The recent increase in the number of COVID-19 cases in North America, particularly among young people ages 20-29, is a cause for concern. The reason for this increase seems to be related to poor compliance with public health recommendations. The past few weeks have been filled with reports of university students, for example, having intimate gatherings at bars and dancing the night away at parties with nary a mask on site.
It would be easy to point the finger at young people for the increased number of COVID-19 cases and community spread, but scapegoating young people short-sightedly fails to acknowledge the multitude of factors that can affect young people’s decision-making and, therefore, compliance with public health measures. With pandemic fatigue hitting hard, people striving for social connection have been going out more, limiting contacts less, and possibly, being less diligent when it comes to mask-wearing and physical distancing than they were earlier on in the pandemic. Either way, blaming and shaming adolescents and young adults is likely to be counterproductive and won’t lead to the type of behavior change we are hoping to see. A strategy that acknowledges powerful motivational factors in adolescents and young adults (referred to as AYA in the medical literature) and seeks to empower them to reduce the risk of contracting and spreading COVID-19 is much more likely to bear fruit.
For AYAs, the drive for socialization and cultivating interpersonal relationships is at the core of their process of identity development, and asking them to isolate themselves from friends and significant others is asking them to go against their powerful sociobiological need to interact with peers. In this context, messaging geared toward people of this age group must seek to demonstrate understanding and acknowledgment that what we’re asking them to do is hard. AYAs may also use different processes in decision-making compared to older adults. Empirical studies of cognitive development suggest that by mid-adolescence (about 14 years of age), adolescents are as able as adults to make rational and reasonable health care decisions. The simple fact that they possess adultlike decision-making capacity does not mean that they will perform at a level commensurate with these cognitive abilities. Adolescents are more affected by the influence of peers, less future-oriented, more impulsive, and differ in their assessment of risks and rewards as compared to adults.
What does this mean concretely when it comes to COVID-19 transmission? If young people are hanging out in close proximity after school or having parties in their parents’ basements, it’s not necessarily because they’re selfish and don’t care about others. Adolescents tend to be risk-averse in general, and if they don’t personally know someone who has been affected by the virus, they might be more likely to engage in these high-risk behaviors because they truly think they and their friends will be fine. You may be thinking that’s all well and good for high-school students, but young adults should know better. This might also be true, but data has shown that the prefrontal cortex, the region of the brain responsible for high-level reasoning, weighing consequences, and emotional regulation is not finalized well into the 20s. For a young adult who is forging their identity and building interpersonal relationships, the emotional importance of human connection might simply outweigh the perceived risk of contracting and transmitting COVID-19. Does all this mean that we should be giving AYAs a free pass for their dangerous behavior, chalking it up to how they’re hard-wired? Absolutely not. It just means that we must understand the neurobiological and societal influences that impact their behavior if we are to have any hope of seeing positive change.
Communicating public health recommendations should also seek to understand and acknowledge AYAs’ motivation for changing behavior. Take, for example, a teenage patient with asthma. If that adolescent is not keen on taking their asthma medication, a sermon on the importance of taking medication to avoid the ER is likely not going to be very effective. However, if the adolescent is on the high school basketball team, and this is really important to them, emphasizing how good asthma control can allow him to miss fewer practices and have better endurance on the court might be just the thing to get him taking his puffers regularly. This is essentially the approach health care professionals use in motivational interviewing, a method of interacting with patients to enhance behavioral change. In the context of the pandemic, messaging that responds to the needs of AYAs will likely be much more effective than any approach that uses scare tactics. “A backyard BBQ in your yard with four close friends and seats spaced out 6 feet apart is a great way to still see your friends, which is so important for you” is more likely to incite positive action compared to, “What are you doing? Don’t you care that you could kill someone’s grandmother?”
Rather than blaming and shaming, we must aim for higher quality communication that is honest, clear, and tailored to the reality and motivations of youth. The pandemic presents a unique set of challenges for all of us; for young people who are having difficulty navigating relationships, suffering from loneliness, mental health issues, financial insecurity and/or uncertainty about the future, remembering not to hug a friend or wear their mask might not naturally be at the top of their priority list. We have a responsibility to help young people to see these public health measures as concrete actions that will directly impact the things they worry about.
Silvana Barone is a board-certified pediatrician with subspecialty training in pediatric hospice and palliative medicine and bioethics. She can be reached at her self-titled site, Dr Silvana Barone, and on Twitter @kidshealthdoc.
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