Promoting the Health of Adolescents: New Directions for the Twenty-first Century

418 Pages·1994·24.21 MB·English

by  Susan G. Millstein

Promoting the Health
of Adolescents
ADVISORY BOARD
Albert Bandura, Ph.D., Department of Psychology, Stanford University
Michael I. Cohen, M.D., Department of Pediatrics, Montefiore Medical Center,
Albert Einstein University
Richard Jessor, Ph.D., Institute of Behavioral Science, University of Colorado
Denise V. Kandel, Ph.D., Department of Psychiatry, Columbia University
Lorraine V. Klerman, Dr.P.H., School of Public Health, University of Alabama at
Birmingham
Julius B. Richmond, M.D., Division of Health, Policy, Research and Education,
Harvard University
Frederick C. Robbins, M.D., University Professor, Epidemiology and
Biostatistics, Case Western Reserve University
Robert Selman, Ph.D., Judge Baker Guidance Center, Harvard University
Promoting the Health
of Adolescents
New Directions for
the Twenty-first Century
EDITORS
Susan G. Millstein, Ph.D.
University of California, San Francisco
Anne C. Petersen, Ph.D.
University of Minnesota
Elena O. Nightingale, M.D., Ph.D.
Carnegie Corporation of New York
New York Oxford
OXFORD UNIVERSITY PRESS
Oxford University Press
Oxford New York Toronto
Delhi Bombay Calcutta Madras Karachi
Kuala Lumpur Singapore Hong Kong Tokyo
Nairobi Dar es Salaam Cape Town
Melbourne Auckland Madrid
and associated companies in
Berlin Ibadari
Copyright © 1993 by Oxford University Press
First published in 1993 by Oxford University Press, Inc.,
200 Madison Avenue, New York, New York 10016
Hrsl issued as an Oxford University Press paperback in 1994
Oxford is a registered trademark of Oxford University Press
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Oxford University Press, Inc.
Library of Congress Cataloging-in-Publication Data
Promoting the health of adolescents:
new directions for the twenty-first century /
editors, Susan G. Millstein, Anne C. Peterson, Elena O. Nightingale.
p. cm. Includes index.
ISBN 0-19-507454-8 ISBN 0-19-509188-4 (pbk.)
1. Teenagers—Health and hygiene. 2. Health behavior in
adolescence. 3. Health promotion. I. Millstein, Susan G., 1950- .
II. Petersen, Anne C. HI. Nightingale, Elena O.
[DNLM: 1. Adolescence. 2. Adolescent Medicine.
3. Health Promotion. WS 460 P9655]
RA564.5.P74 1993
613'.0433—dc20
DNI.M/DI.C 92-22707
2 4 0 8 9 7 53 1
Printed in the United States ol America
on acid-tree paper
FOREWORD
Health Promotion
in Historical Perspective
Julius B. Richmond, M.D.
As the editors point out in their introductory chapter to this book, the way in which
health has been conceptualized has undergone change at various times in history.
In the past, health was viewed in holistic terms, incorporating both ecological and
biological issues. This was true even up to the last century. Rudolf Virchow, the
founder of modern cellular pathology, laid the scientific basis for much of modern
medicine, both conceptually and operationally. Virchow viewed medicine in a
social context and saw physicians as the natural attorneys for the poor.
As the natural sciences developed in the latter part of the nineteenth century,
however, the focus on specific causes for disease became the dominant motif in
medicine. The notion of health tended to move to the background as modern med-
icine became more and more influenced by the rapid advances in the natural sci-
ences. We then moved into a period in which there was an oversimplification of the
concepts used to explain the causes of disease. As modern medicine advanced and
became more focused on these concepts, it became harder to highlight some of the
positive aspects of health. Even then, however, people such as Rene Dubos contin-
ued to speak with medical audiences about multiple causation in disease and about
the relationship of the host and the environment to disease processes. Alan Gregg,
vice-president of the Rockefeller Foundation, aptly said:
Almost by definition an organism is an association of organs so intimately related that no part
can be changed without changing in some way and in some measure all the others. ... It is
intellectual weakness that prompts us to ascribe a given result to only one sufficient cause.
We ignore the value of suspecting that a result may be due to a convergence of several
"causes" which separately or in some other sequence will not produce the result we seek to
explain. This tendency to overlook convergent or multiple causation seduces us as an unrec-
ognized temptation in our enthusiasm as teachers to make things "clear."1
We now seem to have returned to a more comprehensive view of health, consid-
ering not only the biology of health, but its social, psychological, and economic
aspects as well. George Engel has defined this as a biopsychosocial approach. As we
have become more sophisticated about how we conceptualize health, we have
become more specific in how we define it as well. The World Health Organization's
VI FOREWORD
definition of health is "a state of complete physical, mental and social well-heing,
not merely the absence of disease and infirmity." Although there remains some
ambiguity in our attempts to differentiate disease prevention from health promo-
tion, we are making progress. The ambiguity between these concepts should not
become an obstacle to pursuing our goals. Rather, it should be used to encourage
further dialogue on the issue, enriching our conceptual models for health. Perhaps
we are moving toward a taxonomy of health. A number of years ago, Karl Men-
ninger raised the notion of degrees of wellness and suggested that people could be
"weller than well." Clearly, health is not a single entity; in fact, there are probably
many different "healths" that deserve consideration in our models. Furthermore,
we may also want to consider health as a fluid, dynamic process. Biological, ecolog-
ical, and psychosocial factors are dynamic interactions that are likely to influence
health to different degrees and in different ways as a function of the developmental
level of the individual. The present book brings us closer to an understanding of
how these dynamic factors operate during adolescence to influence both health
behaviors and health status.
Why is health promotion timely now? In the mid-1960s, disease prevention was
of little interest to the public or to policymakers. But the beginnings of a movement
were emerging with the first report of the Surgeon General's Advisory Committee
on Smoking and Health in 1964 and later, in 1979, with the publication of Healthy
People, the Surgeon General's report on health promotion and disease prevention.
As awareness and interest in health promotion grew, we saw a corresponding 35%
decline in mortality from heart disease and a 55% decline in mortality from stroke.
Healthy People also offered measurable and achievable public health goals for each
age group in our society. A series of subsequent reports by the Office of Disease
Prevention and Health Promotion of the U.S. Public Health Service outlined
detailed objectives for the nation by the year 2000.2
Today there is a great deal of public interest in disease prevention and health
promotion, and high expectations about what can be achieved. The Centers for
Disease Control and Prevention and the National Institute for Nursing Research
have initiated federal programs on health promotion. Attention to adolescent
health promotion and the need to consider the social context in which adolescents
live are also evident in the recent report on adolescent health by the congressional
Office of Technology Assessment. Professional organizations such as the National
Association of School Boards of Education have issued reports for educators on
improving the health of adolescents, and the American Medical Association has
developed guidelines for adolescent preventive health services. Nonprofit foun-
dations such as Carnegie Corporation of New York, the William T. Grant Foun-
dation, the Kaiser Family Foundation, and others have also contributed to these
efforts through their support of innovative programs and their objective to
increase public awareness of issues facing adolescents.
This book emerges at a time when the need for knowledge, insight, and creative
thinking about adolescent health promotion is deeply felt. To meet the challenge,
the editors have brought together an impressive group of scholars and clinicians
Foreword vii
to discuss the service, research, training, and policy considerations involved in the
promotion of adolescent health. This book should serve as a handbook for profes-
sionals in the various disciplines caring for adolescents. By consolidating current
knowledge on adolescent health promotion from multiple disciplines, the editors
are able to present the reader with a broad range of ideas about opportunities for
future directions. These carefully considered options will help us achieve the objec-
tive of a healthier adolescent population for the next decade and beyond.
Notes
1. See Alan Gregg's Multiple causation and organismic and integrative approaches to medical education
(Conference on Psychiatric Education, Washington, DC: American Psychiatric Association,
1951).
2. See the Surgeon General's report, sponsored by the United States Department of Health and
Human Services, titled Healthy people: National health promotion and disease prevention objectives
(Washington, DC: U.S. Government Printing Office, 1991).
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ACKNOWLEDGMENTS
This volume would not have been possible without the generous support of the
Carnegie Corportion of New York and its operating program, the Carnegie Coun-
cil on Adolescent Development. In particular, we deeply appreciate the contribu-
tions of David A. Hamburg, President of Carnegie Corporation, whose vision
helped provide the stimulus for this volume and whose continued support made it
possible. We also thank Vivien Stewart, Program Chair, The Education and
Healthy Development of Children and Youth, and Ruby Takanishi, Executive
Director of the Carnegie Council on Adolescent Development for their guidance
and foresight throughout the development of the volume. Allyn Mortimer, Pro-
gram Associate, also provided invaluable assistance for which we are extremely
grateful.
We were also exceptionally fortunate to have ongoing guidance and feedback
from a distinguished advisory group who gave generously of their expertise during
the conceptualization of the book and continued to work with the editors as the
volume took shape: Albert Bandura, Michael I. Cohen, Richard Jessor, Denise V.
Kandel, Lorraine V. Klerman, Julius B. Richmond, Frederick C. Robbins, and Rob-
ert Selman.
The many administrative and editorial tasks associated with the development and
production of this book could not have been achieved without the essential con-
tributions of Katharine Beckman, Winifred Bayard, and Annette Dyer at the Car-
negie Council on Adolescent Development. Special acknowledgments are also due
to Leslie Townsend, whose editorial skills and organizational abilities kept the pro-
ject moving forward and on schedule. We thank the Division of Adolescent Medi-
cine, Department of Pediatrics, at the University of California, San Francisco, for
housing the project.
Our goal of presenting the reader with a multidisciplinary perspective could not
have been achieved without the generous contributions of the many professionals
from a variety of disciplines who reviewed chapter drafts and provided us with
important insights. The contributors to this volume also deserve praise for their
willingness to participate in this project in a true spirit of collaboration.
Finally, we express our gratitude to the many other colleagues who stimulated
and challenged our thinking about adolescent health promotion over the years.
December 1992
San Francisco, Calif. S.G.M.
Minneapolis, Minn. A.C.P.
Washington, D.C. E.O.N.