This interview, with Dr. Robert Blum, is the second interview of our “Youth—My Past, and Their Future” series. Dr. Blum is an expert in adolescent reproductive health and is the William H. Gates, Sr. Professor and chair of the Department of Population, Family and Reproductive Health at Johns Hopkins Bloomberg School of Public Health. You can also read the first interview of this series here.

IYWG: Bob, what were you like as a teenager? What is your favorite memory from your adolescence?

RB: As a teenager I was extremely social. I went to the same school from the third grade on, and we developed a very close knit group of friends. While I was a good student, studying was not my passion and I would much rather have been outside on a sunny day playing with friends than completing assignments.

I have many favorite memories growing up, but more than any other, one that shaped my view of the world was traveling. Starting when I was about 12, I traveled with my parents. When I was 16, I spent the summer hitch-hiking around Ireland, sleeping in farmhouses and cow pastures and living off of the kindness of others.

IYWG:   How did you first learn about sex? Do you remember what information you were given? What else do you wish you had been told?

RB: This is a bit of a difficult question to answer since I do not recall really “learning about sex.” I think I discovered it on my own. I grew up in New York City and starting in the seventh grade, we used to have parties at people’s homes where boys and girls would dance together. By eighth grade, I had a girlfriend; and by the ninth grade, parties were as much about “making out” as anything else. I do not think for one moment I thought about STIs, pregnancy, HIV (which did not exist in the 1960s), or just about anything else that came from romantic relationships. The chasm between making out and sexual intercourse was too great for me to even contemplate.

IYWG: What do you think is the biggest issue young people face?

RB: Unemployment. We see a dramatic transition occurring around the world with the young people relocating from rural to urban areas at an unprecedented rate. They come looking for an education, opportunities and jobs that frequently are not there, which leads to a cascade of negative outcomes both for young people and for their communities. I believe we greatly need to improve access to education, the quality of education and the duration that young people are in school. So, too, we have to couple education with new vocational opportunities.

IYWG:  What is one thing about youth that you wish you understood better?

RB: I wish I better understood the disinhibiting effect that social media have for young people. I cannot fathom how someone could send nude pictures of themselves through the Internet believing that it would be a private experience. Neither can I imagine how social media can be a vehicle for unimaginable interpersonal cruelty among young people, and that perpetrators believe they can remain anonymous.  

IYWG:  Please share a little about your work with youth. How did you get started in the field of youth sexual and reproductive health? Why is the health and well-being of young people especially important to you?

RB: I would say that it was never part of my career trajectory to work with youth. When I went to medical school, I envisioned entering internal medicine or family practice and working on an Indian Reservation in the Southwest where I had done extensive volunteer work as a medical student. During my clinical rotations as a medical student I found that I gravitated toward young children and I spent more and more time “after hours” hanging out with them on the wards, playing with them and getting to know them. There was one particular young boy who was three years old who had a terrible disease—rhabdomyosarcoma—and I got to know him and his family well over the months I was on the ward and he was in the hospital. It was that experience more than anything that lead me to pediatrics. And so it was in pediatrics that I had encounters that led me to adolescent medicine, neither of which had anything to do with sexual or reproductive health. I got to know a 16-year-old girl who had cystic fibrosis for the two years before her death. And there was a 14-year-old boy who I got to know quite well who had leukemia, and he, too, later died. But both of these young people taught me how to live in the shadow of uncertainty.

When I went into adolescent medicine, I had my first clinical encounters with girls 13 to 16 years of age in a community clinic; when they came for pregnancy checks I was astounded by the number who appeared indifferent to whether or not they were pregnant. I wanted to better understand how that could be, that some would simply not care whether or not they would bear a child. Understanding sexual decision-making became one of the threads of my research life and, subsequently, I wanted to better understand why so many reared in adversity go on to do well. This is the fundamental notion of resilience and understanding factors that protect young people from harm, I believe, can help us develop better services, programs, interventions and support.

IYWG: What do you think can be done to change young people’s risky sexual behaviors? How can youth be encouraged to adopt protective behaviors?

RB: I think that we know quite a fair amount about how those who are in school are less likely to be engaged in risky sexual behaviors. Those who see a future are likewise less risk-taking. Those who have opportunities and role models do better. Very honestly, I do not think it’s rocket science, but I also do not think it has a lot to do with focusing on sex or sexual behaviors themselves. We know enough to be able to say that most interventions that are focused specifically around sexual risk-taking do not work very well. I do not think this is rocket science but I do think we have built an entire industry around the provision of programs and interventions for young people that are ineffective.

IYWG: What key issue must be addressed in order to improve the health and well-being of today’s youth?

RB: Education and jobs.