If we want more evidence-based practice, we need more practice-based evidence.*

Chapter 6
Adolescent Health

Table of Contents


REFERENCES - since publication of 8th edition



This chapter continues the life span perspective on community health started in the previous chapter with infants and children. Adolescence was separated in Community and Population Health from childhood because of the special needs of this age group. Adolescence is presented as a critical developmental period marked by transitions. But it is a period to be lived, not merely lived through. Although adolescents lack life experience, they are often faced with health decisions that require maturity because they may establish patterns for a lifetime. Statistics that show differences among subpopulations of adolescents demonstrate the need for strategies targeted to groups of adolescents, not the "average" adolescent.


Chapter 6 starts with an overview of the developmental tasks of adolescence and their health consequences. A model of community intervention based on predictable transitions anticipates potential problems known to produce risk factors for leading causes of death and disability. Demographic and epidemiological trends for adolescents are reviewed and considered in relation to Year 2000 objectives for this age group. Recommendations for preventive services for adolescents are discussed. Adolescent health behavior is reviewed on issues of sexual behavior; alcohol, tobacco, and illicit drug use; diet and physical fitness; and mental health. The last part of the chapter outlines adolescent health strategies targeted for this age group.


June 2005 health headlines on adolescents and schools. 

Other 2005 headlines on adolescent and school health.

2001-2004 headlines on adolescent and school health.

Underage drinking resource guide on state laws released for prom and grad weeks. Century Council, May 10, 2005.

Pediatric vaccine supply precarious. Health Affairs, May 9, 2005.

Teen drug abuse shifts to Rx medicines. Partnership for a Drug Free America, Apr 24, 2005.

School Lunch Options Crowd Out Fruits and VegetablesJune 30, 2003

Keeping Tabs on Teens May Curb Alcohol Use and Risks.  Feb. 24, 2003

Smoking, Drinking at School May Be Contagious for Teens.  Feb. 24, 2003

Teens Reveal Strategies To Quit, Cut Back on DrinkingJan. 16, 2003

Boyfriend Pressure Makes Black Teen Girls More Likely To Want Pregnancy.  Jan. 13, 2003

Adult Influences May Predispose Teens To Smoke.  Dec. 28, 2002

Teens on Extreme Diets Likely To Take Other Health Risks.  Dec. 28, 2002

Parental Rules Linked To Safer Teen Driving.  March 28, 2002

Community Initiatives Can Lower Adolescent Pregnancy Rates.  March 28, 2002

Students More Afraid to Attend School After Columbine.  March 21, 2002

Tax Increases Can Cut the Number of Habitual Teen Smokers.  February 15, 2002

Young Injection Drug Users in Baltimore City Have Twice the Rate of HIV and Hepatitis B Infection as IDUs in Chicago, Los Angeles, New Orleans, and New York City. (June 14, 1999, Vol. 8, Issue 24) An ongoing study in Baltimore, funded by the Centers for Disease Control and Prevention and the National Institute on Drug Abuse, reports high prevalence of HIV and Hepatitis B and C infection among young injection drug users (IUDs). For more information, contact Dr. S. Strathdee of Johns Hopkins School of Public Health at (410-614-4255) or Dr. D. Vlahov of the New York Academy of Medicine at (212) 822-7383.

Minnesota Reports on Treatment Gap Among Youth  (CSTAT by FAX June 9, 1999, Vol. 4, Issue 2.) Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services. One-fourth of Minnesota youth estimated to need treatment receive it, according to a study conducted by the Minnesota Department of Human Services. Just over 12,000 youth aged 14-17 were estimated to need alcohol or other drug treatment in 1995, compared to 3,093 youth who received treatment that year. Another 56,580 youth are estimated to be in need of early intervention, such as assessment or counseling, to potentially avoid future, more serious substance abuse-related problems. The Minnesota Department of Human Services is currently developing a brief screening instrument to detect substance use problems among adolescents. It is hoped that this instrument will "improve adolescent access to substance use-related services", and thus reduce the treatment gap estimated by this study. For more information, or to obtain copies of this report, call (651-297-3050) or fax (651-251-5754) the Minnesota Department of Human Services.

Study Suggests Repetition Gets Drug Warnings Across to Teens. NEW YORK (The New York Times, April 26, 1999). National Desk; Section A; Page 14, Column 1, c. 1999 New York Times Company by CHRISTOPHER S. WREN. Parents who talk to children about the risks of illicit drugs sometimes despair that their warning goes in one ear and out the other. But the message just might stick in a young brain if it is repeated enough, according to a study of parental and adolescent attitudes released today. The study by the Partnership for a Drug-Free America, a nonprofit coalition, also reported a dramatic disconnection between parents and children in getting the message through. The study is being released at http://www.drugfree.org/ 

Brits Aim to Cut Teen Pregnancies. LONDON (AP, June 15, 1999) – Teenage mothers would be refused government housing and instead would be placed in supervised hostels under a $96 million government plan aimed at halving the number of teen pregnancies in Britain. Other strategies include school nurses helping youths under 16 obtain contraceptives without the knowledge of their parents, and sending the Child Support Agency after teenage fathers. Central to the plan unveiled Monday by Prime Minister Tony Blair is a major overhaul of sex education and contraceptive services, which will be publicized more openly and made more accessible.

TV Brings Eating Disorders. FIJI (BBC News, May 20, 1999). Fiji, a nation that has traditionally cherished the fuller figure, has been struck by an outbreak of eating disorders since the arrival of television in 1995, a study has shown.

Anti-AIDS Campaign Uses Gritty Words to Educate Youth. (CNews Online May 21, 1999).  The Canadian AIDS Society's campaign, "AIDS: Not in This Body," is taking a new approach to educating young people between the ages 14 and 24. Surveys have indicated that young people take straight and comprehensive talk about AIDS more seriously than information that hedges around the issue. Accordingly, the program will feature explicit brochures and posters that will be distributed to schools and communities throughout the nation about risky sexual behavior and how to safely use sex toys and drug needles.

More Teen AIDS Feared. (London Free Press Online, May 23, 1999); Lem, Sharon. New statistics from Health Canada indicate that of all new HIV infections between 1990 and 1995, half occurred among individuals aged 23 or younger. Dr. Chris Archibald, chief of Health Canada's division of HIV/Epidemiology at the Centre for Disease Control, noted there is risky sexual behavior among the country's teenagers, and he called for increased sexual education in schools. Data reported to Health Canada's Centre for Disease Control suggest a low prevalence of HIV infection among Canadian youth, but a Health Canada HIV/AIDS report notes that sexual behavior statistics indicate the situation could be quite different. A 1992 British Columbian report found that 33 percent of boys and 28 percent of girls aged 12 to 18 reported being sexually active. However, of these students, 30 percent of boys and 24 percent of girls had already had at least four sexual partners, and just 64 percent of boys and 53 percent of girls reported using a condom during their last encounter.

Government Strategy Aims to Halt Youth Smoking. (St. John's, NS, Telegram, May 12, 1999). Joan Marie Aylward, minister of health and community services, outlined the first stages of the government's plan to deal with youth smoking Tuesday. As part of the tobacco reduction strategy, Aylward introduced legislation to amend the Tobacco Control Act. The changes will target the licensing of wholesale and retail vendors of tobacco products. Vendors will now be required to have a license to sell tobacco products. If vendors sell to those under the age of 19, they can have their license suspended for up to two months. With a third violation, the license can be cancelled. If a vendor continues to sell without a license, he or she can be charged and fined, anywhere from $500 to $20,000 dollars, with the amount increasing with each subsequent offence. Youth will no longer be required to take part in a court process. "We are not making criminals of our children," said Aylward. "Instead, we are demanding that vendors act responsibly." http://www.thetelegram.com.

Pap Smear Urged for Some Girls. CHICAGO (AP, Mar. 2, 1999) - Researchers have found that non-urban white girls in New England had high rates of cervical cell abnormalities, which are often caused by a sexually transmitted virus and can lead to cancer. The findings argue for early Pap-smear screening of all sexually active girls, not just those who live in inner cities and belong to minority groups. Past studies indicate human papillomavirus, or HPV, is the most common sexually transmitted virus in the United States, affecting 13% to 46% of young women, researchers said. Among U.S. adolescent girls, about one-third are sexually active by ninth grade and about two-thirds by 12th grade. That puts them at high risk for catching HPV, which is well known to cause cervical cell changes that can lead to cancer, the researchers said. For full story see the March 1999 issue of Pediatrics.

Ministry Releases Lists of Cigarette Chemicals (Victoria, December 16, 1998). Lists of what Canadian tobacco companies put in cigarettes were released today by Health Minister Penny Priddy. British Columbia is the first jurisdiction in the world to require this sort of detailed testing and reporting on tobacco smoke" Priddy said. "We are also first government to release a complete list of ingredients to companies put in cigarettes. "The new data on cigarette ingredients and additives and the level of selected chemicals in their smoke is now available at http://www.cctc.ca -- the internet Web site of the Canadian Center for Tobacco Control."

More Abortions Reported as Teen Pregnancies Rise. (Southam Newspapers January 17, 1999) As teen pregnancies rise so does the rate of abortions. In 1995, 45% of teen pregnancies ended in abortions and accounted for one-fifth of all abortions in Canada.

Sweet Temptation. SYDNEY (Australia )Morning Herald September 30, 1996) Many school canteens provide a rich source of funds for school activities but many of these school-sponsored eating establishments provide students with a large assortment of "junk food".

Justices Reject School Condom Policy Challenge.  (L.A. Times January 9, 1996) The Massachusetts Supreme Court rejected parental challenge to a school program that provided free condoms to junior and senior high school students.

San Francisco Board Bans Clothing with Cigarette Logos.  (San Francisco Chronicle May 29, 1996)  With advertising banned on many school campuses, clothing, especially that with smoking logos have been increasingly worn in schools. The school board moved to ban all clothing that sported cigarette advertising and logos.

For related news stories, click here.


Affordable Colleges Online (ACO) - Guide to understanding and stopping cyberbullying in college



ACO has a section on its web site devoted specifically to addressing cyberbullying in college. The guide offers tips, tools & solutions for recognizing and stopping bullying in social media and online

Student Voices IPTV

Johnston, Iowa WWW Station Middle/High School

Check out this companion Web site for background on the IPTV program that brings young people from across
Iowa together to discuss issues that are important to their lives, and offers links to resources on such topics as self-image, substance abuse, teen pregnancy and violence.

From BBC Education - Learning to Be You http://www.bbc.co.uk/education/id

Learning To Be You Campaign aims to help children increase their decision making abilities by building children's self-esteem and improving their knowledge. This website contains resources to help children boost their self-esteem so that they can cope better with the pressures that might lead them to experiment with sex and drugs. Guidelines for teachers are included.

National Cancer Institute - Smoking

Facts about Tobacco and resource to help quit smoking

Quit Smoking Community


Helps people quit smoking through a combination of quality information and strong community support
North American Quitline Consortium


The Consortium is an international, non-profit organization that seeks to promote evidence based quitline services across diverse communities.

Quitlines are telephone-based tobacco cessation services that help tobacco users quit.

Tobacco Education Research Oversight Committee  (TEROC)


TEROC is a legislatively mandated advisory committee charged with overseeing the use of Proposition 99 tobacco tax revenues for tobacco control and prevention education and for tobacco-related research

Ed Hit: Health for Success


This site, developed by the American Cancer Society, presents information about the national health education standards and explains a few popular myths about health education.

Healthwise http://www.goaskalice.columbia.edu/ask.html

Healthwise, the Health Education and Wellness program of Columbia University Health Service, features an interactive health question & answer service. Includes Q & A on sexuality, relationships, alcohol & other drugs, fitness and nutrition, emotional well-being, and general health.



All about kid's health, this site is a safe place for kids to find out more about their bodies and feelings. Parenting
information ranges from child behavior and development, to nutrition, general health, surgery, and immunizations.

Centers for Disease Control and Prevention
Public Health Service
Division of Adolescent & School Health
4770 Buford Highway, NE -Mailstop K31
Atlanta, GA 30341-3724
Phone: (404) 488-5253

Combines a Health Promotion and Education Database with the AIDS School Health Education Database into the Combined Health Information Database available through BRS on-line retrieval

Planned Parenthood Federation of America
810 Seventh Avenue
New York, NY 10019
Phone: (212) 541-7800

Operates over 700 family planning clinics. Educational efforts directed at specific problems including unintended pregnancies among teenagers. Offers publications on contraceptive methods, fertility, teenage sexuality, sexuality education, and other related topics. Some materials in Spanish.

Department of Adolescent Health
American Medical Association
515 North State Street
Chicago, IL 60610
Phone: (312) 464-5530


Pamphlets, guidelines for adolescent health care, public information materials.  "Teen Talk" is a compilation of more than 30 articles written to promote the health and well-being of young people.  A resource for information on adolescent health issues and   Guidelines for Adolescent Preventive Services (GAPS)
program. Information for health care professionals, adolescents and their families.

Center for Populations Options
1012 14th Street NW
Suite 1200, Washington, DC 20005
Phone: (202) 347-5700

Aims to reduce incidence of un-intended teenage pregnancy.. Focuses on adolescents as a critical group to reach with information on reproductive health and family planning options. Offers a variety of fact sheets guides, reports, and audiovisual materials.

Child Welfare League of Canada
180 Argyle Avenue, Suite 312
Ottawa, Ontario K2P 1B7
Phone: (613) 235-4412
Fax: (613) 788-5075                                              e-mail:  cwlc@magi.com

Access to the Canadian Resource Centre on Children and Youth, recognized as the most comprehensive Canadian collection of resources on children, youth, and their families. The Centre contains over 15,000 documents, including 2,000 French-language references.

The McCreary Centre Society
Vancouver, Canada

Explains Centre's goals, services, and programs for research and action in youth health. Includes publication list, opportunities for youth participation, and research

Adolescence Directory On-Line
http://education.indiana.edu/cas/adol/adol.html - [Link obsolete]

Please see additional links below on adolescence health

Adolescence Directory On-Line (ADOL) is an electronic guide to information regarding adolescent issues and secondary education. This collection of electronic resources is intended for parents, educators, researchers, health practitioners, and teens.

Adolescent Health Transition Project 

The Adolescent Health Transition Project is designed to help smooth the transition from pediatric to adult health care for adolescents with special health care needs. This site is a resource for information, materials, and links to other people with an interest in health transition issues.

African American Resources
http://afgen.com/genesis.html            http://wwwmyblackweb.com                      http://www.healthgap.omhrc.gov/

These sites  list of links to other African American web resources.

Center for Adolescent Studies

CAS's mission is to advance the understanding of the psychological, biological, and social features of normal adolescence.

Centers for Disease Control and Prevention,
Division of Adolescent Health and School Health

The Division of Adolescent and School Health (DASH) pursues four strategies: identifying and monitoring highest priority risks; synthesizing and applying research; implementing national programs to prevent these risks; and, evaluating and improving those programs.

National Campaign To Prevent Teen Pregnancy

The mission of the National Campaign to Prevent Teen Pregnancy is to prevent teen pregnancy by supporting values and stimulating actions that are consistent with a
pregnancy-free adolescence.

National Center for HIV, STD and TB Prevention

National Dropout Prevention Program

National Longitudinal Study on Adolescent Health "Protecting Adolescents From Harm"



A searchable site for teens that pre-sents information about adolescents and their issues including relationships, sexuality, and pregnancy. There is an archive of all of the questions asked. The Warehouse has articles about dating, love, sex, birth control, infections and diseases, abortion, sexual orientation, parents and friends, feelings, and more. World Views presents teen issues from other parts of the world. Hothouse is a teen-written zine. Sponsored by Planned Parent-hood Federation of America.

Guide to nutrition and fitness for students at all levels


The Safety.com Guide to Teen Health and Safety: https://www.safety.com/teen-safety-resource-guide/

 Information on Safer Sex for Teens: http://www.safersex.org

Information for Young Women on Issues Such as Puberty and Menstruation: http://www.troom.com/index2.html

Tips for Teens About Alcohol and Drug Abuse:

Health, Social, and Behavioral Issues In Adolescence: http://www.adolescenthealth.org/Health_Social_and_Behavioral_Issues_In_Adolescence.htm

Local Canadian Site For Teens: http://www.cyberisle.org

The Communication Initiative Website: http://www.comminit.com

Guide to Family Healing: Recovering from the Addicted (A resource to help families heal from the pain and anguish caused by their addicted loved ones):



Resources for parents with teenagers:


Related Websites on The Communication Initiative Website


Journal References

Severe Morbidity and Mortality Associated with Influenza in Children and Young Adults --- Michigan, 2003.  MMWR Weekly Report, 52, No. 35, Sept 4, 2003. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5235a2.htm

An, L.C., O'Malley, P.M., Schulenberg, J.E., Bachman, J.G., & Johnston, L.D. (1999). Changes At The High End Of Risk In Cigarette Smoking Among US High School Seniors, 1976-1995. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (5): 699-705.
    ABSTRACT: Objectives. This study identified high school seniors at low, moderate, and high risk for cigarette use to examine changes in the prevalence of daily smoking within risk groups from 1976 to 1995. Results. Risk group distribution (low = 45%, moderate = 30%, high =25%) changed little over time. Between 1976 and 1990, greater absolute declines in smoking occurred among high-risk students (17 percentage points) than among low-risk students (6 percentage points). Particularly large declines occurred among high-risk African Americans and Hispanics. Smoking increased in all risk groups in the 1990s. Conclusions. Among high school seniors, a large part of the overall change in smoking occurred among high-risk youth. Policies and programs to reduce smoking among youth must have broad appeal, especially to those at the higher end of the risk spectrum.

Armstrong, B., Cohall, A. T., Vaughan, R. D. Scott, M., Tiezzi, L., McCarthy, J. F. (1999). Involving Men In Reproductive Health: The Young Men's Clinic. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 902-905.
    The Journal’s Home Page is at: http://www.ajph.org/.
    ABSTRACT: Objectives. This report describes the population of young men who use the Young Men's Clinic in New York City, presents a profile of their reproductive behaviors, and describes the clinic's model of service delivery Methods. Data were gathered through a routine clinic visit form administered by clinic stair. Results. The clinic sees approximately 1200 predominately Dominican young men each year from a wide range of clinical and mental health services. Two thirds of clients had ever been sexually active, three quarters had ever used birth control, and 69% had used birth control at their last sexual encounter. Conclusions. The Young Men's Clinic may serve as a model for health care delivery to adolescent and young adult males.

Card, Josefina J. (1999). Teen Pregnancy Prevention: Do Any Programs Work? ANNUAL REVIEW OF PUBLIC HEALTH 20: 257-286.
    ABSTRACT/Full-Text: Abstract.

Denman, S. (1999). Health Promoting Schools In England - A Way Forward In Development. JOURNAL OF PUBLIC HEALTH MEDICINE 21(2): 215-220.
http://www.oup.co.uk/pubmed/hdb/Volume_21/Issue_02/210215.sgm.abs.html .

Faggiano, F., Di Stanislao, F., Lemma, P., & Renga, G. (1999). Inequities In Health. Role Of Social Class In Caries Occurrence In 12 Year Olds In Turin, Italy. EUROPEAN JOURNAL OF PUBLIC HEALTH 9 (2): 97-102, 109-113.

Friestad, C. and Rise, J.  (1998).  Smoking Attributions and Adolescents' Intention to Try to Quit Smoking. ADDICTION RESEARCH 6(1): 13-26.

Griesler, P. C. and Kandel, D. B. (1998).  Ethnic Differences in Correlates of Adolescent Cigarette Smoking. JOURNAL OF ADOLESCENT HEALTH 23(3): 167-180.

Kandakai, T. L., Price, J. H., Telljohann, S. K., & Wilson, C. A. (1999). Mothers' Perceptions Of Factors Influencing Violence In Schools. JOURNAL OF SCHOOL HEALTH 69 (5): 189-195.
    ABSTRACT: This study investigated mothers' perceptions of factors contributing to school violence. Of 345 mothers, 225 (65%) from urban public schools and 120 (35%) from suburban public schools, significant differences in perceptions of school violence were found on the enabling factors subscale for school location. Urban school mothers were significantly more likely than suburban mothers to attribute violence problems at their child's school to the lack of dress codes, violent messages in rap music, and poor parent/teacher communication. Significant differences in perceptions of school violence were found on the reinforcing factor subscale for school location, income, family structure, and race. Mothers of low- and middle-income, single parents, and African Americans were much more optimistic about the possibility that violence prevention programs for students, parents, and teachers would work well to stop or reduce school violence than were higher-income, married and White mothers. These mothers also were more likely to believe it was acceptable for their child to fight at school than were their counterparts.

Koivusilta, . L. K. Rimpela, A. H., & Rimpela, M. K. (1999). Health-Related Lifestyle In Adolescence?  Origin Of Social Class Differences In Health? HEALTH EDUCATION RESEARCH 14(3): 339-355.
http://her.oupjournals.org/cgi/content/abstract/14/3/339 .

Krowchuk, D. P., Kreiter, S. R., & DuRant, R. H. (1998). Problem Dieting Behaviors Among Young Adolescents.   ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 152 (9): 884-888. 
    ABSTRACT: http://archpedi.ama-assn.org/issues/v152n9/abs/poa8066.html.    The Journal's website is at http://archpedi.ama-assn.org/.

Lowe, J.B., Balanda, K.P., Stanton, W.R., & Gillespie, A. (1999). Evaluation Of A Three-Year School-Based Intervention To Increase Adolescents Sun Protection. HEALTH EDUCATION & BEHAVIOR 26 (3): 396-408.
    ABSTRACT: The efficacy of a school-based intervention was evaluated using a randomized controlled trial in Australia. In consecutive grades (8, 9, and 10), students in the intervention group received components of a program that addressed issues related to the need to protect yourself from the sun, behavioral strategies related to using sun-protective measures, personal and social images of having a tan, the use of sun-safe clothing, and how to change their schools through forms of structural change. Pre-and post-intervention measures among junior high school students showed greatest improvement in the intervention group's knowledge scores and minimal changes in sun protection behavior from Grade 8 to Grade 9, which were not maintained through Grade 10. Results of the study highlight some limitations of school-based interventions for changing sun protection behaviors.

McCall, D., Hill, B., & Johnston, M. (1999). Youth Involvement In Public Decision-Making: A Report On Nine Case Studies. CANADIAN JOURNAL OF PUBLIC HEALTH 90(3), 1999.
    Go to:

Miller, D.R., Geller, A.C., Wood, M.C., Lew, R.A., & Koh, H.K. (1999). The Falmouth Safe Skin Project: Evaluation Of A Community Program To Promote Sun Protection In Youth. HEALTH EDUCATION & BEHAVIOR 26 (3): 369-384.
    ABSTRACT: A multidimensional community-based skin cancer prevention program was conducted in Falmouth, Massachusetts, combining community activism with publicity campaigns and behavioral interventions to improve sun protection knowledge; attitudes; and practices in parents, caregivers, and children. The program was associated with improvements in target outcomes, based on two telephone surveys of random samples of parents (n = 401, 404). After program implementation, fewer parents reported sunburning of their children, particularly among children 6 years old or younger(18.6% in 1994 vs. 3.2% in 1997), and more parents reported children using sunscreen, particularly continuous use at the beach (from 47.4% to 69.9% in younger children). Hat and shirt use did not increase. Improvements also were seen in parent role modeling of sun protection practices, parents' self-efficacy in protecting children from the sun, and sun protection knowledge..

Murray, N. G., Kelder, S. H., Parcel, G. S., Frankowski, R., & Orpinas, P. (1999). Padres Trabajando Por La Paz: A Randomized Trial Of A Parent Education Intervention To Prevent Violence Among Middle School Children. HEALTH EDUCATION RESEARCH 14(3): 421-426.
http://her.oupjournals.org/cgi/content/abstract/14/3/421 .

Neumark-Sztainer, D., Story, M., & Resnick, M. D. (1998). Disorderd Eating Among Adolescents With Chronic Illness and Disability: The Role of Family and Other Social Factors.  ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 152 (9): 871-878. 
    ABSTRACT: http://archpedi.ama-assn.org/issues/v152n9/toc.html
The Journal's website is at: http://archpedi.ama-assn.org/.

Pierce, J. P., Gilpin, E. A., Emery, S. L., White, M. M., Rosbrook, B., and  Berry, C. C. (1998). Has the California Tobacco Control Program Reduced Smoking?  JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 280 (10): 893-899.

Roy, E., Bolvin, J-F., Haley, N. et al. (1998).  Mortality Among Street Youth (Research Letter).   LANCET (9121): 32.
   ABSTRACT: A research team in Montreal, Canada, questioned 517 youths aged 14 to 25 years who had been without a place to sleep more than once in the previous year or who had frequently used Montreal street youth agencies. At baseline, 99.6 percent were sexually active, with 21.9 percent engaging in prostitution and 17.4 percent engaging in homosexual sex. Additionally, 54.7 percent reported using drugs more than twice a week and 39.1 percent reported injecting drugs at least once in their lifetime. The HIV-1 infection rate among the subjects at baseline was 1.36 percent. The researchers gave follow-up questionnaires at six month intervals; 479 subjects completed at least one follow-up questionnaire. Ten subjects died: four by suicide, three by drug overdose, one from fulminant hepatitis A, one from a car accident, and one from undisclosed causes. Eight of the subjects who died were injection drug users and two were infected with HIV-1. The street youth had a mortality rate of 11.67, adjusted for age and sex, as compared to the general youth population of Quebec. The researchers note that "The striking mortality ratio we observed highlights mental health and substance abuse as major issues that must be addressed by health professionals involved in the care of street youth."

Salonen, J. T., Tuomainen, T-P., & Nyyssonen, K. (1998). Donation of Blood Is Associated with Reduced Risk of Myocardial Infarction. The Kuopio Ischaemic Heart Disease Risk Factor Study. AMERICAN JOURNAL OF EPIDEMIOLOGY 148 (5): 445.

Shuey, D. A., Babishangire, B. B., Omiat, S., & Bagarukayo, H. (1999). Increased Sexual Abstinence Among In-School Adolescents As A Result Of School Health Education In Soroti District, Uganda. HEALTH EDUCATION RESEARCH 14(3): 411-419.
http://her.oupjournals.org/cgi/content/abstract/14/3/411 .

Stamm, W.E.  (1998). EDITORIAL. Expanding Efforts to Prevent Chlamydial Infection. THE NEW ENGLAND JOURNAL OF MEDICINE 339 (11): 768. 
    ABSTRACT: http://content.nejm.org/content/vol339/issue11/index.shtml. The Journal's website is:

Thomson, C., Currie, C., Todd, J., & Elton, R. (1999). Changes in HIV/AIDS education, knowledge and attitudes among Scottish 15-16 year olds, 1990-1994: Findings from the WHO: Health Behaviour in School-aged Children Study (HBSC). HEALTH EDUCATION RESEARCH 14(3): 357-370.
http://her.oupjournals.org/cgi/content/abstract/14/3/357 .

Villarruel, A. M., Jemmott, L. S., Howard, M., et al. (1998).  Practice What We Preach? HIV Knowledge, Beliefs, and Behaviors of Adolescents and Adolescent Peer  Educators. JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE 9 (5): 61.
    ABSTRACT: Researchers from the University of Pennsylvania School of Nursing surveyed 33 predominantly African-American adolescents and adolescent peer educators regarding HIV knowledge and behaviors.   Both groups of adolescents displayed moderately high knowledge of HIV, confidence in their ability to use condoms, and the belief  that condoms would not decrease sexual pleasure or imply  infidelity. A total of 54 percent of the subjects were sexually  active. The authors warn that "despite the high knowledge scores, findings from this study as well as prior research indicate that knowledge is not sufficient to support safer sex behavior." They recommend that HIV prevention efforts include information about specific behaviors, including the use of condoms for oral sex and the cleaning of drug paraphernalia.  Participants in the survey also voiced concerns that many adolescents still engage in dangerous sexual practices and have misconceptions about HIV and AIDS. Their recommendations included increased community-based and church HIV-prevention programs, with messages serving to increase perceptions of HIV risk.

Wiemann, C. M., DuBois, J. C., Berenson, A. B. (1998).  Strategies to Promote Breast-feeding Among Adolescent Mothers. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 152 (9): 862-870. 
    ABSTRACT: http://archpedi.ama-assn.org/issues/v152n9/toc.html. The Journal's website is at: http://archpedi.ama-assn.org/.

Zhu, S-H., Sun, J., Billings, S.C., Choi, W. S., Malarcher, A. (1999). Predictors of smoking cessation in U.S. adolescents. AMERICAN JOURNAL OF PREVENTIVE MEDICINE 16 (3): 202 - 207.
    Abstract: Objective: To identify factors that predict quitting among adolescent smokers. Methods: Adolescent smokers aged 12-19 years (N = 633) from the national Teenage Attitudes and Practices Survey I (1989), were followed up in the Teenage Attitudes and Practices Survey II (1993). Multiple logistic regression was applied to identify the predictors of quitting. Results: A total of 15.6% of adolescent smokers had quit smoking at the follow-up survey four years later. There was no significant difference in the quit rate by age, gender, or ethnicity. Five baseline factors were identified in a multivariate analysis as significant predictors of quitting: frequency of smoking, length of past quit attempts, self-estimation of likelihood of continuing smoking, mother's smoking status, and depressive symptoms. The more risk factors the adolescents had, the less likely they would succeed in quitting. Conclusions: Quitting smoking by adolescents is influenced by multiple biological, behavioral, and psychosocial variables. Identifying these variables can help tailor cessation programs to more effectively help adolescents quit smoking


Books and Reviews

Keyser, B., Morrow, M., Doyle, K., Ogletree, R., Parsons, N. (1998). Practicing the Application of Health Education Skills and Competencies. Boston: Jones & Bartlett. $32.50.
Written for the teacher who is training health education professionals, this book systematically addresses each of the responsibilities and competencies that have been identified by the health education profession as necessary for entry-level health education. The seven chapters correspond to the seven responsibilities of a health educator as put forth by the National Task Force on the Preparations and Practice of Health Educators. To read more about this title, and to place your order, please go to http://catalog.jbpub.com/detail.cfm?i=0533-0 .
Timmreck, T. C. (1998). Health Services Cyclopedic Dictionary, 3rd ed. Boston: Jones & Bartlett. $70.
The most comprehensive dictionary on the full range of health services. Exhaustive listings on public health, health administration, epidemiology, health administration, health promotion, managed care, and other areas of health service provide accurate, detailed definitions. To read more about this title, and to place your order, please go to http://catalog.jbpub.com/detail.cfm?i=515-6  


Other References

Trends in HIV-Related Sexual Risk Behaviors Among High School Students -- Selected U.S. Cities, 1991-1997.
Morbidity and Mortality Weekly Report 48 (21), June 4, 1999.
    Despite recent decreases in sexual risk behaviors among high school students nationwide (1), human immunodeficiency virus (HIV) infection was the seventh leading cause of death among persons aged 15-24 years in the United States during 1997 (2). To determine whether the prevalence of HIV-related sexual risk behaviors among high school students also has decreased in certain urban areas heavily affected by the epidemic, CDC analyzed data from Youth Risk Behavior Surveys (YRBS. This report summarizes the results of this analysis, which indicate that, from 1991 to 1997, the percentage of high school students engaging in HIV-related sexual risk behaviors decreased in some U.S. cities. References cited:
1. CDC. Trends in sexual risk behaviors among high school students—United States, 1991-1997. MMWR 1998;47:749-52.
2. Ventura SJ, Anderson RN, Martin JA, Smith BL. Births and deaths: preliminary data for 1997. Hyattsville, Maryland: US Department of Health and Human Services, CDC, National Center for Health Statistics, 1998. (National vital statistics reports; vol 47, no. 4).
3. Abma J, Chandra A, Mosher W, Peterson L, Piccinino L. Fertility, family planning, and women's health: new data from the 1995 National Survey of Family Growth. Vital Health Stat 1997;23: 1-114.
4. Sonenstein FL, Ku L, Lindberg LD, Turner CF, Pleck JH. Changes in sexual behavior and condom use among teenaged males: 1988 to 1995. Am J Public Health 1998;88:956-9.
5. CDC. HIV/AIDS surveillance report, 1998. Atlanta, Georgia: US Department of Health and Human Services, CDC, 1998.
6. National Center for Education Statistics. Common core of data survey. Washington, DC: US Department of Education, 1997.
7. CDC. Health risk behaviors among adolescents who do and do not attend school--United States, 1992. MMWR 1994;43:129-32.
8. Brener ND, Collins JL, Kann L, Warren CW, Williams BI. Reliability of the Youth Risk Behavior Survey questionnaire. Am J Epidemiol 1995;141:575-80.
9. CDC. School-based HIV-prevention education--United States, 1994. MMWR 1996;45:760-5.

Incidence of Initiation of Cigarette Smoking -- United States, 1965-1996. Morbidity and Mortality Weekly Report, October 9, 1998/Vol. 47/No. 39.
    ABSTRACT: Tobacco use is the single leading preventable cause of death in the United States, and the risk for smoking-attributable disease increases the earlier in life smoking begins (1). Trends in the initiation of cigarette smoking are important indicators for directing and evaluating prevention activities (2). CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) analyzed self-reported data from the National Household Survey on Drug Abuse (NHSDA) for 1994-1997 to study the incidence of initiation of first cigarette smoking and of first daily smoking in the United States during 1965-1996 among persons aged less than or equal to 66 years and to estimate the number of new smokers aged less than 18 years. The findings from the analysis indicated that, during 1988-1996 among persons aged 12-17 years, the incidence of initiation of first use increased by 30% and of first daily use increased by 50%, and 1,226,000 persons aged less than 18 years became daily smokers in 1996.
1. CDC. Reducing the health consequences of smoking: 25 years of progress--a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1989; DHHS publication no. (CDC)89-8411.
2. Substance Abuse and Mental Health Services Administration. Trends in the incidence of drug use in the United States, 1919-1992. Rockville, Maryland: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 1996; DHHS publication no. (SMA)96-3076.

HIV Infection in Disadvantaged Out-of-School Youth: Prevalence for US Job Corps Entrants, 1990 Through 1996. (1998). JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY 19 (1).
    ABSTRACT: Young disadvantaged women, particularly African-American women, are being infected with HIV at younger ages and at higher rates than their male counterparts, according to a new CDC study. The study presents data from 1990 through 1996 on the rates of HIV infection among entrants to the U.S. Job Corps program, a federally funded job training program for disadvantaged out-of-school youth from all 50 states and U.S. territories. The results indicate that of the over 350,000 16-21-year-olds tested, more than 2 per 1,000 were HIV-infected, with rates among young African-American women exceeding 5 per 1,000. Young African-American women had the highest HIV infection rate of any  group. One of the most alarming findings was the elevated risk among young women, compared to young men. During the seven year study period, HIV prevalence was 50 percent higher for women in the study than for men (3 per 1,000 versus 2 per 1,000) as a result of dramatically higher rates of infection among young women 16-18 years of age. These findings point to the critical need to reach young women early and provide them the skills and information needed to protect themselves from infection. Prevention programs for disadvantaged young women should include a focus on building the self-esteem and skills necessary to delay sexual intercourse and to negotiate condom use.


1. Teenage pregnancy objectives of the U.S. Review information provided in this chapter regarding community intervention models, adolescent health education and services, and teenage sexuality and pregnancy. Consider what needs to be done to achieve the 2000 objectives for teenage pregnancy. What would be the elements of a program be in your community to meet the 2000 objectives for teenage pregnancy?

2. Objectives for teenage smoking reduction. Design a specific program that can be implemented in the community to meet the 2000 objectives for teenage smoking reduction.

3. Historical perspectives on teenage pregnancy. The relationship between history, teenage pregnancy, and abortion rates is significant. When society's norms were more closely coordinated with nature's biological clock, teenage pregnancy occurred within the context of relationships. Even if pregnancy occurred prior to marriage, a wedding could be quickly arranged. Currently menstruation occurs at least ten years before the average female marries. The majority of teenage pregnancies occur out of wedlock. Many young women, seeking to move on with their lives, terminated these pregnancies in the past with abortions. Often, the "parents" are too immature to marry and assume responsibility for a family. With changing social norms, more young women are choosing to keep their babies. The gap between sexual maturity and intended pregnancy offers few legitimate sexual outcomes for teenage females. Consider some of the contributing factors to current trends in teenage pregnancies including the media, social services, family structures, values, and education. Are current trends a good thing? If not, what will it take to change them?

4. Service agencies. Prepare a list of agencies in your region that could assist teenagers with problems of pregnancy, adoption, abortion, prenatal care, smoking and family counseling, and shelter.

5. Debate: If a parent tapes the telephone conversations of a teenage child whom he or she suspects of being heavily involved in drug use, is it parental responsibility or indefensible invasion of privacy?

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