Summary

Americans are concerned, even alarmed, by the apparent increase in the numbers of adolescents who engage in high-risk behaviors—behaviors that compromise their health, endanger their lives, and limit their chances to achieve successful adult lives. Adolescence is a natural period of experimentation and risk taking, but some young people—whether poor, middle class, or rich—appear far more likely than others to adopt ''risky life-styles," life-styles characterized by drug use, unprotected sexual behavior, dropping out of school, delinquency, and violence.

The work of this panel began as an attempt to better understand why some adolescents are drawn to risky life-styles while others, similarly situated, engage in only normal adolescent experimentation. As our work progressed, however, we became convinced that a focus on individual characteristics of adolescents would contribute to the overemphasis of the last two decades on the personal attributes of adolescents and their families at the expense of attention to the effects of settings or context. We concluded that it was important to right the balance by focusing on the profound influence that settings have on the behavior and development of adolescents.

It is a truism that behavior and development are the outcome of an interaction between context and person, not of context alone. The focus on context in this report does not mean that the personal characteristics of individuals are unimportant, nor does it



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Losing Generations: Adolescents in High-Risk Settings Summary Americans are concerned, even alarmed, by the apparent increase in the numbers of adolescents who engage in high-risk behaviors—behaviors that compromise their health, endanger their lives, and limit their chances to achieve successful adult lives. Adolescence is a natural period of experimentation and risk taking, but some young people—whether poor, middle class, or rich—appear far more likely than others to adopt ''risky life-styles," life-styles characterized by drug use, unprotected sexual behavior, dropping out of school, delinquency, and violence. The work of this panel began as an attempt to better understand why some adolescents are drawn to risky life-styles while others, similarly situated, engage in only normal adolescent experimentation. As our work progressed, however, we became convinced that a focus on individual characteristics of adolescents would contribute to the overemphasis of the last two decades on the personal attributes of adolescents and their families at the expense of attention to the effects of settings or context. We concluded that it was important to right the balance by focusing on the profound influence that settings have on the behavior and development of adolescents. It is a truism that behavior and development are the outcome of an interaction between context and person, not of context alone. The focus on context in this report does not mean that the personal characteristics of individuals are unimportant, nor does it

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Losing Generations: Adolescents in High-Risk Settings deny awareness of the individual differences that can be observed in every setting. Yet there are compelling reasons for our focus on context, on the role of settings: most simply, over the past two decades the major settings of adolescent life have come under siege in many different ways. For more and more children and adolescents—especially those who are poor and those who must deal with discrimination—the settings of their everyday lives fail to provide the resources, the supports, and the opportunities essential to healthy development and reasonable preparation for productive adulthood. FINDINGS: DETERIORATED SETTINGS Adolescents depend on families, neighborhoods, schools, health systems, and employment and training opportunities, and these institutions are under severe stress. As the fault lines widen, increasing numbers of youths are falling into the juvenile justice system, the child welfare system, and other even more problematic settings. This report attempts to improve understanding of the forces tearing apart the critical institutions in the lives of adolescents, as a first step in developing a viable plan to strengthen them. Among the many factors that contribute to and shape the settings in which adolescents live, family income is perhaps the most powerful. Housing, neighborhoods, schools, and the social opportunities that are linked to them are largely controlled by income; a family's income and employment status also determine its access to health care services and strongly influence the quality of those services. Opportunities for advanced education and training and entry into the workforce are also closely linked to family income. On a more fundamental level, income is a powerful influence in shaping that most important of settings, the family itself. Thus, the decline in economic security of young families has had important and far-reaching consequences for children and adolescents. Since the late 1970s, structural and demographic changes in the U.S. economy and society have caused a substantial and broad-based deterioration in the economic position of prime-age young adults, those aged 25-34. These young adults are the primary means of economic support for the majority of children in the United States (52.1%). A combination of declining real earnings and rising levels of unemployment has pushed a large percentage of these families into poverty. In 1991, 23.1 percent of families

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Losing Generations: Adolescents in High-Risk Settings headed by an adult aged 25-34 had incomes below the poverty level: for whites, the percentage was 18.6; for blacks, 46.0; and for Hispanics, 38.0. The decline in economic security has been severe—between 1973 and 1990, the median inflation-adjusted income of families with children headed by a parent under age 30 dropped by 32 percent. The economic security of young families has declined for many reasons, including the lack of growth in high-wage, high-benefit jobs, such as those in manufacturing; the decline in unionization; competition from recent immigrants for lower wage jobs; the isolation of inner-city residents from suburban jobs; and the inadequacy of worker skills for technically demanding positions. Demographic changes have also had a powerful effect: over the past two decades there has been an almost 40 percent increase in the number of female-headed households with children under age 18. The incidence of poverty among female-headed families with children is consistently 7 to 8 times higher than that among married-couple families with children. Although the increase in single-parent households has been an important factor in increasing the number of children living at or near poverty, two-parent households have also suffered. Most two-parent families have maintained their relative standard of living only by having two wage earners: in 1970 just under 39 percent of children had mothers in the workforce; by 1990 the proportion was 61 percent. The increase in single-parent households and the reduced time that most parents are able to spend with their children materially reduces the effectiveness of families in providing the guidance and support that young people need. Although family income is the most powerful predictor of adolescent outcomes, other factors—such as family structure, home environment, childrearing practices, and child-parent relationships—are independently important to adolescent health and behavior. At all socioeconomic levels, single-parent families and stepfamilies are far more likely to have adolescent children who engage in health-and life-compromising behaviors (dropping out of school, early dating, truancy, running away from home, contacts with the police, smoking) than are two-parent families. The combination of financial insecurity for an increasing proportion of families, increased work effort by parents seeking to maintain their living standard, and the demographic changes that have so dramatically increased the number of children and adolescents living in single-parent households result in increasing numbers

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Losing Generations: Adolescents in High-Risk Settings of adolescents who do not receive the family nurturance necessary for positive development. The child welfare system in general, and foster care in particular, is supposed to provide a "safety net" for children and adolescents from destructive or dysfunctional families. The total number of children in foster care has increased dramatically in the past decade, but the number of adolescents in the system has remained constant. Because their share of the total child welfare population has declined, there has been a reduction in the resources and attention committed to meeting the developmental needs of adolescents in foster care. As a result, the child welfare system is doing an inadequate job of preparing these adolescents to make the transition to productive, independent adulthood. Adolescents who pass through the child welfare system are at high risk of educational failure, unemployment, emotional disturbance, and other negative outcomes. Studies show that adolescents released from foster care fare far worse then either low-income youths or a cross-section of the general adolescent population. Adolescents released from foster care are far less likely to complete high school or hold jobs. In one study more than 60 percent of the young women with a foster care background had given birth to at least one child. Granted that the adolescents were at risk before they entered the system—indeed, many entered the system precisely because they had already been abused or neglected, become truants or runaways, or experienced other serious problems. The findings nevertheless suggest that the child welfare system is unable to meet their needs. On the contrary, there is evidence that the system often excludes adolescents, does not protect them from known abuse, and then, in effect, abandons them. Many children placed in foster care are likely to be emotionally disturbed, in large part because they have been raised in pathological families in which they were abused or neglected. In addition, the very act of separating a child from his or her family is traumatic and may itself cause disturbance. Yet the child welfare system has not been successful in providing mental health services for foster care children. No one in the child welfare field holds any illusions that the system is currently able to provide adequate resources to promote adolescent development or that it has been able to do so for the past decade. Although foster care may sometimes be better for the adolescent than remaining at home or living independently, it is unable to provide the support that is required to help young

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Losing Generations: Adolescents in High-Risk Settings people—most of whom have gone through very damaging experiences—to avoid health-and life-compromising behaviors that mortgage their future. Foster care is now itself a high-risk setting for most adolescents. Outside their families, the most immediate setting of adolescent lives is the neighborhood. Most of the social interactions of families and adolescents are embedded in neighborhoods. They are a place for social interaction, a place for education and human service, and a place for preparing for and engaging in employment. In short, neighborhoods are a key setting for adolescent development. During the 1970s the social composition of an increasing number of neighborhoods deteriorated: there was a 75 percent increase in the number of census tracts with concentrated poverty, and a 331 percent increase in the number of "underclass" neighborhoods. An underclass neighborhood is characterized not only by concentrated poverty, but also by a high degree of social disorganization. By 1980 more than half of all neighborhoods classified as poor in 1970 had become underclass. Underclass and concentrated poverty neighborhoods are a very high-risk setting for adolescents. Most poor neighborhoods are racially stratified as well as being economically isolated. The average black family lives in a census tract in which 30 percent of families are poor; for Hispanic families, the figure is 23 percent; for non-Hispanic whites, 14 percent. The poorest neighborhoods remain the most highly stratified: an estimated 87 percent of all residents in such neighborhoods are members of racial or ethnic minority groups. Adults in poor neighborhoods differ in important ways from those in more affluent areas: high-poverty neighborhoods have much higher proportions of unmarried mothers, single-parent families, and unemployed young men. There are fewer good role models for adolescents and a far higher percentage of adults who are involved in illegal markets. As their economic and social systems break down, the poorest of neighborhoods seem increasingly unable to restrain criminal or deviant behaviors. Not surprisingly, with little legal economic activity, few public and social services, limited recreational and youth development programs, and high levels of crime, adolescents lose hope and often cannot use the few opportunities that are available. The growth in crack and cocaine markets since the early 1980s has placed additional stress on poor neighborhoods. The highly visible, lucrative, and violent drug markets have simultaneously

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Losing Generations: Adolescents in High-Risk Settings accelerated the exodus of stable families and undermined the authority of long-term community leaders. Adolescents who are not involved as participants in drug markets are still influenced by their presence: some are victims of drug-related violence, and many more are unable to engage in normal neighborhood activities because of the dangers associated with drug markets. The increasing numbers of adolescents who are victims of the drugs, poverty, and violent neighborhoods has in turn focused attention on the lack of adequate health and mental health care for many young people. Adolescent health has been identified as a problem by policy makers and researchers only in the past decade. There is emerging recognition that adolescent health issues are different from those of children or adults and that the health status of adolescents has failed to improve over the last two decades. Since the early 1980s, for example, adolescent deaths from suicide and HIV/AIDS, as well as from homicide, have sharply increased. Furthermore, the prevalences of teenage pregnancy, sexually transmitted diseases, and drug use have either increased or remained at high levels relative to those in other Western countries. The American approach to financing and delivering health and mental health services serves most adolescents poorly. Many of the serious health problems faced by adolescents—substance abuse, sexually transmitted diseases, mental disorders, and physical or sexual abuse—are not covered by most health insurance plans, or the coverage is severely restricted and not adequate to provide effective treatment. And increasing numbers of adolescents are without any insurance coverage at all. Even when paying for services is not a problem, appropriate care is often hard to find. Few physicians specialize in adolescent health, and other practitioners are poorly trained in recognizing adolescent health problems, particularly when the symptoms are psychosocial rather than physical. The overall U.S. health system is fragmented, and especially so for adolescents because of the diversity of their needs. Adolescents are unlikely to know where to go and are likely to be referred many times before finding an appropriate setting. The adolescent health and mental health care system lacks all of the essential elements of primary care: a consistent entry point into the system, a locus of ongoing responsibility, adequate backup for consultation and referral services by specialists on adolescence, and comprehensiveness. As a result, the health care system is poorly set up to help adolescents overcome problems resulting from poverty, dangerous neighborhoods, and an inadequate social environment including school and home.

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Losing Generations: Adolescents in High-Risk Settings The current trends for adolescent health services are not promising. Families, communities, and the society at large are generally reluctant to accept adolescent values that diverge sharply from community norms: to the extent that adolescent health problems stem from generally unaccepted behaviors, health services are not responsive to their needs. A movement of the U.S. health system into managed care, with tight controls on the number and extent of services that will be covered, may further place adolescents in jeopardy because of the dearth of knowledge about effective treatment for adolescent problems. The formal institution that directly affects virtually all adolescents is school. Schools are critically important because education is the means by which individuals from economically or socially disadvantaged backgrounds can build the skills and credentials needed for successful adult roles in mainstream American life. Despite two decades of public debate and reform, however, schools do not now work this way for many students. Adolescents from low-income families and neighborhoods are at much higher risk of educational failure than their more affluent suburban counterparts. Because of residential stratification, most of these adolescents attend schools with the fewest material resources. In 1991, for example, per pupil expenditures in the 47 largest urban school districts averaged $5,200; in suburban districts, the figure was $6,073. Although an $875 per pupil funding gap may not appear significant, in an average class of 25 students, the difference is almost $22,000—enough to hire an aide, provide special instructional materials or computers, pay significantly higher teacher salaries, or improve a dilapidated classroom. When the relatively greater need of urban children for special services is taken into account (for health needs, language instruction for non-English-proficient students, etc.), the resource differences are even more critical. Differences in funding of this magnitude can make a clear qualitative difference in the total educational experience. Traditional education practices contribute to the high rates of failure for low-achieving students. Historically, schools have addressed the diversity of student achievement by tracking students into homogeneous ability groups and by retaining students who fail courses because of poor attendance, grades, or test scores. Contrary to expectations, these practices have consistently shown negative academic and social consequences for low-achieving adolescents. For example, research shows that ability grouping does not improve learning among low-achieving students. Rather, placement in a low-track program reinforces, compounds, and often

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Losing Generations: Adolescents in High-Risk Settings exacerbates preexisting differences among students in competency and self-perception. Students placed in lower tracks rarely move into higher tracks: the inferior quality of instruction and learning environments in the lower tracks is one major reason that students seldom move from lower tracks into more advanced programs. In addition, instruction in the lower tracks emphasizes basic skills rather than higher order learning, effectively sorting students' future educational and career options. Adolescents in these classes are keenly aware of their reduced opportunities, and this contributes to their loss of academic interest and motivation. Grade retention has been shown to be similarly ineffective in improving the performance of low-achieving students. Alternatives to tracking and retention are being tried and show promise of effectiveness. However, they require flexibility, a high quality of instruction, and the resources necessary to provide students with individual attention. These are very difficult for most poor school districts to provide, and even school districts with adequate resources have been slow to learn from the research on the needs of low-achieving students. Thus, school systems very often compound the problems that students from low-income families and poor neighborhoods bring to their doors. As the numbers of students who need compensatory attention continues to increase, school systems that serve poor and low-income neighborhoods must struggle to provide not only education, but also health and social services. They will not succeed without adequate resources and without major innovations in their approaches to both education and involvement with the communities they serve. After the structured settings of schools comes the completely unstructured transition to work, one of the keys to productive adulthood. About one-half of high school graduates in the United States do not go on to college, and of those who do, less than half obtain 4-year degrees. Despite the fact that 75 percent of high school graduates will not finish college, far less commitment is made to helping these students prepare for and find work than is made to helping students prepare for and enter college. The result is that most high school students—or college dropouts—have poor information about the occupational choices open to them or what is required to prepare for a field of work and how to obtain the requisite training. Left to themselves, they flounder in the labor market, either jobless or obtaining jobs with low wages and little opportunity for advancement. Adolescents from low-income families face the greatest difficulties. Not only are they the least likely to attend college, but

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Losing Generations: Adolescents in High-Risk Settings they also fare substantially worse on all measures of employment success compared with adolescents from more affluent families. For those under age 20, being raised in a low-income family is the strongest predictor of labor market inactivity. The United States differs from most other industrialized countries in its reliance on market forces to effect the transition of young people from school to work. There are many federal, state, and locally supported programs, but it is difficult to consider them a system, and few have been targeted specifically to adolescents. There are also few structural links among the various programs: in fact, there are strong policy disincentives to such program collaborations. Further, the school-to-work transition system in the United States currently acts almost exclusively on the supply side of the labor market equation. Vocational education and employment training have moved away from their immediate constituencies: vocational education is isolated from the academic curriculum; employment and training programs have moved away from serving youth who are out of the labor market. Vocational education programs do not offer a sequenced series of courses throughout high school, building an integrated academic and applied knowledge base related to the learning and skills required in specific occupational sectors. Although innovative programs have been developed to bridge high school and technical school experience, they are few in number and reach a very small proportion of students. Because they lack support and direction, large numbers of high school graduates (and even higher proportions of high school dropouts) do not acquire the academic and technical skills that are needed to obtain well-paying jobs as adults. Although a certain amount of testing in the labor market is predictable among young adults, far too many churn through jobs without acquiring any training or experience that can lead to careers or good jobs. The failure of the school-to-work transition "system" to adequately respond to the needs of the majority of high school graduates contributes materially to the economic insecurity that characterizes a high proportion of young families. For increasing numbers of adolescents, the second formal institution in their lives is the juvenile justice system or the criminal justice system. These systems assume major roles in the lives of many adolescents, especially the adolescent children of racial and ethnic minorities and the inner-city poor. Economic and residential stratification in the United States concentrates crime, particularly violent crime, in low-income, urban neighborhoods. Young black males, in particular, have a disproportionately high risk of

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Losing Generations: Adolescents in High-Risk Settings encountering the juvenile and criminal justice systems, both as victims and as violators. Young black males who experience education and employment problems have a high probability of being arrested, imprisoned, or criminally victimized. (Involvement in both violent and property crimes peak in mid-to late adolescence.) Because such a large proportion of low-income, minority adolescent males are involved in criminal activities, their treatment at the hands of the juvenile and criminal justice systems is enormously important in determining whether they can be brought back into mainstream society or whether their adult lives will be marked by unemployment, low-wage jobs, ill health, and participation in illegal activities. Both the juvenile and adult criminal justice systems are generally failing in their efforts to rehabilitate adolescent offenders (an increasing number of whom are now consigned to the adult justice system because of participation in drug-related homicides and other particularly violent crimes). The decline of the rehabilitative ideal, a new emphasis on deterrence, and escalating rates of imprisonment affect adolescents as well as adults. The high rates of arrest and imprisonment have many ramifications. Because community-level policing practices display discriminatory patterns, and because the justice system is nevertheless expected to embody high standards of fairness, the justice system has become a particularly difficult forum for black-white relations. The juvenile and criminal justice systems are perceived with suspicion, hostility, distrust, and despair by minority citizens, who too often are treated as suspects. Thus, it is not surprising that ghetto youth who come into conflict with the justice system have self-concepts, attitudes, and interests that aggravate those contacts and, in the longer term, are predictive of poor occupational and other life outcomes. Those contacts in turn do nothing to improve this situation; they are more likely to perpetuate and intensify the negative results. The justice system is unquestionably overburdened. Its emphasis on punishment is expensive, has not resulted in reducing levels of official crime, and probably increases hostility toward the system in ghetto communities. For juveniles, the most effective treatment programs are implemented outside of public facilities, custodial institutions, and the juvenile justice system. They also tend to involve nonpunitive behavior and skill-orientation, multipart treatments that offer alternatives to the more socially and fiscally costly mechanisms of justice system involvement. Because involvement with the justice system has such devastating

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Losing Generations: Adolescents in High-Risk Settings consequences for the future of adolescents—particularly minorities—it is increasingly urgent that alternatives be tried. CONCLUSIONS: GOOD PRACTICE AND NEW RESEARCH DIRECTIONS In response to the failures of many of the major settings in which adolescents are growing up to provide the guidance and support they need for positive development, many community-based service providers have developed new programs that attempt to compensate. The panel found examples of programs organized by local governments and nonprofit groups that appear to be effective in addressing the problems facing many adolescents and their families. Most of these programs are designed to support families and strengthen communities. The overall goal of such efforts is to enable and empower parents and community residents to increase their capabilities to nurture young people. The specific programs are extremely varied in their methods and philosophies, but they have a number of common characteristics. First and foremost, their services for adolescents are comprehensive: the programs transcend categorical labels, organizations, and funding sources to bring together a coherent package of services to young people. Whether programs are offered in a single site or through interagency collaborations, their goal is to provide services that ensure that the emotional, recreational, academic, mental and physical health, and vocational needs of adolescents are explicitly addressed. Although individual programs have shown impressive results and have provided a life raft for some adolescents, they are not a substitute for fundamental improvements in the major settings that are the framework of adolescent life. Those primary settings are crucial, and the first priority must be to strengthen them. It is neither feasible nor desirable to substitute comprehensive service programs for families, schools, neighborhoods, or ongoing health care. Moreover, knowledge about which programs work and why is painfully limited. If the role of community-based programs is to be expanded, major investment is required in rigorous evaluations with carefully defined outcome measures. The models that show success through such evaluations deserve to be more generously supported and replicated. The focus on settings reflects the panel's appreciation of the profound influence that context has on adolescent behavior and our judgment that the power of settings on adolescent development has been underappreciated. The lack of attention to settings

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Losing Generations: Adolescents in High-Risk Settings has resulted in an incomplete picture of adolescence and an excessive concentration on individual adolescent behaviors and programs, such as teenage pregnancy prevention, drug abuse prevention, smoking prevention, and dropout prevention. The categorical focus on individual behaviors has been largely ineffective because behavior is the result of individual and group interactions with the environment. Primary, sustained attention must be paid to reducing the exposure of children and adolescents to high-risk settings, because reducing the risks generated by these settings is virtually the precondition for achieving widespread reductions in health-and life-compromising behaviors. Describing the destructive effects of high-risk settings is far easier than recommending specific policy and program changes to improve them. The demographic changes that are creating large numbers of poor, single-parent families are not well understood, and it is not at all clear what effect specific changes in public policies might have on those trends. Therefore, we have limited ourselves to describing the broad changes that we believe are essential if settings are to become less dangerous for a large proportion of American adolescents and to describing research priorities to improve understanding of the particular policies and programs that might be effective in changing these settings. We note, however, that the problems described are serious and urgent. Although current knowledge of how to improve settings is limited, we believe the nation should give a high priority to beginning the process of research and commitment to improve the security and well-being of its children.