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Engaging youth in communities: a framework for
promoting adolescent and community health
Parissa J Ballard,
S Leonard Syme
University of California,
Berkeley and University of
California, San Francisco,
University of California,
Berkeley, California, USA
Dr Parissa J Ballard, University
of California, Berkeley and
University of California, >#50
University Hall, MC #7360,
San Francisco, CA 94720-
7360, USA; ballardpj@
Received 28 May 2015
Revised 17 September 2015
Accepted 20 September 2015
To cite: Ballard PJ,
Syme SL. J Epidemiol
Community Health Published
Online First: [please include
Day Month Year]
Health researchers and practitioners increasingly
recognise the important role communities play in
shaping individual health. Health researchers recognise
the role of community factors as causes or determinants
of health problems; use community-based methods for
understanding complex health issues; and design
community-level health solutions. In this commentary,
we propose a fourth way to think about the role of
communities in individual health by arguing that the
community engagement process itself has implications
for individual health and strong communities. This topic
is especially important during adolescence, a
developmental window of opportunity during which
individuals need meaningful opportunities to contribute
to the world around them.
The idea that communities play an important role
in individual health is now well accepted in the
ﬁelds of public health and social epidemiology.
Health researchers focus on three roles of commu-
nity for health: they recognise the role of commu-
nity factors as causes or determinants of health
problems; use community-based methods for
understanding complex health issues; and design
community-level health solutions. At the same
time, it should be noted that individuals and
groups contribute to building and maintaining
strong communities. Indeed, current thinking on
the topic extends beyond a unidimensional ‘context
matters for health’conceptualisation in favour of a
more dynamic and bidirectional understanding of
links between people and communities.
commentary, we propose a fourth way to think
about the role of communities for health: By exam-
ining implications of the community engagement
process itself for individual and community health.
From the perspective of developmental psychology,
we argue that understanding the bidirectional links
between adolescents and communities (which we
consider to be groups deﬁned by geographical and
social boundaries) holds special promise for pro-
moting individual health and strong communities.
COMMUNITIES IN HEALTH RESEARCH
The ﬁrst area where health research is affording a
prominent role to communities is in understanding
the social causes or determinants of good and poor
health. A relatively recent movement in health
ﬁelds advocates for emphasising the multiple social
causes of health and health disparities rather
framing health exclusively in individual terms. In
social epidemiology, this can be seen through
increasing attention to the social determinants of
health. In this framework, there is speciﬁc interest
in the role of place in health
based on the under-
standing that communities ‘possess both physical
and social attributes which could plausibly affect
Accordingly, evidence is mount-
ing that features of the built environment (eg, walk-
ability, community greenspace, and access to
healthy food options)
and the social environment
(eg, social networks, trust, cohesion, bonds
contribute to individual health trajectories.
Community-level factors might be especially
important to health and well-being during adoles-
cence; communities become increasingly salient
developmental settings as youth spend more time
outside their homes. Neighbourhood structural
factors, such as socioeconomic conditions, are
linked with a variety of adolescent academic and
and recent prospective
research points to neighbourhood factors, such as
physical disorder, as a risk factor for physical
health (obesity) among early adolescent girls.
Importantly research shows that social environmen-
tal factors such as collective efﬁcacy may play a
protective role for youth development
community level social conditions as modiﬁable
social causes in adolescent health.
Second, there has been a simultaneous movement
in health research towards community-based
methods for understanding health.
Community-based methods are common in public
and are present, although less common, in
social epidemiology (referred to as popular or par-
Most frequently, propo-
nents suggest that health interventions will be most
effective and sustainable when local communities
are treated as partners, stakeholders and infor-
mants, as well as recipients, of health interven-
Community-based methods range from
working with community partners to locate rele-
vant health problems, to engaging communities in
the research process as an empowering health inter-
One subset of community-based methods
used with youth is especially relevant for the
present article. Youth participatory action research
is a community-based approach speciﬁcally
designed to empower youth in their developmental
settings, such as school and after-school pro-
grammes, to combat the ‘developmental mismatch’
between their increasing capacity and desire for
agency and their often constrained opportunities
for meaningful community contribution.
A third example of communities being afforded
prominence in health research is seen through
community-based solutions to health problems. If
health researchers are increasingly recognising the
role of community as causes of health problems
and are employing methods for understanding
Ballard PJ, Syme SL. J Epidemiol Community Health 2015;0:1–5. doi:10.1136/jech-2015-206110 1
Theory and methods
JECH Online First, published on October 6, 2015 as 10.1136/jech-2015-206110
Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd under licence.
complex health issues, it follows that health solutions should be
community-based. A community solution focus is seen in
funding initiatives, for example, focused on promoting a
‘Culture of Health’,
in academic programmes with a speciﬁc
‘Community Health’focus, and in more speciﬁc initiatives for
multilevel and community-based interventions.
grammes share the common goal of improving the health of
groups by recognising that health happens in communities
rather than in isolation. Multilevel health interventions may be
especially effective for youth as they capitalise on individual and
group processes, which are developmentally salient for adoles-
cents. In sum, then, many researchers and practitioners in the
health ﬁelds are shifting towards supporting health and decreas-
ing health disparities by understanding community causes of
health, using methods that partner with communities, and craft-
ing solutions that work for communities.
A FOURTH ROLE OF COMMUNITIES IN HEALTH
Attention to the beneﬁts that individuals receive from being
embedded in cohesive and resourced communities is well docu-
mented in scholarly research. However, a long tradition of
research from psychology and public health reveals that there
may be something special about the ﬂip side of being embedded
in communities: contributing. What people contribute to their
communities, through collaborating with others to address
social issues, may be just as—or even more—beneﬁcial to health
than receiving support.
Community psychologists have
long argued that there are beneﬁts of community participation
for individual and communities;
we add a developmental
argument for focusing on adolescents and suggest psychological
mechanisms that might link civic engagement with health. We
propose an initiative in health research to focus on youth civic
engagement (YCE) as a promising approach to synergise efforts
to promote adolescent and community health (ﬁgure 1).
Youth civic engagement
is a critical window of development characterised
by changes at multiple levels, from biology to social role transi-
during which opportunities for participation in mean-
ingful activities, feeling that one matters, and forming warm and
supportive relationships with adults are crucial to positive youth
11 12 21 22
Furthermore, adolescence is a formative
window for life-long health
and civic trajectories.
civic development and adolescent health are traditionally exam-
ined as separate processes, we believe that there is a compelling
reason for considering them together. A large body of work
documents health effects of certain forms of civic engagement,
such as volunteerism, among older adults.
cents have a different set of developmental goals and needs that
make it a relevant stage to understand how community partici-
pation affects healthy development. For example, a major devel-
opmental task of adolescence is identity formation, which
includes deﬁning one’s role in relation to society
developmental frameworks, such as positive youth development
and sociopolitical development, suggest that youth engagement
within their communities is an important part of
Civic engagement can be deﬁned as ‘individual and collective
actions designed to identify and address issues of public
Diverse youth have access to different types of civic
opportunities and may participate in a variety of such collective
actions aimed at community contribution: formal volunteerism,
political activities such as campaigning and voting ( for older
adolescents), and activism such as protesting.
We believe that
high-quality civic engagement, by offering youth meaningful
and empowering opportunities to engage with their communi-
ties, can provide positive experiences for adolescents at a crucial
developmental period while at the same time channelling the
considerable skills and energy of youth to improve
YCE can promote adolescent health
We propose that high quality YCE can promote adolescent health
by providing adolescents opportunities for care-giving and change-
making. YCE could affect three aspects of adolescent health:
health and risk behaviours, mental health, and indicators of
disease vulnerability or physiological stress markers (eg, inﬂamma-
tion). The most direct evidence that YCE can promote adolescent
health comes from research on care-giving through formal volun-
teering programmes. In a randomised control trial study, Schreier
assigned high school students to volunteer weekly for
2 months in the Fall (intervention group) or Spring (control
group) in after-school programmes with elementary school chil-
dren. The authors found that intervention group participants had
lowered cardiovascular risk as measured through inﬂammatory
markers, cholesterol and body mass index
compared to the
control group, suggesting that volunteering can improve adoles-
cent health. Extensive research with adults points to a link
between volunteerism and better health
and one suggested
mechanism explaining the link between volunteerism and health is
the promotive function of caring for others and giving support.
Although caregiving for close others can increase health risk it
might be protective or promotive for health when not overly bur-
densome and when appraised as meaningful and fulﬁlling.
Indeed, psychological evidence suggests that providing care and
support to close others (family, friends, neighbours) can predict
reduce mortality and morbidity
neural reward systems.
While care-taking may provide health
beneﬁts across ages, adolescents might speciﬁcally beneﬁt from the
opportunity to contribute to their communities in meaningful
Volunteerism is one care-based category of civic activities;
YCE can also take explicitly political forms. Political forms of
civic engagement might affect health though a similar pathway
giving adolescents a chance to contribute, provide care, and ﬁnd
meaning; or, it might operate through altogether different path-
ways, such as through psychological empowerment. Community
and developmental psychologists give special attention to the
positive role of empowerment in adolescent development, espe-
cially among marginalised young people.
High quality civic
programmes can help adolescents come to see themselves as
civic actors with real opportunities to engage with communities.
Such opportunities for civic empowerment among marginalised
youth are positively associated with academic success, political
engagement and general well-being.
Further, civic empower-
ment mediates the links between supportive family and school
contexts on well-being
and political participation.
together, correlational and experimental evidence suggest that
high quality YCE might have a positive developmental function
for many domains of youth development, though more direct
evidence is needed linking YCE and adolescent health. Given
that adolescents self-select into civic activities based on internal
motivations and structural opportunities and constraints
will be important to understand the interplay of selection effects
We consider adolescence to be roughly from age 12 to 21 and refer to
interchangeably with ‘youth’in this paper.
2 Ballard PJ, Syme SL. J Epidemiol Community Health 2015;0:1–5. doi:10.1136/jech-2015-206110
Theory and methods
and the civic experiences themselves on health outcomes.
Other critical questions to address are about mechanisms linking
various forms of YCE and health and understanding which
youth may especially beneﬁt from such experiences (see box 1
for a suggested research questions and hypotheses). Importantly,
high quality YCE should operate at multiple levels to empower
individuals and communities.
YCE can improve structural aspects of communities
Ideally, high quality civic programmes offer youth a chance to
collectively engage with their communities to solve what they
see as pressing social problems. Although such change will be
slow and setbacks inevitable, from the perspective of positive
youth development, youth should be considered assets to com-
with developing skills and ideas that can contribute
to community life with appropriate mentorship from adults.
As an example, youth from the San Francisco Youth
Commission engaged in a multiphase process to identify teen
transportation needs and to lobby for policy changes. After
3 years, the youth commission succeeded in convincing the
San Francisco Municipal Transportation Agency (MUNI) board
to approve a ‘Free MUNI for Youth’programme with an expan-
sion to include 18-year-olds from low to moderate income fam-
ilies in those eligible for free MUNI passes (SF Youth
Commission). In this example, engaged youth formed horizon-
tal partnerships with other youth across districts as well as verti-
cal partnerships with local political leaders. Together, they
successfully changed policy that directly improved the well-
being of San Francisco teen residents and families by providing
transportation access to some of the city’s most vulnerable
young people. Ultimately, incremental improvements in commu-
nities and policies affecting youth should feedback to support
adolescent health and the broader health of communities.
YCE can improve the social aspects of communities
YCE can help build community social capital, increase social trust
between community members, contribute to a sense of commu-
nity social cohesion, and promote collective empowerment.
From the perspective of social capital theory, individual civic
engagement is indeed part of what deﬁnes communities high in
social capital. A critical social aspect of communities is a sense of
collective efﬁcacy, or the perceived ability that communities can
band together to solve social problems that arise. According to
extensive work of Sampson et al,
collective efﬁcacy is a charac-
teristic that varies dramatically by neighbourhood and predicts
Figure 1 Schematic representation of
the role of communities in research on
Box 1 Speciﬁc Proposals for a Research Agenda Linking
Youth Civic Engagement, Adolescent, and Community
1. Community-engaged health intervention projects present an
opportunity for understanding whether the engagement
process has implications for health. Researchers engaging
community members in projects to improve the health of
their communities can add a dimension to studies by
measuring the civic experience of community members and
individual health during community engagement to gain
insight about how community-engagement processes covary
with individual health trajectories.
2. Large national studies of adolescent development can add
measures of civic experiences (eg, participation in different
types of civic activities, feelings of empowerment, and
feelings of contribution and meaning) to see how naturally
occurring civic development affects, and is affected by, other
domains of youth development.
3. To overcome methodological challenges in civic development
research, innovations in study methods for understanding
civic development are needed. For example, randomised
control trial studies will best enable researchers to establish
causal links between civic engagement and health. There are
challenges in designing random assignment studies in the
context of activities that are typically voluntary, but these
challenges can be overcome with creative methods such as
simulation studies. Qualitative studies will be needed to
contextualise particular civic experiences especially as they
vary for adolescents from demographic groups.
4. Researchers should examine complex links between civic
engagement and health, informed by theory. For example, it
is likely that links between civic engagement and health will:
A. Be non-linear over time ( perhaps with negative initial
health effects if civic engagement is stressful and positive
effects over the longer-term if it is empowering)
B. Be moderated by things like social status and quality of
C. Be developmentally differentiated (with links stronger
during developmental transitions)
D. Vary by type of civic engagement (volunteerism vs
E. Vary by type of health outcome (health behaviours, mental
health, physical health
Ballard PJ, Syme SL. J Epidemiol Community Health 2015;0:1–5. doi:10.1136/jech-2015-206110 3
Theory and methods
neighbourhood safety and the health and development of resi-
dents. High quality YCE, should directly increase participants’
sense of collective efﬁcacy, and, especially when visible to other
community members, could lead to broader a sense of commu-
nity collective efﬁcacy.
Although this is a complex process with
nuance regarding the conditions under which civic engagement
indeed increases community capacity and health, ideally, engage-
ment should affect the perceived and actual capacity of communi-
ties to meet their needs.
Elaborating on Cummins et al’s
argument for a broader recogni-
tion of the ‘mutually reinforcing and reciprocal relationship
between people and place,’we argue that the process by which
people and place are reciprocally related also has implications for
individual and community health, especially during the develop-
mental window of opportunity known as adolescence. Ideally,
YCE operates at the individual level by offering youth a meaning-
ful chance to care for others and to become empowered to create
change, while also operating at the community level to increase
local capacity through social action processes. It is very important
to note that YCE also has the potential to undermine adolescent
health and well-being; for example, if such engagement is stress-
ful, burdensome or futile. The focus of the present paper is on
the positive potentials of YCE; the negative possibilities are
explored in depth elsewhere (eg, P J Ballard and E J Ozer. The
implications of youth activism for health and well-Being. In:
Conner J, Rosen S. Contemporary Youth Activism: advancing
Social Justice in the United States (under review)). The promise
of the approach outlined here is twofold: it offers a dual focus on
promoting adolescent and community health and it relies on a
transdisciplinary approach to health. Psychologists, epidemiolo-
gists and population health scientists each understand pieces of
the conceptual puzzle about how people become engaged with
places, how places support this process, and how this process can
promote individual and community health. By offering a frame-
work linking civic engagement, adolescent health, and healthy
communities, we challenge psychologists to focus on promoting
adolescent development in a way that also builds communities
and we challenge population health scientists to consider how
community engagement processes can affect adolescent health
and well-being. YCE can be a lens for simultaneously considering
individual and community health and the processes by which
community participation might improve the health and well-
being of our youth and our communities.
What is already known on this subject
Adolescent health is affected by the communities adolescents
live in. At the same time, adolescents affect their own
communities through civic engagement (ie, taking collective
action to address issues of public concern).
What this study adds
We believe that the community engagement process has
implications for adolescent health and strong communities. We
propose an initiative in health research to focus on youth civic
engagement as a promising approach to synergise efforts for
promoting adolescent and community health.
Acknowledgements The authors thank the Robert Wood Johnson Foundation
Health and Society Scholars program for its ﬁnancial support. The authors thank
Keely Muscatell and Lindsay Till Hoyt for comments on an early draft and our many
colleagues at UCSF and UC Berkeley for ongoing discussion of these ideas. We also
thank Allen Lu from the San Francisco Youth Commission for feedback about the
youth MUNI program.
Contributors PJB conceptualised and wrote this article. SLS discussed
conceptualisation and helped with framing the idea and editing the article.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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