ISSN 1363-8394

Journal of Adolescent Health and Welfare

The Journal of the Youth Support

British Society for Adolescent

Health and Welfare

Volume 14- No 2 –

Summer/Autumn 2001

Incorporating the Newsletter of the International Regional Chapter of the Society for Adolescent Medicine

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Dear Colleagues,

As I put together this issue of the Journal world events are dominated by the terrorist tragedy in New York and Washington. As I write thousands are still missing and it will take decades for the damage  physical and psychological to be healed for the American people, for youth in the USA and for the millions of us who have watched in horror and disbelief as the events unfold.

It therefore seemed appropriate that we should devote this issue of the journal to looking at some comments and words which resonate with this healing process. Our thoughts and sympathy are with all those affected.

The pieces included are –

New York September 11th 2001 - A comment from a young person Usman Farman who survived the tragedy but who worked at the World Trade Center in building #7.  Resilience and A Butterfly – Do we have to go through adversity?

Working with What You Have Left poignantly apt at this time when so many are working with what they have left after disasters such as the New York and Washington terrorist attacks.

Check out our websites publications www.youthsupport.net/YSBOOKS

The journal is on line at www.youthsupport.net/YSBOOKS/journal.htm

Conference details are on www.youthsupport.com

Best wishes -           Diana Birch

Director Youth Support

New York September 11th 2001

A comment from a young person who survived the tragedy.

Youth Survives

My name is Usman Farman and I graduated from Bentley with a Finance degree last May. I am 21 years old, turning 22 in October; I am Pakistani, and I am Muslim. Until September 10th 2001, I used to work at the World Trade Center in building #7. I had friends and acquaintances who worked in tower #1 right across from me. Some made it out, and some are still unaccounted for. I survived this horrible event.

I’d like to share with you what I went through that awful day, with the hopes that we can all stay strong together; through this tragedy of yet untold proportions. As I found out, regardless of who we are, and where we come from, we only have each other.

I commute into the city every morning on the train from New Jersey. Rather, I used to. I still can’t believe what is happening. That morning I woke up and crawled out of bed. I was thinking about flaking out on the train and catching the late one, I remember telling myself that I just had to get to work on time. I ended up catching the 7:48 train, which put me in Hoboken at 8:20 am. When I got there I thought about getting something to eat, I decided against it and took the PATH train to the World Trade Center. I arrived at the World Trade at 8:40 in the morning. I walked into the lobby of building 7 at 8:45, that’s when the first plane hit.

Had I taken the late train, or gotten a bite to eat, I would have been 5 minutes late and walking over the crosswalk. Had that happened, I would have been caught under a rain of fire and debris, I wouldn’t be here talking to you. I’d be dead.

I was in the lobby, and I heard the first explosion; it didn’t register. They were doing construction outside and I thought some scaffolding had fallen. I took the elevators up to my office on the 27th floor. When I walked in, the whole place was empty. There were no alarms, no sprinklers, nothing. Our offices are, or rather, were on the south side of building seven. We were close enough to the North and South Towers, that I could literally throw a stone from my window and hit the North tower with it.

My phone rang and I spoke with my mother and told her that I was leaving, at that moment I saw an explosion rip out of the second building. I called my friend in Boston, waking her up and told her to tell everyone I’m okay, and that I was leaving. I looked down one last time and saw the square and fountain that I eat lunch in, was covered in smoldering debris. Apparently, I was one of the last to leave my building, when I was on the way up in the elevators; my co-workers from the office were in the stairwells coming down. When I evacuated, there was no panic. People were calm and helping eachother; a pregnant woman was being carried down the stairwell.

I’ll spare the more gruesome details of what I saw, those are things that no-one should ever have to see, and beyond human decency to describe. Those are things which will haunt me for the rest of my life, my heart goes out to everyone who lost their lives that day, and those who survived with the painful reminders of what once was. Acquaintances of mine who made it out of the towers, only got out because 1000 people formed a human chain to find their way out of the smoke. Everyone was a hero that day.

Evacuation

We were evacuated to the north side of building 7. Still only 1 block from the towers. The security people told us to go north and not to look back. 5 city blocks later I stopped and turned around to watch. With a thousand people staring, we saw in shock as the first tower collapsed. No-one could believe it was happening, it is still all too-surreal to imagine. The next thing I remember is that a dark cloud of glass and debris about 50 stories high came tumbling towards us. I turned around and ran as fast as possible. I didn’t realize until yesterday that the reason I’m still feeling so sore was that I fell down trying to get away. What happened next is why I came here to give this speech.

I was on my back, facing this massive cloud that was approaching, it must have been 600 feet off, everything was already dark. I normally wear a pendant around my neck, inscribed with an Arabic prayer for safety; similar to the cross. A hasidic Jewish man came up to me and held the pendant in his hand, and looked at it. He read the Arabic out loud for a second. What he said next, I will never forget. With a deep Brooklyn accent he said “Brother, if you don’t mind, there is a cloud of glass coming at us, grab my hand, lets get the hell out of here”. He helped me stand up, and we ran for what seemed like forever without looking back. He was the last person I would ever have thought, who would help me. If it weren’t for him, I probably would have been engulfed in shattered glass and debris.

I finally stopped about 20 blocks away, and looked in horror as tower #2 came crashing down. Fear came over me as I realized that some people were evacuated to the streets below the towers. Like I said before, no-one could have thought those buildings could collapse. We turned around and in shock and disbelief and began the trek to midtown. It took me 3 hours to get to my sisters office at 3 avenue and 47th street. Some streets were completely deserted, completely quiet, no cars, no nothing… just the distant wail of sirens. I managed to call home and say I was okay, and get in touch with co-workers and friends whom I feared were lost.

We managed to get a ride to new jersey. Looking back as I crossed the George Washington Bridge, I could not see the towers. It had really happened.

As the world continues to reel from this tragedy, people in the streets are lashing out. Not far from my home, a Pakistani woman was run over on purpose as she was crossing the parking lot to put groceries in her car. Her only fault? That she had her head covered and was wearing the traditional clothing of my homeland. I am afraid for my family’s well-being within our community. My older sister is too scared to take the subway into work now. My 8 year old sister’s school is under lockdown and armed watch by police.

Violence only begets violence, and by lashing out at each other in fear and hatred, we will become no better than the faceless cowards who committed this atrocity. If it weren’t for that man who helped me get up, I would most likely be in the hospital right now, if not dead. Help came from the least expected place, and goes only to show, that we are all in this together … regardless of race, religion, or ethnicity. Those are principles that this country was founded on.

Please take a moment to look at the people sitting around you. Friends or strangers, In a time of crisis, you would want the nearest person to help you if you needed it. My help came from a man who I would never have thought would normally even speak to me. Ask yourselves now how you can help those people in New York and Washington. You can donate blood, you can send clothing, food, and money. Funds have been setup in the New York area to help the families of fallen firefighters, policemen, and emergency personnel. The one thing that won’t help, is if we fight amongst ourselves, because it is then that we are doing exactly what they want us to do, and I know that nobody here wants to do that.

Brother take my hand

My name is Usman Farman and I graduated from Bentley with a Finance degree last May. I am 21 years old, turning 22 in October; I am Pakistani, and I am Muslim, and I too have been victimized by this awful tragedy. The next time you feel angry about this, and perhaps want to retaliate in your own way, please remember these words:

“Brother, if you don’t mind, there is a cloud of glass coming at us, grab my hand, lets get the hell out of here.”

Resilience and A Butterfly

A man found a cocoon for a butterfly. One day a small opening appeared, he sat and watched the butterfly for several hours as it struggled to force its body through the little hole. Then it seemed to stop making any progress. It appeared as if it had gotten as far as it could and could go no farther. Then the man decided to help the butterfly.

He took a pair of scissors and snipped the remaining bit of the cocoon. The butterfly then emerged easily. Something was strange. The butterfly had a swollen body and shriveled wings. The man continued to watch the butterfly because he expected at any moment, the wings would enlarge and expand to be able to support the body, which would contract in time. Neither happened. In fact, the butterfly spent the rest of its life crawling around with a swollen body and deformed wings. It was never able to fly.

What the man in his kindness and haste did not understand, was that the restricting cocoon and the struggle required for the butterfly to get through the small opening of the cocoon are God’s way of forcing fluid from the body of the butterfly into its wings so that it would be ready for flight once it achieved its freedom from the cocoon. Sometimes struggles are exactly what we need in our life.

If God allowed us to go through all our life without any obstacles that would cripple us we would not be as strong as what we could have been. Not only that, we could never fly.

* CONFERENCE ROUND UP *

Our conferences at the Royal College of Physicians in October 1996 and 1998 have now both been published as proceedings books which are available – see below. Get your personal copy now!!

Proceedings of our conference 1996

Youth - Our Resource for the Future

Now available from Youth Support -£5 by mail order –

13 High Street Penge SE20 7HJ

FAX 44 181 325 8647 or

E mail us at [email-masked]

Proceedings of our International conference October 1998

Youth – Conserving Our Resource for the Future

Available now from above address - £8

Proceedings of our International conference October 2000

Youth – The Promise of a new Millennium?

Available now from above address - £8

Sign up for London 2002 – www.youthsupport.com

Working with what you have left

On Nov. 18, 1995, Itzhak Perlman, the violinist, came on stage to give a concert at Avery Fisher Hall at Lincoln Center in New York City.

If you have ever been to a Perlman concert, you know that getting on stage is no small achievement for him. He was stricken with polio as a child, and so he has braces on both legs and walks with the aid of two crutches. To see him walk across the stage one step at a time, painfully and slowly, is an awesome sight. He walks painfully, yet majestically, until he reaches his chair. Then he sits down, slowly, puts his crutches on the floor, undoes the clasps on his legs, tucks one foot back and extends the other foot forward. Then he bends down and picks up the violin, puts it under his chin, nods to the conductor and proceeds to play.

By now, the audience is used to this ritual. They sit quietly while he makes his way across the stage to his chair. They remain reverently silent while he undoes the clasps on his legs. They wait until he is ready to play.

But this time, the night I was there, something went wrong. Just as he finished the first few bars, one of the strings on his violin broke. You could hear it snap -- it went off like gunfire across the room. There was no mistaking what that sound meant. There was no mistaking what he had to do. People who were there that night thought to themselves "We figured that he would have to get up, put on the clasps again, pick up the crutches and limp his way off stage -- to either find another violin or else find another string for this one."

But he didn't.

Instead, he waited a moment, closed his eyes and then signaled the conductor to begin again. The orchestra began, and he played from where he had left off. And he played with such passion and such power and such purity as they had never heard before.

Of course, anyone knows that it is impossible to play a symphonic work with just three strings. I know that, and you know that, but that night Itzhak Perlman refused to know that. You could see him modulating, changing, recomposing the piece in his head. At one point, it sounded like he was de-tuning the strings to get new sounds from them that they had never made before.

When he finished, there was an awesome silence in the room. And then people rose and cheered. There was an extraordinary outburst of applause from every corner of the auditorium. We were all on our feet, screaming and cheering, doing everything we could to show how much we appreciated what he had done.

He smiled, wiped the sweat from this brow, raised his bow to quiet us, and then he said -- not boastfully, but in a quiet, pensive, reverent tone, "You know, sometimes it is the artist's task to find out how much music you can still make with what you have left."

What a powerful line that is. It has stayed in my mind ever since I heard it. And who knows? Perhaps that is the definition of life -- not just for artists but for all of us. Here is a man who has prepared all his life to make music on a violin of four strings, who, all of a sudden, in the middle of a concert, finds himself with only three strings; so he makes music with three strings, and the music he made that night with just three strings was more beautiful, more sacred, more memorable, than any that he had ever made before, when he had four strings.

So, perhaps our task in this shaky, fast-changing, bewildering world in which we live is to make music, at first with all that we have, and then, when that is no longer possible, to make music with what we have left.

Jack Riemer, Houston Chronicle, February 10, 2001

- International Chapter News -

News of the International Regional Chapter (IRC) of SAM

(Society for Adolescent Medicine)

Co Chairs - Diana Birch   Gustavo Girard  Treasurer Aric Schichor

London          Buenos Aires                     Connecticut

England          Argentina                           USA

Workshops /  Institutes  -

San Diego March 2001

SAM meeting March 2001

Luncheon - International Regional Chapter (IRC) SAM

‘Strengths of Youth – Protective Factors?’

In this session we considered a variety of different challenges which Young People face in growing up and entering adulthood. Rather than looking at the problems and difficulties from the common perspective of the fate of those who have ‘fallen by the wayside’ we considered the positive attributes of those who weather the storms of childhood and adolescence and emerge as fulfilled and productive adults.

‘Strengths of Youth – Protective Factors?’

Notes on the International Regional Chapter workshop 2001

Introduction

During the workshop we consider a variety of different challenges which Young People face in growing up and entering adulthood.  Rather than looking at the problems and difficulties from the common perspective of the fate of those who have ‘fallen by the wayside’ we will consider the positive attributes of those who weather the storms of childhood and adolescence and emerge as fulfilled and productive adults.

Why do teens NOT become young mothers? Why do abused children NOT follow the paths of the victim or allow themselves to be carried along the ‘cycle of abuse’ to harming their own kids? What factors help a young person from a deprived or abusive background to avoid the fate which statistics and professional experience would tend to commit to them. We will in the main be dealing with universal factors applicable to youth throughout the world-albeit influences by local cultures and values.

And lastly, but the most importantly - How can we enhance and encourage these factors? How can we bring them to the fore in our less fortunate kids? How can we utilize these strengths in helping youth as a whole to survive the world, which we have created for them?

Questions and General Considerations

Resilience  - Can we use another word? What do we mean?

Coping skills / Are we looking at survival – but quality of life important

Inherent characteristics or developed responses – Resilience to what?

Regarded loosely as a universal panacea the “resilience” of youth, but basically you develop resilience by being knocked, resilience is in relation to the assaults and problems in life. Just as our bodies develops somatic strength from physical challenge, training, weight lifting etc. so our psyche develops emotional strength from learning to survive hurt and pain.– This sentiment is expressed in phrases such as “creating opportunity out of challenge”  (psych – make use of your breakdown – make use of your crisis)

Is there a ‘passive’ and ‘active’ model?

Is the process necessarily positive?

Is it desirable to be “emotionally strong” implying a certain coldness, distancing, blocking perhaps.  Is the learning process maladaptive.  Each concept, the physical and emotional, can be taken to extremes.

In order to develop emotionally one does not need to take this to extremes, the child does not need to be abused, neglected or abandoned.  It is when this happens that the response to abuse, the survival mechanism, coping strategy, the resilience can be maladaptive

The lower the ‘energy level’ i.e. less able to adapt, lower resilience and flexibility – the higher the passivity with more internalization of feelings – anger hatred, lower self worth, lower coping skills and thus the more likelihood of self hatred, self harming behaviors.

Classic view

Bob Blum describes 8 risk behaviors for development of resilience -

emotional distress,                                            alcohol use,

suicidal thoughts and attempt                 marihuana use.

cigarette use,                                                    Violence involvement,

age of sexual debut or first intercourse   and pregnancy.

What are the things that are associated with protection?.

Family factors connectedness with parent, Parent expectations. families suicide attempts, family income, family structure, (family disconnectedness)

School factors + ve connectedness at least one adult who cares and treated fairly in school.

-ve Risk  doing poorly at school, attention problems on school, held back in school physically out of synch, early and late maturers much high risk school failure is a major public health problem.

Individual factors working more than 20 hrs per week associated with every negative risk behavior.

Looking at it from a different  perspective –

Coping mechanisms / Survival skills  …

Passive                                                                      Active

………. ®   energy  ® ……….

Order                                                                             Chaos

Retreat                                                                           Action

Status quo                                                                     Change

‘Belonging’ – Feeling part of –

Conventional                                Unconventional (find own group)

Parenting

From parent                                From other –Fagin type

From Child (including role reversals)

Resilience in practice –

Richard Mackenzie and his team from Los Angeles Hollywood Teen Community Project led by Jena Bauman presented their work and two young women who had been part of their programme shared their personal experiences.

Jena Bauman, MPH, is the HTCP Project Director. Jena’s role is the overall development and management of HTCP, including administration, planning and implementation, evaluation, advocacy and collaborative activities. Jena has worked in public health with a focus on children, youth and families for thirteen years. She has worked with Peace Corps/Paraguay, Head Start programs nationwide and farm worker clinics in the Northwest U.S. Before HTCP, Jena directed a teen pregnancy prevention program at Los Angeles High and Mount Vernon Middle School.

Facts -  The Hollywood Teen Community Project (HTCP)

•     HTCP is funded by The California Wellness Foundation as part of its ten-year teen pregnancy prevention campaign -to reduce rates of teen pregnancy in California.

•     The division of Adolescent Medicine at Children’s Hospital Los Angeles is the lead agency for HTCP.

•     Hollywood is one of six sites in California funded through this initiative to implement its Community Action Plan to reduce teen pregnancy.

•     Hollywood was chosen due to its status as a hot spot” for teen pregnancy and its demonstrated capacity to respond to this issue with organized community leadership, commitment and involvement of public officials, agencies, businesses and civic groups, and high quality services for youth and their families.

•     To reduce teen pregnancy in Hollywood, HTCP has targeted four key conditions for change:

1.   Young people must receive comprehensive sexuality education and information that values healthy adolescent sexuality (e.g. responsibility for own behavior, expressing love and intimacy in developmentally appropriate ways, decisions about initiating sexual intercourse).

2.   Teens must have access to and know how to use family planning services and contraception.

3.   Teens must have opportunities to develop new skills and be exposed to expanded life options that allow them to develop a vision for their future other than parenthood at an early age.

4.   Teens must have adult and community involvement and support (e.g. open lines of communication with adults about healthy sexuality).

•     To accomplish these key changes, HTCP:

~Provides education and information related to healthy sexuality

~Engages adults and the community in teen pregnancy prevention activities and promotes adult-youth communication about sexuality and decision-making

~ Increases access to family planning and contraceptives

~    Promotes opportunities to motivate and expand life options for youth so youth can develop a vision for their future other than parenthood at an early age.

•     HTCP is driven by the commitment, hard work and vision of all sectors of the Hollywood community, including youth and adult residents, schools, agencies, businesses, faith and civic groups, and political officials.

Tracy Levine, MPH, is the HTCP Community Coordinator. Tracy’s work involves direct and daily contact with community residents and partners, as well as program planning and implementation activities. A Los Angeles native, Tracy comes to HTCP with seven years of experience as a health educator and fifteen years of experience working with youth. Tracy is a bilingual Spanish speaker and has had many cross cultural work experiences, most recently as a Peace Corps Volunteer in Ecuador, South America.

Work with Youth in Hollywood area of LA – issues re teenage pregnancy -

FACTS:     TEEN PREGNANCY IN HOLLYWOOD*

•     Hollywood is a “hot spot” for teen pregnancy in California

•     83% of Hollywood teens think teen pregnancy is a very serious problem

•     94% of Hollywood adults think teen pregnancy is a very serious problem

•     92% of adults think that information about how to talk to their children about sex education, teen pregnancy, and family planning issues would be very useful

•     86% of adults do not know any places, classes or workshops for adults where they can learn about sex and sexuality

•     50% of teens have not talked to their parents/caregivers about sex, birth control or pregnancy. Of those who did, the teen was the one more likely to initiate the conversation

•     92% of adults and 94% of teens believe that teens should be given information to protect themselves from pregnancy and STDs

•     96% of adults and 98% of teens reported they believe children should receive age-appropriate sexuality education in the schools

•     96% of teens think sex education should discourage teens from having sex, yet 95% of those teens also think that sex education should encourage teens that are sexually active to use protection to prevent pregnancy and disease

•     61% of teens and 70% of adults do not know where to go, or where to send a teen for birth control

•     Over 70% of adults and 48% of teens do not know anyone they could ask, or any place a teen can go for help in finding a job or choosing a career

* Information from the Hollywood Teen Community Project Baseline 5urvey. This random door-to-door survey was conducted in July 1999 to 287 Hollywood households where at least one adult and one teen resided.

There is a need to look at the individual and the population level – the need to work on improving conditions in the community and environment and at the same time to work with individuals

The program is a community wide facility – on an individual level it instills confidence in the youth and that is enhanced by youth sharing and presenting in meetings such as this and to the media.  Youth are involved by ‘working’ for the project, by becoming peer educators, by helping produce a magazine and being involved in youth theatre projects.

We need to look at the entire environment and the whole community in terms of considering the multiple contexts in which youth engage.  The whole lives of the young people need to be taken into account rather than focusing on individual behaviors.

Work can be with the individual and with the family or parents.  Youth and adults can be brought together by doing things and learning together – for example adults and youth involved simultaneously in sexual education, learning about condom use and overcoming barriers and embarrassment together.

Often the programs act as catalysts for action.

Monica –   Monica considered her life style and her aspirations in relation to the experiences of her peers and friends who had become pregnant and decided that this was not for her.  She had younger sisters and wanted to ensure that they had advice and services so that they also would be protected.  Monica found herself in a situation where she could have joined a gang and gone on a different path – but made a positive decision to avoid that and wanted to better herself.  She studied and got herself computer literate and has been involved in the project and peer counseling.  She had a vision for what she wanted out of life and was not going to be diverted from this vision by the problems around her – she had other ideas.

Discussion  - discussion of Monica’s points centred on the need to be open and honest with teens and allow them to achieve their potential.  Some have capacity to pull themselves out of difficult situations and others need our support.  But without trust they cannot accept that support.

Arlene – aged 18   Arlene had an aim to be a pediatrician but instead fell into a pattern of rebellion, acting tough, petty crime and violence.  She was kicked out of school, ended up in court and had no thought about others feelings.

Her turning point was when she realized that her mother was unwell and suddenly understood how severely her mother was affected – she realized that she had put her mother through a great deal of stress and that because of her, mother had spent a birthday in court and had to put up with many hardships caused by her daughter’s behavior.

It was at this point that she made a conscious decision to change and could pinpoint the day that she made this change in 1998.  She then became a good student, is aiming at becoming a neuro-psychologist – like the one who treated her mother.  She is actively engaged in the program and is proud that she is not pregnant, she has goals in life, she is a peer educator and a leader and people look up to her – she changed her life.

Arlene showed she had the potential and ability to make positive changes in her life.  She believes in herself.

Discussion focused on - What do we do for teens who do not have the ability to make that decision for themselves?

Question?  Why did Monica decide not to join gang?  What was the factor that made the difference?

She felt that her own goals were more important – that she wanted to ‘make good’ and better herself to be able to ‘get out’ of her environment to something better – gangs and such would detract from her goals and ideals which were too valuable for her.

The question remains – how did she come to believe in those goals and how can we foster them in others?

For Arlene – she became tough and disruptive because she was bullied and so needed to be tough back -–there was an element of revenge in what she did – paying back and being tough back.

Comments – intervention at this level might vary depending on the level of family support.  Do the youth have any support systems?

Both Monica and Arlene contribute to the magazine ‘UNITY’

UNITY Magazine: A Hollywood Teen Community Project Publication

•     UNITY is a publication of The Hollywood Teen Community Project at the division of Adolescent Medicine, Children’s Hospital Los Angeles.

•     UNITY magazine was envisioned, written and designed by HTCP youth with support from volunteer community consultants and HTCP staff.

•     UNITY s produced quarterly and is written by and for Hollywood youth with a focus on healthy adolescent sexuality and teen pregnancy prevention~

•     The UNITY mission statement, created by HTCP youth on October 29, 1999:

We the youth, want to reflect the hearts and minds of our peers in this community. Through UNITY magazine we want to pro vide youth with information dealing with life issues like sex, drugs, school; work and families. We want to help people be open-minded~ make healthy decisions, and understand how to maintain self-respect and awareness. We are doing this because we care about the Hollywood community and the future of its youth

•     The inaugural issue of UNITY was launched September 23, 2000.

•     UNITY s disseminated free of charge, with an anticipated circulation of 5,000. It has been distributed widely in Hollywood to youth, businesses, libraries, youth-serving agencies, schools (Hollywood, Los Angeles, Belmont and Fairfax High Schools) and in other community locales.

•     The response to UNITY has been overwhelmingly positive from community youth and adults, and from local youth-serving agencies interested in receiving additional copies of UNITYand getting involved with a UNlTY production.

An Article by Monica

An Article by Arlene

A note on Teen Suicide

The following press statement was issued by the AAP in connection with a press conference on April 3, 2000.

"AAP UPDATES POLICY ON ADOLESCENT SUICIDE WASHINGTON D.C. In light of a significant number of adolescent deaths from suicide in the United States, the American Academy of Pediatrics (AAP) has updated its policy on adolescent suicide to help pediatricians better recognize and treat the symptoms of depression and pre-suicidal behavior.

In 1997, there were 4,186 suicides among individuals ages 15 to 24 years old. And a 1995 National Youth Risk Behavior Survey of students in grades 7 through 12 indicated that nearly one-fourth of students had seriously considered attempting suicide during the 12 months preceding the survey, nearly 18 percent had made a specific plan and nearly 9 percent had made an attempt. Firearms were used in 67 percent of all adolescent suicides and are the leading cause of death by suicide.

The updated AAP policy, to be released at a news conference April 3 in

Washington D.C., recommends that pediatricians know the risk factors associated with suicide, routinely ask questions about depression and firearms in the home, and serve as a resource for parents and other community leaders on issues related to suicide.

Adolescents at high risk of suicide often have a history of depression, previous suicide attempt, a family history of psychiatric disorders (especially depression and suicidal behavior), family disruption, and certain chronic or debilitating physical disorders or psychiatric illness. Alcohol use has been associated with 50 percent of suicides. While suicide affects young people of all races and socioeconomic groups,15 to 19 year-old males have a suicide rate six times greater than females. Native American males had the highest suicide rate; African American females, the lowest. Homosexual and bisexual youth also have a high rate of suicide and attempted suicide. A statewide survey of students in grades 7 through 12 indicated that 28.1 percent of bisexual and homosexual males and 20.5 percent of bisexual and homosexual females had reported attempting suicide. Pediatricians are urged to work closely with families and health care professionals involved in the management and follow-up of those youths at risk of suicide, or those who have already attempted suicide."

WHO report on Teenage Prostitution.

Sex trade expanding in Asia
13 August 2001

Asia's sex industry is rapidly expanding and changing, threatening efforts to control the region's AIDS epidemic. More men are visiting sex workers, and in a wider variety of settings and areas, says a new report Sex Work in Asia by the World Health Organization (WHO).

The sex trade is spreading from traditional red light areas to suburbs, highways and international borders - wherever there is a high density or movement of people. Often, this growth is not accompanied by rising AIDS awareness. Indeed, it is believed that most commercial sex in Asia takes place without the use of condoms.

The report, presented in Hanoi, Viet Nam, at a WHO meeting on Condom Promotion in High-Risk Situations in the Region, highlighted the need for HIV prevention in the sex trade, which has long driven Asia's AIDS epidemic.

Although substantial improvements have been noted in Cambodia (HIV infections level are decreasing among young sex workers) and Thailand, sex workers remain highly vulnerable to HIV infection - in some urban areas in these countries as well as in India and Myanmar, nearly half the sex workers are infected.

The report notes that most sex workers are unable to insist on condom use. This is especially the case if they are victims of trafficking, migrants or are young, which is all too common across Asia:

·There is a high demand for the young, with the premium age for sex workers in Asia between 12 and 16. This partly reflects cultural norms as women marry in their teens in many parts of Asia.

·In Thailand, many sex workers start in their teens, and a third of foreign sex workers are less than 18 years old.

·In India, it is believed that 40% of female sex workers enter the trade before 18 years, while in Nepal about 35% begin sex work when they are 15.

·A study in Sri Lanka found that one-third of sex workers had been trafficked.

Profitable business

Greater mobility and changing sexual attitudes and economies have led to the sex trade expanding across Asia.

The spread of consumer cultures has had a dramatic impact, with sex becoming increasingly commercialized. "As economies develop, more men have greater spending power. They can spend this on commercial [sex]," the report notes.

The huge resurgence of prostitution in China and Vietnam has been associated with market-oriented policies, and has been boosted by migration.

Although sex tourism is highly visible, particularly in Bangkok and Angeles in the Philippines, it is a relatively small, although lucrative, market.

The domestic market is much larger but far less visible. Regular clients are often men separated from their families - transport workers, seafarers, soldiers, businessmen and migrants.

The industry is extremely profitable:

·In Indonesia, Malaysia, the Philippines and Thailand, it has been estimated to account for 2% -14% of gross domestic product (GDP).

·In Japan, the sex sector's annual earnings have been estimated to account for 1% - 3% of GDP.

·Between 1993 and 1995, profits from the Thai sex industry were believed to be three times as great as from the drugs trade.

Part-time work

The report notes that in all Asian countries, there is a clear move away from direct sex work towards "indirect" prostitution, where selling sex is a part-time occupation. Bars, fitness centres, clubs, massage parlours, karaoke bars, restaurants and hotels are now typical venues. Sex workers increasingly operate in private houses in suburbs, carry mobile phones and may themselves be mobile.

While many enter the trade because of economic hardship, a rising number sell sex because of relative deprivation - students, for example, may become part-time sex workers to help fund their education. Many of these women do not see themselves as sex workers or at high risk of HIV infection, and thus do not use condoms.

Prevention efforts are made especially difficult because with sex work illegal in virtually all of the region, it is often clandestine and hidden, making it difficult to disseminate condoms and advice about HIV/AIDS.

For more information, contact Mr Charles Raby, Public Information Officer at (632) 528 9983 or email: [email-masked]

The Journal of Adolescent Health and Welfare

is published by:-   Youth Support,

Tel No 0181 325 8162             Charity No 296080                  Fax No 0181 325 8647