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Adolescents at Risk

Increasing numbers of America's youth are growing up in circumstances that limit the development of their potential, compromise their health, impair their sense of self, and generally restrict their chances for successful lives. For more and more children and adolescents—especially those who are poor and those who must deal with the discrimination that often faces racial and ethnic minorities—the contexts of their everyday lives fail to provide the resources, supports, and opportunities essential to healthy development and reasonable preparation for productive adulthood. Disorganization of the key settings in which poor and minority young people live their daily lives—schools, neighborhoods, families, and, sometimes, the health care and law enforcement settings—poses a daunting challenge for their successful development during childhood and adolescence. Those settings have deteriorated considerably in recent decades, reducing their contribution to healthy adolescent development.

Those settings—the major contexts in which young people are growing up in contemporary American society—are the focus of this report. To the extent that those contexts or settings, instead of being benign and supportive, have become more dangerous and destructive, the lives of America's youth have been placed at risk. In such settings, the likelihood of healthy or successful development—of doing well in school, of achieving a sense of competence, of involvement in prosocial activities, of being prepared to assume adult roles, of avoiding too early childbearing or encounters



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Losing Generations: Adolescents in High-Risk Settings 1 Adolescents at Risk Increasing numbers of America's youth are growing up in circumstances that limit the development of their potential, compromise their health, impair their sense of self, and generally restrict their chances for successful lives. For more and more children and adolescents—especially those who are poor and those who must deal with the discrimination that often faces racial and ethnic minorities—the contexts of their everyday lives fail to provide the resources, supports, and opportunities essential to healthy development and reasonable preparation for productive adulthood. Disorganization of the key settings in which poor and minority young people live their daily lives—schools, neighborhoods, families, and, sometimes, the health care and law enforcement settings—poses a daunting challenge for their successful development during childhood and adolescence. Those settings have deteriorated considerably in recent decades, reducing their contribution to healthy adolescent development. Those settings—the major contexts in which young people are growing up in contemporary American society—are the focus of this report. To the extent that those contexts or settings, instead of being benign and supportive, have become more dangerous and destructive, the lives of America's youth have been placed at risk. In such settings, the likelihood of healthy or successful development—of doing well in school, of achieving a sense of competence, of involvement in prosocial activities, of being prepared to assume adult roles, of avoiding too early childbearing or encounters

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Losing Generations: Adolescents in High-Risk Settings with law enforcement agencies—is acutely jeopardized. And when danger comes to characterize most of the settings in a young person's life—a decaying school, a dangerous neighborhood, and a broken family, for example—that youth is, quite evidently, at high risk of failing to become a healthy, competent adult. Indeed, under such circumstances, the risk of health-and life-compromising experiences, such as school failure or dropout, trouble with the law, or heavy commitment to substance abuse, becomes substantially greater. Over the past two decades, the major settings of adolescent life have become increasingly beleaguered, especially where the number of families living in poverty has expanded and where their concentration in the inner cities of large urban areas has increased. Schools in such areas do not have the resources needed to sustain their mission, school buildings are in disrepair, and there is often the threat of violence in classrooms and corridors; neighborhoods are more disintegrated, buildings more dilapidated, and streets often physically dangerous; communities are also fraying as ever-rising mobility destroys personal ties and traditional institutions, such as churches, and local businesses suffer from disinvestment; families are more frequently headed by a single parent, often a working mother unable to obtain competent child care or by two working parents with less time for childrearing because they are striving to maintain their standard of living in the midst of a general decline in wages. Such settings have become the crucible in which the lives of increasing numbers of America's youth are being shaped. SETTINGS AND INDIVIDUALS The decision to focus this report on the major settings in which young lives are formed reflects the profound influence that context has on the behavior and development of children and adolescents. It reflects, too, awareness that the elements essential for healthy and positive development—resources and supports and opportunities—are differentially distributed and differentially available among sectors of American society, generally present in the more affluent settings and often absent or limited in poor and racially or ethnically separate communities. Settings are important not only the ''first chances" they provide, but also for "second chances," those opportunities to redeem past failures or inappropriate choices. Such second chances are clearly less available when settings are in disarray, limited in resources, and subject to continuing pressure toward illegitimate activities.

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Losing Generations: Adolescents in High-Risk Settings It is, of course, a truism that behavior and development are the outcome of an interaction between context and person, and not of context alone. This report's focus on context does not mean that the personal characteristics of individuals are unimportant, nor does it deny awareness of individual differences within every setting. Whatever the context, individual differences are ubiquitous, and there will always be some people who overcome adversity and thrive, even as many others do not. Yet there are compelling reasons for the focus adopted in this report: to give primacy to context and to illuminate the role of deteriorating settings in putting the lives of many young people at risk. First, in the history of inquiry about the development of youth, the focus has traditionally been on individuals rather than context, and the latter has generally been ignored. This is a good time to right the balance, to extend understanding, to acknowledge and elaborate the pervasive influence of contexts or settings. Second, the role a setting plays must actually be seen as twofold, and thus, doubly important: it influences the development of a person over time, through experience, socialization, and exposure in various contexts, and it also interacts with that person at any given time in influencing the specific behavior that occurs. Third, it is evident that there are large variations in rates or levels of health-and life-compromising experiences and behavior associated with different contexts, especially for differences that relate to the level of poverty (for example, rates of school failure and dropout, unprotected sexual intercourse, aggression and violence, and drug and alcohol use). Fourth, as this report clearly details, the significant and noticeable changes over the past two decades have indeed been in the contexts or settings of adolescent life. Thus, it seems especially important to consider the reverberating effects that such changes might have on the behavior and development of youth. Finally, policy efforts to prevent or ameliorate bad outcomes (such as school failure) are clearly more feasible and more likely to be efficient when targeted toward changing contexts or settings—using what is known broadly as a public health approach—than when targeted at changing individuals on a one-by-one basis. For all of these reasons, this report articulates the ways in which the major settings of adolescent life, and especially their recent deterioration, have contributed to placing many of America's adolescents at risk. In describing the impact of settings on adolescents, the panel is cognizant of the difficulty in disaggregating the influence of specific parts of environments: family, neighborhood, schools, the

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Losing Generations: Adolescents in High-Risk Settings health care system, etc. (For a discussion of these methodological problems, see Inner-City Poverty in the United States; Lynn and McGeary, 1990.) We instead call attention to the fact that all of the major settings or contexts of adolescent life are under stress. This report uses the term adolescents to describe young people in their teenage years (13 to 19). The concept of "risk" as used in the report is drawn from the tradition of epidemiology, reflecting a concern for adverse outcomes. The definition of adverse outcomes, however, extends beyond morbidity and mortality to encompass the failure to acquire the academic knowledge, social skills, and personal behaviors required to succeed in contemporary American society. THE ROLE OF FAMILY INCOME Family income is perhaps the single most important factor in determining the settings in which children and adolescents spend their lives. Housing, neighborhoods, schools, and the social opportunities that are linked to them are largely controlled by income; a family's income and employment status decide 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. Although the nature of the causal relationships remains unclear, a family's financial status is the single most important factor in predicting differences in socioeconomic attainment of children, whether from two-parent or other families. Children who experience poverty at any time during their lives are three times more likely to be poor as adults than children who have never been poor (Hill et al., 1985; Hill and Duncan, 1987). Furthermore, prolonged exposure to poverty is more damaging than short episodes of poverty, perhaps because in short episodes, the assets derived from prior financial security exert some protective influence. Persistent poverty has a strong racial bias. Although white children account for the largest proportion of all poor children (42 percent in 1990), persistent long-term poverty (more than 6 years) is relatively rare for white families. Fewer than 5 percent of children from poor white families experience sustained poverty. The experience of black families is different: almost 40 percent of black children experience persistent or long-term poverty (Sawhill, 1992).

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Losing Generations: Adolescents in High-Risk Settings This report gives particular emphasis to the adverse effects of poverty-related settings on the lives of adolescents. We chose this emphasis because of the large and still increasing numbers of children and adolescents whose developmental years will be spent in settings of extreme deprivation. As this report is about adolescents, the consequences of impoverished settings on younger children are not discussed in detail. However, it is important to note that a large proportion of the adolescents growing up in impoverished environments were born poor and have lived in poverty for significant periods of their lives; this is particularly true for black adolescents. Many of these children enter adolescence with a set of vulnerabilities (physical, developmental, psychological, and emotional) that are not only additive in their effects, but also negatively interact with the deleterious effects of the settings discussed in this report. In 1990, 9.8 million children under age 6—more than 4 of every 10 in the country—lived in low-income (poor and near-poor) families, families with incomes of less than 185 percent of the federal poverty level ($13,924 for a family of 4 in 1991) (National Center for Children in Poverty, 1992). Although it is generally recognized that poverty can be harmful to children, the diverse mechanisms by which lasting damage to a child's health and development occurs are not widely appreciated. Poverty affects children directly by limiting a family's ability to purchase goods and services essential to health, including adequate housing and food (Klerman with Parker, 1991). Children in poor households are also more likely to be exposed to health risks and to experience events that damage their health, such as lead-based paint and home fires. Families living in poverty are subject to multiple stresses and constraints that lead to feelings of hopelessness and helplessness and often reduce parents' ability to provide children with the emotional support and stimulation critical to healthy development (Zill et al., 1991). Poverty may also limit parents' ability to engage in health-promoting activities, resulting in unhealthier life styles (National Center for Children in Poverty, 1990). Together these forces serve to place a highly significant proportion of American children at high risk for physical, mental, and developmental disabilities that will influence the remainder of their lives. It is important to note, however, that even among children exposed to long-term poverty, the risks to children's development vary greatly and may be mitigated by such factors as the availability of positive social support (Cochran and Brassard, 1979; Wilson, 1989), neighborhood cohesion (Garbarino and Sherman,

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Losing Generations: Adolescents in High-Risk Settings 1980), extended family networks (Furstenberg et al., 1987; Kellam et al., 1977), and the resilience of the child (Werner and Smith, 1982). The increased risk starts before birth. Poverty has been shown to be a consistently important predictor of inadequate or late prenatal care. Poor women are also less likely to eat a nutritious diet and to experience adequate weight gain (Brown, 1988). Whether poor women are more likely to abuse substances during pregnancy is unclear. Poor women are less likely to smoke or drink alcohol than are higher income women, but poor women who do smoke are more likely to continue smoking during pregnancy (Henshaw and Silverman, 1988) but less likely to drink alcohol (Pamuk and Mosher, 1988). The reported increased use of illegal drugs during pregnancy by poor women may depend more on which drugs are studied and the study site (U.S. General Accounting Office, 1990; Chasnoff et al., 1990; Frank et al., 1988). Pediatric AIDS is closely associated with drug abuse among pregnant women and their partners in impoverished neighborhoods (National Commission on AIDS, 1992). These factors help to place infants born to poor women at higher risk of being premature and low birthweight (Berkowitz, 1981). Low-birthweight babies are nearly twice as likely to suffer severe developmental delay or congenital anomalies (Institute of Medicine, 1985). They are also at significantly greater risk of such long-term disabilities as cerebral palsy, autism, and mental retardation, and vision and hearing impairments and other developmental disabilities (Shapiro et al., 1983). These detrimental health and developmental effects of preterm delivery and low birthweight are all greater among poor children (Wise and Meyers, 1988; Parker et al., 1988). Both premature and low-birthweight infants are believed to be at increased risk of abuse because they exhibit "abuse provoking" characteristics, such as prolonged and irritating crying, and often demand a great deal of care (Frodi, 1981; Ammerman, 1990, 1991). However, this association was not found in a predominantly middle-class sample (Crnic et al., 1983). Thus, difficult babies may only precipitate abuse in parents who are already stressed because of such factors as economic deprivation (Ammerman, 1990). Early childbearing is associated with many adverse developmental outcomes, even if a child is carried to term and is born at a normal weight. In 1989, slightly more than one-half million children were born to mothers under the age of 20 (Children's Defense Fund, 1992). Children of adolescent mothers score lower

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Losing Generations: Adolescents in High-Risk Settings on standardized tests of language and intellectual functioning, beginning in preschool and continuing in elementary grades (Marecek, 1979). They are also more likely than children born to older mothers to exhibit behavior problems, ranging from hyperactivity to poor impulse control (Brooks-Gunn and Furstenberg, 1986; Hofferth, 1987). Poverty is often linked to early childbearing. Among poor children under age 6, 47 percent had mothers who first gave birth before the age of 20; among nonpoor children, the proportion was only 17 percent (National Center for Children in Poverty, 1990). The child of a poor mother faces the double jeopardy of exposure to poverty and a mother who may lack the emotional maturity or knowledge to be a good parent. Being single, young, black, and poor is the combination most likely to be associated with a lack of success for the parent and poor caregiving (Egeland and Erickson, 1990). All children who experience inadequate attention, maltreatment, abuse, or neglect are at high risk for developmental, learning, emotional, and academic difficulties, and the more such experiences a child has, the more negative the developmental outcomes will be (Sameroff et al., 1987). There are strong links between economic deprivation and child maltreatment, although the exact processes that mediate between poverty and developmental risk are controversial. Abuse and maltreatment are not confined to poor families, but successive studies have documented the highest incidence of child neglect in families living in extreme poverty and the most severe injuries from abuse or neglect occurring in the poorest families (Pelton, 1981; Wolock and Horowitz, 1984; Giovannoni and Billingsley, 1970). In fact, neighborhoods that are socially impoverished as well as economically stressed have higher rates of abuse (Garbarino and Sherman, 1980). Mothers of young children who are living below the poverty line are at the greatest risk of violent behavior toward children (Gelles, 1992), and living in poverty also appears to increase the likelihood of continuing abusive patterns across generations (Egeland, 1988). Poverty exposes children to a number of other environmental risks of physical injury that strongly influence a child's socialization and success in school. For example, at least two major causes of brain dysfunction have a high correlation with poverty: head injuries (whether intentional or accidental) and exposure to lead (Reiss and Roth, 1993). Accidental injuries occur more frequently among poor children (Rivera and Mueller, 1987) and appear to be the result of living in dangerous housing and neighborhoods, as

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Losing Generations: Adolescents in High-Risk Settings well as inadequate protection by parents and other caregivers (National Center for Children in Poverty, 1990). Both exposure to lead and blood-lead concentrations in children under 5 years have been shown to increase as family income decreases (Mahaffey et al., 1982). Even a low level of exposure to lead in childhood may result in higher rates of learning disability, low achievement, and failure to graduate from high school (Needlemen et al., 1990). In summary, the evidence is clear and compelling that persistent poverty exacts a significant price on children's health, development, educational attainment, and socioeconomic potential, even though the causal relationships are not well understood in all cases. These effects become more pronounced by adolescence. The economic and demographic changes of the last two decades have led to a significant increase in the proportion of adolescents who have lived in poverty for prolonged periods. In 1991, the poverty rate for all children under 18 years was 21.8 percent (Bureau of the Census, 1992). Although the majority of such children will survive the experience and go on to a productive adult life, many will not. And the increasing proportion of all American children who will live in poverty at some point in their lives means that a steadily increasing percentage of adolescents are at risk of a compromised future. Though this report focuses on adolescents, their life settings, and the changes that have occurred in them over the last two decades, we note again that the adolescents who enter these settings are a product of their early life experiences. Those whose early experience was marked by poverty suffer increased vulnerability to many of the settings discussed in this report. REFERENCES Ammerman, R.T. 1990 Etiological models of child maltreatment: a behavioral perspective. Behavioral Modification 14(3):230-254. 1991 The role of the child in physical abuse: a reappraisal. Violence and Victims 6(2):87-101. Berkowitz, G.S. 1981 An epidemiologic study of preterm delivery. American Journal of Epidemiology 113(1):81-92. Brooks-Gunn, J., and F.F. Furstenberg, Jr. 1986 Antecedents and consequences of parenting: the case of adolescent motherhood. In A. Fogel and L.G. Melson, eds., The Origins of Nurturance: Developmental, Biological, and Cultural Perspectives on Caregiving. Hillsdale, N.J.: Lawrence Erlbaum Associates. Brown, S., ed. 1988 Prenatal Care: Reaching Mothers, Reaching Infants. Committee to

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Losing Generations: Adolescents in High-Risk Settings Study Outreach for Prenatal Care, Institute of Medicine. Washington, D.C.: National Academy Press. Bureau of the Census 1992 Poverty in the United States: 1991. Current Population Reports, Series P-60, No. 181. Washington, D.C.: U.S. Department of Commerce. Chasnoff, I.J., H.J. Landress, and M.E. Barrett 1990 The prevalence of illicit drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida. New England Journal of Medicine 322(17):1202-1206. Children's Defense Fund 1992 The Health of America's Children, 1992. Washington, D.C.: Children's Defense Fund. Cochran, M., and J. Brassard 1979 Child development and personal social networks. Child Development 50:601-616. Crnic, K.A., M.T. Greenberg, A.S. Ragozin, N.M. Robinson, and R.B. Basham 1983 Effects of stress and social support on mothers and premature and fullterm infants. Child Development 54:209-217. Egeland, B. 1988 Breaking the cycle of abuse: implications for prediction and intervention. Pp. 87-99 in K.D. Browne, C. Davies, and P. Strattor, eds., Early Prediction and Prevention of Child Abuse. New York: John Wiley and Sons, Inc. Egeland, B., and M.F. Erickson 1990 Rising above the past: strategies for helping new mothers break the cycle of abuse and neglect. Zero to Three 11(2):29-35. Frank, D.A., B.S. Zuckerman, H. Amaro, K. Aboagye, H.J. Bauchner, H. Cabral, L. Fried, R. Hingson, H. Kayne, S.M. Levenson, S. Parker, H. Reece, and R. Vinci 1988 Cocaine during pregnancy: prevalence and correlates. Pediatrics 82(6):888-895. Frodi, A.M. 1981 Contribution of infant characteristics to child abuse. American Journal of Mental Deficiency 85:341-349. Furstenberg, F., J. Brooks-Gunn, and S. Morgan 1987 Adolescent Mothers in Later Life. New York: Cambridge University Press. Garbarino, J., and D. Sherman 1980 High-risk neighborhoods and high-risk families: the human ecology of child maltreatment. Child Development 51:188-198. Gelles, R.J. 1992 Poverty and violence toward children. American Behavioral Scientist 35(3):258-274. Giovannoni, J.M., and A. Billingsley 1970 Child neglect among the poor: a study of parental adequacy in families of three ethnic groups. Child Welfare 49:196-204. Henshaw, S.K., and J. Silverman 1988 The characteristics and prior contraceptive use of U.S. abortion patients. Family Planning Perspectives 20(4):158-168. Hill, M.S., and G.J. Duncan 1987 Parental family income and the socioeconomic attainment of children. Social Science Research 16:39-73.

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Losing Generations: Adolescents in High-Risk Settings Hill, M.S., S. Augustyniak, G. Duncan, P. Gurin, J. Liker, J. Morgan, and M. Ponza 1985 Motivation and Economic Mobility. Research Report Series. Ann Arbor: Institute for Social Research, University of Michigan. Hofferth, S.L. 1987 The children of teen child bearers. Pp. 174-276 in S.L. Hofferth and C.D. Hayes, eds., Risking the Future: Adolescent Sexuality, Pregnancy, and Childbearing, Vol. II. Committee on Child Development Research and Public Policy, Commission on Behavioral and Social Sciences and Education, National Research Council. Washington, D.C.: National Academy Press. Institute of Medicine 1985 Preventing Low Birthweight. Committee to Study the Prevention of Low Birthweight. Washington, D.C.: National Academy Press. Kellam, S., M.E. Ensminger, and R. Turner 1977 Family structure and the mental health of children. Archives of General Psychiatry 34:1012-1022. Klerman, L.V., with M.B. Parker 1991 Alive and Well? A Research and Policy Review of Health Programs for Poor Young Children. New York: National Center for Children in Poverty , Columbia University. Lynn, L.E., Jr., and M.G.H. McGeary, eds. 1990 Inner-City Poverty in the United States. Committee on National Urban Policy, Commission on Behavioral and Social Sciences and Education, National Research Council. Washington, D.C.: National Academy Press. Mahaffey, K.R., J.L. Annest, and J. Roberts 1982 National estimates of blood lead levels: United States, 1976-1980: association with selected demographic and socio-economic factors. New England Journal of Medicine 307(10):573-579. Marecek, J. 1979 Economic, Social and Psychological Consequences of Adolescent Childbearing: An Analysis of Data from the Philadelphia Collaborative Perinatal Project. Institute for the Continuous Study of Man, Philadelphia. National Center for Children in Poverty 1990 Five Million Children: A Statistical Profile of Our Poorest Young Citizens. New York: Columbia University School of Public Health. 1992 Five Million Children: 1992 Update. New York: Columbia University School of Public Health. National Commission on AIDS 1992 The Challenges of HIV/AIDS in Communities of Color. Washington, D.C.: National Commission on AIDS. Needlemen, H.L., A. Schell, D. Bellinger, A. Leviton, and E.N. Allred 1990 The long-term effects of exposure to low doses of lead in childhood. New England Journal of Medicine 322(2):83-88. Pamuk, E.R., and W.D. Mosher 1988 Health Aspects of Pregnancy and Childbirth: United States, 1982 . Vital and Health Statistics, Series 23, No. 16. Hyattsville, Md.: National Center for health Statistics. Parker, S., S. Greer, and B. Zuckerman 1988 Double jeopardy: the impact of poverty on early childhood development. Pediatric Clinics of North America 35(6):1227-1240.

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Losing Generations: Adolescents in High-Risk Settings Pelton, L.H. 1981 The Social Context of Child Abuse and Neglect. New York: Human Sciences Press. Reiss, A.J., Jr., and J.A. Roth, eds. 1993 Understanding and Preventing Violence. Panel on the Understanding and Control of Violent Behavior, Committee on Law and Justice, National Research Council. Washington, D.C.: National Academy Press. Rivera, F.P., and B.A. Mueller 1987 The epidemiology and causes of childhood injuries. Journal of Social Issues 43(2):13-32. Sameroff, A.J., R. Seifr, R. Barocas, M. Zax, and S. Greenspan 1987 Intelligence quotient scores of 4-year-old children: social-environmental risk factors. Pediatrics 79(3):343-350. Sawhill, I. 1992 Young children and families. In H.J. Aaron and C.L. Schultze, eds., Setting Domestic Priorities: What Can Governments Do? Washington, D.C.: Brookings Institution. Shapiro, S., M.C. McCormick, B.M. Starfield, and B. Crawley 1983 Changes in infant morbidity associated with decreases in neonatal mortality. Pediatrics 72(3):408-415. U.S. General Accounting Office 1990 Drug-Exposed Infants: A Generation at Risk. Washington, D.C.: U.S. General Accounting Office. Werner, E.E., and R.S. Smith 1982 Vulnerable but Invincible: A Longitudinal Study of Resilient Children and Youth. New York: McGraw-Hill. Wilson, M.N. 1989 Child development in the context of the black extended family. American Psychologist 44(2):380-385. Wise, P.H., and A. Meyers 1988 Poverty and child health. Pediatric Clinics of North America 35(6):1176. Wolock, I., and B. Horowitz 1984 Child maltreatment as a social problem: the neglect of neglect. American Journal of Orthopsychiatry 54(4):530-543. Zill, N., K.A. Moore, E.W. Smith, T. Stief, and M.J. Coiro 1991 The Life Circumstances and Development of Children in Welfare Families: A Profile Based on National Survey Data. Washington, D.C.: Child Trends.