CHAPTER 24

Adolescent Health Promotion and

Disease Prevention
Ralph]. DiClemente and Brenda Cobb

Introduction
Adolescence has traditionally been conceptualized as a period of transition between
childhood and adulthood. While adolescence is less studied and less understood than
other developmental periods, activities that youth begin to experience during this
transition have been described as risky behavior predisposing adolescents to injury
and illness. Thus, the development of interventions to promote the adoption and
maintenance of healthy behaviors requires a careful consideration of the develop-
mental characteristics of adolescence.
In accomplishing the maturational transition from childhood to adolescence,
increasing autonomy and identity formation are key developmental goals. For
some youth, the need for social acceptance may outweigh the perceived dangers of
participating in activities that place them in situations that could prove life-threat-
ening. While risk taking among adolescents has been noted as a necessary process
in the healthy development of youth (Jessor, 1991), many of these activities can also
result in devastating consequences for the individual, their family and society in
general.
This chapter describes the factors that contribute to the vulnerability of adoles-
cents, reviews the characteristics of risky behaviors in which adolescents engage, and
presents models that attempt to explain the initiation and maintenance of risky be-
haviors. Health promotion interventions designed to either prevent adolescents' in-
volvement in risky behaviors or reduce negative consequences of these behaviors are
also presented. And, finally, we describe directions for future research in the area of
adolescent health promotion and disease prevention.

RIllph]. DiClemente • Department of Behavioral Sciences and Health Education, Rollins School of Public
Health, Emory University, and Emory/Atlanta Center for AIDS Research, Atlanta, Georgia 30322.
Brenda Cobb • School of Nursing, UAB Center for Health Promotion, University of Alabama at Birming-
ham, Birmingham, Alabama 35294.
Handbook of Health Promotion and Disease Prevention, edited by Raczynski and DiClemente.
Kluwer Academic/Plenum Publishers, New York, 1999.

491
492 VII • SPECIAL POPULATIONS AND ISSUES

Sociodemographics of American Adolescents

The United States Bureau of the Census estimates that, as of December 1996, the
number of youth between ages 10 and 19 years was almost 38 million, representing
approximately 14% of the total US population; more than half (51%) were male. This
number has grown by 1.2 million since 1990. Most of this growth is among teenagers
10 to 14 years. Further, the proportion of minorities has increased over the past six
years (US Bureau of the Census, 1997a).
Family constellations have changed markedly over the past several decades.
Children living in single-parent families have increased from 11.3% in 1970 to 24.5%
in 1994; this change is most prominent among African Americans, changing from
33.6% in 1970 to 59.5% in 1994 (US Bureau of the Census, 1996a,b). These changes
have been predominately toward a growing number of mother-only families and
have implications for the availability of financial resources for youth. In 1995, the pro-
portion of married persons with children under 18 years of age living in poverty was
8.7% compared with 44.8% of female-headed families with children (Baughner &
Lamison-White, 1996). In 1995, 13.8% of the total population were living below
poverty (Baughner & Lamison-White, 1996). Table 1 displays the ethnic/racial distri-
bution by family type. Overall, poverty disproportionately plagues minority popula-
tions and female-headed households.
Children in married families among all ethnic/racial groups have a greater eco-
nomic advantage relative to those from single-parent families. In addition to single-
parent families, there also is an increasing number of mothers who work outside the
home (Bianchi, 1995), creating opportunities for youth to participate in risky activities
as a result of a lack of parental supervision during large portions of the day.
The poverty rate for children under the age of 18 was 20.8%, higher than any
other age group (Baughner & Lamison-White, 1996) and has increased from 17.1% in
1975 (US Bureau of the Census, 1997b). While the majority of poor children are white,
the rates for whites are markedly lower (11.7%) relative to African American (42%)
and Hispanic (40%) children (Baughner & Lamison-White, 1996). Youth under 18
years of age were particularly vulnerable in the South, as this region had the highest
poverty rates for this age group (23.5%).
Poverty may not, in and of itself, create a risk factor for adolescents' participa-
tion in risky activities. However, poverty can force families to live in neighborhoods
in which there is a high prevalence of crime, violence, and substance use, which may
negatively impact the development of youth (Brooks-Gunn, Duncan, Klebanov, &
Sealand, 1993; Crane, 1991). Approximately 5% of all children in the United States live
in poor neighborhoods [US Department of Health and Human Services (USDHHS),

Table 1. Ethnic/Racial Distribution by Family Type

Caucasian African American Hispanic

Population below poverty level 11.2% 29.3% 30.3%

Two-parent families below poverty level 9.6% 28.5% 29.2%
Single-parent families below poverty level 29.7% 48.2% 52.8%
Youth < 18 years old below poverty level 16.2% 41.9% 40.0%
Married couple with child < 18 years old 7.0% 9.9% 22.6%
Female head of household with child < 18 35.6% 53.2% 7.3%