Urban adolescents' perceptions of health worldwide

Abstract

BackgroundAdolescents aged 10–19 years account for 18% of the world's population—the largest proportion in history. Adolescents' behaviours affect their future health, wellbeing, and life expectancy. Changes in the global economy, education, family structure, and technology are altering societies worldwide, and reshaping adolescence. The extent to which these changes affect adolescents' perceptions of health is unknown. Furthermore, many of the most disadvantaged adolescents who live in urban areas have little access to education and employment and other community resources; therefore, other mechanisms to link young people to health information and care are needed. We investigated how disadvantaged adolescents in different urban environments define health and ill health, and described where adolescents go for health information and services, and the barriers they face in seeking or accessing help. MethodsWell-being of Adolescents in Vulnerable Environments is a six-city international study of young people in vulnerable urban environments. We chose six sites: Baltimore (MD, USA), Johannesburg (South Africa), Shanghai (China), New Delhi (India), Ibadan (Nigeria), and Rio de Janeiro (Brazil). Participants were recruited with different methods depending on the site, through local community workers, flyer distribution, word-of-mouth, or at community events. Researchers in each site used identical methods: 20 male and female adolescents had in-depth face-to-face interviews; 10 male and female adolescents participated in Photovoice, in which participants had photography training and took photographs of what they perceived to be the meaning of health in their communities; 80 adolescents participated in community mapping and focus groups, in which adolescents were grouped on the basis of age and sex and asked to draw maps of their communities and discuss health issues related to their community; and 20 key informant adults who work with young people in their communities were interviewed. Data were recorded, transcribed, and analysed with Atlas.ti (version 7). A core set of codes was used by all sites during the initial coding process and additional site-specific codes were added by the qualitative researcher at each site. Themes were compared across sites by creating matrices of the major codes and examined for patterns and differences. Findings468 adolescents, aged 5–19 years, participated in the study. Data from Rio de Janeiro are not included because of delays in data collection. Violence, personal safety, limited access to care, and gender role hierarchies were all top adolescent health concerns, although they differed in priority by site. The factors that contributed to these concerns varied between sites. In New Delhi, concerns about personal safety were related to harassment of girls; in Shanghai, to theft and discrimination; in Baltimore, to gun violence and drugs; in Johannesburg, to neighbourhood violence and overcrowding; and in Ibadan, to harassment of girls and armed robberies at night. Across the sites, female adolescents were perceived to be at greatest risk of victimisation and were generally perceived to be unsafe in their communities. Adolescents made a strong connection between their environment and their health. They described their living conditions as poor and dirty, characterised by inadequate sanitation, overcrowded buildings, and a lack of resources and opportunities. Consequentially, there was generally little trust in adults and service providers in the community, and in the notion that health services could be helpful to them. InterpretationAlthough the sites are in very different places, adolescents had similar health concerns. To promote health, development efforts should be expanded to address gender equality and safety issues for adolescents in severely depressed urban communities and their need for multifaceted health-care services. FundingAstraZeneca.