JOURNAL OF ADOLESCWT HEALTH 1992;13:436-441
SOCIETY FOR ADOLESCENT MEDICINE
Turning Adolescent residential Address) KAREN HEIN,
icine
M.D.
Turning Adolescent Medicine inside out means turning our attention from a focus on us to ways we can be more powerful, effective spokespeople for youth. This is a call for activism. During my year as SAM President I plan to change the focus from “us” to “them”. The scope of adolescent health issues has been sketched out. Our discipline is now defined and is board certifiable. Our training programs and continuing education courses are replete with the fundamentals of our specialty. Now it’s time to put more of our efforts into speaking out for the youth we serve. It’s time to turn Adolescent Medicine inside out. When The Society for Adolescent Medicine was first started two and one-half decades ago, the impetus was to provide a time and place for the few Adolescent Medicine specialists from around the country to get together. They compared notes and discussed common problems and successes in launching the nation’s first wave of adolescent-specific programs during the early 1970s. They communicated through the S.AM newsletter. As the scientific basis of our discipline grew, the newsletter turned into the journal of Adolescent Health and the get-togethers turned into the Annual Research Meeting of the Society. As the number of adolescents grew, the membership grew and the Society expanded its scope and dimension. Over the past few years, however, it became evident that our internal skeleton hadn’t kept pace with the external growth spurt. Infras-
Dresenfed Mmh 22, 1992 at NreAnnwnf Meefbtgof The Societyfor Adolescent Medicine, Wmhingfon, D.C. Kmx Hein, M.D., Professor of Pedinfrics, Albert Einstein College of Medicine, Division of Adokent Medicine, Department of Pediatrics, Montejiore Medical Center, 111 East 210 Street, NW 674, Bronx, NY 10467-2490.
436
1054-139x/92&%00
tructural changes are being made now that will assure the inner strength to support turning SAM and Adolescent Medicine inside out. This next step will require more than our concern and dedication of our time in the roles we have played so far. To be effective activists for youth, we will need more than the facts; we will treed to articulate a strategy, a political, vocal, visible strategy that will help to put adolescents higher on the priority list for this country and others around the world,. Facts, alone, are not sufficient. Efforts to do good health care, to set up great programs, and-to provide good role models are not sufficient. Research documenting the problems, solutions, successes, and failures are not sufficient. We know the data, but people in a position to change the priorities of this and other nations have not heeded our call nor our warnings. We have made it as a subspecialty and as a Society, but our youth have not made it as vocal, important members of the society at large. Only by turning SAM and Adolescent Medicine inside out can this be accomplished. The decade of the 1990s will set the pace for the next century. The adolescents of the 199Os, born in the late 197Os, grew up during the 1980s. They are helping and watching our nation and the world reject the values and emphasis of the 1980s. They struggle to fit into a world whose very map is being redrawn, whose political structure is being torn down and replaced, and whose economic relationships have reversed 50 years of coalitions and animosities. Have we as a discipline kept pace with the rate of change in the adolescents’ worid? Our fate and theirs is inextricably linked, but they depend upon us to assure them a place in the new world order. The transformation of Adolescent Medicine as it
0 Society for Adolescent Medicine, 1992 Published by Elsevier Science Publishing Co., Inc., 655 Avenue of the Americas, New York, NY 10010
July 1992
turns inside out should be expressed in four arenas: first, health priorities in the United States; second, the response to the HIV/AIDS epidemic; third, concerns for the status of young women; and, last, the impact of recent economic and political changes on the health of youth around the world.
Health Priorities in the United States As the population becomes disproportionately weighted toward the elderly, the shrinking proportion of adolescents will be expected to support the growing number of elderly people. The percentage of children under 17 years of age is falling from roughly 30% of the total U.S. population in 1980 to less than 20% by the year 2020. By the year 2030, the percent of adults greater than 65 years of age will exceed the percent of children. The unwieldy pyramid will depend on a shrinking pool of young workers. How are adolescents faring in the workforce at the moment? ;idolescents ages 16-19 years of age and older meli over 55 years are the two age groups in greatest trouble in terms of employment during the 1980s (1). In addition to lack of income, being unemployed as adolescents means lacking additional work experience and the necessary skill to progress as the current recession ends and the next century begins. Many youths have even given up looking for jobs and feel completely unprepared for the few jobs that are available to them. As we plan for the next century, let’s take stock of the nation’s health goals for the year 2000. Using the 1990 benchmark to measure progress toward achieving health goals for adolescents, we have failed our youth (2). Adolescents are the only age group of the four groups (infants, children, adolescents, and adults) that will not even achieve the 1990 goal for reduction in death rates. Although there was a decline in death rates to 103 per 100,000 adolescents, this was 93 deaths per 100,000 below the 1990 goal and far above the year 2000 goal of 85 per 100,000. Several of the indicators of health have actually worsened for adolescents 15-24 years of age since 1980 including suicide (40% increase) and homicide (6% increase). The Child Welfare League of America, using data from the late 1980s sketched a portrait of a graduating class of 40 students in the year 2000 (3). Thirty-six would have used alcohol, 8 tried cocaine, 17 marijuana, 11 would be unemployed, 15 living in poverty, 6 run away from home, 8 would not even have graduated, but dropped out, 2 would
i’RESK@NTIA!, ADDRESS
437
have given birth, and “awould have committed suicide. Clearly, there is overlap in these problem behaviors, but if current trends continue, by the year 2000, they (and we) will be in big trouble. According to the recent report on Adolescent Health by the Office of Technology Assessment, one of seven adolescents has no health insurance. One of three adolescents living in poverty is uninsured, (4). The plans for national health reform based upon employment schemes don’t even consider the plight of adolescents who may require either confidential services or who, for a variety of reasons, are not employed or included under their parents’ employment-based schemes. The current strategy of “out of sight, out of mind” won’t work for much longer. The invisible adolescent will become visible. The consequences of our national neglect will be paid out in more than the dollars needed to rescue the Savings and Loan banks. Attempts to keep pace with social changes among youth have been thwarted by current national political policies. The y*eceni“unfunding” by the Department of Heaith and Human Services of a major national study of current sexual practices among youth is but one example of this shortsightedness (5). Despite the provision for respondents to skip questions and safeguards for informed consent and confidentiality, the study was scrapped because it was determined to be an invasion of privacy. Turning Adolescent Medicine inside out means taking a stand for youth against repression of research that is essential for documenting what is happening to our young people. Promulgating the fallacy that asking or talking about sex encourages sex among adolescents is ludicrous in light of studies and evidence showing just the opposite (6). Studies in five Western industrialized nations showed that although the age at first intercourse was the same in the United States, Canada, and the European nations studied, countries that have adequate comprehensive sex education had far lower rates of unintended pregnancies and abortions. Birthrates in American teenagers have been going up sharply since 1986 even though the pregnancy rate is down. The discrepancy is due to the decrease in access to abortions. In fact, the percent of adolescents having sexual intercourse has continued to increase during the 1980s (7), the decade when supposedly everyone learned about AIDS, and the “Just say no to sex” campaign was su pposed to now be added to the simplistic, ” Jus t sa y no to drugs” campaign, with equally ineffective results. According to the YRBSS
438
HEIN
(youth Risk Behavior Surveillance System) SuPvey’S by the Centers for Disease Control (a), rates of sexual intercourse among adolescents went up. The survey included a representative sample of 11,631 students in grades 9-12 in 50 states, the District of Co!umbia, Puerto Rico, and the Virgin Islands. Male high school students were significantly more likely than female to have had se;
SOCIETY FOR ADOLESCENT MEDICINE
Turning Adolescent residential Address) KAREN HEIN,
icine
M.D.
Turning Adolescent Medicine inside out means turning our attention from a focus on us to ways we can be more powerful, effective spokespeople for youth. This is a call for activism. During my year as SAM President I plan to change the focus from “us” to “them”. The scope of adolescent health issues has been sketched out. Our discipline is now defined and is board certifiable. Our training programs and continuing education courses are replete with the fundamentals of our specialty. Now it’s time to put more of our efforts into speaking out for the youth we serve. It’s time to turn Adolescent Medicine inside out. When The Society for Adolescent Medicine was first started two and one-half decades ago, the impetus was to provide a time and place for the few Adolescent Medicine specialists from around the country to get together. They compared notes and discussed common problems and successes in launching the nation’s first wave of adolescent-specific programs during the early 1970s. They communicated through the S.AM newsletter. As the scientific basis of our discipline grew, the newsletter turned into the journal of Adolescent Health and the get-togethers turned into the Annual Research Meeting of the Society. As the number of adolescents grew, the membership grew and the Society expanded its scope and dimension. Over the past few years, however, it became evident that our internal skeleton hadn’t kept pace with the external growth spurt. Infras-
Dresenfed Mmh 22, 1992 at NreAnnwnf Meefbtgof The Societyfor Adolescent Medicine, Wmhingfon, D.C. Kmx Hein, M.D., Professor of Pedinfrics, Albert Einstein College of Medicine, Division of Adokent Medicine, Department of Pediatrics, Montejiore Medical Center, 111 East 210 Street, NW 674, Bronx, NY 10467-2490.
436
1054-139x/92&%00
tructural changes are being made now that will assure the inner strength to support turning SAM and Adolescent Medicine inside out. This next step will require more than our concern and dedication of our time in the roles we have played so far. To be effective activists for youth, we will need more than the facts; we will treed to articulate a strategy, a political, vocal, visible strategy that will help to put adolescents higher on the priority list for this country and others around the world,. Facts, alone, are not sufficient. Efforts to do good health care, to set up great programs, and-to provide good role models are not sufficient. Research documenting the problems, solutions, successes, and failures are not sufficient. We know the data, but people in a position to change the priorities of this and other nations have not heeded our call nor our warnings. We have made it as a subspecialty and as a Society, but our youth have not made it as vocal, important members of the society at large. Only by turning SAM and Adolescent Medicine inside out can this be accomplished. The decade of the 1990s will set the pace for the next century. The adolescents of the 199Os, born in the late 197Os, grew up during the 1980s. They are helping and watching our nation and the world reject the values and emphasis of the 1980s. They struggle to fit into a world whose very map is being redrawn, whose political structure is being torn down and replaced, and whose economic relationships have reversed 50 years of coalitions and animosities. Have we as a discipline kept pace with the rate of change in the adolescents’ worid? Our fate and theirs is inextricably linked, but they depend upon us to assure them a place in the new world order. The transformation of Adolescent Medicine as it
0 Society for Adolescent Medicine, 1992 Published by Elsevier Science Publishing Co., Inc., 655 Avenue of the Americas, New York, NY 10010
July 1992
turns inside out should be expressed in four arenas: first, health priorities in the United States; second, the response to the HIV/AIDS epidemic; third, concerns for the status of young women; and, last, the impact of recent economic and political changes on the health of youth around the world.
Health Priorities in the United States As the population becomes disproportionately weighted toward the elderly, the shrinking proportion of adolescents will be expected to support the growing number of elderly people. The percentage of children under 17 years of age is falling from roughly 30% of the total U.S. population in 1980 to less than 20% by the year 2020. By the year 2030, the percent of adults greater than 65 years of age will exceed the percent of children. The unwieldy pyramid will depend on a shrinking pool of young workers. How are adolescents faring in the workforce at the moment? ;idolescents ages 16-19 years of age and older meli over 55 years are the two age groups in greatest trouble in terms of employment during the 1980s (1). In addition to lack of income, being unemployed as adolescents means lacking additional work experience and the necessary skill to progress as the current recession ends and the next century begins. Many youths have even given up looking for jobs and feel completely unprepared for the few jobs that are available to them. As we plan for the next century, let’s take stock of the nation’s health goals for the year 2000. Using the 1990 benchmark to measure progress toward achieving health goals for adolescents, we have failed our youth (2). Adolescents are the only age group of the four groups (infants, children, adolescents, and adults) that will not even achieve the 1990 goal for reduction in death rates. Although there was a decline in death rates to 103 per 100,000 adolescents, this was 93 deaths per 100,000 below the 1990 goal and far above the year 2000 goal of 85 per 100,000. Several of the indicators of health have actually worsened for adolescents 15-24 years of age since 1980 including suicide (40% increase) and homicide (6% increase). The Child Welfare League of America, using data from the late 1980s sketched a portrait of a graduating class of 40 students in the year 2000 (3). Thirty-six would have used alcohol, 8 tried cocaine, 17 marijuana, 11 would be unemployed, 15 living in poverty, 6 run away from home, 8 would not even have graduated, but dropped out, 2 would
i’RESK@NTIA!, ADDRESS
437
have given birth, and “awould have committed suicide. Clearly, there is overlap in these problem behaviors, but if current trends continue, by the year 2000, they (and we) will be in big trouble. According to the recent report on Adolescent Health by the Office of Technology Assessment, one of seven adolescents has no health insurance. One of three adolescents living in poverty is uninsured, (4). The plans for national health reform based upon employment schemes don’t even consider the plight of adolescents who may require either confidential services or who, for a variety of reasons, are not employed or included under their parents’ employment-based schemes. The current strategy of “out of sight, out of mind” won’t work for much longer. The invisible adolescent will become visible. The consequences of our national neglect will be paid out in more than the dollars needed to rescue the Savings and Loan banks. Attempts to keep pace with social changes among youth have been thwarted by current national political policies. The y*eceni“unfunding” by the Department of Heaith and Human Services of a major national study of current sexual practices among youth is but one example of this shortsightedness (5). Despite the provision for respondents to skip questions and safeguards for informed consent and confidentiality, the study was scrapped because it was determined to be an invasion of privacy. Turning Adolescent Medicine inside out means taking a stand for youth against repression of research that is essential for documenting what is happening to our young people. Promulgating the fallacy that asking or talking about sex encourages sex among adolescents is ludicrous in light of studies and evidence showing just the opposite (6). Studies in five Western industrialized nations showed that although the age at first intercourse was the same in the United States, Canada, and the European nations studied, countries that have adequate comprehensive sex education had far lower rates of unintended pregnancies and abortions. Birthrates in American teenagers have been going up sharply since 1986 even though the pregnancy rate is down. The discrepancy is due to the decrease in access to abortions. In fact, the percent of adolescents having sexual intercourse has continued to increase during the 1980s (7), the decade when supposedly everyone learned about AIDS, and the “Just say no to sex” campaign was su pposed to now be added to the simplistic, ” Jus t sa y no to drugs” campaign, with equally ineffective results. According to the YRBSS
438
HEIN
(youth Risk Behavior Surveillance System) SuPvey’S by the Centers for Disease Control (a), rates of sexual intercourse among adolescents went up. The survey included a representative sample of 11,631 students in grades 9-12 in 50 states, the District of Co!umbia, Puerto Rico, and the Virgin Islands. Male high school students were significantly more likely than female to have had se;
