Disparities and Resiliency in Adolescent Health

Continuously experiencing adversity or having multiple risk factors can create toxic stress, which is when the body experiences “prolonged activation of the stress response systems in the brain and body.”³ Adverse Childhood Experiences (ACEs) can include neglect, abuse, poverty, and witnessing and/or experiencing violence. Experiencing multiple ACEs has been shown to negatively affect a person’s health over the life course and can even affect multiple generations.⁴

Additionally, allostatic load is a measure of “wear and tear on the body caused by [a] constant adaptation to stress.” Research on high allostatic load has found that there is a tipping point at which the body’s ability to self-regulate is overburdened and can no longer function properly. This can have cumulative and harmful long-term effects for youth who are simultaneously dealing with toxic stress and the normal stressors related to adolescent physical and cognitive development.⁵

There are many resources available on ACEs that provide background information, approaches, and success stories. Additionally, The Center on the Developing Child at Harvard University has found four key “counterbalancing factors” that can lead to resilience in the face of toxic stress and adverse childhood experiences. The purpose of these factors is to help a child or adolescent be able to develop skills such as planning, monitoring, and regulating behavior. These skills can help an individual have positive experiences and be able to better adapt to their circumstances. These key factors include:

1. Promoting supportive adult-child relationships.
2. Building a sense of self-efficacy and perceived control.
3. Providing opportunities to strengthen adaptive skills and self-regulatory capabilities (for middle-school youth and high school youth).
4. Encouraging and supporting involvement with sources of faith and/or cultural traditions.⁶

Research has found that living in a neighborhood that has little to no economic viability in childhood and adolescence was the “single strongest predictor of biological risk” for having chronic health issues in adulthood, such as cardiovascular disease, diabetes, and depression.⁷ Furthermore, in the same study it was found that youth who lived in low-income areas that had higher unemployment and poverty rates showed higher levels of allostatic load in adulthood.⁸

Resiliency factors within neighborhoods can be utilized to help lessen the effects of a neighborhood’s economic status and promote positive outcomes for adolescents. Strong family and community relationships can help promote a sense of safety in the home and at school, a sharing of ideas in how to respond to problems in the community, and a network of support in times of need.⁹ There is also the approach of working with local businesses to help prevent child abuse and neglect.

It is important to understand the challenges that marginalized youth (e.g., racial minorities, LGBT, AI/AN) face in the U.S., such as prejudice, discrimination, and historical trauma, which can contribute to health disparities among marginalized groups of adolescents. These stressful experiences can contribute to a youth’s allostatic load, increasing their risk of developing physical and behavioral health issues. Additionally, members of minority groups typically “have less access to healthcare, receive worse healthcare, experience more serious health conditions, and have higher mortality than whites.”¹⁰

For instance, Native American/Alaskan Native youth disproportionately suffer from the burden of mental health disorders, among other health issues. Similarly, LGBT youth face multiple adversities because of how others respond to their sexual orientation or gender identity/expression, such as experiencing discrimination at school or rejection from family members. This discriminatory stress places LGBT youth at higher risk for mental health issues such as depression and suicide. Youth with physical, mental, intellectual, and/or sensory disabilities often face environmental and attitudinal barriers to access and fully participate in home, school, work, and social activities, which can adversely affect their physical and mental health.

Resources for marginalized youth are similar to other resiliency approaches in that self-regulation, positive relationships, and a connection to one’s culture can all contribute to building resiliency. This includes promoting behavioral skills such as self-regulation for Native communities, emotional support for LGBT transitional age youth, and using trauma-informed care in treatment settings and teaching practices.