Adolescents At Risk

Medical and Social Perspectives

David E. Rogers

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9780367166595
• eBook ISBN: 9780429715297
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

This text seeks to examine the factors that cause teenage violence, risky sexual behaviour (including risk of AIDS), and alcohol and drug abuse. It also addresses the guidelines that should be followed by those who seek to reduce societal costs resulting from the disfunctional behaviour of young people unable to make the transition from adolescence to young adulthood without special assistance and support.

1 Overview

DOI: 10.4324/9780429046582-1

Eli Ginzberg

This introductory chapter has a number of interrelated objectives and goals. It aims to provide a road map to those that follow by providing a broad perspective of what we know about adolescents at risk; what we don't know about them; how we can best fill the lacunae in our knowledge; the extent to which the American people are using the knowledge they have to reduce the ravages of adolescents' malfunctioning; and finally to pinpoint the many different groups that should redouble their efforts to reduce and eliminate the great individual and societal losses stemming from the dysfunctional behavior of adolescents.

The following chapters deal sequentially with these critical themes: the conceptual frameworks that provide the best understanding of the dynamics of adolescent risk behavior; what is known about the causative factors supporting teenage violence, sexual behavior (including risk of AIDS), and alcohol and drug abuse; and what guidelines should be followed—and by whom—in seeking to reduce and eliminate the large individual and societal costs engendered by adolescents who are so unsettled and upset that they are unable to make the transition from adolescence to young adulthood without special assistance and support.

By way of stage setting it may be helpful to inform the reader about the scale and scope of the problems subsumed under the descriptive title “adolescents at risk." The chapters that follow relate to a population of plus or minus 7 million young people who are at serious risk of not being able to negotiate without special assistance the transition from adolescence to young adulthood. This means that a high proportion of them are likely to be consigned to a peripheral role in adult society, at best marginally involved in performing their roles as workers, parents, and citizens.

To make matters worse, many of them will never reach their midtwenties for they will have become the victims of homicide, suicide, or be headed for premature death as a consequence of having contracted HIV infection or having become a drug addict.

Clearly, the subject of adolescents at risk should be high on the nation's agenda for study and action. But the incontrovertible fact is that the subject, although it is of concern to a small number of researchers, has surely not been at the center of public policy. The explanation for this paradox is embedded in the complexity of conceptualizing the processes of adolescent risk behaviors and the related complexities of modifying the critical societal institutions that must be altered if the adverse behaviors are to be prevented or reduced. To complicate matters, most adolescents reared in intact families with reasonable income, housing, schooling, and social status are able to make the transition from childhood to adulthood without encountering life-threatening pressures and challenges. Hence, middle-class America is not knowledgeable about or even sympathetic to the plight of young people growing up in families mired in poverty, living in dilapidated housing in dangerous neighborhoods where crime is predominant, who attend schools that are unable to provide them the knowledge and skill training required for work and life, and where a high proportion of the young people at risk are members of minority groups afflicted with the additional burdens and disabilities of racism.

The two conceptual chapters that immediately follow provide the building blocks for a better understanding of the processes leading to aberrant adolescent behavior and they point to directions for improved interventions. Both chapters emphasize the need for a developmental model that sees the roots of adolescent malperformance in the earlier life experiences of these young people; make room for the interaction between psychological and social forces in the shaping of adolescent behavior; and distinguish between younger and older adolescents (the former are at risk of engaging in dysfunctional behavior while the latter are already engaged in such behaviors).

The next group of chapters (4 through 8) focus on a number of highrisk behaviors including violence, early sexual intercourse with exposure to AIDS, and alcohol and drug use. One important point that emerges is the fact that violence in inner-city poverty areas is approaching epidemic proportions; homicide is the single leading cause of death for young black males. The causes for this epidemic are not well understood, so successful interventions must, at one and the same time, be directed to deepening the knowledge base while moving simultaneously to reduce access to hand guns and to provide adolescents with alternative modes of conflict resolution other than resort to violence.

Adolescents, by virtue of their biological development, are capable of sexual activity, and the age of first intercourse has been dropping. Thus, all adolescents are at risk, not just because they engage in sexual intercourse but because they don't do so "safely." Many fail to use contraceptive devices and find themselves pregnant or suffering from a sexually transmitted disease; small but growing numbers, especially of inner-city youth, contract AIDS.

There are several challenges confronting the American people as they search for ways to respond constructively to adolescent sexuality. The first is to recognize that although it may prove possible to encourage young adolescents to delay having sexual intercourse until sixteen or seventeen or so, there is little prospect of further delay for most of them. Large numbers of parents and organizations have been unwilling to acknowledge the reality that stands in the way of initiating constructive actions aimed at making adolescent sexual behavior less risky to the individual and to society.

When it comes to adolescents' use of alcohol and drugs, the assessment of risk factors is complicated by the fact that experimentation with one or the other or both reflect “normal" experimentation behavior. For most adolescents it remains just that, but for a significant minority the experimentation progresses to addiction with serious and often lethal consequences. We need more knowledge about how to differentiate between the experimenters and those who are getting more deeply involved in substance abuse; we need much improved education and training of physicians and other health care personnel to become sensitive to the importance of preventive and therapeutic interventions; and we need much expanded treatment programs aimed at detoxification of those who have become addicted.

The two concluding chapters (9 and 10) focus on programs and policies. The first presents an evaluation of 100 or so diverse community programs that have been introduced to change high-risk behaviors among adolescents. These programs aim at prevention, therapy, and rehabilitation. The common core of these successful programs was their focus on the critical importance of multiagency, community-wide programs. There is no single institution in our society capable of providing the range of services that adolescents at risk need, but the school offers probably the best-positioned community resource on which to center comprehensive multiagency efforts.

In the concluding chapter we are reminded about some important but often neglected, if not ignored, truths that need to be brought back into the center of all policy discussions and action. Most adolescents reared in intact families and in decent neighborhoods with loving and caring families will face and surmount the turmoils of adolescence without special difficulty or danger.

It is not possible nor desirable to remove all challenges and dangers from the adolescent's environment because the young person requires challenges to increase his or her coping skills and to gain the assurance that comes with meeting challenges successfully. The great danger faced by adolescents being reared in deprived circumstances is that they lack the personal skills and access to the opportunities that would empower them to achieve the basic material goals of adulthood—to obtain a regular job and earn an income that would enable them to marry and have a family.

Here are a few concluding observations about common themes that surfaced or failed to surface in the illuminating and insightful chapters that make up this volume.

Ours is a society that looks to the nuclear family to assume and discharge the multiple responsibilities of transforming the infant into the child and later into an adolescent, so that he or she can perform effectively as an adult. Unfortunately, our contemporary American society has an increasing number of dysfunctional families that are unable to meet this primary responsibility.

To complicate matters our society has been slow to put in place the range of supportive programs that would shore up the capabilities of families at risk so that the parents would be better able to carry out their responsibilities. Many families live in poverty because of our society's unwillingness to provide for the basic income needs of people who cannot work or who are unable to earn enough from their work.

We have an educational system in place that is poorly serving many children and young people from disadvantaged families because of its inability to provide them with the basic knowledge and skills that they need to obtain and hold a regular job when they complete their schooling. In fact, sizable numbers of young people find their schooling so unattractive that they drop out long before they have acquired the minimum competencies for successful adulthood.

A further complication arises from the fact that the U.S. economy, despite its generally good record of job creation, still does not provide sufficient work opportunities for all who need and want to work. The poorly educated, high school drop-outs, particularly from minority groups, are likely to find themselves at the end of the job queue.

A wide array of governmental and private sector programs are directed to helping families and young people at risk but their effectiveness is greatly reduced because each operates within a narrowly defined orbit that fails to address the problems of the adolescent or his or her family. A major challenge is to improve the coordination among the large numbers of those preventive and remedial programs, to increase the resources available to them, and to evaluate their effectiveness so as to improve the outcomes that they are seeking.

To help families and young people at risk, society's efforts need to be increasingly directed to assuring that the basic institutions on which society depends—the family, the school, and the world of work—are strengthened so that every person will be better able to cope successfully with the challenges that he or she encounters in moving from childhood to adulthood.

2 Etiologies of Adolescents at Risk

DOI: 10.4324/9780429046582-2

Jerome Kagan

Each child in the world's societies, ancient as well as modern, must be able to avoid or to cope successfully with a number of challenges before reaching a period of adult life characterized by occasional moments of satisfaction and a reasonable sense of virtue. The major obstacle to attaining these goals for most children, both past and present, was disease or early death. And in many parts of the contemporary world almost half of live births do not survive beyond the fifth birthday. If a child survives to adolescence in the many small, isolated agricultural villages with minimal health services he or she has a temporary era of adaptation for a few decades.

Modem technological societies have turned this profile of probabilities upside down by making the risk status of an adolescent greater than that of an infant. Moreover, the structure of modern societies has created conditions in which a single adolescent at risk for criminal behavior or AIDS represents a threat to the community that is qualitatively different from the threat contained in a contagious mood generated by the dysphoria of a family who has lost a one-year-old to dysentery. Thus, in addition to our natural sympathy for children, which David Hume understood and celebrated, we are also concerned with the morale and integrity of our neighborhoods and are motivated to solve the serious problems of contemporary youth, even though some scholars have begun to claim that Americans have become too obsessed with the risks inherent in modern life.¹

Preparation of this paper was supported in part by a grant from the John D. and Catherine T. MacArthur Foundation.

It is a truism that whenever a particular phenomenon is complex—and the behaviors that concern us fit that criterion—there will be several different conditions that produce similar outcomes. Thus, it is likely that the large category of adolescents at risk contains qualitatively different types of youth. This fact was acknowledged more explicitly several decades ago when psychologists dominated the scientific study of delinquency. When a large number of psychologists abandoned that domain, first to sociologists and later to political scientists and economists, the legitimate concern of these latter scholars with the influence of social settings was accompanied by some indifference to the heterogeneity of the children in a particular risk category. This statement does not mean that the contexts of growth are unimportant, only that the explanatory constructs and predictive signs we will require for benevolent intervention must combine individual and contextual factors.

The Attribution Error

The human mind is prone to an error in the description and interpretation of natural events that pervades all of the sciences. The cognitive flaw is the tendency to attribute to the features of a discrete agent (or entity) all of the causal force that determines its present and future functions and, simultaneously, to be indifferent to the influence of the context in which the agent (or entity) acts. This error occurs in molecular biology when the scientist ascribes to a gene, or a set of genes, all of the power to produce a disease while ignoring the surrounding DNA or the DNA sequences on other chromosomes that influence the penetrance of a particular gene or genes.

The error occurs among those historians or political scientists who assume that a nation is poor because of its inherent characteristics rather than because its historical enemies and contemporary rivals created conditions that made it difficult for the state to become economically prosperous. The Republic of Ireland provides one example of this claim.

The error occurs in psychology when a scholar assumes that a oneyear-old who becomes a friendly, popular, five-year-old retained the attachment from infancy, rather than suggesting that the secure infant grew up in an environment that permitted the early attachment to be actualized in a particular way. This error also pervades some interpretations of children at risk-delinquents, drug addicts, unwed mothers—for some psychologists assume that the personality characteristics of these children are resistant to changes in context.

In each of the above examp...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Table of Contents Page
• List of Tables and Figures Page
• Introduction
• 1 Overview
• 2 Etiologies of Adolescents at Risk
• 3 Risk Behavior in Adolescence: A Psychosocial Framework for Understanding and Action
• 4 Adolescent Sexuality: Negative Outcomes of a Normative Behavior
• 5 Alcohol and Other Drug Use and Abuse in Adolescents
• 6 AIDS and Adolescence: A Challenge to Both Treatment and Prevention
• 7 Not Fear, Nor Quarantine, But Science: Preparation for a Decade of Research to Advance Knowledge About and Control of Violence in Youths
• 8 Providing Primary Care to the Adolescent
• 9 Adolescents at Risk: A Summary of Work in the Field— Programs and Policies
• 10 Adolescents at Risk: New Directions
• Summary
• About the Contributors
• Cornell University Medical College Seventh Conference on Health Policy
• Index