SEX, DRUGS AND JUNIOR YEAR ABROAD: DOCTORS WORK TO PROTECT TRAVELERS

As kids trek through Europe on post-graduation jaunts or plan
soul-searching trips to Nepal and junior years abroad, many parents
are probably worried about terrorism and mysterious viruses.

They're nervous about the wrong things.

The real scourges of overseas travel are far more mundane: pregnancy,
drug use and mental illness. Now, doctors, colleges and youth-travel
programs are stepping up their efforts to prevent these problems.

Sure, kids get into trouble with sex and drugs in their dorm rooms,
but recent studies have confirmed what travel doctors and educators
have long suspected: The risks rise with travel. Removed from friends,
family and school and faced with the challenges of a new language and
culture, even stable young adults can fall into dangerous behavior.

"My students aren't getting malaria; they're getting pregnant," said
Susan Anderson, a travel-medicine doctor at the Palo Alto Medical
Foundation.

In one ongoing study of young travelers to Southeast Asia, 75% said
they took drugs during their trip, according to the study's author,
Israel Potasman, head of the infectious-diseases and travel clinic at
the Bnai Zion Medical Center in Haifa, Israel. In another study
published in the Journal of Travel Medicine by Dr. Potasman, 11% of
young travelers had an episode of psychiatric symptoms, including
sleeping disturbances and depression, during their trips, compared
with only 2.3% who had sought treatment before travel.

Colleges are focusing more on these tough and often delicate problems
because of the soaring popularity of studying abroad. The number of
students studying overseas has jumped 55% in the past five years,
according to the Institute of International Education in New York. And
that doesn't include the legions of kids taking off on their own trips
- -- a favored choice for jobless graduates who are waiting for the
economy to improve.

These days, physicians such as Dr. Anderson send women off with a
prescription for pills that can be taken after unprotected sex to
prevent pregnancy. Princeton University added a feature to its
Not-2-Late Web site during the past few years that lets students see
what types of emergency contraceptives are available in each country
they are visiting.

At the University of Chicago, administrators try to identify students
with mental illnesses and then make sure at-risk students have
adequate medication. They sometimes even make advance appointments
with psychiatrists and therapists at the students' destinations. A
leading study-abroad program, the Institute for the International
Education of Students, has hired 20 new staff members during the past
three years, primarily to deal with a surge in health and safety
issues (depression and allergies are the top two) among the 3,000
college students it sends overseas each year.

About five years ago, the program had to bring six students home
because they had developed severe anorexia and bulimia; it hasn't had
to evacuate any students for eating disorders since the new efforts
were put in place.

Of course, travel is a positive experience for most kids. They learn
new languages, open up to new cultures and become more
self-sufficient. But doctors say the everyday stress of having to find
a place to sleep, eating strange foods, figuring out train schedules
and witnessing poverty can be a catalyst for depression, anxiety or an
eating disorder.

Doctors also cite a "magical thinking" phenomenon. "The environment is
so different that there's a subconscious feeling that what they do
doesn't really count," says David R. Shlim, medical director of the
Jackson Hole Travel and Tropical Medicine clinic in Wyoming. "So they
do stuff they don't normally do, such as have more casual sex, ride a
bike without a helmet or ride a motorcycle while barefoot."

As young strangers travel together, what Susan McClellan at Tulane
University Health Sciences Center calls the "love boat thing" can lead
to casual sex. Studies estimate that about 2% to 10% of returning
travelers have acquired sexually transmitted infections while abroad.

More troubling, sexual assault is not uncommon during travel: It is
one of the top reasons students need medical evacuations during their
trips, according to International SOS Assistance Inc., a provider of
travel health-insurance policies.

In response, some doctors encourage young women to carry emergency
contraceptives in case of sexual assault, though other doctors say
that the pills should be used under medical supervision.

Some medical-school students and relief workers get prescriptions for
antiretrovirals, pills that can prevent HIV transmission after a
potential exposure. Dr. Anderson in Palo Alto also prescribes the
medication for women taking extended trips to rural Africa (where HIV
rates are high). But the medication is expensive, has serious side
effects and needs to be started almost immediately after exposure.

Young people often encounter novel and exotic drugs overseas, and they
may be more willing to try these drugs since they carry less of a
stigma at home. While most study-abroad programs have long had strict
drug policies and pretravel lectures, some schools are enhancing their
efforts.

There is little that can be done -- beyond preaching common sense --
to prevent the No. 1 causes of death and injury during travel:
motor-vehicle accidents and drownings. But there are many steps kids
and parents can take to prevent health problems abroad.

First, check with your insurance company to make sure coverage applies
while you are overseas. You can take out extra insurance from
companies such as International SOS (www.internationalsos.com) or
Medjet Assistance (www.medjetassistance.com) to cover emergency
medical evacuations. Also, check with a local U.S. embassy to see
where its staff gets medical care. International SOS operates clinics
staffed by Western-trained doctors. IJET Travel Risk Management
(www.ijet.com) sells country reports that detail safety and health
issues and gives information on the best hospitals and clinics.

Young adults and their parents should honestly evaluate their mental
health, the stresses they could face, and the support and medication
available at their destination. They should also set up an e-mail and
phone-support system with friends and family before they leave, so
they have a familiar person to turn to. Check with family doctors,
travel specialists or student health services to see if they do e-mail
consultations. Many doctors now answer e-mail for patients, often
without an extra fee.