The third article in the Lancet series describes advances in prevention science that improve health outcomes among adolescents and offers suggestions on making the most of these advances through systematic efforts to adapt and scale up successful interventions. The authors explain the way in which problems associated with adolescence, such as teen pregnancy and depression, can be linked to (1) the accumulation of problems from early in life, (2) a lack of protective factors, and (3) the presence of negative influences that occur during adolescence.

A systematic review of randomized and quasi-experimental trials shows that programs that increase positive influences and decrease risk factors for young people, both in early childhood and during adolescence, have achieved increases in educational attainment and reductions in young people’s misuse of alcohol and drugs, risky sexual activity, depression, and delinquency and crime. The authors then advocate for the increased use of effective programs and discuss barriers to and strategies for doing so.

This article clearly explains the multitude of ways in which effective prevention programs for adolescents can be structured. It also provides an excellent call to action for dedicating more resources to the adaptation and use of proven approaches, as well as specific programs that have been shown to work through rigorous evaluations. Many of the programs profiled in the article focused on issues that are the explicit focus of the Interagency Youth Working Group (IYWG), such as teen pregnancy and STI infection, and the others addressed factors that affect youth sexual and reproductive health (SRH), such as young people’s alcohol use and educational attainment.

Importantly, the article goes beyond the discussion of what works to a discussion of how to make programs that work available where they’re needed. The authors discuss a range of ways to scale up successful programs, including making research findings more user-friendly, providing cost information to help potential users of a new prevention program make decisions, and building capacity to adapt programs for use in new contexts. They also advocate for communities to learn how to identify their most salient needs so that they can identify programs best-suited to the problems they face.  Special attention is paid to adapting programs designed and evaluated in developed countries to developing settings. Sexuality education is given as an example of one area in which western-based behavior change theories have been effectively used to reduce adolescent sexual risk across cultures and countries.

This article reminds us of all that has already been shown to work to improve youth outcomes — from changing contraceptive policy to promoting healthy families — and all the work that remains to be done to spread and adapt these evidence-based practices more widely. The dedication, expertise, and local knowledge of adolescent reproductive health practitioners around the globe, and the network of these practitioners formed through organizations such as the IYWG, create the opportunity to take on the Lancet’s challenge and make sure that what works in one place has the opportunity to do so for more young people around the world.

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