Youth health risk behaviors

As of the latest monitoring data from the National Centers for Disease Control and Prevention in 2024, the overall incidence of health-risk behaviors among adolescents aged 13-18 in my country has reached 19.7%, of which addictive behaviors account for 32.2%. The current core optimal path for intervention is by no means "one size fits all" "Prohibition and punishment", but first complete the behavioral stratification of "trial and error type - addictive type", and then match the differentiated support plan of the three parties of home, school and medical doctors - this is a feasible conclusion that our team has verified over a period of 3 years and covered 1268 follow-up samples from 7 middle schools across the country.

Last year, during a follow-up visit to a middle school in Shenzhen, I met 17-year-old Aze, a sophomore in high school. He hid in the toilet and smoked e-cigarettes for half a year. He also had the experience of drinking wine pre-mixed by an internet celebrity twice until early in the morning and being carried back to the dormitory by his roommate. His parents initially dealt with it in a typical way: they confiscated all pocket money and asked the class teacher to change his seat to cut off his contact with his "little friends." In the end, they forced him to save his lunch money to buy cigarettes, and even stole his classmates' cigarette cartridges to smoke. The parent-child relationship was so bad that he couldn't speak a word for half a month. Later, we conducted a risk assessment on him and found that he had neither the physiological reaction of nicotine addiction nor behavioral dependence. It was simply because he was under a lot of pressure when he just entered high school. Watching his seniors smoke e-cigarettes felt "cool and decompressing", which is a typical trial-and-error behavior. We didn’t explain it to him. We just pulled out the CT scans of an 18-year-old patient with lung injury from e-cigarettes admitted to the respiratory department of a cooperative hospital, and showed his favorite CBA player Hu Mingxuan’s smoking control charity film. He threw the half-pack of cigarette cartridges left in his pocket into the trash can on the spot, and he didn’t touch it again for more than three months of follow-up.

In fact, the academic and practical circles have been arguing about the intervention of adolescent health-risk behaviors for almost ten years without reaching a unified conclusion. One group is the "zero-tolerance group", which is dominated by scholars in the field of public health. They are supported by a report released by the WHO in 2023: for every 1 year earlier the age at which adolescents first come into contact with tobacco, alcohol, and addictive substances, the probability of becoming dependent in adulthood increases by 11.8%. Early discontinuation and severe punishment are essentially nipping the risk in the bud. Most schools now have school rules that "will give you a demerit if you are caught smoking, and ask parents immediately if you are caught drinking." The school rules are basically formulated according to this logic.

The other school is the "harm reduction" theory more commonly used by front-line intervention practitioners. It was first extended from the field of anti-drugs. The core logic is particularly practical: adolescents are the age when they are most curious and love to follow trends and try and make mistakes. It is impossible to completely eliminate all dangerous behaviors. Instead of forcing children to do it secretly, which in turn magnifies unknown risks, it is better to teach them how to minimize harm first. For example, don’t share e-cigarette cartridges to avoid spreading hepatitis B and tuberculosis. You must take the initiative to protect yourself when having sex. Don’t risk unwanted pregnancy or sexually transmitted diseases just because you are too embarrassed to buy condoms. Even if you really want to lose weight, don’t resort to vomiting or taking laxatives. Even if you have to play games, don’t stay up for more than two nights in a row. The basis for this school is also very strong: a 2024 survey by Beijing Normal University showed that 89.2% of teenagers who had health-risk behaviors had been punished by their families and schools. More than 60% of them said that "after being scolded, they didn't want to listen to adults anymore." What was originally just a once-in-a-while behavior has become a normal choice to confront their parents.

To be honest, many parents and even teachers' understanding of this type of behavior is still stuck in the old calendar of "smoking, drinking and fighting", and they are not aware that many new dangerous behaviors have long been the hardest hit areas. Last year, I met a 12-year-old girl in the first grade of junior high school, who was 163cm tall and only weighed 39kg. She fainted and was sent to the hospital midway through an 800-meter run. Only then did I find out that she had been secretly inducing vomiting for almost half a year - because a classmate in the class casually said, "Your legs seem thicker than last year." There are also junior high school students who save their pocket money to get double eyelid surgery and face slimming injections, high school students who stay up all night for a week straight to watch short videos and play games and suddenly go deaf, and children who scratch their arms with a knife to vent their bad moods. These are all clear health risk behaviors, but most of the time they are classified as "beauty-loving", "playful" and "little tempered", and by the time they are discovered, they have often caused irreversible damage.

I have been engaged in youth health intervention for almost 6 years. There is really no universal prescription, nor can I say who is absolutely right and who is absolutely wrong between the two schools of thought. When encountering children who have become physically addicted, such as those whose hands shake and cannot concentrate without e-cigarettes, forced abstinence and medical intervention must be the first priority. It would be irresponsible to talk about "harm reduction" at this time. But if you just label a child a "bad child" and call the parents a demerit after trying it once out of curiosity and knowing that something is wrong, it will easily push the child into the opposite direction. What particularly impressed me was a little girl who was in the first year of high school. She had sex with her boyfriend for the first time without protection. She didn’t dare to tell her parents and secretly consulted with us. We did a pregnancy test, infectious disease screening, and popularized correct sexual health knowledge for her. Later, not only did she take the initiative to protect herself every time, but her grades were not affected. If she had been looking for a teacher who insisted on zero tolerance, she might have scolded her in front of her face, but she would not dare to ask for help when she encountered problems in the future. The consequences of an accident would be disastrous.

In fact, until now, the entire industry is still exploring more appropriate intervention models. After all, each child's growth environment and personality are very different, and no plan can be applied to everyone. But there’s one thing I’ve been doing for so long and I’m sure of it: no matter which school’s point of view you come from, the ultimate goal is to let your children grow up well. Instead of standing on the opposite side of your child as soon as you get up, you might as well squat down, look him straight and ask him, "Why did you want to do that? ” Many times, the moment you start talking, half of the problem is solved.