Performance Improvement 1995. Developing Effective Health Communication Strategies for High-Risk Youth Outside of School



This study assessed the knowledge and attitudes of high-risk youth who regularly engage in practices such as tobacco use, substance use, unprotected sex, and violence. High-risk youth were found to be fairly knowledgeable about healthy practices, yet they do not incorporate this awareness into practice. Their willingness to listen to trusted, credible adults in alternative settings was among the findings that can be incorporated into the delivery of targeted health promotion programs and the design of future research projects.


High-risk youth, who often do not attend school, are less likely than their counterparts to be reached by health promotion programs and services provided through schools and other youth-oriented community organizations. This project was undertaken to learn more about the attitudes and beliefs of these young people in order to foster the development of more effective health promotion programs and services.


Many serious health problems affect young people. For example, in 1987, approximately 2.5 million teenagers were infected with a sexually transmitted disease. In that same year, an estimated 2.5 million teenage girls became pregnant unintentionally. Many young adults with AIDS were likely infected with HIV during adolescence (because of the lag time between infection and onset of AIDS). Youth at particular risk are those ages 10 to 18 who regularly engage in a cluster of risky practices: smoking and drinking, using drugs, having unprotected sex, and/or being victims or perpetrators of violence. These risky behaviors, which begin as experimentation and may become ingrained habits, compromise the possibility of a long and healthy life.

Prevention strategies must reach and influence young people before they adopt risky behaviors, but conventional health education programs may not reach high-risk youth who do not attend school regularly or participate in community activities.


This focus group study, conducted by S.W. Morris & Company, Inc., questioned 160 high-risk youth ages 10 to 18 about their health practices. From December 1990 through March 1991, 24 focus groups were conducted with young people of various races and ethnic groups. Each focus group was composed of individuals of the same age, gender, and race/ethnicity. Community-based organizations recruited participants and provided facilities for the focus groups. The moderator followed a standard format seeking answers to questions about health as a priority; knowledge and attitudes toward smoking, AIDS, pregnancy, alcohol and other drugs, and violence; barriers to the adoption of positive health practices; and opportunities for programs to address risky behaviors.

To the extent possible, each group was led by a moderator of the same gender and race/ethnicity as the participants. To ensure confidentiality and encourage the trust of participants, moderators audiotaped and kept handwritten notes of the focus group discussions. African-American and Mexican-American participants were recruited from the inner city. Another group of Mexican Americans came from a suburban alternative school. Other African Americans, Mexican Americans, and American Indians were drawn from inner-city community-based and religious organizations and a tribal community center. White participants were identified through a rural site with countywide acces-sibility.

After the focus groups were completed, two meetings were conducted with staff from national youth organizations and local youth programs. The staff recommended that discussion groups be conducted with the parents and caregivers of high-risk youth. In December 1992, eight mixed-gender adult discussion groups were conducted at the same sites as the youth focus groups.

Focus group methodology has several limitations. Because population sampling procedures are not used, results are not generalizable. Moreover, Mexican-American youth were the only Hispanic participants, and no Asian/Pacific Islander Americans were included in this study. White participants were drawn from a rural area, while all other groups were recruited from suburban and inner-city communities. Estimates of health-related behaviors were based on participant self-reports. The findings of the study represent an analysis of moderators' observations, transcripts, and other information derived from the study. As such, the findings are qualitative, not quantitative, in nature.


Approximately two-thirds of the focus group participants resided in households receiving public assistance. Nearly one-half lived with a single parent. The majority were truants or school drop-in/dropouts. About one-third reported substance abuse or arrest records. Adult supervisors estimated that over 40 percent were involved in gangs.

Participants were fairly knowledgeable about many current health issues, such as smoking, unprotected sexual activity, and alcohol and other drug use. They were not as knowledgeable about HIV infection and AIDS. Their knowledge resulted from high exposure to health information from many channels, especially from parents, families, and friends. There was little reported reliance on mass media as a source of health information.

Despite awareness of the consequences, many participants reported engaging in behaviors that pose health risks. In this population, risk, violence, and death were seen as a normal part of life, and there was a lack of faith in the future. Therefore, potential future benefit offered little motivation to discontinue a risky practice experienced as enjoyable. Of 12 life priorities, participants selected "being loved" and "having a family" as the top two. "Being healthy" ranked eighth, suggesting a relative lack of emphasis.

Participants reported having much unstructured, unsupervised time. Many expressed a desire to talk with a nonjudgmental adult they could trust, someone who understands what they are experiencing in life, but they did not have such a person at home or at school. Adult focus group participants identified numerous influences on youth, including friend/peer pressure, media and popular culture, and racism/prejudice. Many parents found it difficult to initiate discussions about risky behaviors with their children. Many parents and caregivers reported practicing risky health behaviors themselves. They recognized that their actions conveyed a mixed message when they tried to discourage youth from adopting the same behaviors. While acknowledging responsibility for the young people in their care, these adults also felt that communities should do more for at-risk youth.

Use of Results

The focus group findings reinforced the tenet that knowledge alone is insufficient to change health practices. Participants' emphasis on linkages between health problems (e.g., substance abuse and AIDS) underscored the need for a multiple risk factor approach in the design of outreach programs. Any approach must also incorporate the provision of specific services to help at-risk youth develop the skills to adopt healthier lifestyles. Outreach programs must also take advantage of trusted, credible adults who can help youth make difficult changes.

Findings suggest that health information, programs, and services might be effectively provided in alternative settings that high-risk youth view as "safe havens," that is, those outside mainstream institutions. Nevertheless, a family outreach component should be included, since at-risk youth identified family as an important and trusted influence. Parents need services and support to become better role models and to enhance their communication skills.

Music may have potential as a communication channel to high-risk youth. High-risk youth were suspicious about messages from celebrities, who they thought were interested only in money or exposure. They expressed concern about subtle racial and ethnic stereotyping in health messages, even those intended to be culturally relevant. Therefore, the report recommended careful message crafting, testing, and targeting. Because at-risk youth cannot envision their own future, they cannot be motivated to avoid or discontinue risky health behaviors on the basis of future benefits. Health communications need to impart the belief that there will be a future.


Not yet published.

Agency sponsors:

U.S. Department of Education, U.S. Department of Health and Human Services, U.S. Department of Justice, and U.S. Department of Transportation

Federal contact:

Mary Jo Deering, Ph.D.
Office of Disease Prevention and Health Promotion
Office of the Assistant Secretary for Health
Switzer Building, Room 2132
330 C Street SW
Washington, DC 20201
(202) 205-5968 Fax: (202) 205-9478

Principal investigator:

Ruth Karimi
S.W. Morris & Company, Inc., Bethesda, MD

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