Introduction

There are more than one million adolescents in New Jersey ages 10 through 19. As adolescents move through the transitional years from childhood to adulthood, they face innumerable pressures, decisions, and challenges from both their peers and the adults in their lives. The decisions they make regarding smoking, drug use, drinking, sexual activity, academic performance, and social behavior can have a profound impact on both their health and their futures.

Traditionally, the family is the social institution that fosters the adolescent's sense of community values. Most families still perform that function successfully, but changes in social structure, such as the entry of women into the workforce, the increase in divorces and single-parent households, and the dispersal of the extended family, have challenged families' abilities to provide the guidance and supervision that young people need. Adolescents, particularly economically disadvantaged urban minority and rural youth, can become isolated in subcultures. These groups can promote risk-taking behaviors resulting in disproportionate health problems. The leading problems influencing the health and well being of adolescents in New Jersey are: injuries, both intentional and unintentional; substance abuse (alcohol, tobacco, marijuana, cocaine and other drugs); unintended pregnancy; and sexually transmitted diseases (including HIV).

It is difficult to reach high risk youth with effective health promotion and disease prevention messages and programs. The outlook for achieving year 2000 goals for adolescents is mixed, but New Jersey will continue to invest in the most promising strategies for persuading young people to avoid risky behaviors.

Outlook For Reaching Specific Objectives:
	Achieve target:		Likely	Unlikely	Uncertain
3A.	Reduction in birth rates for:
		total females, 10-14
		minority, 10-14
3B.	Reduction in birth rates for:
		total females, 15-19
		minority, 15-19
3C.	Increase in females receiving family planning services
3D.	Reduction in smoking by high school students
3E.	Reduction in high school students who use:
		alcohol
		cocaine
		marijuana
3F.	Reduction in motor vehicle fatality rate for youth
3G.	Reduction in suicide rate for young white males
3H.	Reduction in homicide rate for young minority males
3I.	Reduction in alcohol-related motor vehicle fatality rate for youth

Data Update

3A. Reduce the total number of births per 1,000 females aged 10 through 14 to:

0.7 in total females
2.0 in minority females

Achieve target:	Likely	Unlikely	Uncertain
total females, 10-14
minority females, 10-14

Recent declines in the birth rate in the total population of females 10 through 14 years of age, and, in particular, in minority females in this age group, make it appear likely that the year 2000 objectives will be met. Although more years of data are needed to confirm the trend toward a decreased birth rate in this age group, this decline has also been identified in other states and in the nation as a whole.

3B. Reduce the total number of births per 1,000 females aged 15 through 19 to:

25.7 in total females
55.8 in minority females

Achieve target:	Likely	Unlikely	Uncertain
total females, 15-19
minority females, 15-19

The birth rate among 15 through 19 year old females, while substantially higher than that for 10 through 14 year olds, has been generally decreasing for most of the 1990s, and in recent years has declined substantially reaching below its 1985 level for the total population for the first time in 1996. If current trends continue, the year 2000 birth rate objectives for females in this age group, including minority females, are likely to be achieved.

3C. Increase the number of adolescent females who receive family planning services as a percentage of all adolescent females in need of these services to:

50.0 percent

Achieve target:	Likely	Unlikely	Uncertain

*Adolescent females who were provided publicly funded family planning services (the numerator in these percentages) were defined for the purpose of 1987 and 1990 computations as females under the age of 20. In 1995, the numerator was defined as females under the age of 21. Therefore, the percentages for 1987 and 1990 are not comparable to the 1995 percentage.

Even taking into account the definitional change that occurred in 1995, the percentage of adolescent females who are receiving family planning services relative to those who need them appears to be declining. The year 2000 objective will not be met if this trend continues. It should be noted that, given the decline in adolescent birth rates, this reduction in the proportion of adolescent females receiving family planning services is counter-intuitive. It may be possible that other programs directed toward prevention of teenage pregnancy have had an effect on birth rates among adolescent females.

3D. Reduce the prevalence of cigarette smoking among high school students to:

20.0 percent

Achieve target:	Likely	Unlikely	Uncertain

The percentage of high school students who say that they are currently smoking is obtained from surveys conducted every three years by the New Jersey Department of Law and Public Safety. The percentages include students who report smoking "on occasion" as well as those who say they smoke from "less than" to "more than" half a pack of cigarettes per day. Results from these surveys have fluctuated over the recent past, but have shown no indication of a decline in the percentage of students who currently smoke. The data above do not reflect the potential impact of more recent interventions to reduce youth smoking. However, since the 1995 prevalence of smoking was about twice the target level, it seems unlikely that the objective will be met by the year 2000.

3E. Decrease the percentage of high school sophomore, juniors and seniors who have used the following substances in the past 30 days to:

37.0% for alcohol
9.0% for marijuana
1.6% for cocaine

Achieve target:	Likely	Unlikely	Uncertain
alcohol
marijuana
cocaine

The percentage of high school students who reported having used alcohol in the thirty days prior to interview in the Department of Law and Public Safety's surveys declined steadily from 1980 through 1992. It appeared likely that the year 2000 objective would be met until the 1995 results indicated a reversal in the downward trend. Due to the increase in reported use of alcohol in the most recent survey, achievement of the objective is now uncertain.

A similar trend occurred in the reported use of marijuana by high school students. The percentage of students who said they had used marijuana in the past 30 days dropped dramatically from 36 percent in 1980 to 13 percent in 1992, then increased in 1995 to 22 percent. It does not now seem likely that the year 2000 target will be met.

The percentage of students who report using cocaine is small relative to the reported use of alcohol and marijuana, and this percentage also declined during the 1980s. It appears from the past two surveys, however, that the percentage of students using cocaine is increasing, and this objective also will not be met.

3F. Decrease the number of deaths per 100,000 population aged 15 through 19 caused by motor vehicles to:

15.0

Achieve target:	Likely	Unlikely	Uncertain

Over the past decade the overall trend in the death rate from motor vehicle-related injuries among the 15 through 19 year age group has been a declining one, and the year 2000 objective was actually achieved in 1994. Despite substantial fluctuation in the rate from year to year, which makes it difficult to predict the trend, it now seems more likely than not that the year 2000 target will be achieved.

3G. Decrease the number of suicides per 100,000 white males aged 15 through 19 to:

5.7

Achieve target:	Likely	Unlikely	Uncertain

Although the suicide death rate among young white males has declined since 1985 and virtually reached the target level in 1992 and 1994, the rate tends to fluctuate from year-to-year. This is due to the relatively small yearly number of suicides in this age group. However, in order to achieve the year 2000 objective, rates for some years must be lower than the target rate. This happened in 1996, and it now seems likely the year 2000 target can be achieved.

3H. Decrease the number of homicides per 100,000 minority males aged 15 through 19 to:

30.0

Achieve target:	Likely	Unlikely	Uncertain

The death rate from homicide among 15 through 19 year-old minority males varies widely from year to year in New Jersey, due to the relatively small numbers of deaths from this cause. There may be other factors which are related to the fluctuations in the number of homicides in this age group. The year 2000 target was essentially met in 1990, but has increased dramatically since then. If current trends continue, this objective will not be achieved by the year 2000.

3I. Decrease the number of deaths per 100,000 youth aged 15 through 19 due to alcohol-related motor vehicle fatalities to:

2.0

Achieve target:	Likely	Unlikely	Uncertain

Deaths in motor vehicle accidents in which alcohol was involved have decreased dramatically among the youngest drivers over the past ten years. In fact, the year 2000 objective was reached in 1994. However, in the following two years, the death rate rose to its highest point since 1990. Some of this fluctuation may be due to the relatively small numbers involved. Data from subsequent years will be required to determine whether the trend has actually reversed. At this time, the prospects for reaching the target level for a sustained period of time are uncertain.

Discussion

The problems and issues that adolescents face do not occur in isolation. Efforts to improve the health status of our youth must incorporate a broader-based risk reduction approach. The same teen at risk for contracting STDs may also be at risk for HIV infection, teen pregnancy, injury, and substance use. Collaboration among government agencies, health care providers, community-based agencies, parents and other concerned individuals can bridge the gaps between programs and service systems and address issues comprehensively.

Lack of access to appropriate and regular sources of primary health care is a major health concern for many adolescents. This is due to, or compounded by, the fact that many adolescents do not have health insurance. The new NJ KidCare program offers comprehensive, low-cost insurance coverage to all eligible uninsured children through 18 years of age living in families with incomes under 200 percent of the federal poverty level.

Teen pregnancy is a critical public health issue. There are nearly 10,000 births to 10 through 19 year-olds in New Jersey each year. Adolescent pregnancy affects the health, education, social and economic future of both the mother and her child. Pre-teen and teenaged mothers are less likely to complete high school or college and are more likely to live in poverty and require public assistance. Pre-teen and teen mothers have higher rates of low birth weight babies than other age groups. Adolescents are less likely to seek out prenatal care, yet prenatal care remains the most effective intervention in promoting the birth of a healthy child.
While rates of births to adolescents have declined substantially, with the most dramatic decreases occurring among young minority females, the numbers are still too high. The disparity in teen birth rates between minorities and the total population also remains too large. Education, abstinence promotion, peer and adult support, and access to contraception are prevention methods that have contributed to the declining rates of adolescent pregnancy in New Jersey. State-funded agencies that provide confidential family planning health and education services to adolescents and women are available in each county.

There are also Healthy Mothers, Healthy Babies initiatives which provide special outreach programs to adolescents in cities with high rates of adolescent pregnancy. In addition, new programs for adolescent parents have been created in Newark and Cumberland County, the areas with the highest adolescent pregnancy rates. Besides educating the adolescent mothers in how to be good parents and care for their children, these programs also aim to prevent repeat pregnancies in these young women.

Adolescents need to avoid not only risky behaviors that result in pregnancy, but also those that lead to sexually transmitted diseases, particularly HIV/AIDS. One technique that has proven successful in influencing adolescent behavior is using teens to bring health messages to other teens. In 1996, the Department launched a high school peer leadership program for HIV and AIDS, which trains high school students to educate their peers about behaviors that increase the risk of HIV infection. Each year 800 students from over fifty schools receive training in peer education.

There is a high correlation between alcohol and drug use and unintentional injuries and violence. Unintentional injuries, including motor vehicle fatalities, accidental poisoning and drowning, are the leading cause of death for all youth ages 10 through 21. However, among black males aged 10 through 21, homicide is the leading cause of death. Unfortunately, the most recent data indicate increases in the use of tobacco, alcohol, and illegal drugs among adolescents, reversing a long term trend of declining use of these substances.

Recognizing that it is critical to begin educating adolescents before they reach high school age on the need to avoid substance use, in 1997 the Department launched a middle school peer leadership program focusing on tobacco, alcohol and drugs. This program builds on the same principle that has proven successful among high school students for HIV/AIDS education. As of December, 1998, 74 schools have participated in the program. Over 900 adolescents and 225 adults have been trained.

Reducing tobacco use by adolescents has been a major focus of recent Department efforts. In addition to the middle school program, New Jersey significantly increased its cigarette excise tax, from $0.40 to $0.80 per pack in 1998. Teenagers have been proven to be especially sensitive to tobacco price increases, and it is expected that this measure will help reduce teen smoking. For several years the state has also stepped up its enforcement of tobacco age-of-sale laws, greatly increasing retailer compliance with restrictions on sales of these products to minors. Finally, in 1997 the Department launched an anti-smoking media campaign, targeted to teens and employing print, radio, TV and Internet outlets.

With the acceptance by New Jersey and 45 other states of a settlement of lawsuits against the tobacco industry to recover the costs of publicly-funded health care for smokers, New Jersey will begin receiving roughly $300 million per year for 25 years, beginning in 2000. Governor Whitman has called for dedicating all of these funds to health purposes, including a comprehensive tobacco control program. Building on its current initiatives the Department is developing a major tobacco control effort, to be implemented upon receipt of the tobacco settlement funds.

In addition to these statewide efforts, the Department also supports programs targeted to areas of need. Community Partnership for Healthy Adolescents grants have been awarded to community-based coalitions in 11 communities to assist in coordinating existing adolescent health programs, and to expand outreach and health promotion activities. There are also School-Based Youth Services programs in 30 New Jersey schools, which make it easier for adolescents to get access to health services.