Start Now.

Humility, Gratitude, and Inspiration

Good morning, afternoon, evening, or night, whatever time zone you are in! I was hoping to greet you from beautiful San Diego, California, but nevertheless, I am thankful to have the opportunity to greet you from beautiful Cincinnati, Ohio—home of the Reds, the Bengals, and Fiona the hippo—and appreciate that you are taking the time to listen to this address. Before I start my address, I want to acknowledge how deeply disappointing it was for all of us that our annual SAHM meeting had to be cancelled due to the coronavirus pandemic, to protect the health of our members. However, I am thankful to the SAHM leaders who have spent countless hours managing this unprecedented challenge for our Society. These include the Executive Committee; our Executive Director Ryan Norton and his team at Kellen; the Program Committee, and our Board of Directors. What I have learned through this experience is that we are a powerful and resilient organization, and we will overcome this challenge and emerge even stronger. How do I know this? Because what I have observed over the past 2 weeks is that these constraints are bringing people even closer together and unleashing people's imaginations in all kinds of ways. This challenge has led to so many creative ideas; for example, how our meeting presenters can share content online, how committees and special interest groups can facilitate virtual meetings, and how we can foster networking in innovative ways. You will be hearing much more about these efforts over the coming days and weeks, but what I can tell you now is that we will continue to learn from, connect with, interact with, and support each other over the coming months.

So let's now look to our future together, and I'd like to start this address by sharing with all of you some of my emotions as I begin as your SAHM President. First, humility. I never could have imagined, when I attended my first SAHM meeting as a resident in 1996, that I would be giving a Presidential address one day to all of you whom I admire so deeply, and who are doing so much collective good in this world. I am humbled to be following in the footsteps of my heroes and heroines, who established and advanced the field of Adolescent Health and Medicine. Today I am thinking especially of Dr. Jerry Rauh, a founder of our field, who was a genuine servant leader and one of the kindest people I have ever met. He established the Division of Adolescent Medicine at Cincinnati Children 60 years ago, and it is a tremendous privilege to hold a Chair in his name. He served as SAHM's fifth President, and I'll serve as the 50th: I know that he would be tickled by that symmetry. I am also thinking of Dr. Gail Slap, who gave the Presidential address at the first SAHM meeting I attended and then—lucky for me—offered me my first faculty position. She was a brilliant and visionary leader, and she was incredibly supportive of me as a young mother. She encouraged me to flex my hours and take a 12-week maternity leave after the birth of my third child, which was a revelation and a key reason I remained in academic medicine. Finally, I am thinking of Dr. Manny Schydlower. The year he gave his Presidential address, 2001, was just a few weeks after my mom had died. I had hesitated to go to the annual meeting, but his words during the Presidential address resonated powerfully with me that day and made me realize why I needed to be there. He said, “For many years, I have felt that warmth, comfort, and sense of belonging to an organization that is my professional home and family.” Recently, after we made the decision to cancel this year's annual meeting, he immediately reached out to reassure us that we had made the best possible decision, with the best interests of all in mind, and he finished with “Hard knocks do nothing to SAHM's resilience. We are unvanquished. Know that you have the solidarity and confidence of our Society.” This was unimaginably comforting, and an example of what truly great leadership looks like.

Second, I feel gratitude. For the incomparable opportunity to serve all of you and this organization that I love. For my wonderful Cincinnati colleagues, who are here with me, who organized mini-SAHM meetings this week, and who are hard at work planning our Ohio Valley SAHM meeting for the Fall. And for my amazing and phenomenally supportive family, whom I adore.

But most of all, I feel inspiration. If I had to choose one word to describe how I've felt at every one of the 25 SAHM meetings I've attended, unquestionably it would be inspired. The word inspire derives from the Latin root inspirare–to breathe into. During each annual meeting and throughout the year, my interactions with all of you breathe new energy into me, fill me with determination, motivate me, and give me the resilience I need to “put my hoodie on and get to work,” as Dr. Trent has encouraged us to do over the past year. We inspire each other to go back to each of our workplaces and communities to care for youth and educate others to care for youth. We inspire each other to conduct research that will transform their health and well-being. We inspire each other to advocate passionately for policies and programs that will enable youth to thrive.

It's my hope that by the end of this talk you will be just a little bit more inspired to lead—no matter what your discipline, which career stage you are in, wherever you live in the world, and whatever organization or community you work in—to advance the health and well-being of youth. Because our youth today face serious threats to their health and well-being: threats that will be insurmountable without your leadership. Let's talk about threats to adolescent health, opportunities to address them through your leadership, and how SAHM can amplify your leadership.

Adolescent Health: Threats and Opportunities

Those of you in this room are well aware of the threats to adolescent health and well-being. HIV and other infectious diseases disproportionately affect youth. More than 30% of all new HIV infections globally occur among youth 15–25 years of age [1]. Young black and Hispanic men who have sex with men are especially vulnerable, and we cannot overcome the HIV epidemic unless we end the stigma, promote testing, prevent HIV, and keep people living with HIV healthy [2]. The infection on all of our minds today is the novel coronavirus. Although thankfully, most youth appear to have mild disease, we still do not know the risk for youth with underlying medical conditions, and the lives of youth are being disrupted significantly by this pandemic; for example, due to loss of loved ones and social distancing measures that are severely interrupting their personal lives and education.

Poor sexual and reproductive health is another major challenge for young people aged 15–24 years, who account for half of the 20 million new cases of sexually transmitted infections in the U.S. each year [3]. Think about it—that is 10 million preventable infections if we make education, screening, and treatment more accessible.

The U.S. and countries around the world are in the midst of a behavioral health crisis, driven by increasing rates of depression and anxiety and the opioid epidemic. Depression is the most common mental health disorder in adolescents and young adults, affecting nearly one in eight each year [[4], [5], [6]]. Drug addiction and suicide in young adults are drivers of the devastating decrease in life expectancy we have seen in the U.S. And as the need for services grows, so too does the shortage of trained mental health care professionals. We must focus on closing this gap through training, effective prevention, and advocacy for policy solutions.

Chronic physical illnesses such as asthma, obesity, diabetes, epilepsy, inflammatory bowel disease, and neurodevelopmental conditions affect 15%–20% of adolescents [7]. They represent major threats to adolescent health and well-being.

Finally, youth are at unacceptably high risk for serious injuries and violence. Firearm injuries from homicides and suicides are the leading cause of death for adolescents and young adults aged 12–24 years in the U.S. [[8], [9]]. We can and must prevent these deaths.

All of these conditions are inextricably linked to social determinants of health: conditions in the environments in which people are born, live, learn, work, play, worship, and age. Social determinants affect health outcomes, health risks, and quality of life and include neighborhoods, economic realities, education, social and community context, and health care. Those of us who care for adolescents have a deep understanding of the drivers of social determinants, including neighborhood crime and violence, poor access to health care, discrimination, incarceration, poverty, and food insecurity. And we understand that structural and systemic issues such as racism, sexism, heterosexism, classism, and ableism exacerbate and even cause many of these conditions (Figure 1 ) [10].

Figure 1

Social determinants of health.

These threats are increasing in today's political climate and in the policy realm, due to health policies that threaten the well-being of youth. Cuts by the U.S. government to Medicaid, defunding of family planning clinics, and bills that prevent evidence-based care of transgender youth are just a few of the policies that seriously threaten adolescent health.

So why should we feel inspired, despite these threats and the challenges we face in our work and in our society? Because we in adolescent health and medicine are in the unbelievably privileged position to be able to address them and create change. What are our opportunities to improve adolescent health and well-being, or to quote our annual meeting theme, to turn risk to wellness? First, continue to address preventable and treatable adolescent health conditions: HIV, sexual health, injury, violence. Second, invest in our health care system and prevention programs to address noncommunicable diseases. Third, work to decrease disparities in health and well-being, by focusing our efforts on socially and economically marginalized adolescents [11].

How can we turn these opportunities into realities? Many of you in this room are already deeply involved in this work. We must continuously strive to improve the care we provide to adolescents, using quality improvement methods and learning health systems. We must improve health equity by addressing social determinants of health, and that means talking openly and often about inequities. We must conduct research that will transform adolescent health outcomes. We must grow our workforce and teach the next generation to address major threats to adolescent health. And we must advocate at every level of government for policies that will promote adolescent well-being and improve health equity—and this includes voting.

The challenges are formidable, but we can't allow ourselves to be discouraged - because our patients and clients are counting on us. We urgently need to inspire each other to create change by leading from wherever we are.

Leading From Where You Are

So let's talk about leading from where you are. I'll first introduce to you two leadership principles that you can use to accelerate your leadership effectiveness, starting today, then touch on the many opportunities available through SAHM to achieve your leadership goals, and end with my commitment to helping you unleash your leadership potential over the next year.

First, effective leadership is not positional but relational: it doesn’t have to do with accumulating power, but with enhancing influence [12]. The fundamentals of influence are building self-awareness, practicing empathetic listening, and creating trusting relationships. One of my favorite leadership paradoxes is that the more you give power away, the more powerful and influential you become as a leader. These two photos, of Kim Jong-un and Dr. Martin Luther King, Jr., capture the essential difference between power and influence.

The second principle is that leadership development is self-development and who you are as a leader is driven by who you are as a person; so outstanding leadership is built upon a foundation of self-awareness: understanding your life story, delineating your values, and defining your purpose [12].

Let's talk about each of these foundations. Understanding your life story is key to effective leadership, because it's the basis for leading authentically and defining your leadership passion and purpose. You can't check your personal life at the door if you are to be an effective leader. Some of the key events in my own life story that had an impact on my leadership are being the child and grandchild of Holocaust survivors, and growing up in Alabama during the Civil Rights movement. These have given me a passion for incorporating social justice, equity, diversity, and inclusion into my work. I also had devoted mentors, sponsors, family, and friends who helped me navigate challenging times in my life, and this gave me a deep determination to give back and lift up others. These experiences have driven my career choices and the way I lead every day, and I know the same is true for each of you.

Delineating your values is also a key to effective leadership: it drives your leadership principles, defines your ethical boundaries, and prepares you to navigate difficult decisions and crises that you will face as a leader. Great leaders live their values by making sure that their intentions, words, thoughts, and behaviors align with their beliefs. My own leadership values are integrity, humility, kindness, curiosity, inclusiveness, and service. I come back to them time and time again to navigate challenging situations and recalibrate.

Finally, leadership effectiveness is maximized when you can define the purpose of your leadership, which represents an alignment of your motivations and capabilities [12]. If you are operating in the sweet spot at the intersection of these, you will be a powerful and resilient leader.

One of the ways in which you can clarify your leadership purpose is by creating a personal mission statement. Mission statements help you to focus on and maintain motivation to reach your long-term leadership goals and also communicate your purpose to others. My own is to encourage, inspire, and support family, friends, colleagues, and mentees to find their purpose and soar.

André Martin, formerly of the Center for Creative Leadership, describes everyday leaders as those who, in connection with others, accomplish the tasks of setting direction, building commitment, and creating alignment. You have the capability to set direction by articulating your vision for positive change; build commitment by creating trust and accountability with your colleagues; and create alignment by building a shared understanding of goals. In this way, you can be an everyday leader who transforms the lives of adolescents—in the clinic, in the laboratory, in the community.

I'd like to highlight a few of the many everyday leaders in SAHM who are doing just that. Veronica Svetaz, Chair of the SAHM Diversity Committee, who founded the Aqui Para Ti youth development program and advocates passionately for health equity. Laura Grubb, who is doing a spectacular job in leading our SAHM Advocacy Committee. Matthew Aalsma, who co-chairs the Mental Health Committee and whose research focuses on mental health of youth in the juvenile justice system. Nneka Holder, who leads work in adolescent vaccination as chair of our SAHM vaccination committee. Holly Fontenot, who leads the SAHM nursing research SIG and a research program focusing on prevention of HIV and HPV. Tornia Wyllie, our new Trainee Representative to the Board of Directors, whose goal is to develop Adolescent Medicine in the Caribbean. Jason Nagata, who facilitates the careers of young professionals through both SAHM and the International Association for Adolescent Health. And Nuray Kanbur, our new international chapter representative on the BOD and a leader in adolescent medicine in Ankara, Turkey.

As these leaders demonstrate, engagement with SAHM can provide enormous opportunities to lead and to unleash the power you have to create change. This aligns perfectly with SAHM's mission—to support each of you to lead in the promotion of optimal health and well-being of all adolescents and young adults through the advancement of clinical practice, care delivery, research, and advocacy.

There are two ways that engagement with SAHM can help you lead: first, by giving you the knowledge, resources, support, and networks needed to lead in your own institutions and communities, and second, by giving you opportunities to lead within our organization.

There are so many opportunities to lead through SAHM. These include the following: the Board of Directors, with representation from our trainees, our international members, and our regional chapters; more than 25 committees and subcommittees, from Advocacy to Health Services, and from Research to Diversity; 37 special interest groups, from spirituality to substance use, and from juvenile justice to college health; and 17 regional and international chapters. Other opportunities include engaging with the Journal of Adolescent Health, whose Editor-in-Chief is former SAHM President Dr. Carol Ford; contributing to publications including writing position papers or newsletter articles and serving on the publications committee; participating in advocacy efforts; and involvement in grant and funding opportunities.

SAHM is led by an elected Board of Directors, working in close collaboration with our dedicated team at Kellen, which is led by the one-and-only Ryan Norton, our superbly talented Executive Director. We are in the midst of a strategic planning process that will lead to a positive transformation in SAHM's infrastructure and governance, which is foundational to our ability to achieve our vision and missions. The Governance Review Committee, led by Dr. Nicola Gray, has been working diligently over the last year on a deep dive of our governance structures involving data collection from many SAHM members. The Annual Meeting Strategic Planning Committee, led by Dr. Gina Sucato, recently sent out a survey to the SAHM membership which is gathering valuable feedback. Three early themes that have emerged from this work is that you, our SAHM members, want: (1) improved communication and transparency across the organization; (2) more clearly defined roles and responsibilities for the SAHM Board, Committees, Regional Chapters, and special interest groups; and (3) clearer pathways toward leadership opportunities.

You will hear much more about the recommendations of these committees and the changes that will result from your feedback over the coming months, but for now I'd like to focus on my commitment to you over the next year.

My primary priority as your President will be to enable you to lead from wherever you are, whether that means leadership within your own institutions and communities or within SAHM. I believe that a leader's fundamental task is to unleash the strengths, motivations, talents, and passions of those who they lead, to achieve a shared mission.

What unites us all is our mission to promote the optimal health and well-being of all adolescents and young adults, but we each have unique talents and passions, and I believe that our strength and power as an organization is driven by this diversity of interests, this multitude of answers to “why” we do the work we do. One of my favorite quotations, by Mark Twain, is as follows: “The two most important days in your life are the day you are born and the day you find out why.” This is a mosaic of just a subset of our many “whys” (Figure 2 ). Just think of the transformative power of our work if all of us are leading in our areas of passion toward a shared mission.

Figure 2

SAHM whys.

So, what will I do over the next year to help you unleash your leadership potential and achieve your why, so that individually, you can be most effective in whatever area of adolescent health is your passion, and so that together, we can transform adolescent health? First, I will create opportunities for you to share your personal mission statements and your leadership stories, so that we can all learn from each other, and to scale up the work that so many of you are leading. Please share those with me over the coming year, so that I can include them in our SAHM Matters newsletter—in a section of my President's column called “SAHMLeads,” and through the listserv and web site. Second, I will facilitate ways in which members can more meaningfully engage with and lead within SAHM, guided by the work of our strategic planning committees and board. Third, we will create clearer paths to leadership, including leadership workshops I hope to launch at the 2021 annual meeting. Fourth, we will ensure that our leadership is diverse in all dimensions: because the more diverse, the better equipped we will be to solve the most complex challenges in adolescent health. And by the way, I am exceedingly proud to be part of an organization whose last 20 presidents were 50% women; 30% of whom were African-American. Just look at these incredible, powerful women: Drs. Trina Anglin, Andrea Marks, Abigail English, Mary-Ann Shafer, Leslie Walker-Harding, Debra Katzman, Carol Ford, Tamera Coyne Beasley, Deborah Christie, and Maria Trent.

Finally, I will launch the process for developing an aspirational strategic plan. Our current strategic plan focuses on changes that we must make within SAHM to become a more effective organization, and this is foundational to the development of any long-term, aspirational strategic plan. But it is time for SAHM to begin to move toward the creation of an aspirational strategic plan to ensure that the adolescents of the future can lead healthy and meaningful lives. In the next 10–20 years, powerful forces will affect adolescent health and well-being globally. We in SAHM—in partnership with our sister organizations such as the International Association of Adolescent Health and the American Academy of Pediatrics—are exceptionally well positioned to be the voice for our patients on a national and global stage and to address the following questions: What clinical strategies should we develop and scale that will transform health outcomes and promote equity? How can we harness advances in science and technology—including artificial intelligence, big data, and genomics—to improve adolescent health? How can we advocate most effectively for the issues that will impact adolescent health in the future, such as climate change? How can we maximize our understanding of adolescents across different cultures and their unique strengths and needs? How can we best engage adolescents and families in this work? Finally, how can SAHM create the workforce of the future by considering demand for adolescent health services and innovations in education and professional development?

These are the questions that I and our program committee chairs, Drs. Anisha Abraham and Nicholas Westers, would like us to begin to consider as an organization over the next year, and which we will come together to discuss during our annual meeting in 2021.

Call to Action: Your Leadership Starts Now

I'd like to close with a call to action for all of you. Take some time to think about leading from where you are, to reflect on your life story and how it drives your values and purpose, and to sketch out your personal mission statement. Contribute your mission statements and leadership stories for the SAHMLeads section of the newsletter, the listserv, and the web site: to make it easy for you to contribute, I created an e-mail address that I hope will be easy to remember - sahmpresident@gmail.com. In my first President's column in our newsletter, I would like to include a list of SAHM members' mission statements. Promise that you are going to send me these personal mission statements and leadership stories!

Step up and get involved in committees, special interest groups, regional SAHM chapters, and strategic planning teams. Plan to attend next year's workshop on paths to leadership in SAHM. Reach out and create a developmental network of SAHM colleagues to further your career. Nominate, support, and encourage diverse colleagues to take on leadership roles. Join our work to create an aspirational strategic plan for youth by sending your ideas to me through the e-mail address above. Finally, join us in Baltimore for the 2021 annual meeting—I am confident it's going to be the greatest SAHM meeting ever!

I'll end with a poem, written by a Nigerian poet, Ijeoma Umebinyuo. She captures beautifully the concept of leading from where you are, with courage and resilience.

Start now.

Start where you are.

Start with fear.

Start with pain.

Start with doubt.

Start with hands shaking.

Start with voice trembling but start.

Start and don’t stop.

Start where you are, with what you have.

Just … start.

This poem highlights some powerful emotions that you can harness in your leadership. Tap into the inspiration from your SAHM colleagues to turn your fear into activism and your pain into empathy; to transform your doubt into confidence and those shaking hands into healing hands; and to convert that trembling voice into a powerful voice to advocate for adolescents.

As I start as your SAHM President—with humility, gratitude, and inspiration—I invite you to find your why and start now—and I look forward to traveling on this journey with all of you.