If we want more evidence-based practice, we need more practice-based evidence.*
Table of Contents
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.
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.
Smoking, Drinking at School May Be Contagious for Teens. Feb. 24, 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 athttp://www.cctc.ca -- the internet Web site of the Canadian Center for Tobacco Control. " The data can also be accessed through http://www.tobaccofacts.org. --the B.C. Health Ministry's Web site on tobacco.
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.
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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.
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.
Card, Josefina J. (1999). Teen Pregnancy Prevention: Do Any Programs Work? ANNUAL REVIEW OF PUBLIC HEALTH 20: 257-286.
Denman, S. (1999). Health Promoting Schools In England - A Way Forward In Development. JOURNAL OF PUBLIC HEALTH MEDICINE 21(2): 215-220.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Stamm, W.E. (1998). EDITORIAL. Expanding Efforts to Prevent Chlamydial Infection. THE NEW ENGLAND JOURNAL OF MEDICINE 339 (11): 768.
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.
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.
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.
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.
Books and Reviews
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?