Theoretically, adolescents should be among the healthiest age group in the United States and globally. They’ve survived the diseases of infancy and childhood and have not yet begun to experience the trials associated with aging. However, even in developed countries, mortality and morbidity among adolescents remains shockingly high. The top causes of death, which include unintentional injury and suicide, illustrate that behavioral and emotional issues play a large role in why adolescents remain at risk despite their general good physical health.
As an adolescent clinical psychologist, I occupy an interesting niche within the field of public health. I was trained in a scientist-practitioner model; my research and clinical practice are inherently connected. I spend time each week engaging in clinical practice at UCSF’s New Generation Health Center, a sexual and reproductive health clinic that services predominantly low-income youth in San Francisco’s Mission District. In this setting, it is easy to see the challenges that youth face both on individual and contextual levels. I am consistently reminded why knowledge-based education about sexual health only takes us so far. Collaborating with researchers in OB-GYN at UCSF, we are currently devising new ways for practitioners to intervene with youth that take culture, context, and individual barriers and strengths into consideration.
I also study developmental transitions, behavior, and contextual factors that influence adolescents’ health and well-being. There is a documented secular trend in the United States towards earlier pubertal onset among girls, which has established negative effects on physical and mental health. Through the Bay Area Breast Cancer and the Environment Research Center (BCERC), my colleagues at UCSF, Kaiser Permanente Northern California Division of Research, and the State Department of Public Health and I have been working on a transdisciplinary model to explain why puberty may be starting earlier among young girls.
We work closely with community groups, including Zero Breast Cancer in San Rafael, to integrate public concerns into our research questions and have committed to reporting our research findings in a timely manner to the community. We have convened many community forums—with researchers and advocates sitting side by side—to address questions and concerns about pubertal timing, environmental exposures, and risk for breast and other reproductive cancers. We also hold “tea talks” with our researchers and participants, where we talk with parents of the girls in our study about how to manage their daughters’ transitions through puberty and help them navigate the emotional and social challenges they face. This intense level of community involvement and public engagement informs and enriches our research.
Recently, BCERC researchers worked closely with Zero Breast Cancer to educate Kaiser pediatricians about our findings related to early puberty in an effort to enhance their clinical practice. We have also collaborated to release fact sheets, monographs, and videos to the public that describe the work that we have done in both animal and human models examining the links between pubertal determinants, pubertal timing, and breast cancer risk. As a result of our efforts, the epidemiologic studies of the BCERC were recently awarded an additional five years of funding from NIEHS and NCI to follow our participants into adolescence.
Ultimately, the work that my colleagues and I engage in has value, not just for local advocates and community members, but to inform public policy more broadly. Given the strong current investments at the federal level to improve adolescent health in the areas of sexual and reproductive issues and overweight and obesity, I believe that our research has far-reaching implications that are practical—and critical—at this point in time.