Adolescent health: from individual risk behaviours to wellbeing ecosystems: learning from the paradigm shift

Recent years have seen a plateauing of most risky behaviours initiated in adolescence and an increase in mental health issues and social isolation. In parallel, there has been a shift from adolescents' risk behaviour management to whole-school-based well-being interventions. This paper charts this paradigmatic shift and provides an evidence base for future interventions. Using an overall realist logic of analysis, the study incorporates evidence from 116 published articles with qualitative data from 28 young people, 22 school nurses and 6 education professionals. The findings highlight the importance of school ethos, relationships, community and culture. Leadership needs to centre care and nurture positive attitudes, interactions and support networks. Secure attachments belonging and safety are vital for adolescent health and well-being, with schools able to act as a buffer where other attachments may be impaired. Young people's distinct and intersectional identities should inform programme development. Our study draws on decades of evidence in health-promoting interventions, to highlight the importance of the relational aspects of education. Too often underutilised in school settings, caring pedagogies highlight the need for care, reciprocity, attentiveness, trust and acceptance. Educators must deliver on both good health and academic success. Ambidextrous organisational theory may help get this balance right.