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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/25552.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/25552.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/25552.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/25552.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/25552.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/25552.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/25552.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/25552.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/25552.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/25552.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/25552.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/25552.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

PROMOTING POSITIVE ADOLESCENT HEALTH BEHAVIORS AND OUTCOMES Thriving in the 21st Century Committee on Applying Lessons of Optimal Adolescent Health to Improve Behavioral Outcomes for Youth Robert Graham and Nicole F. Kahn, Editors Board on Children, Youth, and Families Division of Behavioral and Social Sciences and Education Health and Medicine Division A Consensus Study Report of

THE NATIONAL ACADEMIES PRESS   500 Fifth Street, NW   Washington, DC 20001 This activity was supported by a contract between the National Academy of S ­ ciences and the Office of the Assistant Secretary for Health of the United States Department of Health and Human Services (#10004318). Support for the work of the Board on Children, Youth and Families is provided primarily by grants from the Heising-Simons Foundation (award number is 2016-210), Jacobs Foundation (award number 2015-1168), and the Marguerite Casey Foundation (award number 2018-245). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-49677-3 International Standard Book Number-10: 0-309-49677-2 Digital Object Identifier: https://doi.org/10.17226/25552 Library of Congress Control Number: 2020932720 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2020 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. (2020). Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century. Washington, DC: The National Academies Press. https://doi. org/10.17226/25552.

The National Academy of Sciences was established in 1863 by an Act of C ­ ongress, signed by President Lincoln, as a private, nongovernmental ­nstitution i to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the char- ter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medi- cine at www.nationalacademies.org.

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typi- cally include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opin- ions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

COMMITTEE ON APPLYING LESSONS OF OPTIMAL ADOLESCENT HEALTH TO IMPROVE BEHAVIORAL OUTCOMES FOR YOUTH ROBERT GRAHAM (Chair), Kansas City, MO ANGELA BRYAN, University of Colorado Boulder TAMMY CHANG, University of Michigan Medical School ROSALIE CORONA, Virginia Commonwealth University TAMERA COYNE-BEASLEY, University of Alabama at Birmingham BONNIE HALPERN-FELSHER, Stanford University JEFFREY W. HUTCHINSON, The Wade Alliance, LLC VELMA MCBRIDE MURRY, Vanderbilt University SANDRA JO WILSON, Abt Associates NICOLE F. KAHN, Study Director RICHARD ADRIEN, Associate Program Officer (through August 2019) REBEKAH HUTTON, Program Officer (beginning August 2019) PAMELLA ATAYI, Program Coordinator v

BOARD ON CHILDREN, YOUTH, AND FAMILIES ANGELA DIAZ (Cochair), Department of Pediatrics and Deparment of Environmental Medicine and Public Health, Mount Sinai Adolescent Health Center, Icahn School of Medicine at Mount Sinai DAVID V. B. BRITT (Cochair), Sesame Workshop (retired CEO) HAROLYN BELCHER, Kennedy Krieger Institute and Johns Hopkins University School of Medicine RICHARD F. CATALANO, School of Social Work, University of Washington DIMITRI CHRISTAKIS, Seattle Children’s Research Institute, University of Washington JEFFREY W. HUTCHINSON, The Wade Alliance, LLC STEPHANIE J. MONROE, The Wrenwood Group, LLC JAMES M. PERRIN, Harvard Medical School and MassGeneral Hospital for Children NISHA SACHDEV, Bainum Family Foundation DONALD F. SCHWARZ, Robert Wood Johnson Foundation MARTÍN J. SEPÚLVEDA, IBM Corporation (retired) MARTIN H. TEICHER, Developmental Biopsychiatry Research Program at McLean Hospital and Harvard Medical School JONATHAN TODRES, Georgia State University College of Law NATACHA BLAIN, Director vi

Acknowledgments We are grateful to many people for their support and contributions to this report. First and foremost, we would like to thank the study sponsor, the Office of the Assistant Secretary for Health (OASH) of the U.S. Depart- ment of Health and Human Services. We would also like to thank the members of the study committee, who dedicated their time, energy, and expertise to the report. The com- mittee also received significant contributions from several outside experts. Thank you to Robert Mahaffey (Rural School and Community Trust), Wesley Thomas (District of Columbia Public Schools), Sandra Shephard (Prince George’s County Board of Education), Lisa Rue (cliexa), Ty Ridenour (RTI International), Elizabeth D’Amico (RAND Corporation), Aaron Hogue (­ enter on Addiction), Heather Hensman Kettrey (Clemson C University), Kim Robinson (Forum for Youth Investment), Randall Juras ­ (Abt Associates), Irene Ericksen (Institute for Research and Evaluation), ­ and Jennifer Manlove (Child Trends) for sharing their work and expertise during our public information-gathering session. We also would like to thank the authors of our five commissioned papers: Cady Berkel (Arizona State University) for “The Role of Sexual Agency and Consent in Healthy Adolescent Development,” Bethany Everett (University of Utah) for “Optimal Adolescent Health to Improve Behavioral Outcomes for LGBTQ Youth,” Willi Horner-Johnson and Lindsay Sauvé (Oregon Health & Science University) for “Applying Lessons of Optimal Adolescent Health to Improve ­ ehavioral Outcomes for Youth with Disabilities,” Megan Moreno B (University of Wisconsin–­ adison) for “Adolescent Health and Media,” M and the University of Michigan MyVoice team for “Youth Perspectives vii

viii ACKNOWLEDGMENTS on Being Healthy and Thriving.” We are grateful as well to the following Teen Pregnancy Prevention (TPP) program Tier 1B grantees, who shared successes and challenges of program implementation in memorandums to the committee: the Baltimore City Health Department, the Mary Black Foundation, Methodist Le Bonheur Community Outreach, Morehouse School of Medicine, San Diego Youth Services, and the Center for Black Women’s Wellness, Inc. In addition, we would like to sincerely thank the youth who provided valuable input for this report. Thank you to Richard Nukpeta (Mentor Foundation USA), Shayna Shor (University of Maryland Health Center Peer Educator Program), and Natnael Abate (Promising Futures DC) for taking a healthy risk and sharing their experiences at our public information-­ gathering session. We also thank the MyVoice project participants, whose responses to our text message poll added important depth to this report. This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manu- script remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: Suzanne R. Bakken, School of Nursing, Columbia University; Claire D. Brindis, Philip R. Lee Institute for Health Policy Studies, University of C ­ alifornia, San Francisco; Julianna Deardorff, Center of Excellence in Maternal, Child, and Adolescent Health, University of California, Berkeley; Phillip W. Graham, Center on Social Determinants, Risk Behaviors, and Prevention Science, RTI International; Norval J. Hickman, Tobacco-Related Disease Research Program, University of California Office of the President; Denese Shervington, Institute of Women and Ethnic Studies, New Orleans, L ­ ouisiana; Laurence Steinberg, Department of Psychology, Temple Univer- sity; Benjamin W. Van Voorhees, Department of Pediatrics, University of Illinois at Chicago; and Janet A. Welsh, Bennett-Pierce Prevention Research Center, Pennsylvania State University. Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by Rosemary Chalk, independent consultant, Bethesda, Maryland, and Bobbie A. Berkowitz, Columbia University School of Nursing (emerita). They were responsible for making certain that an independent examination of this report was car- ried out in accordance with the standards of the National Academies and

ACKNOWLEDGMENTS ix that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. We are grateful to the staff of the National Academies, in particular to Richard Adrien and Rebekah Hutton, who provided critical research, writing, and editing support. To Pamella Atayi, thank you for the behind the scenes administrative and logistical support that was essential to our success. We would also like to thank Katrina Ferrara for her help during the editing process. In addition, we are exceedingly grateful to the Research Center at the National Academies, particularly Jorge Mendoza-Torres, for conducting our systematic literature search and fact checking this report. Thank you to Natacha Blain, director of the Board on Children, Youth, and Families; Mary Ellen O’Connell, executive director of the Division of Behavioral and Social Sciences and Education (DBASSE); and Monica Feit, deputy executive director of DBASSE, who provided helpful over- ­ sight throughout this ­ roject. We are also grateful to Anthony Bryant p and Faye Hillman for providing assistance in managing finances for this project. From the DBASSE Reports Office, we thank Kirsten Sampson Snyder and Yvonne Wise, who organized and moved this report through the review and production processes. In addition, we would like to thank Douglas Sprunger from the DBASSE Communications Office and Nicole Joy from the Health and Medicine Division Communications Office, who helped identify, plan, create, and execute our ideas for communication and dissemina­ion. Finally, we thank Steve and Sarah Olson for their technical t writing support and Rona Briere for her detailed editing. Robert Graham, Chair Nicole F. Kahn, Study Director Committee on Applying Lessons of Optimal Adolescent Health to Improve Behavioral Outcomes for Youth

Contents Summary 1 1 Introduction 7 Study Overview, 8 Brief Overview of the Teen Pregnancy Prevention Program, 10 Study Approach, 10 Data Sources, 13 Definitions, 14 Organization of the Report, 21 References, 21 2 Normative Adolescent Development 25 Conclusions of The Promise of Adolescence: Realizing Opportunity for All Youth (2019), 26 Adolescent Development According to the Five Domains of the Optimal Health Framework, 26 Conclusions, 42 References, 44 3 The Current Landscape of Adolescent Risk Behavior 53 The Nature of Adolescent Risk Taking, 54 Alcohol Use, Tobacco Use, and Sexual Behavior: Trends and Influences, 64 Conclusions, 88 References, 89 xi

xii CONTENTS 4 Core Components of Programs Focused on Optimal Health 101 The Core Components Approach to Evidence-Based Practice, 102 The Committee’s Approach, 104 Results of the Committee’s Systematic Review, 117 Results of Core Components Paper Review, 129 Conclusions, 134 References, 137 5 Recommendations and Promising Approaches 143 Recommendations for Research, 144 Recommendation for OASH Programs, 148 Promising Approaches, 150 References, 153 APPENDIXES A Literature Search Strategy 157 B MyVoice Methodology 163 C Comparison of Youth Risk Behavior Survey (YRBS) and National Survey of Family Growth (NSFG) Survey Items on Sexual Behavior 165 D Public Information Gathering Session Agenda 173 E Biosketches of Committee Members and Staff 175

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Adolescence is a critical growth period in which youth develop essential skills that prepare them for adulthood. Prevention and intervention programs are designed to meet the needs of adolescents who require additional support and promote healthy behaviors and outcomes. To ensure the success of these efforts, it is essential that they include reliably identifiable techniques, strategies, or practices that have been proven effective.

Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century identifies key program factors that can improve health outcomes related to adolescent behavior and provides evidence-based recommendations toward effective implementation of federal programming initiatives. This study explores normative adolescent development, the current landscape of adolescent risk behavior, core components of effective programs focused on optimal health, and recommendations for research, programs, and policies.

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