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Adolescents as Deliberative Citizens: Building Health Competence in Local Communities
Abstract
Given the host of tragic events that children experience, it is often compelling for well-intended adults to respond in a protective and charitable fashion. The child rights approach asks for more. Building on their collective experiences in the developmental and social sciences, the authors present in roughly chronological fashion a synopsis of the theoretical explorations and scientific evaluation that completes a framework to advance the status of children as citizens. The recognition of the agency and capability of a child and the dynamic and enduring source of socialization from and social integration within the community are fundamental to this project. The participatory rights enshrined in the Convention on the Rights of the Child serve as an impetus and inspiration to this project, the Young Citizens Program. What began with small-scale deliberative groups in Chicago matured into a cluster randomized controlled trial in northern Tanzania.
... The encouraging results of this observational study challenged us to design an experimental intervention to enable young adolescents to strengthen collective efficacy in their local neighborhoods (Earls & Carlson, 2002). To achieve this, the YC Program established its feasibility, safety and acceptability within a framework grounded in theory and empirical research necessary to guide implementation and multilevel outcome measurement (Carlson & Earls, 2011a; Chan, Trickett, Carlson, & Earls, 2003). Several social and behavioral science theories are foundational to the YC Program. ...
... Each session script was introduced by a standard agenda containing: review of previous session, introduction to current agenda and objectives, cooperative roles, activities, snack break, reflections, and preview of objectives of the subsequent session. The development of sessions was a collaborative effort between the investigators and supervisory staff based on the theory that guided the YC Program (Carlson & Earls, 2011a) and the evaluation of reports from the previous week's session (Carlson & Earls, 2011b ). Quality control was achieved by careful selection, training and supervision of team members, along with standardized, detailed reports of all sessions and team meetings. ...
... The YC Program was conceived as a structural intervention aimed at strengthening personal and collective efficacy to promote HIV/AIDS community competence (Carlson & Earls, 2011a). The participatory curriculum enabled young adolescents to acquire the scientific knowledge and the communicative and critical thinking skills needed engage in informed public deliberations around HIV/ AIDS in their neighborhoods. ...
... The articles defining the participatory rights place the adolescent on the path toward the full expression of citizenship. These rights reflect a turn in our notion of children's interests and capacities and their status in society (Carlson & Earls, 2011a;Earls, 2011). They represent the boldest and most conspicuous component of the CRC. ...
The United Nations Convention on the Rights of the Child (CRC, United Nations General Assembly, 1989) is a transformative document which has already improved the lives of millions of young people worldwide. Ratified into law by the majority of the countries of the world, it is the first human rights treaty focusing specifically on the rights of individuals under 18 years of age. The rights described in the treaty, however, are often seen as more important for younger children than for adolescents. This policy statement reviews the germane research on the period of adolescence and affirms that the protections and entitlements in the CRC are as important for adolescents as for younger children. Recommendations for policy and research are included.
The questions of optimization of educational process are considered on the basis of forming to health-improvement competence of student young people. Basic factors, influencing on the confidence of man in the capabilities, are selected: successful experience in the past; vicariation teaching; verbal persuasion; interiorization of motivation; succession of the teaching programs. It is marked that at forming of competence it is necessary to take into account the role of motivation, degree of estimation of the capabilities and confidence in the possibilities. Forming cognitive activity, positive motivation and steady interest to employments are the basic constituents of successful development of personality. It is marked that forming of competence foresees: providing knowledge about the methods of activity; the real application of knowledge is in practical activity; interiorization of motivation and individual approach; it is providing of succession of the teaching programs.
In 1989 the UN General Assembly adopts the Convention on the Rights of Children and Adolescents (CRC) recognizing children and adolescents as subjects of rights. To be mandatory, its ratification involves creating conditions for children and adolescents to express themselves and be considerate. This means that their voice must be included in the scientific work, not as a complement or contrast, but as an actor priority, especially in public policies that compete. This work aims to contribute to the development of productions to consider the participation of children and adolescents, through the approach of challenges and scope for research analysis focusing on three areas: the role of the State, families and the extent of child participation. The paper is organized in compliance with two objectives. First, to describe the theoretical bases that support the right of participation of children and adolescents, checking the CRC and the Model of Integral Protection of Children; the CRC and the right of participation; and the approach to child participation in research in relevant areas. And second, to characterize empirical research involving children and adolescents conducted in various contexts since 1998. We conclude that the speech of the CRC has faced in practice with traditional conceptions about the role of children and adolescents, both in macro scenarios (politics and State) as well as microsocial scenarios (the family), "crashing" with traditional prevailing approaches (guardian). The lack of understanding of the meaning of participation and the resistance to change of the place of childhood acts as barriers to the installation of studied law, prevailing form of action mediated by adult link. By contrast, the concept of scaffolding will allow a shift in the promotion of citizenship and children's role and its forms of observation, challenging us to investigate the childhood experience from promotion (not from deficiencies), independent of particular features incorporating the concepts of agency, equity and governance.
The purpose of the review is to investigate various relations between the concepts of competence and participation found within child and youth research with the aim of identifying differences in practical reasoning of the various kinds of child research. The search identified 260 articles, and an in-depth analysis of 39 articles was conducted, elaborating the conceptual differences inherent in the different child research fields. Based on a philosophy of practice, the analysis identified 3 different causal connections between the concepts of competence and participation, indicating 3 different ways of understanding means and ends in child research. The review thereby offers an understanding of how and why interdisciplinary problems sometimes occur in education and child care.
Ultimately achieving an AIDS-free generation might rely more than we thought on developing adolescent leaders as agents of change -- not simply behavior change but societal and legal change. Innovative programming may be expanding adolescents’ social networks and engagement increasing their HIV-specific knowledge and increasing demand for HIV testing and treatment; but what is to meet this demand; and how will the effects of these programs be rigorously measured? Technology companies and mobile host sites are not clinicians or experts in evaluation. Even dizzying advances in technology are useless if adolescents have no access to them or are not able to access health promoting information services or networks. Moving forward technology and social innovators -- young and old -- must task themselves with removing barriers to testing and treatment that will reduce the sheer numbers of HIV infections and AIDS deaths in this population. Innovations must support adolescents’ access to a wider array of confidential testing options available in the community and through the health sector link them to biomedical and other prevention services of proven efficacy such as antiretroviral therapy medical male circumcision and to specific harm reduction interventions. In the years to come it is network disruption -- of entrenched social mores stigma attitudes and discriminatory practices -- that will constitute true innovation. (Excerpts)
Despite growing attention to both public engagement in policy development, and youth civic engagement, the engagement of young women and young mothers receives little attention. This article proposes guidelines for engaging with young women in provincial public policy development via their participation in public engagement initiatives. Developed in the context of a small Canadian province, the guidelines are based on an existing public engagement framework, modified to consider young women's identities and engagement strategies. The guidelines are presented relative to the context, process, tools, and outcomes of public engagement initiatives. In presenting the guidelines, this article grapples with paradoxes of young women's engagement, including the role of policy and policy discourses in creating and governing their identities, the role of public engagement in upholding and dismantling neoliberal policy agendas, and the challenges and benefits of reconciling appropriate conceptualisations of young women with a positivistic, masculine engagement framework.
At the 2011 Greenville Family Symposium, we facilitated a deliberative workshop on the implementation of a theoretically based participatory health promotion curriculum for adolescents to situate and guide their public actions. This intervention, known as the Young Citizens Program (YCP), was most recently implemented in Moshi, Tanzania, a midsized municipality in the Kilimanjaro Region, during peak years of the HIV pandemic extending across Sub-Saharan Africa. The individual and community level impacts of this intervention were measured in a cluster randomized controlled trial (CRCT) in which neighborhoods served as the units of randomization. This article builds on the workshop by providing more details on the implementation and program evaluation of the YCP that are not available in our previous publications. In this article, we reference the theories and previous publications in conjunction with discussing the topics. This intervention reflects an evolving societal view of children as capable of conveying detailed knowledge, portraying real-life dilemmas, and engaging adults in critical thinking about possible actions and solutions. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Correlational analysis, classical test theory, confirmatory factor analysis, and multilevel Rasch modeling were used to refine a measure of adolescents' exposure to violence (ETV). Interpersonal violence could be distinguished from other potentially traumatic events; it was also possible to distinguish three routes of exposure (victimization, witnessing, and learning of). Correlations confirmed that ETV subscales are related to measures of aggression, delinquency, and depression/anxiety. Reliability was improved by combining ETV subscales and/or caregiver and youth reports. Valid and reliable measures of ETV are critical to future research in associating violence exposure with common mental health and behavioral outcomes and disorders, and tracking how early violence exposure may affect future outcomes for adolescents. © 2007 Wiley Periodicals, Inc. J Comm Psychol 35: 603–618, 2007.
Roughly 3 million people worldwide were receiving antiretroviral therapy (ART) at the end of 2007, but an estimated 6.7 million were still in need of treatment and a further 2.7 million became infected with HIV in 2007. Prevention efforts might reduce HIV incidence but are unlikely to eliminate this disease. We investigated a theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, and examined the conditions under which the HIV epidemic could be driven towards elimination.
We used mathematical models to explore the effect on the case reproduction number (stochastic model) and long-term dynamics of the HIV epidemic (deterministic transmission model) of testing all people in our test-case community (aged 15 years and older) for HIV every year and starting people on ART immediately after they are diagnosed HIV positive. We used data from South Africa as the test case for a generalised epidemic, and assumed that all HIV transmission was heterosexual.
The studied strategy could greatly accelerate the transition from the present endemic phase, in which most adults living with HIV are not receiving ART, to an elimination phase, in which most are on ART, within 5 years. It could reduce HIV incidence and mortality to less than one case per 1000 people per year by 2016, or within 10 years of full implementation of the strategy, and reduce the prevalence of HIV to less than 1% within 50 years. We estimate that in 2032, the yearly cost of the present strategy and the theoretical strategy would both be US$1.7 billion; however, after this time, the cost of the present strategy would continue to increase whereas that of the theoretical strategy would decrease.
Universal voluntary HIV testing and immediate ART, combined with present prevention approaches, could have a major effect on severe generalised HIV/AIDS epidemics. This approach merits further mathematical modelling, research, and broad consultation.
Differences in maternal characteristics only partially explain the lower birth weights of infants of African-American women. It is hypothesized that economic and social features of urban neighborhoods may further account for these differences. The authors conducted a household survey of 8,782 adults residing in 343 Chicago, Illinois, neighborhoods to assess mean levels of perceived social support and used US Census data to estimate neighborhood economic disadvantage. Data on birth weight and maternal risk factors were gathered from 95,711 birth certificates (1994-1996). Before statistical adjustment of the data, infants born to African-American mothers were found to be, on average, 297 g lighter than those born to White mothers. After adjustment for individual-level risk factors, this difference was reduced to 154 g. For African-American mothers only, mean birth weight decreased significantly as the neighborhood level of economic disadvantage increased. For White mothers only, a significant positive association was found between perceived levels of neighborhood social support and infant birth weight. Adding these neighborhood-level predictors to the model reduced the adjusted White versus African-American difference in birth weight to 124 g. Results support the hypothesis that neighborhood-level factors are significantly associated with infant birth weight.
To estimate the cause-effect relationship between exposure to firearm violence and subsequent perpetration of serious violence, we applied the analytic method of propensity stratification to longitudinal data on adolescents residing in Chicago, Illinois. Results indicate that exposure to firearm violence approximately doubles the probability that an adolescent will perpetrate serious violence over the subsequent 2 years.
A community-based cluster randomized control trial in a medium-sized municipality in Tanzania was designed to increase local competence to control HIV/AIDS through actions initiated by children and adolescents aged 10 to 14 years. Representative groups from the 15 treatment communities reached mutual understanding about their objectives as health agents, prioritized their actions, and skillfully applied community drama ("skits") to impart knowledge about the social realities and the microbiology of HIV/AIDS. In independently conducted surveys of neighborhood residents, differences were found between adults who did and did not witness the skits in their beliefs about the efficacy of children as HIV/AIDS primary change agents.
We propose a theoretical framework on the structural sources and spatially embedded nature of three mechanisms that produce collective efficacy for children. Using survey data collected in 1995 from 8,782 Chicago residents, we examine variations in intergenerational closure, reciprocal local exchange, and shared expectations for informal social control across 342 neighborhoods. Adjusting for respondents' attributes, we assess the effects of neighborhood characteristics measured in the 1990 census and the role of spatial interdependence. The results show that residential stability and concentrated affluence, more so than poverty and racial/ethnic composition, predict intergenerational closure and reciprocal exchange. Concentrated disadvantage, by contrast, is associated with sharply lower expectations for shared child control. The importance of spatial dynamics in generating collective efficacy for children is highlighted-proximity to areas high in closure, exchange, and control bestows an advantage above and beyond the structural characteristics of a given neighborhood. Moreover, spatial advantages are much more likely to accrue to white neighborhoods than to black neighborhoods.
The Program on Human Development and Criminal Behavior (the "Program") has developed a sophisticated, interdisciplinary, and intellectually ambitious agenda for research on the causes and prevention of crime.
This book summarizes the conclusions from the first two years of work on the Program.
We have aimed to design a comprehensive research agenda to study the causes and prevention of conduct disorder, delinquency, criminality, and serious antisocial conduct. The major components of that research agenda are described in this book and are briefly summarized in this introduction.
There are five key issues to be resolved by the proposed program of research. The first issue is to identify factors that place children at risk of becoming delinquent. . . . The second is to chart developmental sequences that lead from early conduct disorder to delinquent and criminal behavior. The third addresses the interrelationships among individual characteristics, family environments, and community structures as they relate to criminal behavior. The fourth is concerned with identifying opportunities during development when interventions are likely to be most effective. The final issue is to select the most promising strategies for experimental intervention. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study reports on the development of a structured interview, My Exposure to Violence (My ETV), that was designed to assess child and youth exposure to violence. Eighty participants between the ages of 9 and 24 were assessed. Data from My ETV were fit to a Rasch model for rating scales, a technique that generates interval level measures and allows the characterization of both chronic and acute exposure. Results indicated that the fit statistics for six scales, covering both lifetime and past year victimization, witnessing of violence, and total exposure, were all good. These scales were found to have high internal consistency (r=.68 to .93) and test-retest reliability (r=.75 to .94). Evidence of construct validity was provided by the item analysis, which revealed a theoretically sensible ordering of item extremity, and also by analysis of bivariate associations. As expected, younger subjects generally reported less exposure to violence than did older subjects, males reported more exposure than did females, African-American subjects reported higher levels of exposure than did White subjects, violent offenders reported more exposure than did non-offenders, and those living in high crime areas reported more exposure than did those residing in low crime areas. Future areas of investigation and the potential contribution to studies of antisocial behavior and post-traumatic stress disorder are discussed.
The social scientific study of children is an evolving discipline, a fact that benefits society in that our knowledge about
the lives of children presumably improves with every refinement of the scientific method. Among the latest and most important
innovations to appear is Search Institute’s methodology of developmental assets, which offers a “set of benchmarks” for families
and communities to follow to help ensure “positive child and adolescent development” (Benson, Leffert, Scales, & Blyth, 1998). The framework of developmental assets represents a huge step forward in social science because it studies positive youth
development, not merely negative actions such as delinquency or drug use, and strives to characterize both “external assets”
in the community and “internal assets” held by children themselves.
It is hypothesized that collective efficacy, defined as social cohesion among neighbors combined with their willingness to
intervene on behalf of the common good, is linked to reduced violence. This hypothesis was tested on a 1995 survey of 8782
residents of 343 neighborhoods in Chicago, Illinois. Multilevel analyses showed that a measure of collective efficacy yields
a high between-neighborhood reliability and is negatively associated with variations in violence, when individual-level characteristics,
measurement error, and prior violence are controlled. Associations of concentrated disadvantage and residential instability
with violence are largely mediated by collective efficacy.
The term social ecology refers to the nested arrangement of family, school, neighborhood, and community contexts in which children grow up. In this chapter, new directions in public health science as reflected in the theoretical and methodological implications of the concept are explored. The contributions of this ecologically oriented approach to child health practice, designed as it is from a health promotions perspective, are considered. A critique of the term social capital is also presented because of its growing popularity in matters of child health. The point is made that application of this vague term carries the serious risk of misspecifying social phenomena. Future trends in the promotion of child well-being are in a position to flourish given the confluence of advances in theory, methods, and analytical capacity. The capacity to benefit children is also enhanced as public health science aims to translate the principles of child rights into health practice and policy.
Evidence suggests that African American youths initiate sexual activity at earlier ages than do European American or Latino youths. Using data from a multilevel study in Chicago, we developed and tested a neighborhood-based model of the timing of first adolescent intercourse that emphasizes the impact of neighborhood structural disadvantage and collective efficacy on early sexual activity (at ages 11 to 16). In turn, we explored the extent to which neighborhood factors account for racial differences in the timing of first intercourse. The findings indicate that demographic background, family processes, peer influences, and developmental risk factors account for about 30% of the baseline increased likelihood of early sexual onset for African American youths compared with European American youths. However, a significant residual racial difference remained even after we considered a host of micro-level factors. Neighborhood-level concentrated poverty largely explained this residual racial difference. Collective efficacy also independently contributed to the delay of sexual onset. No significant baseline difference in age of sexual initiation was found between Latino and European American youths.
Little research has investigated possible effects of neighborhood residence on mental health problems in children such as depression, anxiety, and withdrawal.
To examine whether children's mental health is associated with neighborhood structural characteristics (concentrated disadvantage, immigrant concentration, and residential stability) and whether neighborhood social processes (collective efficacy and organizational participation) underlie such effects.
The Project on Human Development in Chicago Neighborhoods is a multilevel, longitudinal study of a representative sample of children aged 5 to 11 years in the late 1990s recruited from 80 neighborhoods. A community survey assessing neighborhood social processes was conducted with an independent sample of adult residents in these 80 neighborhoods and is used in conjunction with US census data to assess neighborhood conditions.
A total of 2805 children (18.1% European American, 33.8% African American, and 48.1% Latino) and their primary caregivers were seen twice.
Child Behavior Checklist total raw and clinical cutoff scores for internalizing behavior problems (depression, anxiety, withdrawal, and somatic problems).
The percentages of children above the clinical threshold were 21.5%, 18.3%, and 11.5% in neighborhoods of low, medium, and high socioeconomic status, respectively. A substantial proportion of variance in children's total internalizing scores (intraclass correlation, 11.1%) was attributable to between-neighborhood differences. Concentrated disadvantage was associated with more mental health problems and a higher number of children in the clinical range, after accounting for family demographic characteristics, maternal depression, and earlier child mental health scores. Neighborhood collective efficacy and organizational participation were associated with better mental health, after accounting for neighborhood concentrated disadvantage. Collective efficacy mediated the effect of concentrated disadvantage.
A large number of children in poor neighborhoods have mental health problems. The mechanism through which neighborhood economic effects operated was community social control and cohesion, which may be amenable to intervention.
The pandemic of HIV/AIDS is actually a composite of many regional and national-level epidemics. The progress made in many parts of the developed and developing world is tempered by the continued devastating consequences of HIV infection in sub-Saharan Africa (SSA). This review focuses on the ways in which children and adolescents are impacted by the epidemic, giving particular attention to their mental health.
A health promotion framework is adopted to guide analysis. Three issues are covered: prevention of HIV infection, care and treatment of children infected with HIV, and care of children whose caregivers are ill or have died of AIDS. Existing reviews and literature search engines were used to review the scientific literature, focusing on the past five years.
Preventive interventions continue to manifest limited benefits in behavioral changes. More complex causal models and improved behavioral measures are needed. In the African context, the time has come to view pediatric AIDS as a chronic disease in which the mental health of caregivers and children influences important aspects of disease prevention and management. Increasingly sophisticated studies support earlier findings that social and psychological functioning, educational achievement and economic well-being of children who lose parents to AIDS are worse than that of other children.
Important changes are taking place in SSA in increased access to HIV testing and antiretroviral therapies. To be effective in promoting mental health of children and adolescents, interventions require a more fundamental understanding of how to build HIV competence at personal and community levels. A key recommendation calls for the design and execution of population-based studies that include both multilevel and longitudinal features. Such rigorous conceptual and empirical investigations that assess the capacities of children are required to mobilize children, families and communities in comprehensive actions plans for prevention, treatment and care in response to the enduring HIV/AIDS pandemic.
Social ecology and the development of stress regulation
- Mary Carlson
- Felton Earls
Promoting human capability as an alternative to early crime prevention
- Felton Earls
- Mary Carlson
Adolescents as collaborators
- Felton Earls
- Mary Carlson
- Bronfenbrenner, Urie