CONNECTIONS THAT MAKE A DIFFERENCE
"Risk-Proofing" Youth in a High Risk Society

by
Gary L. Hopkins, M.D., Dr.P.H. & Bruce Heischober, M.D.
with Karen Flowers
Gary L. Hopkins, M.D., Dr.P.H., is professor of Behavioral Science, Andrews University and Assistant Clinical Professor of Health Promotion and Education, School of Public Health, Loma Linda University. He is the director of the Center for Adolescent Health Behavior Research and director of the Institute for the Prevention of Addictions.
Bruce Heischober, M.D., holds the positions of Attending Physician, Emergency Department, Loma Linda Medical Center and Assistant Professor, Department of Emergency Medicine, Loma Linda University. He also serves as Medical Director, Chemical Dependency Services, San Antonio Community Hospital, Upland, California.
1999

PRESENTATION HELPS

Introduction
Children and youth face a number of significant challenges as they make their way through the formative years of life. Some potential difficulties spring from the process of physical, emotional and social development within young people, especially as they interact with family, peers and the wider society. As parents and leaders of youth seek to facilitate their growth, there is cause for concern about the prevalence of emotional distress, suicidal thoughts and attempts, running away, violence, use of cigarettes, alcohol and marijuana, premarital sexual involvement, and unwed pregnancy (Transparency #1 Critical Challenges Facing Youth). In this seminar, we want to look at both good news and bad news—at both the areas of strength in youth today and areas where they have a special need for support.

What Research Reports Show
The good news is that between 1980-1990 in the United States, there was an overall decline in several significant statistics:
• juvenile motor vehicle deaths
• use of alcohol
• use of cigarettes and illicit substances
• incidence of some sexually transmitted diseases.

The bad news is that new data released in 1997 (Resnick, 1997) reports these trends:
• teenage cigarette smoking and marijuana use on the rise
• poverty affecting more teens in the 90's than in the last decade
• teen homicide rates up
• teen pregnancy, violence, runaways and suicide are still with us.

Adventist academy student research. A study conducted among Seventh-day Adventist youth attending 69 Seventh-day Adventist academies throughout the United States and Canada in 1994-1995 (Hopkins, Hopp, Hopp, Neish & Rhoads, 1998) measured the extent to which Seventh-day Adventist youth use drugs and alcohol and engage in sexual intercourse outside of marriage. There is good news:
• Adventist youth participating in the study reported lower levels of substance abuse than non-Adventist youth attending public school (Table 1) (Handout #1 Research on Youth Behaviors-1).
• The number of Adventist students using drugs and alcohol who began to do so before the age of 13 was fewer than non-Adventist youth attending public school (Table 2) (Handout #2 Research on Youth Behaviors-2).
• Adventist students were also less sexually experienced than their non-Adventist counterparts in public schools—16.3% (Adventist); 53.1% (Non-Adventist).

The bad news is obvious. Seventh-day Adventist youth are not immune. Significant numbers of Adventist students are using drugs and alcohol. Some begin as preteens. A percentage of nearly one in five Adventist students participating in the study report having engaged in premarital sex.
World church data. In 1994, the General Conference Department of Family Ministries initiated the Adventist Family Study. Data is now in from over 8,000 respondents, eighteen years of age and older. Seven world divisions are represented in whole or in part. This research confirms that concerns similar to those raised by the NAD Adventist academy student study are warranted in the world Church. In one world division other than North America, three out of five respondents reported sexual activity prior to marriage. In another non-NAD division, two in five respondents acknowledged having lived together in a sexual relationship with a person without being married to that person. While a strong majority of respondents in most divisions disagree with the statement "Sexual intercourse between two unmarried persons is not wrong if they really love one another," in two non-NAD divisions, close to 40% of respondents believe that this statement is true. In every division touched by the study, at least one in five agree with the statement. These results may well represent a shifting in traditional Adventist beliefs as well as practice around the world.

A Look at the Big Question: WHY?
What is it that makes drug use, premarital sex, and other high risk activities so attractive? Why do young people get involved in these activities? Take drugs, for example. We see the devastating results of drug use every day—in real life, in the newspapers, on the television news. Isn't it logical to assume that people of all ages, after seeing these reports, would determine never to personally experience the devastating effects of the abuse of these substances? Similar questions could be asked about aggressive driving, teen pregnancy, gang warfare, or any behavior that puts a person at high risk. Then why do people participate in high risk behaviors? Let's probe for some answers.

There are no simple answers, but let's apply our common sense to these questions one at a time. The insights we gain may have broad application and aid in our understanding of why children and teenagers engage in behaviors with high risk.
Drugs. Let's start with drugs. As far back as history is recorded, people have used drugs. No culture has avoided the abuse of them. There have always been people looking for activities and substances that effectively alter their moods, feelings, and thoughts. On one end of the continuum, kids seek the thrills of amusement parks, paying high fares to get in so they can twirl around until they are dizzy, hang upside down, be thrown around on roller coasters, and take rides which put them on the edge of sickness. On the other end of the continuum, kids seek ever increasing highs through substance abuse. All, to one degree or another, in search of a thrill.
Historically, substances found in nature were used as a means of becoming intoxicated or inducing a feeling that seemed to provide an escape from reality. These substances were sometimes used in religious rituals, a practice which continues until today. People mostly used these substances at home, since they lacked the mobility we have today, and there was little spread from country to country. But as transportation improved and people started moving about the earth more easily, their drugs went with them, for personal use and as commodities for trade. As science also advanced, these naturally occurring substances were altered to form drug derivatives, some of which may be more than 100 times stronger than the original.
Drugs have even been a factor in international warfare. In the 1800's, the marketing of opium in China was the presenting issue of the Opium Wars between the British who occupied India and the Chinese who tried to stop its transport into their country. Drug trafficking has always inspired a passionate response, in part because of the large sums of money associated with the sale and use of drugs.
Today, every drug that has ever been discovered or created is available for abuse. No drug which people have abused has ever been eliminated completely. Trends in drugs of choice may change, but the drugs themselves weather all storms. Substances have always been used, and always will be used, to alleviate anxiety, produce relaxation, provide relief from boredom, alleviate pain, increase strength or work tolerance, or provide a temporary distortion of reality.
Premarital sex. So what about premarital sex? What are the obvious similarities between the reasons children and youth do drugs and the why's that may explain significant numbers of youth getting into sexual relationships before marriage? Certainly there is excitement to be found in doing something you've been told not to do, in making sure you don't get caught, in taking the chance you can beat the odds against pregnancy and sexually transmitted diseases. For some, sexual involvement creates a temporary oasis from anxiety and personal pain. Others possess little or no information about sexuality or the risks of sexual behavior. Still others pick up on mixed messages that swirl about as to whether it's realistic to expect youth today to abstain from premarital sex or whether the Scripture even sets chastity as God's ideal. Peer pressure to conform with norms of the group is strong. All youth are impacted to some degree and may well be encouraged to engage in premarital sex by the sex-saturated media and pragmatic "safe-sex" educational campaigns.
This generation also faces the additional challenge of managing their sexuality for an extended period of time between the onset of puberty, which is occurring earlier, and the completion of educational goals and readiness to take up adult responsibility, which are occurring later. In the eighteenth century in the Western world, the average age when a girl began menstruating was 16 or 17 years. Since that time, the age of first period has steadily decreased to a current average of 12.8 years. The exact onset of puberty is not as easy to mark in boys, but one thing is sure, among both males and females, interest in the opposite sex is aroused at a much earlier age than before. Two hundred years ago, sexual interest began to awaken in late adolescence, coinciding with the average age for marriage. Today, sexual interest is in full swing in early adolescence, while the average age of marriage in the Western world is delayed considerably by the pursuit of educational goals and the difficulty young adults find in taking up full adult responsibility due to the lack of good jobs.
The implications of these phenomenon are significant. Obviously, young people today have to manage their sexual desires for a much longer period before marriage than in times past. However, the cognitive capacities and maturity necessary to manage their sexual behavior wisely are not typically in place in early adolescence. Early adolescents often have difficulty putting several pieces of information together and then making a decision on the basis of that information. More commonly, they base their decisions on the influence of others. Thus the support of family, church and community to help them make good decisions and to live by them becomes crucially important.

Research insights. Recent research reported that a low level of physical activity among high school students was associated with cigarette smoking, marijuana use, lower fruit and vegetable consumption, more television watching, failure to wear a seat belt, and a lower level of importance placed on academic performance (Pate, Heath, Dowda & Trosh, 1996). In addition, young girls who are involved in strenuous physical activity have their first menstrual periods later than average. A vegetarian diet is also associated with a later onset of puberty (Moisan, Meyer & Gingras, 1990).

It's All About Connectedness
More and more researchers today are becoming interested in the reality that, despite negative external influences and difficult circumstances, some young people are more resilient than others. Resilient youth seem to be able to rise above these influences and circumstances and resist involvement in behaviors that put them at high risk. In a recent article in the Adventist Review, Bailey Gillespie and Gary Hopkins (Gillespie & Hopkins, 1998) report that the resilience studies of youth return again and again to a common theme: Resilient youth had "at least one person in their lives who accepted them unconditionally, regardless of temperament, physical attractiveness, or intelligence. Sounds like the ‘gift love' Jesus modeled to us during His life on earth" (p. 16).
Think of all the times you've said to yourself things like, "It's not what you know, but who you know." Think of the opportunities that have opened for you, or perhaps have been closed to you, because you did or did not have connections in the right places. A huge study of American teenagers released in 1997 has just put your hunches about the importance of connections on a sound research base. It may not be as trite as it sounds to say, "It's all about connectedness."
The 1997 National Longitudinal Study of Adolescent Health studied 90,000 teenagers and 18,000 parents across the United States. It provides a basis for understanding (1) the factors which predispose today's children and youth to involvement in high risk behaviors and (2) those factors which are most likely to protect them from harm. The results of this study puts families, congregations and communities in a better position than ever before to decrease the vulnerability of their children to risky behaviors that threaten their health and safety and to enhance the "risk-proofing" factors that promote their overall well-being.
The conclusion of this landmark study (Handout #4 Connections Make a Difference) is summed up on the cover page of a monograph (Blum & Rinehard, n.d.) which outlines the research findings (Transparency #2 Connections Make a Difference-1):

Independent of race, ethnicity, family structure and poverty status, adolescents who are connected to their parents, to their families, and to their school community are healthier than those who are not.

The authors continue (Transparency #3 Connections Make a Difference-2):

Adolescent health is influenced not only by the strengths and vulnerabilities of individual adolescents but also by the character of the settings in which they lead their lives. These settings—the schools they attend, the neighborhoods they call home, their families, and the friends who comprise their social world—play an important but still incompletely understood role in shaping adolescent health. They do so by influencing both how adolescents feel about themselves as well as the choices they make about behaviors that can affect their health and their future lives.

A Closer Look at the Family "Risk-Proofing" Factors
The 1997 Adolescent Health Study detailed a number of family factors which appear to "risk proof" children and adolescents against harmful behaviors. It also highlighted factors which are associated with increased risk. A resounding conclusion to the 1997 study is: When youth feel connected to their families and when parents are involved in their children's lives, teens are protected.
Here are the significant "risk-proofing" factors identified by the study which were associated with decreased involvement of youth in behaviors which put their health, safety and overall well-being at risk:
•Feelings of closeness to their parents.
•Satisfaction with family relationships.
•Sense of being loved and cared for.
•Participation in activities with their parents.
•Parents' physical presence in the home at key times during the day, i.e., in the morning, after school, at dinner, and at bedtime (though access to a parent and parental supervision may be more significant than finding the magical time of day for a parent to be home).
•No easy home access to guns, cigarettes, alcohol, drugs.
•High parental expectations for the child's educational advancement and school performance.
•Clear parental disapproval of behaviors which put youth at risk.

The Seventh-day Adventist sample from 69 academies also highlighted the importance of parental modeling. Table 3 indicates the strong association between the student's use of all substances when at least one of their parents used a substance (Handout #3 Research on Youth Behaviors-3).
Some additional points of interest. Of course the individual attitudes, beliefs and past experiences have important effects on each young person's emotional health and on their choices about personal involvement in risky behaviors. However, since family is the primary place where attitudes and beliefs are developed and many of life's most significant experiences are lived, there are many implications for the family in these findings as well. For example, the 1997 Adolescent Health Study indicates:
•High self-esteem is generally associated with lower involvement in risky behaviors.
•When religion and prayer are important to an adolescent, they are less likely to smoke, drink or become involved in premarital sexual activity.
•When adolescents work more than 20 hours a week at a part-time job, the positive effects of working—such as increased self-esteem and additional income—seem to be negated by fatigue and excessive discretionary funds.
•Teens who are developmentally "out-of-sync," particularly those who appear older than their peers, are at higher risk and may need additional support.
•Children who experience learning and behavior problems in school are at higher risk. More study needs to be given to how to help these children. Simple solutions such as keeping them back a grade is associated with increased involvement in risky behaviors.

School connectedness also matters. The significant school factors involve the kind of environment fostered by the school. "Risk-proofing" environments are those in which students feel:
•Fairly treated
•Close to one another
•A part of the school

Conclusion: No Shortcuts
Limitations of education. Over the past couple of generations parents and community leaders have tried to get young people to resist involvement in behaviors that put their health and safety at high risk primarily through education about the harmful effects of such behaviors. This much we have learned. Information is important, and we ought not to leave education undone. But as a solitary means of preventing at-risk behaviors, education alone is not very effective. Think about it. If information was highly effective at motivating us to live healthfully, all adults would exercise (we all know it keeps us healthier and prolongs life); all smokers would quit (the dangers of smoking are well known); all Seventh-day Adventists would be vegetarians (the value of the original human diet has been scientifically verified); no one would be obese (we all know obesity is a health risk); and everyone would wear seat belts (we have all seen enough pictures of accident fatalities where a seat belt might have saved a life). Education is vitally important, but connectedness requires more.
Indispensable value of connection. Connectedness takes time. Connectedness requires genuine interest in young people and their issues. It means going where the kids are. It involves listening as well as dialogue.
Connectedness is about warmth and caring and love and making friends. It is also about setting limits and supervision. It's about building trust and holding on during the hard times.
Connectedness is about mentoring and making wholesome values winsome. It prepares youth to face new situations and challenges. It requires a willing to negotiate and release responsibility to young people, in keeping with their growing maturity.
Connectedness is about getting involved and giving of yourself. It is about looking out for the vulnerable. Connectedness is about helping someone who has made a mistake begin again.
Connectedness is about supporting parents and families. It means opening your family to include others in your circle of caring and fun. Connectedness is about becoming community. It can't happen without people like you.

References
Blum, R. W. and Rinehard, P. M. (n.d.). Reducing the risk: Connections that makes a different in the lives of youth. Division of General Pediatrics and Adolescent Health, University of Minnesota, Box 721, 420 Delaware St., S.E., Minneapolis, MN 55455.

Gillespie, V. B. & Hopkins, G. L. (August 20, 1998). Preventing Addictions: It's All About Relationships. Adventist Review, 14-16.

Hopkins, G. L., Hopp, J., Hopp Marshak, H., Neish, C., & Rhoads, G. (1998). AIDS risk among students attending Seventh-day Adventist schools in North America. Journal of School Health 68, (4), 141-145.

Moisan, J., Meyer, F. & Gingras, S. (1990). A nested case-control study of the correlates of early menarche. American Journal of Epidemiology 132, (5), 953-961.

Pate, R. R., Heath, G. W., Dowda, M., & Trosh, S. G. (1996). Associations between physical activity and other health behaviors in a representative sample of U.S. adolescents. American Journal of Public Health 86, (11), 1577-1581.

Resnick, M. D. (September 10, 1997). Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. Journal of the American Medical Association.