Designing health promotion approaches to high-risk adolescents through formative research with youth and parents.

Young people who engage in multiple health risk behaviors such as alcohol and other drug use, unprotected sexual activity, smoking, and violence, are a serious public health concern. To help identify potential strategies for influencing these behaviors, focus groups were conducted with 160 youth ages 10-18 years. For additional insights, focus groups also were held subsequently with 70 parents and grandparents of youth of similar ages. The youth participants were well-informed about most of the risky behaviors and their health consequences. Safe sex practices and the prevention of human immunodeficiency virus (HIV) infection were the exceptions. Despite this understanding, participants spoke of engaging in these behaviors as part of a lifestyle common to the high-risk environments where they live. The youth said that knowing why these practices were harmful was not enough to help them change the behavior. The need for skills building and support systems to reinforce their generally high level of awareness was evident. Love, home, family, and safety were cited as very important. Many participants said they wanted to talk to someone they could trust, who knew what they were going through. The groups of parents and grandparents were concerned about the physical dangers facing their adolescents and about peer influence. They also acknowledged their own mixed messages to their youth. The focus group findings suggest that health promotion strategies for high-risk youth should be comprehensive rather than categorical, with nonjudgmental, interpersonal communication integrated into community-based programs. To be relevant, program strategies must reach outside the usual channels and incorporate the high-risk environment where these youth live.