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UNC adolescent health expert talks about connectedness, gun violence, and the power of youth to change the world

Tamera Coyne-Beasley, MD, MPH
Tamera Coyne-Beasley, MD, MPH

Tamera Coyne-Beasley, MD, MPH, is Professor of Pediatrics and Internal Medicine within the UNC School of Medicine, Director of Adolescent Medicine Education in the Department of Pediatrics in the UNC School of Medicine, and Pediatric and Adolescent Director of the North Carolina Network Consortium, and Director of the North Carolina Child Research Health Network at the North Carolina Translational and Clinical Sciences (NC TraCS) Institute. Last year, she became the president of the Society for Adolescent Health and Medicine. Here, she talks with TraCS writer Marla Broadfoot about the first year of her presidency and about the pressing issues of today.

Q:   You have so many titles behind your name — what made you want to add one more, as President of the Society for Adolescent Health and Medicine?

A:   It was important to me to give back to the organization that has given so much to me and my own professional growth and development. As you may be aware, not many clinicians specialize in the field of adolescent medicine. Because of that, a lot of my education, my support, my professional growth, and my mentorship came from individuals within the Society for Adolescent Health and Medicine. So, I was honored when I was nominated for the post. It has been a huge opportunity to serve, and a real privilege.

Q:   Why is it so important to focus on adolescents?

A:   Oh, that's a really important question, and part of it's that adolescents are such a neglected group. But it's also an important time in their life trajectory, when they're trying to discover who they are in terms of their moral and social identity. It can be a confusing time in a world that often gives them conflicting messages about who they should be and what they should value. They are exposed to greater risks — alcohol and other substances, driving while impaired, risky sexual behaviors, less parental involvement — so it's a real opportunity to assist in optimizing the trajectory of a young person's life so they can transition successfully into healthy adulthood.

Q:   It sounds like there is so much ground to cover — how did you decide what your main goals would be, once you took the helm of this presidency?

A:   Adolescents are becoming an influential force in the world and their prevalence is increasing. About a quarter of the world's population are between the ages of 10 to 24, and while many people often think of them in terms of their risk behaviors, they actually have tremendous capacity to change the world. If we can just give them the support they need, they can do great things and change the destructive paths we may see ourselves going down now. They tend to be individuals who are very innovative, very creative, who already have a global understanding and appreciation and value for different cultures and different ways of thinking, and different ways of interacting with people that some older individuals don't have.

When I started my presidency, the meeting theme and my focus was on connectedness. Adolescents need to feel connected to society, to each other, to community. We want to also broaden our connectedness more globally, so that we're not just focusing on what's happening in the United States. Having a global perspective is incredibly important because the emergence of the internet and social media mean there are no limits and boundaries to how people connect and what kind of messages are shared between countries, between communities.

Q:   You talk about this idea, of connectedness and globalization, at a time when many leaders in this country take a more isolationist view. It must have been difficult to take over this post, given the current political climate.

A:   The political climate has made it incredibly challenging. There has been a continual onslaught of policies that actually threaten the lives of adolescents and young people. I've had to communicate with our membership on an almost weekly basis, about our positions on CHIP to what was happening in Charlottesville to DACA to words being banned at the CDC. Parkland was the 18th school shooting in 2018.

Our youth are watching, and what we don't want them to become desensitize or feel that this is this new normal. We don't want them to be complacent or not care for each other. It's a mixed message that's not just happening in the United States, but in other countries as well, where individuals are looking more inward as opposed to outward, ignoring our connectedness, which jeopardizes the health and well-being of everyone.

Q:   It was amazing to see many of the survivors who had been hiding in the closet during the Florida shooting walk out and grab the microphone and start speaking out about how legislators need to do a better job protecting them. They were so telegenic and intelligent and well-spoken, and no longer willing to let other people speak for them. I think that shows the power of this generation.

A:   The power to transform this world really is going to come from our young people. I saw an interesting article that a young person wrote that said "my generation's not going to stand for this," that they are not going to allow our legislators to continue to refuse to talk about gun violence, to refuse to pass any sensible gun legislation. Hopefully it won't take as long as waiting for these young people to become the legislators. We want to support their positivity, help them be healthy and well. We want them to maintain their optimism, instead of succumbing to fear and discontent, so that they can be the change makers.

Q:   When people talk about solutions to gun violence, many turn their attention to legislators or voters, but medical doctors also play a big role in protecting our youth, don't they?

A:   Yes, they do. Ideally, as an adolescent professional, you would see your adolescents and young adults at least once a year at their well visit. There are all kinds of factors that keep that from happening, not the least of which is the tenuous healthcare financing system in the United States. But ideally, you would have a routine visit, where you would screen for health risk behaviors, for depression and other mental health issues, and for resiliency. We do this in our pediatric clinic at UNC.

For example, we screen our young people for anxiety, depression and access to firearms. Interestingly there are some places, like Florida where a doctor counseling about firearms or asking about firearms in the home is banned legislatively. Doctors have a large role to play, and so our role as a society is to make sure that we continue to train people in adolescent medicine and finance health care for all individuals especially adolescents and young adults. We also need more mental health providers and better financing for mental health services.

Q:   What do you think are the biggest risks to adolescent health today?

A:   If you look at the United States, the leading cause of death between the ages of 10 and 24 is motor vehicle crashes. Many of those crashes are caused by alcohol, but now we've also got distracted driving to add to the causes of crashes. The second leading cause of death, depending on the population that you're looking at, is either homicide or suicide. The sad truth is that young people are taking their own lives for a variety of reasons, including mental health related issues. The majority of adolescent and young adult firearm suicides occur with a weapon that's found in their home or the home of one of their family members or friends, so being able to talk to families about firearm ownership and access is actually very important.

Research has demonstrated that the majority of firearms used in school shootings were also found in the home of the perpetrator or in the home of one of their friends or family members. So the top leading causes of death are motor vehicle crashes, homicide, suicide, and if you look worldwide, those are actually the leading causes of death as well. There's lots of similarities, although we all have our own different cultures and contexts. There are lots of commonalities in which we can learn and develop preventative strategies. We also have the use of substances including opioids as big risk to adolescent health. In the U.S. we also have the use of drugs and other substances, such as opioids, alcohol and tobacco as a big risk to adolescent health.

Q:   What has been your accomplishment in the first year of your presidency?

A:   I'm really proud that we added "equity" into our society's vision. While it was always implied, equity is a huge consideration because if you look at the national stage, we're always being divided by a variety of factors, whether it's our race, our ethnicity, our religion, our sexual orientation. These are all of the things that we use to divide us instead of bringing us together, and so it was important to intentionally incorporate equity for all into our vision. Now our vision is "to be a leader in the promotion of health, well-being and equity for all adolescents and young adults."

Another great thing that happened this year is I traveled quite a bit internationally to build capacity and partnerships around the world. In September I was in Portugal, in October I was in India, and in November I was in Ethiopia. It's interesting because we might see some of their problems and think "Oh, that's just a low and middle income country issue," when in reality we too have to be concerned about similar things such as the quality of the water that we drink. Who would have ever thought that we would have water in the United States that would be dangerous to drink?

I'm also been really proud of our advocacy and our ability to mobilize and work together to deal with harmful policies that have been proposed. We need to continue to broaden what we do beyond our offices to help people understand the importance of voting, talking with legislators, helping people understand the importance of speaking up and taking action to do whatever they can. The stakes are extremely high, and if we don't do anything, it could mean the end of the world as we know it.

Q:   You raised two adolescents, who are now bright and talented young adults. How do you feel about their future, and the future of our youth?

A:   This past year has been a very difficult one for young people. Some people have learned how to hate, even more intensely than they did before, and they've learned that hating is actually okay and condoned. They have learned about superiority. Some people have learned to be fearful, and for really good reasons such as all the the sexual assaults that have become more visible, shootings by police and mass shootings. But there is a silver lining and I am optimistic. In public health they call it the tipping point, and though I don't know exactly when the tipping point is going to occur, you can see people, organizations and groups rising up to protest the things that they believe are unjust.

Just like those students after the shooting who said, "Okay, if you guys won't do it. We'll figure it out." People will have to say enough is enough. What we hope to be able to do in SAHM and through our partnership with others is to more quickly approach that tipping point, but approach it in a way that we can reach a positive and peaceful resolution.

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