Civic engagement is positively associated with important health and developmental benefits for participating adolescents and young adults. As illustrated by youth political participation, social activism, and rallies for racial justice during the COVID-19 pandemic, youth civic engagement is often inspired by and responsive to problems that are salient to a young person’s lived experiences. Providers can empower youth and encourage civic engagement by eliciting issues that are important to them and directing them to community resources and opportunities for civic participation that can help them address these issues.
Civic engagement, broadly defined, is any individual or collective action designed to identify or address the concerns or well-being of a community, social group, or society in general. It can encompass a range of activities, including political participation (eg, voting, writing legislators, political campaigning), volunteering and community service, sociopolitical action (eg, protesting and social activism), belonging to a community or civic organization (eg, Boy Scouts of America, fraternal service organization, neighborhood association), or charitable giving and fundraising. Increasingly, especially among youth, civic engagement can be digital by using online tools to participate in the aforementioned activities, developing and articulating one's civic identity, engaging in sociopolitical stances and ideologies, or engaging with an otherwise inaccessible larger audience or community.1
Whether digital or conventional, civic engagement can have important developmental and health benefits for participating adolescents and young adults (AYA). One of the developmental tasks of adolescence and young adulthood is the development of one's personal and social identity.2 Civic engagement can foster this identity development by helping AYA understand what it means to belong and have a place in society,3 by exposing AYA to positive modeling through interactions with supportive adults,4 and by increasing social capital and social support.5 AYA civic engagement has been associated with important markers of a successful transition to adulthood, including school engagement and academic achievement, as well as future educational attainment and higher adult socioeconomic status.6 Civic engagement is also an important component of positive youth development (PYD), a strengths-based approach to AYA development that promotes the development of internal strengths and assets, and highlights the external and environmental supports needed to achieve these assets.7,8 Civic engagement contributes to PYD by facilitating AYA asset development, fostering psychological and social development, and connecting AYA to community supports.8
Although difficult to establish directionality, several studies have demonstrated a positive association between civic engagement and important AYA health outcomes, including well-being, mental health, and health-risk behaviors. In a study examining the association between civic engagement and depressive symptoms using the National Longitudinal Study of Adolescent to Adult Health data, adolescent and early young adulthood community engagement were associated with lower depressive symptoms at later time points.9 In a study of civic engagement experiences in college students across 27 campuses, traditional political engagement (involvement in a political campaign, voting, etc) was positively associated with well-being in college students.10 The authors posit that these conventional forms of political engagement empower young people and make them feel they are contributing to their communities in a meaningful way. In a recent review article, Piliavin and Siegl found civic engagement, specifically volunteering, among teenagers and college students was associated with lower rates of depression, substance use, and other problem behaviors (eg, delinquency, school dropout, poor academic performance, and unintended pregnancy).11 PYD models have long recognized the association between increased developmental assets and decreased adolescent risk behavior.12 Researchers have recently explored the connections between civic engagement and adolescent risk behavior. Ballard et al used National Longitudinal Study of Adolescent to Adult Health data to examine associations between 3 forms of civic engagement (activism, volunteering, and voting) performed during adolescence and early adulthood, and subsequent socioeconomic status and mental and physical health in adulthood.6 They found volunteering and voting to be associated with lower health-risk behaviors and, conversely, activism to be associated with increased health-risk behavior. The health-risk behaviors assessed in this study included substance use (eg, binge drinking, cigarette smoking, marijuana use) and behaviors not typically associated with adolescent risk (eg, fast food consumption, low physical activity, high screen time). Nevertheless, the increased risk associated with activism is consistent with previous work theorizing an overlap between youth activism, the experience of discrimination or marginalization which may inspire activism, and risks associated with being marginalized.6,13
Activism as a Form of Civic Engagement and Youth Empowerment
Activism as a form of civic engagement can also be an important tool for empowering AYA, particularly those who may be vulnerable or otherwise marginalized. The police shootings of unarmed African Americans and the deportation of undocumented minors prompted national sociopolitical movements (eg, DREAMers movement, #BlackLivesMatter [BLM]) to resist these social injustices, which were largely led14 or galvanized15 by the racial/ethnic minority youth most impacted by these injustices.6
Activism has similarly been used by sexual and sex-diverse youth and their allies to resist and advocate for changes in homophobic and transphobic policies and practices impacting their fundamental human rights and well-being.16,17 Youth affected by gun violence have developed and led national movements (eg, March For Our Lives) calling for gun control legislation.18 These well-structured, national movements notwithstanding, many marginalized youth have less access to structured civic engagement programs, resources to build or sustain them, or media visibility to propel their sociopolitical activism to the national stage. Yet, informal or unstructured youth activism focused on combatting social injustices at the local level can be equally important and empowering for marginalized youth. Wray-Lake and Abrams explored the civic engagement experiences of 87 Black and Black multiracial AYA aged 12 to 19 years living in impoverished areas of Rochester, NY.19 They found civic action among these youth was largely informal, localized, and, for some, contextualized explicitly as a response to the violence they had identified as a problem in their community. Civically engaged youth in this study described feeling empowered through their civic action and by the adults who role-modeled, guided, and supported that action.19
As noted earlier, youth activism, particularly among vulnerable subgroups, although rewarding, may not be without risk. A recent study of 4970 adolescents aged 11 to 15 years highlighted activism's divergent effects on adolescents. The study surveyed adolescents enrolled in the Adolescent Brain Cognitive Development Study about their engagement with BLM. Respondents experienced strong engagement and positive emotions (inspiration and hope) with BLM demonstrations. Yet, Black adolescents reported higher levels of negative feelings (ie, anger and fear) and experiences (ie, witnessing police use of force at demonstrations), in addition to higher positive emotions than white adolescents.20 Youth whose activism is tied closely to their self-identity or purpose may also be negatively impacted by their activism. In a qualitative study of youth activists on college campuses across the United States, youth commonly ascribed stress, emotional exhaustion, and burnout to their activism activities, but continued despite their psychological distress because their activism was central to their identity.21
COVID-19 and Youth Civic Engagement
The coronavirus disease 2019 (COVID-19) pandemic significantly impacted AYA well-being through disruptions in employment, education, social connections, and mental health. Opportunities for civic engagement, including political participation, out-of-schooltime programs (eg, sports, youth groups, community service, and volunteerism), and social activism were also disrupted by strategies to mitigate the pandemic. Yet, civic engagement seems to have continued, perhaps because of, rather than despite, the pandemic. In a study of the impact of the COVID-19 pandemic on college students' civic behaviors, investigators found that students from marginalized backgrounds because of economic circumstances or racial/ethnic identity were more likely to engage in system-challenging forms of civic engagement in particular (eg, social, community, and political activism), compared with students from more privileged backgrounds.22 In another study, a participatory-action project with immigrant youth of color, participants describe the pandemic and the associated social, class, and racial inequities as a call to action to focus their efforts on civic engagement and community-based participation to combat these inequities.23 These studies, although limited, suggest the social and racial inequality observed during the pandemic, such as the murders of unarmed African Americans by police, have inspired civic engagement and a desire for social justice for impacted youth and their allies.
COVID-19–related health threats also seem to have inspired civic action among youth. Tufts University's Center for Information and Research on Civic Learning and Engagement (CIRCLE) polled youth about 8 COVID-19–related civic actions (eg, wearing a mask in public, making masks to protect others, delivering food or groceries to neighbors, working as a poll worker). Ninety-three percent of youth surveyed had performed at least 1; 38% performed 5 or more.24
Voting as a Form of Civic Engagement
In the middle of the COVID-19 pandemic, a record number of Americans voted in the 2020 general election, including AYA aged 18 to 29 years. Historically, AYA are the least represented age demographic at voting polls across the United States; dating back to 1980, voting rates among youth aged 18 to 29 years have nearly all been <50%.25 The 2020 presidential election saw an appreciable increase in AYA turnout, with CIRCLE estimating that 52% to 55% of youth aged 18 to 29 years voted in the 2020 election.26 AYA endorsed concerns about COVID-19, racism, climate change, gun control legislation, and jobs as their motivation for voting.26 AYA voter turnout allowed these youth to make their voices heard on these critical issues and influenced the election results. Using data from exit polls of the 2020 general election, CIRCLE reported that the increase in young voter turnout, with the majority of voters supporting the democratic candidate for president, was decisive in the election outcome in critical battleground states, including Arizona, Pennsylvania, and Michigan. In each of these states, the net young adult vote for the winning candidate far exceeded the margin of victory.
Initiatives to Increase the Youth Vote
The 2020 election cycle featured several youth-focused initiatives to increase AYA voting and political participation. Many specifically prioritized historically disenfranchised or otherwise marginalized youth. Fair Fight, a political action committee developed and led by Stacey Abrams in Georgia, focuses on voter mobilization and education to combat voter suppression of racial/ethnic minorities and young voters. As a result of these efforts, voter registration among youth aged 18 to 24 years in Georgia increased by 35% since 2016, and there was a 25% increase in voter turnout among youth aged 18 to 29 years in the January 6 Georgia runoffs compared with the November 3 general election, an increase driven significantly by the mobilization of young Black voters.27 The Get Out the Vote: Voter Mobilization and Civic Education Series is a nonpartisan initiative focused on equipping youth with the tools, civic knowledge, organizing skills, and support needed to mobilize their peers to vote. This initiative, sponsored by the Making Caring Common Project of the Harvard Graduate School of Education, featured a series of seminars, training courses, and individual and small group sessions leading up to the 2020 general election.28 Rock the Vote is a nonpartisan nonprofit focused on the political empowerment of youth for 30 years through popular culture, the arts, and technology. The flagship of the Rock the Vote initiative is its online voter platform that third-party organizations can use to register voters. Over 12 million voters have been registered since Rock the Vote’s launch in 1999, including >800 000 before the 2018 midterm elections.29
Each of these initiatives has supported and featured young leaders. However, AYA have also recognized the importance of their political participation and have started their own formal and informal initiatives to encourage their peers to vote. In 2019, Zev Shapiro, who was 17 at the time, developed the youth activism app TurnUp to provide AYA with a centralized platform and social network to learn about issues, social network, and promote activism. The app includes an activity feed, maps of progressive virtual and in-person events, voter registration information, and a network of civic organizations, youth leaders, and supportive adults. Already a community activist since grade school, Zev was inspired by the power of youth organization after the Parkland shooting to create a platform to facilitate youth activism and propel it into the future.30
Role of Health Care Providers in Promoting Voter Registration
In their editorial in Academic Medicine, Milligan and Jones describe encouraging clinicians to promote voting and civic engagement among their patients. Although health care providers' primary responsibility is attending to the health of their patients, it is challenging to disentangle health from public policy.31 Similarly, the editor in chief of the American Medical Association’s Journal of Ethics emphasized the critical role clinics and hospitals can play in helping their patients with voter registration during the COVID-19 pandemic, when traditional voter registration sites were limited or not available.32 For providers in communities subject to voter suppression or otherwise disenfranchised, helping patients navigate voter registration or other civic engagement activities is critically important.33
During the 2020 election cycle, the American Academy of Pediatrics (AAP) encouraged providers to encourage their patients (and parents of patients) to vote because “voting is 1 of the main ways we can influence the public policies that address health inequities in our communities.”34 The AAP initiative Get Out the Vote provides resources for pediatricians to learn about the connection between health and voting, learn how to register patients to vote, and understand key health issues.
Additionally, the AAP partnered with VotER, a voter registration initiative for patients in health care waiting areas.35 VotER was founded by an emergency department physician in collaboration with behavioral scientists at Harvard Kennedy School. Entirely nonpartisan, this project provides patients, families, and staff with the ability to check their voter registration status and register to vote within the health care setting. This initiative started locally but became a nationwide project as >300 hospitals registered to participate.
Several other physician-led projects focus on provider education, as well as patient empowerment. One example, The Voice Project, is a UCSF Benioff Children's Hospital Oakland pediatric resident-led initiative, which offers voter engagement health care training for providers and practical steps for young adults on voter registration and participation in the election process as part of their overall mission of building more equitable public policies and healthier communities in a nonpartisan manner.
Practical Steps for Pediatric Providers to Promote AYA Civic Engagement
Conversations with AYA patients about voting and civic engagement are key to increasing youth engagement in their communities. Providers must first be knowledgeable about this topic and empowered to have these conversations with their patients.
Providers can promote, among patients and families, local opportunities for civic engagement and participation by sharing information about volunteer and community service opportunities or partnering with youth-serving organizations that provide positive adult role modeling and structured opportunities for civic action. As described throughout this paper, youth civic engagement is often inspired by and responsive to problems salient to a young person's lived experiences (eg, racial injustice; anti-lesbian, gay, bisexual, transgender, queer, or questioning [LGBTQ] stigma; and gun violence). Providers can empower youth by engaging them about sociopolitical or community issues that are important to them and directing them to community partners and resources that can help them address these issues. Because youth civic engagement is also highly associated with parental, family, and community civic engagement activities and attitudes, pediatricians can encourage parents and other caregivers to talk to their adolescents about volunteering, community service, sociopolitical activism, and political participation.
Providers should feel comfortable asking patients about their voter registration status if approached in a nonpartisan manner. Providers can ask, “Are you registered to vote?” during the clinical encounter. For unregistered patients, this will give them an opportunity to learn about how voting is associated with positive health outcomes. Further, several studies have demonstrated that, for AYA patients, voter registration in clinical settings is feasible.36,37 In 2018, patients aged 18 to 22 years attending an urban primary health care clinic in Michigan were asked about voter registration by their medical provider or clinical social worker. Fifty-seven participants (47.5%) were registered to vote, whereas 43 (35.8%) registered in the clinic.37 There are also several tools providers can access to help register patients to vote, including VotER (https://vot-er.org) described above or other local and state platforms. If time does not permit clinic-based registration, patients can be referred to resources like vote411.org and www.vote.org. It is also important that pediatric providers are aware of their jurisdiction's voter registration laws. Although the federal voting age is 18 years, many states allow individuals to register to vote 1 to 2 years before 18 years of age. Therefore, providers can begin to have these discussions with their patients as young as 15 to 16 years of age.
Finally, pediatricians should understand the potential positive effects and the potential risks of civic engagement, particularly those associated with sociopolitical activism discussed earlier. It is important that providers include discussions of both in the anticipatory guidance they provide for AYA and their families.
Equipped with these practical tools and an understanding of the association between civic engagement and health, well-being, and positive youth development, we are hopeful that more pediatrics providers will incorporate the promotion of civic engagement in their clinical practice and care of AYA.
Conclusions
Adolescent civic engagement is associated with benefits to health, well-being, and positive health-related behaviors. The directionality of this association is not well known, because youth who participate in civic engagement may already be on positive developmental trajectories. Yet, civic engagement seems to be associated with positive benefits that can persist into adulthood. Providers have an opportunity to use the clinical setting to encourage AYA to be civically engaged. With multiple resources available to empower providers to have these conversations, pediatric providers can inspire their AYA patients to participate in civic engagement activities that can empower, contribute to positive youth development, and potentially promote the overall health and well-being of our future generations.
All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
FUNDING: Funded by National Institute of Child Health and Human Development T32HD052459.
CONFLICT OF INTEREST DISCLAIMER: The authors have indicated they have no conflicts of interest relevant to this article to disclose.
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