Adolescent connectedness: cornerstone for health and wellbeing
BMJ 2022; 379 doi: https://doi.org/10.1136/bmj-2021-069213 (Published 27 October 2022) Cite this as: BMJ 2022;379:e069213Read our Adolescent Wellbeing collection
- Robert W Blum, professor1,
- Joanna Lai, health specialist2,
- Michelle Martinez, doctoral student1,
- Cassandra Jessee, independent consultant3
- 1Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- 2United Nations International Children’s Emergency Fund (Unicef), New York, USA
- 3Washington DC, USA
- Correspondence to: R W Blum rblum{at}jhu.edu
Social connections are cornerstones of health and wellbeing, and for adolescents the connections with family, peers, and community have a critical effect on development. Youth development programmes that treat adolescents as problems to be solved don’t tend to work,1 yet governments and non-governmental organisations continue to invest in them. Instead programmes should be focusing on maximising human connectedness, which evidence shows is a critical element of effective youth programmes.
By connectedness we mean a sense of being cared for, supported, belonging, and closeness with others that comes from protective and sustained relationships within families, schools, and communities.234 A supportive social network of parents, peers, and teachers has been shown to improve adolescent mental and behavioural health5678 and have lifelong benefits. The National Longitudinal Study of Adolescent Health in the United States, for example, found that adolescents who reported feeling connected to home or school at ages 12-17 years were as much as 66% less likely to experience health risk behaviours related to sexual health, substance use, and violence and to have better mental health in adulthood than less connected peers.9 Likewise, after following a cohort of over 700 men for more than 70 years, the Harvard Study of Adult Development reported that people who are connected to family, school, and community are happier, live longer, and are healthier than their less connected peers.10
Recognising that connectedness promotes wellbeing and protects against a range of risks,11 we consider what is known about the three central dimensions of social connectedness for adolescents—connections with families, peers, and communities.
Family connectedness
Research strongly suggests that family remains a central influence in the lives of adolescents even as the importance of peers and the internet increases.12 Compared with less connected peers, adolescents who are connected to at least one parent experience fewer emotional problems,13 fewer suicide attempts,14 less conduct disorder, better school performance,15 higher self-esteem, and less involvement in violence16 and substance use.17 But the evidence is equally clear that family stress (as measured by parental unemployment, poverty, domestic violence, and substance abuse) undercuts parent-adolescent connectedness.14
When researchers study family connectedness they find at least some common components relating to parents’ awareness of what is going on in their adolescent child’s life as well as adolescents’ feelings towards their parents. In families where connectedness is high parents are generally aware where their adolescent children are most of the time. They also tend to know their child’s friends and their parents, and they are engaged with their adolescent’s learning, knowing their teachers and monitoring academic performance. In addition, in families where connectedness is high adolescents feel that they can talk with their parents about concerns, turn to them for advice, feel close with at least one parent, and feel that their parents care about and understand them.181920
Simply stated, fostering parent-adolescent connectedness fosters healthy adolescent development, which in turn leads to better health and wellbeing.
Peer connectedness
Developmental science has shown that as a child matures, peers become an increasingly important part of the social fabric of their lives. However, this does not imply a linear relationship between increasing peer importance and the diminishing influence of parents.21 The rising importance of peers is partially the consequence of social, emotional, and neurological development that occurs at the time of puberty, which among other things results in young adolescents having a greater tendency to do things to get the adulation of peers (and thus the brain stimulation that goes with it) than younger children or older adolescents.21 Specifically, neurodevelopmental research suggests that peer influences on behaviour tend to be greater for those under 14 years of age than for those aged 14 to 18 years.22
But numerous factors beyond neurodevelopment also contribute to the increasing importance of peers during adolescence. In many societies young people spend more time with friends without their parents than do younger children. They may be more involved with work, school activities, sports clubs, or community activities with their friends than when they were younger.
Factors that comprise positive peer connectedness include being able to count on friends, feeling accepted by peers, feeling good about friendships, having fun, spending time doing things, feeling peers want to talk and be with them, feeling friends are there to help one another out.23 In order to foster positive peer connections adolescents need to develop and learn skills, including competence in initiating relationships, willingness to share emotions and feelings, asserting displeasure with others’ actions, providing emotional support, and managing interpersonal conflicts.24
Young people who have strong peer relationships have better social and emotional functioning than more isolated people of the same age.25 Additionally, positive peer connections have been show to be strongly associated with adolescent wellbeing26; positive peer relationships are also associated with school connectedness.27 Efforts to enhance skills and environments that promote positive peer relationships in and out of school as well as on and offline are therefore important.
Community connectedness
The neighbourhood in which a young person lives has a big effect on their wellbeing and behaviours. Research has consistently shown that where social cohesion exists young people are less likely to engage in high risk behaviours and experience emotional distress282930 and are more likely to have increased positive health behaviours and greater personal efficacy.31
But what is community connectedness? This concept focuses on adolescents’ perceptions of adult caring and belonging in the neighbourhoods where they live.32 Authors use various terms to convey similar concepts. For example, some authors talk about community self-efficacy or the perceived capability of a community to effect change.33 Such connectedness is often measured by adolescent perceptions of the extent to which people look out for each other, report vandalism and crime, and create a sense of belonging for young people. For adolescents such community connectedness is influenced by the quality of youth-adult interactions, opportunities for meaningful input into community affairs, a sense of safety in the community, and being welcome in public spaces.34
Other researchers talk about social capital as a component of community connectedness. For example, Putnam defines social capital as engagement with community organisational life, public affairs, community volunteering, informal sociability, and social trust.35 Like financial capital, social capital accrues in various ways. In high income countries social capital is often acquired through university education and employment. However, social capital can also be acquired through family,36 as well as through neighbourhood and community engagement. Thus, fostering opportunities for community service and volunteering not only benefits communities but also young volunteers, whose social capital increases. The World Bank has repeatedly shown that social capital potentiates financial capital by creating human networks that maximise individual financial resources.37 Thus, building community connections enriches social capital the benefits of which have far reaching implications.
Online connectedness
Digital connections are an increasingly integral part of most adolescent’s lives. It has changed the way young people connect socially with family, peers, and broader online communities. Use of digital and social media has been shown to have both positive and negative effects on wellbeing of adolescents.38 The effects of digital connections on adolescents vary based on the technologies and platforms used, how often and in what ways they are used, and the online context they are exposed to, including reactions from online audiences.
The importance of the online world to adolescent lives might suggest that it has replaced the human connections of previous generations. Through technology adolescents today have the potential of continuous connectivity. Smartphones, mobile devices, and social media have become an integral part of their in-person and face-to-face interactions. The same elements that characterise in-person adolescent relationships can often be found in online friendships.38
However, the online and digital connections alone do not entirely compensate for in-person relationships.39 A large study on adolescent loneliness using data from the Programme for International Student Assessment (PISA) across 37 countries from 2012 to 2018 found loneliness increased in all but one country. The study, which included over a million 15 and 16 year olds, found a direct relation between loneliness and the use of smart phones and the internet. Whether this relation is causal is still unclear, but the associations showed a dose-response relation at individual and group levels.11 Another study among adolescents in Belgium during the covid pandemic looked at social media as a source of coping and found that active engagement with social media buffered anxiety but did not seem to affect feelings of loneliness.40
Within the rapidly emerging body of research around digital and social media use and adolescent wellbeing, a stronger focus on understanding how online connections can enhance or undermine connectedness with peers, family, and community in different contexts is needed.
Fostering connectedness
Policy and programmatic engagement with adolescents is often in response to a perceived escalation of problems such as youth violence, substance use, and unintended pregnancy. It has therefore tended to focus on strategies to reduce the problem. However, researchers have found that most problem reduction strategies are ineffective. Evaluations of programmes such as Scared Straight for violence prevention,1 fear based and abstinence pregnancy prevention programmes,41 and information based programmes for preventing drug abuse42 show that they have no effect or, worse, exacerbate the problem. Several factors contribute to their lack of effectivess. Fear is at best a temporary response to a situation: no one can function in a chronic state of fear and eventually denial kicks in. Information campaigns may not align with the lived experiences of young people, and even when they do, young people, like all people, select the information that best conforms to their beliefs. The young people who are most likely to benefit from programmes and services are also often those least receptive to fear or knowledge based programmes.
The past 15 years has seen increasing use of interventions that foster adolescent connectedness, some of which have been implemented under the banner of positive youth development.4344 These programmes aim to enhance at least one of six Cs: confidence, competence, character, caring, connection, and contribution. The positive youth development approach focuses on enhancing connectedness and opportunities for young people to contribute to the communities in which they live; programmes often provide opportunities to engage with pro-social adults and, in doing so, acquire positive values. Some, such as the UN Office on Drugs and Crime’s Strong Families programme45 and Big Brothers Big Sisters mentoring programme,46 simply aim to enhance connectedness. Others, such as Stepping Stones47 and Keepin’ it Real,48 use these strategies to reduce problem behaviours such as violence and substance use.
Such positive youth development approaches see young people as resources rather than problems and assume that they all have the potential to grow and change. Evaluation of effective programmes suggests that parents, schools, and community are critical (box 1).
What makes an effective adolescent programme?
Positive parenting—for example, connectedness, emotional availability, responsiveness, high behavioural and educational expectations, and behavioural monitoring
School programmes are most effective when they create an environment that is emotionally and physically safe, where teachers are perceived as supportive and caring, where high academic expectations are coupled with supports, and where rules and discipline are seen as fair
Community—Positive neighbourhoods provide safety and structure, belonging, and group membership and an opportunity for young people to engage with peers and nurturing adults
We now need to focus on developing interventions that deliberately strengthen young people’s relationships with their family and peers as well as within their school and communities. Research is also needed to help leverage digital and social media for improving the quality of these connections. A policy focus on promoting connectedness is essential to improve adolescent health and wellbeing.
Key messages
Connectedness is a cornerstone of healthy development
Government programmes focusing on reducing adolescent problem are mostly ineffective
Evidence suggests that successful programmes aim to strengthen connectedness with parents, peers, schools, and community
Future programmes should view young people as resources rather than problems
Footnotes
?Contributors and sources:? This article is based on a paper commissioned by the United Nations H6+Working Group of PMNCH that was written by the authors plus David Henry, Audrey-Marie Schuh Moore, Anjali Singla, and Sarah Thomsen. RB has written extensively on adolescent health and adolescent connectedness. CJ was chief of party at USAID to build the evidence and knowledge generation hub to improve youth programming and has written extensively on positive youth development. JL is adolescent health specialist at Unicef. MM’s studies focus on international adolescent health. RB assumed primary responsibility for drafting the article. CJ had primary responsibility for the section on fostering connectedness. JL contributed to all drafts of the manuscript but had primary input into the section on online connectedness. MM had lead responsibility for the background research. All authors contributed to researching, writing, and revising the article.
Competing interests: We have read and understood BMJ policy on declaration of interests and have no interests to declare.
Provenance and peer review: Commissioned; externally peer reviewed.
This article is part of a collection proposed by the Partnership for Maternal Newborn and Child Health. Open access fees were funded by the Bill and Melinda Gates Foundation. The BMJ commissioned, peer reviewed, edited, and made the decision to publish these articles. Emma Veitch was the lead editor for The BMJ.
This is an Open Access article distributed under the terms of the Creative Commons Attribution IGO License (https://creativecommons.org/licenses/by-nc/3.0/igo/), which permits use, distribution, and reproduction for non-commercial purposes in any medium, provided the original work is properly cited.