U.S. DEPARTMENT 0F STATE / BUREAU OF INTERNATIONAL INFORMATION PROGRAMS

GLOBAL ISSUES

JANUARY 2005

GROWING	UP	HEALTHY

eJOURNALALUSA
Editor.........William T. Peters

Managing Editor.................Charlene Porter

Contributing Editors .........Jenifer Bochner 

 Rhobyn K. Costen-Sykes

Cynthia Lacovey

Cheryl Pellerin

Rosalie Targonski

Gerri Williams

Reference Specialists.................Lynne Scheib

Joan R. Taylor

 Art Director.................Tim Brown

Designer.................Chloe D. Ellis

Illustrator .........................Jeffrey Pelo

Publisher..................Judith S. Siegel

Executive Editor......................Guy E. Olson

Production Manager.................Christian Larson

Assistant Production Manager.........................Chloe D. Ellis

Editorial Board.........George Clack

Kathleen R. Davis

Peggy England

Alexander Feldman

Francis B. Ward

The Bureau of International Information Programs of 

the U.S. Department of State publishes five electronic 

journals under the eJournal USA logo—Economic 

Perspectives, Global Issues, Issues of Democracy, Foreign 

Policy Agenda, and Society & Values—that examine major 

issues facing the United States and the international 

community as well as U.S. society, values, thought, and 

institutions. Each of the five is catalogued by volume 

(the number of years in publication) and by number (the 

number of issues that appear during the year). 

One new journal is published monthly in English and is 

followed two to four weeks later by versions in French, 

Portuguese, Spanish, and Russian. Selected editions also 

appear in Arabic and Chinese.

The opinions expressed in the journals do not necessarily 

reflect the views or policies of the U.S. government. The 

U.S. Department of State assumes no responsibility for 

the content and continued accessibility of Internet sites to 

which the journals link; such responsibility resides solely 

with the publishers of those sites. Journal articles, photographs, and illustrations may be reproduced and translated outside the United States unless they carry explicit 

copyright restrictions, in which case permission must be 

sought from the copyright holders noted in the journal.

The Bureau of International Information Programs 

maintains current and back issues in several electronic 

formats, as well as a list of upcoming journals, at 

http://usinfo.state.gov/journals/journals.htm. Comments are 

welcome at your local U.S. Embassy or at the editorial 

offices:

Editor, eJournal USA: Global Issues

IIP/T/GIC

U.S. Department of State

301 4th St. S.W.

Washington, D.C. 20547

United States of America

E-mail: ejglobal@state.gov

Aly Wagner (right), Mia Hamm (left), and Abby Wambach celebrate a goal 

during a December 2004 game between the United States’ and Mexico’s 

Women’s National teams. These female football players have inspired young girls 

to become more involved in team sports, which are widely viewed by experts as 

effective in helping adolescents grow up physically and emotionally healthy. 

GLOBAL ISSUES 

GLOBAL ISSUES / JANUARY 2005
1 GLOBAL ISSUES / JANUARY 2005

About This Issue

eJOURNAL USA

The notion that “children represent the future” is an 

old one, but it has never been more true than today. 

Adolescents (defined in this journal as persons 

between childhood and adults—roughly age 10 to 24) 

make up fully 20 percent of the world’s population, a larger 

proportion than ever before.

This demographic phenomenon arises at the same 

time that medical and social scientists are gaining increased 

understanding of the many changes that lie along the path 

between youth and adulthood. Disease or injury, violence or 

substance abuse, recklessness or exploitation—any number 

of events may imperil the body or the mind of a young 

person. At the same time, the physical and mental changes 

that mark adolescence present important opportunities for 

growth and development. Scientists now know that physical and emotional well being are essential for youngsters as 

they grow to become healthy, educated, contributing adult 

members of their societies.

This edition of eJournal USA examines many of the latest findings about the risks and challenges that young people face today and strategies and solutions for dealing with 

them. Experts discuss the medical, social, and environmental conditions that can harm our youths. And some famous 

young athletes who have fresh memories of adolescence tell 

us how they coped with problems they encountered on the 

journey to adulthood. The journal also provides rich bibliographic and Internet resources for additional exploration of 

the issue. We hope readers will be informed and sometimes 

inspired by what they find here.
2 GLOBAL ISSUES / JANUARY 2005 

GROWING UP HEALTHY

U.S. DEPARTMENT OF STATE / JANUARY 2005 / VOLUME 10 / NUMBER 1

HTTP://USINFO.STATE.GOV/JOURNALS/JOURNALS.HTM

Adolescent Health: Global Issues, Local 

Challenges

ROBERT BLUM M.D., M.P.H., PH.D., WILLIAM H. 

GATES SR. CHAIR, THE DEPARTMENT OF POPULATION AND FAMILY HEALTH SCIENCES, JOHNS HOPKINS

BLOOMBERG SCHOOL OF PUBLIC HEALTH

Rapidly changing social and economic conditions 

around the world present new risks to the growth 

and development of young people.

Box: Students Against Violence 

Everywhere

SAVE, a national group working in violenceprevention programs, grew out of the shooting death 

of a single boy to become a nationwide movement.

My Own Words: Mia Hamm on 

Self-Esteem

America’s best-known female football player shares 

memories of her own adolescence and ideas on how 

to cope with life’s rough patches.

KidsHealth Offers Answers

NEIL IZENBERG, PEDIATRICIAN AND EDITOR-IN-CHIEF, 

KIDSHEALTH

An awarding-winning Web site gives youngsters 

straight talk online about health issues that matter to 

them.

Protecting Youth from AIDS in the 

Developing World

CONSTANCE A. CARRINO, DIRECTOR, OFFICE OF HIV/

AIDS, BUREAU FOR GLOBAL HEALTH, U.S. AGENCY

FOR INTERNATIONAL DEVELOPMENT

The U.S. Agency for International Development 

sponsors several programs dealing with health and 

lifestyle that enable youngsters to better protect 

themselves from HIV infection.

My Own Words: Shawn Bradley on 

Being Different

A player with the National Basketball Association’s 

Dallas Mavericks recalls how he dealt with teasing 

and ridicule as a child.

The Global Epidemic of Obesity

WILLIAM DIETZ, M.D., PH.D., DIRECTOR OF THE

DIVISION OF NUTRITION AND PHYSICAL ACTIVITY, U.S. 

CENTERS FOR DISEASE CONTROL AND PREVENTION

The growing occurrence of obesity among the young 

is producing dangerous and potentially lifelong 

health problems.

My Own Words: Marvin Lewis on 

Finding Your Way

A star collegiate athlete who graduated from the 

Georgia Institute of Technology offers advice on 

choosing a life path.

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eJOURNAL USA
3 GLOBAL ISSUES / JANUARY 2005

Promises That Work

MARGUERITE W. SALLEE, PRESIDENT AND CHIEF

EXECUTIVE OFFICER, AMERICA’S PROMISE—ALLIANCE

FOR YOUTH

America’s Promise is a nonprofit alliance that rallies 

organizations of all kinds to keep promises that promote safety, security, and health care for youth. 

My Own Words: Eliseo Quintanilla on 

Growing Up Fast

A professional football player with D.C. United 

describes his experiences entering professional sports 

and moving to the United States from his native 

El Salvador at a very young age. 

Environmental Health Risks to Young 

People

LYNN R. GOLDMAN, M.D., M.P.H., PROFESSOR OF

ENVIRONMENTAL HEALTH SCIENCES, JOHNS HOPKINS

BLOOMBERG SCHOOL OF PUBLIC HEALTH

Growing young people may have greater vulnerabilities than adults to risks and toxins in the environment.

Box: Turn That Music Down!

Everyday activities and appliances pose threats of 

long-term hearing damage.

Bibliography

Internet Resources

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eJOURNAL USA
4 GLOBAL ISSUES / JANUARY 2005 

Adolescent Health: 

Global Issues, Local Challenges

Robert Blum

Rapidly changing social and economic conditions around 

the world have a significant influence on how young people 

grow and prepare for adulthood. A medical expert discusses 

the leading causes of death among the world’s youth and 

identifies key factors in reducing their health risks.

Over the past 20 years, dramatic social, political, 

and economic shifts have radically altered the 

landscape for adolescents around the world. A 

generation ago, AIDS was unknown; today, between a 

quarter and a third of adolescent females in Botswana, 

South Africa, and Zimbabwe are infected, and the threat 

of this disease casts a shadow over maturing young people 

everywhere.

A generation ago, infectious diseases predominated 

as the major sources of morbidity (disease) and mortality 

globally. Today, social, behavioral, and environmental factors (such as diet and smoking) predominate.

A generation ago, the age of marriage was significantly lower than it is today; more people lived in rural communities and fewer young people attended school. In one 

generation, school enrollment has dramatically increased 

in most countries in the developing world. In many countries, education is increasingly the same for young women 

as for young men.

Robert Blum, M.D., M.P.H., Ph.D., is the William H. Gates Sr. Chair 

of the Department of Population and Family Health Sciences at the 

Johns Hopkins Bloomberg School of Public Health in Baltimore, 

Maryland. Dr. Blum was co-investigator for the National Longitudinal 

Study on Adolescent Health, the largest survey of American youth ever 

undertaken. His research interests include adolescent sexuality, chronic 

illness, and international adolescent health care issues.

eJOURNAL USA
5 GLOBAL ISSUES / JANUARY 2005

Family size is shrinking, and, for the first time in history, many young women are able to control their reproductive futures. As economies shift from an agricultural 

and pastoral base to a service and industrial base, education 

and employment are more closely intertwined than ever.

These are but some of the key transitions that continue to have a profound impact on the health and well 

being of young people. This is the world that adolescents 

live in today.

POPULATION AND SOCIAL TRENDS

Today, young people aged 10 to 19 comprise 20 

percent of the world’s population. More than 85 percent of 

these young people reside in developing countries. Between 

now and the year 2025, there will be an increase of about 

150 million young people between ages 10 and 24 in the 

world, and most of this population growth will be in subSaharan Africa.

Today, in many countries of sub-Saharan Africa, the 

median age is between 28 and 41. In 2000, the median age 

in Europe was double that of Africa. In fact, the 10 youngest countries in the world are in sub-Saharan Africa.

Today’s generation is on the move, from countryside 

to city, from nation to nation. The United Nations estimates that during the next 30 years essentially all population growth will occur in urban areas, where young people 

go to look for work.

Globalization is another major force affecting the lives 

of young people around the world. As jobs move from 

industrialized to less-developed countries, young people are 

frequently the beneficiaries of these new work opportunities. While there has been income growth in most regions 

of the world as a result, this is not the case in much of 

sub-Saharan Africa.

MORTALITY AND MORBIDITY

What are the major causes of death and disease among 

youths aged 15 to 29?

In all regions of the world, the five leading causes of 

death among young people (in various orders, depending 

on the region) include unintentional injuries, AIDS, other 

infectious diseases, homicide, war and other intentional 

injuries, and suicide and self-inflicted injuries.

Accidental injuries, particularly vehicular injuries, 

represent the leading causes of death for young people in 

most of the world. In South America, however, almost as 

many young people die from intentional injuries (such as 

suicide) as from accidents. In Africa, the leading cause of 

death for young people is AIDS, followed by other infectious diseases.

In much of the developing world, maternal mortality is a major cause of death among adolescent females, 

and these deaths result from pregnancy complications 

and unsafe abortions conducted illegally and secretly (an 

estimated 40 percent of maternal mortality). 

In addition to maternal mortality, reproductive-healthrelated conditions are a major cause for disease among 

youths around the world. Specifically, the World Health 

Organization (WHO) estimates that in “high mortality countries, reproductive and sexual health problems 

account for 63 percent of DALYs [Disability, Adjusted 

Life Years—the sum of years of potential life lost due to 

premature death and the years of productive life lost due to 

disability], of which 37 percent is due to HIV.”

In much of sub-Saharan Africa, female genital cutting is still widely practiced (in countries like Egypt and 

Somalia it remains a nearly universal practice), and, while 

some evidence indicates a decline in the procedure in some 

countries, the practice carries with it very high risks of 

infection, sterility, and permanent sexual dysfunction.

Another issue that has recently gained more visibility 

is the high prevalence of sexual abuse of young males and 

females in industrialized and developing countries around 

the world. Human trafficking and commercial sex work 

have been in the media and policy spotlight. Studies in 

Asia, Africa, and the Caribbean have revealed prevalence 

rates for sexual abuse between 19 percent and 48 percent 

among young women and 5 percent to 32 percent among 

adolescent males. Sexual vulnerability is emerging as a 

major issue that jeopardizes young people’s health.

In the past decade there have been important efforts 

to reduce smoking among adolescents in much of the 

industrialized world. In response, cigarette companies have 

shifted aggressive tobacco marketing toward less-developed 

countries, where there has been a noticeable increase in 

tobacco use. Smoking prevalence rates are widely divergent among regions of the world and in countries of each 

region, but overall trends are truly worrisome. The WHO 

estimates that 10 million deaths a year are due to cigarette 

smoking, and it predicts that will triple or quadruple in the 

next 30 years.

What factors reduce harm? A growing body of research from around the world identifies key factors associated with less involvement among young people in a wide 

range of negative health and social outcomes. Rick Little, 

founder of the International Youth Foundation in BaltiGROWING	UP	HEALTHY

eJOURNAL USA
6 GLOBAL ISSUES / JANUARY 2005 

more, Maryland, summarizes these important elements as 

the “4Cs”:

• Confidence in areas that improve the quality of 

young people’s lives, such as literacy, employability, and 

interpersonal, vocational, and academic skills that allow 

individuals to contribute to their communities

• Connection of youths to persons in the community 

who provide mentoring, tutoring, leadership, and community service opportunities

• Character through values such as individual responsibility, honesty, community service, responsible decision 

making, and integrity, and relationships that give meaning 

and direction to young people

• Confidence-building experiences that give youths 

hope and self-esteem through success in setting and meeting goals

It is clear from research that focusing on risk reduction alone is not sufficient to reduce risks and that most 

such strategies have proven ineffective. Rather, successful 

interventions build on the strengths and confidence of 

young people, creating meaningful roles and opportunities 

to contribute.

Effective interventions link young people with positive adult role models. They create safe places for young 

people to congregate, to have fun, to develop friendships, 

and to engage with adults. Effective programs provide 

opportunities for young people to contribute to others. 

A caring adult, opportunities to contribute, school and 

community activities, and a safe place for young people all 

appear to be part of a critical formula for improved health 

and social outcomes.

Youth is a time of opportunity but also a time of risk. 

The risk for us is that if we fail to support the rapidly 

growing population of young people around the world, 

we will be left to pick up the pieces. We have a choice but 

it is not a choice between action and inaction. Rather, it is 

a choice between whether we operate an ambulance at the 

bottom of the cliff to pick up the young people who fall, 

or climb the cliff and build a fence around it. 

The opinions expressed in this article do not necessarily reflect 

the views or policies of the U.S. government.

eJOURNAL USA
7 GLOBAL ISSUES / JANUARY 2005

My dad was in the Air Force. When I was 

a kid, we moved every few years. That 

meant a lot of good-byes. It also meant 

getting used to a whole new community and a whole 

new school each time we moved. It was scary because 

I was really shy. I can still feel what it was like to have 

to walk into the new school—that sinking feeling in 

my belly, that lump in my throat. All the kids already 

knew each other. It would always take time for me 

to learn how everything worked, what was cool and 

what was not. It was always a struggle to fi nd where I 

fi t in—never a fun struggle either.

Feelings happen. Sadness, anger, stress, worry, 

nervousness, and all other emotions are normal. 

It’s what makes us human. But the emotion commotion can hit girls especially hard during the teen 

years. Changing bodies, changing friends, changing 

schools, and just growing up can make life confusing 

and hard. It’s totally normal.

But the battle to fi t in wore on me. Already shy, I 

didn’t have much self-confi dence in my friend-making abilities. I was the girl walking in the halls with 

her head down, fi dgeting. I would check my clothes 

and hair every two seconds. When I spoke, you 

could hardly hear my soft voice. I was nervous and 

doubted myself a lot.

It’s a fact—girls are likely to face a drop in 

self-esteem during the teenage years. That means 

all those feelings about self-worth and competence 

take a big hit. I think part of that is due to wanting 

to fi t in. And part of it is due to what girls see in the 

media. We are bombarded with nasty messages in 

videos, magazines, and television—about how girls 

are “supposed” to be.

Mia Hamm is the world’s best-known female 

football (known as soccer in the United States) player, 

an Olympic gold medalist, a World Cup champion, 

and a three-time All American collegiate star. She 

was named the Women’s World Player of the Year in 

2001 and 2002 by FIFA, the Fédération Internationale de Football Association (the world football governing body). She retired from professional competition in December 2004. Go to www.gogirlgo.com for 

more information about Mia, other athletes, physical 

activity, and sports.

Parts of this article are reproduced from earlier 

publications. This article is printed with permission 

from the Women’s Sports Foundation. (http://www.w

omenssportsfoundation.org/cgi-bin/iowa/index.html) 

My Own Words

Mia Hamm

On Self-Esteem and Sport

eJOURNAL USA
8 GLOBAL ISSUES / JANUARY 2005 

Low self-esteem might lead to some very serious 

consequences. Have you heard the statistics? Before 

graduating high school, nearly one out of every three 

girls will experience depression, anxiety, or eating 

disorders—almost twice the rate of boys. Now that’s 

scary!

It was very hard not having a history with everyone else. I was an outsider. But what I did have 

was soccer. Wherever I went, I knew that I could 

fi t in with the soccer ball. The soccer team meant a 

familiar place and immediate friends for me. I could 

express myself on the fi eld. Playing hard helped to 

get rid of all my nervousness. Girls who play sports 

and are physically active are more likely to feel good 

about themselves. And that goes for all kinds of 

physical activities, from yoga to basketball.

Even today, I am not confi dent all the time. I 

still think about getting people to like me. When I 

start feeling like that, I just call my mom or sister or 

a friend and talk about it. Or I’ll do things that make 

me feel good, like exercising, cooking, or reading.

There are always going to be things that make 

you nervous and uncertain. That’s life. And even 

in my lucky life, I still have those feelings—at the 

beginning of the new sports season, when meeting 

new people, or making important decisions. I keep 

a small, core group of really good friends. Most have 

been my teammates for years. We have shared a lot 

together. They have seen the good, the bad, and 

the ugly sides of me, and they still accept me. They 

have taught me that it’s how you treat others that 

makes you valuable in life. I guess I have history with 

friends now.

Throughout our lives, our self-esteem goes down 

when we feel like a failure, and it goes up when we 

feel successful. Doing something well, being praised, 

and feeling loved goes a long way. We all need to 

explore opportunities where we can be good at something and feel good about ourselves. Physical activity 

and sport participation is a terrifi c way to build up 

your sense of self-confi dence and self-worth. You get 

to set goals for yourself, you get challenged, you feel 

good about your accomplishments, and you learn 

that after today’s failure—there’s tomorrow’s chance.

Mia Hamm (previous page) celebrates a teammate’s goal in the last 

game of her professional career, December 9, 2004, against the Mexico 

women’s national team. (below) Mia goes for the ball in a game against 

Germany during a semifi nal match of the 2004 Olympic Games. 

(© AP/WWP)

eJOURNAL USA
9 GLOBAL ISSUES / JANUARY 2005

S

ofia can’t sleep. She is worried that her friend may 

have an eating disorder and wonders what she can 

do to help.

Jamie, who is 11 years old, wants to learn about diabetes so he can understand why his grandfather needs to 

take insulin shots every day.

Thirteen-year-old Lori looks into the mirror and 

wonders why her friends are more physically developed 

than she. Is something wrong?

Where can kids and teens turn when they need to 

learn more about growth, emotions, and how their bodies 

work? They can talk to their parents, of course—but that’s 

not always easy—and sometimes their parents may not 

have the answers. Even during a doctor’s appointment 

there usually isn’t time to ask and answer questions that 

kids and teens may have.

Fortunately, there is a place that’s easy to understand, 

always available, and (according to its readers) even cool. 

It’s a Web site called KidsHealth, created by doctors and 

other health experts. The award-winning, friendly site has 

thousands of easy-to-understand articles, mini-movies, 

and even games to help answer just about any question 

that a teen, kid, or parent might have. Whether it’s to 

learn something new or to get help for a school project, 

every week about one million people visit KidsHealth, 

making it the most popular site of its kind on the Web.

KidsHealth encourages families to discuss topics with 

each other—that’s why most topics have separate articles 

written for parents, kids, and teens. To make each version 

of the article really fit the reader, KidsHealth editors use 

words and phrases that are appropriate and engaging—for 

example, words like “yucky” and “icky.”

KidsHealth gives teens their own homepage that is 

written just for them—just the way they like it. During 

nearly a decade online, the site has received about 100,000 

e-mails from readers, many from teens who write, “This 

site is so cool” and “I like it because it’s written with a low 

cheese factor.”

What subjects are most popular with kids and teens? 

Teens look for just about all topics, but some of the most 

Neil Izenberg, M.D., is editor-in-chief and founder of the youth-oriented Web site KidsHealth. He is also a pediatrician and the author of 

several books on children’s health issues. 

The World Wide Web is bubbling with information about 

health. Do sites offer solid information? Are they speaking 

in a language that youngsters can understand? The medical 

experts and other professionals who produce KidsHealth

provide authoritative, easy-to-understand information on 

health and personal development for young readers.

KidsHealth Offers Answers

Neil Izenberg

eJOURNAL USA
10 GLOBAL ISSUES / JANUARY 2005 

popular areas are sections about puberty and physical 

development, sexuality, diet and nutrition, and emotional 

concerns. Kids often go to the site to learn how the body 

works—usually for homework help or a school assignment.

KidsHealth, which features hundreds of articles in 

Spanish, has as much information as a 40-volume encyclopedia and is updated and expanded daily. Whether the 

article is about a serious, complex medical condition or 

a simple recipe for kids with special dietary needs, each 

article is reviewed multiple times by doctors and other 

health experts. We get rid of all the doctor-speak so people 

can really understand it.

KidsHealth has been growing and developing on the 

Web since 1995. In 2004, the site won the prestigious 

Webby Award for the Best Health Site on the Web—as 

well as the 2004 Parents’ Choice Gold Award and the 

2004 Teachers’ Choice Award. KidsHealth was also chosen 

as one of the “50 Coolest Websites” by Time magazine.

KidsHealth goes to a lot of effort to earn its reputation. Everything we put on the site has to be current and 

accurate. Unlike books that become quickly outdated, 

KidsHealth is a resource that can be counted on as an upto-date resource filled with lots of other great things—like 

interactive movies, sounds, and activities that you just 

can’t find on paper. 

KidsHealth.org is a project of the non-profit Nemours 

Foundation. It has no pop-ups, advertisements, or privacy 

infringements. The staff of KidsHealth is a unique group of 

pediatricians, editors, graphic designers, and programmers 

based at the renowned Alfred I. duPont Hospital for Children 

in Wilmington, Delaware.

Other youth oriented sites are:

U.S. Centers for Disease Control and Prevention—Adolescents & Teens: http://www.cdc.gov/health/doc.do/id/

0900f3ec80227093

Health Initiatives for Youth: http://www.hify.org/index.html

The Prevention Institute: at http://www.preventioninstitute.o

rg/children.html

The opinions expressed in this article do not necessarily reflect 

the views or policies of the U.S. government.

GROWING	UP	HEALTHY

eJOURNAL USA
11 GLOBAL ISSUES / JANUARY 2005

Protecting Youth From AIDS 

in the Developing World

Constance A. Carrino

Constance A. Carrino, Ph.D., is director of the Office of HIV/AIDS in 

the Bureau for Global Health at the U.S. Agency for International Development. Dr. Carrino holds a Ph.D. in economics, with emphases in 

public finance and trade, and is a recipient of the Arthur Fleming Award 

for excellence in administration in the U.S. government.

The emerging generation in the developing world will 

play a critical role in the future, and the U.S. Agency for 

International Development (USAID) works to help equip 

them for the challenges ahead. A USAID official discussses 

the emphasis placed on youth and HIV prevention in the 

President’s Emergency Plan for AIDS Relief.

Numbering 1.7 billion, today’s youths1

are the 

largest generation ever to enter the transition 

to adulthood. Comprising 30 percent of the 

population in the developing world, young people present 

a set of urgent economic, social, and political challenges 

that are crucial to long-term progress and stability. The 

values, attitudes, and skills acquired by this generation of 

young men and women—and the choices they make—

will influence the course of current events and shape our 

future world in fundamental ways.

 Youths are encountering formative stages in life. When 

given a chance to participate, youths have played a catalytic role in promoting democracy, increasing incomes, 

helping communities develop, and slowing the AIDS 

epidemic. In Uganda and Zambia, teens and young adults 

have been key to reducing HIV infection rates through 

their adoption of more responsible behaviors.

Those who lack opportunities for education and 

advancement are more susceptible to crime and to being 

eJOURNAL USA
12 GLOBAL ISSUES / JANUARY 2005 

co-opted into armed conflict and terrorism, undermining social cohesion. 

Marginalized youths are also more 

likely to engage in risky behaviors 

leading to unintended pregnancy, 

chronic substance abuse, and HIV 

infection. When young men and 

women lack the skills, support, and 

opportunities to become productive 

citizens, their potential to contribute 

to society is underused. Youths in 

these circumstances are more likely to 

be a long-term drain on public and 

private resources in terms of increased 

unemployment, higher health and social welfare costs, and lower economic 

growth. An intangible cost is the 

diminished quality of leadership available to countries and 

the international community.

As a multisectoral development agency, the U.S. Agency for International Development (USAID) addresses youth 

issues across many dimensions. Youth unemployment rates 

have been rising in recent years. In many developing and 

transition countries, one-third to one-half of 15- to 24-yearolds are unemployed. Political violence and deteriorating 

poverty and social cohesion disrupt community and family 

structures, leaving millions of young people abandoned, orphaned, or forced into military service. In response, USAID 

is making skills-training for young adults more relevant to 

their daily lives, equipping them to earn a livelihood. In the 

Central Asian Republics, USAID targets youths in an effort 

to foster democratic values and develop a constituency for 

economic and political reform. Health and lifestyle issues 

also demand our attention. Worldwide, USAID is committed to helping developing countries provide young people 

with the knowledge, skills, support, and services they need 

to protect themselves from HIV.

YOUTH AND AIDS

HIV/AIDS is now a major threat to the lives of young 

people. About half of all new HIV infections occur among 

those aged 15 to 24. In the hardest-hit countries, nearly 

75 percent of individuals now age 15 are projected to die 

eventually of AIDS. Yet youths represent a window of 

opportunity for reversing HIV rates, especially when effective prevention programs reach them before they engage 

in risky behavior.

The President’s Emergency Plan for AIDS Relief, a 

$15-billion, five-year plan announced in 2003, reinforces 

the United States’ commitment to 

HIV prevention. It seeks to avert 

seven million new infections and 

includes a special emphasis on youths 

through abstinence and behaviorchange interventions. Twenty percent 

of the President’s Emergency Plan 

funds are set aside for prevention, 

and one-third are for abstinenceuntil-marriage programs. USAID is 

expanding support for activities that 

reflect this focus.

The environment in which 

young people live profoundly influences their behaviors. USAID seeks 

to strengthen protective factors in 

society that help youths make healthy 

choices. In particular, close relationships with parents and 

other adults, school attendance, and supportive community norms lay foundations for positive youth behaviors. 

Conversely, young people who experience family instability, practice other risk behaviors, and have negative peer 

role models are more likely to engage in early and unsafe 

sex. Poverty, including the impact of AIDS on family 

income, forces many young people out of the protective 

environments of home and school, increasing their risk 

of exploitation and unsafe sexual behavior. Street youths 

and displaced and orphaned youths are at particular risk. 

Young people may also fail to recognize their personal 

risks because of a lack of knowledge and understanding of 

HIV.

Young women are at considerably higher risk of HIV 

infection. In some African communities, young women 

aged 15 to 19 have HIV rates six times higher than young 

men the same age. Poverty, vulnerability to sexual exploitation and coercion, and relationships with older, more 

sexually experienced men put girls at risk. Economic 

factors also pressure girls to trade sex for money. USAID 

helps communities recognize and address social norms 

that put young women—and youths more generally—at 

risk of HIV infection.

CHANGING BEHAVIORS

Behavior change is the cornerstone of HIV prevention. More than 70 percent of premature adult deaths 

are linked to behaviors begun in adolescence, such as 

smoking and risky sexual behavior. USAID endorses the 

“ABC” model, made famous by its success in Uganda. “A” 

stands for abstinence (including delayed sexual initiaYouth today are our 

most precious resource, 

and their well-being 

in the world now and 

in the future is a 

cornerstone 

of continuing 

development.

eJOURNAL USA
13 GLOBAL ISSUES / JANUARY 2005

tion among youths), “B” for being faithful, and “C” for 

correct and consistent condom use. The ABC approach 

must be adapted to a particular country context or target 

population. For youths specifically, USAID gives primary 

emphasis to A and B. USAID supports skills-based HIV 

education to provide young people with a basic understanding of HIV, help them personalize risk, and develop 

the self-esteem, communication, and decision-making 

skills they need to make positive life choices.

In many countries hardest hit by HIV/AIDS, sexual 

activity begins early, before marriage. Surveys show that, on 

average, slightly more than 40 percent of women in sub-Saharan Africa have had premarital sex before age 20; among 

young men, sex before marriage is even more common. 

Moreover, a significant minority of youth have their first 

sexual experience before age 15. Abstinence-until-marriage 

programs are a particularly important resource for young 

people because fully half of all new infections occur in the 

15- to 24-year-old age group. Delaying sexual debut by even 

a year can have significant impact on adolescents’ health and 

well-being and on the progress of the HIV/AIDS epidemic.

In 2004, USAID initiated $117 million in new 

multicountry central agreements for abstinence and behavior-change programs for youths in 14 of the 15 focus 

countries of the President’s Emergency Plan. Thirteen 

organizations won the five-year grants through a competitive awards process. One new faith-based partner will 

work with more than 1.8 million youths in Haiti, Kenya, 

Mozambique, and Rwanda, and with parents, churches, 

schools, and other local partners to support youths in 

choosing abstinence as the best means of HIV prevention. Another new partner will collaborate with Red Cross 

branches and volunteer networks in Guyana, Haiti, and 

Tanzania to reach more than 760,000 youths with an 

interactive peer education curriculum. Theatrical, sports, 

and musical events will help mobilize communities in 

support of healthy behaviors.

USAID’s decentralized nature allows it to respond to 

varying needs in diverse settings, harmonizing prevention 

messages at the community level. Mass media campaigns 

involve the creative use of videos, concerts, radio, and 

television programs that appeal to young people. In Tanzania, 35,000 youths recently celebrated Youth Week, a 

popular holiday, by participating in sports, music, drama, 

and writing competitions. More than 1,000 participants, 

40 chosen from each of 32 primary schools, wore Tshirts that said, “Praise work, exercise and studies, NOT 

SEX” or “One minute of pleasure does not pay, WAIT.” 

Educational messages on abstinence and faithfulness in 

sexual relations were integrated into the competitions, and 

there were quizzes, question-and-answer games, and other 

activities. In Jamaica, a mass media campaign encouraging 

abstinence for younger youths and responsible behavior 

for older youths has produced a significant decrease in 

teen pregnancies.

Peer education builds on existing youth-oriented networks to provide a safe and comfortable environment for 

adolescents to explore sensitive issues. In Kenya, USAID 

supports the national Girl Guides Association to raise 

HIV awareness among its membership by holding HIV 

contests and having guides work toward merit badges 

relating to various aspects of HIV. The program provides 

a forum for girls and young women to discuss HIV and 

support each other in avoiding risky behaviors.

While prevention is paramount in working with 

youths, programs must include the continuum of HIV 

services, including care and treatment. HIV-positive youths 

need an array of services, including psychosocial support, 

prevention of mother-to-child transmission, palliative care, 

and antiretroviral therapy. USAID supports expanding access to services for sexually active youths, including education on correct and consistent condom use, treatment for 

sexually transmitted infections, and HIV testing.

HIV testing is important for youths to learn their 

status and adopt safer behaviors. In Zimbabwe, USAID 

supports 14 New Start centers that provide high-quality 

HIV counseling and testing services. These services are 

promoted to individuals at risk of HIV, including young 

couples and adolescents. For HIV-positive and -negative clients, New Start provides counseling to encourage 

behaviors that avoid and reduce risk.

OUR FUTURE

Youth today are our most precious resource, and their 

well-being in the world now and in the future is a cornerstone of continuing development. The world’s poorest and 

often most politically unstable countries will have the largest youth populations through 2020. Accordingly, USAID 

and its partners are striving to expand youth programs 

across health, education, skills-training, democracy and 

governance, and other areas. Investing in youths will help 

developing countries advance healthier lifestyles, equitable 

economic growth, and stronger civil society. Investing in 

these young men and women will create hope for a better 

future for generations to come. 

1. Youths are individuals in transition from childhood to adulthood. This 

figure refers to 10- to 24-year-olds.

GROWING	UP	HEALTHY

eJOURNAL USA
14 GLOBAL ISSUES / JANUARY 2005 

Castle Dale is a small town in central Utah. 

My grandfather’s farm is a few miles to the 

north. I grew up here. Castle Dale has about 

2,000 people and just about as many cattle. Milking a cow, feeding the chickens, chopping the wood, 

and walking the fi elds to tend the water were daily 

chores. Grandpa had me carrying a shovel when it 

was actually taller than I was. This was work and we 

learned to do it at a young age.

People in this small town knew your business but 

they also looked out for you. I was tall, very tall at 

a really young age. This caused all sorts of problems 

and opportunities. I remember going to an amusement park for my fourth birthday. We arrived at a 

bumper car ride and everyone got to ride the cars 

except me. They said I was too old. I remember feeling sick inside because the worker didn’t believe me. 

I was not lying. My folks taught me not to lie. I sat 

down and started to cry, watching all my friends ride 

the cars. Finally, my mother realized what was happening and explained the situation. I wasn’t too old, 

I was just taller than kids my age. I was able to ride 

with my friends after that.

We carried my birth certifi cate with us everywhere we went after that until I was in high school. 

My unusual height caused people to look, ask questions, laugh, tease, and sometimes even challenge me 

to fi ght. I was teased relentlessly as a kid. It wasn’t 

fair, I knew, but that was just the way it was. Luckily, I was taught at a very young age a very important 

lesson. I matter and I’m important. No one could 

ever take that away from me. God loved me no matter what. If everyone in the entire world hated me, 

God did not. I knew this then, and I know this now. 

That alone helped me through the frustrations and 

heartaches of normal life.

When I was in junior high school, I realized 

something else that helped me cope. Most teasing 

and harassing came from one of two places—people 

who were either jealous or ignorant. I couldn’t 

Shawn Bradley has played professional basketball since 

1993, starting with the Philadelphia 76ers, then with the 

New Jersey Nets and the Dallas Mavericks. One of the National Basketball Association’s great shot-blockers, Shawn 

led the league with 228 blocks in 2000-01.

Shawn traveled to South Africa in September 2004 

to participate in the Basketball Without Borders Africa 

Camp. An international basketball and community relations outreach program, Basketball Without Borders runs 

instructional basketball camps in Africa, Europe, South 

America, and Asia. The NBA and the International Basketball Federation run the programs, which also focus 

on community outreach and education, grassroots basketball development, product donation, and HIV/AIDS 

awareness.

My Own Words

Shawn Bradley

On Being Different

eJOURNAL USA
15 GLOBAL ISSUES / JANUARY 2005

change the way they were, but I could affect the way 

I felt. I was not going to feel bad because of their 

ignorance or jealousy. It wasn’t worth it! Realizing 

this didn’t stop them, or change the fact that these 

comments hurt. It did, however, give me a way to 

understand these people and deal with their treatment in a way that was okay for me.

These things still happen today. It will probably 

happen the rest of my life. I will always be 7 feet, 6 

inches (2.29 meters) tall. I wouldn’t change that for 

anything. People will always look because it is not every day that you see someone that tall. I learned that 

at a young age and I now try to teach my own children that they are important! They matter and, most 

importantly, God loves them. That is the message I 

give to you. Regardless of your race, religion, ethnic 

background, or circumstances ... God loves you! 

Dallas Mavericks’ Shawn Bradley (previous page) poses with a fan 

after a December 2004 game. (below) Shawn pulls in a rebound 

during a January 2004 game against the Denver Nuggets. 

(© AP/WWP)

eJOURNAL USA
16 GLOBAL ISSUES / JANUARY 2005 

Obesity is an epidemic in nearly every country in the 

world. The most likely explanation for the spread of this 

health problem is substantial lifestyle changes—from more 

reliance on automobiles and less on everyday physical 

activity to the increasing availability of processed foods.

The prevalence of obesity among children and 

adolescents around the world is growing at an 

alarming rate. This epidemic—some call it a 

pandemic—has causes and possibly cures. In this interview, 

obesity and nutrition expert Dr. William Dietz from the 

Centers for Disease Control and Prevention (CDC) in 

Atlanta, Georgia, discusses the reasons for this escalating 

problem and what can be done to prevent it. Dr. Dietz’s 

work includes the first study to demonstrate the relationship 

between television viewing and obesity (1985), the earliest 

report that overweight was increasing among children 

and adolescents in the United States (1987), and the first 

suggestion that children and adolescents have critical periods 

for becoming overweight (1994). Dr. Dietz talked with 

Global Issues science writer Cheryl Pellerin.

Question: How do you define obesity?

Dietz: In the United States, obesity in adults is defined 

as a body mass index (BMI) greater than or equal to 30. 

Body mass index is defined as weight in kilograms, divided by height in meters, squared. This definition identifies 

people at significant risk of diseases related to obesity, such 

as type 2 diabetes, cardiovascular disease, and cancer.

[Type 1 diabetes is usually diagnosed in children 

and young adults and used to be called juvenile diabetes. 

In type 1, the body does not produce insulin. The body 

needs insulin so it can use sugar, the basic fuel for cells in 

the body. Type 2 diabetes is the most common form of 

diabetes. In type 2 diabetes, the body produces insulin at 

high levels, but the levels are not adequate to allow the 

body to process sugar properly.]

The definition of obesity in children and adolescents 

corresponds to a BMI of 30 in a young adult, but because 

children and adolescents are growing, their BMIs change 

throughout childhood and adolescence until growth 

is complete. So instead of using a BMI of 30 to define 

obesity, we use a BMI greater than or equal to the 95th 

percentile in CDC growth charts [http://www.cdc.gov/

growthcharts/] that are specific for the U.S. population. 

William Dietz, M.D., Ph.D., is director of the Division of Nutrition 

and Physical Activity in the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and 

Prevention (CDC). He is the author of more than 150 publications in 

the scientific literature and editor of three books, including A Guide to 

Your Child’s Nutrition.

The Global Epidemic of Obesity

An Interview with William Dietz

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17 GLOBAL ISSUES / JANUARY 2005

We know that adolescents who have a BMI greater 

than or equal to 30 have biochemical evidence of risk factors that predict type 2 diabetes and cardiovascular disease 

in adulthood. Risk factors for those diseases are already 

present in 5- and 10-year-olds. More than 60 percent have 

at least one additional cardiovascular disease risk factor, 

such as elevated blood pressure, elevated insulin or glucose 

levels, or elevated lipid levels (low HDL or elevated LDL 

cholesterol).

Type 2 diabetes, which was rare in children and 

adolescents 20 years ago, is seen with greater frequency. 

In some communities, type 2 diabetes now accounts for 

almost 50 percent of all new cases of childhood diabetes. 

We also know that overweight in an adolescent is likely 

to persist into adulthood and seems to be associated with 

more severe obesity in adulthood than adult-onset obesity.

In 2000, international growth charts were released by 

the International Task Force on Obesity and were published as a study in the British Medical Journal.

1

 The study 

aimed to develop an internationally acceptable definition 

of child overweight and obesity, and it used data from six 

large nationally representative cross-sectional growth studies from Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the United States.

Q: Why do we say that obesity is epidemic?

Dietz: Obesity is epidemic because of how rapidly it has 

increased and how many people are affected. Between 

1980 and 2000, there was a two-fold increase in the 

prevalence of overweight 6- to 11-year-old children in the 

United States, and a three-fold increase in the prevalence 

of overweight adolescents. Internationally, in every place 

where longitudinal [over time] data have been collected, 

there has been an increase in the prevalence of overweight. 

An international epidemic is called a pandemic, and that 

term has been used to describe what is going on internationally. I don’t have good comparative data on children, 

but a couple of years ago I looked at changes in the 

prevalence of obesity in British women compared to U.S. 

women, and the rate of increase was exactly the same.

Q: Why is there an obesity epidemic?

Dietz: The most likely explanation is because of very 

substantial environmental changes. In the United States, 

reliance on fast food, soft drink consumption, and variety 

in the food supply have increased, and family meals and 

physical activity as part of everyday life have declined. 

Fewer children walk to school, and there is more reliance 

on cars to get from one place to another or do errands 

because of the way communities are designed, particularly 

in the Southeast and Southwest. You can’t do errands by 

walking because the communities are not walkable—they 

lack sidewalks. Even if they had sidewalks, they would 

lack schools and shopping facilities that you could walk 

to. Similar things seem to be happening in new communities elsewhere. The food supply has also changed 

internationally as urbanization has progressed. I think that 

obesity is associated with substantial dietary changes elsewhere in the world because people are moving from a diet 

that was largely plant-based and one that they grew themselves to a diet of primarily processed, higher-fat food.

Q: Are there countries around the world that don’t have 

an obesity problem?

Dietz: Not that I am aware of. The prevalence differs a lot 

from country to country. Even countries like China and 

Japan, which have not had this problem in the past, are 

increasingly concerned about it.

Q: What can be done about obesity?

Dietz: This problem requires both medical and community-based approaches. Medical approaches are essential 

for the more severely affected individuals. Community 

approaches are those that are implemented in schools 

and communities. For example, daily physical education 

at school is a recommended strategy to increase physical 

activity.

I think it’s important to recognize that at some level 

physical activity will prevent the development of obesity, 

but its most important effect is that it reduces the consequences associated with obesity. Physical activity should 

be fun and something that adolescents want to do.

The Centers for Disease Control and Prevention is 

promoting six strategies for fighting obesity in children, 

and physical activity is one of them. The first three are 

strategies for which we think there’s relative scientific certainty. The other three strategies are promising strategies.

As I mentioned, physical activity is a crucial strategy 

for reducing the risk of diseases associated with obesity. 

The Guide for Community Preventive Services,

2

 published 

by the Task Force on Community Preventive Services, 

provides evidence-based approaches to increasing physical activity. Physical education in schools is one of those 

recommended strategies.

eJOURNAL USA
18 GLOBAL ISSUES / JANUARY 2005 

For early prevention of obesity, 

breastfeeding seems to be an effective strategy. We don’t know why it’s 

effective, but I think it has to do with 

the fact that when a mother is nursing 

her infant, the infant’s cues help tell 

her the infant has had enough. There’s 

no way of knowing that other than by 

seeing the infant’s cues. In contrast, in 

bottle-fed babies, the tendency is to 

look at the bottle, not at the infant, 

and use that as a gauge as to whether 

the infant has had enough or not.

There are data that suggest 

that the more parents try to control 

children’s food intake, the less capable children are at 

controlling food intake themselves. That’s been shown 

in cross-sectional [one point in time] studies, but it’s not 

clear in those cross-sectional studies whether parents try to 

control children’s food intake because they recognize that 

the child is incapable of doing so, or whether the child is 

less capable of controlling their food intake because the 

parents are controlling it. It’s an external versus an internal 

control.

Control of television time is another important 

factor. In this country, the average household has more 

than three television sets. Twenty-five percent of children 

younger than two years of age have a television in their 

room, and 65 percent of all children have a television set 

in their room.

In the United States, children often eat while watching television, and they tend to eat the foods advertised 

on television, which tend to be high-caloric-density foods. 

One effect of controlling TV time is to reduce children’s 

eating episodes. Increasingly, the Internet is a source of 

food advertising. If you go on the Internet and look up 

some foods children eat, those Web sites have games that 

children can play, and the games have frequent mention of 

those products. It’s another food-promotion source.

Fruit and vegetable intake. Fruits and vegetables are 

things that all people should be eating as much of as they 

can get. People don’t eat calories. Fullness is determined 

by the volume of food they eat. Therefore, foods that are 

of low-caloric density—meaning they have a high water 

content and fewer calories per gram—are more filling 

and provide fewer calories than calorically dense food. 

For example, if you start a meal with a salad, you’ll have 

less room for other high-calorie foods. The same is true 

for soups. The gap is that we don’t really know whether 

people who eat lots of fruits and vegetables are at lower risk for obesity.

Soft drink consumption. There’s 

a growing body of data that suggests 

that increased soft drink intake may 

be associated with excess weight and 

that reducing soft drink intake may be 

an effective way to control weight. For 

the average adolescent in the United 

States, soft drinks, which include both 

soda and 10-percent juice, account for 

13 percent of the average adolescent’s 

daily caloric intake. Substituting a 

lower-calorie choice like water or 

diet soft drinks is a good strategy for 

reducing calorie intake from soft drinks.

Portion size. The larger the portion an individual is 

presented with, the more of that portion they’re likely to 

eat. But we don’t have good data that link portion size to 

obesity, and I’m not sure we’re going to get it because it’s 

hard to measure portion size. The strategy is to serve a 

small portion first and let people go back for second helpings if they want them, rather than loading up plates with 

large portions to begin with.

Q: What is important for adolescents to know about 

obesity?

Dietz: I think that adolescents should be encouraged to 

be active and to do things with their friends. Seventh and 

eighth graders don’t think watching television is fun; it’s 

a default activity they do when they don’t have anything 

better to do. Another strategy is to think of things that 

are fun to do in place of watching television, like spending time with friends or doing active things with friends. 

Teenagers should be encouraged to drink water when they 

are thirsty and to start meals with soup or a salad.

Q: Is obesity as serious a problem in its magnitude and 

consequences as malnutrition and undernutrition?

Dietz: Malnutrition covers a broad waterfront. The way 

the term is broadly used, malnutrition means both obesity 

and undernutrition. The problem is that micronutrient 

malnutrition—that is, vitamin and mineral deficiency—is 

still a major problem worldwide, particularly iodine, iron, 

and vitamin A deficiencies.

If you look strictly at morbidity [the burden of disease], 

micronutrient malnutrition is still a bigger problem than 

There are data that 

suggest that the more 

parents try to control 

children’s food intake, 

the less capable children 

are at controlling food 

intake themselves. 

eJOURNAL USA
19 GLOBAL ISSUES / JANUARY 2005

obesity. But in many countries in the developing world, there 

is a growing problem with children who are stunted and 

overfat. Stunted means they’re short, and that’s a consequence 

of chronic undernutrition. Now we’re adding obesity to this 

problem, so they’re suffering from a double problem. 

I think it’s fair to say that in countries in nutritional 

transition—that is, the transition from a traditional agriculturally or plant-based diet to a more processed diet—

that stunted people seem to be at double risk because of 

their history of stunting and overweight. It’s happened in 

a couple of places. The data I’m most familiar with came 

from Brazil and Peru.

Q: What is a good way to increase physical activity among 

adolescents?

Dietz: School-based approaches offer a good example. As 

I mentioned earlier, daily physical education classes are 

a recommended strategy for increasing physical activity. 

That recommendation comes from the Task Force on 

Community Preventive Services.2

Walk-to-school programs are a strategy for restoring physical activity to everyday life. The problem is that 

only one-third of U.S. children who live within a mile of 

school walk to school, partly because the schools are not 

accessible and partly because the neighborhoods are not 

safe. Another strategy is TV turnoffs. Controlling television time in school-based interventions is an effective 

way to reduce weight gain or obesity. A couple of years 

ago, libraries initiated a TV Turnoff Week. Now there is a 

national TV Turnoff Week program.

Another strategy is to make it easier for children to 

eat healthful foods at school. “Competitive foods” are 

foods like ice cream and cookies that are served in the 

lunch line as a profit-maker for schools. Schools do this 

to raise money. “Pouring contracts” are contracts schools 

sign with soft drink vending machine companies to sell 

those products in schools. Many schools depend on this 

revenue.

At CDC, we’re trying to create a revenue-neutral 

situation—to allow schools to make the same amount of 

money but help increase consumption of healthful items. 

One strategy is to increase the prices of less healthful items 

and use that income to subsidize more healthful items that 

you sell at a lower price. It appears that children are pricesensitive, and when you raise the prices of less healthful 

foods and lower the prices of more healthful foods, it is 

revenue-neutral for the school and consumption changes 

in the right direction.

Comprehensive school-based interventions are 

another strategy. A really good program in Massachusetts 

called Planet Health [http://www.hsph.harvard.edu/prc/

proj_planet.html] combined four strategies—a low-fat 

diet, more fruits and vegetables, less television time, and 

more physical activity. The program showed a significant 

reduction in overweight among middle-school girls. The 

study 3 was published in 1999, and the program is now 

being expanded to the Boston school system.

Q: How does the health care system deal with obesity?

Dietz: The kind of care delivery system necessary for 

chronic diseases like obesity is different from the traditional 

patient-provider relationship. So many patients in this 

country are overweight that the one-to-one provider-patient 

relationship is probably archaic. It’s based on an acute-care 

model—our medical system has evolved to treat infectious 

diseases or injuries. It didn’t evolve to treat chronic diseases, 

and it didn’t evolve around prevention. Providers are not 

financially rewarded when they prevent disease; they’re 

rewarded when patients get sick or need hospitalization.

In an ideal system for treating overweight and obesity, 

we need better strategies that are of proven effectiveness. Physicians will oversee care, but people other than 

physicians, like nutritionists or nurse practitioners, will 

likely deliver the care. Self-management has to be the 

cornerstone of therapy. The notion that providers manage 

problems for patients is archaic; patients manage problems 

for themselves. The role of the provider should be to help 

patients solve problems, or to help patients identify the 

problem and its priority and help them solve problems 

that make it difficult for them to deal with it.

That such changes are needed is increasingly widely 

recognized, but it’s not clear how to solve the problem 

because it goes to the heart of the medical-care delivery 

system. 

The CDC National Center for Disease Prevention 

and Health Promotion homepage is located at http:

//www.cdc.gov/nccdphp/.

1. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard 

definition for child overweight and obesity worldwide: international survey. 

2000;320(7244):1240.

2. Centers for Disease Control and Prevention. Increasing physical activity: 

a report on recommendations of the Task Force on Community Preventive 

Services. MMWR 2001;50(No. RR-18).

3. Gortmaker SL, et al. Reducing obesity via a school-based interdisciplinary 

intervention among youth. Archives of Pediatrics and Adolescent Medicine. 

GROWING	UP	HEALTHY

eJOURNAL USA
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I

remember what it was like being a teenager, 

wanting to fi t in, but still feeling like maybe I 

never would, that I’d never fi nd what was right 

for me. You want to fi nd that place, fi nd that niche 

of friendship and feel like you belong. So what I did 

was get involved in a lot of extracurricular activities, 

trying to fi nd something that I enjoyed.

I did a little bit of everything. I played multiple 

sports, not just one sport. I played basketball, football, baseball. I also joined after-school activities just 

to see what I liked, and to see what type of people 

I liked, and fi gure out if that was something that I 

wanted to do.

Sometimes you fi nd out you’re lousy. Sometimes 

you screw up and you’re afraid people are going to 

laugh at you, but so what? You have to do your best 

to not be afraid of people laughing or not agreeing 

with what you’re doing. You have to stand up and be 

your own person fi rst of all. And second, when you 

fi nd that thing you do enjoy doing, that thing you’re 

good at, keep at it.

And it’s not like you have to fi gure all this out 

by yourself. I remember I had one really good friend 

who was my age. He could kind of tell me the positives and negatives about things I was doing. I also 

had relatives who could be objective and tell me if 

things I was into were good or bad. And they didn’t 

judge me. That was a really big thing. I was really 

looking for somebody who wouldn’t judge me for 

what I was doing. They would just support me as 

much as they could.

Maybe you’re thinking, “Sure, Marvin. Who’s 

going to help me?” You’d be surprised. If you go out 

and ask for help, people are more than willing to 

help you. If you need somebody to talk to, if that’s 

in school, if it’s a guidance counselor or a relative, 

they’ll probably help you. You just have to ask. 

My Own Words

Marvin Lewis

On Finding Your Way

Marvin Lewis, outstanding student and athlete, 

graduated from the Georgia Institute of Technology in 

2004, after leading the basketball team all the way 

to the semi-fi nals of the National Collegiate Athletic 

Association tournament. His career achievements on 

the court put him in the Georgia Tech record book for 

total games played and career scoring. Marvin won the 

Tech team’s top student athlete award in 2003 and was 

twice named to the regional Atlantic Coast Conference 

All-Academic team for men’s basketball in his four-year 

college career. Now 22, he is employed by an accounting 

fi rm in Atlanta, Georgia, and is studying to become a 

certifi ed public accountant.

Marvin Lewis drives down the court during a February 2004 game in which 

he led all scorers with 24 points. (© AP/WWP)

eJOURNAL USA
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Promises That Work

Marguerite W. Sallee

I

n 1997, leaders from across the United States 

attended the Presidents’ Summit for America’s Future 

in Philadelphia, Pennsylvania, to address the needs 

of children and youth. President Clinton, and former 

Presidents Bush, Carter, and Ford, and former First Lady 

Nancy Reagan representing her husband, challenged the 

nation to make youth a national priority. Joining them 

in their call to action were approximately 30 governors, 

100 mayors, 145 community delegations, business 

leaders, and thousands of concerned citizens. 

Colin Powell, who in 2001 would become Secretary 

of State, served as chair of the summit and subsequently 

as founding chairman of America’s Promise—The 

Alliance for Youth, the organization that grew out of 

the summit. President George W. Bush affirmed his 

commitment to the organization after becoming president 

in 2001. The current chair is Alma J. Powell, wife of 

Colin Powell. 

America’s Promise is the managing partner of a 

broad alliance of communities and local and national 

organizations dedicated to bringing their collective 

America’s Promise—The Alliance for Youth is dedicated 

to mobilizing people from every sector of American life 

to build the character and competence of our nation’s 

youth by fulfilling Five Promises: ongoing relationships 

with caring adults, safe places with structured activities, 

a healthy start, marketable skills, and opportunities to 

give back. When consistently fulfilled, the Five Promises 

can significantly advance the health and well-being of the 

next generation—increasing the chances of youth becoming 

successful adults.

Marguerite W. Sallee is president and chief executive officer of America’s 

Promise—The Alliance for Youth. Information about America’s Promise—

The Alliance for Youth is available at http://www.americaspromise.org.

eJOURNAL USA
22 GLOBAL ISSUES / JANUARY 2005 

power together to fulfill our nation’s 

obligation to assure that all young 

people have five fundamental 

resources: 

• Caring adults in their lives, as 

parents, mentors, tutors, coaches

• Safe places with structured 

activities in which to learn and 

grow

• A healthy start and healthy future

• An effective education that equips 

them with marketable skills

• An opportunity to give back to their 

communities through their own 

service

These fundamental resources 

also are known as the Five Promises. 

And, research reveals that the Five 

Promises work. Children who 

experience the Five Promises are less 

likely to engage in negative behaviors and are five to 10 

times more likely to succeed as students, citizens, parents, 

and employees who make meaningful contributions to 

their communities.

STRENGTH IN NUMBERS

The United States is a large and diverse country. 

America’s Promise—The Alliance for Youth brings 

together corporations, faith-based institutions, civic 

groups, and other nonprofit partners committed to 

the belief that children are key to our nation’s future. 

With national organizations and community champions 

working as one, the Alliance is producing positive 

outcomes for children and youth, one promise at a time. 

Here are several examples from around the country:

• In response to the President’s call for a united response 

to the tsunami devastation in South and Southeast Asia, 

more than 100 youth-serving organizations dedicated 

to children and service and 10 highly regarded relief 

partners joined together to form the Quarters From 

Kids initiative. Quarters From Kids ensures that 

America’s youngest, and the adults who work with 

them, can reach out to the victims of the tragedy by 

raising and contributing funds to established relief 

organizations. Contributions raised for Quarters 

From Kids from scouting troops, 

after-school programs, classrooms 

projects, bake sales, and car washes 

will be distributed to those in need.

 

• In Charleston, South Carolina, 

WCIV-TV has been informing 

viewers about the Five Promises 

and how they can help fulfill 

them locally. The station also 

adopted five schools in 2004 and 

sponsored Charleston’s Promise 

School Event Days, an initiative 

to bring the Five Promises to the 

area’s neediest children and raise 

community awareness. A top goal 

of the event was to recruit caring 

adults to serve as mentors, thereby 

improving students’ lives and 

academic performance. “We’re 

really trying to get mentors into 

the schools, because a mentor can 

help change a child’s mindset and help them redefine 

their expectations of themselves,” says Ava Swain, sales 

coordinator for WCIV-TV. 

• In Bloomington, Minnesota, the Allen family—David, 

Mary, and sons Treb (age 20) and Matt (age 18)—is 

actively involved in the Bloomington Youth Coffeehouse 

Initiative. With help from community volunteers and 

support from the Points of Light Foundation, which 

honored the family with its National Family Volunteer 

Award, the Allens raised funds to open a coffeehouse to 

serve as a safe place where Bloomington youths could 

spend time during non-school hours. Their coffeehouse 

is part of a community-wide effort to combat the high 

rates of alcohol, tobacco, and drug use among high 

school students.

• A group of industrious youths in Alleghany County, 

North Carolina, led food drives in each of the county’s 

schools, collecting 30,000 pounds of food for the 

local food bank that serves the county’s poor residents. 

Alleghany County is one of many counties in which 

the U.S. Department of Agriculture administers food 

and nutrition assistance programs to help give youths 

a healthy start. Among these programs is the National 

School Lunch Program, which operates in more than 

100,000 schools and residential child-care institutions 

 Children who 

experience the Five 

Promises are less likely 

to engage in negative 

behaviors and are 

five to 10 times more 

likely to succeed as 

students, citizens, 

parents,and employees 

who make meaningful 

contributions to their 

communities.

eJOURNAL USA
23 GLOBAL ISSUES / JANUARY 2005

to provide free or reduced-price lunches to an average 

28 million children from low-income families every 

school day.

• Sappi Fine Paper North America sponsored a poster 

contest for sixth graders at the five elementary schools 

in Muskegon Heights, Michigan, where the company 

has a paper mill. Based on marketable skills, the contest 

asked students to consider their career ambitions and to 

draw a poster illustrating their goals and the skills they 

would need to achieve them. The contest drew dozens 

of creative entries. DeMario Thomas won first prize, 

receiving a $500 U.S. Savings Bond. Four runners-up 

each received a $100 U.S. Savings Bond. Sappi printed 

2,000 copies of Thomas’s poster, donating 1,500 copies 

to the five participating schools so they could be sold to 

raise funds.

• Following the series of hurricanes that devastated parts 

of southwestern Florida in 2004, the ManaTEEN Club, 

a youth service group in Manatee County, Florida, 

seized upon an opportunity to serve. Its 11,000 

members worked side-by-side with volunteers for 

AmeriCorps*VISTA, a government-sponsored program, 

and United Way, a nonprofit organization, to collect 

food and help find shelter for thousands of displaced 

neighbors. 

All these local efforts, which span the nation and 

involve various sectors, were successful because the 

communities that led them believed in the power of the 

Five Promises to effect real change for children and youth. 

More importantly, the communities put their belief into 

action.

Information about America’s Promise—The Alliance for 

Youth is available at http://www.americaspromise.org.

The opinions expressed in this article do not necessarily reflect 

the views or policies of the U.S. government.

GROWING	UP	HEALTHY

eJOURNAL USA
24 GLOBAL ISSUES / JANUARY 2005 

I

began playing soccer [football] when I was 11 

and then went on to represent the national team 

of El Salvador. I became a professional athlete at 

age 16.

On the team that I played for when I was 

young, we would train in the afternoon, and in the 

morning I would go to school. My family helped 

me a lot; they always supported me in my education 

and also my playing soccer. I owe a lot to my family. 

Even today, although my parents are not with me, 

their support is most important in my life. 

Fortunately for me, I did not encounter any 

barriers in my goal to be a professional soccer player. 

If I didn’t succeed as a player, I planned to continue 

in my studies. While with the Club Aguila of El 

Salvador, I played in a match in Los Angeles. The 

management at D.C. United watched the game 

tapes and signed me with the club in 2002.

Adjusting to a new country and professional 

life is a very difficult experience, especially for a 

young person. Going to the supermarket, living in 

a different climate and culture, and getting adjusted 

to new surroundings were all challenges. The biggest 

barrier was language—communicating with my 

teammates and coaches, both on and off the field. 

My teammates helped make the transition easier. 

I’ve always had to deal with much older people in 

the soccer profession, and this has forced me to mature. 

Sports have taught me a lot about discipline and also 

about how to be humble and how to lead a healthy 

lifestyle. Most of all, I value the bonds of friendship I 

have developed with teammates and coaches. 

In 2004, I was injured at a preseason training 

camp and was unable to play the season. When 

setbacks like that happen, you can get down on 

yourself or even go into a state of depression. There 

was a time when I asked myself if I would ever play 

soccer again. Fortunately for me, I had a circle of 

friends who supported me during rehabilitation, and I 

kept busy with different activities to stay motivated. 

I have a lot of contact with young people, especially 

fans, both in the United States and in El Salvador. 

I try to relate to them my own experiences, because 

these young people also have aspirations and dreams. 

I try to tell them that, first and foremost, you have 

to have an objective in life and choose what you 

want to do. Second, you have to dedicate yourself to 

the goal you choose. And you have to stay motivated 

every day to be the best that you can be. 

My Own Words

Eliseo Quintanilla

On Growing Up Fast

Eliseo Quintanilla joined D.C. United, the football 

team of the nation’s capital, in 2002 at age 19, 

becoming one of El Salvador’s youngest players to 

ever join a foreign team. He had strong seasons in 

2002 and 2003 and then faced a sidelining injury in 

2004. More about Eliseo’s record is available at http:

//dcunited.mlsnet.com/MLS/players/bio.jsp?team=dcu&

player=quintanilla_e&playerId=qui458455

Eliseo Quintanilla, midfi elder, scored the fi rst goal for D.C. United in a 6-0 rout 

over CD Municipal in a September 2004 game. (photo: Tony Quinn/Wireimage)

eJOURNAL USA
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Medical science has been pursuing the 

connection between environmental 

factors and human health for just a 

few decades. Only a fraction of that research has 

specifically focused on young people, and there 

is much to learn. Science has revealed 

enough for us to offer some advice, however, on steps to protect the health and 

development of young people.

Health at any age depends on a number of factors, including biology (gender, 

age, genes, and stage of physical development), social factors, behavior, and environment, which broadly is defined as any 

external influence, from hazardous exposures 

to smoking to dietary influences. This article 

focuses on adverse exposures in the environment and the impact on young people’s 

health, recognizing that many factors influence 

human health.

To understand a youngster’s vulnerability 

to environmental exposures, one needs to look 

at biological processes that are underway with puberty—

with its rapid growth and change—remaining mindful of 

the potential for development of lifelong problems during 

this formative stage of life. We also need to understand 

patterns of exposure to substances in the environment and 

hazards associated with materials to which youngsters may 

be exposed.

SUSCEPTIBILITY

Changes associated with puberty and the adolescent 

growth spurt are well known. What is less well appreciated is the potential for harm during this period. Pubertal 

changes are under the control of hormones, and, at least 

theoretically, exposures to chemicals that have hormonal 

properties (called endocrine disruptors) could alter this 

process, either advancing or delaying these changes. 

The body of environmental law and regulation is largely 

based in recognition of the link between human health 

and environmental conditions. Now science is learning 

that young, growing people may have greater vulnerabilities than adults to risks and toxins in the environment.

A medical expert reviews several reasons why the young are 

more susceptible—and often more exposed—to air pollution, 

contaminants in food and water, tobacco smoke, and other 

hazardous substances.

Environmental Health Risk to 

Young People

Lynn R. Goldman

Lynn R. Goldman, M.D., M.P.H., is a pediatrician and a professor 

of Environmental Health Sciences at the Johns Hopkins Bloomberg 

School of Public Health in Baltimore, Maryland.

eJOURNAL USA
26 GLOBAL ISSUES / JANUARY 2005 

Only very recently have researchers 

begun to assess whether exposures 

during adolescence affect the onset of 

puberty.

Some laboratory and animal 

studies in the United States have 

linked precocious puberty (abnormal 

early onset of puberty) to toxic exposures, but to date there are no studies 

to support this in people. Other 

environmental exposures may delay 

puberty. Most notably, a study from 

a national survey of growth in the 

United States found that exposure to 

lead in adolescent girls is associated 

with a delay in puberty. For girls, 

this is a time of rapid development of breasts and, for 

boys, prostate glands. Some scientists have hypothesized 

that small changes in development of these organs, and 

exposures during the time of their rapid growth, could be 

involved in cancer risk later in life.

Adolescence is a time of very rapid growth of bones, 

muscles, lungs, and organ systems. On a theoretical basis, 

any time of rapid growth is a time of greater vulnerability to cancer-causing agents. Very little research has 

been done on exposure to carcinogens in this age group. 

One study, of tobacco smoke, found that adults who had 

started smoking at a younger age had much more evidence of genetic damage in lung tissues than smokers who 

started later, even after adjusting for years of smoking. 

This is because the lung grows very rapidly during this 

time period.

This model suggests that it is especially important for 

young people to avoid exposure to carcinogens, of which 

there are a variety in cigarette smoke. Such exposures during this period could result in cancers later in life, though 

it may be difficult to directly connect these cases to the 

earlier exposures.

We now know that brains also go through a particularly important stage of development during adolescence 

and early adulthood. Modern brain imaging techniques 

have allowed us to see and appreciate the complex changes 

that are unfolding, while psychologists report that young 

people continue to develop in areas of executive decision 

making and abstract reasoning during this time.

These data have come to light only in the last decade; 

at this time we know very little about the impact of neurotoxic substances on these developmental stages. It has 

been suggested that faulty brain maturation at this stage 

of development is responsible for 

the development of schizophrenia; 

however, this is unproven and no 

evidence links this and other neurological conditions during this time to 

environmental exposures.

Young adults often are on the 

verge of becoming, or already have 

become, parents in their own right. 

Thus, exposures to pollutants and 

toxins at this time of life can have 

a direct impact on the lives of two 

generations. Such exposures can 

affect fertility for young men by 

causing changes in sperm counts and 

morphology.

Exposures for young women can cause the buildup of 

toxic materials such as lead (which accumulates in bone) 

or persistent organic pollutants (which accumulate in 

body fat). These body burdens are transferred to the fetus 

during pregnancy and to the infant in breast milk. Other 

exposures are transmitted to the fetus only when exposures occur around the time of conception and during 

pregnancy.

EXPOSURES

Young people’s behavior is inextricably linked to 

patterns of environmental exposure. Worldwide there is 

much variability in behavior patterns, yet some universal 

patterns are of interest. Generally, as people emerge into 

adulthood, they gradually become more independent of 

their parents. With independence comes mobility, which 

often confers additional risk for injuries, such as those that 

occur in vehicular accidents.

Young people are vulnerable to these because often 

they are more impulsive and more likely to take risks, 

because they have less experience as drivers or cyclists, 

in many instances because of alcohol or drug use (which 

impairs judgment), and, at the younger end of the scale, 

because their bodies are smaller and thus more vulnerable to injury. In many parts of the world, young people 

emerging into adulthood also are more exposed to violence and homicide.

Other exposures in the environment, while more 

subtle, can be just as lethal in the long run. Air pollution 

can harm the lungs of young people, particularly outdoor 

athletes who breathe more air per minute than nonathletes. Nutrition is critical during growth spurts, and young 

Young people’s behavior 

is inextricably 

linked to patterns 

of environmental 

exposure. 

eJOURNAL USA
27 GLOBAL ISSUES / JANUARY 2005

people’s food intake can be greater than for adults. During 

such times, a young person would have greater exposure 

per body weight than an adult to contaminants in food.

Young people are more likely than older people 

to spend time in such institutional settings as schools, 

military training camps, and recreational campgrounds. 

Some settings have well-controlled environments; in others, there is a greater likelihood of contaminated food and 

drinking water (campgrounds), indoor air contaminants 

(as have been found in many U.S. schools), or poorly understood exposures in the environment (military service).

Young people may be involved in hobbies or pastimes 

that include the use of any number of potentially hazardous materials, including hunting (lead shot), art (chemicals in glues and paints), cosmetic products (fingernail 

glue), and automobiles and other machines (fuels, lubricants, paints, exhaust fumes). In some parts of the world, 

chemicals like glue and gasoline are used as substances 

of abuse, leading to enormous intentional (and harmful) 

exposures.

Young people work in large numbers worldwide. 

Work can be of great value to children by improving 

financial circumstances for them and their families, 

preparing them for adulthood, and encouraging initiative. 

All too often, however, young people are employed under 

hazardous conditions, depending on the emphasis on 

control of workplace exposures in countries. The International Labor Organization has estimated that 60 percent 

of working children have been exposed to hazardous 

conditions.

In the United States, and in much of the world, 

children are often engaged in farm work, particularly 

children who are members of farm families. Such children 

have been found to have high injury rates associated not 

only with poor judgment and greater risk taking, but also 

because equipment designed to be safe for adults often has 

poor ergonomic design for smaller people.

In developing nations, high exposure levels have been 

associated with working with hazardous substances such 

as lead and pesticides, doing outdoor work in highly polluted urban areas, and coming into contact with chemicals when scavenging reusable or recyclable materials from 

waste dumps. Laws that restrict certain kinds of work for 

the youngest children, and assure workplace safety for all 

people, have been most effective at preventing some of 

these exposures.

CONCLUSION

We know that young people often are more susceptible and more exposed to certain environmental risks. At 

the same time, much of the basis for concern comes from 

our knowledge of biology and from animal studies and 

not from direct observation of health effects on young 

people as they encounter exposures in their environments. 

Over the next few years this situation should change given 

that, worldwide, a wealth of new scientific data is emerging, both on biological changes that occur during this 

stage of life and on long-range impacts of environmental 

exposures.

In this regard, it is important that the many critical 

studies underway to evaluate childhood environmental exposures be continued to include adolescents and 

young adults. At the same time, it seems sensible to take 

a precautionary approach to assure that young people are 

protected from potentially harmful effects, for their health 

now and in the future, and for the health of the next generation, their children. 

The opinions expressed in this article do not necessarily reflect 

the views or policies of the U.S. government.

GROWING	UP	HEALTHY

eJOURNAL USA
28 GLOBAL ISSUES / JANUARY 2005 

Turn That Music Down!

Loud music may not be just annoying your parents. It could be damaging your hearing. Check 

out what the hearing experts say.

Both the amount of noise and the length of 

time you are exposed to the noise determine its 

ability to damage your hearing. Noise levels are 

measured in decibels (dB). The higher the decibel level, the louder the noise. Sounds louder 

than 80 decibels are considered potentially 

hazardous. Examples of noise levels considered 

dangerous by experts are a lawnmower, a rock 

concert, firearms, firecrackers, headset listening systems, motorcycles, tractors, household 

appliances (garbage disposals, blenders, food 

processors/choppers, etc.), and noisy toys. All 

can deliver sound over 90 decibels and some 

up to 140 decibels. The noise chart below gives 

an idea of average decibel levels for everyday 

sounds around you.

Reprinted with permission. American Speech-Language-Hearing Association, www.asha.org

eJOURNAL USA
29 GLOBAL ISSUES / JANUARY 2005

Aspy, Cheryl B., et al. “Adolescent Violence: The Protective Effects of Youth Assets,” Journal of Counseling and 

Development: JCD, vol. 82, no. 3, Summer 2004, pp. 

268-277

Blum, Robert W. and Heather P. Libbey. “School Connectedness—Strengthening Health and Educational Outcomes for Teens: Executive Summary,” Journal of School 

Health, vol. 74, no. 7, September 2004, pp. 231-232

Brook, Judith S., et al. “Tobacco Use and Health in 

Young Adulthood,” Journal of Genetic Psychology, vol. 165, 

no. 3, September 2004, pp. 310-323

Currie, Candace, Chris Roberts, Antony Morgan, Rebecca Smith, Wolfgang Settertobulte, Oddrun Samdal, 

and Vivian Barnekow Rasmussen, eds. Young People’s 

Health in Context. Health Behaviour in School-Aged Children (HBSC) Study: International Report From the 2001/

2002 Survey. Geneva: World Health Organization, 2004

http://www.euro.who.int/Document/e82923.pdf

Evans-Whipp, Tracy, et al. “A Review of School Drug 

Policies and Their Impact on Youth Substance Abuse,” 

Health Promotion International, vol. 19, no. 2, 2004, pp. 

227-234

Fardy, Paul S., Ann Azzollini, and Ariela Herman. 

“Health-Based Physical Education in Urban High 

Schools: the PATH Program,” Journal of Teaching in 

Physical Education, vol. 23, no. 4, October 2004, 

pp. 359-371 

Farrington, Jan. “Why Teens Need More Sleep,” Current 

Health 2, vol. 30, no. 3, November 2003, pp. 6-12

Food and Agriculture Organization, United Nations 

Environmental Programme, and World Health Organization. Child Pesticide Poisoning: Information for Advocacy and Action. Rome: FAO, UNEP, and WHO, 2004

http://www.fao.org/newsroom/common/ecg/51018_en_

maquette_childhood.pdf

Foshie, Vangie A. “Assessing the Long-Term Effects of 

the Safe Dates Program and a Booster in Preventing and 

Reducing Adolescent Dating Violence, Victimization and 

Perpetration,” American Journal of Public Health, vol. 94, 

no. 4, April 2004, pp. 619-624

Fulton, Janet E., et al. “Public Health and Clinical Recommendations for Physical Activity and Fitness,” Sports 

Medicine, vol. 30, no. 9, 2004, pp. 581-599

Goldman, Lynn R., et al. “Environmental Pediatrics and 

Its Impact on Governmental Health Policy,” Pediatrics, 

vol. 113, no. 4, April 2004, pp. 1146-1157

http://pediatrics.aappublications.org/cgi/reprint/113/4/

S1/1146

Gordon, Bruce, Richard Mackay, and Eva Rehfuess. 

Inheriting the World: The Atlas of Children’s Health and the 

Environment. Geneva: World Health Organization, 2004

http://www.who.int/ceh/publications/atlas/en/index.html

Grunbaum, Jo Anne, et al. “Youth Risk Behavior Surveillance—United States, 2003,” Morbidity and Mortality 

Weekly Report, vol. 53, no. SS-2, May 21, 2004, pp. 1-96

http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf

Hemphill, Sheryl A., et al. “Levels and Family Correlates 

of Positive Adolescent Development: A Cross-National 

Comparison,” Family Matters, no. 168, Winter 2004, 

pp. 28-35

Hinnant, Laurie, Christian Nimsch, and Brenda 

Stone-Wiggins. “Examination of the Relationship Between Community Support and Tobacco Control Activities as a Part of Youth Empowerment Programs,” Health 

Education & Behavior, vol. 31, no. 5, 2004, pp. 629-640

Kelley, Thomas M. “Positive Psychology and Adolescent 

Mental Health: False Promise or True Breakthrough,” 

Adolescence, vol. 39, no. 154, Summer 2004, pp. 257-278

Kohn, Alfie. “Rebuilding School Culture to Make 

Schools Safer,” Education Digest, vol. 70, no. 3, November 2004, pp. 23-30

Kowalski, Kathiann M. “Alcohol: A Real Threat,” Current Health 2, vol. 30, no. 4, December 2003, pp. 6-11

Bibliography

Additional readings on the health and well being of young people

eJOURNAL USA
30 GLOBAL ISSUES / JANUARY 2005 

Lopez, Ralph I. Teen Health Book: A Parent’s Guide to 

Adolescent Health and Well Being. New York: W.W. Norton 

& Company, 2003

Lyznicki, James M., Mary Anne McCaffree, and Carolyn B. Robinowitz. “Childhood Bullying: Implications 

for Physicians,” American Family Physician, vol. 70, no. 9, 

November 1, 2004, pp. 1723-1728

http://www.aafp.org/afp/20041101/1723.html

Marks, Andrea and Betty Rothbart. Healthy Teens, Body 

and Soul: A Parent’s Complete Guide. New York, NY: 

Simon & Schuster, 2003

Mastny, Lisa. “The Hazards of Youth,” World Watch, vol. 

17, no. 5, September/October 2004, pp. 18-21

Michaud, Pierre-Andre, Robert W. Blum, and Gail B. 

Slap. “Cross-Cultural Surveys of Adolescent Health and 

Behavior: Progress and Problems,” Social Science & Medicine, vol. 53, no. 9, November 2001, pp.1237-1246 

Nonnemaker, James M., Clea McNeely, and Robert 

W. Blum. “Public and Private Domains of Religiosity 

and Adolescent Health Risk Behaviors: Evidence from 

the National Longitudinal Study of Adolescent Health,” 

Social Science and Medicine, vol. 57, no. 11, December 

2003, pp. 2049-2054

Oman, Roy L., et al. “The Potential Protective Effect 

of Youth Assets on Adolescent Alcohol and Drug Use,” 

American Journal of Public Health, vol. 94, no. 8, August 

2004, pp. 1425-1430

http://w3.ouhsc.edu/hps/Oman_et_al_04.pdf

Patton, George C., et al. “Puberty and the Onset of 

Substance Abuse and Use,” Pediatrics, vol. 114, no. 3, 

September 2004, pp. e300-e306

http://pediatrics.aappublications.org/cgi/reprint/

114/3/e300

Rapp-Paglicci, Lisa A., Catherine N. Dulmus, and 

John S. Wodarski, eds. Handbook of Preventive Interventions for Children and Adolescents. New York: John Wiley 

& Sons, 2004

Resnick, Michael D., Marjorie Ireland, and Iris 

Borowsky. “Youth Violence Perpetration: What Protects? What Predicts? Findings from the National Longitudinal Study of Adolescent Health,” Journal of Adolescent 

Health, vol. 35, no. 5, November 2004, pp. 424e1-424e10

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Rew, Lynn. Adolescent Health: a Multidisciplinary Approach to Theory, Research, and Intervention. Thousand 

Oaks, CA: Sage Publications, 2004

Seth, Carrie McVicker and Maria Garin Jones. “Providing Options and Opportunities for Youth,” Children’s 

Voice, vol. 13, no. 6, November/December 2004, 

pp. 14-18

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Strauch, Barbara. The Primal Teen: What the New Discoveries About the Teenage Brain Tell Us About Our Kids. 

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United Nations. Economic and Social Council. World 

Youth Report 2003: The Global Situation of Young People. 

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United Nations Children’s Fund and the Micronutrient 

Initiative. Vitamin & Mineral Deficiency: A Global Progress 

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http://www.unicef.org/media/files/vmd.pdf

U.S. National Institute of Medicine. Preventing Childhood Obesity: Health in the Balance. Washington, DC: 

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Children’s Environmental Health and Disease Prevention 

Research. Symposium on Children’s Environmental Health: 

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Verkler, Erin. “Try a Little Tenderness,” Prevention, vol. 

56, no. 10, October 2004, pp. 129-130

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4510-1,00.html

Wilkinson, Ross B. “The Role of Parental and Peer Attachment in the Psychological Health and Self-Esteem of 

Adolescents,” Journal of Youth and Adolescence, vol. 33, 

no. 6, 2004, pp. 479-493

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Windle, Michael. “Alcohol Use Among Adolescents and 

Young Adults,” Alcohol Research and Health, vol. 27, no. 1, 

2003, pp. 79-85

http://www.findarticles.com/p/articles/mi_m0CXH/is_1_

27/ai_112937517/pg_1

Windle, Michael and W. Alex Mason. “General and 

Specific Predictors of Behavioral and Emotional Problems 

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12/ai_114005542

Wise, Paul H. “The Transformation of Child Health 

in the United States,” Health Affairs, vol. 23, no. 5, 

September/October 2004, pp. 9-25

World Health Organization. Shape the Future of Life 

[Shape Healthy Environments for Children]. Geneva: 

WHO, 2003

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informaterials/Hec-BroEn.pdf

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Guidelines for Drinking-Water Quality. 3rd ed., Geneva: 

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Students of Service (SOS) Program for Sexual Abstinence 

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The U.S. Department of State assumes no responsibility for the content 

and availability of the resources from other agencies and organizations 

listed above. All Internet links were active as of December 2004.

GROWING	UP	HEALTHY

eJOURNAL USA
32 GLOBAL ISSUES / JANUARY 2005 

Internet Resources

Online resources promoting the health and well being of young people

America’s Promise—The Alliance for Youth

http://www.americaspromise.org/

Campaign for Tobacco-Free Kids

http://www.tobaccofreekids.org/

Global Health Council

Child Health

http://www.globalhealth.org/

Health Initiatives for Youth

http://www.hify.org/index.html

The Healthy Refrigerator

http://www.healthyfridge.org/

Insurance Institute for Highway Safety

http://www.iihs.org/safety_facts/teens/teenager.htm

KidsHealth

http://www.kidshealth.org/

National Longitudinal Study of Adolescent Health

http://www.cpc.unc.edu/projects/addhealth

National Organizations for Youth Safety

http://www.noys.org/

National Youth Anti-Drug Media Campaign

http://www.mediacampaign.org/

National Youth Anti-Drug Media Campaign

Free Vibe

http://www.freevibe.com/

National Youth Development Information Center

http://www.nydic.org/nydic/

National Youth Violence Prevention Resource Center

http://www.safeyouth.org/scripts/teens.asp

Para los Niños

http://www.paralosninos.org/home.html

President’s Council on Physical Fitness and Sports

http://www.fitness.gov/

Prevention Institute

Children and Youth

http://www.preventioninstitute.org/children.html

Search Institute

http://www.search-institute.org/

Students Against Violence Everywhere

http://www.nationalsave.org/

Teen Advice Online

http://www.teenadviceonline.org/

United Nations Office on Drugs and Crime

Global Youth Network

http://www.unodc.org/youthnet/

U.S. Centers for Disease Control and Prevention

 Health Topic: Adolescents and Teens

 http://www.cdc.gov/health/adolescent.htm

 Division of Adolescent and School Health

 Healthy Schools, Healthy Youth

 http://www.cdc.gov/HealthyYouth/index.htm

U.S. Department of Health & Human Services

Administration for Children and Families

http://www.acf.hhs.gov/acf_about.html

U.S. Department of Health & Human Services

Office of Adolescent Pregnancy Programs

http://opa.osophs.dhhs.gov/titlexx/oapp.html

U.S. National Highway Traffic Safety Administration

New Driver Safety

http://www.nhtsa.dot.gov/people/injury/newdriver/

U.S. National Institute on Alcohol Abuse and Alcoholism

Underage Drinking: A Major Public Health Challenge

http://www.niaaa.nih.gov/publications/aa59.htm

U.S. National Institute of Child Health and 

Human Development

http://www.nichd.nih.gov/

U.S. National Institute of Environmental Health Sciences

Centers for Children’s Environmental Health and Disease Prevention Research

http://www.niehs.nih.gov/translat/children/children.htm

U.S. National Institute on Deafness and Other Communication 

Disorders

Wise Ears

http://www.nidcd.nih.gov/health/wise/index.asp

eJOURNAL USA
33 GLOBAL ISSUES / JANUARY 2005

U.S. National Institute on Drug Abuse

http://www.nida.nih.gov/

U.S. Office of National Drug Control Policy

http://www.whitehousedrugpolicy.gov/

USA Freedom Corps

Youth Achievement

http://www.usafreedomcorps.gov/content/priorities/youth/index.asp

World Health Organization

Youth Violence

http://www.who.int/violence_injury_prevention/violence/youth_

violence/en/

The U.S. Department of State assumes no responsibility for the content 

and availability of the resources from other agencies and organizations 

listed above. All Internet links were active as of December 2004.

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U.S. DEPARTMENT 0F STATE / BUREAU OF INTERNATIONAL INFORMATION PROGRAMS