Adolescence is a time when youth make decisions, both good and bad, that have consequences for the rest of their lives. Some of these decisions put them at risk of lifelong health problems, injury, or death. The Institute of Medicine held three public workshops between 2008 and 2009 to provide a venue for researchers, health care providers, and community leaders to discuss strategies to improve adolescent health.

This informative and useful volume provides a substantial contribution to the understanding of adolescent risk behavior. The book combines theoretical analysis and the findings of a broad-based research project, with accessible presentation throughout.

Adolescents obviously do not always act in ways that serve their own best interests, even as defined by them. Sometimes their perception of their own risks, even of survival to adulthood, is larger than the reality; in other cases, they underestimate the risks of particular actions or behaviors. It is possible, indeed likely, that some adolescents engage in risky behaviors because of a perception of invulnerabilityâ€"the current conventional wisdom of adults' views of adolescent behavior. Others, however, take risks because they feel vulnerable to a point approaching hopelessness. In either case, these perceptions can prompt adolescents to make poor decisions that can put them at risk and leave them vulnerable to physical or psychological harm that may have a negative impact on their long-term health and viability. A small planning group was formed to develop a workshop on reconceptualizing adolescent risk and vulnerability. With funding from Carnegie Corporation of New York, the Workshop on Adolescent Risk and Vulnerability: Setting Priorities took place on March 13, 2001, in Washington, DC. The workshop's goal was to put into perspective the total burden of vulnerability that adolescents face, taking advantage of the growing societal concern for adolescents, the need to set priorities for meeting adolescents' needs, and the opportunity to apply decision-making perspectives to this critical area. This report summarizes the workshop.

Adolescence is a developmental period of accelerating physical, psychological, social! cultural, and cognitive development, often characterized by confronting and surmounting a myriad of challenges and establishing a sense of self-identity and autonomy. It is also, unfortunately, a period fraught with many threats to the health and well-being of adoles cents and with substantial consequent impairment and disability. Many of the adverse health consequences experienced by adolescents are, to a large extent, the result of their risk behaviors. Many adolescents today, and perhaps an increasing number in the future, are at risk for death, disease, and other adverse health outcomes that are not primarily biomedical in origin. In general, there has been a marked change in the causes of morbidity and mortality among adolescents. Previously, infectious diseases accounted for a dispro portionate share of adolescent morbidity and mortality. At present, however, the over whelming toll of adolescent morbidity and mortality is the result of lifestyle practices.

This book is based on the idea that increasing juvenile risk behaviours – like substance abuse, nonsuicidal self-injury, and antisocial or suicidal behaviour – allow adolescents to fulfill developmental tasks like identity-formation and regulation of self-worth. Narcissistic self-exploitation, mobility tasks, flexibility and the challenges of new media exert social pressure on parental figures, distracting and putting strain on their mental resources, which in turn changes and even destroys the emotional dialogue with their offspring. If children themselves experience neglect and lack of emotional bonding - resulting in a lack of self-regulating capacities – risk behaviours are the consequence. The book combines different views in the psychological, social and metatheoretical domains. It consists of three parts: developmental problems of young people, diagnosis of risk behaviours in the nosological framework, and presentation of new morbidity with an increase in symptom prevalence. The book also discusses the threat of the acceleration of social processes and the risks of postmodern society.

This report constitutes one of the first activities of the Forum on Adolescence, a cross-cutting activity of the Institute of Medicine and the National Research Council of the National Academies. Established under the auspices of the Board on Children, Youth, and Families, the forum's overaching mission is to synthesize, analyze, and evaluate scientific research on critical national issues that relate to youth and their families, as well as to disseminate research and its policy and programmatic implications. The goals of the forum are to: (1) review and establish the science base on adolescent health and development and make efforts to foster this development; (2) identify new directions and support for research in this area, approaching research as a resource to be developed cumulatively over time; (3) showcase new research, programs, and policies that have demonstrated promise in improving the health and well-being of adolescents; (4) convene and foster collaborations among individuals who represent diverse viewpoints and backgrounds, with a view to enhancing the quality of leadership in this area; and (5) disseminate research on adolescence and its policy implications to a wide array of audiences, from the scientific community to the lay public.

The articles in this volume illustrate how development is propelled by the bidirectional relations that occur between the person and all levels of the context. The authors argue that adolescent life is embedded in a complicated developmental system involving multiple features of the individual (e.g., biology, emotions, personality, and cognition) and the multiple levels of his or her social ecology (e.g., peers, family, school, the workplace, and the public policy and legal systems that structure and impact behavioural opportunities for and the actions of adolescents). These articles have important implications for the design of interventions aimed at adolescent problem behaviours.