Robert Blum

Johns Hopkins University | JHU · Department of Population, Family and Reproductive Health

Bullying is a major public health concern for Indonesian adolescents, with well-documented links to a range of emotional and behavioral problems. Despite such evidence, few investigations have employed qualitative methods to illuminate youth’s own perceptions of bullying and its psychosocial correlates in this context. The current study aimed to ad...

Purpose Early adolescence (ages 10–14) is a critical period for psychosocial development, but few studies have focused on risk and protective factors for emergent psychosocial challenges among youth living in low- and middle-income countries. This study explored the contribution of social environmental factors to patterns of emotional and behaviora...

Early adolescents (ages 10–14) living in low- and middle-income countries have heightened vulnerability to psychosocial risks, but available evidence from these settings is limited. This study used data from the Global Early Adolescent Study to characterize prototypical patterns of emotional and behavioral problems among 10,437 early adolescents (5...

Purpose In low- and middle-income countries, there are limited data on mental disorders among adolescents. To address this gap, the National Adolescent Mental Health Surveys (NAMHS) will provide nationally representative prevalence data of mental disorders among adolescents in Kenya, Indonesia, and Vietnam. This paper details the NAMHS study protoc...

•Agency, a domain of empowerment, is a measurable construct amongst early adolescents age 10-14.•Three sub-scales - Voice, Freedom of Movement, and Behavioral Control and Decision-making - comprise the measurement of agency.•Differences in the Freedom of Movement sub-scale show a growing equity gap between boys and girls across multiple countries.•...

This paper reports the development and baseline data of a vignettes-based measure of gender equality. Methods: Vignettes were developed through 3-day long focus groups. After piloting in 13 sites and repiloting a revised version in 6 countries, responses were categorized by the construct tapped and a scoring system developed. Finalized vignettes we...

Purpose: The purpose of the study was to develop a measure of ACEs applicable for young adolescents in low- and middle-income countries (ACEs) and to analyze the relationships of ACEs against two outcomes: depressive symptoms and violence perpetration. There is a paucity of research on the consequences of adverse child experiences (ACEs) on adoles...

Approximately 1 in 9 teenagers and young adults aged 16-24 in the United States is currently disconnected from school and employment. These disconnected young people (ie, opportunity youth) are not only at high risk for long-term emotional, behavioral, and health problems, but they also represent a loss of human capital, with high social and econom...

Objective: To understand adolescent and parental attitudes toward education, child marriage, and the changes in matriculation for boys and girls over one generation. Methods: Two-staged household sampling method was used in six provinces with low educational enrollment in Afghanistan during 2016. Final sample included 910 adolescents aged 12-15...

Objectives: To understand Afghan adolescents' and parents' attitudes toward interpersonal violence. Methods: We used a 2-stage sampling method in 6 provinces during 2016; we included 916 adolescents aged 12 to 15 years and 454 parents. Results: In the abstract, a minority of adolescents or parents endorsed violence; however, specific situation...

The need for early prevention approaches to improve young people’s sexual and reproductive health is gaining attention, yet little is known about the sexual experiences of early adolescents aged 10–14 years. Drawing on cross-sectional survey data collected from 365 early adolescents in a Nairobi slum, we used latent class analysis to identify subgr...

The contemporary study of adolescent development emphasizes that the process of development involves mutually influential relations between the developing individual and the features of his or her complex and changing context. These relations are most often framed by models derived from a relational developmental systems metatheory, an approach to...

A B S T R A C T Purpose: Little is known about how gender norms regulate adolescents’ lives across different cultural settings. This study aims to illustrate what is considered as violating gender norms for boys and girls in four urban poor sites as well as the consequences that follow the challenging of gender norms. Methods: Data were collected a...

Purpose: The Global Early Adolescent Study (GEAS) was launched in 2014 with the primary goal of understanding the factors in early adolescence that predispose young people to subsequent sexual risks, and conversely, those that promote healthy sexuality across different cultural contexts. The present article describes the methodology that was used...

Background There is growing recognition that youth sexual health entails a broad range of physical, emotional and psychosocial responses to sexual interactions, yet little is known about sexual dysfunctions and well being in youth populations. This study explored sexual dysfunctions among youth and its associations with other domains of sexual heal...

Purpose: Black churches are an important community resource and a potentially powerful actor in adolescent health promotion. However, limited research exists describing the factors that may influence the successful implementation of evidence-based adolescent sexual health programs in churches. In the present study, a multi-informant approach was u...

PURPOSE: Intimate partner violence (IPV) affects one in three women globally, with adolescent and young adult women at highest risk. Less is known about IPV perpetration. We compare the prevalence and correlates of IPV perpetration among 15- to 19-year-old adolescent males in Baltimore (United States), Johannesburg (South Africa), Delhi (India), an...

Background: Early adolescence (ages 10-14) is a period of increased expectations for boys and girls to adhere to socially constructed and often stereotypical norms that perpetuate gender inequalities. The endorsement of such gender norms is closely linked to poor adolescent sexual and reproductive and other health-related outcomes yet little is kn...

Data extraction template. Standardized templates used to extract data on all studies according to their design (quantitative, qualitative or mixed-methods). (XLSX)

Search strategies. Detailed overview of the search terms applied to each database. (DOCX)

Systematic Review Protocol. Unpublished protocol outlining the background, rationale and methods for the present review. (DOCX)

Qualitative codebook. Overview of the final codebook that was used to code the qualitative studies, organized by descriptive and analytical themes. (XLSX)

Study Summaries. Document summarizing all includes studies in the current review (author, year, study settings, study objective, theory, sampling and sample, data collection and analysis, key findings). (DOCX)

This study is one of the first to explore the relevance of trust to the health of adolescents living in a disadvantaged urban setting. The primary objectives were to determine the differences in the sociodemographic characteristics between adolescents who do and do not trust and to examine the associations between trust and health. Data were drawn...

Previous studies have documented Black churches' receptivity to implementing adolescent sexual health programs within their congregations. Some authors have argued for new sexual health programs to be designed specifically for churches, similar to the development of school- and community-based interventions. However, strategies and curricula used i...

The purpose of this article is to provide policy guidance on how to assess the capacity of minor adolescents for autonomous decision-making without a third party authorization, in the field of clinical care. In June 2014, a two-day meeting gathered 20 professionals from all continents, working in the field of adolescent medicine, neurosciences, dev...

Early timing of first sex is a common risk factor for adverse sexual and reproductive health (SRH) outcomes. This study explored characteristics and circumstances associated with early sexual experience (at or below age 14) among Swedish youth. Data were drawn from UngKAB09, a national study of youth SRH in Sweden. 24,000 youth 16-28 years were ran...

Gender-based violence (GBV) is a global health and human rights issue with individual and social determinants. Youth are considered high risk; national influences include norms, policies and practices. By age, nation, and region, we contrast key GBV indicators, specifically intimate partner violence (IPV) and forced sexual debut among adolescent an...

We systematically reviewed peer-reviewed and gray literature on comprehensive adolescent health (CAH) programs (1998–2013), including sexual and reproductive health services. We screened 36 119 records and extracted articles using predefined criteria. We synthesized data into descriptive characteristics and assessed quality by evidence level. We ex...

Social capital is essential for the successful development of young people. The current study examines direct measures of social capital in young people in five urban global contexts.Methods The Well-Being of Adolescents in Vulnerable Environments is a global study of young people aged 15–19 years living in disadvantaged, urban settings. Respondent...

Adolescent substance use has numerous consequences. Our goals in this article are to compare the prevalence and correlates of substance use among ethnically diverse adolescents.Methods Data were from 2,332 adolescents aged 15–19 years recruited via respondent-driven sampling from disadvantaged settings in five cities. Multivariate logistic regressi...

The global adolescent population is larger than ever before and is rapidly urbanizing. Global surveillance systems to monitor youth health typically use household- and school-based recruitment methods. These systems risk not reaching the most marginalized youth made vulnerable by conditions of migration, civil conflict, and other forms of individua...

This study uses data collected as part of the Well-Being of Adolescents in Vulnerable Environments study to (1) compare the perceptions of neighborhood-level factors among adolescents across five different urban sites; (2) examine the associations between factors within the physical and social environments; and (3) examine the influence of neighbor...

Recent research has driven home the close relationship between place and health. Geography is often a greater driver of adolescent morbidity and mortality than behavior. To elucidate these relationships, the Well-Being of Adolescents in Vulnerable Environments study has collected and analyzed data on the health and well-being of adolescents' lowest...

The impact of pregnancy on the health and livelihood of adolescents aged 15–19 years is substantial. This study explored sociodemographic, behavioral, and environmental-level factors associated with adolescent pregnancy across five urban disadvantaged settings.Methods The Well-Being of Adolescents in Vulnerable Environments study used respondent-dr...

Background: High HIV/AIDS and teen pregnancy rates exist disproportionately among low income adolescents residing in disadvantaged neighborhoods. Churches and faith leaders are trusted individuals who have the ability to communicate important health messages to large groups. We describe a research project collaboratively designed and conducted by S...

Purpose: Disapproval of homosexuality is the cause of tremendous suffering among sexual minorities. No research has examined determinants of Vietnamese attitudes toward homosexuality. This article examined predictors of such attitudes among Vietnamese youth. Methods: Data were from Vietnamese youth aged 15–24 years nationally surveyed in 2009 (Surv...

The Well-being of Adolescents in Vulnerable Environments (WAVE) is a global study of young people living in disadvantaged urban communities from Baltimore, MD, Johannesburg, South Africa, Shanghai, China, New Delhi, India and Ibadan, Nigeria. WAVE was launched in the summer of 2011 to: 1) explore adolescents' perceived health and their top health c...

Adolescents in Vietnam have a low level of sexual activity, but this may increase with urbanisation and economic development. The aim of this analysis is to understand trends in correlates of permissive attitudes towards premarital sex among Vietnamese adolescents using an ecological framework. Data from the Survey Assessment of Vietnamese Youth fr...

Abstract Early adolescence (ages 10-14 years) is among the most neglected stages of development, yet there are few stages during the life course where changes are as dramatic. The present conceptual framework proposes four central goals to be achieved by early adolescence: engagement with learning, emotional and physical safety, positive sense of s...

This study was conducted to determine the prevalence and the associated factors for unintended pregnancy among never-married sexually active youth (15-24 years old) in Shanghai. Using a probability sample (n = 765, including 502 males and 263 females) from 2006, we estimated prevalence of unintended pregnancy involvement for females and males by de...

Over the past 20 years, dramatic social, political, economic shifts, and medical and public health interventions have radically altered the landscape of adolescent health around the world. A generation ago, AIDS was unknown; today, between a quarter and a third of adolescent females in Botswana, South Africa, and Zimbabwe are infected. A generation...

Background Based on previous data, road traffic injury (RTI) was a leading cause of non-fatal injury in all-age groups in Vietnam, and among the top causes of injury in children and adolescents. Specific analysis on RTIs in young people, however, has yet to be fully investigated. Using the results of two surveys in 2004 and 2009, the present study...

China's rates of internal migration increased to an all-time high of over 200 million individuals at the beginning of the twenty-first century. Yet, there is a dearth of information on the lives of young migrant populations. The aim of this study was to explore how migration influences the sexual attitudes and behaviours of 18-24-year-old migrant m...

Bronfenbrenner's ecological systems theory, a multisystem framework, was used to identify risk and protective factors associated with adolescent mental and physical health (AMPH) in the English-speaking Caribbean. A structured literature review, using the online databases of Medline, PsychInfo, and Scopus, was conducted to identify peer-reviewed st...

Objective: To describe the current situation of intentional injury among Vietnamese youth as well as risk and protective factors. Method: The Sample of Survey Assessment of Vietnamese Youth 2009 (SAVY2) involving 10,044 youth aged 14 to 25 in 2009 was used and compared with SAVY1 in this study. The data were analyzed using bivariate and multivar...

Despite increasing rates of suicide among youth in Asian cultures, there is a lack of suicide data among 15-24 year-olds, and little is known about the risk and protective factors for suicidality. This study examines the prevalence of suicidal ideation and attempts among 15-24 year-olds and identifies the sociodemographic correlates of suicidality...

Despite the exceptionally large population of young migrants in China, as well as increasing rates of HIV and sexually transmitted infections in recent years, condom use and contraceptive consistency among this population remains critically under-studied. This study examines the association between migration and condom use and contraceptive consist...

To identify risk and protective factors associated with adolescent sexual and reproductive health (ASRH) in the English-speaking Caribbean through a structured literature review. Peer-reviewed articles published between January 1998 and December 2009 focused on the sexual and reproductive health of adolescents, aged 10-19 years, were included in th...

The Johns Hopkins Urban Health Institute in collaboration with Sisters Together and Reaching, Inc. (STAR) was awarded an NIH Grant (R21) to better understand the influence on adolescents of youth ministers within African American churches located in low income, urban communities with disproportionately high rates of teen pregnancy, HIV/AIDS, and ST...

Violent acts in young people constitute one of the most serious forms of violence in any society. Violence by young people in schools, on the streets, and in their families has been documented in many studies worldwide. Homicide and non-fatal assaults involving young people have been reported as a great global burden of premature death, injury and...

Premarital sex and unprotected sexual intercourse are issues of growing concern in Vietnam. The present study aims to explore the factors associated with the onset and delay of premarital sex among youth in Vietnam. A cross-sectional in-home survey was undertaken in a suburb of Hanoi, Vietnam among a sample of 2,394 never married youth ages 15 to 2...

The increased stress on military families during wartime can be particularly difficult for adolescents. The current study employed 11 focus groups with military youth, parents, and school personnel working with military youth to better understand how youth and their families cope with stressors faced as result of living in a military family. An ind...

Adolescents and young adults experience higher risks of occupational injuries and fatalities compared to adult workers. Consequently, understanding the risk and protective factors for young workers through a developmental lens is all the more compelling. This study describes the developmental processes of adolescence using a bioecological framework...

The research on highly mobile military adolescents has produced mixed findings. Whereas early descriptive studies reported that adolescents experiencing multiple residential moves exhibited symptoms of what was termed military family syndrome, more recent quantitative studies have found few negative effects after controlling for prior status. Howev...

In the January 2009 issue of this journal, Males argues that adolescent brain science perpetuates the “myth of adolescent risk taking.” He contends that those who study adolescent neuromaturation are biological determinists who ignore the profound social and environmental forces that influence adolescent behavior to further their own agendas. Males...

Adolescent Health in an International Context: The Challenge of Sexual and Reproductive Health in Sub-Saharan Africa Adesegun Fatusi, Robert W. Blum Today's young people are growing up in a world that is rapidly changing and vastly different from that of previous generations. The health challenges confronting them are also significantly different a...

Longitudinal neuroimaging studies demonstrate that the adolescent brain continues to mature well into the 20s. This has prompted intense interest in linking neuromaturation to maturity of judgment. Public policy is struggling to keep up with burgeoning interest in cognitive neuroscience and neuroimaging. However, empirical evidence linking neurodev...

Over the past 25 years, there have been major shifts in causes of mortality and morbidity among young people (aged 10—24 years). HIV/AIDS was essentially unknown 25 years ago, and other infectious diseases, such as pulmonary infections, were leading causes of death in this age-group....

The primary focus of this article is to determine which risk and protective factors are most important to adolescent reproductive health in developing countries. A comprehensive and systematic literature search was conducted on studies that examined factors in relation to the following outcomes: ever had premarital sex, condom use, pregnancy, early...

The objectives of this study were (1) to explore the consequences of parental deployment for adolescents and their families and (2) to identify potential strategies that may help adolescents cope with a parent's deployment. Eleven focus groups were conducted among adolescents in military families, military parents, and school personnel in military-...

Considerable change in the romantic and sexual behaviors of Asian young people may be occurring as traditionally Confucian societies modernize and increase outside contacts. This study explores the dimensions and context of this change in three sites at different stages in the process of modernization: Hanoi (early), Shanghai (intermediate), and Ta...

The primary purpose of this study was to compare the risk and protective factors for delinquent behaviors among American Indian youth in three distinct tribal communities. Focus group discussions were used to gather data from elders, parents, youth workers, and youth in each tribal community. Findings showed that the key source for increasing risk...

Claims that women who have elective abortions will experience psychological distress have fueled much of the recent debate on abortion. It has been argued that the emotional sequelae of abortion may not occur until months or years after the event. Despite unclear evidence on such a phenomenon, adverse mental health outcomes of abortion have been us...

Adolescent sexual risk-taking behavior has numerous individual, family, community, and societal consequences. In an effort to contribute to the research and propose new directions, this chapter applies the core competencies framework to the prevention of high-risk sexual behavior. It describes the magnitude of the problem, summarizes explanatory th...

Few studies examine the long-term consequences of family socialization experienced during early adolescence for the health and well being of young adults. This study investigates how two salient dimensions of family socialization--family closeness and parental behavioral control--are associated with three distinct risk-taking behaviors in early adu...

Early sexual debut among adolescents is associated with considerable negative heath and development outcomes. An understanding of the determinants or predictors of the timing of sexual debut is important for effective intervention, but very few studies to date have addressed this issue in the Nigerian context. The aim of the present study is to exa...

To examine the relationship between increased physical activity in adolescence and adult weight status. Cohort study based on data from the National Longitudinal Study of Adolescent Health. In-home interviews. A total of 3345 adolescents in grades 8 to 12 with body mass index (calculated as weight in kilograms divided by height in meters squared) d...

Sub-Saharan Africa is going through rapid social, political, and economic transformations that have a profound impact on youth. The present review explores trends and outcomes as they relate to education, family formation and sexual and reproductive health and the interrelationships among these areas. It is based on both published and unpublished r...

Several recent adolescent health studies in Vietnam have shown low levels of premarital sex among youth compared to neighboring countries and other regions of the world. One possible explanation for these findings is that adolescents in Vietnam are less willing to reveal their true behaviors. This study aims to assess the level of reporting of sens...

We used data from a nationally representative sample of US adolescents in school grades 7 through 12 to explore the effects of public and private religiosity on initiation, escalation, and cessation of smoking. We found that adolescents' decisions to experiment with smoking are influenced by both their individual practice of their faith and by part...

Individual health risk behaviors among Caribbean youth account for the majority of adolescent morbidity and mortality in that area. This study explores the associations between individual factors, socioenvironmental factors, and sexual health-related behaviors in Caribbean youth. Data from the 1995 Caribbean Youth Health Survey, a nine-country, cro...

To examine the relationships among risk behaviors for Caribbean youth; and to determine the correlations between initiation of sexual activity and other risk behaviors. The associations between cigarette smoking, alcohol and marijuana use, early initiation of sexual intercourse, involvement in violence and delinquency were examined using odds ratio...