Part A
1. Which student groups are experiencing the achievement gap? Discuss factors that may contribute to educational inequality.
2. How can society and/or individuals support parents in gaining the cultural capital that children need to succeed academically?
You may use your learning resources for the week or find other resources outside of the classroom. Your sources must be credible. Be sure to include in-text citations and a reference list where appropriate to support your responses.
part B
You are a working single parent of a 16-year-old son and a 13-year-old daughter. Your son has an 11 PM curfew on weekends, but recently, he has been ignoring curfew and coming home after midnight. When you try to address this with him, he either ignores you or gets angry and starts screaming at you. When he’s at home, he tends to shut himself away in his room. His latest report card shows that his grades are slipping. You are getting very concerned, but you work full-time and parent by yourself, so you are getting frustrated as well.
At the same time, your daughter has been telling you that she doesn’t feel well and doesn’t want to go to school. After some prodding, she shared that she has been getting teased at school and bullied online.
After reviewing the learning resources for this week, come up with a strategy for dealing with your children that is supported by the literature on adolescent discipline. What are some of the things that you need to take into consideration? What actions would you implement to try and address the problematic behaviors you are witnessing? What actions would you avoid?
For this discussion, an excellent response will be well written and at least 2-3 paragraphs in length, incorporating at least 3 of the learning resources provided. You may also include other resources that you find outside of the classroom. Remember to use in-text citations and a reference list to identify the ideas that you learned from your sources. Any idea that came from something you read must be cited. When in doubt, cite it!
McGilley, Beth M., a
n
d Tamara L. Pryor. ‘‘Assessment and
Treatment of Bulimia Nervosa.’’ American Family
Physician 57 (June 1998): 1339.
Miller, Karl E. ‘‘Co
g
nitive Behavior Treatment of Bulimia
Nervosa.’’ American Family Physician 63 (February 1,
2001): 536.
‘‘Position of the American Dietetic Association: Nutrition
Intervention in the Treatment of Anorexia Nervosa,
Bulimia Nervosa, and Eating Disorders Not Otherwise
Specified.’’ Journal of the American Dietetic Association
101 (July 2001): 810–28.
Romano, Steven J., Katherine A. Halmi, Neena P. San-
kar, and others. ‘‘A Placebo-Controlled Study of
Fluoxetine in Continued Treatment of Bulimia
Nervosa After Successful Acute Fluoxetine Treat-
ment.’’ American Journal of Psychiatry 159 (January
2002): 96–102.
Steiger, Howard, Lise Gauvin, Mimi Israel, and others.
‘‘Association of Serotonin and Cortisol Indices with
Childhood Abuse in Bulimia Nervosa.’’ Archives of
General Psychiatry 58 (September 2001): 837.
Vink, T., A. Hinney, A. A. van Elburg, and others. ‘‘Asso-
ciation Between an Agouti-Related Protein Gene Poly-
morphism and Anorexia Nervosa.’’ Molecular
Psychiatry 6 (May 2001): 325–28.
Walling, Anne D. ‘‘Anti-Nausea Drug Promising in Treat-
ment of Bulimia Nervosa.’’ American Family Physician
62 (September 1, 2000): 1156.
ORGANIZATIONS
Academy for Eating Disorders, Montefiore Medical School,
Adolescent Medicine. 111 East 210th Street, Bronx, NY
10467. Telephone: (718) 920-6782.
American Academy of Child and Adolescent Psychiatry.
3615 Wisconsin Avenue N.W., Washington, DC 20016-
3007. Telephone: (202) 966-7300. Fax: (202) 966-2891.
American Anorexia/Bulimia Association. 165 W. 46th
Street, Suite 1108, New York, NY 10036. Telephone:
(212) 575-6200.
American Dietetic Association. Telephone: (800) 877-1600.
Anorexia Nervosa and Related Eating Disorders, Inc.
(ANRED). P.O. Box 5102, Eugene, OR 97405. Tele-
phone: (541) 344-1144.
Center for the Study of Anorexia and Bulimia. 1 W. 91st St.,
New York, NY 10024. Telephone: (212) 595-3449.
OTHER
‘‘Bulima Nervosa.’’ U.S. Department of Health and Human
Services. read/bulnervosa-etr.htm>.
Rebecca Frey, PhD Bullying Bullying is a persistent pattern of threatening, Description
‘‘Kids will be kids,’’ the saying goes, so warning There are many forms of bullying. Bullies may There are many reasons to stop bullying. Bullying People who are bullies as children often become Recently, attention has been turned to the topic of G A L E E N C Y C L O P E D I A O F M E N T A L H E A L T H , S E C O N D E D I T I O N 183
B in than they. Those bullied at work often become per-
ceived as ineffective, thus abrogating their career suc-
cess and influencing their earning potential. Victims of
workplace bullying often change jobs in search of a
less hostile environment because organizations are
frequently not sensitive to the issue of workplace bul-
lying or equipped to adequately or justly deal with it.
Demographics
Bullying in children
Bullying among children is a persistent and sub-
stantial problem. According to a study published in
2001 by the Kaiser Family Foundation and Nickel-
odeon Television, 55% of 8–11-year-olds and 68% of
12–15-year-olds said that bullying is a ‘‘big problem’’
for people their age. Seventy-four percent of the 8–11-
year-olds and 86% of the 12–15-year-olds also
reported that children were bullied or teased at their
school. Children at greatest risk of being bullied are
those who are perceived as social isolates or outcasts
by their peers, have a history of changing schools, have
poor social skills and a desire to fit in ‘‘at any cost,’’ are
defenseless, or are viewed by their peers as being
different.
A study of more than 16,000 children in the sixth The National Center for Education Statistics A young boy faces bullying from older and bigger kids. (Gideon Mendel/Alamy)
184 G A L E E N C Y C L O P E D I A O F M E N T A L H E A L T H , S E C O N D E D I T I O N
B g hallway monitors. Victims of bullying were more Children who are identified as bullies by the time Bullying in the workplace
Although research has been conducted on bully- In the survey, 80% of the women and 20% of the Causes and symptoms
As of this writing, there is no evidence to support Bullying in children According to the U.S. Department of Health and Warning signs and factors that may indicate risk � lack of impulse control (frequent loss of temper, � family factors (abuse or violence within the family, � behavioral symptoms (gang affiliation, name calling Symptoms that a child may be being bullied � social withdrawal or isolation (few or no friends; G A L E E N C Y C L O P E D I A O F M E N T A L H E A L T H , S E C O N D E D I T I O N 185
B � somatic complaints (frequent complaints about ill- � avoidant behavior (not wanting to go to school; skips � affective reactions (crying easily; having mood � physical clues (bringing home damaged possessions � behavior changes (changes in eating or sleeping � aggressive behavior (threatening violence to self or Each child will react to bullying in a different Bullying in the workplace Bullying in the workplace is usually motivated by Common tactics used by bullies in the workplace � discounting/belittling victim in public (making state- � false accusations (rumors about victim, lies about � harassment (verbal putdowns based on gender, race, � isolating behaviors (encouraging others to turn � nonverbal aggression (staring, glaring, silent treatment)
� sabotages victim’s work
� unequal treatment (retaliating against victim who Diagnosis
Bullying in itself is not a mental disorder, although
aggressive or harassing behavior may be symptomatic
of a number of disorders, particularly antisocial per- someone is a bully. First, to qualify as bullying, the
bully’s behavior must be intended to cause physical or
psychological harm to the other person. Second, bully-
ing behavior is not an isolated incident but results in a
consistent pattern of such behavior over time. Third,
bullying occurs where there is an imbalance of power
whereby the bully has more physical or psychological
power than the victim. Harassing behavior is not con-
sidered to be bullying if it occurs between individuals of
equal strength and status or if it is a one-time event.
Bullying behavior in children can include any of � dominance (enjoying feeling powerful and in control, � lack of empathy (deriving satisfaction from the fears, � negative emotions or violence (displaying uncon- � lack of responsibility (blaming others for his/her � other behaviors (using drugs or alcohol, or being a Victims of bullying—whether children or adults—
may need to be assessed and treated for an anxiety from bullying.
Treatments and prevention
If bullying behavior is symptomatic of an under- 186 G A L E E N C Y C L O P E D I A O F M E N T A L H E A L T H , S E C O N D E D I T I O N
B in which bullying behavior is not part of a pattern Bullying in children To help keep a child from becoming a bully, it is If parents suspect that their child may be being Bullying in the workplace Bullying in the workplace can be minimized if the Bullies are not the only ones needing help. The consequences from being the victim of a bully. If the Resources
BOOKS
Einarsen, Ståle, Helge Hoel, Dieter Zapf, and Cary L. Espelage, Dorothy L., and Susan M. Swearer, eds. Bullying Erlbaum Associates, 2003.
Geffner, Robert A, Marti Tamm Loring, and Corinna Research, and Interventions. Binghamton, New York: Needham, Andrea. Workplace Bullying: The Costly Business O’Moore, Mona, and Stephen Minton. Dealing with Bully- lishing, 2004.
K E Y T E R M S
Antisocial personality disorder—A personality dis- Anxiety disorder—A group of mood disorders Representative sample—A subset of the overall G A L E E N C Y C L O P E D I A O F M E N T A L H E A L T H , S E C O N D E D I T I O N 187
B Rigby, Ken. New Perspectives on Bullying. London: Jessica VandenBos, Gary R.,ed. APA Dictionary of Psychology. tion, 2007.
PERIODICALS
Ahmed, Eliza, and Valerie Braithwaite. ‘‘Forgiveness, Bowling, Nathan A., and Terry A. Beehr. ‘‘Workplace Psychology 91.5 (2006): 998–1012.
Chan, John H. F. ‘‘Systemic Patterns in Bullying and Cossa, Mario. ‘‘How Rude!: Using Sociodrama in the Sociometry 58.4 (2006): 182–94.
Heydenberk, Roberta A., Warren R. Heydenberk, and Vera Skills for School Success.’’ Conflict Resolution Quar- Kim, Young Shin, Bennett L. Leventhal, Yun-Joo Koh, ing and Youth Violence: Causes or Consequences of Ledley, Deborah Roth, and others. ‘‘The Relationship
Between Childhood Teasing and Later Interpersonal Lee, Raymond T., and Céleste M. Brotheridge. ‘‘When Prey ogy 15.3 (2006): 352–77.
Lewis, Sian E. ‘‘Recognition of Workplace Bullying: A Sector.’’ Journal of Community and Applied Social Lutgen-Sandvik, Pamela. ‘‘Take This Job and . . . : Quitting Communication Monographs 73.4 (2006): 406–33.
Moayed, Farman A., Nancy Daraiseh, Richard Shell, and Ergonomics Science 7.3 (2006): 311–27.
Nickel, Marius K., and others. ‘‘Influence of Family Ther- and Quality of Life in Bullying Male Adolescents: A Parkins, Irina Sumajin, and Harold D. Fishbein. ‘‘The
Influence of Personality on Workplace Bullying and
Discrimination.’’ Journal of Applied Social Psychology Patchin, Justin W., and Sameer Hinduja. ‘‘Bullies Move
Beyond the Schoolyard: A Preliminary Look at Cyber- Peskin, Melissa Fleschler, Susan R. Tortolero, and Christine
M. Markham. ‘‘Bullying and Victimization Among Phillips, Debby A. ‘‘Punking and Bullying: Strategies in Twemlow, Stuart W., Peter Fonagy, Frank C. Sacco, and chiatry 52.3 (2006): 187–98.
ORGANIZATIONS American Academy of Child and Adolescent Psychiatry. 3615 Mental Health America. 2000 N. Beauregard Street, 6th
Floor, Alexandria, VA 22311. Telephone: (800) 969- National Institute of Child Health and Human Develop-
ment. P.O. Box 3006, Rockville, MD 20847. Tele- National Institute of Mental Health (NIMH), Public Infor- 20892-9663. Telephone: (866) 615-6464. TTY: (866) National Mental Health Information Center. P.O. Box
42557, Washington, DC 20015. Telephone: (800) 789-
2647. TDD: (866) 889-2647. samhsa.gov>.
National Youth Violence Prevention Resource Center. P.O. U.S. Human Resources and Service Administration, Stop Workplace Bullying Institute. Telephone: (360) 656-6630.
Ruth A. Wienclaw, PhD
Bupropion Bupropion is an antidepressant drug used to ele- 188 G A L E E N C Y C L O P E D I A O F M E N T A L H E A L T H , S E C O N D E D I T I O N
B p n sponsored tour of classrooms in 1895. This time he Rice served as editor of the Forum from 1897 See also: Assessment, Classroom; Education Re- B I B L I O G R A P H Y
Houston, Camille M. E. 1965. ‘‘Joseph Mayer Rice, Joseph M. 1893. The Public-School System of Rice, Joseph M. 1898. The Rational Spelling Book. Rice, Joseph M. 1913. Scientific Management in Ed- Rice, Joseph M. 1915. The People’s Government. Janet L. Miller
RISK BEHAVIORS
DRUG USE AMONG TEENS
Christopher L. Ringwalt
HIV/AIDS AND ITS IMPACT ON ADOLESCENTS Denise Dion Hallfors Bonita Iritani
SEXUAL ACTIVITY AMONG TEENS AND TEEN Sheila Peters
SEXUALLY TRANSMITTED DISEASES
Angela Huang
SMOKING AND ITS EFFECT ON CHILDREN’S HEALTH Christopher S. Greeley
SUICIDE
Peter L. Sheras
TEEN PREGNANCY
Douglas B. Kirby
DRUG USE AMONG TEENS Substance abuse is an international problem of epi- Causes
A number of models and theories address the causes TABLE 1
RISK BEHAVIORS: DRUG USE AMONG TEENS 2055 the family domain, ATOD use has been associated Protective Factors
Protective factors, or factors that promote resiliency, Prevention Strategies
A variety of strategies have demonstrated effective- tobacco and alcohol outlets, including restrictions The results of two decades of evaluative research Unfortunately, relatively little is also known It is known that even the most effective and 2056 RISK BEHAVIORS: DRUG USE AMONG TEENS those that reinforce their messages across multiple See also: Drug and Alcohol Abuse; Guidance B I B L I O G R A P H Y Botvin, Gilbert J.; Baker, Eli; Dusenburg, Center for Substance Abuse Prevention. Divi- Center for Substance Abuse Prevention. Na- Dusenbury, Linda. 2000. ‘‘Implementing a Com- Eggert, Leona L.; Thompson, Elaine A.; Hert- er, Barbara G. 1994. ‘‘Preventing Adolescent Ellickson, Phyllis L.; Bell, Robert M.; and Mc- Ennett, Susan; Tobler, Nancy S.; Ringwalt, Hawkins, J. David; Catalano, Richard F.; and Pacific Institute for Research and Evalua- Spoth, Richard Lee; Redmond, Cleve; and Lep- Tobler, Nancy S. 1986. ‘‘Meta-Analysis of 143 Ad- University of Michigan News and Informa- I N T E R N E T R E S O U R C E
Join Together OnLine. 1999. ‘‘Alcohol Abuse RISK BEHAVIORS: DRUG USE AMONG TEENS 2057 Christopher L. Ringwalt HIV/AIDS AND ITS IMPACT ON Acquired immunodeficiency syndrome (AIDS) is a HIV Transmission
The majority of HIV infections among adolescents Many adolescents are sexually experienced, but sexually active. Sexual risk increases with the num- The presence of other sexually transmitted in- Drug use also places young people at risk for Pathways to HIV Prevention
Longitudinal studies that follow high-risk youth into 2058 RISK BEHAVIORS: HIV/AIDS AND ITS IMPACT ON ADOLESCENTS stand the developmental pathways of problem be- Although most adolescents will grow out of Given the complexity of factors that contribute See also: Guidance and Counseling, School; B I B L I O G R A P H Y Bandura, Albert. 1986. Social Foundations of Berman, Stuart M., and Hein, Karen. 1999. ‘‘Ad- Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, Cooper, M. Lynne; Peirce, Robert S.; and Hu- DiClemente, Ralph J. 1996. ‘‘Adolescents at Risk DiClemente, Ralph J., and Wingood, Gina M. RISK BEHAVIORS: HIV/AIDS AND ITS IMPACT ON ADOLESCENTS 2059 Division of STD Prevention–Centers for Dis- Duncan, Susan C.; Strycker, Lisa A.; and Dun- Fortenberry, J. Dennis, et al. 1997. ‘‘Sex under the Graves, Karen L., and Leigh, Barbara C. 1995. Hein, Karen, and Hurst, Marsha. 1988. ‘‘Human Hoyert, Donna L.; Kochanek, Kenneth D.; and Institute of Medicine—Committee on Preven- Jessor, Richard; Donovan, John Edward; and Kirby, Douglas. 1999. ‘‘Sexuality and Sex Educa- Lowry, Richard, et al. 1994. ‘‘Substance Use and Resnick, Michael D., et al. 1997. ‘‘Protecting Ado- Rotheram-Borus, Mary Jane, et al. 2000. ‘‘Pre- Stanton, Bonita, et al. 1993. ‘‘Early Initiation of Stiffman, Arlene Rubin, et al. 1995. ‘‘Person and I N T E R N E T R E S O U R C E Centers for Disease Control and Prevention. Denise Dion Hallfors SEXUAL ACTIVITY AMONG TEENS Adolescent sexuality is often viewed from a negative Early Sexual Activity
Early sexual activity is a growing issue in adolescent 2060 RISK BEHAVIORS: SEXUAL ACTIVITY AMONG TEENS AND TEEN PREGNANCY TRENDS vey of Family Growth and the Youth Risk Behavior Peer pressure to engage in adult-like activities In regard to puberty, early-maturing adoles- For both male and female adolescents, adoles- Much of the research on early sexual activity in Adolescent condom use has increased for both is, in part, attributable to an increase in contracep- Teenage Pregnancy
The association of early sexual activity with teenage Teenage mothers are at risk for poverty and A significant risk factor for early sexual experi- Girls with a history of sexual trauma are also at RISK BEHAVIORS: SEXUAL ACTIVITY AMONG TEENS AND TEEN PREGNANCY TRENDS 2061 tem, particularly if they do not have supportive The use of alcohol and drugs reduces inhibi- Efforts to conduct sexuality education within Pregnancy Prevention
Adolescents receive most of their information about ing on other outcomes, such as academic achieve- Joy Dryfoss has proposed the need for compre- Young people from poor, underserved, inner- Within inner-city communities of color, pro- 2062 RISK BEHAVIORS: SEXUAL ACTIVITY AMONG TEENS AND TEEN PREGNANCY TRENDS cally deprived communities with high rates of multi- Positive psychosexual development is important The Role of Parents
Parents need resources to support their vital role in In the face of community efforts to address In addition, parents are encouraged to become Other effective models of service include gen- There has been some debate regarding gender- RISK BEHAVIORS: SEXUAL ACTIVITY AMONG TEENS AND TEEN PREGNANCY TRENDS 2063 threat by male counterparts. On the other hand, in In order to address premature sexual activity See also: Guidance and Counseling, School; B I B L I O G R A P H Y Crockett, Lisa, and Chopak, Joanne S. 1993. Dryfoss, Joy. 1990. Adolescents at Risk: Prevalence Hoffman, Saul D. 1998. ‘‘Teenage Childbearing Is Kirby, Douglas. 2001. Emerging Answers: Research Koch, P. B. 1993. ‘‘Promoting Healthy Sexual De- Intervention, ed. Richard Lerner. Hillsdale, NJ: I N T E R N E T R E S O U R C E S
Advocates for Youth. 2002. ‘‘Adolescent Preg- National Campaign to Prevent Teen Pregnan- National Center for Chronic Disease and Wertheimer, Richard, and Moore, Kristin. Sheila Peters Sexually transmitted diseases (STDs) are viral and The Institute of Medicine coined the phrase Biological Factors
During each sexual encounter, women are at an in- 2064 RISK BEHAVIORS: SEXUALLY TRANSMITTED DISEASES tion because of the increased amount of immature Behavioral Risk
Behavioral risk factors that predispose individuals to In addition to having more than one sexual choose a partner who is older than themselves. Addi- Studies have shown that adolescents who are in- The high prevalence of STDs among adolescents Prevalent Bacterial STDs
The most prevalent bacterial STDs are gonorrhea Prevalent Viral STDs
Genital herpes simplex virus (HSV-2) and human RISK BEHAVIORS: SEXUALLY TRANSMITTED DISEASES 2065 with HSV-2, HPV, or HIV may result in negative re- Studies indicate that one in six Americans is in- Based on data from twenty-five states with inte- Impact
STDs prevent adolescents from leading healthy lives. cult pregnancy, genital and cervical cancer, neonatal See also: Guidance and Counseling, School; B I B L I O G R A P H Y Kagan, Jerome, and Gall, Susan B., eds. 1998. The McIlhaney, J. S., Jr. 2000. ‘‘Sexually Transmitted I N T E R N E T R E S O U R C E S Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Angela Huang SMOKING AND ITS EFFECT ON The impact of tobacco use in the United States and 2066 RISK BEHAVIORS: SMOKING AND ITS EFFECT ON CHILDREN’S HEALTH million children are exposed to smoke in their Pregnancy/Perinatal/SIDS
It has been estimated that 19 percent to 27 percent Newborn infants are in a unique situation when Childhood Diseases
The risks of ETS are not simply restricted to the new- Adolescence
Between 4 million and 5 million adolescents in the There are many reasons why a child or adoles- RISK BEHAVIORS: SMOKING AND ITS EFFECT ON CHILDREN’S HEALTH 2067 toward recruiting new child or adolescent smokers. Costs
The true cost of smoking is incalculable, but there See also: Guidance and Counseling, School; B I B L I O G R A P H Y Aligne, C. Andrew, and Stoddard, Jeffrey J. American Academy of Pediatrics Committee Centers for Disease Control and Prevention. Smoking among Adults, and Children’s and Ad- Cunningham, Joan, et al. 1994. ‘‘Environmental DiFranza, Joseph R., and Lew, Robert A. 1997. Joad, Jesse. 2000. ‘‘Smoking and Pediatric Respira- Christopher S. Greeley School-age children can engage in many behaviors In 1999 the surgeon general of the United States, Occurrence
Suicide rates for children and adolescents are regu- 2068 RISK BEHAVIORS: SUICIDE tistics in the U.S. Department of Health and Human A review of statistics regarding rates of suicide Suicides can be completed using a variety of In addition to completed or accomplished sui- detected or are confided only to the closest of Risk Factors
Many factors have been examined as contributors to In the case of children and adolescents, two Protective Factors Just as some factors seem to increase the incidence RISK BEHAVIORS: SUICIDE 2069 fective and appropriate clinical care; access to treat- Warning Signs
The warning signs of imminent suicidal behaviors Formulation of the Problem
According to Jerry Jacobs, writing in 1971, early re- It is important to realize that suicidal behavior resolution skills, hopelessness or frustration, chronic Prevention The best strategies for the prevention of suicide are Finally, it must be acknowledged that the prob- See also: Guidance and Counseling, School; B I B L I O G R A P H Y Berman, Alan L., and Jobes, David A. 1991. Ado- Fremouw, William J.; de Perczel, Maria; and Group for the Advancement of Psychiatry. Jacobs, J. 1971. Adolescent Suicide. New York: Peters, Kimberly D.; Kochanek, Kenneth D.; 2070 RISK BEHAVIORS: SUICIDE Robbins, Paul R. 1998. Adolescent Suicide. Jeffer- Shaffer, David, and Craft, Leslie. 1999. ‘‘Meth- Sheras, Peter L. 2001. ‘‘Depression and Suicide in U.S. Department of Health and Human Ser- U.S. Public Health Service. 1999. The Surgeon Peter L. Sheras In the United States, teen pregnancy is an important The U.S. pregnancy rate is higher for females On the positive side, the 1997 teen pregnancy While the teenage pregnancy rate is, by defini- mean that all the males involved in these pregnancies About four-fifths of teen pregnancies are unin- Among mothers under the age twenty, the per- Consequences of Teen Childbearing
According to a 1996 report written by Rebecca A. It is the children of teenage mothers, however, Although the greatest costs are to the families Adolescent Sexual and Contraceptive Behavior
Obviously, teens become pregnant because they have RISK BEHAVIORS: TEEN PREGNANCY 2071 creased from 27 percent among fifteen-year-olds to Most sexually experienced teenagers use contra- Factors Associated with Sexual Risk-Taking and While nearly all youth are at risk of engaging in sex Other more indirect environmental factors, Furthermore, teens are more likely to engage in and lack plans for higher education; (2) use alcohol Family Planning Services
The efforts most directly involved with preventing Large numbers of sexually active female teen- In addition to those practicing at family plan- Sex and HIV Education Programs
To reduce teen pregnancy and also STDs, including 2072 RISK BEHAVIORS: TEEN PREGNANCY of studies have demonstrated that these programs do Programs that are short and that focus upon Many people have proposed abstinence-only In an effort to reduce teen pregnancy and STDs, Service-Learning Programs
Whereas the programs summarized above focus pri- By definition, service-learning programs include Although service learning does have strong evi- Comprehensive and Intensive Programs
A few programs designed to reduce teen pregnancy Conclusion
Despite declines in the teen pregnancy rate in the RISK BEHAVIORS: TEEN PREGNANCY 2073 youth. The diversity of these programs increases the See also: Guidance and Counseling, School; B I B L I O G R A P H Y Alan Guttmacher Institute. 1994. Sex and Allen, Joseph P.; Philliber, Susan; Herrling, Boekeloo, Bradley O.; Schamus, Lisa A.; Sim- Centers for Disease Control and Prevention. Curtin, Sally C., and Martin, Joyce A. 2000. Darroch, Jacqueline E., and Singh, Susheela. Henshaw, Stanley K. 1999. U.S. Teenage Pregnan- Kirby, Douglas B. 2001. Emerging Answers: Re- Kirby, Douglas B.; Barth, Richard; Leland, Maynard, Rebecca A. 1996. Kids Having Kids: A Moore, Kristin A.; Driscoll, Anne K.; and Lind- National Campaign to Prevent Teen Pregnan- Orr, Donald P.; Langefeld, Carl D.; Katz, Terry, Elizabeth, and Manlove, Jennifer. 2000. Douglas B. Kirby RISK MANAGEMENT IN HIGHER During the late twentieth century, American society 2074 RISK MANAGEMENT IN HIGHER EDUCATION
Emily Jane Willingham, PhD
Definition
harassing, or aggressive behavior directed toward
another person or persons who are perceived as
smaller, weaker, or less powerful. Although often
thought of as a childhood phenomenon, bullying can
occur wherever people interact, most notably observ-
able in the workplace and in the home. Bullying is also
called harassment.
signs of bullying are often overlooked as a natural part
of childhood. However, although playground bullies
have been around since time immemorial, such behav-
ior should neither be considered acceptable nor excus-
able. Bullying is a form of abuse and violence, and the
tragic Columbine High School massacre in 1999
underscores the potential dangers of unchecked
bullying.
intimidate or harass their victims physically through
hitting, pushing, or other physical violence; verbally
through such actions as threats or name calling; or
psychologically through spreading rumors, making
sexual comments or gestures, or excluding the victim
from desired activities. Such behavior does not need to
occur in person: Cyberbullying is a persistent pattern
of threatening, harassing, or aggressive behavior car-
ried out online.
interferes with school performance, and children who
are afraid of being bullied are more likely to miss
school or drop out. Bullied children frequently expe-
rience developmental harm and fail to reach their full
physiological, social, and academic potentials. Chil-
dren who are bullied grow increasingly insecure and
anxious, and have persistently decreased self-esteem
and greater depression than their peers, often even as
adults. Children have even been known to commit
suicide as a result of being bullied.
bullies as adults. Bullying behavior in the home is
called child abuse or spousal abuse. Bullying also
occurs in prisons and in churches.
bullying in the workplace (sometimes called harass-
ment), where bosses and organizational peers bully
those whom they perceive as their inferiors or weaker
u
lly
g
through tenth grades conducted for the National Insti-
tute of Child Health and Human Development found
that bullying is a common problem in the United
States and requires serious attention. Nearly 60% of
the children responding to the survey reported that
they had been victims of rumors. More than 50% of
the children reported that they had been the victims of
sexual harassment.
(NCES) of the U.S. Department of Education found
that white, non-Hispanic children were more likely to
report being the victims of bullying than black or other
non-Hispanic children. Younger children were more
likely to report being bullied than older children, and
children attending schools with gangs were more likely
to report being bullied than children in schools with-
out a major gang presence. No differences were found
in these patterns between public and private schools.
Fewer children reported bullying in schools that were
supervised by police officers, security officers, or staff
u
ll
y
in
likely to be criminally victimized at school than were
other children. Victims of bullying were more afraid of
being attacked both at school and elsewhere and more
likely to avoid certain areas of school (for example, the
cafeteria, hallways or stairs, or restrooms) or activities
where bullying was more likely to take place. Signifi-
cantly, victims of bullies were more likely to report
that they carried weapons to school for protection.
they are eight years of age are six times more likely
than other children to have a criminal conviction by
the time they are 24 years old. Bullying behavior may
also be accompanied by other inappropriate behavior,
including criminal, delinquent, or gang behavior.
ing in Europe for some time, the topic has only
recently become of interest in the United States.
There are no ‘‘official’’ figures currently available for
incidents of bullying in the workplace. However, the
nonprofit Workplace Bullying Institute conducted
an informal survey of 1,000 self-selected volunteer
respondents. Although it cannot be assumed that the
volunteers answering the survey are representative of
individuals in the workplace in general, the results do
give food for thought concerning the prevalence of
workplace bullying.
men reported having been bullied at work. Sixty-one
percent of the victims of workplace bullying said that
the behavior was ongoing. The survey also found that
70% of victims of workplace bullying lose their jobs:
37% of the victims were fired or involuntarily termi-
nated and 16% of the victims transferred to another
position within the same organization. On the other
hand, the survey found that only 4% of bullies stopped
their aggressive or harassing actions after punishment
and that only 9% of workplace bullies were trans-
ferred, fired, or involuntarily terminated. Contrary
to the cartoon portrait of male bullies, the survey
showed that 50% of workplace bullying was done by
women victimizing other women. Men bullying
women accounted for only 30% of bullying, while
men bullying men accounted for 12% of workplace
bullying and women bullying men accounted for 8%.
The figure with women bullying other women is par-
ticularly interesting because such same-sex harass-
ment (with the exception of sexual harassment) is
usually outside the scope of antidiscrimination laws
and is typically not tracked.
the theory that there is a genetic component to bully-
ing behavior. Particularly in children, it is most often
theorized that bullying is a result of the bully copying
the actions of role models who bully others. This
frequently happens when bullies come from a home
in which one parent bullies another or one or both
parents bully the children. When such behavior is
modeled for children with personality traits such as
lack of impulse control or aggression, they are partic-
ularly prone to bullying behavior, which is often con-
tinued into adulthood.
Human Services, children with dominant personal-
ities and who are more impulsive and active are more
prone to becoming bullies than children without
these traits. Bullies also often have a history of emo-
tional or behavioral problems. Victims of bullying,
on the other hand, tend to be more anxious, insecure,
and socially isolated than their peers, and often lack
age-appropriate social skills. The probability of vic-
timization can be compounded when the victim has
low self-esteem due to physical characteristics (for
example, the victim believes her/himself to be unat-
tractive or is outside the normal range for height or
weight) or problems (for example, health problems or
physical or mental disability).
for being or becoming a bully include:
extreme impulsiveness, easily frustrated, extreme
mood swings)
substance or alcohol abuse within the family, overly
permissive parenting, lack of clear limits, inadequate
parental supervision, harsh/corporal punishment,
child abuse, inconsistent parenting)
or abusive language, carrying a weapon, hurting ani-
mals, alcohol or drug abuse, making serious threats,
vandalizing or damaging property, frequent physical
fighting)
include:
feeling isolated, sad, and alone; feeling picked on or
persecuted; feeling rejected or not liked; having poor
social skills)
u
lly
in
g
ness; displaying victim body language, including
hanging head, hunching shoulders, and avoiding
eye contact)
classes or skips school)
swings; talking about hopelessness, running away,
or suicide)
or reports that belongings were ‘‘lost’’)
patterns)
others, taking or attempting to take weapon to
school)
manner, and some children will react with only a few
of these symptoms. This, however, does not mean that
bullying is not severe or that intervention is not
needed.
political rather than personal reasons. Workers com-
pete over scarce resources such as promotions, raises,
and the corner office or other honors. In an attempt to
climb the ladder of success, some individuals do what
they can to not only present themselves in a good light
to their superiors, but to make one or more coworkers
seem unworthy or inept. Bullying bosses demonstrate
poor leadership styles and poor motivational skills,
frequently attempting to further either their own or
the company’s agenda through harassment, belittling,
or other negative behaviors.
include:
ments such as ‘‘that’s silly’’ in response to victim’s
ideas, disregarding evidence of satisfactory or super-
lative work done by victim, taking credit for victim’s
work)
victim’s performance)
disability)
against victim, socially or physically isolating the
victim from others)
files a complaint, making up arbitrary rules for vic-
tim to follow, assigning undesirable work as a pun-
ishment, making unreasonable/unreachable goals or
deadlines for victim, performing a constructive dis-
charge of duties)
sonality disorder and schizoid behavior. There are,
however, a number of criteria to help determine if
the following behaviors:
seeking to dominate or manipulate others, being a
poor winner or loser)
pain, or discomfort of others; enjoying conflict
between others; displaying intolerance and prejudice
toward others)
trolled anger or a pattern of impulsive and chronic
hitting, intimidating, or aggressive behavior)
problems)
gang member; hiding bullying behavior from adults;
having a history of discipline problems)
disorder if they need help responding to or recovering
lying mental disorder such as antisocial personality
disorder, treatment and prevention should be guided
by and address the underlying disorder. For situations
u
ll
y
in
g
associated with an underlying mental disorder, treat-
ment and establishing organizational or familial proc-
esses for dealing with it are required.
important to be a role model for nonviolent behavior.
Parents should also clearly communicate to the child
that bullying behavior is not acceptable, and clear
limits should be established for acceptable behavior
and consequences for ignoring the limits should be
defined. Teaching good social skills—including effica-
cious conflict resolution skills and anger management
skills—can also help potential bullies learn alternative,
socially acceptable behaviors. If the child persists in
bullying behavior or if the parent(s) suspect that their
child is a bully, help can be sought from mental health
professionals and school counselors. Taking the child
to a child psychologist and participating in family
therapy as appropriate can help teach a bully better
interpersonal skills. Contacting the school counselor
or a child psychologist is also an appropriate step in
helping the victims of bullies.
bullied, they should make sure that he or she under-
standsthatthe problem isnot hisor herfaultand that he
or she does not have to face the situation alone. Parents
can discuss ways to deal with bullies, including walking
away, being assertive, and getting help. Parents should
also encourage the child to report bullying behavior to a
teacher, counselor, or other trusted adult. However,
parents should not try to resolve the situation them-
selves but should contact the school to report the behav-
ior and for recommendations for further assistance.
organization develops and enforces anti-harassment
policies and procedures. These should include a stated
definition on what constitutes harassment, creating
and implementing a disciplinary system to punish the
bully rather than the victim, and instituting a formal
grievance system to report workplace bullying. Other
measures that can be taken include inclusiveness and
harassment training, awareness training to educate
employees on how to spot bullying behavior, and
offering courses in conflict resolution, anger manage-
ment, or assertiveness training.
intention of a bully is to harm the other person; vic-
tims, therefore, may experience a number of negative
behavior associated with being a victim persists after
the bullying situation has been resolved or if the sit-
uation continues without just resolution, victims
should be assessed for depression and/or an anxiety
disorder if their symptoms warrant, and receive the
appropriate treatment.
Cooper, eds. Bullying and Emotional Abuse in the
Workplace: International Perspectives in Research and
Practice. New York: Taylor and Francis, 2003.
in American Schools: A Social-Ecological Perspective on
Prevention and Intervention. Mahwah, NJ: Lawrence
Young, eds. Bullying Behavior: Current Issues,
Haworth Maltreatment and Trauma Press, 2002.
Secret. New York: Penguin Global, 2004.
ing in Schools: A Training Manual for Teachers, Parents
and Other Professionals. London: Paul Chapman Pub-
order characterized by aggressive, impulsive, or
even violent actions that violate the established
rules or conventions of a society.
characterized by apprehension and associated
bodily symptoms of tension (such as tense muscles,
fast breathing, rapid heart beat). When anxious, the
individual anticipates threat, danger, or misfortune.
Anxiety disorders include panic disorder (with or
without agoraphobia), agoraphobia without panic
disorder, specific phobias, social phobia, obses-
sive-compulsive disorder (OCD), post-traumatic
stress disorder (PTSD), acute stress disorder, gener-
alized anxiety disorder, anxiety disorder due to a
general medical condition, and substance-induced
anxiety disorder.
population of interest that is chosen so that it accu-
rately displays the same essential characteristics of
the larger population in the same proportion.
u
lly
in
g
Kingsley Publishers, 2002.
Washington, D.C.: American Psychological Associa-
Reconciliation, and Shame: Three Key Variables in
Reducing School Bullying.’’ Journal of Social Issues
62.2 (2006): 347–70.
Harassment from the Victim’s Perspective: A Theoret-
ical Model and Meta-Analysis.’’ Journal of Applied
Victimization.’’ School Psychology International 27.3
(2006): 352–369.
Investigation of Bullying and Harassing Behavior and
in Teaching Civility in Educational Communities.’’
Journal of Group Psychotherapy, Psychodrama and
Tzenova. ‘‘Conflict Resolution and Bully Prevention:
terly 24.1 (2006): 55–69.
Alan Hubbard, and W. Thomas Boyce. ‘‘School Bully-
Psychopathologic Behavior?’’ Archives of General
Psychiatry 63.9 (2006): 1035–41.
Functioning.’’ Journal of Psychopathology and Behav-
ioral Assessment 28.1 (2006): 33–40.
Turns Predatory: Workplace Bullying as a Predictor of
Counteraggression/Bullying, Coping, and Well-Being.’’
European Journal of Work and Organizational Psychol-
Qualitative Study of Women Targets in the Public
Psychology 16.2 (2006): 119–35.
and Other Forms of Resistance to Workplace Bullying.’’
Sam Salem. ‘‘Workplace Bullying: A Systematic Review
of Risk Factors and Outcomes.’’ Theoretical Issues in
apy on Bullying Behaviour, Cortisol Secretion, Anger,
Randomized, Prospective, Controlled Study.’’ Cana-
dian Journal of Psychiatry 51.6 (2006): 355–62.
36.10 (2006): 2554–77.
bullying.’’ Youth Violence and Juvenile Justice 4.2
(2006): 148–69.
Black and Hispanic Adolescents.’’ Adolescence 41.163
(2006): 467–84.
Middle School, High School, and Beyond.’’ Journal of
Interpersonal Violence 22.2 (2007): 158–78.
John R. Brethour Jr. ‘‘Teachers Who Bully Students: A
Hidden Trauma.’’ International Journal of Social Psy-
Wisconsin Avenue N.W., Washington, DC 20016-3007.
Telephone: (202) 966-7300.
6642. TTY: (800) 433-5959.
phone: (800) 370-2943. TTY: Telephone: (888) 320-
6942.
mation and Communications Branch. 6001 Executive
Boulevard, Room 8184, MSC 9663, Bethesda, MD
415-8051.
Box 10809, Rockville, MD 20849-0809. Telephone:
(866) 723-3968. TTY: (888) 503-3952.
Bullying Now!
Definition
vate mood and promote recovery of a normal range of
emotions in patients with depressive disorders. In
u
p
ro
io
was armed with the first comparative test—a school/
student survey—ever used in American education or
psychology. During sixteen months of study, Rice
administered his survey to nearly 33,000 fourth- to
eighth-grade children, and he carefully tabulated
modifying conditions such as age, nationality, envi-
ronment, and type of school system. The survey fo-
cused, in part, on the pedagogy of spelling. Rice
found no link between the time spent on spelling
drills and students’ performance on spelling tests.
His study was far ahead of its time, not only method-
ologically but also pedagogically, as he pointed to
‘‘the futility of the spelling grind.’’
through 1907. He retired in Philadelphia in 1915, the
same year that he published his last book, The Peo-
ple’s Government. He had married Deborah Levin-
son in 1900; they had two children. He died in
Philadelphia, June 1934.
form; Herbart, Johann.
Rice: Pioneer in Educational Research.’’ M.S.
thesis, University of Wisconsin, Madison.
the United States. New York: Century.
New York: American Book.
ucation. New York: Hinds, Noble and Eldredge.
Philadelphia: Winston.
Carolyn Tucker Halpern
PREGNANCY TRENDS
demic proportions that has particularly devastating
effects on youth because the early initiation of alco-
hol, tobacco, or other drug (ATOD) use within this
population is linked to abuse and related problem
behaviors among adults. The cost of alcohol abuse
to society is estimated to be $250 billion per year in
health care, public safety, and social welfare expendi-
tures. Key trends in substance use by twelfth graders
are displayed in Table 1.
of adolescent ATOD use. The most salient of these
is the ‘‘Risk and Protective Factor’’ framework,
which has identified a variety of psychosocial factors
associated with ATOD use. In the individual do-
main, substance use has been linked to values and
beliefs about and attitudes toward substances, genet-
ic susceptibility, early ATOD use, sensation seeking,
and various psychological disorders including anti-
social, aggressive, and other problem behaviors. In
with familial substance use, poor parenting practices
including harsh or inconsistent discipline, poor in-
trafamilial communication, and inadequate supervi-
sion and monitoring of children’s behaviors and
peer associations. In the peer domain, substance use
has been linked to social isolation and association
with ATOD-using and otherwise deviant peer net-
works. In the school domain, ATOD use has been
linked to poor academic performance and truancy,
as well as a disorderly and unsafe school climate and
lax school policies concerning substance use. In the
community and environmental domains, ready social
and physical access to ATODs has been associated
with use, as has lack of recreational resources (espe-
cially during the after-school hours).
have also been identified in these various domains.
Among those most frequently cited are religiosity or
spirituality, commitment to academic achievement,
strong life skills, social competencies, and belief in
self-efficacy. Protective factors in the family and
school domains include strong intrafamilial bonds,
positive family dynamics, and positive attachment to
school. In the community and environmental do-
mains, strongly held adult values antithetical to sub-
stance use constitute protective factors, as do clearly
communicated and consistently enforced regula-
tions concerning use.
ness in preventing or reducing ATOD use. Project
Alert, described by Phyllis Ellickson and colleagues
in a 1993 article, and Life Skills Training Program,
described by Gill Botvin and colleagues in 1995, are
the two most-prevalent effective classroom-based
curricula. The ‘‘Reconnecting Youth’’ Program, de-
scribed by Leona Eggert and colleagues in 1994, is
designed for high school students who manifest poor
academic achievement or who are at high risk for
dropping out and other problem behaviors. In the
family domain, the Iowa Strengthening Families
Program, described by Richard Spoth and colleagues
in 1999, has received considerable attention. In the
community and environmental domains, strategies
have been developed to increase the enforcement of
public policies and ordinances that inhibit adoles-
cent substance use. These include efforts targeting
on their location and density and on alcohol and to-
bacco advertising. Also effective is the vigorous en-
forcement of laws governing sales to minors,
including using underage youth to buy alcohol and
tobacco products in ‘‘sting’’ operations. Increasing
excise taxes on alcohol and tobacco products has
also been associated with reductions in use, as has
linking apprehension for infractions of laws related
to purchasing and consuming ATODs to suspension
or revocation of driver’s licenses. Other preventive
measures that target youth drivers include ‘‘zero tol-
erance’’ laws linking evidence of alcohol on the
breath with suspension or revocation of driving
privileges.
have yielded considerable information suggesting
that a number of approaches to adolescent ATOD
use prevention do not work. Scare tactics, designed
to frighten adolescents into avoiding drugs, are often
recognized as such by their target audiences and can
even be counterproductive. Efforts to raise self-
esteem as a drug prevention strategy have long been
discredited given the lack of association between
self-esteem and ATOD use. Strategies designed to in-
crease knowledge and convey information about the
risks and dangers of drug use are generally recog-
nized to be failures, in part because of the lack of as-
sociation between knowledge and use. Indeed, all
largely didactic approaches to prevention education,
such as Project ‘‘Drug Abuse Resistance Education’’
(Project DARE), are widely understood to be inef-
fective, especially if they concentrate on long-term
risks. Mass media campaigns are of dubious value,
especially if they are brief, aired in contexts that are
unlikely to reach their target audience, and uncoor-
dinated with a comprehensive, community-wide
strategy.
about prevention on college campuses. Many college
campuses have cultures that are at least covertly sup-
portive of alcohol consumption, and many adminis-
trators treat the issue with benign neglect. While
most drinking on college campuses occurs in neigh-
borhood bars and residential contexts such as frater-
nities, relatively little has been done to develop and
implement demonstration programs that increase
enforcement of, and penalties for, selling or other-
wise supplying liquor to underage students.
comprehensive school-based strategies, and even
grade levels, are only slightly more effective than
school-based programs that are generally discredited
in the early twenty-first century. There has evolved
a consensus among both practitioners and research-
ers that school-based programs, by themselves, are
insufficient. Such efforts should be part of a broad
and comprehensive array of prevention approaches
that integrate both supply and demand reduction
strategies in the family and community, as well as
the individual, domains.
and Counseling, School; Family Composition
and Circumstance, subentry on Alcohol, Tobac-
co, and Other Drugs; Out-of-School Influ-
ences and Academic Success; Risk Behaviors,
subentry on Smoking and Its Effect on Chil-
dren’s Health.
Linda; Botvin, Elizabeth M.; and Diaz,
Tracy. 1995. ‘‘Long-Term Followup Results of
a Randomized Drug Abuse Prevention Trial in
a White Middle-Class Population.’’ Journal of
the American Medical Association 273:1106–
1112.
sion of Knowledge Development and Eval-
uation. 1998. Science-Based Practices in
Substance Abuse Prevention: A Guide. Washing-
ton, DC: Substance Abuse and Mental Health
Services Administration, Center for Substance
Abuse Prevention, Division of Knowledge De-
velopment and Evaluation.
tional Center for the Advancement of
Prevention. 2000. 2000 Annual Summary: Ef-
fective Prevention Principles and Programs. Rock-
ville, MD: Center for Substance Abuse
Prevention.
prehensive Drug Abuse Prevention Strategy.’’ In
Increasing Prevention Effectiveness, ed. William
B. Hansen, Steve M. Giles, and Melodia Fear-
now-Kenney. Greensboro, NC: Tanglewood Re-
search.
ing, Jerald R.; Nicholas, Liela J.; and Dick-
Drug Abuse and High School Dropout through
an Intensive School-Based Social Network De-
velopment Program.’’ American Journal of
Health Promotion 8:202–215.
Guigan, Kimberley. 1993. ‘‘Preventing Ado-
lescent Drug Use: Long-Term Results of a
Junior High Program.’’ American Journal of
Public Health 83:856–861.
Christopher L.; and Flewelling, Robert L.
1994. ‘‘How Effective Is Drug Abuse Resistance
Education? A Meta-Analysis of Project DARE
Outcome Evaluations.’’ American Journal of
Public Health 84:1394–1401.
Miller, Janet Y. 1992. ‘‘Risk and Protective
Factors for Alcohol and Other Drug Problems
in Adolescence and Early Adulthood: Implica-
tions for Substance Abuse Prevention.’’ Psycho-
logical Bulletin 112:64–105.
tion. 1999. Strategies to Reduce Underage Alco-
hol Use: Typology and Brief Overview.
Washington, DC: U.S. Department of Justice,
Office of Justice Programs, Office of Juvenile
Justice and Delinquency Prevention.
per, H. 1999. ‘‘Alcohol Initiation Outcomes of
Universal Family-Focused Preventive Interven-
tions: One- and Two-Year Follow-Ups of a
Controlled Study.’’ Journal of Studies on Alcohol
13:103–111.
olescent Drug Prevention Programs: Quantita-
tive Outcome Results of Program Participants
Compared to a Control or Comparison Group.’’
Journal of Drug Issues 16:537–567.
tion Services. 2000. ‘‘‘Ecstasy’ Use Rises
Sharply among Teens in 2000: Use of Many
Other Drugs Stays Steady, but Significant De-
clines Are Reported for Some.’’ December 14
news release. Ann Arbor: University of Michi-
gan, News and Information Services.
Costs Society $250 Billion Per Year.’’
ADOLESCENTS
significant threat to youth and young adults. It is the
seventh leading cause of death among U.S. youth
aged fifteen to twenty-four. More than 126,000 cases
of AIDS among individuals ages twenty to twenty-
nine had been diagnosed in the U.S. through June
2000. Given the long latency period between infec-
tion and symptoms, most of these individuals were
infected as adolescents. Estimates of human immu-
nodeficiency virus (HIV) among adolescents range
from 112,000 to 250,000 in the United States, al-
though actual prevalence is not known because rep-
resentative data are not available. Estimates of HIV
incidence in the early twenty-first century suggest
that at least 50 percent of the 40,000 new infections
in the United States each year are among individuals
under twenty-five years old, and 25 percent are
among persons aged twenty-one or younger.
are contracted through sexual activity. Among HIV
positive thirteen to nineteen year-old females who
had not developed AIDS, 49 percent of the cases
were associated with exposure through sexual con-
tact, 7 percent through injection drug use, 1 percent
through blood exposure, and 43 percent through a
risk not reported or identified. Among males in the
same age group, 50 percent were associated with
male to male sex, 5 percent with injection drug use,
5 percent with both male to male sex and injection
drug use, 5 percent with hemophilia or coagulation
disorder, 7 percent with heterosexual exposure, 1
percent with blood exposure, and 28 percent with an
unreported or unidentified risk.
the extent of experience and risk varies for different
groups of adolescents. Youth Risk Behavior Survey
(YRBS) data indicate that about half of all high
school students report having engaged in intercourse
at least once. Almost 10 percent of youth were youn-
ger than age thirteen at first sexual intercourse, and
by twelfth grade, 65 percent of students have become
ber of partners and the failure to use condoms. In
the YRBS data, about 16 percent of high school stu-
dents report having had sex with four or more part-
ners; 48 percent of adolescent African-American
males report four or more sexual partners. Forty-
two percent of sexually active respondents did not
use a condom at last intercourse.
fections (STIs) can also facilitate HIV transmission.
Adolescents and young adults are physiologically
and behaviorally at higher risk for acquiring STIs.
An estimated three million cases of STIs other than
HIV are acquired each year among persons between
ten and nineteen years old. Youth under the age of
twenty-five account for two-thirds of the total num-
ber of cases of STIs diagnosed annually. Rates of
chlamydia, gonorrhea, and human papillomavirus
are particularly high among sexually active female
teens. An individual’s risk is affected by STI preva-
lence among the pool of potential sex partners. Afri-
can-American and Hispanic teens, for example, are
disproportionately overrepresented among AIDS
cases and cases of other STIs. Given that sexual net-
works tend to be homogeneous by race, these youth
are more likely to face greater prevalence of HIV
among their sex partners.
HIV. The most direct route is through sharing nee-
dles. Addicts may engage in sex with multiple part-
ners to obtain drugs or money to buy drugs, and
may thus increase the spread of infection to other-
wise low-risk individuals. Non-injected drugs may
also reduce inhibitions, influencing the individual to
engage in risky sexual activity. Studies show that
there are positive relationships between substance
use and various facets of sexual behavior, such as
timing of initiation, frequency, persistence, and risk
taking, for both adolescents and young adults. How-
ever, findings regarding this pathway are mixed and
may vary by race/ethnicity. For example, the link be-
tween substance use and sexual activity may be less
strong among African Americans. Alcohol con-
sumption has been linked to sexual risk taking
among white adolescents, but a more recent study
found that young women’s condom use patterns
were not linked to pre-coital substance use.
adulthood provide a way for researchers to under-
havior. Greater involvement with problem behavior
as a youth is predictive of greater involvement in
young adulthood. However, problem behavior in
the teen years does not necessarily lead to poor adult
outcomes. For most adolescents, drug use and sexual
activity reflect behavior that is experimental and so-
cially normative. Longitudinal studies have shown
that a ‘‘maturing out’’ process typically occurs, par-
ticularly if the individual is embedded in conven-
tional institutions such as marriage.
many risk behaviors, prevention efforts are needed
to reduce the risk of HIV infection during adoles-
cence. As has been found with other risk behaviors,
studies have demonstrated that knowledge about
risk is not sufficient for the prevention of HIV risk
behavior. This is not really surprising, given the vari-
ety of individual and contextual factors that contrib-
ute to motivation and the persistence of risk
behaviors into young adulthood. For example, sub-
stance abuse, suicidality, and depression in adoles-
cence are strong predictors of increasing or
maintaining HIV high risk behaviors in young adult-
hood. Other contributing factors are problems in re-
lationships with parents, friends’ misbehaviors,
stressful events, and neighborhood violence and un-
employment.
to risk behavior, prevention efforts that focus exclu-
sively on knowledge are unlikely to be successful.
However, there are effective school-based HIV pre-
vention programs, which typically rely on principles
of Social Cognitive (Learning) Theory. These princi-
ples include the use of experiential activities that
allow for the modeling and practicing of skills, and
the reinforcement of group norms against unpro-
tected sex. A focus on reducing sexual risk behaviors
and the use of trained motivated teachers enhance
program effectiveness. However, adolescents live
and learn in a variety of social contexts, and it is im-
portant to expand the scope of HIV prevention to
include contextual interventions. For example, con-
sistent adult monitoring can reduce opportunities
for risky behaviors, and religious involvement pro-
tects adolescents from premature sex and drug use
behaviors. Although they are currently very limited,
school-based or school-linked clinic services, such as
condom distribution and STI diagnosis and treat-
ment, can be another important strategy for preven-
tion.
Health Services; Out-of-School Influences
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New York: McGraw-Hill.
2000. ‘‘U.S. HIV and AIDS Cases Reported
through June 2000.’’ HIV/AIDS Surveillance Re-
port 12(1):1–44.
2000. Be a Force for Change: Talk with Young
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selid, Rebecca Farmer. 1994. ‘‘Substance Use
and Sexual Risk Taking among Black Adoles-
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and Incidence of HIV.’’ In Understanding and
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Drug Use, ed. Stuart Oskamp and Suzanne C.
Thompson. Thousand Oaks, CA: Sage Publica-
tions.
2000. ‘‘Expanding the Scope of HIV Prevention
for Adolescents: Beyond Individual-Level Inter-
ventions.’’ Journal of Adolescent Health
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Influence: A Diary Self-Report Study of Sub-
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24(6):313–319.
‘‘The Relationship of Substance Use to Sexual
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States.’’ Family Planning Perspectives 27(1):18–
22, 33.
Immunodeficiency Virus Infection in Adoles-
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Confronting Sexually Transmitted Diseases.
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10(2):195–209.
HIV-related Sexual Behaviors among U.S. High
School Students: Are They Related?’’ American
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al Longitudinal Study on Adolescent Health.’’
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278(10):823–832.
vention of HIV Among Adolescents.’’ Preven-
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Sex and Its Lack of Association with Risk Behav-
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diatrics 92(1):13–19.
Environment in HIV Risk Behavior Change be-
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America’s Youth.’’
Carolyn Tucker Halpern
Bonita Iritani
AND TEEN PREGNANCY TRENDS
perspective that focuses primarily on sexual behav-
ior and its association with other high-risk behav-
iors. Youth are sometimes negatively viewed as sex-
crazed, hormone-driven individuals who want the
perceived independence of adulthood without the
responsibility of adulthood. On the other hand, psy-
chosexual development is a critical developmental
process during adolescence. P. B. Koch has identified
the need for research identifying healthy psychosex-
ual development in adolescents. As children emerge
into adolescence, their developing gender identity
shapes whom they interact and associate with, espe-
cially peers. Negative media images that appear to
promote lustful, irresponsible sexual behavior are
often associated with early sexual activity among ad-
olescents. However, it is crucial to identify what pro-
tective factors can shape positive psychosexual
development, including delaying the onset of sexual
activity. Research has yet to identify gender-specific
strategies that can promote positive psychosexual
development in boys and girls.
development. According to both the National Sur-
Survey, adolescents are engaging in sexual activity at
earlier ages. In general, older adolescents (age fifteen
and older) demonstrate a reduction in early sexual
activity, whereas adolescents younger than thirteen
demonstrate an increase in sexual activity. In addi-
tion, two-thirds of high school students report hav-
ing sex before graduating from high school. These
findings persist in the face of an apparent leveling off
of sexual activity in adolescents.
can encourage adolescents to engage in various levels
of sexual experimentation. Adolescents who engage
in sexual experimentation are at increased risk for
sexually transmitted diseases, including HIV/AIDs,
and pregnancy. Moreover, risk for early sexual ex-
perimentation is associated with other high-risk be-
haviors in adolescence, including sexual abuse and
drug and alcohol use, and emotional adjustment.
cents are more likely to engage in early sexual experi-
mentation than are later-maturing adolescents. They
confront their emerging sexuality at younger ages
than their peers do, and are more likely to be pur-
sued by older peers in social settings because they
appear physically older than their chronological age.
cence represents, in part, a time for pressure to en-
gage in sexual intimacy. As girls enter adolescence
(typically a few years before boys), they begin to
grow into womanhood and become sexualized ob-
jects. Within the media, images of sexuality and
overly thin body images can socialize girls into see-
ing themselves as sexual objects. On the other hand,
boys are pressured to exhibit their manhood
through sexual conquests.
adolescents does not address early patterns of non-
coital sexuality. Noncoital sexuality is defined as in-
volvement in sexual contact that does not include
the exchange of body fluids. Research suggests that
by middle adolescence most youths have begun to
engage in sexual experimentation, including kissing,
with 97 percent of adolescents experiencing their
first kiss by age fifteen. Understanding the onset of
noncoital sexuality and factors influencing its timing
is vital to delineating patterns of early sexual activity
in teenagers.
males and females. The decline in teenage pregnancy
tive use. However, since psychosexual development
is a new challenge faced during adolescence, some
youths are ill informed, and even though they may
choose to use contraceptives, they may use these
methods incorrectly.
pregnancy has been a societal concern for decades.
For females, teenage pregnancy can complicate ado-
lescent development and contribute to a trouble-
some transition to young adulthood, which involves
a potential future as a single parent with limited edu-
cational and economic opportunities. Since the
1990s the overall teenage pregnancy rate has de-
clined, though, according to the National Campaign
to Prevent Teen Pregnancy, four out of ten girls still
get pregnant before their twentieth birthday. The
United States has the highest teen pregnancy, birth,
and abortion rates of any industrialized nation.
school failure, while their offspring are at risk for low
birthweight, poor access to health care, poverty, and
early childhood developmental problems. Programs
such as Aid to Families with Dependent Children
(AFDC), which were created to support single par-
ent mothers, have been criticized as being an incen-
tive for the birth of children out of wedlock in poor
communities. Consequently, poor teen mothers
have sometimes been blamed for their circumstances
and negatively portrayed within the media and the
public arena. Yet the overall decline in teenage preg-
nancy has occurred across all ethnic groups, includ-
ing the poor ethnic minority groups that are most
likely to be demonized in the media as having exces-
sive teenage pregnancy rates.
mentation is a history of sexual trauma. This is true
for both males and females, though the level of risk
is increased for females. Adolescent girls who have
a history of sexual trauma during childhood and/or
adolescence may try to cope during their adolescent
years by being sexually provocative. This coping
mechanism is negative; however, victims of sexual
abuse may try to control future sexual encounters by
initiating sexual contact. This may influence the like-
lihood of their involvement in prostitution and
other sexually exploitative illegal activities.
great risk for involvement in the juvenile justice sys-
home environments that allow them the opportuni-
ty to heal from their traumas. Girls within the juve-
nile justice system are likely to exhibit runaway
behaviors in an effort to get out of abusive home en-
vironments. Through these runaway patterns, some
girls are introduced to sexual exploitation in their ef-
fort to survive on the street. Boys who are victims of
sexual abuse are at risk for offending behaviors if
they lack supportive home environments, and they
are also at risk for involvement in the juvenile justice
system.
tions, and can therefore influence participation in
unprotected sexual activity. Boys and girls with a
history of smoking and alcohol use have an in-
creased risk for early sexual activity, in part because
the use of these substances can influence the decision
making of adolescents in social contexts.
the home environment have been found to be insuf-
ficient. Parents need to provide supportive learning
environments in which children can develop a
healthy understanding of their sexuality, particularly
during their adolescent years. Adolescence repre-
sents a time of fundamental change, as adolescents
are introduced to new reproductive capacities that
have to be understood cognitively, socially, and
emotionally.
sexuality from peers, which often leads to misinfor-
mation. Adolescents need structured formal and in-
formal learning environments with age-appropriate
peers to address issues of sexuality. These program-
matic models may be available within school and
community-based settings. Most pregnancy preven-
tion programs fall within three categories: knowl-
edge interventions, access to contraception, and
programs to enhance life options. Lisa Crockett and
Joanne Chopack suggest three categories of pro-
grams: programs that focus on sexual antecedents,
programs that focus on nonsexual antecedents, and
programs that focus on a combination of both sexu-
al and nonsexual antecedents. Programs that focus
on sexual antecedents directly target sexual behavior
and often focus on reducing sexual activity, mini-
mizing the number of sexual partners, and contra-
ceptive use. Programs that focus on nonsexual
antecedents indirectly target sexual activity by focus-
ment, youth development (including leadership
skills), and service-learning models.
hensive health-promotion models as the best prac-
tice within sexuality education. This practice not
only seeks to minimize risk, but to provide leader-
ship and prosocial skills development to shape the
changing lives of young people. Scholars and activ-
ists continue to debate the usefulness of abstinence
versus education, including birth control strategies.
Abstinence-based models show mixed results when
rigorously researched, with a limited demonstrated
effect on sexual behavior. Many abstinence-only
proponents believe that birth control education in-
creases the likelihood of teen sexual activity; howev-
er, the evaluations do not support this notion. Sex
education models designed to support the psycho-
sexual development of adolescents have been exten-
sively debated, based on religious, moral, family, and
community values and attitudes. Educational sys-
tems have been permitted to provide abstinence-
based education to combat historically high teenage
pregnancy rates. Those that propose that birth con-
trol education should include life-skills development
assert that interventions need to be grounded in the
realities of those who are at greatest risk for prema-
ture sexual activity and associated negative conse-
quences.
city communities are at risk for poor access to health
care, including health education, which increases
their risk of negative developmental outcomes relat-
ed to early sexuality activity. Programmatic efforts
need to take into account the social context of these
communities. Young people living in such an envi-
ronment particularly need increased life options
rooted in effective decision making, which may lead
to a delay in early sexual activity in the adolescent
years. According to Saul Hoffman, author of ‘‘Teen-
age Childbearing Is Not So Bad After All . . . Or Is
It? A Review of the New Literature,’’ teenage preg-
nancy prevention programs targeting teen mothers
in poor, underserved communities may yield indi-
rect effects in addition to reducing teen pregnancy.
These programs may represent pathways out of pov-
erty for these poor populations of teen mothers.
gram models such as the I Have a Future program
founded by Dr. Henry Foster provide a supportive
learning community for youths residing in economi-
generational teen pregnancy and sexually
transmitted diseases. Such families often remain
trapped in poverty, poor health care systems, and
economic deprivation. The I Have a Future model
provides comprehensive adolescent health services,
prosocial skills development, leadership develop-
ment, alcohol and drug education, gender and eth-
nic identity development, and academic support. In
addition, participants gain exposure to positive role
models within the supportive staff and through
community linkages to colleges and universities.
This program represents a mixed-gender context in
which both males and females adolescents can devel-
op positive decision-making skills regarding delayed
sexual activity, and it provides a promising frame-
work for effective interventions for high-risk youth.
in making a successful transition through adoles-
cence. Adolescents need safe opportunities to relate
to peers and develop meaningful attachments with-
out bringing harm to themselves. Psychosexual de-
velopment is shaped by media, family, community,
and peer contexts, and comprehensive strategies that
address these contexts are needed to fully support
adolescent development. Media literacy can be in-
corporated into intervention models in order to in-
crease understanding of gender stereotypes. Girls
must confront the overwhelming stereotypes of thin,
sexually provocative body images of females, where-
as males must confront macho images reinforcing
masculine control.
shaping the lives of adolescents. Families, and par-
ents in particular, need help in learning effective
ways of supporting their adolescent’s psychosexual
development. In the face of declining teenage preg-
nancy rates, it is imperative that research focus on
targeted evaluations of promising practices that can
influence positive developmental outcomes. Some
communities and individual programs are strapped
for funds to establish and maintain programming,
while evaluation goals are deferred because of limit-
ed funding. Academic communities can partner with
local communities and health promotion agencies to
assist in the development of rigorous research para-
digms that can increase knowledge of effective inter-
ventions that can be potentially replicated in other
communities.
teenage pregnancy, some parents may be apprehen-
sive about other adults influencing their children re-
garding personal, sensitive issues. For parents who
feel comfortable and equipped in addressing these
issues with their children, the National Campaign to
Prevent Teen Pregnancy offers several tips for par-
ents, including being aware of their own personal
values and attitudes regarding sexuality and how
they want their children to be introduced to the sen-
sitive topic of sexuality. Effective parent–child com-
munication regarding love and intimacy, as well as
family rules and standards about teenage dating, can
provide needed support for adolescents who are
confronting the social and emotional challenges re-
lated to puberty. Parents are encouraged to intro-
duce the topic of sexuality and sex education early
in a child’s development. How early this occurs is
again influenced by the personal values and attitudes
of the parents. Parents can also assist as interpreters
of negative media images that foster inconsistent
and controversial attitudes toward early sexual activ-
ity and promiscuity.
knowledgeable about their children’s social contexts.
Monitoring children’s activities includes not only
knowing where one’s children are, but also who are
the friends and peer associates of one’s children. It
is also important to provide life options that provide
children with constructive, safe opportunities for
personal growth.
der-specific interventions that assist adolescents in
understanding positive manhood and womanhood
development. Through the development of positive
gender identity, adolescents can fully consider their
role in relationships with family, peers, and commu-
nity.
specific versus mixed-gender programs to address
the issue of teenage pregnancy. Programs are en-
couraged to be intentional in their efforts to maxi-
mize opportunities for education and life-skills
development, whether in same-gender or mixed-
gender environments. Same-gender programs can
provide safe learning environments in which groups
can fully consider the challenges facing adolescents
to engage in early sexual activity. In particular, for
girls who may have been traumatized by males, it is
critical that they have opportunities to voice their
concerns and experiences without any perceived
the absence of trauma-related experiences, adoles-
cents may benefit from healthy, mixed-gender pro-
grams that focus on the shared responsibility of both
sexes in family planning. Otherwise, the burden for
safe sex, including contraceptive use, is often per-
ceived as the responsibility of the female. Even
though females are more likely to experience puber-
tal changes earlier than their male counterparts,
these females are not necessarily advanced in their
emotional maturity to the point that they can as-
sume sole responsibility for sexual behavior.
among teenagers effectively, comprehensive com-
munity strategies are needed to address the myriad
of issues involved and the diversity in social and
community contexts. In 2002, thirteen community
partnerships within eleven states were implementing
comprehensive youth preventive interventions to
combat teenage pregnancy. These partnerships dis-
tribute the responsibility for sexuality education
across the family, community, and school.
Health Services; Parenting; Out-of-School
Influences and Academic Success; Risk Behav-
iors, subentry on Sexually Transmitted Diseas-
es; Sexuality Education.
‘‘Pregnancy Prevention in Early Adolescence: A
Developmental Perspective.’’ In Early Adoles-
cence: Perspectives on Research, Policy, and Inter-
vention, ed. Richard Lerner. Hillsdale, NJ:
Erlbaum.
and Prevention. New York: Oxford University
Press.
Not So Bad After All . . . Or Is It? A Review of
New Literature.’’ Family Planning Perspectives
30(5):236–239, 243.
Findings on Programs to Reduce Teen Pregnancy.
Washington, DC: National Campaign to Pre-
vent Teen Pregnancy.
velopment During Early Adolescence’’ In Early
Adolescence: Perspectives on Research, Policy, and
Erlbaum.
nancy and Childbearing.’’
cy. 2002. ‘‘Ten Tips for Parents to Help Their
Children Avoid Teen Pregnancy.’’
Health Promotion. 2002. ‘‘Preventing Teen
Pregnancy.’’
2002. ‘‘Childbearing by Teens: Links to Welfare
Reform.’’ Urban Institute.
SEXUALLY TRANSMITTED DISEASES
bacterial infections passed from one person to an-
other through sexual contact. In 1960 there were two
common STDs; by the beginning of the twenty-first
century, there were more than twenty-five. In 1980
alone, eight new STD pathogens were recognized in
the United States. In 1995 STDs accounted for 87
percent of cases reported among the top ten diseases
in the United States.
‘‘the hidden epidemic’’ to describe the problem of
STDs in the United States. STDs disproportionately
affect women and young people. In 1996 an estimat-
ed 15 million new cases of STDs occurred in the
United States, of which at least one-quarter were
among adolescents between the ages of fifteen and
nineteen. Adolescents are at a higher risk for con-
tracting sexually transmitted disease because of bio-
logical and behavioral factors.
herently greater risk of acquiring an STD than men
are. Young women are especially vulnerable to infec-
ectopic tissue on the endocervix, which increases the
likelihood of acquiring certain STDs such as chlamy-
dia, gonorrhea, and HIV. Adolescent women also
have ‘‘immature’’ or unchallenged local immune
systems that make them more vulnerable to STD in-
fections. Most sexually transmitted diseases are
asymptomatic and go undiagnosed, further promot-
ing the spread of infection.
STDs include age at initiation of sexual activity, hav-
ing multiple sexual partners or a partner with multi-
ple partners, use of barrier protection, and use of
diagnostic and treatment services. Furthermore, risk
of STDs may be compounded by additional socio-
economic factors, though this relationship is un-
clear. Many markers of STD risk (e.g., age, gender,
race/ethnicity) are associated with fundamental de-
terminants of risk status (e.g., access to health care,
residing in communities with high prevalence of
STDs) to influence adolescents’ risk for STDs. Since
the early 1980s the age of initiation of sexual activity
has steadily decreased and age at first marriage has
increased, resulting in increases in premarital sexual
experience among adolescent women and an in-
creasing number of women at risk. Multiple (se-
quential or concurrent) sexual partners rather than
a single, long-term relationship increases the likeli-
hood that a person may become infected. The Cen-
ters for Disease Control and Prevention (CDC)
showed that almost 45 percent of women who initi-
ated sexual activity before the age of sixteen had
more than five lifetime sexual partners. Among
women who delayed first sex until after the age of
twenty, however, only 15 percent had more than five
lifetime sexual partners. Of women who delayed
their first sexual activity until after the age of twenty,
close to 52 percent had only one lifetime sexual part-
ner, compared with about 19 percent of women who
had initiated sex before the age of sixteen. The risk
of STDs increases with the total number of lifetime
sexual partners, whether over a short time period or
spread over a life course.
partner, adolescents may be more likely to engage in
unprotected intercourse or engage in high-risk sexu-
al activities such as anal sex. They may also select
partners at higher risk. For example, young women
are more likely than women in other age groups to
tionally, oral sex and mutual masturbation may also
lead to the spread of infection and should be consid-
ered risky activities.
volved in one risky behavior are more likely to be in-
volved in others. Adolescent boys and girls who have
had sex are also more likely to drink alcohol, take
drugs, and smoke cigarettes than adolescents who
have not had sex. A quarter of adolescents inter-
viewed reported that they were under the influence
of drugs or alcohol when they last engaged in sexual
intercourse. There is evidence that young people
who avoided risky behavior had positive influences
in their lives, such as a strong relationship with their
parents.
may also reflect multiple barriers to quality STD pre-
vention services. Adolescents may lack insurance or
the ability to pay for such services. They may lack
transportation to reach an adequate facility. Addi-
tionally, they may feel uncomfortable in facilities
and with services designed for adults. Adolescents
may also be concerned about the confidentiality of
their visits. Most studies following adolescents who
have been diagnosed and treated for STDs by health
care providers show a high incidence of reinfection
at follow-up visits.
and chlamydia. Ongoing surveys of women in clinic
settings has shown that adolescent women consis-
tently have higher rates of chlamydia infection when
compared to other age groups. In 2000 women aged
fifteen to nineteen years old had the highest rates of
chlamydia infection among all women even when
overall prevalence declined. Chlamydia rates are low
among men. Though the rates of gonorrhea de-
creased among adolescent women ages ten to nine-
teen years between 1996 and 2000, in 2000 the
highest age-specific gonorrhea rates were among
women in the fifteen- to nineteen-year-old age
group. Adolescent men ages fifteen to nineteen years
had the third-highest rates of gonorrhea when com-
pared to other age groups of men.
papillomavirus (HPV) are prevalent among sexually
experienced adolescents. Furthermore, infection
productive morbidity, including neonatal transmis-
sion of these infections, cervical and genital cancer,
and even premature death. As of yet, there are no ef-
fective cures for these viral infections.
fected with HSV-2, reflecting a ninefold increase
since the early 1970s. An estimated 4 percent of Cau-
casians and 17 percent of African Americans are in-
fected with HSV-2 by the end of their teenage years.
One study of low-income pregnant women found an
HSV-2 infection rate as high as 11 percent in women
fifteen to nineteen years of age and 22 percent in
women twenty-five to twenty-nine years of age.
grated HIV and AIDS reporting systems, the CDC
reported that for the period from January 1996 to
June 1999 young people (aged thirteen to twenty-
four) accounted for a much greater proportion of
HIV (13%) than AIDS cases (3%). Though the num-
ber of new AIDS cases diagnosed during the period
declined, no decline was observed in the number of
newly diagnosed HIV cases among youth. Because
progression from HIV infection to AIDS may be on
the order of years, the reported number of AIDS
cases may not reflect the actual rate of HIV infection
among adolescents. At least half of all new HIV in-
fections in the United States are among people
under age twenty-five, and the majority of young
people are infected sexually. In 1999 there were
29,629 cumulative cases of AIDS among those aged
thirteen to twenty-four years. The CDC further re-
ported that in 1999, of the cases of AIDS in young
men aged thirteen to twenty-four years, 50 percent
were among men who have sex with men; 8 percent
were among injection drug users; and 8 percent were
among young men infected heterosexually. Among
young women aged thirteen to twenty-four years, 47
percent of cases reported were acquired heterosexu-
ally and 11 percent were acquired through injection
drug use.
They lead to declines in school performance, in-
creased poverty, and higher crime rates. The finan-
cial cost of STDs runs in the billions each year. As
a consequence of STDs, many adolescents experi-
ence serious health problems that often alter the
course of their adult lives, including infertility, diffi-
transmission of infections, and AIDS.
Health Services; Out-of-School Influences
and Academic Success; Risk Behaviors, suben-
tries on HIV/AIDS and its Impact on Adoles-
cents, Sexual Activity Among Teens and Teen
Pregnancy Trends; Sexuality Education.
Gale Encyclopedia of Childhood and Adolescence.
Detroit: Gale.
Infection and Teenage Sexuality.’’ American
Journal of Obstetrics and Gynecology 183:334–
339.
National Center for HIV, STD and TB Pre-
vention. Division of Sexually Transmitted
Diseases. 2002. ‘‘STDs in Adolescents and
Young Adults: STD Surveillance, Special Focus
Profiles.’’
National Center for HIV, STD and TB Pre-
vention. Division of Sexually Transmitted
Diseases. 2002. ‘‘STD Surveillance 2000.’’
CHILDREN’S HEALTH
worldwide is staggering. According to the World
Health Organization, 1.1 billion people worldwide
regularly smoke tobacco products, and smoking ac-
counts for 10,000 deaths per day. In 1990 there were
418,000 deaths in the United States alone attributed
to smoking and its effects. Smoking kills two and
one-half times more people than alcohol and drug
use combined. In the United States 25 percent of the
population regularly uses tobacco, with 6,000 new
adolescent smokers each day—half of whom will go
on to be regular smokers. Every day more than 15
homes. Environmental tobacco smoke (ETS), also
known as ‘‘second hand smoke,’’ poses significant
risks to children. The United States Environmental
Protection Agency (EPA) has classified ETS as a class
A carcinogen, which means that ETS is known to
cause cancer in humans. Exposure to ETS before the
age of ten will increase a child’s chances of develop-
ing lymphoma and leukemia (i.e., cancers of the
blood) as an adult. The effects of ETS are actually
worse than those acquired from smoking cigarettes
directly.
of pregnant women smoke during their pregnancy.
The pregnant woman who smokes not only affects
her own health, but she harms the baby she is carry-
ing as well. A major risk of smoking during pregnan-
cy is the increased rate of premature delivery of the
baby. Infants who are born prematurely can have
many severe medical problems, including lung im-
maturity and brain injury. Maternal smoking con-
tributes to 5 percent of all perinatal deaths (i.e.,
2,800 deaths per year). Pregnant women who smoke
are at a greater risk of miscarriage and low-birth-
weight infants, as well as higher rates of long-term
behavioral and mental problems in her child. Infants
born to mothers who smoked during pregnancy
have a much higher rate of Sudden Infant Death
Syndrome (SIDS) than infants born to mothers who
did not smoke during pregnancy. There is a dose-
dependent relationship between ETS exposure dur-
ing pregnancy and the rate of SIDS: The greater the
exposure of cigarette smoke to an unborn baby, the
higher their risk of SIDS. Cigarette smoke exposure
is one of the few preventable risk factors for SIDS.
it comes to exposure to their mothers’ smoke. Coti-
nine, a metabolite of nicotine, is found in newborn
babies’ blood at levels almost equivalent to their
mothers’. There are significant levels of cotinine in
a newborn’s blood even if the mother herself does
not smoke, but simply lives in a household where
there is ETS exposure. There is a direct relationship
between the maternal and newborn infant’s blood
levels of cigarette smoke products. The mother who
smokes during pregnancy transfers the products in
cigarette smoke to the fetus through the placenta, as
well as to the newborn infant though breast-feeding.
In fact, breast-fed infants have the same urinary coti-
nine levels as active adult smokers.
born infant. There are many childhood illnesses that
are dramatically worsened by exposure to smoke. A
1994 study by Joan Cunningham and colleagues
showed that there was an increased risk of colds,
wheezing, shortness-of-breath, and emergency room
visits by children living in households where there
is a smoker. There is also a significant increase is the
risk of ear infections in children who live in house-
holds where there are smokers. Children born to
mothers who smoke have a higher risk of developing
asthma. Along with an increased risk of asthma, chil-
dren of mothers who smoked during pregnancy will
be at a greater risk of have problems with environ-
mental allergies (e.g., hay fever). These effects can be
seen in newborn infants as well as school-aged chil-
dren.
United States smoke daily. Each year more than 1
million people under eighteen years of age become
daily smokers. Ninety percent of adults who regular-
ly smoke began smoking before they were nineteen
years of age. Throughout the 1990s the age at which
children began smoking became increasingly youn-
ger. In 1990, 31 percent of all twelfth graders report-
ed recent (within the last month) tobacco use while
21 percent were daily smokers. Shockingly, 8 percent
of all eighth graders reported daily tobacco use. By
the end of the 1990s the percentages of twelfth and
eighth graders who recently used cigarettes was up
to 36 percent and 21 percent, respectively. The
younger and younger beginning smoker is reflected
in the higher percentage of adolescent smokers as
compared to the adult population. Besides the nega-
tive health effects of smoking itself, adolescents who
smoke are fifteen times more likely to use drugs than
their peers who do not smoke.
cent will begin to smoke. The most common influ-
ence is family and peer pressures, but the most
potent factor is the media portrayal of ‘‘glamorous’’
smoking. The top three most popular brands of ciga-
rettes amongst adolescents were the top three com-
panies that spent the most on advertising. In 1993
these companies collectively spent $153 million dol-
lars on advertising. Many popular sporting events
are still sponsored by tobacco companies, and there
is some evidence that advertising had been directed
To combat the draw of the media for adolescents to
begin smoking, the Centers for Diseases Control and
Prevention (CDC) began, in the fall of 2000, the Sur-
geon General’s Report for Kids on Smoking. This was
an attempt to enlist celebrities and sports figures to
promote an antismoking message to young people.
It involves posters and media advertisements direct-
ed toward children and adolescents, informing them
of the health damages caused by cigarette smoking.
are some very practical measures that can be seen.
In 1997 American children made more than 500,000
doctor visits for asthma, and 1.3 million visits for
cough that were directly attributed to smoke expo-
sure. This does not include the 115,000 cases of
pneumonia, 260,000 cases of bronchitis, and more
than two million ear infections. The annual cost of
ear infections in children in the United States caused
by smoke exposure is $1.5 billion. The actual total
financial costs, directly related to the exposure of
American children to ETS, are broken into direct
medical costs and the loss of life costs. In 1997 the
total medical cost of the complications of cigarette
smoke on American children was $4.6 billion. The
loss of life cost (calculated based upon loss of earn-
ings and costs needed to prevent disease) was $8.2
billion. The true cost of cigarette smoking, however,
is in the impact smoking has on the health of infants
and children.
Health Education; Health Services; Out-of-
School Influences and Academic Success; Risk
Behaviors, subentry on Sexual Activity Among
Teens and Teen Pregnancy Trends.
1997. ‘‘Tobacco and Children: An Economic
Evaluation of the Medical Effects of Parental
Smoking’’ Archives of Pediatrics and Adolescent
Medicine 171(7):648–653.
on Substance Abuse. 2001. ‘‘Tobacco’s Toll:
Implications for the Pediatrician.’’ Pediatrics
107:794–798.
1997. ‘‘State-Specific Prevalence of Cigarette
olescents’ Exposure to Environmental Tobacco
Smoke—United States, 1996.’’ Morbidity and
Mortality Weekly Reports 46:1038–1043.
Tobacco Smoke, Wheezing, and Asthma in
Children in Twenty-Four Mothers.’’ American
Journal of Respiratory and Critical Care Medicine
86:1398–1402.
‘‘Morbidity and Mortality in Children Associat-
ed with the Use of Tobacco Products by Other
People.’’ Pediatrics 97:560–568.
tory Health.’’ Clinics in Chest Medicine
21(1):37–46.
SUICIDE
of concern to adults as a function of their develop-
ment as well as the changing culture and environ-
ments in which they live. Perhaps the most
concerning and baffling of these risk behaviors are
the tendencies in some to consider ending their own
lives at so young an age. Why children and adoles-
cents consider these self-destructive actions is a
complicated puzzle to understand and solve. Such
behaviors must be considered in light of young peo-
ple’s vulnerability to external models, their increased
anxiety related to issues of social acceptance, their
desire to develop a unique identity, and the existence
of unstable and abusive families.
David Satcher, issued a call to action to prevent sui-
cide. Satcher noted the continuing increase in sui-
cide rates among the young, with the rate tripling
from 1952 to 1996. He stated that Americans under
the age of twenty-five accounted for 15 percent of all
completed suicides and that risk factors for suicide
attempts among the young included depression, al-
cohol or drug use disorders, and aggressive and dis-
ruptive behaviors. Suicide was not just a mental
health problem but a public health problem as well.
larly reported by the National Center for Health Sta-
Services. These reports count only those for whom
suicide is listed as the cause of death. For this reason
it is believed that suicides may be underreported.
Those who sign death certificates (family physicians,
emergency room staff, and medical examiners) may
not always list the cause of death as intentional in
order to avoid stigma for the family or because evi-
dence of suicide may not be immediately present. It
is suspected that vehicular accidents and deaths re-
lated to substance abuse, for instance, may in some
cases be suicides, but they may not be recorded as
such.
reveal a number of facts. For those aged fifteen to
twenty-four, suicide stands as the third-leading
cause of death behind accidents and homicides. As
of 1996, the rate of suicide deaths for Americans
aged ten to fourteen was 1.6 deaths per 100,000 pop-
ulation (2.3 per 100,000 for males and 0.8 per
100,000 for females). For fifteen- to nineteen-year-
olds the rate was 9.7 deaths per 100,000 (15.6 per
100,000 for males and 3.5 per 100,000 for females),
and for those aged twenty to twenty-four the rate
was 14.5 deaths per 100,000 (24.8 per 100,000 for
males and 3.7 per 100,000 for females). Young males
(aged fifteen to nineteen) are more likely to succeed
at killing themselves than females by a ratio of at
least five to one. Reports from the surgeon general
also suggest that gay and lesbian youth may be two
to three times more likely to commit suicide. Al-
though accomplished suicide rates were highest for
white males, young African American males showed
the greatest increase during the 1980s and 1990s.
White females had the next highest rates, followed
by African-American females. Research on Hispanic
populations indicated that rates of suicide in young
men and women may be higher than for whites.
means. Nearly 63 percent of suicides occur using
firearms. Most other deaths are a result of more pas-
sive means such as drug poisonings or hangings. Sui-
cide attempts are less likely to involve firearms and
may, therefore, provide opportunities for discovery
and rescue.
cides, many young people attempt suicide. Accurate
rates for this group of attempted suicides, often
called parasuicides, are even more difficult to obtain.
Hospitals and emergency rooms may identify at-
tempters, but many parasuicides go completely un-
friends. Possible ratios of attempts to completions
may range from 10:1 to 150:1, depending upon the
research and the definition of attempts. The contin-
uum of suicidal behaviors, which includes actual sui-
cide on one end and attempted suicides in the
middle, includes on the other end the least severe
form of self-destructiveness, usually identified as
suicidal ideation or intent. The idea of killing oneself
may occur quite frequently in young people, but it
becomes serious only when there is intent to actually
act. Such suicidal intent often includes a plan and a
timetable in the person’s mind.
the likelihood that a school-age child will become
suicidal. Some factors appear to be historical or situ-
ational whereas others are psychological. A large
percentage (perhaps as high as 90 percent) of those
who are victims of suicide have diagnosable psychi-
atric disorders at the time of death. Many suffer
from mood disorders, and a large percentage have
made previous suicide attempts. Risk factors may in-
clude: psychiatric disorder, previous suicide attempt,
co-occurring drug use and mental disorder, family
history of suicide, impulsive or aggressive tenden-
cies, feelings of hopelessness, loss of significant rela-
tionship, loss of job, physical illness, stress, lack of
access to mental health treatment, availability of le-
thal means (e.g., guns or drugs), feelings of isolation
and alienation, influence of peers or family mem-
bers, unwillingness to seek help, cultural or religious
beliefs or traditions, influence of the media, current
epidemics of suicidal behaviors, and being a victim
of bullying.
major themes related to increased risk for suicide are
fears of humiliation by others and feelings of invisi-
bility. Additional themes may also include general
levels of stress, breakdown of psychological defenses,
self-deprecatory thoughts, and a negative personal
history.
of self-destructive suicidal intent, so also there ap-
pear to be conditions that make these thoughts and
behaviors less likely. Such circumstances or charac-
teristics are considered to be protective. Among
those cited by the surgeon general in 1999 were: ef-
ment and support for seeking help; restricted access
to lethal means; family and community support; on-
going medical and mental health care relationships;
learned skills in problem solving, conflict resolution
and nonviolent dispute management; and a belief
system, either cultural or religious in nature, that
discourages suicide. Skills in anger management, im-
pulse control, and appropriate action in the face of
victimization have been also cited as protective fac-
tors.
can appear in many forms. They can be verbal, spo-
ken to others; written as poems, songs, diary entries,
or suicide notes; or made as threats directly (‘‘I am
going to kill myself’’) or indirectly (‘‘You won’t have
me to kick around anymore’’). Other warning signs
include social withdrawal, getting things in order,
giving things away, constant crying, or an angry or
hostile attitude. Some signs occur in the person’s en-
vironment, such as the death of someone close, fam-
ily problems, or failure in school or at work. Lastly,
some signs are those characteristic of depression or
general mental and emotional difficulties. These lat-
ter signs might include sleep disturbance, feelings of
despair, appetite change, or radical and abrupt
changes in behavior or personality.
search into suicide examined five major stages seen
in suicidal children. These included a history of
problems, an escalation of problems, the failure of
coping, the experience of helplessness, and finally, a
justification for taking a self-destructive action. Al-
though these stages may be present, in many cases
adults do not observe them, but rather they are
shared with peers. Adults may merely see the final
behaviors.
can best be seen not as a disease (although it may in
some cases be the manifestation of one), but rather
as a symptom with many different possible underly-
ing causes. Just as a headache could be caused by
many things, so the action to end one’s own life can
be a result of any number of causes: depression or
other mental illness, stress, grief or loss, unresolved
conflict, substance use, unexpressed anger or rage,
social pressure, lack of problem-solving or conflict
victimization, a desire for visibility or respect, the
need to avoid humiliation, or the desire to be no-
ticed.
those that reduce the number of risk factors and in-
crease protective factors. This means making re-
sources available to families and schools to aid in
this process. In some cases early intervention is
needed. Prevention or primary interventions need
to: develop strategies for detecting suicidal individu-
als, treat all threats seriously, educate those who
work with kids about suicide, increase peer educa-
tion about suicide, teach families and communities
to look for warning signs, reduce the availability of
lethal means, make twenty-four-hour hotlines avail-
able, and use the media to teach the public how to
recognize those at risk.
lem of self-destructive behavior affects everyone.
Parents, schools, and communities must make a
commitment to work to end this behavior and its
causes.
Mental Health Services and Children; Par-
enting; Out-of-School Influences and Aca-
demic Success.
lescent Suicide: Assessment and Intervention.
Washington, DC: American Psychological Asso-
ciation.
Ellis, Thomas E. 1990. Suicide Risk: Assessment
and Response Guidelines. New York: Pergamon
Press.
1996. Adolescent Suicide. Washington, DC:
American Psychiatric Press.
Wiley.
and Murphy, Sherry L. 1998. ‘‘Deaths: Final
Data for 1996.’’ National Vital Statistics Reports
47(9). Hyattsville, MD: National Center for
Health Statistics.
son, NC: McFarland.
ods of Adolescent Suicide Prevention.’’ Journal
of Clinical Psychiatry 60(suppl. 2):70–74.
Adolescence.’’ In The Handbook of Clinical
Child Psychology, 3rd edition, ed. Eugene Walk-
er and Michael Roberts. New York: Wiley.
vices, National Center for Health Statis-
tics. 1998. Vital Statistics of the United States.
Hyattsville, MD: U.S. Public Health Service.
General’s Call to Action to Prevent Suicide.
Washington, DC: U.S. Public Health Service.
TEEN PREGNANCY
problem. In 1997, the last year for which accurate es-
timates are available, about 896,000 young women
under the age of twenty became pregnant. Among
women aged fifteen to nineteen, 94 per 1,000 (or
about 9%) became pregnant. This rate is much
higher than that in other Western industrialized
countries. In addition, according to a 1997 publica-
tion of the National Campaign to Prevent Teen
Pregnancy, more than 40 percent of young women
in the United States become pregnant one or more
times before they reach twenty years of age.
aged eighteen and nineteen (142 per 1,000) than for
females fifteen to seventeen (64 per 1000). It is also
higher for African Americans (170 per 1,000) and
Hispanics (149 per 1,000) than for non-Hispanic
whites (65 per 1,000). Much of this ethnic variation,
however, reflects differences in poverty and oppor-
tunity.
rate in the United States was the lowest pregnancy
rate since it was first measured in the early 1970s.
The rate fluctuated considerably over the course of
the 1970s, 1980s, and 1990s, however, reflecting
both changing percentages of youth who have sex
and improved use of contraception among those
having sex.
tion, based upon female teenagers, this does not
are teenagers. Indeed, in 1994, whereas 11 percent
of fifteen- to nineteen-year-old females became
pregnant, only 5 percent of fifteen- to nineteen-year-
old males caused a pregnancy.
tended. Accordingly, in 1997, 15 percent of all teen
pregnancies ended in miscarriages, 29 percent ended
in legal abortions, and 55 percent ended in births.
centage of births that occur out of wedlock has risen
dramatically—from 15 percent in 1960 to 79 percent
in 2000. This large increase in and high rate of non-
marital childbearing has alarmed many people and
motivated many efforts to reduce teenage preg-
nancy.
Maynard, when teenagers, especially younger teen-
agers, give birth, their future prospects decline on a
number of dimensions. Teenage mothers are less
likely to complete school, more likely to have large
families, and more likely to be single parents. They
work as much as women who delay childbearing for
several years, but their earnings must provide for a
larger number of children.
who may bear the greatest brunt of their mothers’
young age. In comparison with those born to moth-
ers aged twenty or twenty-one, children born to
mothers aged fifteen to seventeen tend to have less
supportive and stimulating home environments,
poorer health, lower cognitive development, worse
educational outcomes, higher rates of behavior
problems, and higher rates of adolescent childbear-
ing themselves.
directly involved, adolescent childbearing leads to
considerable cost to taxpayers and society more gen-
erally. Estimates of these costs are in the billions.
sex without effectively using contraception. In the
United States, the proportion of teens who have ever
had sexual intercourse increases steadily with age. In
1995, among girls, the percentage increased from 25
percent among fifteen-year-olds to 77 percent
among nineteen-year-olds, while among males it in-
85 percent among nineteen-year-olds. Among stu-
dents in grades nine through twelve across the Unit-
ed States in 1999, 50 percent reported sexual
experience.
ception at least part of the time. Condoms and oral
contraceptives are the two most common methods,
but small and increasing percentages of teens use
long-lasting contraceptives such as Depo-Provera or
Norplant. Like some adults, however, many sexually
active teenagers do not use contraceptives consis-
tently and properly, thereby exposing themselves to
risks of pregnancy or sexually transmitted diseases
(STDs).
Pregnancy
and thus girls becoming pregnant, many risk and
protective factors distinguish between youth who
engage in unprotected sex and sometimes become
pregnant and those who do not. For example, when
teens have permissive attitudes toward premarital
sex, lack confidence to avoid sex or to use contracep-
tion consistently, lack adequate knowledge about
contraception, have negative attitudes toward con-
traception, and are ambivalent about pregnancy and
childbearing, then they are more likely to engage in
sex without contraception.
however, also affect teen sexual risk-taking, either by
decreasing motivation to avoid sex or through other
mechanisms. For example, teens are more likely to
engage in unprotected sex and become pregnant (1)
when they live in communities with lower levels of
education, employment, and income and thereby
have fewer opportunities and encouragement for ad-
vanced education and careers; (2) when their par-
ents also have low levels of education and income;
(3) when they live with only one or neither biologi-
cal parent and believe they have little parental sup-
port; (4) when they feel disconnected from their
parents or are inappropriately supervised or moni-
tored by their parents; (5) when they have friends
who obtain poor grades and engage in nonnorma-
tive behaviors; and (6) when they believe their peers
are having sex and are failing to use contraceptives
consistently.
sex when they, themselves, (1) do poorly in school
and drugs, engage in other problem or risk-taking
behaviors, and are depressed; (3) begin dating at an
early age, go steady at an early age, have a large num-
ber of romantic partners, or have a romantic partner
three or more years older (the latter being a particu-
larly telling factor); or (4) were previously sexually
abused. These individual and environmental, sexual
and nonsexual, risk and protective factors are the
factors that programs try to change when they at-
tempt to reduce teen sexual risk-taking and preg-
nancy.
pregnancy among sexually experienced teens are
family planning services. The primary objectives of
family planning clinics or family planning services
within other health settings are to provide contra-
ception and other reproductive health services and
to provide patients with the knowledge and skills to
use their selected methods of contraception.
agers obtain family planning services each year.
Many of these young women receive oral contracep-
tives and to a lesser extent other contraceptives that
are more effective than condoms or other non-
prescription contraceptives. Accordingly, these fam-
ily planning services prevent large numbers of
adolescent pregnancies.
ning clinics, some clinicians in health clinics also
focus upon the adolescent’s sexual behavior. Several
studies have found that these visits can increase con-
traceptive use when clinicians spend more time fo-
cusing upon the teen patients’ sexual behavior; give
a clear message about always using protection
against pregnancy and STDs; show videos or provide
pamphlets and other materials; discuss patients’ bar-
riers to avoiding sex or using contraception; and
model ways to avoid sex or use condoms or contra-
ception.
HIV, most schools have implemented sex and HIV
education programs. Typically, these programs em-
phasize that abstinence is the safest method of avoid-
ing pregnancy and STD, but they also encourage
condom and contraceptive use if teens do have sex.
Contrary to the fears of some people, a large number
not have negative behavioral effects, such as increas-
ing sexual behavior. To the contrary, many studies
have demonstrated that some, but not all of these
programs, delay the initiation of sex, decrease the
frequency of sex, and increase the use of contracep-
tion once youth have sex. They thereby reduce risk
of pregnancy, as well as STD. Some sex and HIV ed-
ucation programs have been found to be effective in
multiple states in the country, and some have found
positive behavioral effects for almost three years.
knowledge increase knowledge, but they tend not to
change behavior. In contrast, programs that effec-
tively reduce sexual risk-taking (1) focus on chang-
ing specific sexual or contraceptive behaviors; (2) are
based on health theories that specify the risk and
protective factors to be addressed by the program;
(3) give a clear message about avoiding unprotected
sex; (4) provide basic, accurate information about
the risks of teen sexual activity and about methods
of avoiding intercourse or using contraception; (5)
address social pressures that influence sexual behav-
ior; (6) provide modeling and practice of communi-
cation, negotiation, and refusal skills; (7) employ a
variety of teaching methods designed to involve the
participants and help them personalize the informa-
tion; (8) are appropriate to the age, sexual experi-
ence, and culture of the participants; (9) last a
sufficient length of time to complete important ac-
tivities adequately; and (10) select teachers or peer
leaders who believe in the program they are imple-
menting and then provide them with training.
programs as a solution to reducing teen pregnancy
and STDs. Such programs emphasize that abstinence
is the only acceptable method of avoiding pregnan-
cy, and they either fail to discuss contraception or
emphasis its limitations. Although some abstinence-
only programs might delay sex, there is thus far sim-
ply too little research to know which abstinence-only
programs are effective.
including HIV, hundreds of high schools have made
condoms available or have opened school-based
health centers that provide reproductive health ser-
vices. Although studies have demonstrated that these
services do not increase teen sexual behavior, they
have also found inconsistent results on improved
contraceptive use.
marily on changing the sexual risk factors of adoles-
cent sexual behavior, some programs focus primarily
on the nonsexual risk and protective factors. In 1997
researchers Joseph P. Allen and associates found the
strongest evidence for teen pregnancy reduction for
one type of program, service learning.
voluntary or unpaid service in the community (e.g.,
tutoring, working in nursing homes, helping fix up
recreation areas) and structured time for prepara-
tion and reflection before, during, and after service
(e.g., group discussions, journal writing, composing
short papers). Often the service is voluntary, but
sometimes it is prearranged as part of a class.
dence for reducing teen pregnancy, other youth de-
velopment programs have not reduced teen
pregnancy or childbearing (e.g., the Conservation
and Youth Service Corps, the Job Corps, JOB-
START). Thus, it remains unclear why some pro-
grams are effective and others are not.
have been designed for high-risk youth and are both
intensive and comprehensive. One of them, the
Children’s Aid Society Carrera program, is an inten-
sive program operating five days per week and last-
ing throughout high school. It includes family life
and sex education, medical care including reproduc-
tive health services, individual academic assessment
and tutoring, a job club, employment, arts, and
sports. Research demonstrates that it reduced both
pregnancy and birthrates over a three-year period.
United States in the 1990s, teen pregnancy remains
an important problem and diminishes the well-
being of both teen mothers and their children. For-
tunately, by the beginning of the twenty-first century
there were a diverse group of programs that were
demonstrated to be effective in reducing teen sexual
risk-taking or pregnancy. These include reproduc-
tive health services and clinic protocols focusing
upon patient sexual behavior, sex and HIV educa-
tion programs, service-learning programs, and in-
tensive and comprehensive programs for higher risk
choices for communities. To reduce teen pregnancy,
communities can replicate much more broadly and
with fidelity those programs with the greatest evi-
dence for success with populations similar to their
own; replicate more broadly programs incorporat-
ing the common qualities of programs effective with
populations similar to their own; and design and im-
plement programs that effectively address the im-
portant risk and protective factors associated with
sexual risk-taking in their communities.
Health Services; Out-of-School Influences
and Academic Success; Risk Behaviors, suben-
tries on HIV/AIDS, Sexual Activity Among Teens
and Teen Pregnancy Trends, Sexually Trans-
mitted Diseases; Sexuality Education.
America’s Teenagers. New York: Alan Guttm-
acher Institute.
Scott; and Kuperminc, Gabriel P. 1997.
‘‘Preventing Teen Pregnancy and Academic
Failure: Experimental Evaluation of a Develop-
mentally-Based Approach.’’ Child Development
64:729–742.
mens, Samuel J.; Cheng, Tina L.; O’Connor,
Kathleen; and D’Angelo, Lawrence J. 1999.
‘‘An STD/HIV Prevention Trial among Adoles-
cents in Managed Care.’’ Pediatrics 103(1):107–
115.
2000. ‘‘CDC Surveillance Summaries.’’ Morbidi-
ty and Mortality Weekly Report 49(SS-5).
‘‘Births: Preliminary Data for 1999.’’ National
Vital Statistics Reports 48(14). Hyattsville, MD:
National Center for Health Statistics.
1999. Why Is Teenage Pregnancy Declining? The
Roles of Abstinence, Sexual Activity, and Contra-
ceptive Use. New York: Alan Guttmacher Insti-
tute.
cy Statistics with Comparative Statistics for
Women Aged 20–24. New York: Alan Guttm-
acher Institute.
search Findings on Programs to Reduce Sexual
Risk-Taking and Teen Pregnancy. Washington,
DC: National Campaign to Prevent Teen Preg-
nancy.
Nancy; and Fetro, Joyce. 1991. ‘‘Reducing the
Risk: A New Curriculum to Prevent Sexual
Risk-Taking.’’ Family Planning Perspectives
23:253–263.
Robin Hood Foundation Special Report on the
Costs of Adolescent Childbearing. New York:
Robin Hood Foundation.
berg, Laura D. 1998. A Statistical Portrait of
Adolescent Sex, Contraception, and Childbearing.
Washington, DC: National Campaign to Pre-
vent Teen Pregnancy.
cy. 1997. Whatever Happened to Childhood? The
Problem of Teen Pregnancy in the United States.
Washington, DC: National Campaign to Pre-
vent Teen Pregnancy.
Barry P.; and Caine, Virginia A. 1996. ‘‘Be-
havioral Intervention to Increase Condom Use
among High-Risk Female Adolescents.’’ Journal
of Pediatrics 128:288–295.
Trends in Sexual Activity and Contraceptive Use
among Teens. Washington, DC: National Cam-
paign to Prevent Teen Pregnancy, 2000.
EDUCATION
and higher education experienced a substantial in-
crease in lawsuits resulting from some form of per-
sonal injury, according to John F. Adams and John
W. Hall. A response to the trend of litigiousness, risk
management seeks to control exposure to legal risk,
thus limiting the negative impact of liability on the
institution. In 1995 William A. Kaplin and Barbara
A. Lee described four of the most common methods
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