WORKING TO AVOID THE AMERICAN WAY

Under-age, over-sexed and on its way: a snapshot of US adolescence
presented at a recent conference in Galway may be a glimpse of the
future for health education experts here.

Serial sexual partnerships at age 13, smoking heroin in high school,
roving gangs, binge drinking as the norm - Prof Randy Page's
contemporary portrait of American adolescence made startling listening
at the recent Summer School in Health Promotion at the National
University of Ireland, Galway.

It has been said that where America leads, we follow with lemming-like
myopia. But if the transatlantic teenage snapshot he offers is
prophetic, then the Irish professionals have plenty to think about.

At the conference, jointly organised by NUI's Department of Health
Promotion and the Western, North Western and MidWestern Health Boards,
Page, coordinator of health education at the University of Idaho,
examined issues that threaten the health and well-being of young
people. His impression of the situation over here was that while Irish
young people scored well in healthy looks ("the first thing I noticed
was that you don't have very fat kids", he says), he believes our
under-age drinking problems are more severe.

Page drew on ongoing research from the Centre for Disease Control,
Atlanta which surveys 12,000 schools nationally every two years. What
emerged was the need to update constantly, school programmes aimed at
each curious and hungry generation - what worked a few years ago won't
necessarily work with a new batch of children.

The rising trend of suicide among young people which is being
experienced in Ireland is already well established in the US:
"Suicides have tripled since 1960; 5,000 young people aged between
15-24 now commit suicide each year, the rates for young male suicides
are the highest, though more young women than young men make a suicide
attempt," he says. "We have 22 [teenage] homicides a day. The reasons
for both homicides and suicide are alienation, family breakdown, drug
and alcohol-related hopelessness. The easy availability of guns
contributes to homicides - the gang becomes your family, belonging is
a huge issue."

Young American illegal drug use has doubled between 1992 and 1996.
Answering the question "have you ever used drugs?": 11 per cent of
13-year-olds in 1992 said they had, by 1996 this had risen to 24 per
cent. Over the same period, the percentage of 15-year-old drug users
rose from 20 per cent to 38 per cent and of 17-year-olds from 27 per
cent to 40 per cent. There is apparently no problem about supply.

"There's been an over-exaggeration on the part of parents, teachers
and adults regarding the problems of cannabis and some of the increase
in use is a deadly boomerang. We need to be more realistic in our
messages - 'this is what science has shown to this point' - cannabis
may be a dangerous drug, but it's not a poison and we shouldn't say
so.

"Heroin is changing, it used to be of low purity and, therefore, had
to be injected: the purity is such that people can now snort or smoke
it which lessens the addictive property. However, some people become
madly infatuated with heroin, others less so.

"We felt we had the drug problem licked in the 1980s. The country was
awash with drug programmes, high-profile publicity, Nancy Reagan, and
perhaps we got a bit complacent. The lesson is you can't ever assume
you've done it, the message has to be boosted all the time."

Similarly with alcohol: "We can have an ambivalent attitude about

underage drinking. Some parents are relieved that a son or daughter is
only coming home drunk, it's okay. That attitude is understandable.
Alcohol is socially acceptable. Again, it's about getting the message
right.

"Alcohol is one area where Irish youth seems to have a higher rate
than we have. We class binge drinking as having five or more drinks on
one occasion, but talking to some Irish people, five drinks doesn't
seem to be regarded as so significant," he says.

Getting the US message right about adolescent smoking seems to have
failed: 37 per cent of 13to 17-year-olds are current smokers, boys are
a few percentage points higher than the girls, but white females are
the highest of all. Black females don't begin smoking till some years
after their white counterparts: "They're not initiated into it, we
don't exactly know why," he says.

"Tobacco is the single preventable cause of greatest deaths - 400,000
people die from smoking related diseases each year, much more than
from alcohol and illicit drugs.

"Characters in films are all smoking again, models are smoking. We are
not allowed advertise cigarettes on TV but they are on billboards,
newspapers, magazines, displays, the Internet. This has to be a
factor," he says.

Turning to eating habits, surveys show that only 16 per cent of young
people are eating the right amount of fat and only 9 per cent the
right amount of saturated fat. The rest are eating too much fat. In
one survey, 42 per cent didn't have any fruit or vegetables the day
before sampled, and 41 per cent ate no vegetables. In many homes,
people don't cook any more, but rely on take-aways and instant meals
which are usually high in fat. America, he says, is full of very fat
kids, who are teased, bullied and at risk of heart disease.

This survey corresponds with physical activity data which indicates
that less than half of 12- to 21-year-olds take any physical activity,
with PE programmes in schools less supported than in the past. The
reasons? "Latch-key kids, technology, television, video, more
dangerous streets so that they don't go out to play. They are some of
the reasons."

Regarding sexual behaviour, 38 per cent of 13- to 17-year-olds
surveyed said they had sex within the previous three months. This
broke down to 9 per cent of 13-year-olds, 24 per cent of 15 year olds
and 50 per cent of 17 year olds. Asked if they ever had sex, 53 per
cent said 'yes' including 66 per cent of 17-year-olds, of who 18 per
cent had four or more sexual partners. Contraceptive use is patchy -
while condoms are widely available, some American states don't allow
adolescents to be prescribed the pill without parental knowledge.

"We currently have our highest rate of teenage pregnancy," says Page,
"11 per cent of girls aged 15-19 are becoming pregnant, we have 1.1
million teenage pregnancies every year, half are aborted, 86 per cent
are unplanned, and 21 per cent are second child or higher order births.

"There is a big ethnic disparity rate. Pregnancy among young black
women is double the rate of white women; the black culture now accepts
teen mothers as normative. There is no stigma." He agrees that young
people may be sexual together, but not necessarily intimate, and may
not have the language or maturity to cope with what they feel is
expected of them when dating. "They can have a real tough time," he
says.

What about intervention strategies? "One of the large studies shows
that parental connectedness is crucial. Lack of parental connectedness
is associated with all the risk factors we've been discussing. If
you're a loved and valued part of a family unit, if you're bonded with
the family, you've a lot going for you. It's nice to know about this,
but what do you do about it? Getting parents involved is difficult, as
we all know. There are many community-based programmes but they are
very fragmented."

Which is partly why so many programmes are focused in schools where
delivery is easier. "We're learning that some school programmes are

too narrow in focus," says Page. "Health education must take the total
person into account. Such programmes must include developing skills in
decision-making, assertiveness, self-esteem, conflict resolution,
managing anger, it's not just about giving information."

Checked-by: "Rich O'Grady"