least 90 percent by the year 2000. In 1992, the high school completion rate for people aged 19 to 20 was 84.7 percent, and for those aged 21 to 22, the rate was 86.2 percent. Although the difference between current school completion rates and the National Education Goal does not appear to be great, the graduation rate is significantly lower in many inner city and rural areas. Furthermore, the Bureau of the Census has projected that the population of academically at-risk children will continue to grow. Because these children are more likely to fail and drop out of school, the 90 percent goal may be more difficult to attain than the data indicate. To assist the growing number of school-aged children at risk of school failure, some experts have proposed comprehensive interventions that deliver a range of human services to students in schools (GAO, 1993).

The New Social Morbidities

A century ago, infectious disease and untreated physical defects put students at risk of school failure. Today, most of these problems can be addressed in whole or in part with immunizations, antibiotics, eyeglasses, and other medical treatments. Yesterday's problems, however, have been replaced by special health care needs, chronic diseases, and a new set of problems based in behavior and life-style choices, and these problems are not amenable to simple well-defined solutions. The Centers for Disease Control and Prevention (CDC) has found that the following six categories of behavior are responsible for 70 percent of the mortality and morbidity among adolescents: (1) behaviors that cause unintentional and intentional injuries, (2) drug and alcohol abuse, (3) sexual behaviors that cause sexually transmitted diseases and unintended pregnancies, (4) tobacco use, (5) inadequate physical activity, and (6) dietary patterns that cause disease (Kann et al., 1995). These problems are based in behaviors that can be prevented or changed. These behaviors usually are established during youth, persist into adulthood, are interrelated, and contribute simultaneously to poor health, education, and social outcomes.

The CDC's Youth Risk Behavior Survey of 1993 (CDC, 1995) found that 19.1 percent of all high school students rarely or never used a safety belt, 35.3 percent had ridden with a driver who had been drinking alcohol during the 30 days preceding the survey, 22.1 percent had carried a weapon during the preceding 30 days, 80.9 percent had ever consumed alcohol, 32.8 percent had ever used marijuana, and 8.6 percent had attempted suicide during the 12 months preceding the survey. Among high school seniors, 89 percent reported having used alcohol, and 39 percent of seniors reported having five or more drinks at one time in the past two weeks. In addition, 53 percent of students in grades 9–12 have had sexual intercourse, and 19 percent of them have had four or more sexual partners



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