Salient Areas of Adolescent Health 477Resnick, & Harris, 1994). Speci“c ef fects on development
also re”ect the type of disorder, including chronicity, course,
visibility, side effects of medication, amount of disruption of
control, and prognosis. A highly visible disease with signi“-
cant cosmetic effects, such as psoriasis, may cause more
emotional distress and peer rejection than an illness such as
Hodgkin•s disease. Disorders or trauma that affect mobility
and independence (e.g., amputation or seizure disorders) can
have particular impact on adolescents• need for self-mastery,
with resulting risks for psychological and social development
(Neinstein & Zeltzer, 1996). Teenagers with chronic condi-
tions often experience repeated and extended hospital stays,
and various strategies have been suggested to structure
the adolescent ward and its management to be appropriate
for adolescents• stage of development and their concerns
(Neinstein & Zeltzer, 1996).
Health Promotion
Because so much of morbidity and mortality in adolescence
is preventable, promoting health via prevention has become
an increasingly important focus, especially in the past
decade. Anticipatory guidance for teenagers and parents is a
prominent component of the AMA•s GAPS recommenda-
tions for primary care. Speci“c interventions have included
public service spots on television, largely addressing sub-
stance use and staying in school, and a host of special school
and/or community programs designed to reduce the risk of
pregnancy, violence, and substance abuse.
Current prevention efforts employ a dual strategy, attempt-
ing to reduce risk factors and also enhance protective factors.
The concept of resilience has provided a framework for under-
standing how children can thrive even in adverse circum-
stances. Considerable evidence has identi“ed consistent
protective factors that cut across racial, gender, and economic
groups. One key characteristic of resilient young people is
having a close relationship with at least one caring, competent,
reliable adult who promotes prosocial behavior; optimally,
this sense of connectedness to adults is enhanced by opportu-
nities to develop social skills and other skills, which engender
self-con“dence and self-esteem (see Resnick, 2000). Attempts
to promote such adult relationships have focused on strength-
ening family functioning and communication as well as on the
development of extrafamilial relationships through adult men-
toring programs and community service.
Another important aspect of health promotion is advo-
cacy, both for individuals and at the state/national level.
Advocacy efforts range from increased funding for health
care (English et al., 2000) to legal intervention. Advocacy for
laws requiring infant car seats and bicycle helmets have re-
duced childhood injuries. Analogously, efforts to reduce the
toll of automobile accidents on adolescents have assessed
the effectiveness of current strategies and explored promising
new ones. Research indicates that traditional driver education
has not been effective whereas a graduated driver licensing
system and nighttime curfews have decreased accidents, in-
juries, and fatalities for teenage drivers. The most successful
measures to date have been mandatory seatbelt use, mini-
mum drinking age laws, and drunk driving laws, while other
promising interventions„ignition interlock devices, admin-
istrative alcohol laws, random screening programs, and edu-
cation regarding vehicle crash-worthiness„are under study
(see Patel et al., 2000).SALIENT AREAS OF ADOLESCENT HEALTHHealth care for teenagers and prevention efforts have focused
on the major contributors to morbidity and mortality (trauma,
substance misuse, and risky sex) as well as on problems that
typically emerge during adolescence (anorexia and bulimia).
Such efforts have resulted in more widespread development of
shock trauma centers to reduce the impact of severe trauma
and the burgeoning “eld of sports medicine. For example,
there is now considerable evidence that athletes engage in
more health-risk behaviors than nonathletes (e.g., less seat belt
and helmet use, more alcohol and physical “ghts) and a subset
of thrill-seekers are at very high risk for trauma. More re-
cently, there has been increased attention to the other major
contributor to trauma„violence (see Pratt & Greydanus,
2000). Finally, substance use and misuse is of concern per se
but also as a contributor to other risky behaviors.
Many threats to adolescent health are thus interrelated,
and increasing evidence suggests that multiple types of risk-
taking behaviors co-occur in clusters (Irwin, 1990). A com-
prehensive review of these salient areas of adolescent health
is beyond the scope of this chapter (see DiClemente, Hanson,
& Ponton, 1996). However, a brief review of risky sexual be-
havior is presented in the following section.Sexual Activity and Health ConsequencesSexual activity among American teenagers has increased dra-
matically over the past 40 years, largely because sexual inter-
course is now initiated at a younger age (see Phillips, 1997a).
Among young people ages 18 to 21, 82% reported having had
sexual intercourse in a 1991 survey (see Neinstein, 1996c).
Precise prevalences of sexual activity among younger