A special issue of the Journal of Adolescent Health in July 2019 contains several cost-benefit estimates of investing in health, education, productivity and safety in low & middle income countries. "The papers in this supplement present an important milestone in addressing this challenge, helping the international development field to move forward by focusing on the question of investing at scale for a few key components of the adolescent health agenda that are especially relevant for low- and middle-income contexts. All the empirical papers assess the effectiveness of implementing a specific set of interventions nationally at scale for their prioritized outcome of interest—health, education, productivity, safety—for a sustained period through 2030. The analyses confirm that the resulting benefits in all cases are substantial, both for the adolescents and for the economic and social progress of their nations. Four of the five empirical papers also model the costs of these interventions, and three papers further extend their analysis to calculate benefit-to-cost ratios (BCRs) of such investments. The BCRs range from 5.8 to 12.6, indicating a compelling case for national and global decision-makers to prioritize investing in adolescents."  ....

• "Sweeney et al. [10] make the case for investments to improve outcomes in adolescent sexual and reproductive health, the health of adolescent mothers and their newborn children, and adolescent relevant communicable and noncommunicable diseases. They examine investments in intervention-specific costs, program costs, and health systems costs for 40 low- and middle-income countries. For the 66 adolescent health interventions modeled through 2030, they estimate 7.0 million deaths and 1.5 million serious disabilities averted at the average cost of $4.5 per capita each year. They also estimate BCRs of 12.6 for low-income, 9.9 for lower middle-income, and 6.4 for upper middle-income countries.  
• Rassmusen et al. model the effects of a set of identified interventions on child marriage (life skills, community mobilization, and cash transfers) and education (availability and proximity of schools, teacher quality, and cash incentives) for 31 low- and middle-income countries [11]. They find that the interventions result in an 8% reduction in marriage rates for 15-17 year olds by 2050, an increase of 19.3% in school attendance and completion, and 22.7% increase in productivity by 2030. The average BCR for these interventions is 7.4.
• Wils et al. [12] find that in 44 low- and middle-income countries, school dropout among preadolescents is now very rare. Rather, dropout is mainly an adolescent effect—especially between ages 14-19 years and particularly for girls. Their analysis shows that at the cost of $10.5 per capita per annum, nine identified interventions can be sustained through 2030, increasing secondary completion rates by 25% and doubling the quality of secondary schooling as measured by the learning index.
• On a continuum to this analysis, Sheehan and Shi [13] estimate the economic returns to both the quantity and quality of education for adolescents in the context of the actual employment patterns in 72 low- and middle-income countries. They find that with sustained investment through 2030, the economic benefits of better education for adolescent cohorts lead to an increase in Gross Domestic Product (GDP) of 40% overall and 50% in low-income countries.
• Noting that in 75 low- and middle-income countries, death rates by road accidents are disproportionately high and the leading cause of death for adolescents, Symons et al. [14] provide an assessment of interventions to reduce these deaths and injuries for adolescents. Modeling of their preferred interventions results in 1 million deaths and 3 million serious injuries averted, at a cost of $1.2 per capita and a BCR of 7.6   

Read more.....

A research review reported in the July 2019 issue of the Journal of Adolescence found that "Greater density of same race/ethnic peers led to better mental health for all youth" and that ".No overall mental health advantage in schools with increased diversity was found."A range of mental health outcomes were assessed (e.g., internalizing behaviors, psychotic symptoms) in order to broadly capture the relationship between school context on mental health and psychological wellbeing. Methods: A search across six databases from 1990 to 2018 resulted in 13 articles from three countries (United States, United Kingdom, and the Netherlands) that met inclusion criteria following a two step review of titles/abstracts and full-text."  Read more....

An article in the July 2019 issue of Pediatrics examined associations between adolescent connectedness and multiple health-related outcomes in adulthood. "We used weighted data from Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (n = 14 800). Linear and logistic models were used to examine associations between family and school connectedness in adolescence and self-reported health risk behaviors and experiences in adulthood, including emotional distress, suicidal thoughts and attempts, physical violence victimization and perpetration, intimate partner physical and sexual violence victimization, multiple sex partners, condom use, sexually transmitted infection (STI) diagnosis, prescription drug misuse, and other illicit drug use.In multivariable analyses, school connectedness in adolescence had independent protective associations in adulthood, reducing emotional distress and odds of suicidal ideation, physical violence victimization and perpetration, multiple sex partners, STI diagnosis, prescription drug misuse, and other illicit drug use. Similarly, family connectedness had protective effects for emotional distress, all violence indicators, including intimate partner violence, multiple sex partners, STI diagnosis, and both substance use indicators. Compared to individuals with low scores for each type of connectedness, having high levels of both school and family connectedness was associated with 48% to 66% lower odds of health risk behaviors and experiences in adulthood, depending on the outcome.  Read more......

(An item from the ISHN Member information service) Last week, we noted several news stories covering the release of an American report (CDC) suggesting that schools adjust their start times for students, especially adolescents, so that they can get more sleep. The CDC noted several health and academic benefits. An article in Volume 81, 2015 of Accident Analysis & Prevention reports on a French study that shows a strong correlation between injuries and sleep problems."The study population included 1559 middle-school adolescents from north-eastern France who completed at the end of school year a self-administered questionnaire to gather school and out-of-school injuries during the school year, and to assess sleep difficulty and previous injury risk factors which were socioeconomic factors, school performance, obesity, alcohol/tobacco/cannabis/hard drugs use, health status, psychological health, and involvement-in-violence. For sleep difficulty and behaviour and health-related difficulties their first occurring over adolescent’s life course was gathered. Multinomial logistic regression models were used retaining only sleep difficulty and other risk factors which had started before the school year (thus before the injuries studied). School and out-of-school injuries and sleep difficulty were frequent. The adolescents with sleep difficulty without medical treatment had a higher risk of single school and out-of-school injuries and a much higher risk of repeated school and out-of-school injuries. The adolescents with persistent sleep difficulty despite a medical treatment also had a higher risk of single school and out-of-school injury, and a much higher risk of repeated school and out-of-school injuries." The authors conclude that "Injury prevention should focus on sleep difficulty, especially among adolescents with socioeconomic difficulties, via physician–parent–school–adolescent collaborations."  Read more>>