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.

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

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.

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.
http://news.bbc.co.uk/1/hi/health/347637.stm

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.

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.

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.

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.

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.

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.

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..

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.

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

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  

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.
References
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?