On behalf of the Lancet Commission and the UNICEF Office of Research – Innocenti, I am very pleased to announce the birth of a new series of seven briefs on how to conduct research with adolescents in low- and middle-income countries.
The current cohort of adolescents and young adults is the largest the world has ever seen – 1.8 billion. Investments in adolescent health and well-being offer a triple dividend: to adolescents today, towards health and well-being across the lifespan, and to the next generation of the world’s children. While much is understood about adolescence, The Lancet Commission on Adolescent Health and Wellbeing highlights the great need for continuing research with young people, so that we address the tremendous unrealized opportunities, not only for the health and well-being of young people themselves, but also for the future of society and future generations.
These seven new briefs focus on research methodologies and are intended to identify best-practice approaches for conducting research with adolescents. The briefs cover diverse topics including: indicators and data sources; research ethics; research with disadvantaged, vulnerable and/or marginalized populations; participatory research; measuring the social determinants of health, and economic strengthening interventions for improving adolescent well-being. Written by leading experts in adolescent health and well-being, the briefs are designed to improve how research on adolescent health and well-being in low- and middle- income countries is conducted and interpreted.
The briefs cover: indicators and data sources; research ethics, research with disadvantaged, vulnerable and/or marginalized populations, participatory research, measuring the social determinants of health, and economic strengthening interventions for improving adolescent well-being.
Adolescents are unique human beings—no longer children but not quite fully-formed adults. They have distinctive needs, exceptional capabilities, and matchless potential. As the father of two adolescent men, I understand first-hand the exhilaration, the frustration, and the pride that adolescence draws out of us. As an adolescent medicine physician, I have had the supreme pleasure of working closely with, and learning from, this special group of human spirits. And as a public health policy wonk, I have been amazed to see the recent global explosion of interest in adolescence. A key global force driving this recent interest has been the Lancet Commission and its fearless leader: George Patton from the University of Melbourne. The Lancet Commission provides a blueprint for a new understanding of the importance of adolescence in a lifetime of health and well-being.
I was pleased to be able to lead the writing of Brief 3, Inclusion with protection: obtaining informed consent when conducting research with adolescents. This brief addresses ways to work ethically with adolescents in conducting research. Research ethics has been a long-standing cause for me. Too often adolescents have been excluded from essential research, based on the false premise of protection from research risk. Brief 3 provides an avenue to inclusion with protection building on the concepts of the Convention on the Rights of the Child, particularly the concept of emerging capacities. Adolescents are often best able to make informed and sensible decisions about their own lives. Inclusion of adolescents in research is essential if adolescents are to reap the full benefits of research. Research can guide the creation of improved policies and programs for adolescents and appropriately tailored services and infrastructure. Research can also strengthen adolescent resiliency, promote wholesome development, reduce adolescent morbidity and mortality, improve nutritional status, promote educational success and mental health, prevent risk behaviours, and prevent or treat infectious disease.
In my own service on ethics committees, I have too often seen adolescents excluded from specific research projects – even low-risk studies. Either the investigators or the ethics committee could not figure out an ethical way to include adolescents in studies which could promote adolescent health and well-being. We can and should do better. Brief 3 suggests ethical and practical ways to resolve these dilemmas.
These briefs are part of a broader effort to increase understanding of the social and structural determinants of adolescent well-being. Adolescence is marked by multiple physical, psychological, and social role transitions. Social and structural determinants and social role transitions are key drivers of health and well-being during the adolescent period. By influencing vital social transitions from adolescence into adulthood, these social and structural determinants have enormous implications for an adolescent’s health and well-being during adolescence and across the lifespan. Briefs 1, 6 and 7 address the scope of these social determinants and ways to address them in research.
The briefs should be useful to a wide range of stakeholders interested in adolescence research, but are primarily designed to assist professionals, including UNICEF staff, who conduct, commission, or interpret research and/or evaluate research findings in international development contexts, in order to make decisions about programming, policy, and advocacy. The seven briefs are available online at: unicef-irc.org/adolescent-research-methods/
The UNICEF research briefs are the result of a year’s work by a small army of contributors: authors, reviewers, and advisors, all acknowledged in the briefs, who worked tirelessly to refine the briefs and made special efforts to ensure the writing was accessible and its utility, maximized. Special thanks to my collaborator and co-editor Nikola Balvin from the UNICEF Office of Research – Innocenti. I join her in thanking the UNICEF Innocenti, which insightfully recognized the importance of this effort and generously supported the writing and publication of these briefs.
Serving as an editor is a bit like having a baby. There is always a bit of uncertainty about arrival dates and how the offspring will arrive. The gestation period often seems a bit longer than expected; the labor pains can be sharp. Despite all the travails, the delivery is accompanied with pride and wonder. What a beautiful product we have helped bring into the world!
We hope this effort will make the world a better place for the adults who care about adolescents and – especially – for the adolescents themselves.
Dr. John Santelli is a Professor of Population and Family Health and Pediatrics and was the chair of the Department of Population and Family Health at the Mailman School of Public Health, Columbia University.