As childhood and adolescent deaths from infectious diseases have declined worldwide, policymakers are shifting attention to preventing deaths from noncommunicable causes, such as drug and alcohol use, mental health problems, obesity, traffic crashes, violence and unsafe sex practices.
"We now need to think of how to prevent these behavior problems and conditions early in life because they don't only cause problems in adolescence, they can launch health issues across life," said Richard Catalano, director of the University of Washington's Social Developmental Research Group.
In a new paper, Catalano and colleagues provide examples of cost-effective policies and programs that rigorous research shows can prevent a variety of behavior problems and conditions contributing to poor health. The article will be published April 25 by The Lancet , as part of a series on adolescent health.
"Despite the growing prevention science research base and the shift in in importance of behavioral problems implicated in noncommunicable disease worldwide, communicable disease prevention and treatment of behavior problems get the vast majority of resources dedicated to child and adolescent health," Catalano said.
The practices have been developed, tested over the past 30 years in high-income countries, with more recent testing in lower- and middle-income countries.
Catalano and his co-authors argue that these prevention policies and programs could be used more widely by both high-income and lower- and middle-income nations, to prevent worldwide adolescent behavior problems and states that are related to lifelong morbidity and mortality.
Samples of their recommended programs are:
Catalano and his team also recommend some prevention policies:
The biggest challenge is getting governments, schools and parents to buy into effective prevention programs and policies, the authors write. One tack is to choose programs based on local need, which can be assessed with the Communities That Care youth survey.
Cost should also be factored in. Catalano and his team included six programs in their review that have demonstrated a return on investment ranging from $2 to $42 for every dollar invested.
"Prevention science requires you to think systemically across society to see the savings," he said. "If we ward off adolescent behavior problems and states that impact adolescent and adult health, like smoking, drinking and risky sex, that means we will likely have less health care expenses, as well as better workers, students, parents and scientists, all involved with making the world a better place."
Co-authors are Abigail Fagan, University of South Carolina; Loretta Gavin, U.S. Centers for Disease Control and Prevention; Mark Greenberg, Pennsylvania State University; Charles Irwin, University of California, San Francisco; David Ross, London School of Hygiene and Tropical Medicine; and Daniel Shek, The Hong Kong Polytechnic University.
For more information, contact Catalano at 206-543-6382 or catalano@uw.edu .
The Lancet