes that your teen might see.
• Help them identify what's good and what's bad about the media.
• Boost their media literacy by helping them think objectively about what they're seeing on television, TikTok, in the movie theater, or in a video game.

According to the National Institute of Mental Health (NIMH), an estimated 5 million adolescents in the U.S. have had at least one major depressive episode . That means 20% of American teenagers may experience depression before reaching adulthood. Data from NIMH also shows that depression is much more prevalent in female teens (29.2%) than male teens (11.5%) and among teens who reported two or more races (27.2%).

Spending too much time on electronic devices may be preventing young people from in-person activities with their peers, such as sports or other physical activities, that can help ward off depression.  They're also experiencing new conditions like "fear of missing out" or FOMO, which further leads to feelings of loneliness and isolation.

Keep in mind that depressive disorders are treatable, but it's important to seek professional help. Here's how to navigate this situation:

• Schedule an appointment to a health care provider or contact a mental health professional if your teen seems withdrawn, experiences a change in sleep patterns, or starts to perform poorly in school.
• Consider online therapy as an option if your teen is reluctant to meet with a therapist in person.
• Be willing to discuss what they're thinking or feeling, including their thoughts of suicide. Having these conversations can reduce their fears and let them know someone is willing to listen, but it also needs to be handled thoughtfully.
• Call the  National Suicide Prevention Lifeline  at  988  or  911 if they are in immediate danger.

Nearly one in four teens between the ages of 12 and 18 report being bullied each year.  Research suggests that social media has made bullying much more public and more pervasive. In fact, cyberbullying has replaced in-person bullying as the most common type of harassment that teens experience.

To help guard against these kinds of teenage troubles, regularly talk to your teen about bullying and consider utilizing these tips to help:

• Discuss what they can do when they witness bullying.
• Talk about options if they become a target themselves.
• Recognize that being proactive is key to helping your child deal with a bully.
• Talk to your child about when and how to get help from a trusted adult.
• Acknowledge that talking about how someone has humiliated them is never an easy topic.
• Remind them that asking for help isn't a sign of weakness; it's a show of courage.

According to the Youth Risk Behavior Surveillance System (YRBSS) survey, 30% of high school students reported having had sex and 21% said they were currently sexually active . That represents a decline over the past decade (47% had had sex in 2011; 34% were currently sexually active).

This decline in sexual activity doesn't necessarily mean teens nowadays are using contraceptives, though. Just over half of sexually active teens reported using a condom in their last sexual encounter, according to YRBSS data, while about one-third used hormonal birth control and 10% used both.

This may explain why more than half of the 26 million new sexually transmitted infections in the U.S. are among young people between the ages of 15 and 24. Here are some things you can do to ensure that your teen understands the risks of teen sex and how to be safe:

• Talk to your teen about sex and allow them to ask questions.
• Let them know they can come to you about anything and that no questions are off-limits.
• Do your best to not shame them or make them feel embarrassed by their inquiries.
• Instill the importance of safe sex practices—even if you don't think your child is engaging in sexual activity.
• Discuss contraception options and make sure they have access to contraception if they're sexually active.
• Give them resources to learn about safe sex.

The percentage of teens nowadays using illicit substances is roughly 10.9% of eighth graders, 19.8% of 10th graders, and 31.2% of 12th graders, according to most recent data from the Monitoring the Future Survey published by the National Institute on Drug Abuse. While this decline has been noted since the survey began in 1975, there has been a dramatic rise in overdoses among teens.

Illicit fentanyl, a powerful synthetic drug, is largely responsible for these overdoses. Drug dealers are adding it to counterfeit pills made to resemble prescription medications, which means that although teen drug use is declining, it's becoming more risky for those who do partake.

It's important to have regular conversations with your teen about the dangers of drugs. Here are some key topics you need to discuss:

• Mention the dangers of over-the-counter drugs and prescription medications. Many teens don't recognize the risks associated with taking a friend's prescription or popping a few pills.
• Tell your teen that drug use during adolescence increases their risk for developing a substance use disorder later in life.
• Address how easily addictions can happen.
• Discuss how drug and alcohol use can affect their brain development.
• Talk about the risks associated with overdosing.
• Explain the danger of illicit fentanyl contaminating counterfeit drugs.
• Recognize talks about drug use are not one-and-done conversations, but something you should be discussing on a consistent basis.

Alcohol use and binge drinking continue to decline among teenagers. Still, 15.1% of eighth graders, 30.6% of 10th graders, and 45.7% of seniors say they used alcohol in the past year. The forms of alcohol teens are using have also changed. More kids are choosing flavored alcohol (also called "alcopops") and alcohol with caffeine in it. About 36% of seniors reported drinking flavored alcohol.

It's important to talk to your teen about the risks of underage drinking. Here are some tips on how to navigate those conversations.

• Educate them about the dangers of alcohol use, including the fact that alcohol can take a serious toll on their developing brain.  
• Express your disapproval of underage drinking. Saying you don't approve can make a big difference in whether your teen decides to drink.
• Discuss the dangers of drinking and driving.
• Let them know that if they do decide to drink, they should call you or another trusted adult for a ride rather than risk getting behind the wheel.
• Assure your teen that it's safe to reach out to you if they make a mistake and need help.

About 22% of 12- to 19-year-olds in the U.S. are obese, according to Centers for Disease Control and Prevention (CDC) data. Hispanic and Black children are more likely to be overweight or obese than White or Asian children.

Children and teens who are overweight or obese are often targeted by bullies and are at a much greater risk of lifelong health problems such as diabetes , arthritis, cancer, and heart disease.  They may also struggle with body image issues or develop eating disorders as a way of changing their appearance.

But surveys show parents may not recognize when their kids are overweight.  They tend to underestimate their child's size and the risks associated with being overweight. Here are some ways you can help:

• Ask their health care provider privately about their weight in comparison to their height and age—though many health care providers will alert you to an issue without asking.
• Find ways to support and empower your teen , especially if their doctor recommends a different eating plan or exercise.
• Ensure your teen has the necessary tools to make changes, but recognize that they must want to change. You can't force the issue, nor should you try to control them,
• Avoid shaming or embarrassing your teen about their weight, but instead communicate acceptance for who they are as a person. They need to know their worth is not tied to their weight.

About 5% of high school students drop out of high school each year in the United States, according to the National Center for Education Statistics.  A high school dropout is likely to earn significantly less over their lifetime when compared to a high school graduate, which can have a significant impact on a young person's future.

But it's no longer just "troubled teens" who are dropping out of school. Some teens feel so much pressure to get into a good college that they're burning themselves out before they graduate from high school.

Here are some ways you can help your teen avoid academic problems:

• Stay involved in your teen's education.
• Provide support and guidance when needed.
• Be ready to assist your teen if they encounter problems.
• Try to remove some of the pressure they may be facing by not placing so much emphasis on grades, achievements, and college acceptances.

Bringing up any difficult subjects with your teen can feel uncomfortable. And your teen isn't likely to respond well to a lengthy lecture or too many direct questions. But having a conversation with your teen about social issues and other teenage troubles isn't something you should shy away from.

Even when it seems like they're not listening, you're the most influential person in your teen's life. It's important to lay a strong foundation before the window of opportunity closes. A good way to strike up a conversation about drugs, sex, vaping, or other uncomfortable situations is to ask a question like, "Do you think this is a big issue at your school?"

Listen to what your teen has to say. Try not to be judgmental, but make your expectations and opinions clear. It's important that your teen understands that you don't condone certain behaviors and that they know the consequences of breaking the rules. That said, you also need to communicate that if they do make a poor choice, it's not the end of the world and that you're there to help.

Technology-Based Communication and the Development of Interpersonal Competencies Within Adolescent Romantic Relationships: A Preliminary Investigation .  J Res Adolesc . 2017.

Growing Up Wired: Social Networking Sites and Adolescent Psychosocial Development .  Clin Child Fam Psychol Rev . 2014.

Associations Between Social Media and Cyberbullying: A Review of the Literature .  Mhealth . 2016.

Smartphones, Social Media Use and Youth Mental Health .  CMAJ . 2020.

Sexting, Mental Health, and Victimization Among Adolescents: A Literature Review .  Int J Environ Res Public Health . 2019.

Emotional Desensitization to Violence Contributes to Adolescents' Violent Behavior .  J Abnorm Child Psychol . 2016.

Screen Violence and Youth Behavior .  Pediatrics . 2017.

Tips on How to Deal With Media Violence . Common Sense Media.

Major Depression . National Institute on Mental Health.

Physical Exercise in Major Depression: Reducing the Mortality Gap While Improving Clinical Outcomes .  Front Psychiatry . 2018.

The Myths & Facts of Youth Suicide . Nevada Division of Public and Behavioral Health (DPBH) Office of Suicide Prevention .

Bullying Statistics: Rates of Incidence . National Bullying Prevention Center .

Cyberbullying Prevalence Among US Middle and High School-Aged Adolescents: A Systematic Review and Quality Assessment .  J Adolesc Health . 2016.

Youth Risk Behavior Survey Data Summary & Trends Report 2011–2021 . Centers for Disease Control and Prevention.

Sexually Transmitted Diseases: Adolescents and Young Adults . Centers for Disease Control and Prevention .

Monitoring the Future: National Survey Results on Drug Use, 1975-2023: Secondary School Students . National Institute on Drug Abuse.

Reported Drug Use Among Adolescents Continued to Hold Below Pre-Pandemic Levels in 2023 . National Institute on Drug Abuse.

The Effect of Alcohol Use on Human Adolescent Brain Structures and Systems .  Handb Clin Neurol . 2014.

Prevalence of Childhood Obesity in the United States . Centers for Disease Control and Prevention.  

Morbidity and Mortality associated With Obesity .  Ann Transl Med . 2017.

BMI Health Report Cards: Parents' perceptions and reactions .  Health Promot Pract . 2018.

Status Dropout Rates . National Center for Education Statistics. 

Burned Out to Drop Out: Exploring the Relationship Between School Burnout and School Dropout .  Eur J Psychol Educ . 2012.

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Health behaviours & problems among young people in India: Cause for concern & call for action

Singh sunitha.

Department of Epidemiology, Centre for Public Health, WHO Collaborating Centre for Injury Prevention & Safety Promotion, National Institute of Mental Health & Neuro Sciences, Bangalore, India

Gopalkrishna Gururaj

The young people in the age group of 10-24 yr in India constitutes one of the precious resources of India characterized by growth and development and is a phase of vulnerability often influenced by several intrinsic and extrinsic factors that affect their health and safety. Nearly 10-30 per cent of young people suffer from health impacting behaviours and conditions that need urgent attention of policy makers and public health professionals. Nutritional disorders (both malnutrition and over-nutrition), tobacco use, harmful alcohol use, other substance use, high risk sexual behaviours, stress, common mental disorders, and injuries (road traffic injuries, suicides, violence of different types) specifically affect this population and have long lasting impact. Multiple behaviours and conditions often coexist in the same individual adding a cumulative risk for their poor health. Many of these being precursors and determinants of non communicable diseases (NCDs) including mental and neurological disorders and injuries place a heavy burden on Indian society in terms of mortality, morbidity, disability and socio-economic losses. Many health policies and programmes have focused on prioritized individual health problems and integrated (both vertical and horizontal) coordinated approaches are found lacking. Healthy life-style and health promotion policies and programmes that are central for health of youth, driven by robust population-based studies are required in India which will also address the growing tide of NCDs and injuries.

Introduction

Young people form precious human resources in every country. However, there is considerable ambiguity in the definition of young people and terms like young, adolescents, adults, young adults are often used interchangeably. World Health Organization (WHO) defines ‘adolescence’ as age spanning 10 to 19 yr, “youth” as those in 15-24 yr age group and these two overlapping age groups as “young people” covering the age group of 10-24 yr 1 . Adults include a broader age range and all those in 20 to 64 yr 2 . Adolescence is further divided into early adolescence (11-14 yr), middle adolescence (15-17 yr), and late adolescence (18-21 yr) 3 . Individuals in the age group of 20 - 24 yr are also referred to as young adults 4 . The National Youth Policy of India (2003) defines the youth population as those in the age group of 15-35 yr 5 .

Population aged 10-24 years accounts for 373 million (30.9%) of the 1,210 million of India's population with every third person belonging to this age group. Among them, 110 and 273 million live in urban and rural India, respectively. Males account for 195 million and females 178 million, respectively 6 . As per the National Sample Survey (NSS), (2007-08) 32.8 per cent of this group attend educational institutions and 46 per cent (2004-05) are employed 7 .

What characterizes adolescents and youth?

Youth - the critical phase of life, is a period of major physical, physiological, psychological, and behavioural changes with changing patterns of social interactions and relationships. Youth is the window of opportunity that sets the stage for a healthy and productive adulthood and to reduce the likelihood of health problems in later years. A myriad of biological changes occur during puberty including increase in height and weight, completion of skeletal growth accompanied by an increase in skeletal mass, sexual maturation and changes in body composition. The succession of these events during puberty is generally consistent among the adolescents often influenced by age of onset, gender, duration, along with the individual variations. These changes are also accompanied by significant stress on young people and those around them, while influencing and affecting their relationships with their peers and adults. It is also an age of impulsivity accompanied by vulnerability, influenced by peer groups and media that result in changes in perception and practice, and characterized by decision making skills/abilities along with acquisition of new emotional, cognitive and social skills 3 .

Young people's health is vital and crucial

Most young people are presumed to be healthy but, as per WHO, an estimated 2.6 million young people aged 10 to 24 yr die each year and a much greater number of young people suffer from illnesses ‘behaviours’ which hinder their ability to grow and develop to their full potential. Nearly two-thirds of premature deaths and one-third of the total disease burden in adults are associated with conditions or behaviours initiated in their youth ( e.g . tobacco use, physical inactivity, high risk sexual behaviours, injury and violence and others) 8 . The behavioural patterns established during this developmental phase determine their current health status and the risk for developing some chronic diseases in later years 9 . A significant reduction in the mortality and morbidity of communicable, maternal and neonatal disorders since 1990 due to concerted and integrated efforts 10 , 11 led to a shift in focus towards the health, safety and survival of the young people. It is crucial to understand health problems of this population, processes and mechanisms that affect their health, identify interventions and strategic approaches that protect their health and develop and implement policies and programmes.

The present review focuses on the health behaviours and problems affecting young people in the age group of 10-30 yr in India. The review also examines some policy initiatives and interventions and identifies issues that need to be addressed for health and safety of young people in India.

Review methods

All available population based studies (with large sample size, being multicentric in nature, covering urban and rural areas), independent studies and reports published since 2001 were considered. Searches were conducted using PubMed, Medline, Ovid, Karger, ProQuest, Sage Journals, Science Direct, Springer, Taylor & Francis and Wiley Online Library. Various search terms and key words were used, including young, youth, adolescent, young adult and outcomes of interest namely undernutrition, obesity, overweight, common mental health problems, stress, depression, suicide, alcohol, tobacco use, substance use, violence and road traffic injury. All efforts were made to retrieve the unpublished reports by contacting individual researchers. Case reports and case series were excluded from the search.

From a methodological perspective, majority of the studies were cross-sectional in nature, on varying sample size and undertaken in urban and rural (or both) areas. As there are no comprehensive studies that have focussed on all health problems of this age group, studies have been individualistic in nature based on researchers’ and/or organisational interest. Further, definitions used for age cut-offs and condition under investigation, screening and diagnostic assessments, nature of study, reporting bias, statistical methods add to the complexities of the problem and thus, studies are non-comparable in nature.

Health problems of young people

Although adolescence and young adulthood are generally considered healthy times of life, several important public health and social behaviours and problems either start or peak during these years 12 . Most of these problems are linked with social determinants and lifestyles operating and interacting in complex environments that precipitate or trigger these conditions or behaviours. Developmental transition of young people make them vulnerable particularly to environmental, contextual or surrounding influences 13 . Environmental factors, including family, peer group, school, neighbourhood, policies, and societal cues, can both support or challenge young people's health and well-being 12 .

Available evidence indicates that young people are prone to a number of health impacting conditions due to personal choices, environmental influences and lifestyle changes including both communicable and non-communicable disorders and injuries. Others include substance use disorders (tobacco, alcohol and others), road traffic injuries (RTIs), suicides (completed and attempted), sexually transmitted infections (STI) including human immunodeficiency virus (HIV) infection, teen and unplanned pregnancies, homelessness, violence and several others. In all countries, whether developing, transitional or developed, disabilities and acute and chronic illnesses are often induced or compounded by economic hardship, unemployment, sanctions, restrictions, poverty or poorly distributed wealth at both individual and country level 14 .

Undernutrition and micronutrient deficiencies

Data shown in Table I indicate a high prevalence of undernutrition and stunting in the age group of 10-30 yr that has an adverse bearing on their health. Data from Nutrition Survey of National Institute of Nutrition during 2001 and 2006 showed that more than half the population aged 10-18 yr was undernourished 15 , 16 . This observation is also supported by other studies with sample size varying from 500 to 1000 with the prevalence of undernutrition in 10 to 24 yr ranging from 56.4 to 68.5 per cent 17 , 18 , 19 . A school based study showed that 38.8 per cent of boys and 36.9 per cent of girls were stunted 20 , while a community based study showed that 51.7 per cent adolescents were stunted 18 . The prevalence of micronutrient deficiencies in rural area was as high as 25 per cent as reported by Choudhary et al 19 with high prevalence of anaemia, more among girls, ranging from 30-82 per cent 17 , 18 , 21 . Anaemic adolescent mothers are at a high risk of miscarriage, maternal mortality and still births; also, low birth weight babies with low iron reserves 24 . Poor nutritional status of adolescents is an outcome of socio-cultural, economic and public policies relating to household food security compounded by behavioural dimensions.

Status of undernutrition and micronutrient deficiency in India

Overweight and obesity

Conversely, overweight and obesity - another form of malnutrition with serious health consequences is increasing among other young people in India and other Low Middle Income Countries (LMICs) 8 . A meta-analysis of nine studies in 2012 showed 12.6 per cent of children to be overweight and 3.3 per cent to be obese indicating the seriousness of the situation 23 . A review of a few select studies ( Table II ) during 2001 to 2012 showed a prevalence of overweight among children aged 10-19 yr to be 9.9 to 19.9 per cent; high in both boys (3 to 15.1%) and girls (5.3 to 13.3%) indicating early onset of obesity 26 , 27 , 28 , 29 , 30 , 31 , 33 affecting more of urban school adolescents (3.4 to 6.5%) 26 , 27 , 28 , 32 as compared to 0.6 per cent among the rural adolescents 15 with significant gender variations 26 , 29 , 32 . Studies from Karnataka 27 , 32 have shown a higher prevalence of obesity as compared to studies from northern India 26 , 28 , 30 . It is clear that India is facing the dual burden of undernutrition and overnutrition as also seen from other reports 34 , 35 . There is also a challenge of nutritional transition as Indians are moving away from traditional diets high in cereal and fiber to more western pattern diets high in sugars, fat, and animal-source food (fast food culture) that are closely associated with different non communicable diseases (NCDs) seen in later years 36 , 37 .

Prevalence of overweight and obesity as reported in Indian studies

High risk sexual behaviour

High-risk sexual behaviour is a broad term covering early sexual activity especially before 18 years of age and includes unprotected intercourse without male or female condom use except in a long-term, single-partner (monogamous) relationship, unprotected mouth-to-genital contact except in a long-term monogamous relationship, having multiple sex partners, having a high-risk partner (one who has multiple sex partners or other risk factors), exchange of sex (sex work) for drugs or money, having anal sex or having a partner who does except in a long-term, single-partner (monogamous) relationship and having sex with a partner who injects or has ever injected drugs 38 . It is a known risk factor that puts individuals at risk for contracting HIV/AIDS and a range of other sexually transmitted diseases like gonorrhoea, herpes, genital warts, Chlamydia, syphilis, trichomoniasis, etc . The National Family Health Survey (NFHS) 3 (2005-06) indicated that 4 per cent of young women and 15 per cent of young men had ever experienced sex before marriage and only 14.1 per cent (14.7% urban vs 13.9% rural) of unmarried sexually active adolescent females used a contraceptive 39 . Young people aged 15 to 24 yr commonly engage in premarital sex more so in men (15-22%) as compared to women (1-6%) 39 , 40 , 41 , 42 , 43 . Kumar et al 40 in a study of 2,475 never married boys and girls noticed that only 22.3 per cent males and 6.3 per cent females reported consistent condom use for premarital sex in the last 6 months. A study from Gujarat observed that nearly 40 per cent males and 7.4 per cent females in the age group of 15 to 24 yr reported having multiple-partner sex, while 32.1 per cent males and 3.2 per cent females reported having paid/exchange (money/gift) sex 44 . Thus, data shown in Table III indicate that prevalence of high risk sexual behaviour among the young people is not only high but vary widely across studies and needs immediate attention to reduce the occurrence of HIV and related diseases.

Prevalence of high risk sexual behaviour among young Indians

Common mental disorders

At least 20 per cent of young people are likely to experience some form of mental illness - such as depression, mood disturbances, substance abuse, suicidal behaviours, eating disorders and others 8 . A meta-analysis of five psychiatric epidemiological studies yielded an estimated prevalence of mental morbidity including 16 mental and behavioural disorders (classified into eight groups of organic psychosis, schizophrenia, manic affective psychosis, manic depression, endogenous depression, mental retardation, epilepsy, phobia, generalized anxiety, neurotic depression, obsession and compulsion, hysteria, alcohol/drug addiction, somatisation, personality disorders and behavioural/emotional disorders) of 22.2 per 1000 population among 15 to 24 years 47 .

Data available from community based studies on common mental disorders in India depict a high prevalence among the young people ( Table IV ), but comparisons and extrapolations need to be cautiously made due to variations across studies. The prevalence of overall psychiatry morbidity (depression, conduct disorder, social anxiety, panic disorder) among adolescents has varied from 12 to 16.5 per cent 48 , 49 . Pillai et al observed a low prevalence of 1.8 per cent of DSM-IV disorders among adolescents aged 12-16 yr which was attributed to methodological factors and the presence of protective factors 50 . A six years follow up study in Chandigarh showed the incidence rate of psychiatric disorder to be 0.18 per cent per year among the 10-17 yr old adolescents 51 . Among the few specific common mental disorders, the prevalence of depression has varied from 0.1 to 18.5 per cent 48 , 49 , 52 , 53 , 54 , 55 , conduct disorders from 0.2 to 9.2 per cent 48 , 49 , 53 , and anxiety from 0.1 to 24.4 per cent 48 , 49 , 50 , 53 , 55 , 56 across different studies. Two studies showed prevalence of severe and extreme grade of depression in 11.2 per cent of the school dropouts and 3 per cent among the school going adolescents aged 13 to 19 yr and 18.4 per cent among the 9 th standard students using Beck's depression Inventory 52 , 54 . Promoting mental health and responding to problems on a continuous basis requires a range of adolescent-friendly health care and counselling services in communities 57 .

Common mental disorders among young Indians

Stress is a consequence of or a general response to an action or situation arising from an interaction of the person with his environment and places special physical or psychological demands, or both, on a person. The physical or psychological demands from the environment that cause stress, commonly known as stressors and the individual reaction to them take various forms and depends on several intrinsic and/or extrinsic factors. Significant difficulties have been experienced in quantifying and qualifying stress. Some studies have tried to quantify the stress levels among young people, while others have given a mean stress score (influenced by methods of measuring stress) 58 , 59 . Sahoo et al 55 using Depression Anxiety Stress Scale (DASS) observed that 20 per cent young adults experienced stress. Dabut et al 60 using life stress scale found that among adolescent girls studying in 12 th standard from Hisar and Hyderabad, 47.5 and 72.5 per cent, were in the moderate category of family stress; financial stress was reported by 60 and 50 per cent and, 90 and 85 per cent had moderate level of social stress, respectively. Sharma & Sidhu in a study, among adolescents aged 16-19 yr using self-made questionnaire based on Bisht Battery of Stress found that 90.6 per cent adolescents had academic stress 61 .

According to the World Health Organization (WHO) estimates about one million people commit suicide each year 62 . In India, nearly 1,36,000 persons voluntarily ended their lives in a suicidal act as per official reports in 2011 63 . The official report indicates that age specific suicide rate among 15-29 yr is on the rise increasing from 3.73 to 3.96 per 1,00,000 population per year from 2002 to 2011 63 ( Fig. 1 ). About 40 per cent of suicides in India are committed by persons below the age of 30 yr 64 . The Million Death Study using RHIME (Representative, Re-sampled, Routine Household Interview of Mortality with Medical Evaluation) method revealed the annual mortality rates to be 25.5 and 24.9 per 1,00,000 population among males and females aged 15-29 yr 65 , respectively. Other studies have shown incidence among young individuals to vary from 100.1 to 72.2 per 1,00,000 population 66 . Study from Bangalore showed that of the 5115 attempted suicide covering all age groups, 2.1, 8.4 and 28.6 per cent individuals were in the age group 10-15, 16-20 and 21-25 yr, respectively; and among 912 completed suicides, 2.2, 16.2 and 21.6 per cent were in the age group 10-15, 16-20 and 21-25 years, respectively 67 . The suicide rates among young females were high (152 per 1,00,000) compared to suicide rates among young men being 69 per 1,00,000 as reported by Aaron et al 66 with similar observations by other authors 65 , 68 . Soman et al 69 found an age specific suicide incidence rates among males and females aged 15-24 yr to be 5.1 and 8.1 per 1,00,000 population per year 69 . Suicidal ideas and attempts were also found to be high in Chandigarh 70 and South Delhi 71 with nearly 6 per cent of individuals aged 11-17 yr and 15.8 per cent adolescents aged 14 to 19 yr reporting suicidal ideas, while 0.4 per cent students aged 11-17 yr and 5.1 per cent students aged 14 to 19 yr reported suicidal attempts.

Completed suicide among 15-29 yr per 100,000 population from 2002 to 2011 (rate/1,00,000 population). Source : Ref. 63 .

Tobacco use

The vast majority of tobacco users worldwide begin the use of tobacco during adolescence. Currently, more than 150 million adolescents use tobacco, and this number is increasing globally 57 . NFHS-3 revealed that 40 per cent of males and 5 per cent of females aged 15 to 24 yr consumed tobacco nationwide 21 . Systematic review of 15 studies across India aged 13-15 yr showed a median prevalence of tobacco use (ever users) to be 18.2 per cent; 14 per cent among males and 6.3 per cent among females 72 . Global Youth Tobacco Survey (GYTS) 2006 and 2009 across India covering 13 to 15 yr old adolescents in 180 schools highlighted an increase in the current users of any form of tobacco from 13.7 to 14.6 per cent and current users of cigarette from 3.8 to 4.4 per cent from 2006 to 2009 73 . A study from Karnataka showed 4.9 per cent point prevalence and 5.1 per cent life-time prevalence of tobacco use among adolescents aged 13-15 yr 74 , while a study from Noida city indicated that 11.2 per cent of adolescents aged 11 to 19 yr were users of any kind of tobacco 75 . Other studies have shown 9.8 to 20.3 per cent life time prevalence of any tobacco products among adolescents 76 , 77 . Gender variations for usage of any kind of tobacco varied from 2.9 to 8.5 per cent in boys and 1.5 to 9.8 per cent in girls 78 . The study in Noida city also found that 8.8 per cent of adolescents aged 11 to 19 yr were ‘ever smokers’ (including current smokers), 4.6 per cent were ‘ever tobacco chewers (including current chewers), 3.7 per cent were ‘exclusive smokers’ and 2.5 per cent were ‘exclusive tobacco chewers’ 75 . Data from several studies ( Table V ) clearly point to the fact that tobacco addiction is emerging as a big threat among young Indians.

Prevalence of tobacco use in young people

Harmful alcohol use

Harmful drinking among young people is an increasing concern in many countries and is linked to nearly 60 health conditions. It increases risky behaviours and is linked to injuries and violence resulting in premature deaths 57 . A national review on harmful effects of alcohol reported greater social acceptability of drinking, increasing consumption in rural and transitional areas, younger age of initiating drinking, and phenomenal socio-economic and health impact, more so among young people 81 . Data from the National Household Survey (NHS) by United Nations Office on Drugs and Crime (UNODC), 2002 covering urban and rural areas of 24 States of India revealed a prevalence of 21.4 per cent of alcohol use among men aged 12 to 18 yr 82 . The World Health Survey - India reported that among individuals aged 18 to 24 yr, 3.9 per cent were infrequent heavy drinkers and 0.6 per cent were frequent heavy drinkers 83 . The NFHS-3 survey showed that 1 per cent women and 11 per cent men aged 15-19 yr and 1.4 per cent women and 28.8 per cent men aged 20-24 yr consumed alcohol 21 . Other population based studies have shown the prevalence of alcohol consumption varying from 1.3 to 15.6 per cent across studies 84 , 85 , 86 , 87 with a high consumption among males (12.6 to 20.7%) 88 , 89 and more in urban (5.2%) as compared to rural (7.3%) areas 90 ( Table VI ).

Alcohol use prevalence and patterns among young adults

Other substance use disorders

Substance abuse apart from tobacco and alcohol is one of the major emerging problems among the young population and needs to be tackled effectively. The National Household Survey by UNODC showed that 3.0 per cent of males consumed cannabis and 0.1 per cent opiates 82 with common substances used being alcohol, tobacco, cannabis, cocaine and heroin 84 , 86 , 88 , 89 , 90 , 91 , 92 , 93 . Studies have shown that non tobacco substance abuse is common, nearly 30 per cent, among street children 92 with 57.4 per cent of the male street children aged 6 to 16 years having indulged before coming to the observation home 88 . Around 43 per cent adolescents indulge in substances abuse 93 with 58.7 per cent of the students having used one or more substances at least once in life, while 31.3 per cent regularly use one or more substances 94 . Chaturvedi et al reported that among 10-29 yr old individuals, apart from tobacco and alcohol use, 2.2 per cent of men and 0.3 per cent of women were opium users 84 . The use of prescription drugs (benzodiazepines and opiods) has also been a matter of great concern with its overuse being 16.2 per cent 91 . Data on prevalence of injecting drug users available in India, showed that 5.6 and 14.4 per cent of the males in the age group of 20-24 yr and 25-29 yr, respectively were injecting drug users 95 . The data from the National Health Survey suggested that about 0.1 per cent of the male population (12-60 yr) reported ever injecting any illicit drug. Injecting drug use was reported more often from the NE region of the country 82 .

Non-communicable diseases (NCDs)

NCDs include a number of conditions that are behaviour linked and lifestyle related in nature. Indian population, especially young people, is passing through a nutritional transition and is expected to witness higher prevalence of adult non-communicable diseases such as hypertension, diabetes and chronic lung diseases in the coming years.

At the Indian level, a few studies have shown hypertension among the young people to vary from 2.4 to 5.9 per cent comparable to global level (4.5%) 96 , 97 , 98 , 99 . In another Indian study, hypertension (first instance) was seen in 10.10 per cent of normal weight, 17.34 per cent of overweight and 18.32 per cent of obese children 100 . The prevalence of youth-onset type 2 diabetes is increasing worldwide in parallel with the obesity epidemic. Study from Chennai reported a temporal shift in the age at diagnosis of type 2 diabetes to a younger group with a prevalence of 3.7 per cent among 20-29 yr 101 . A study from Delhi also reported a high prevalence of insulin resistance in post pubertal children which was associated with excess body fat and abdominal adiposity 102 . Chronic lung diseases are also increasing among the young and globally, approximately one in ten young people have asthma 99 . A study among the school going children (5-15 yr) using modified ISAAC questionnaire in Jaipur city showed 7.59 per cent children to have asthma (in last 12 months) 103 and 4.9 per cent in another study in South India 104 .

Road traffic injuries (RTIs)

Road traffic injuries (1,85,000 deaths; 29 per cent of all unintentional injury deaths) are the leading cause of unintentional injury mortality in India 105 . National Crime Records Bureau (NCRB) report of 2011 of India showed that 31.3 per cent of the road traffic deaths were seen among 15 to 29 years individuals 63 ( Fig. 2 ). Transport Research Wing of the Ministry of Road Transport & Highways (MORTH) revealed that of the total road accident casualties, 30.3 per cent were in the age group of 15-24 yr 106 . The Registrar General of India (in 2001-03) showed that motor vehicle injuries contributed to 3.7 per cent of deaths in 5-14 years and 6.9 per cent deaths in 15-24 years (1.7 and 12.4% in females and males, respectively) 107 . A survey of 20,000 households covering 96,414 individuals in Bangalore found that deaths due to RTIs among children aged 6-15 yr ranged from 5 to 20 per cent and serious injuries from 10-21 per cent and over half of all killed and seriously injured in RTIs occurred to the young adults aged 16-45 yr, more so among those aged 16-30 yr 108 . The Bangalore Injury Surveillance Project has reported that 38.9 and 36 per cent in 15-29 yr age group had fatal RTI in urban and rural areas, respectively, while 36 per cent had non-fatal RTI in both areas among the same age group 109 . Sharma et al from Chandigarh 110 reported that RTI constituted 11 per cent of the total unnatural deaths among 16-20 yr age group. The incidence of non fatal RTIs among children examined in a few studies revealed that the age-sex adjusted incidence rate among 5-14 yr age group was 18.5 per cent and the age-sex-adjusted annual rate of RTI requiring recovery period of >7 days was 5.8 per cent 111 . The same authors reported an annual non-fatal RTI incidence rate adjusted for sex among 10-14, 15-19 and 20-29 yr of 23.5, 30.1 and 20.9 per 100 persons per year, respectively 112 .

Trend of road traffic injuries among 15-29 yr old individuals from 2002 to 2011 in India. Source : Ref. 63 .

The WHO defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal development or deprivation” 113 . Interpersonal violence among youth ranging from minor acts of bullying to severe forms of homicide contribute greatly to the burden of premature death, injury and disability; harming not just the affected but also their families, friends and communities. An average of 565 adolescents and young adults between the ages of 10 and 29 yr die each day as a result of interpersonal violence across the world 114 . NFHS-3 from India revealed that 27 per cent married young females experienced physical, sexual, or emotional violence by their spouse and 7 per cent of all females and 11 per cent of married females experienced sexual violence 21 . Studies from India ( Table VII ) reported that 19 to 42.8 per cent of adolescent females had experienced domestic violence 115 , 116 and 25.3 and 32.2 per cent of young married women experienced physical and sexual violence within marriage, respectively 117 . Deb et al 118 in a sample of students aged 14 to 19 yr showed that 20.9, 21.9 and 18.1 per cent of the children experienced psychological, physical and sexual violence, respectively. Sharma et al 121 showed that 13.5 per cent adolescents aged 14 to 19 yr had threatened or injured someone with a weapon in the past 12 months; 49.1 per cent boys and 39.6 per cent girls reported being involved in a physical fight in the past 12 months. Both the genders were commonly involved in inter-personal violence as shown by Baruah and Baruah 119 where 42 per cent males and 49.6 per cent female aged 15-29 yr had indulged in interpersonal violence and 48 per cent males and 60.4 per cent females had indulged in self inflicted violence.

Prevalence and pattern of violence among young people

Multiple health behaviours and co-morbid conditions

It is important to highlight that some behaviours and conditions listed above and several others not covered here do not occur in isolation but are often seen as coexisting behaviours and as co-morbid conditions. It is widely acknowledged that tobacco and alcohol use coexists, while binge drinking is closely linked to road crashes and violence. Alcohol is linked to more than 60 health problems and a variety of social issues ranging from domestic violence to diabetes. Similarly, depression and obesity are closely linked to a number of NCDs and depression in particular with suicides. The Health Behaviour Study in Bangalore covering nearly 10,000 individuals aged 18 to 45 yr from urban, rural, slum and transitional areas reported that 30 per cent had more than five behaviours/conditions existing in the same individual 122 . Evidence from National Household Survey showed that over 26 per cent adult men found to be alcohol users also had higher prevalence of STIs 123 . Thus, it becomes apparent that while addressing one problem becomes critical, addressing multiple issues in an integrated manner becomes a need in health policies and programmes.

Responding to the challenge

The importance of investing in youth has been recognized in India's Constitution. One of the Directive Principles of State Policy, states that “…it is imperative that children are given opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity and that childhood and youth are protected against exploitation and against moral and material abandonment” 124 . Policies and programmes focussing on education [National policy on education (1986 modified in 1992) 125 , Sarva Shiksha Abhiyan 126 , Rashtriya Madhyamik Shiksha Abhiyan ] 127 , welfare [National Policy for the Empowerment of Women (2001) 128 ; Balika Samridhi Yojana , 1997 129 ; National Policy on Child Labour, 1987] 130 , employment ( Swarnjayanti Gram Swarozgar Yojana ) 131 and others (National Policy for Persons with Disabilities) 132 have included young people and highlight health as one of the components. In many of these, the detailed implementation – monitoring and evaluation plan are not elaborated in detail and their impact needs to be examined in detail.

Some of the health policies and programmes have also given a place for youth; a few have a specific youth health focus while others make an indirect mention. The Implementation Guide for State and District Programme Managers under National Rural Health Mission notes that “friendly services are to be made available for all adolescents, married and unmarried, girls and boys” 133 . Some of these are also focussed on mothers and children. The National Population Policy 2000, the National Health Policy 2002 and the National AIDS Prevention and Control Policy 2002 have all articulated India's commitment to promoting and protecting the health and rights of adolescents and youth, including those relating to mental, and sexual and reproductive health 134 . The Recent National Programme on Prevention and Control of Cancer, Cardiovascular Diseases, Diabetes and Stroke also has a focus on health promotion and early recognition of health impacting behaviours.

The exclusive National Youth Policy of 2003 driven by the Ministry of Youth Affairs & Sports has attempted to focus on special requirements of youth, covering 13 to 35 years, further subdivided into 13-19 years and 20-35 years. The adapted strategies include youth empowerment, gender justice, inter-sectoral approach, and an information and research network. The priority target groups under the policy include rural and tribal youth, out-of-school youth, adolescents particularly females, youth with disabilities and adolescents under special circumstances like victims of trafficking; orphans and street children 135 . A number of State-specific policies and programmes also exist that highlight State strategies for meeting the needs of youth 134 . It is also apparent that the impact of these policies on health of youth has not been evaluated for its coverage, comprehensiveness, efficacy and effectiveness.

The present review, though limited in nature highlights that a significant proportion of youth has health impacting behaviours and conditions that affect their growth and development, that the problem is on the increase, many are interlinked and coexist, and likely to increase in the coming years. Some of the major health impacting behaviours and problems among the young people include undernutrition and overnutrition, common mental disorders including stress and anxiety, suicidal tendencies and increased suicidal death rates, increased consumption of tobacco, alcohol and other substance use, NCDs, high risk sexual behaviours including STIs and importantly, injuries mainly RTIs and violence. Many of these problems are closely linked to ongoing nutrition and epidemiological transition and are behaviour related with a life course perspective. There is a strong need for public health community to identify, prepare, integrate and implement activities that help to promote health and healthy lifestyles of young people and establish mechanisms for delivery of population-based interventions along with measuring its impact. There is a need to generate good quality and robust population data that can drive policies and programmes. Strategic investments in health, nutrition, education, employment and welfare are critical for healthy growth of young people and these programmes need to be monitored and evaluated for their efficacy and effectiveness using public health approaches.

Mental Health Issues Urgent in Youth Athletes

Many young athletes need support with their mental health..

Posted June 21, 2021 | Reviewed by Lybi Ma

• Athletes can experience the same mental health disorders as non-athletes but have additional demands such as intense physical training.
• Professional athletes often have ample resources to address their mental health challenges, but youth athletes often don't.
• The American Medical Society for Sports Medicine recommends psychotherapy to athletes plagued by problematic personality traits and disorders.

Naomi Osaka’s recent statement about her reasons for exiting the French Open has thankfully prompted a more open discussion about the mental health struggles of professional athletes.

As a neuropsychologist who has worked with professional athletes for more than 20 years, I have seen firsthand the enormous stresses endured by professional athletes. Fortunately, they often have significant resources available to assist them.

There are a limited number of professional athletes, but there are millions of youth athletes in this country, many of whom are also facing mental health problems. Yet there is less focus on them and fewer resources available to youth athletes.

Youth athletes and mental health

Approximately 45 million American children participate in youth sports; children and adolescents reap enormous physical and mental benefits when they participate in sports. They have lower obesity rates, lower use of tobacco, alcohol , and illicit drugs, higher graduation rates, and overall fewer struggles with mental health than compared to their non-athlete peers.

Youth athletes who participated in team sports have an even lower rate of depression anxiety than compared individual sport athletes. Parents have reported that the mental health benefits of sports are part of the reasons for their children to play.

However, these positive attributes should not obscure the very real mental health issues faced by American children and adolescents. Approximately 25 percent of youths experience a mental health disorder in a given year, and it is a leading cause of non-fatal disease burden and disability.

But only about one-third will receive services for their illness, with only half of adolescents with “severely impairing” mental health conditions getting mental health treatment.

Researchers have noted that athletes can experience the same mental health disorders as non-athletes, such as depression, anxiety, ADHD , and eating disorders. But they have the additional stressors of demanding physical training (including overuse injuries), exposure to bullying /hazing in their sport, increased pressure to use performance-enhancing drugs, sleep deprivation, and loss of identity when not playing. Inadequate sleep is especially detrimental to the young, developing brain. Unfortunately, athletes seek mental health support at a lower rate than their non-athlete peers.

Many commentators on this topic point to the “professionalization” of youth sports and the role of parents in adding stress to their athletic children with unrealistic expectations of college scholarships or future professional league play.

Addressing mental health conditions in young athletes

All of these concerns are valid but there needs to be a systematic approach to assessing and treating these mental health conditions in youth athletes. Much of the previous research is focused on the elite athlete, rather than the significantly larger group of youth athletes.

The recent position statement on mental health issues in athletes by the American Medical Society for Sports Medicine is laudable. The statement notes that “ personality traits and disorders deemed problematic for athletes may best be addressed via psychotherapy ” and the use of cognitive-behavioral therapy was stressed as an effective treatment for anxiety, depression, sleep disorders, and other mental health conditions in the athletic population.

The authors also acknowledge the short and long-term health consequences of bullying and hazing in sports and direct the interested reader to the resources on the National Collegiate Athletic Association website. The researchers also encourage national governing bodies in youth sports to assist athletes who are retiring from sports, particularly addressing the psychological impact of retirement due to injury.

Searching for trained sports psychologists for specialized care of the athletes is another good option.

These are critical issues for youth athletes. The message needs to be amplified to all stakeholders of youth sports; athletes, parents, coaches, administrators, and officials. Parents especially need to be educated on the indications that their child may be struggling with a mental health condition.

Osaka is modeling behavior for all athletes. Youth athletes coming forward with their mental health concerns to address them positively is a win-win.

To find a therapist, please visit the Psychology Today Therapy Directory .

Elizabeth Pieroth, Psy.D. , is the director of the Concussion Program at Rush University Medical Center and Midwest Orthopedics at Rush.

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Essay on The Role of Youth Today

Students are often asked to write an essay on The Role of Youth Today in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on The Role of Youth Today

The importance of youth.

Youth is the foundation of a society. They are the future leaders, innovators, and change-makers. Their role is crucial for societal development.

Education and Youth

Education empowers the youth. It gives them the knowledge and skills to contribute positively to society.

Youth and Technology

Youth today are tech-savvy. They use technology to learn, communicate, and solve problems, which is beneficial for the modern world.

Youth and Social Change

Youth are often at the forefront of social change. They challenge old norms and fight for equality and justice.

The role of youth today is significant. They have the potential to shape a better future.

250 Words Essay on The Role of Youth Today

The catalysts of change.

Youth today are not just the leaders of tomorrow, but also the partners of today. They represent a dynamic, energetic, and innovative segment of the population. Their role in society is not confined to self-development and securing a future, but extends to shaping the present.

The Power of Innovation

The digital native generation is at the forefront of technological innovation. They are not just consumers, but creators, harnessing the power of technology to develop new solutions to old problems. From climate change to social justice, the youth are using their digital prowess to drive change.

Agents of Social Transformation

Youth today play a pivotal role in social transformation. They challenge traditional norms, advocate for equality, and strive for a more inclusive society. Their voices are loud and clear in movements against racial discrimination, gender inequality, and environmental degradation.

Driving Political Change

The role of youth in politics is increasingly significant. They are not just voters, but active participants, influencing policy and demanding accountability. The youth’s engagement in politics is redefining democracy, making it more participatory and representative.

The Challenges Ahead

However, the youth face numerous challenges, including unemployment, mental health issues, and a lack of access to quality education and healthcare. Addressing these challenges is crucial for harnessing the full potential of the youth.

In conclusion, the role of youth today is multifaceted and crucial. They are the catalysts of change, the drivers of innovation, and the agents of social and political transformation. The future lies in their hands, and it is our collective responsibility to ensure they are equipped to shape it.

500 Words Essay on The Role of Youth Today

The significance of youth in the contemporary world.

In today’s rapidly evolving society, the role of youth is more critical than ever. They are the torchbearers of change and progress, acting as catalysts in the transformation of society. They are the ones who question, challenge, and break the rigid structures of the past to pave the way for a more progressive future.

The Youth as Agents of Change

The youth of today are not just the leaders of tomorrow – they are also the leaders of today. They are at the forefront of social, political, and environmental movements, driving change in their communities and countries. From climate change activists like Greta Thunberg to social justice advocates like Malala Yousafzai, young people are making their voices heard on the global stage.

Their activism is not limited to public protests and speeches. They are leveraging technology and social media to amplify their voices, mobilize support, and effect change on a scale that was previously unimaginable. They are harnessing the power of digital platforms to challenge the status quo and push for reforms in various spheres of life.

The Youth as Innovators

In addition to being change-makers, the youth are also innovators. They are the ones pushing the boundaries of technology, science, and art, creating new possibilities for the future. They are not afraid to take risks and experiment, and this spirit of innovation is what drives societal progress.

Young entrepreneurs are disrupting traditional industries with innovative business models and technologies. They are creating jobs, driving economic growth, and contributing to societal development. Their innovations are not just about profit – they are also about solving pressing social and environmental problems.

The Youth as Builders of Peace

The youth also play a crucial role in peacebuilding. They are the ones who can bridge cultural, ethnic, and religious divides, fostering mutual understanding and respect. They can challenge divisive narratives and promote a culture of peace and tolerance.

In conflict-ridden societies, the youth can play a crucial role in reconciliation and healing. They can promote dialogue and understanding, helping to mend the social fabric and pave the way for a peaceful future.

The Challenges Facing the Youth

Despite their potential, the youth face numerous challenges. They are often marginalized and excluded from decision-making processes, their voices unheard and their needs unmet. They also face numerous socio-economic challenges, including unemployment, lack of access to quality education and healthcare, and discrimination.

These challenges are not insurmountable. With the right support and opportunities, the youth can overcome these obstacles and fulfill their potential as agents of change, innovators, and builders of peace.

In conclusion, the role of youth today is multifaceted and crucial. They are the agents of change, the innovators, and the peacebuilders. Their energy, creativity, and resilience make them a powerful force for progress. It is therefore essential that we recognize their potential, address their challenges, and provide them with the opportunities they need to thrive. After all, the future of our society depends on them.

That’s it! I hope the essay helped you.

If you’re looking for more, here are essays on other interesting topics:

• Essay on The Role of Youth in Nation Building
• Essay on Price Hike
• Essay on The Power of Words

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Children of Flint water crisis make change as young environmental and health activists

Dozens of children of the Flint water crisis -- now teenagers and young adults -- have turned their trauma into advocacy (AP video: Mike Householder)

Sima Gutierrez, right, observes as a teammate examines water at the Flint Community Water Lab, Wednesday, April 3, 2024, in Flint, Mich. The lab, with more than 60 high school and college interns, has provided free water testing for thousands of residents since 2020. (AP Photo/Carlos Osorio)

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The Flint water tower stands at the City of Flint Water Plant, Monday, March 25, 2024. (AP Photo/Carlos Osorio)

Sima Gutierrez points to discoloration of her skin due to the water crisis during an interview, Monday, March 25, 2024, in Flint, Mich. Dozens of children of the water crisis, including Gutierrez, have turned their trauma into advocacy. (AP Photo/Carlos Osorio)

Sima Gutierrez checks the clarity of a water sample at the Flint Community Water Lab, Wednesday, April 3, 2024, in Flint, Mich. The lab, with more than 60 high school and college interns, has provided free water testing for thousands of residents since 2020. (AP Photo/Carlos Osorio)

Sima Gutierrez checks the pH levels of a water sample at the Flint Community Water Lab, Wednesday, April 3, 2024, in Flint, Mich. The lab, with more than 60 high school and college interns, has provided free water testing for thousands of residents since 2020. (AP Photo/Carlos Osorio)

Sima Gutierrez shows a photo of herself with her mother, during an interview, Monday, March 25, 2024, in Flint, Mich. It was a decade ago that she complained her stomach hurt when she drank water. (AP Photo/Carlos Osorio)

Water flows at the Stepping Stone Falls, Monday, March 25, 2024, in Flint, Mich. (AP Photo/Carlos Osorio)

Dr. Mona Hanna-Attisha, a pediatrician who first flagged rising lead levels in Flint kids’ blood, is interviewed Tuesday, March 19, 2024, in Flint, Mich. “Our young people are amazing,” said Hanna-Attisha. “They are not okay with the status quo and they are demanding that we do better for them and for generations to come.” (AP Photo/Carlos Osorio)

People walk by a mural in downtown Flint, Mich., Monday, March 25, 2024. (AP Photo/Carlos Osorio)

Mari Copeny, known as Little Miss Flint, is interviewed about her involvement with Hydroviv, a water filter company, Thursday, March 18, 2024, in Flint, Mich. Copeny has partnered with the water filter company to help donate water filters to low income families across the U.S. (AP Photo/Carlos Osorio)

A Hydroviv water filter is displayed on Thursday, March 18, 2024, in Flint, Mich. Mari Copeny, known as Little Miss Flint, has partnered with the company to help donate water filters to low income families across the U.S. (AP Photo/Carlos Osorio)

Asia Donald creates a smoothie at her employment, Tuesday, March 19, 2024, in Flint, Mich. Donald remembers feeling helpless and bewildered when her little sister developed rashes and her mom boiled pot after pot of bottled water for baths when the water crisis began 10 years ago. But just a couple years later, she was part of the Flint Public Health Youth Academy, which guided kids from Newark, N.J., as they went through their own lead-in-water crisis. (AP Photo/Carlos Osorio)

Asia Donald is interviewed, Tuesday, March 19, 2024, in Flint, Mich. Donald remembers feeling helpless and bewildered when her little sister developed rashes and her mom boiled pot after pot of bottled water for baths when the water crisis began 10 years ago. But just a couple years later, she was part of the Flint Public Health Youth Academy, which guided kids from Newark, N.J., as they went through their own lead-in-water crisis. (AP Photo/Carlos Osorio)

A Flint, Mich., resident walks home after picking up food from a food bank, Tuesday, March 19, 2024, in Flint. (AP Photo/Carlos Osorio)

FLINT, Mich. (AP) — Their childhood memories are still vivid: warnings against drinking or cooking with tap water, enduring long lines for cases of water, washing from buckets filled with heated, bottled water. And for some, stomach aches, skin rashes and hair loss.

Ten years ago in Flint — April 25, 2014 — city and state environmental officials raised celebratory glasses as the mayor pressed a button to stop the flow of Lake Huron water supplied by Detroit for almost half a century. That set in motion a lead and bacteria public health crisis from which the city has not fully recovered.

But dozens of children of the water crisis — now teenagers and young adults — have turned their trauma into advocacy. They provide input on public health initiatives, participate in social issue campaigns, distribute filters and provide free water testing for homeowners.

They know that Flint is a place that still struggles. The population has fallen by some 20,000 in the past decade, leaving abandoned houses as targets for arsonists. Almost 70% of children live in poverty, and many struggle in school. Although the water has been declared safe to drink, distrust runs deep , and hundreds of lead water pipes remain in the ground because homeowners were allowed to opt out of replacing them.

But the young activists say they want to help make a difference and change how their city is perceived by outsiders. And they want to defy expectations.

“One of the biggest issues about growing up in Flint is that people had already decided and predetermined who we were,” said 22-year-old Cruz Duhart, a member of the Flint Public Health Youth Academy.

“They had ideas about our IQ, about behavioral things, but they never really stopped to speak to us and how we thought about it and the type of traumas that we were going through.”

Sima Gutierrez points to discoloration of her skin due to the water crisis during an interview, Monday, March 25, 2024, in Flint, Mich. (AP Photo/Carlos Osorio)

It’s always been easiest for 16-year-old Sima Gutierrez to express herself through art. Drawings, paintings and wire sculptures decorate her family’s tidy bungalow.

Now the self-described “very shy” teen who rarely spoke up for fear nobody wanted to hear what she had to say collects water samples in people’s homes and takes them to the Flint Community Water Lab, where more than 60 high school and college interns have provided free testing for thousands of residents since 2020.

She helped plan public awareness campaigns about topics like gun violence and how racism affects public health as a member of the Flint Public Health Youth Academy.

“I wanted to be surrounded by people who weren’t going to cover up the whole fact that people are still having problems,” said Sima. “I was able to ... share my life (with) anybody else who’s going through what I’m going through.”

It was a decade ago that she complained her stomach hurt when she drank water. Her mom insisted it would help Sima’s body flush out medication she took for an autoimmune disorder that was causing her hair to fall out in patches and leaving her skin with light splotches.

Residents had begun reporting skin rashes and complaining about discolored, smelly and foul-tasting water soon after the city began drawing from the Flint River to save money, until it could hook into a new Lake Huron pipeline. But they were assured everything was fine.

Sima said she wasn’t aware of problems until one of her elementary school classmates, Mari Copeny — then a 7-year-old beauty pageant winner known as Little Miss Flint — began protesting. Mari became the face of the crisis, and continues to highlight environmental justice issues to almost 200,000 Instagram followers and to raise money, including for water filters that she gives out in communities across the U.S.

“I want to keep on using my voice to spread awareness about the Flint water crisis because it’s not just Flint that has a water crisis,” Mari said. “America has a water crisis.”

Almost a year and a half after Flint made its switch, residents frustrated with the water quality reached out to an expert who then found high lead levels caused by the city’s failure to add chemicals that prevent pipe corrosion. State officials had said these were unnecessary. Around that same time, a pediatrician discovered that levels in kids’ blood had doubled after the switch.

Outbreaks of Legionnaire’s disease, including a dozen deaths, ultimately were also linked, in part, to the city’s water supply.

Flint reconnected to its old water line shortly afterward, but pipes continued to release lead. The state provided residents filters and bottled water.

Lead is a potent neurotoxin that can damage children’s brains and nervous systems and affect learning, behavior, hearing and speech. There is no safe childhood exposure level and problems can manifest years later.

Dr. Mona Hanna-Attisha, a pediatrician who first flagged rising lead levels in Flint kids’ blood, is interviewed Tuesday, March 19, 2024, in Flint, Mich. (AP Photo/Carlos Osorio)

Data collected over a decade now show that children in Flint have higher rates of ADHD, behavioral and mental health problems and more difficulty learning than children assessed before the water crisis, said Dr. Mona Hanna-Attisha, the pediatrician who first flagged rising lead levels in Flint kids’ blood. She said other issues, including nutrition, poverty, unemployment and systemic inequalities also could be factors.

Sima and three of her sisters were found to have elevated lead levels and have since been diagnosed with attention-deficit hyperactivity disorder; Sima also has a learning difficulty.

“I felt responsible for forcing my child to drink something that was hurting her so bad, and I didn’t believe her,” said her mother, Jessica Gutierrez, who works as a public health advocate for hospitals and nonprofits and fears for her daughters’ long-term health.

Sima Gutierrez shows a photo of herself with her mother, during an interview, Monday, March 25, 2024, in Flint, Mich. (AP Photo/Carlos Osorio)

Guilt and anxiety are “part of the trauma of the crisis,” Hanna-Attisha said.

That’s why it’s important for kids from Flint to feel they’re being heard, to be part of the solutions, she said. For example, the Flint Youth Justice League, an advisory board to her Pediatric Public Health Initiative , has offered suggestions on programs that include prescribing fresh fruits and vegetables, reducing poverty and connecting residents to public services.

“Our young people are amazing,” said Hanna-Attisha. “They are not okay with the status quo and they are demanding that we do better for them and for generations to come.”

Asia Donald is interviewed, Tuesday, March 19, 2024, in Flint, Mich. (AP Photo/Carlos Osorio)

Asia Donald remembers feeling helpless and bewildered when her little sister developed rashes and her mom boiled pot after pot of bottled water for baths.

But just a couple years later, she was talking to kids from Newark, New Jersey, guiding them through their own lead-in-water crisis. Over Zoom meetings, the kids from Flint explained parts per billion, how to test water for lead and how they had coped with fear.

“They felt the exact same way that I felt when I was ... going through it,” said Asia, 20, now an aspiring accountant and one of 18 interns at the Flint Public Health Youth Academy.

They’re paid a monthly stipend to run the academy — writing grants, creating budgets, analyzing data, conducting focus groups and creating public awareness campaigns. They have a biweekly talk show on YouTube, where they’ve discussed everything from mental health to COVID.

Last summer, they planned and hosted a summer camp for dozens of kids that focused on gun violence and school shootings. This year, together with the Community Foundation of Greater Flint, they’re coordinating a youth summit on community violence.

Dr. Kent Key, a public health researcher with the Michigan State University College of Human Medicine in Flint, started the academy after studying health disparities in the Black community as part of his doctoral dissertation.

He wanted to introduce Black kids to potential health careers, but also felt like “everyone had written Flint youth off because of the impacts of lead.” So he gave them more than a voice, he said. He gave them control.

“I did not want (the water crisis) to be a sentence of doom and gloom for youth,” he said. “ I wanted it to be a catapult ... to launch the next generation of public health professionals.”

Dionna Brown, who was 14 when the water crisis began, became interested in advocacy after taking a class on environmental inequality at Howard University. Now she’s planning her life around it — completing a master’s degree in sociology from Wayne State University with plans to become an environmental justice attorney.

She’s also national director of the youth environmental justice program at Young, Gifted & Green, formerly called Black Millennials for Flint and founded by advocates from Washington to support Flint after the crisis.

Brown holds a two-week summer environmental justice camp in Flint every year to teach teens about issues such as policy, climate justice, sustainability and housing disparities. She also works with kids in Baltimore and Memphis.

She said the water crisis made Flint kids resilient.

“I tell people all the time: I’m a child of the Flint water crisis,” said Brown. “I love my city. And we put the world on notice that you cannot just poison a city and we’ll forget about it.”

Associated Press video journalist Mike Householder contributed to this story.

The Associated Press receives support from the Walton Family Foundation for coverage of water and environmental policy. The AP is solely responsible for all content. For all of AP’s environmental coverage, visit https://apnews.com/hub/climate-and-environment

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We, the voters

Where gun violence is common, some students say physical safety is a top concern.

Meg Anderson

The busy halls of North Community High School in Minneapolis in between classes. Caroline Yang for NPR hide caption

The busy halls of North Community High School in Minneapolis in between classes.

The students at North Community High School in Minneapolis have seen a lot. Some things, morbid curiosities: a bullet, freshly fired, spinning and melting the rubber on the track surrounding the school's football field.

Others, much more painful: the murder of Deshaun Hill Jr., shot and killed two years ago just blocks from the school. He was 15 years old, and the quarterback of the football team.

"That was my best friend, so we did everything with each other. I feel like that's the toughest thing, just knowing that he's not physically by my side anymore," senior Kahlil Brown says.

Last spring, another member of the football team was shot in both legs. He survived.

"It is not normal. It shouldn't be seen as normal. But we go through it so much that it is normal here," senior Jalen Beard says.

Kahlil Brown, 18, says teammate Deshaun Hill Jr., the student and quarterback who was shot and killed in 2022, was his best friend. Brown, shown posing for a portrait at the North Community High School football field in Minneapolis on April 9, will attend St. Olaf College in the fall. Caroline Yang for NPR hide caption

Kahlil Brown, 18, says teammate Deshaun Hill Jr., the student and quarterback who was shot and killed in 2022, was his best friend. Brown, shown posing for a portrait at the North Community High School football field in Minneapolis on April 9, will attend St. Olaf College in the fall.

Across the country, millions of young people are enduring this same reality: Firearm injuries are the leading cause of death for children and teens over age 1 nationwide.

The federal government is investing billions of dollars to combat this problem. But on the north side of Minneapolis, some students living under the threat of gun violence say there's a disconnect between what the government is offering and what they say they need.

"We needed that police officer at our school and they took it out"

Gun violence affects children and teenagers in devastating ways, says Sonali Rajan, an associate professor at Columbia University's Teachers College. That goes far beyond the physical harm guns can cause.

"Witnessing firearm violence, surviving a shooting, hearing gunshots," Rajan says. "There's a real range of experiences that we have to consider when we think about its impacts and the emotional trauma that goes hand-in-hand with that — nightmares, anxiety, difficulty concentrating, typical symptoms we might associate with post-traumatic stress disorder."

Students exposed to gun violence are less likely to do well in school and less likely to graduate . What's more, the rate of firearm deaths for Black children is six times higher than it is for white children. In Minneapolis, students at North High are well aware of those effects.

"If you're outside, you don't really feel comfortable, you don't really get to relax," Beard says. "Even if you're not the one doing it, even if you're not a part of no gang, nothing like that. But you could still end up being the one on the ground."

A portrait of Deshaun Hill Jr. hangs outside on the fence surrounding the North Community High School track and football field in Minneapolis. Caroline Yang for NPR hide caption

A portrait of Deshaun Hill Jr. hangs outside on the fence surrounding the North Community High School track and football field in Minneapolis.

In response, the Biden administration is awarding $1 billion across the next several years as part of the Bipartisan Safer Communities Act . That money aims to increase the number of mental health professionals in schools.

As part of the same legislation, the administration distributed about another $1 billion in grants to create what it calls "safer and healthier learning environments," employing a wide range of strategies — including anti-bullying and violence prevention programs, staff training and metal detectors.

Minneapolis Public Schools will receive at least $500,000 of this federal aid, much of which is focused on drug and alcohol prevention. The district plans to apply for the mental health grants and has received other state and federal funding specifically for preventing gun violence.

When it comes to more mental health resources, Beard says he would welcome that extra support, as long as a counselor can truly relate.

"You don't want to talk to a stranger who has never been in this situation, who never had one of their best friends pass away at 15," Beard says. "They wouldn't understand. And it would feel like I'm talking to an alien, basically."

In 2020, George Floyd was murdered by a police officer in this same city. Shortly after, the school district ended its contract with the city's police — and pulled school resource officers from its buildings.

"So now the police is out of our schools," says Brown, the senior whose best friend was killed. "We needed that police officer at our school and they took it out."

The school still has a security monitor, but that person is not a sworn officer. The security monitor can't arrest people and doesn't carry a weapon. Students say they don't want to be overpoliced, much less by officers they don't know. But at North, the school resource officer was also the head coach of the football team — and still is.

"That's a trusted person," Beard says. "If I knew my coach was out there protecting me, I'm fine."

Jalen Beard, 18, a friend and teammate of Deshaun Hill Jr., stands by the football field at school. Beard plans to attend St. Olaf College. Caroline Yang for NPR hide caption

Jalen Beard, 18, a friend and teammate of Deshaun Hill Jr., stands by the football field at school. Beard plans to attend St. Olaf College.

Studies have shown the presence of police can criminalize the school space and serve as a pipeline into the criminal justice system, says Rajan, the Columbia researcher. Still, she says, the need for real physical safety is valid.

"We can't necessarily employ a cookie cutter approach to gun violence prevention," Rajan says. "There are 51 million children in our public school system right now. So there is a lot of nuance here we have to contend with."

"What are we doing to prevent that violence from happening at all?"

Every morning, Principal Friestleben stations herself in the hallway to greet students. She says that's intentional: Structure and consistency communicate to students that they're safe.

"My children are walking in with generational and personal experience of not being protected and not being valued and centered," she says.

North Community High School Principal Mauri Friestleben stands in a newly renovated classroom on April 9. Caroline Yang for NPR hide caption

North Community High School Principal Mauri Friestleben stands in a newly renovated classroom on April 9.

Educators need to understand that even though they can't control what happens in the neighborhood, schools can make a real difference in student well-being, says Dan Flannery, a professor who researches gun violence at Case Western Reserve University.

"If you have a positive school climate and culture, if kids feel attached to the school, they're going to have a much more positive experience," Flannery says. "You need to have a commitment to that perspective. The staff and teachers and principals have to understand that this is an important thing to do."

The all-hands-on-deck approach is part of a larger way of thinking: treating gun violence as a disease.

"Public health is predicated on the notion that we should invest as much as we can in what we call primary prevention," Rajan says. "Prevention is saying 'What are we doing years and years before an individual is posing a potential threat to a school community? What are we doing to make it harder? What are we doing to prevent that violence from happening at all?'"

She says alongside stricter gun laws, strengthening communities at large — investing not just in school culture, but also in things like affordable housing and neighborhood green space — can act as a sort of vaccine against violence.

Friestleben wants to see that investment. And though she welcomes the funds, she isn't sure the latest federal grants will get at the root problems that can lead to gun violence.

Jalen Beard holds a pendant he wears in remembrance of his friend. Caroline Yang for NPR hide caption

Jalen Beard holds a pendant he wears in remembrance of his friend.

"It's no different than one of my kids being hungry and going to the corner store and getting chips. It's satisfying a teeny, tiny little bit of hunger, but not in a healthy, sustainable, longstanding way," she says.

This year Jalen Beard and Kahlil Brown will graduate and go on to college.

They'll attend St. Olaf College, a small liberal arts school about 45 miles from home. They're going to be roommates, and they'll both be playing football, something they talked about doing with their friend who's no longer here.

"He wasn't getting in trouble. He went to class. He had good grades," Beard says. "To me, he was doing everything right. He was doing everything he was supposed to be. And he still didn't get his opportunity."

Note: Meg Anderson was a teacher for Minneapolis Public Schools several years ago. Her spouse works for the district.

• school resource officers
• children's mental health
• school safety
• school shootings
• gun violence
• mental health

AI use cases in health care will likely apply to pets first—then humans

There was one undisputed winner of the pandemic era: pets. People adopted more pets , spent more time with them , and lavished them with more spending . But that boom has not necessarily benefited the workforce that cares for our furry friends.

Veterinarians earn a median annual salary of $119,100 , less than half of what physicians make despite spending as much time in school, graduating with two-thirds as much student debt, and experiencing higher turnover. The result: 0.8 vets per 1,000 cats and dogs. The shortage of veterinary technicians is even worse. My niece studied to be a vet tech but switched out of the program when she realized three years of training would net her a job with a limited career path and low wages. 

One leader who thinks about this a lot is Kristin Peck, CEO of Zoetis , an $8.5 billion-a-year global leader in developing vaccines, medicines, diagnostics and other technologies for pets and livestock. Her clients are vets, so she’s been on the frontlines, trying to address issues through regulation and innovation. “We believe you need to create more licensure in vet tech, so they can do more things such as giving injections,” Peck says. With more robust certification and on-the-job training, she argues, technicians can help relieve pressure on vets—and build more rewarding careers. 

AI also promises to unlock productivity in pet care. In fact, some of the most creative use cases for AI and health tech are likely to emerge first in the animal realm, where patients are unencumbered by privacy laws and other well-intentioned regulations. Zoetis, for one, has an AI-powered device that can quickly diagnose disease from blood, urine and other samples. Meanwhile, Nestlé Purina Petcare North America CEO Nina Leigh Krueger recently told me about her company’s innovations in tech-enabled pet health monitoring. “They want to know, ‘Is my pet getting enough exercise? Is it eating the right amount?’” she says. My personal favorite: a smart litter box that alerts cat owners to changes in habits that may indicate health issues. “We know from years of research how important pets are to our mental health,” she adds. 

And if you doubt that, consider that Chewy CEO Sumit Singh lets everyone bring their pets to work, potbellied pigs and all. As he told Michal Lev-Ram and Alan Murray in a recent Leadership Next podcast , the pet business “used to be a sleepy category” that’s become the next frontier for innovation as technology allows for greater personalization and joy—for animals, their owners, and the professionals who care for them.

Meanwhile, as Alan prepares to move on to his next venture, we’ve received a lot of comments from CEOs on why Fortune is important to them. Here’s one that really resonated with me. 

Fortune ’s thought-provoking content and insightful articles have been an incredible resource for me and my fellow leaders as we all navigate an increasingly complex landscape. In an era where we are being bombarded with so much information, Fortune helps me stay current on market trends, business strategies and leadership advice.

–Thasunda Brown Duckett, CEO, TIAA

More news below.

Diane Brady @dianebrady [email protected]

The FTC targets another merger

The Federal Trade Commission is suing to block Tapestry’s $8.5 billion acquisition of Capri Holdings, alleging the deal could affect employee wages and benefits. The merger would put brands like Coach, Michael Kors, and Versace under one roof. The FTC is more aggressively trying to block mega-mergers, including a $25 billion deal between grocery stores Kroger and Albertsons. The Wall Street Journal

Europe's TikTok probe

The European Commission could order TikTok to shutter its rewards program in the EU due to concerns over child addiction. TikTok Lite allows users to earn points through activities like watching videos or following creators. It’s the second European investigation into TikTok following a February probe into whether the app breached rules on transparent advertising. Reuters

Bubble tea bust

Shares in Chinese bubble tea brand Chabaidao sunk by as much as 37% in Hong Kong on Tuesday, the first trading day for the shares after the city’s biggest IPO for 2024 thus far. IPO proceeds in Hong Kong fell to their lowest level in two decades last year, as companies worry about geopolitical tensions and Chinese regulatory scrutiny. On Friday, China’s markets regulator said it would facilitate Chinese companies hoping to list in Hong Kong. Bloomberg

AROUND THE WATERCOOLER

Commentary: How to fix Boeing, according to a former Airbus technology chief by Paul Eremenko

Baby boomer packed housing markets are unfazed by higher mortgage rates—the rest don’t have enough homes or sellers by Alena Botros

Musk turned Democrats off Teslas at a critical time. Here’s what they bought instead by Alicia Adamczyk

Google CEO’s new memo on employee activism echoes progressive villain Coinbase by Jeff John Roberts

Gen Z women flock to Uniqlo as return-to-office mandates force them to merge work and evening wear by Ryan Hogg

T his edition of CEO Daily was curated by Nicholas Gordon. 

This is the web version of CEO Daily, a newsletter of must-read insights from Fortune CEO Alan Murray. Sign up to get it delivered free to your inbox.

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