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approximately the second decade of the life cycle, was first presented as a subject for
scientific inquiry only a century ago by G.Stanley Hall (1904) and was characterized as
the developmental stage of “storm and stress.” Manifestations of storm and stress included
adolescents' tendencies to contradict their parents, experience mood changes, and engage
in antisocial behaviors (Arnett, 1999). After nearly 100 years of research, this picture of
adolescence seems both limited in scope and too broad a generalization (even if the
tendencies are still familiar and relevant). In particular, as we enter the twenty-first
century, adolescence is viewed as part of life span development, with continuities from
childhood, unique developmental challenges and tasks, and implications for adulthood.
Adolescence is also examined within context, so that adolescence is seen as a dynamic
developmental process that is influenced by proximal and distal social environments. The
manifestation of this developmental process can be seen in adolescents' behaviors,
behaviors that cause considerable concern in American society. Thus, this paper attempts
to provide a snapshot of the dynamics of adolescence and adolescent behavior, what
factors influence the adoption or maintenance of behavior, examples of how changes in
behavior have been achieved, and the implications of this research for healthful adolescent
development in the twenty-first century.
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TABLE 1
Adolescent Health Risk Behaviors: Prevalence and Risk Status by Racial or Ethnic Group
and Gender.
Drug Use
The gateway drugs—tobacco, alcohol, and marijuana—require particular attention during
adolescence because they are initiated during this period; cause injury, illness, and death
during adolescence and in adulthood; and are precursors to “heavier” drugs such as
cocaine, hallucinogens, and heroin (U.S. DHHS, 1994). In addition, the majority of
adolescents in the United States engages in each of these behaviors before they graduate
from high school—74% have tried a cigarette, 84% have had an alcoholic drink, and 52%
have used marijuana (CDC, 1998). Clearly, societal and personal decisions concerning
tobacco, alcohol, and marijuana use are an integral part of examining adolescence in the
United States, as the entire population can be considered “at risk.”
There are important differences in tobacco, alcohol, and marijuana use by ethnic or racial
group and gender. These differences are particularly important to note as the United States
continues to become increasingly multicultural (Vega and Gil, 1998). Overall, African
American adolescents smoke, drink, and use illegal drugs at significantly lower rates than
white and Hispanic adolescents CDC, 1998). White students are more likely to smoke
cigarettes than Hispanic students (U.S. DHHS, 1998). National data from American
Indian and Asian students have only recently become available from the Monitoring the
Future study (Johnston et al., 1998; U.S. DHHS, 1998), and rates of tobacco, alcohol, and
marijuana use among American Indians are consistently as high or higher than among
white students, while Asian students' use was similar to African Americans and lower
than other racial or ethnic groups (Beauvais, 1992; Gruber et al., 1996; Neumark-Sztainer
et al., 1996; Epstein et al., 1998; U.S. DHHS, 1998; Chen et al., 1999).
Several authors make note, and this is relevant across all behaviors, that the classification
of ethnic or racial groups masks significant differences within groups, such as differences
between American Indian tribal groups and whether they live on or off reservation lands,
and subcategories of Asians (Chinese, Japanese, Korean, etc.) and Hispanics (Gruber et
al., 1996; Epstein et al., 1998; Bell et al., 1999). The classifications also do not account
for levels of acculturation among recent immigrant groups and differences in drug use
based on level of acculturation (Vega et al., 1993; Chen et al., 1999).
Gender differences in drug use among adolescents are also noted. Males are more likely
than females to use smokeless tobacco, engage in episodic heavy drinking, and use
marijuana (CDC, 1998), but females now are equally as likely as males to use other
substances. Finally, rates of tobacco and marijuana use increased substantially in the
1990s, although that increase may now have leveled off; the increases occurred across all
ethnic or racial and gender groups (Johnston et al., 1998).
Sexual Behavior
Sexual behavior also has its debut in adolescence, with two out of three adolescents
reporting having had sexual intercourse prior to high school graduation (CDC, 1998). This
sexual activity incurs the risk of pregnancy and infectious diseases, which have significant
social, economic, and physical health ramifications (Ozer et al., 1998). Overall, males are
more likely to initiate sexual activity earlier than females (Ozer et al., 1998; Upchurch et
al., 1998). Black adolescents are more likely than Hispanics and whites to have initiated
sexual intercourse, to have had more sexual partners, and to have had begun sexual
activity at a younger age (Ozer et al., 1998). Asian adolescents appear to begin sexual
activity later (Upchurch et al., 1998; Bell et al., 1999) and American Indian adolescents
earlier, than do whites (Gruber et al., 1996; Neumark-Sztainer et al., 1996), but these were
not nationally representative samples.
In contrast with drug use behavior, sexual behaviors have declined in prevalence since the
early 1990s. This decline occurred after a steady two-decade increase in the percentage of
adolescents engaging in sexual activity. The decline is associated with changes in related
sexual behaviors. About 75% of teens report using contraceptives at first intercourse (up
from 62% in 1988) and 54% report using condoms (Ozer et al., 1998). Condom use is
more prevalent among younger adolescents, while the use of birth control pills increases
with age (Kann et al., 1996). Whites are more likely than blacks or Hispanics to use
contraception at first intercourse (Ozer et al., 1998).
Similarly, rates of pregnancy also appear to be declining after dramatic increases since the
1970s. Still, 12% of all females ages 15–19 become pregnant each year—19% of black
females, 13% of Hispanic females, and 8% of white females. Notably, of the 1 million
adolescents who become pregnant each year, most (85%) report that their pregnancy was
unintended (Ozer et al., 1998). More than half of these pregnancies result in births and
more than a third result in abortion (Ozer et al., 1998). The birth and abortion rates among
black and Hispanic adolescent females is about double that of white females. About 70%
of these births occur out of wedlock. And, unfortunately, for the children of teenage
mothers, there are also consequences—lower birth weight, lower cognitive and
socioemotional functioning, and greater likelihood of death during the first year of life.
These outcomes are linked to lower socioeconomic status, which is both a predictive
factor for teenage pregnancy and an outcome of the limited opportunities and instability
that are associated with being a teenage mother (Irwin and Shafer, 1992).
Sexual behavior may also result in sexually transmitted diseases, with adolescents at
greater risk for these infectious diseases than any other age group (Irwin and Shafer,
1992). Chlamydia is most prevalent, affecting about 2% of female adolescents ages 15–19
(CDC, 1997). Gonorrhea and syphilis decreased in the 1990s; both of these infectious
diseases are most prevalent among black adolescents (Ozer et al., 1998). Finally, although
AIDS cases among adolescents are rare because of the 10-year incubation period, many
adolescents become infected with HIV that will become manifest when they are in their
20s. Young adults, ages 20–29, comprise nearly one-fifth of the AIDS cases in the United
States. Thus, teenage sexual behavior, while now appearing to decline, has increased
dramatically in the past 25 years. The outcomes—teenage pregnancy, abortion, out-of-
wedlock births, sexually transmitted diseases, and HIV—have significant implications for
the future for these young people as well as for the next generation of young people in the
United States.
FIGURE 1.
The etiology of adolescent health behavior: Examples of predictive factors. SOURCE:
Adapted from Petraitis et al. (1995), Flay and Petraitis (1994), and Perry (1999b).
A common thread in the recent etiological research, which parallels the trend in
intervention development, is increased attention to the social environment and social
context of adolescents. This has not been the exclusive focus of recent etiological
research; some very interesting genetic and individual-level work has also been done
(Kandel, 1998). Still, since adolescents are in a state of social transition, their social
contexts acquire new and important meanings and influence. Adolescents are searching
the social environment for clues on how to accomplish their developmental tasks, and
peers, family members, other adults, and media all become “mentors” in the quest for
development. How the environment “fits” the needs of adolescents becomes critical to
successful development (Eccles et al., 1993). Thus, important concerns in analyzing
adolescent health behavior are the type, frequency, and source of messages and
opportunities that young people are exposed to, particularly as these relate to decisions
about becoming an adult in this society. Aspects of the social environment that have
received new or renewed research attention in the past decade, and have important
implications for intervention design, include the role of social capital, poverty, media and
advertising, family relations, work, school, and peers in the health behaviors of young
people.
Social Capital
One of the most important new perspectives on adolescent behavior is the notion of social
capital (Coleman, 1988). Similar to financial capital (wealth) and human capital (skills
and knowledge), which are quantifications of personal acquisitions (or access) associated
with more successful development, social capital is “accrued” by the types of available
relationships in a young person's community, neighborhood, school, or family (Coleman,
1988; Furstenberg and Hughes, 1995; Runyan et al., 1998). Important components of
social capital are social structures that effectively promote positive social norms and
appropriate role models, provide useful information, are trustworthy in meeting
obligations, and have definite expectations (Coleman, 1988). Runyan and colleagues
(1998) demonstrated that social capital, in particular church affiliation, the perception of
personal social support, and neighborhood support, was strongly associated with
children's well-being. Furstenberg and Hughes (1995) found, in a longitudinal study of
higher-risk adolescents, that most measures of social capital during adolescence were
predictive of success in young adulthood. Significant predictors included having support
from one's mother, living with one's biological father, having parents' help with
homework, having a strong helping network in the community, frequently visiting with
close friends, and the quality of the school (Furstenberg and Hughes, 1995). Social capital
was also found to be a significant macrolevel predictor of firearm homicide rates at the
state level (Kennedy et al., 1998), even when controlling for other factors. Thus, the social
context and social environment, as measured by particular attributes within the family,
neighborhood, school, and community, can facilitate healthy development of adolescents
by providing greater opportunities, more stability, consistent norms, access to human
capital, and social support.
As an example of the influence of social capital at the community level, we assessed
social environmental factors related to young adolescents' alcohol use as part of a 20-
community prevention trial, Project Northland (Perry et al., 1996). It was interesting to us
that there was such a large amount of variability in alcohol use among eighth grade
students among the 20 communities, since they appeared very homogeneous—small rural
and mostly white communities in northeastern Minnesota. The prevalence of past-month
alcohol use among eighth grade students, however, ranged from 16 to 43% in these
communities. By creating scales with indicators of norms, role models, opportunities, and
social support that were aggregated at the community level, we found that community-
level norms and role models accounted for nearly 50% of the variance in eighth grade
alcohol use rates (Roski et al., 1997). This guided our efforts during the second phase of
Project Northland: to create appropriate community norms concerning high schools
students' alcohol use (Perry, Williams et al., 2000).
Poverty
Social capital may be able to mediate some of the effects that poverty and the lack of
financial resources have on young people's health (Kennedy et al., 1998). But the effects
of poverty are still far-reaching in our society. In 1998, children made up 39% of the poor
but only 26% of the total population. The poverty rate for children (18.9% in 1998) is
higher than for any other age group, although lower than its recent peak of 22.7% in 1993.
In 1998, 13.5 million children were poor. Black and Hispanic households were twice as
likely to live in poverty than were white households (U.S. Census Bureau, 1999), although
socioeconomic status does not explain all racial or ethnic group differences in health
status (Lillie-Blanton and Laveist, 1996).
Poverty exerts its influence as an environmental and social factor in many aspects of
young people's health behavior. Poor, urban youth are exposed to high rates of community
violence that influence subsequent aggressive and violent behaviors and depression
(Farrell and Bruce, 1997; Gorman-Smith and Tolan, 1998). Young people who are poor
are less likely to finish school and are more likely to experience conduct problems and
conflicts with peers (Lerner and Galambos, 1998). Young people living in poverty are
more likely to experience hunger, fewer food options, and less fresh produce (Crockett
and Sims, 1995), undermining their nutritional health. Thus, adolescents who live in
poverty often live in poor communities, where exposure to drugs and violence is high and
where access to healthful resources also may be limited. Thus, the elimination of poverty
for children and adolescents must be an important goal for those involved in improving
the health of young people. Secondarily, efforts should be directed toward alleviating
those influences within poor communities that exacerbate health problems for young
people, such as by providing more-than-adequate educational opportunities, restricting
access to weapons, and offering supervised afterschool and weekend activities, free and
reduced-fat meals at schools, and mentoring programs.
Family Relationships
The families of the twenty-first century bear little resemblance to those 100 years ago. It is
now normative for adolescents to have experienced the separation or divorce of their
parents, to have both parents working outside the home, to prepare meals for themselves,
and to have several hours of unsupervised time after school (Fuchs and Reklis, 1992;
Crockett and Sims, 1995). These changes, among others, provide considerable new
challenges for healthy development among adolescents.
The National Longitudinal Study on Adolescent Health (Resnick et al., 1997) provides
important quantification of the ways families influence adolescent behavior. Adolescents
were found to be less at risk for emotional distress, violence, and drug use if they
perceived themselves as connected to their parents: that is, they experienced feelings of
warmth, love, and caring from their parents. This was more important than the actual
presence of parents during key times of the day, although that was a significant factor as
well. Parents having high expectations for their adolescents concerning school attainment
was also associated with healthier and less risky behavior. On the other hand, adolescents
in homes with easy access to tobacco, alcohol, drugs, and guns were more likely to be
involved in violence and drug use themselves (Resnick et al., 1997).
The notion of “family capital” was developed by assessing parents' human, social, and
education capital (Marjoribanks, 1998). Family capital included parents' own educational
attainment, parent-child activities and homework time together, parents' aspirations for
their children in terms of education and work, and parents' values on independence and
learning. Family capital was found to have a moderate to large association with
adolescents' academic performance and aspirations for the future (Marjoribanks, 1998).
Several researchers have examined the changes in family relationships in the context of
adolescent development and developmental tasks. Associated with the task of striving for
autonomy, parent-adolescent conflict has received considerable attention, although most
empirical examinations show little evidence of increased conflict after early adolescence,
even though there may be more emotional intensity in the conflict from early to middle
adolescence (Laursen et al., 1998). When conflict exists, it is primarily concerning
mundane issues such as cleaning one's room or curfew, which may be attempts by
adolescents to define themselves or make their own decisions (Eccles et al., 1993).
Adolescents express a desire for more participation in the decisions made in the family,
and when allowed to participate more fully, there were positive results in school
motivation and self-esteem (Eccles et al., 1993). Likewise, adolescents who received
support from their parents to be more autonomous were less likely to initiate sexual
intercourse; those who were more emotionally attached to their parents were less likely to
engage in fighting and drug use (Turner et al., 1993). Finally, adolescents who perceived
that their parents knew their friends, where they went at night, how they spent their
money, what they did with their free time, and where they were most afternoons, were less
likely to begin to use drugs (Steinberg et al., 1994).
Fostering competence and positive connections between adolescents and their parents
seems critical to promoting healthy development (Resnick et al., 1997; Masten and
Coatsworth, 1998). These connections may include involvement in activities together,
having clear expectations about school performance, allowing greater decision making for
the adolescent within the family, and communicating about how, where, and with whom
the adolescent is spending time. As available time becomes an issue, these connections
may need to be provided by the larger community of caring adults.