What Is an ‘At-Risk’ Youth? Part 1

It’s 4:18pm and you’re driving home from work. When you notice the time on the dashboard, you feel overwhelmingly tired, and also thankful. As a school nurse, the end of your work day is hours before that of your colleagues who work in inpatient settings. So, you are thankful for your set hours, 7:30am – 3:30pm Monday – Friday. Yet, as the sole provider for this part of this county, you are also tired. Exhausted, actually. You manage the caseloads of one high school and three middle schools, and the needs of the youth you take care of are tremendous.

As you sit at the stoplight and think about the mix of gratitude and weariness, you notice a familiar teen just ahead. This girl attends the high school you serve and you’ve heard the administration mention her name at the weekly Student Support Team (SST) meetings. The words “grief group” and “truancy” come to mind when you try to recall her specific risks. 

When the light turns green and you drive past the intersection where she’s lingering, you can’t help but notice the other people, mostly males, are significantly older than she is. They are all smoking. 

Is she OK, you wonder? Should you stop and help her? What kind of help does she really need? Which problem matters most – the acute grief in her life, the substances she’s using, her absences from school, the ages of the friends she’s keeping? 

It all feels so overwhelming. 

The girl you passed on your way home from work is an at-risk youth. 

If you are a healthcare professional, youth services case manager, school counselor, or any other professional who works with youth, her story is likely familiar. 

In fact, the Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Surveillance System (YRBSS) published its most recent set of data in 2019, shedding light on the prevalence of youth risk behaviors and/or factors, including behaviors that contribute to unintentional injuries and violence; sexual behaviors related to unintended pregnancy and sexually transmitted infections; alcohol and other drug use; tobacco use; unhealthy dietary behaviors; and more.  

Here are a few key findings from the 2019 report

  • More than 1 in 3 students and nearly half of female students reported persistent feelings of sadness or hopelessness in 2019
  • Almost 1 in 5 students were bullied at school during the past year
  • Overall, more students missed school because of safety concerns from 2009 through 2019. 

(Editor’s note: The 2021 report will be released in the spring of 2023, and we will update these findings at that time). 

This article is Part I of a comprehensive guide to at-risk youth, where we will provide an overview of –  

What Is An “At-Risk Youth”? 

Youth health professionals and policy makers do not share a single, consistent definition of what makes a youth ‘at risk.’ Yet, it is a term that has a strong intuitive meaning and drives the mission of many of you reading this article. When we hear the term ‘at-risk youth,’ we understand it to refer to an individual who is vulnerable in some way. Perhaps he is at risk of failing in school, or she is experimenting with illicit substances, or they are driving while texting. We know that the youth who are at risk are in need of some type of intervention or support. 

For the sake of consistency and to ground our discussion for the remaining of this article, we will separate and define 3 terms related to the idea of youth risk:

At-risk youth – youth who are vulnerable to experiencing adverse outcomes as a result of engaging in risk behaviors or experiencing risk factors 

Risk behavior – an action that a youth engages in that increases the likelihood of adverse outcomes

  • Examples – using illicit substances; not wearing a helmet; carrying a weapon; having multiple sexual partners

Risk factorcircumstances in a youth’s life that increase the likelihood of adverse outcomes; risk factors are not behavioral choices 

  • Examples – experiencing depression or anxiety; presence of domestic violence in the home; experiencing bullying; lack of a trusted, caring adult

Experiencing one risk factor or engaging in one risk behavior does not automatically mean a youth will experience negative consequences. We know it is possible to send a text message while driving and be OK. We know a youth who engages in sex without using a condom might not contract a sexually transmitted infection (STI). However, the potential for adverse outcomes exists in the presence of risk, and the more risks a youth takes (or has), the greater the likelihood of unwanted or harmful outcomes. 

What Are Youth Risks? 

Youth risks include both risk behaviors and risk factors, as noted above. The list below is not exhaustive, but represents the great majority of behaviors and factors that contribute to youth risk. 

Youth Risk Behaviors

  • Substance use and/or abuse, including: 
    • Illicit substance use (e.g., cocaine) 
    • Opioids (when misused or abused) 
    • Alcohol consumption (for youth under age 21)
    • Alcohol abuse (for any age)
    • Marijauna use (youth under age 21)
    • Nicotine use, including vaping (for youth under age 18)
  • Carrying a weapon
  • Early onset sexual activity
  • Having multiple sexual partners
  • Using substances prior to engaging in sexual activity
  • Unprotected sex (engaging in sexual activity without use of condoms and/or birth control)
  • Sexting
  • Distracted driving, including driving while texting
  • Driving while under the influence 
  • High speed driving 
  • Not wearing a helmet
  • Not wearing a seatbelt
  • Poor diet (e.g., lack of fruit and vegetables)
  • Dieting
  • Disordered eating habits
  • Carrying a weapon
  • Lack of physical exercise

Youth Risk Factors

  • Untreated mental illness, including (but not limited to) depression, anxiety, suicidality 
  • Engaging in self-harm or self-injurious behavior
  • Unintended pregnancy 
  • Present of domestic violence in the home
  • Community violence 
  • Experiencing physical, sexual, and/or emotional abuse 
  • Experiencing neglect  
  • Financial hardship, financial uncertainty, lack of basic resources
  • Experiencing bullying, including cyber bullying
  • Lack of protective factors, including trusted, caring adults
  • Homelessness
  • Poor body image
  • Full–blown eating disorders, including anorexia, bulimia, binge eating disorder

Interrelated Nature of Risks

It is important to note the interrelated nature of risk behaviors and risk factors. You might think of the connection with the phrase, “risk begets risk.” For example, youth who have unprotected sex and/or engage in sexual activity with multiple partners are more likely to have unintended pregnancies in adolescence. Unplanned and unintended pregnancies may interrupt or delay school completion, increase financial hardship, and increase long-term economic and vocational outlook.  It works the other way, too. Meaning, the presence of certain risk factors may be causally related to increased risk behaviors. For example, youth with untreated depression are more likely to use substances than youth without mental illness. And, teens who experience interparental conflict, including hostility, coerciveness, and anger between their two parents, are at an increased risk for behavioral, emotional, and social problems. 

Preventing Adverse Outcomes

Not all adverse outcomes from youth risk behaviors and youth risk factors are preventable, but the majority are. 

Does that surprise you? 

In fact, nearly 75% of serious injury and adolescent death is a result of preventable risk behaviors, like texting while driving or abusing substances. Because of this, it is critically important for youth health professionals to understand which of the youth they serve are at risk, why they are at risk, and what to do about it. 

Leading professional organizations recommend regular youth screening to identify and intervene in the interrelated risk areas mentioned above. The US Preventive Service Task Force: AHRQ recommends screening for depression, anxiety, tobacco use/prevention, obesity, intimate partner violence, and sexual activity. 

Possibilities For Change offers youth risk screening tools that address all of the key screening recommendations from these leading professional organizations: 

  • American Medical Association (AMA)
  • American Academy of Pediatrics (AAP)
  • US Preventive Service Task Force (USPSTF) AHRQ
  • American Academy of Family Physicians (AAFP)
  • Department of Health & Human Services Office of Population Affairs (OASH)

Consequences of Youth Risks

Risk behaviors (like vaping) and risk factors (like being bullied) create the potential for serious, long-term consequences across domains: they can negatively impact one’s physical health, emotional wellness, healthy social development, economic outlook, and more. 

The behaviors and factors mentioned above increase the risk of premature death, disability, and incidence of chronic disease. Some risk behaviors are obviously and immediately dangerous, like driving while intoxicated. Other behaviors may not pose as strong of a threat in the short-term, but can be deadly in the long-term. Consider the impact of physical inactivity and a poor diet over many years. According to the World Health Organization (WHO), a sedentary lifestyle increases all causes of mortality – “doubles the risk of cardiovascular diseases, diabetes, and obesity, and increases the risks of colon cancer, high blood pressure, osteoporosis, lipid disorders, depression and anxiety.” It might be hard for a youth (or anyone, for that matter) to see the connection between skipping the vegetables or lounging on the couch and heart disease, but study after study shows harmful impact of these risk behaviors. 

Premature death, disability, and disease are the overarching categories of adverse outcomes of youth risks. Consequences may be short- or long-term, and are costly to the youth who transition into adulthood, to their families, and to society. 

Be on the lookout for Part II of our guide to At-Risk Youth, where you will learn about why youth are more vulnerable than adults, the continuum of risks, and who is most at risk.