Today’s youth are at risk for multiple behaviors that negatively impact their physical and mental health and development, as well as harm their performance in school and sports.
The top three most common substance use habits among American teens are alcohol, e-cigarette, and marijuana consumption, with tobacco, non-medical opioid and other illicit drug use also posing significant health, addiction, and safety hazards.
Large proportions of US high school seniors have drank alcohol (61.6%), been drunk (36.7%), vaped e-cigarettes (38.8%), used cannabis (38.3%), and used illegal drugs other than cannabis (13.2%) in their lifetimes, according to the most recent 2022 Monitoring the Future study: https://monitoringthefuture.org/wp-content/uploads/2022/12/mtf2022.pdf
Chronic Disease and Mental Health Risk Behaviors
Even more ubiquitous among US adolescents are their risks for chronic disease and mental health problems.
These include physical inactivity, poor eating habits like skipping breakfast and under-consumption of fruits and vegetables, getting inadequate sleep, and uncontrolled daily stress.
Among high school students, only 23.2% participated in one-hour of physical activity every day, 15.5% were obese, only 33.1% ate breakfast every morning, only 14% ate vegetables three or more times per day, only 22.1% got eight or more hours of sleep a night, and 36.7% felt so sad or hopeless that it interfered with their daily activities, according to the latest Youth Risk Behavior Survey Data 2019: https://yrbs-explorer.services.cdc.gov/#/
Multiple risk behaviors, including substance use and chronic disease and mental health risk habits during adolescence can lead to significant adverse health and social outcomes in young adulthood: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378566/
Meanwhile, healthy lifestyle behaviors like physical activity and good eating habits are associated with positive youth development: https://link.springer.com/chapter/10.1007/978-3-030-70262-5_8
Brief Integrated Interventions
Providing programs that address multiple health risks designed to prevent substance use and promote healthy behaviors are therefore critical to reducing mental and physical harm and promoting positive youth development.
Integrating multiple risk behaviors within single prevention interventions is also likely to be more cost-effective than providing individual programs targeting each substance use and chronic disease and mental health risk behavior separately.
An ideal vehicle for providing multiple risk behavior programs to youth are brief interventions.
Brief interventions have a decades-old history of successfully influencing both substance use and healthy behavior change and are identified as an evidence-based practice by multiple health agencies, such as the Substance Abuse and Mental Health Services Administration (SAMHSA)(https://www.samhsa.gov/sbirt) and the American Academy of Pediatrics (AAP): https://www.thenationalcouncil.org/resources/aap-policy-statement-screening-brief-intervention-and-referral-to-treatment/
In addition, brief interventions have the potential to increase public health reach to broader youth populations across diverse settings when compared to more intensive or lengthy prevention programs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864856/
Below are six steps for simultaneously preventing youth substance use while promoting their health-promoting behaviors using brief intervention strategies.
6 Steps for Integrating Prevention with Wellness
Step #1: Use screening to increase health behavior reflection
Reflecting upon one’s health behaviors is the first step in changing personal habits. Assessing which substance use and healthy behaviors you are currently engaged in is essential for increasing awareness of your health risks and strengths.
In addition, thinking about specific steps you can take to improve each of your health behaviors is a necessary first step in setting goals to improve your habits.
Using screening surveys or asking questions is a great way to enhance reflection on one’s health behaviors.
Strategies:
- Have youth complete a brief survey of their current substance use and healthy habits
- Ask youth which specific types of healthy habits they’d like to increase
- Discuss with youth what specific steps they could take to improve each of their healthy habits
- Ask youth which specific types of substance use they’d like to avoid in the future
Step #2: Highlight benefits of healthy behaviors, especially positive future images
Identifying the benefits of engaging in each healthy behavior will increase positive expectancies which in turn increases motivation to participate in those behaviors.
For example, some benefits of regular physical activity are that it reduces stress and helps you sleep better.
Positive future images, as well as images of peers engaging in specific healthy habits are associated with one’s personal identity and are desirable outcomes that hold particular motivational strength.
Unconscious positive future images associated with engaging in healthy behaviors can be cued using image terms and illustrations, unleashing their motivational force.
For example, some positive future images of engaging in regular physical activity include being more energetic, successful, and calm under pressure.
Strategies:
- Present feedback to youth highlighting benefits and future images of engaging in each healthy behavior they do and do not currently practice
- Show youth illustrations of peers experiencing positive outcomes from participating in healthy behaviors
- Ask youth to think about how they would look and feel in the future if they engaged in individual healthy habits
- Have youth compare themselves now and a year from now if they participated more regularly in specific healthy behaviors
Step #3: Illustrate how substance use harms healthy habits & benefits
Linking how specific substance use harms or interferes with achieving healthy behaviors is key to addressing multiple health risks within single programs.
These messages should also illustrate how substance use sabotages achieving positive benefits and desired future images associated with participating in specific healthy habits.
For example, marijuana use reduces your energy, motivation and stamina needed to participate in regular physical activity and be more active.
These messages should demonstrate how using alcohol, e-cigarettes, cannabis, or opioids, for example, counteract the beneficial effects of healthy behaviors and prevents one from reaching desired goals in life.
Strategies:
- Provide feedback to youth illustrating how specific substances harm achieving healthy behavior goals, outcomes, and positive identities
- Ask youth to identify how specific substances can interfere with achieving healthy behaviors and their benefits
- Have youth list negative outcomes from using specific substances to health and healthy behaviors
Step #4: Address other known risk factors for substance use
In addition to linking specific substance use to healthy behaviors, it’s important to target other known risk factors for using substance use to strengthen brief multiple behavior interventions.
These risk factors include perceived harmfulness of using substances, social norms, drug myths, resistance skills, environmental influences, and healthy alternatives to using substances.
Strategies:
- Present individual substances as increasing the likelihood of experiencing salient life problems such as academic failure (perceived harmfulness)
- Correct misperceptions that most peers use and approve of using specific substances (social norms)
- Address common myths regarding substances, for example, that cannabis is less harmful than alcohol use (drug myths)
- Discuss how to resist and say “NO” to offers to use substances (resistance skills)
- Illustrate how friends, family and certain settings can increase or decrease risk for using substances (environmental influences)
- Have youth generate healthy alternatives to using substances, such as exercise, music, relaxation strategies, art, etc. (healthy alternatives)
Step #5: Help youth make a multiple health behavior plan
Setting goals, particularly short-term goals, is essential to initiating and achieving behavior change, as well as developing self-regulation skills and self-efficacy.
Goals should be specific, that is measurable, as well as achievable.
Multiple behavior goals should be set to prevent substance use while increasing one or more healthy lifestyle behaviors.
Strategies:
- Have youth set weekly (7-day) goals to both avoid substance use and increase a healthy behavior
- Have youth sign and date and you co-sign the goal to make it a public commitment and increase motivation for change
- Give youth a 7-day calendar log to monitor their goal success every day during the week
- Goals should at a minimum identify what (specific behavior to change), how much (quantity of change) and when (frequency)
- Congratulate youth for setting a goal to improve their health and lifestyle
- Provide youth with additional instructions on sharing their goals with others, reinforcing goal achievement, and resetting goals every week
Step #6: Follow-up to promote continued goal setting and monitoring
The more youth set, monitor and achieve short-term goals the more they will increase their self-regulation skills and self-efficacy.
Following-up to remind youth to keep resetting goals every week is key to them achieving long-term goals resulting in improved physical and mental wellness.
Strategies:
- Remind youth regularly to monitor their daily goals and reset goals each week
- Give youth an assignment or opportunity to discuss weekly goal successes and failures to learn how to better set and achieve goals
- Ask youth to set a goal addressing a different healthy behavior once they’ve reached their initial goal. For example, if they are now getting 8 or more hours sleep each night, have them consider setting a goal toward getting more physical activity, eating healthier, or practicing daily relaxation strategies
Conclusions
Today’s youth are at risk for substance use, chronic disease, and mental health problems. Addressing multiple health risks within integrated, brief interventions has the potential to cost-effectively increase physical and mental wellbeing of young people.
Six steps for providing brief interventions, campaigns and other strategies that integrate substance use prevention with wellness promotion were presented, along with specific strategies for achieving each step.
Together, these steps and strategies can be applied to achieve broader health outcomes for a wider range of youth and young adults in schools, communities and homes across the US.