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


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


Chapter 6
- Archives of Headlines
Adolescent Health


From the McGraw Hill Health Update  
The transition from age 12 to 13 is the most critical turning point in the lives of young adolescents, according to the 1998 Back to School Teen Survey from the National Center on Addiction and Substance Abuse at Columbia University. It is the year when their access and exposure to illegal drugs skyrockets, while at the same time parental involvement in their lives sharply diminishes.

According to the study, 13-year-olds are three times more likely than 12-year-olds to know other students who use and sell pot, acid, cocaine, or heroin; learn where to buy these drugs and who to buy them from; and significantly change their attitudes about reporting student drug users and sellers. By age 13, their attitudes about communicating openly with parents have also changed dramatically. At the same time, almost one-half (47%) of 13-year-olds say their parents have never seriously discussed the dangers of illegal drugs with them. Nearly two-thirds of all teens report that their parents have discussed the dangers of drugs with them fewer than three times.

Based on a survey of 1,000 teens, 824 teachers, and 822 principals, the study also found that teens who attend religious services at least four times a month were less likely than others to use tobacco, alcohol, and drugs, and that parental monitoring of teens' activities was inversely related to the amount of the teens' pot smoking.  The number of American teens who took up smoking as a daily habit jumped 73 percent between Joe Camel's debut in 1988 and 1996, according to a new study from the U.S. Centers for Disease Control and Prevention (CDC). More than 1.2 million teenagers began smoking daily in 1996, compared with 708,000 in 1988.

CDC blamed tobacco ads that relied heavily on giveaways and kid-friendly cartoons, such as Joe Camel. A spokesperson for R.J. Reynolds Tobacco Co. asserted that peer pressure and smoking parents were the primary causes for teen smoking, not advertising. Joe Camel retired in 1997, after critics called the character a blatant example of cigarette marketing aimed at children. 

Schools becoming new arena for breast cancer awareness (The Associated Press, Dec. 1, 1998).- Even though the risk of breast cancer is slim for teen-agers, high schools are becoming a new arena for health officials who say getting teen-age girls into the habit of doing breast self-exams will help them detect any lumps later in life. "Learning breast self-exams is a skill. The teen-age years is a good time to learn to do it," said Joann Schellenbach, spokeswoman for the American Cancer Society.  It also may be the only time to teach young girls collectively about breast cancer. If they don't go to a  gynecologist or take a health class in college, there's little chance they'll learn about breast self-exams. Now, a very small percentage -- less than 10 percent nationwide -- of girls are being taught in school about breast self-exams, she said.
With girls more physiologically mature and more sexually active, more schools are willing to include subjects like breast cancer in their health education programs, Ms. Schellenbach said.  Northside Hospital has expanded its program to reach students at some colleges, including the University of Georgia, Emory University and Morris Brown College.

Good News About Teens and Sex.
(Washington Times, 10/19/98) P. A19; Fields, Suzanne. -- Recent data from the National Center for Health Statistics  indicate that the teen birth rate in the United States dropped almost 3 percent last year and that the number of abortions also  declined. According to the Alan Guttmacher Institute, the drop in teen pregnancies is due to a number of factors, including fear of sexually transmitted diseases and AIDS. Still, the Chlamydia  rate is increasing among young girls, report scientists at Johns Hopkins University. Data from more than 3,000 females between the ages of 12 and 19 revealed that over 25 percent of 14-year-olds had Chlamydia. Fields notes that one abstinence-based program in some public schools, "Best Friends," emphasizes self-restraint as a method of building self-respect as well as character. The program, which provides 110 hours of moral and social guidance each year from the fourth grade through high school, found that in one study among Washington participants, 1 percent of Best Friends became pregnant compared to over 25 percent of their classmates.

Study links alcohol ads to teen drinking.
SAN FRANCISCO (Reuters) - Children who watch televised beer ads featuring animated characters and celebrities are at a higher risk of drinking larger quantities of alcohol more frequently when they get older, a researcher said Tuesday. In a presentation delivered at the annual meeting of the American Academy of Pediatrics, Joel Grube of the Prevention Research Center in Berkeley, Calif., blamed teen-age alcohol abuse on the prevalence of alcohol-related television advertisements - especially during sports programs. Grube said the results of a 12-year study he conducted on the effects of alcohol tend to contradict arguments by beverage companies that their ads on alcohol products do not make young people drink.


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Teenagers in Turmoil USA Today (10/05/98) P. 1D; Sternberg, Steve. Many teenage deaths each year are avoidable, with approximately 10,000 of the 37,000 deaths among young people related to murder, suicide, or AIDS complications. HIV is increasingly becoming a problem among young people in the United States; according to the Centers for Disease Control and Prevention, around 50 percent of the 40,000 new HIV case in America occur in people under the age of 25. The CDC Youth Risk Behavior Surveillance Survey recently concluded that many teens were engaging in risky behaviors. Steve Small, a professor at the University of Michigan, also notes: "They [adolescents] do things like drink and smoke and become sexually active" and says that adolescence runs longer now than it did 25 years ago. Despite widespread behavioral risks taken by teens, a CDC study released last month indicates that sexual activity has declined among high school students for the first time in 20 years and that fewer students report having sex with a series of partners. The study of more than 10,000 students also shows that sexually active students were using condoms more often. Even though there has been a decline, one-tenth of all adolescents are sexually active before age 13, according to Janet Collins of the CDC. Suggestions from students at a recent CDC-sponsored meeting on the subject in Atlanta included increased positive role-modeling by parents and additional education initiatives.

A national survey on teen drinking by the American Academy of Pediatrics
was released. Chicago Schools CEO Paul Vallas and Richard Burnstine, president of the pediatric group's Illinois chapter, both urged a ban on TV ads for alcoholic beverages. Cigarette ads are already banned from TV. The national study showed most teens start drinking at age 14 and nearly one in five of 16- to 19-year-olds have experienced an alcohol-induced blackout.  Vallas called alcohol ``in many ways, our No. 1 drug problem'' and said a new health curriculum due out this school year will address it starting in kindergarten. A recent telephone survey of 600 teens, age 16 to 19, conducted by the academy showed that the average teen drinks 5 1/2 days a month, but the more frequently teens drink, the more they drink at each sitting. Slightly more than half of teens drink 3 1/2 drinks per sitting, the survey showed, but teens who drink at least six days a month average 5.6 drinks per sitting. Vallas pointed to other studies, showing college students with D or F grade point averages drank three times as much as those who earn As, and that those who start drinking at age 15 are four times more likely to become alcoholics than those who start drinking at age 21. Some of the ``cleverest ads'' on TV are the alcohol ads, and ``the industry is appealing to younger and younger people,'' Vallas said. Vallas and Burnstine urged that alcohol be subject to the same advertising ban as cigarettes, and Vallas urged that the ban even be extended to billboards.

White House Announces Grants for Community Substance Abuse Prevention.
President Clinton announced Saturday (Sept. 12, 1998) the allocation of $8.7 million in new funding to help local programs seeking to prevent young people from abusing drugs or using tobacco or alcohol. In his weekly radio address, the President said the money will go to 93 communities, including Atlanta, Los Angeles, Chicago and Miami.

Drug czar Barry McCaffrey said the grants will fund programs that bring together young people, parents, media, law enforcement, school officials and religious organizations. The idea, according to McCaffrey, will target the use of illegal drugs, alcohol and tobacco.

McCaffrey said in a statement: "Community coalitions are the heart and soul of drug prevention. Groups like the Boys and Girls Clubs, the Elks, the Lions, YMCA, 100 Black Men, Big Brother-Big Sister and other mentoring leaders, are examples of the organizations we need to support through coalitions."

"Sports Means Sex for Boys, Not Girls"
USA Today (08/26/98) P. 1D; Elias, Marilyn A new survey reveals that high school boys who play sports are more sexually active than their non-sports playing peers, while high school girls involved in sports are less likely to be sexually active when compared with their peers. According to the survey of 611 students, conducted by Kathleen Miller of George Washington University, male athletes were more likely to have had sex and those who had generally started earlier than their non-athlete counterparts. Fifty-four percent of teenage girls involved in sports were still virgins, while 41 percent of girls who did not play sports were virgins. By age 14, 10 percent of athletic girls had engaged in sexual intercourse, with one-quarter of non-athletes losing their virginity. Approximately 50 percent of high school boys and one-third of girls play sports. In another study of 17,394 teens and their mothers, researchers found that teenagers from immigrant families are more likely to engage in sex and other risky behaviors as they become more Americanized. The respondents were divided into three groups: those who had come to the United States, those who were born to immigrant parents, and those who were born to native-born parents. According to lead researcher Kathleen Mullan Harris, 15 percent of foreign-born children had engaged in two or more problem behaviors, such as marijuana or weapon use. One-quarter of native-born kids with immigrant parents had engaged in two or more of the behaviors, while up to 35 percent of children born to native parents had engaged in the activities.

"Abuse Linked to Later Sex"
Toronto Sun Online (08/25/98); Lem, Sharon A study published by the Canadian Medical Association indicates that women who are sexually abused are more likely to smoke, have sex with more than 20 partners, and contract a sexually transmitted disease. The three-year study, led by Dr. T. Kue Young of the University of Manitoba, also found that women who had been sexually abused were more likely to have had sex before the age of 12. Younger women who had been abused were more likely to be unemployed, separated or divorced, with a five-fold greater chance of having been pregnant.  The evaluation report of the first two years of the CHAMPS (Community Health Adolescent Murraylands Peer Support) Mental Health Promotion Project has been completed, authored by Douglas McColl and Cindy Turner. Copies at a cost of $5.- can be obtained from Cindy Turner on email: mbcamhs@lm.net.au.

An excerpt from the Executive Summary of the report follows: "Promoting and supporting a positive sense of emotional wellbeing is central to the everyday concerns of young people, although they do not  readily connect this with the concept of "mental health" as understood by adult workers in the field. The CHAMPS youth mental health promotion project enabled young people in the Murraylands region to take action that promoted their "mental health" on their terms and according to their priorities with the support of adults. This occurred through the establishment of regular CHAMPS forums consisting of up to 30 young people from across the Murraylands Region. These forums were the core of CHAMPS, from which all priorities and activities were decided.

CHAMPS was based on the philosophy and practice of Youth Partnership Accountability (see Section 2.2 and Appendix 1), primary health care and health promotion principles (World Health Organisation, 1986), social justice and practices of inclusion. Thus, adults were in positions of support in relation to young people and were accountable to young people for their actions, a whole of population focus and holistic approach to mental health were taken and efforts were made to transcend barriers of distance and difference for young people. At every turn of the project, whether it was in determining the role of the CHAMPS Forums, setting priorities for action, designing elements of mental health promotion projects, strategising about the future of CHAMPS or designing the evaluation process, there has been a committed endeavour to live out the practices of youth partnership accountability.
The goal of CHAMPS was to improve the mental health and well being of 13-18 year old youth in the Murraylands region by enabling them to have a voice in shaping the way in which mental health services are provided to them and to participate in mental health promotion activities. It far exceeded its initial expectations, in terms of anticipated outcomes held by both Project Staff and young people in CHAMPS, and spawned many peer designed mental health promotion projects, including:
CHAMPS by the River, a youth designed youth-friendly recreation area in Murray Bridge.
CHAMPS Camp, which incorporated extensive planning for CHAMPS projects.
Media Liaison, where young people write for and/or participate in media activities.
YARN (Youth Access and Resource Network), a young person to young person peer support phone service.
Youth Week activities held in the Inaugural State Youth Week in Sept, including the opening of CHAMPS by the River.
CHAMPS Youth Art, free workshops to promote youth art and prepare a piece of public youth art at the CHAMPS by the River recreation area on the Art Wall.
The Rage Cage, a sporting facility consisting of a court designed for a variety of ball sports and skating in a safe youth friendly environment as an addition to CHAMPS by the River.
Consultations for government, other agencies and community groups.
Conference presentations at seven conferences, both national and international.
Intersectoral collaboration with other agencies and sectors.
"Talking Together: Young People Educating Adults" Inaugural CHAMPS conference to educate adult health, welfare, educational workers and community members on youth friendly practice, the principles of youth partnership accountability and discuss the community=C6s commitment to supporting a sustainable future for CHAMPS.

CHAMPS has been extensively evaluated, both during and at the end of its first two years of operation. This evaluation has involved all key stakeholders. Overall, CHAMPS has been perceived as a very successful project that lived up to its intention of establishing a best practice model for working in partnership with young people and comprehensively met all its objectives.

The overwhelmingly consistent outcomes have been: the need for CHAMPS to be ongoing in the Murraylands; the recommendation that programs like CHAMPS be made available in other areas of South Australia, and; the endorsement of youth partnership accountability as a highly recommended approach to working with young people which enables them to not
only have a voice on concerns central to their lives, but be responded to by adults and workers in respectful ways" (Stacey & Turner, 1998, pp. 3-4)

"Mortality Among Street Youth (Research Letter)"
Lancet (07/04/98) Vol. 352, No. 9121, P. 32; Roy, Elise; Bolvin, Jean-Francois; Haley, Nancy; et al. 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."

"School Condom Policy Upheld by Appeals Court"
Philadelphia Inquirer Online (07/10/98); Slobodzian, Joseph A.  The U.S. Court of Appeals for the Third Circuit upheld on Thursday a program in Philadelphia city schools that allows   schools to dispense condoms to students without parental consent. The judges, who decided unanimously for the program, said the  policy "coerces neither parents nor students." Participation in  the program is optional; parents can return an opt-out form after which their children will receive neither condoms nor counseling. The judges noted that the policy helps promote good health and disease prevention. The school system was sued by Parents United for Better Schools Inc. in 1991, when the program was initiated  to help reduce teen pregnancy and control the spread of sexually  transmitted diseases, including HIV. In addition to dispensing   condoms, private health care providers are also available to  counsel the students in school-based centers. At the beginning of the school year, nine of the city's 40 public high schools were using the program.

Girl smokers hope to lose weight. Habit starts in an effort to shed excess pounds, study finds.   MSNBC STAFF AND WIRE REPORTS   
"Girls Fight Weight with Fire," Globe & Mail, August 3, 1998
Aug. 4, 1998 -Most teenage girls who take up smoking do so in an effort to lose weight, according to a British and Canadian study. Those who do smoke are 30 percent more likely to be overweight than their nonsmoking peers, the study authors found.            
THE RESEARCHERS surveyed nearly 2,800 girls in Britain and Ottawa, Canada, ranging in age from 11 to 18, and found that 20 percent smoked. Those who did light up were twice as likely as the other girls to be concerned about their bodies and to vomit frequently after overeating.  In addition, more than 30 percent of the smokers feared they would eat more and put on weight if they tried to give up cigarettes, the researchers said.
Young girls are "trading pounds off their weight for years off their life," said Arthur Crisp, the professor at London's St. George's Hospital Medical School who conducted the study.
The study, published in the Postgraduate Medical Journal, comes at a time when the number of young female smokers continues to grow. The most recent figures available from the Office of National Statistics in England found that a quarter of girls ages 11 to 15 were occasional or regular smokers in 1996, up from 20 percent in 1982.
The study, funded by the Cancer Research Campaign, also revealed that girls who drank alcohol were seven times more likely to be smokers and that peer pressure and parental smoking were not major factors in their decision to smoke.

Teens taking more sex risks
: Education, contraceptives fail to curb rates of disease, unwanted pregnancy. Tuesday, June 30, 1998  The Globe and Mail
Canadian teens are at greater risk than ever from unsafe sex, a panel that presented new national guidelines for birth control warned yesterday. The annual meeting of the Society of Obstetricians and Gynecologists heard some grim statistics:
The number of teen pregnancies in Canada rose 18 per cent from 1987 to 1994, the last year a total was compiled. The upward trend is continuing, and as many as 50 per cent of teen pregnancies are unintended.
The increase in the number of abortions for young women between 15 and 19 is 50 per cent greater than the increase among women 20 and over.  Teen-aged females have the highest rates of sexually transmitted diseases of any age group. The rate of Chlamydia in the 15-to-19 age group is nine times the average among all women.

(see below)
Some World Wide Web news reports regarding the President's address and related activities may be found at:

Also Saturday (March 7), a Minnesota judge ordered the release of tobacco industry documents, including documents reportedly covering the industry's efforts to study smoking behavior of children as young as age 5. Online report covering this matter may be found at: http://www.cnn.com/US/9803/07/minn.tobacco/

The Oval Office - Saturday, March 7, 1998

THE PRESIDENT: Good morning. Since I took office I've done everything in my power to protect our children from harm. We've worked to make their streets and their schools safer, to give them something positive to do after school and before their parents get home. We've worked to teach our children that drugs are dangerous, illegal and wrong. This week, we took a major step to protect our children, indeed, all Americans from the dangers of drunk driving by proposing bipartisan legislation to lower the legal limit to .08 in every state.

Today, I want to talk to you about the historic opportunity we now have to protect our nation's children from an even more deadly threat: smoking. Smoking kills mores people every day than AIDS, alcohol, car accidents, murders, suicides, drugs and fires combined. Nearly 90 percent of those smokers lit their first cigarette before they turned 18.

Today, the epidemic of teen smoking is raging throughout our nation as, one by one, our children are lured by multimillion dollar marketing schemes designed to do exactly that. Consider this: 3,000 children start to smoke every day illegally, and 1,000 of them will die sooner because of it. This is a national tragedy that every American should be honor-bound to help prevent. For more than five years we've worked to stop our children from smoking before they start, launching a nationwide campaign with the FDA to educate them about the dangers of smoking, to reduce their access to tobacco products, and to severely restrict tobacco companies from advertising to young people.

But even this is not enough to fully protect our children. To put an end to the epidemic, Congress must act. Last fall, I called on Congress to put aside politics and pass comprehensive bipartisan legislation to reduce teen smoking by raising the price of cigarettes by up to $1.50 a pack over the next 10 years, imposing strong penalties if the tobacco industry keeps selling cigarettes to our children, affirming the FDA's full authority to regulate tobacco, to prevent children's access to tobacco products, and to restrict tobacco ads aimed at young people, so that our children can't fall prey to the deadly threat of tobacco.

Now, we learned last month that if we do this, we'll cut teen smoking by almost half over the next five years. That means if we act now, we have it in our power to stop 3 million children from smoking -- and to save a million lives as a result.

Today there are as few as 70 working days left before this Congress adjourns. On every one of those days, 1,000 adults will die from smoking. On every one of those days, 3,000 children will light their first cigarettes. On every one of those days, this Congress has the opportunity to stop it.

Will this Congress be remembered for putting politics aside and protecting our children from tobacco -- or for letting the public health opportunity of a lifetime pass us by? There will be no greater measure of your commitment to the health of our children or the future of our nation.

Thanks for listening.

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