RISK BEHAVIOR IN YOUTH STAGE.
http://www.cinterfor.org.uy/public/spanish/region/ampro/cinterfor/temas/youth/bajarch/doc/not/word/libro37/libro37.doc
KRAUSKOPF
DINA 1. Introduction.
In recent decades there have been many advances in health and attention to the situation youth. The prolongation of life expectancy, modernity and globalization with its wide range of complex stimuli, increases the need for adolescents and young people to find, in the new circumstances that surround them, the elements to assume the biopsychosocial changes they experience in building a social role that matches the identity, organize their behavior from a do in the world that objectifies positively and sustain a life plan that gives meaning to your present relationship with the environment, which in many areas of Latin America also includes the difficulties of poverty.
Advances in medicine have great potential in reducing of suffering and prolongation of life, what attention has increasingly specialized to different life stages and even consider gender differences. From the perspective of disease was observed that juvenile mortality was the particular and important characteristic of being desecadenada mainly by external and behavioral factors: drugs, accidents, suicides, escapes, dropouts, pregnancies, STDs, violence, bringing to organize care for adolescents through these issues. This led to the concept that was, of adolescence as a healthy age, is passed to the emphasis of the behavior risk and that the programs for that age period will be focused in a specific way for each of the problems. Thus the vertical programs as adolescents received separate responses to each risk or harm, drugs, accidents, STDs / AIDS, pregnancy, and articulate a plan that would meet health in adolescence. The experiences showed that the problems were related and also damage and risk behaviors, protective factors were therefore approaches began to get rich (Donuts, 1992).
other hand many of the issues that affect youth social peace are associated with risky behaviors, adolescents named more attention when problems were outsourced when suffering from depression, isolation, sexual abuse, etc., which attracted wide attention from various social sectors, as communicators, teachers, etc., and youth became increasingly identified as a segment of the population problem that often reached a stigmatized perspective. This has consequences risky, because the recognition pejorative people who cross the adolescent period, facilitates the construction of the negative identity (Erikson, 1974), as the social value contributes to the development of identity and youth need to be recognized as someone has to prefer to be someone feared, hated to be anybody.
socializing agencies such as family, school, media, etc., Meet new contexts to address the various social changes and generate feedback that seek to be channeled in youth policies that set the challenge respodan appropriate options for this strategic sector of society and have the sign of the problematization and exclusion of youth, the positive sign for incorporating personal and social development.
is especially accomplished in the decade after the declaration of the Youth Year in 1985, accumulating studies perspectives are promoted positive proposals and programs that offer a more complex view of youth, recognizing their importance in social development, their contributions and difficulties, the interaction of its features with the possibilities of the environment.
The concept of risk in the juvenile period has been highlighted by the possibility that the behaviors or situations lead to developmental damage that can affect all of its damage potential as well-being and health (Weinstein, 1992). Currently, the focus of attention to youth health, try on a more comprehensive and articulated to reduce risk factors, increasing protective factors and provide reconstruction and development opportunities of the situation. The conceptualization of health is therefore relates to a goal, a process, not a state, particularly in people who are in a critical period of growth and not merely undergoing a transition from childhood to adulthood.
In order to identify the key dimensions to consider in a comprehensive vision of youth risk behaviors, this paper will begin with a characterization of the risk approach in health promotion, and then differentiate high-risk behaviors behaviors that involve the risks inherent in the process of identity development in adolescence addition to analyzing the relationship between risk and protective factors of vulnerability, the damage and the ability to overcome adversity. Finally some guidelines outline the strategies for intervention in youth health to promote full development potential, contribute successfully to their social integration and reduce the prominence of morbid processes.
2. The risk approach in health care.
Risk involves the likelihood that the presence of one or more characteristics or factors increase the occurrence of adverse consequences for health, life planning, personal survival or others. Awareness of risk is a measure of the need for care and comprehensiveness of the factors taken into account, the possibility that the intervention is appropriate. However it leads to the certainty that the damage occurs. It has been found, for example, that the risk of a crash is different for individuals and groups of individuals of a given population (Suárez and Krauskopf, 1992).
The risk approach assumes that greater knowledge about negative events more likely to act on them in advance to avoid them by changing the conditions that expose an individual or group to acquire the disease or injury-prevention-primary, modified consequences ensuring the presence of services if the problem arises, to intervene in the early stage of the disease process and prevent the development or spread-secondary prevention. Primordial prevention aims to promote the development and its terms and tertiary prevention is aimed at those already damaged or diseased and intervenes to address the pathological symptoms, control the progression and prevent further complications and to control its spread (Silber , 1992).
The potential risk approach is to set goals aimed at identifying factors that lead to undesirable results, measure the association between these factors and the results to plan intervention actions in reducing the damage (Backett, et al, 1984). These interventions are guided by one side to the general population may be affected, but in particular focus on those who are most at risk.
is present the risk approach by emphasizing the action wherever they are the greatest potential for emergence of diseases, disorders and injuries, for which should be recognized protective factors (family support, vaccinations, stay in the educational system, safe work access to health care), risk behaviors (driving car at high speed, impulsive behavior) and risk factors (Unemployment, stagnant water) to reach its reduction or elimination. Actions toward people should be organized according to life cycle stage, gender, cultural background and other (Donuts, 1994).
Jessor (1991) explains that the epidemiological tradition, the concept of risk is associated particularly with the results leading to morbidity and mortality and possible breakthroughs in control factors such as water pollution, reduced levels cholesterol linked to cardiovascular disease, etc.
This approach also led to social and behavioral factors identified as leading to increased risk elements to be damaged, such as social accessibility to alcohol and snuff and personal stress. A risk factor may be a link in the chain leading to disease or injury, can also be an indicator of the presence of this link, The usefulness of these factors is that they are observed or identified before the event occurs they predict. A simplified example would predict that if a guy riding a motorcycle can have an accident.
On the other hand, the risk approach led to the identification of protective factors, understood as the conditions that prevent the emergence of the risk behaviors that lead to it, thus decreasing the vulnerability and promote damage resistance.
From the angle of health care, attacking the risk factors was a great success in reducing perinatal problems, other aspects of maternal and child health especially in the application to cardiovascular problems, as identify the factors significantly associated with the presentation of such damages in situations allowed to increase above the predictability of its occurrence and prevent acting on them. However, when these criteria are applied to adolescent development, predictions are not met so linearly. Suárez (1993) gives an interesting example of how the psychosocial analysis can change the negative weight attributed to risk factors illustrate the existing U.S. studies concluded that the son of an unmarried adolescent Latina mothers tend to be criminals or drug addicts, a conclusion that was broken when it was recognized that the presence in those cases extended family, favored Latino children compared with whites.
Importantly, the situation may be at high risk at a time when the life cycle and cease to be in another period. This is because the personal development gains such as skills acquisition biological, psychological and social resources affect well as environmental conditions according to the degree that they are protective, dangerous, disabling, capacitate them. Their interaction with potential and personal skills will largely determine the vulnerability of the individual or group. Therefore, the destructive consequences of risk vary during the life cycle in relation to the aging process, the conditions of protection and personal resources to make adjustments or additions that transform the situation.
addition, biological and psychosocial damage that an individual experience, may not be evident at the time of the conditions of risk: childhood settings affect aspects presented in the juvenile phase or vulnerabilities suffered in the adolescent period may adversely affect the adult stage. So there will be youth behaviors in adulthood will result in drug addiction, alcoholism, crime, AIDS (Weinstein, 1992).
3. Youth problems in the risk approach.
The risk approach, as applied to adolescents, particularly mentioned risk behaviors of young people themselves as a factor leading to mortality. As Irwin points out: "The behaviors associated with mortality and morbidity prevalent in adolescence involving a common theme: the taking of risks."
3.1. Damage
Damage most frequently encountered are: car accidents, death by drowning, unwanted pregnancy, AIDS and other sexually transmitted diseases, suicides, homicides, other unintended injuries, drug addiction, criminal behavior, chronic promiscuity. A national survey in Costa Rica revealed that while health statistics confirm the accident as one of the significant injuries in their teens, are not identified by this age group, or their relatives, as a priority issue requiring immediate attention to prevent risk (Krauskopf et. al. 1992).
3.2. behaviors as a risk factor.
behaviors juveniles have been identified as a risk factor are: sex, particularly early, unprotected and with multiple partners, the intensive consumption of alcohol and other drugs, including snuff, driving at an early age and without use of protection devices (seat belts, helmets for motorcycles), drunk or being a passenger of a drunk driver, prone to physical fights, carrying weapons or particular fire (Department of Health, United States 1994).
Interestingly, the gender difference against the risk noted by Silber (1992) and that is reflected, for example in which males are more severely affected in the statistics of accidents, homicides and suicides. It is a fairly widespread, they are more suicide attempts in women and that actual suicides are more common in men. In the same vein, Weinstein said that there is an increased psychosocial risk among men than among women, vulnerability is the result of the difficulty of access to education and employment, their more risky with addictions, sexuality, criminal justice system and lack of support networks.
3.3. Risk circuits.
has been established that the specific behaviors of adolescence que favorecen los daños de la salud se encuentran interrelacionados. Weinstein (1992:8) señala que "existen ciertos circuitos de riesgo y que el joven que ha ingresado a uno de ellos va adicionando vulnerabilidades de distinto orígen". Irwin (1990) reporta estudios de diversos autores que observan la relación entre el alcohol, consumo de cigarrillos y accidentes vehiculares. El consumo de alcohol es considerado también un predictor de ingestión de drogas ilícitas y actividades de sexo no protegido. Silber (1992:550,551) concuerda con esta posición al señalar que una conducta juvenil aislada como fumar, puede ser el preanuncio de otras conductas de alto riesgo a corto plazo y sugiere que en tales circunstancias es recomendable assess more carefully the possibility of other drug use, unprotected sex and establish peer groups. He adds that high-risk behaviors occur more frequently in adolescents with a psychological profile "characterized by aggression, excessive emphasis with respect to personal independence and the tendency to deviant activities."
3.4. Predictors of increased vulnerability.
The start of certain activities becomes a more serious risk predictor when it occurs at younger ages. So Weinstein stresses the early entry into employment, job performance marginal, early school dropout, sexual initiation at an earlier age. Bejarano and Jimenez (1993) highlights the start of the drinking career in the early stages of adolescence as a predictor of deterioration of this and other addictions in the future.
Important factors that come directly from their behaviors have been identified as links that increase youth vulnerability that are present in the media or social contexts where the individual is developed and its antecedents of personality. Among the various factors related to risk behaviors in adolescent development, Irwin (1990), like many researchers, emphasizes the child's academic success and behavior problems in school. Literature indicates that agrees to pay particular attention to environmental changes occurring in the school system and highlights the passage from primary to secondary schooling. These and other transitions in school life are particularly stressful nature, which results in frequent disruptive behaviors in adolescence. In Latin America there are various circumstances, such as the fact that in rural areas of some countries there are no secondary schools and migrations occur to swell the ranks of poor urban youth, without further preparation for the cultural and employment needs.
Several studies identified low education or desertion as a factor associated with pregnancy teenager. Krauskopf and Cabezas (1989) found that in the metropolitan area of \u200b\u200bSan Jose, pregnancy occurred mainly in girls who had dropped out of school, which is consistent with other Latin American research and differs from U.S. data, which indicate the dserción pregnancy as a cause of school (although there appears to be associated with previous difficulties in performance). In rural areas, on the other hand, establishing a union is a cause of dropout and dedication to home, which includes the procreation of children (Porras, 1993).
Torres Rivas (1989) reports that, according to the Census of Costa Rican prison population, conducted in 1982, illiteracy remains the property of many young offenders (40% of those under 17 years). In addition 63.4% had incomplete primary and all had no permanent job. Weinstein
highlights some behaviors that are the product of poverty in Latin America as the premature entry to employment, job performance and lower marginal contractualism, which leads to lack of health protection and labor rights, the prolonged unemployment ; conflicts of legal or criminal, especially those that lead to experiences of arrest and detention, the repeated repetition while within the school system and the expulsion for academic or disciplinary reasons, and early dropout from the system, lack of support networks to cope with the difficulties experienced in family, employment, sexuality, addictions, depression, etc. ..
Several authors indicate that the environment of extreme poverty is thus more exposed to serious risks and lower protective resources, the chronic high conflict family environment especially if accompanied by neglect, abuse, expulsion from home, presence of alcoholism, physical abuse and sexual, not having family, peer group membership that focus on social transgression, violence or addiction to drugs, stay in center legal detention, lack of support networks (Blum, 1995; Weinstein, 1992), no study or work, lack of opinions on development of skills that enable self-reliance and social recognition. It is important to recognize that among the risk factors are specific aspects of psychological and social functioning of youth such as low self-esteem and lack of a future project.
4. risky behaviors in the juvenile period.
the juvenile period in the biological, social and psychological staff and rethinking the definition of the human being through a second individuation process of exploration that moves, differentiation the family environment, looking for belonging and meaning of life, anxiety involving transitional and specific vulnerabilities (Bloss, 1981, Ausubel, 1954, Erikson, 1974).
4.1. The context of modernity.
Modernization has brought a weak and often contradictory structure of programming offered at this period of growth. In this context, the everyday becomes a challenge and uncertainty in time through which young people develop their identity. Our society, unlike primitive societies, it is not clear to raise public requirements to engage young people ritually as a member of recognized value.
Larson (1988) notes that "If we seek an equivalent of the adolescent rite of passage in our society we can see that, at present, the brave challenges that are designated to serve as a decisive demonstration prestigious roles in our society, probably not are both physical strength as his own personal independence and ability to think and work. The academic projects, dissertations and theses are closer to this description. " Obviously this option is only available to a small number of young people, and that even for them, these rituals appreciate the intellectual sphere only and do not consider the physical and socio-affective aspects.
may risk behaviors such as smoking, boldly drive cars, drink, equal rites of passage, generated in the youth subculture itself when there are opportunities to prove their passage to adulthood by testing their emerging skills to a society that welcomes them. In this regard, countries that have implemented the delivery of the Youth Card, fill part of the void indicated.
4.2. identity.
The construction of identity can be resolved through the recognition of personal characteristics and exploration of new possibilities from the perspective of a future commitment of its staff and society. When the behavior Risk appears in this direction, may be part of the meeting with the potential and enriching experience. It is increasingly evident in current studies that certain behaviors, even if they involve risks "may also lead to the contrary, becoming a source of learning and a kind of antidote to any damage (Weinstein, 1992:8).
When the bases of identity development are deficient, the claim states lacking teen structuring a compromise that seeks to avoid hazards in order to preserve the present achievements and Furuta. Instead, increase risky behavior who seek instant gratification or affirmation through actions that are fleeting sensations of achievement and recognition.
4.3. options.
satisfaction or dissatisfaction with personal performance has implications for the balance staff (self-image), social integration (social value) and the development of capacities to respond to this and plan ahead. The lack of solution to these problems affect the health and welfare of young people, leading to increased risk behaviors, and contributes to lower their chances of successful social integration. In these circumstances, the youth is vulnerable to obtaining rewards through behavior indiscriminate, short-range, immediate and accessible "to affirm their self-esteem, feelings of success find the same risk, finding emotional support in dangerous activities that do not provide consequences or anesthetized (drugs, mass activities, games that isolate them from reality ) to not feel overwhelming frustration, all of which leads to damage.
opportunities opening expands the range of experience enables the adolescent to have credentials for successful integration and provides goals to which no motivation to postpone pseudosolutions immediate risk. The reduction of negative chain reactions repeat prevents maladaptive responses and does not give the negative attitudes of others.
If the situation in which such perspectives are not offers, adolescents themselves revert to vent their dissatisfaction and anger against the environment, which provides them with the feeling of power. Your vulnerbilidad has increased and consequently increases susceptibility to reactively avoid frustration by risky and fleeting satisfaction of their needs for self-esteem and belonging.
4.4. risk behaviors.
agree with Jessor (1991) when he suggests differences between 1) risk behaviors are those that undertake aspects of psychosocial development or survival of the person during their youth development and even, on occasion, seek the danger in itself and 2) behaviors that involve risks, which are specific to young people who take risk assessments (not very different from adults) aware of it and how part of the commitment and the need for a richer and fuller development. Jessor considered unfortunate tendency to treat all adolescents as people who have risk behaviors, as the generalization leads to risky behavior are explained by occur in adolescents and can not delve into those young people who really have a style of life consistent in risky behaviors (true risk factors), which constitute important vulnerability of target groups to promote their health, welfare and social integration.
psychosocial The reformulation of the concept of risk led to a cost-benefit analysis of behavior, which is particularly important in the approach to be given to youth. Jessor (1991) exemplifies his position with the anti-drug campaigns that teach the teenager to say No. It raises the possibility that teens leave as risky behavior is strongly related to the possibility that astisfacción offered valuable alternative for them.
dissatisfaction and concern that adolescents have for their personal performance (both educational and labor) lack of socio-affective and cognitive nutrients, show their need for a present that will open possibilities for discovery and certainty about their own abilities and value. This is particularly important in the considerations of preventive interventions, because the issues dealt with are of high sensitivity, intimacy and have numerous personal and sociocultural implications.
Jessor (1991:598) notes that "smoking, drinking, dangerous driving of vehicles or early sexual activity can be ways to gain acceptance and respect from peers, to establish autonomy from their parents, in repudiating the conventional authority , its values \u200b\u200band standards in managing their anxiety, frustration and anticipation of failure or to assert their maturity and show the transition from childhood to adulthood. "Jessor's position is not aimed at justifying the continuation of these behaviors but to highlight the complexity of the intervention to be effectively achieved.
5. damage, protective factors and resilience.
In previous issues we have mentioned risk factors, and vulnerability. The picture would not be complete (at least at the current level of contributions on the subject) if resilience considered an important factor that is reflected in the amazing ability shown by many human beings grow and develop in adverse media and competency levels and health that in other cases, not enough individuals were not subjected to severe trauma or negative situations.
5.1. Resilience
The term resilience, which Rutter (1992) conceptualized with important research and theoretical developments, comes from a company identified in metals that can withstand shocks and recover its internal structure. It refers to the ability of humans to recover from adversity and, indeed, transform adversities into an element of encouragement and development. It is the ability to effectively confront adverse events, which may even be a factor for improvement (Smith, 1993).
Resilience provides a lower susceptibility to stress and reduces the potential of being affected by negative events, even some damage. Reflected in the fact that at different times of life of people show greater ability to cope, resist and recover from factors that can be destructive.
factors that increase resilience, Rutter (1992) highlights the previous exposure to psychosocial adversity with a successful coping with stress and danger. Graded doses of coping with difficulties may operate similarly to the immunizations. Conversely, overprotection appears to act in the opposite direction. One possible explanation for this is that in overprotection, decisions and their consequences are in the hands of others, which fosters an external locus of control and individual self-esteem does not consolidate the testing of their skills and personal and social recognition of the outcome of their responsibilities, so which is more at the mercy of external events. On the other hand, are permanently subjected to hardships and stress, seems to greatly reduce the development of resilience (Grottberg, 1992).
5.2. protective factors. Notes
Rutter that the same factor may be at risk and / or protection (for the development of new attitudes and skills) in the circumstances. That is, reducing the impact to vulnerability occurs to understand more fully the meaning of danger have been gradual exposure to this type of situation or ability to respond effectively to have the necessary support and learning to develop alternative non-destructive response, significant adults receive the modeling approaches developmentally appropriate responses to resolve problems that are part of human life. In a small study in Costa Rica it was found that adolescents whose homes they discussed the problems facing any member and usually talking about real alternative solution or confrontation, developed a greater sense of competence to conduct themselves in situations conditions (Krauskopf, 1994).
The possibility of establishing a positive self-esteem based on achievement, performance and recognition of responsibilities, opportunities to develop social skills, cognitive and emotional coping, decision making and anticipate consequences, increasing internal locus of control (ie recognize itself the possibility of transforming circumstances so that they respond to their needs, preservation and aspirations) personal protective factors can be promoted, which are connected with the development of resilience.
family needs to support the adolescent growth, confirm the process of individuation, can analyze the new expressions emerging changes in the juvenile phase without stigma; solve emerging affective dimensions in the context of acceptance of family system dynamics, share the needs of new roles and may, from an empathic perspective, guide, advise, assist, monitor . The protection from physical self-care (nutrition, exercise, safe sex) development of new interests, of rewards through the expression of talent and social participation to reduce the exposure risk free.
are also key external protective factors. It is not like the fate of a teen & Researchers who have the ability to access non-repudiation prenatal care, can continue with their education, with the support and guidance dealing with their situation, a young woman who happens otherwise. Nor will the equally effective AIDS prevention workshops for teens that promote responsible sexual relations with a capacity of assertiveness, internal locus of control and protection through condom use, if desired external protective factors are not consistent. Examples may be: censorship pharmacy clerk at the request of condoms, the difficulty for some staff assigned to training to be convinced of the position on the prevention modality youth sexuality, fear of girls being exposed to condoms by their parents, adult disbelief about the possibility that young people really take precautions in times of both emotion and anguish to accept the existence of youth sexuality.
5.3. factors predisposing to injury.
structuring factors impeding the achievement behaviors are the challenges consumerism, ephemeral offered to the teen sector and greater accessibility of participation in evación cultures of transgression, while opportunities for bonuses and options for constructive social relevance are restricted. Gresham
(1986) points out that teens who have not learned to deal with situations resulting from the tensions of its development and environmental conditions, have been frequently involved in chaotic homes and models devoid of capacity for containment and handling.
If the construction of identity is given to feelings of self worth and efforts to achieve social integration are accompanied by positive recognition and an internal locus of control, increasing the risk protection required in the exploration activities. If, however, identity is constructed so confusing, incomplete, partial, with feelings of personal devaluation and exclusion social vulnerability will be greater and the propensity for risky behaviors to meet the withdrawal at any cost, the more likely.
6. intervention strategies against the risk in the juvenile phase.
not intend to present in this section a comprehensive study of the problems and opportunities involving the development of policies to address youth risk behaviors, but provide some modest reflections that constitute milestones in the complexity of the challenge. The analysis conducted thus far to conclude that most of the causes of mortality and morbidity in the juvenile phase are preventable. To prevent damage and risk behaviors is necessary to adopt appropriate strategies combiene neutralizing risk factors, limits on out of control behaviors, strengthening protective factors and identify not only individual negative aspects, but also personal traits that allow success social integration, positive self-image.
social programs aimed at youth show a strong concern for reducing vulnerability and the damage they are exposed to large numbers of young American. This has been frequently mentioned and look for programs targeting youth at high risk. One difficulty This is the definition and operationalization of the target groups and areas to be identified to assess their vulnerability.
6.1. Instruments juvenile risk assessment.
The assessment of behaviors and risk factors for the justification of intervention and prevention strategies, ways have been opened in operationalizing the problem with the development of instruments to assess the presence of risk behaviors in male and female adolescents. Among these we can point to Hofmann (1990) who has a targeted approach to the detection of psychological and interpersonal aspects. The author develops a psychosocial inventory for performance assessment of health risk that consists of six main sections: home, school, peers, romantic relationships, substance use, antisocial behavior. Consider the performance deterioration as a sign of potential problems and identifies as a key element in the assessment of risk behaviors to health, poor cognitive level and the lack of youth involvement in the learning of the decision-making.
The National Survey on Youth Risk Behavior conducted in the United States in 1992 built a series of interesting indicators that included both high-risk behaviors, factors related to risk and protective factors each properly operationalized for assessment (Department of Health and Human Services, 1994).
This kind of approach needs to be refocused according to the characteristics of both Latin American lifestyles and in relation to the presence of contingents of young people living in exclusion, impoverishment of options for cognitive development, creativity, recognition production and lack of adequate social integration options are recognized as valuable.
Weinstein (1992) provides the construction of a Psychosocial Risk Index in Young that incorporates ten dimensions of vulnerability of recognized value as predictors of psychosocial harm during youth or impact in adulthood. Consider the following dimensions subjected to a weighting of experts: socioeconomic status, family origin, couples, addictions, sexuality, relationship to formal education related to employment, relationship with the legal system and criminal, psychological characteristics, support networks . The dimensions of the highest weighting in the index are the family of origin and relationship to formal education.
6.2. Actions risk reduction and increased protection .
is essential to refer to the role of protective factors in risky youth behavior. As we have said, a major focus is on the opportunities for skills development and social inclusion. Roldán (1994) highlights three fundamental ecological environments in the development of children and adolescents: the womb, the family and school.
Regarding the latter stressed that not all born with equal opportunities to respond to the formal education system. Argentina develops an action research program which aims to detect risk and protective factors for adolescent health in schools and developed a successful training experience for teachers and school authorities and health workers. Specifies the need for early detection of people at risk of being eliminated from the educational system for learning difficulties and discipline and necessary to achieve reduction in the number of students at risk for truancy, poor performance, penalties, exclusion from the system by authorities. Documents
World Health Organization (1989) recognize the importance of school, the role it can play in primary prevention and primary and highlight the need to promote healthy lifestyles among youth. Usually the opposite is analyzed, that is, whether adolescents meet the criteria for success of the educational system. In this case, the possibility of promoting health approach is quite excluded.
6.3. priority target groups.
While no breakdown of the target groups for their exposure to risk or presence of damage, as this requires in each detection area planning and priority strategies, we refer briefly to some groups that have been identified as relevant coincidentally.
Most of the analysis of risk behaviors can be concluded that among the priority target group for prevention of risk behaviors are the teenage dropouts and potential dropouts.
is a factor risk that is associated with many behaviors that lead to injury. Identify, characterize the conditions of their vulnerability to provide action tools to educational institutions through its faculty, seek solutions to promote successful retention of students is important area to develop. Although students can not avoid the drop can be crucial guide them after identifying their resources to developing their life plan and guidance to enable them to constructively redirect the course of their difficulties. Another important area of \u200b\u200bfocus is adolescent sexuality concern is with teen pregnancy are more visible young people and emerge the need to include this segment of the population in the agenda of health planning. However, in reproductive health care is necessary to include more emphatically masculine values \u200b\u200band the role that fits the male (Population Council, 1990). On the other hand, the concern about pregnancy seems to predominate, which when looking antoconceptivos not necessarily considered the prevention of sexually transmitted diseases. This area also involves many other aspects of interpersonal type and sometimes even social pathology: early prostitution, sexual abuse, etc.
rural-urban migration and membership in an extremely poor socioeconomic requiring adolescents to develop coping strategies to satisfy their basic needs: food, housing, and so on., increasing exposure to risk factors. Young people for whom the streets are important needs satisfaction are devoid of many protective factors.
high risk groups are those sectors whose behavior is out of control for belonging to strata with little access to the options and be subject to particularly intense disruptive stimulation for various reasons (economic, political, military, marginality, distorting impact of modernization, lack of employment and education), and pose an urgent challenge to find possible instances give appropriate continence and driving opportunities in their care.
The youth offenders, violent, addicted are important target groups. The experiences based primarily on social control have not proved sufficient to lead to the reduction of these behaviors and subsequent damage, and at times have come to be risk factors. Prevention programs should be All in addition to the level of arrest and detention (when necessary), the more accurate identification teenage problem, the supply of comprehensive models that allow repair missing elements through voluntary admission to these programs, which in turn are articulated with social inclusion pathways that facilitate the independence and productivity. This requires the involvement of developers able to motivate and inform young people in risk areas.
regard to accidents, fundamental cause of juvenile mortality, it should discuss the creation of new approaches to strengthen existing measures. Interestingly, driver's license, is somehow one of the few rites of passage into adulthood that our society offers (the others are achieved by young people entering secondary schooling and the right to vote), which could help to develop preventive programs linked to this.
6.4. Youth involvement in prevention strategies.
One aspect that gains increasing recognition methodology is the need to involve young people themselves to proposals and program implementation. Weinstein (1992:82) recommends that "social programs aimed at psychosocial risk youth should explore communication strategies to consider ways and sources of information that this age group and has social." Emphasizes that the information circulating in the local level, Nearby motivating these young leaders for their information and opinion can influence them. Indeed these strategies have been implemented successfully in several Latin American countries and constitute a form of work promoting the situation of young people at risk for progressing and strengthening comprehensive.
The focus of care involves taking into account the presence of risk factors present in early adolescence. On the other side in the last stage of adolescence -17 to 20 years, the concerns and appear to increase self-care capabilities.
There is increased awareness of risks at both the sexual in the field of drug and psychosocial aspects of development are more clearly perceived. These youth can be trained to promote health in its various aspects and act as multiplier agents because of their strong interaction with peer groups.
7. Final Remarks.
is possible to identify sectors with greater exposure to risk, with various health assessments, with varying development of resources that allow us to provide, promote and enhance the quality of life. Biological and sociocultural differences defined that, besides the health problems shared by men and women, there are manifestations of the prevailing mortality or are unique to either sex, which is present more or less, and even features different in ethnicity, socioeconomic status, rural or urban areas and special very important and critical in the juvenile phase.
preventive interventions for risk behavior and risk factors consider both internal and external security and increased vulnerability to early age (teens: 10 to 15 years) and better self-care ability and leadership in health promotion and social integration in the proper period youth (15 to 24 years).
Youth participation in the design and implementation of strategies is fundamental, the articulation with adults who are trained and convinced of the appropriateness of actions. The existence of capacitated networks, promoters of street groups prioritize circuits embedded in high-risk, rites of passage that value publicly joining adult responsibilities are important support in the development of actions.
Finally, it is important to conclude with Perry and Jessor (1985), when they point out that the promotion of health from risky behavior is not simply a matter of personal responsibility. The immediate context of the lives, the modeling of personality and social roles are related to economic, social and political. Changes in social approaches in the structure of educational opportunities, employment, recreation and personal development are essential for a comprehensive approach to health promotion, all of which can not occur without input from those interested in investigating and acting permanently commitment to overcome the risk aspects of the juvenile phase at all possible levels.
In recent decades there have been many advances in health and attention to the situation youth. The prolongation of life expectancy, modernity and globalization with its wide range of complex stimuli, increases the need for adolescents and young people to find, in the new circumstances that surround them, the elements to assume the biopsychosocial changes they experience in building a social role that matches the identity, organize their behavior from a do in the world that objectifies positively and sustain a life plan that gives meaning to your present relationship with the environment, which in many areas of Latin America also includes the difficulties of poverty.
Advances in medicine have great potential in reducing of suffering and prolongation of life, what attention has increasingly specialized to different life stages and even consider gender differences. From the perspective of disease was observed that juvenile mortality was the particular and important characteristic of being desecadenada mainly by external and behavioral factors: drugs, accidents, suicides, escapes, dropouts, pregnancies, STDs, violence, bringing to organize care for adolescents through these issues. This led to the concept that was, of adolescence as a healthy age, is passed to the emphasis of the behavior risk and that the programs for that age period will be focused in a specific way for each of the problems. Thus the vertical programs as adolescents received separate responses to each risk or harm, drugs, accidents, STDs / AIDS, pregnancy, and articulate a plan that would meet health in adolescence. The experiences showed that the problems were related and also damage and risk behaviors, protective factors were therefore approaches began to get rich (Donuts, 1992).
other hand many of the issues that affect youth social peace are associated with risky behaviors, adolescents named more attention when problems were outsourced when suffering from depression, isolation, sexual abuse, etc., which attracted wide attention from various social sectors, as communicators, teachers, etc., and youth became increasingly identified as a segment of the population problem that often reached a stigmatized perspective. This has consequences risky, because the recognition pejorative people who cross the adolescent period, facilitates the construction of the negative identity (Erikson, 1974), as the social value contributes to the development of identity and youth need to be recognized as someone has to prefer to be someone feared, hated to be anybody.
socializing agencies such as family, school, media, etc., Meet new contexts to address the various social changes and generate feedback that seek to be channeled in youth policies that set the challenge respodan appropriate options for this strategic sector of society and have the sign of the problematization and exclusion of youth, the positive sign for incorporating personal and social development.
is especially accomplished in the decade after the declaration of the Youth Year in 1985, accumulating studies perspectives are promoted positive proposals and programs that offer a more complex view of youth, recognizing their importance in social development, their contributions and difficulties, the interaction of its features with the possibilities of the environment.
The concept of risk in the juvenile period has been highlighted by the possibility that the behaviors or situations lead to developmental damage that can affect all of its damage potential as well-being and health (Weinstein, 1992). Currently, the focus of attention to youth health, try on a more comprehensive and articulated to reduce risk factors, increasing protective factors and provide reconstruction and development opportunities of the situation. The conceptualization of health is therefore relates to a goal, a process, not a state, particularly in people who are in a critical period of growth and not merely undergoing a transition from childhood to adulthood.
In order to identify the key dimensions to consider in a comprehensive vision of youth risk behaviors, this paper will begin with a characterization of the risk approach in health promotion, and then differentiate high-risk behaviors behaviors that involve the risks inherent in the process of identity development in adolescence addition to analyzing the relationship between risk and protective factors of vulnerability, the damage and the ability to overcome adversity. Finally some guidelines outline the strategies for intervention in youth health to promote full development potential, contribute successfully to their social integration and reduce the prominence of morbid processes.
2. The risk approach in health care.
Risk involves the likelihood that the presence of one or more characteristics or factors increase the occurrence of adverse consequences for health, life planning, personal survival or others. Awareness of risk is a measure of the need for care and comprehensiveness of the factors taken into account, the possibility that the intervention is appropriate. However it leads to the certainty that the damage occurs. It has been found, for example, that the risk of a crash is different for individuals and groups of individuals of a given population (Suárez and Krauskopf, 1992).
The risk approach assumes that greater knowledge about negative events more likely to act on them in advance to avoid them by changing the conditions that expose an individual or group to acquire the disease or injury-prevention-primary, modified consequences ensuring the presence of services if the problem arises, to intervene in the early stage of the disease process and prevent the development or spread-secondary prevention. Primordial prevention aims to promote the development and its terms and tertiary prevention is aimed at those already damaged or diseased and intervenes to address the pathological symptoms, control the progression and prevent further complications and to control its spread (Silber , 1992).
The potential risk approach is to set goals aimed at identifying factors that lead to undesirable results, measure the association between these factors and the results to plan intervention actions in reducing the damage (Backett, et al, 1984). These interventions are guided by one side to the general population may be affected, but in particular focus on those who are most at risk.
is present the risk approach by emphasizing the action wherever they are the greatest potential for emergence of diseases, disorders and injuries, for which should be recognized protective factors (family support, vaccinations, stay in the educational system, safe work access to health care), risk behaviors (driving car at high speed, impulsive behavior) and risk factors (Unemployment, stagnant water) to reach its reduction or elimination. Actions toward people should be organized according to life cycle stage, gender, cultural background and other (Donuts, 1994).
Jessor (1991) explains that the epidemiological tradition, the concept of risk is associated particularly with the results leading to morbidity and mortality and possible breakthroughs in control factors such as water pollution, reduced levels cholesterol linked to cardiovascular disease, etc.
This approach also led to social and behavioral factors identified as leading to increased risk elements to be damaged, such as social accessibility to alcohol and snuff and personal stress. A risk factor may be a link in the chain leading to disease or injury, can also be an indicator of the presence of this link, The usefulness of these factors is that they are observed or identified before the event occurs they predict. A simplified example would predict that if a guy riding a motorcycle can have an accident.
On the other hand, the risk approach led to the identification of protective factors, understood as the conditions that prevent the emergence of the risk behaviors that lead to it, thus decreasing the vulnerability and promote damage resistance.
From the angle of health care, attacking the risk factors was a great success in reducing perinatal problems, other aspects of maternal and child health especially in the application to cardiovascular problems, as identify the factors significantly associated with the presentation of such damages in situations allowed to increase above the predictability of its occurrence and prevent acting on them. However, when these criteria are applied to adolescent development, predictions are not met so linearly. Suárez (1993) gives an interesting example of how the psychosocial analysis can change the negative weight attributed to risk factors illustrate the existing U.S. studies concluded that the son of an unmarried adolescent Latina mothers tend to be criminals or drug addicts, a conclusion that was broken when it was recognized that the presence in those cases extended family, favored Latino children compared with whites.
Importantly, the situation may be at high risk at a time when the life cycle and cease to be in another period. This is because the personal development gains such as skills acquisition biological, psychological and social resources affect well as environmental conditions according to the degree that they are protective, dangerous, disabling, capacitate them. Their interaction with potential and personal skills will largely determine the vulnerability of the individual or group. Therefore, the destructive consequences of risk vary during the life cycle in relation to the aging process, the conditions of protection and personal resources to make adjustments or additions that transform the situation.
addition, biological and psychosocial damage that an individual experience, may not be evident at the time of the conditions of risk: childhood settings affect aspects presented in the juvenile phase or vulnerabilities suffered in the adolescent period may adversely affect the adult stage. So there will be youth behaviors in adulthood will result in drug addiction, alcoholism, crime, AIDS (Weinstein, 1992).
3. Youth problems in the risk approach.
The risk approach, as applied to adolescents, particularly mentioned risk behaviors of young people themselves as a factor leading to mortality. As Irwin points out: "The behaviors associated with mortality and morbidity prevalent in adolescence involving a common theme: the taking of risks."
3.1. Damage
Damage most frequently encountered are: car accidents, death by drowning, unwanted pregnancy, AIDS and other sexually transmitted diseases, suicides, homicides, other unintended injuries, drug addiction, criminal behavior, chronic promiscuity. A national survey in Costa Rica revealed that while health statistics confirm the accident as one of the significant injuries in their teens, are not identified by this age group, or their relatives, as a priority issue requiring immediate attention to prevent risk (Krauskopf et. al. 1992).
3.2. behaviors as a risk factor.
behaviors juveniles have been identified as a risk factor are: sex, particularly early, unprotected and with multiple partners, the intensive consumption of alcohol and other drugs, including snuff, driving at an early age and without use of protection devices (seat belts, helmets for motorcycles), drunk or being a passenger of a drunk driver, prone to physical fights, carrying weapons or particular fire (Department of Health, United States 1994).
Interestingly, the gender difference against the risk noted by Silber (1992) and that is reflected, for example in which males are more severely affected in the statistics of accidents, homicides and suicides. It is a fairly widespread, they are more suicide attempts in women and that actual suicides are more common in men. In the same vein, Weinstein said that there is an increased psychosocial risk among men than among women, vulnerability is the result of the difficulty of access to education and employment, their more risky with addictions, sexuality, criminal justice system and lack of support networks.
3.3. Risk circuits.
has been established that the specific behaviors of adolescence que favorecen los daños de la salud se encuentran interrelacionados. Weinstein (1992:8) señala que "existen ciertos circuitos de riesgo y que el joven que ha ingresado a uno de ellos va adicionando vulnerabilidades de distinto orígen". Irwin (1990) reporta estudios de diversos autores que observan la relación entre el alcohol, consumo de cigarrillos y accidentes vehiculares. El consumo de alcohol es considerado también un predictor de ingestión de drogas ilícitas y actividades de sexo no protegido. Silber (1992:550,551) concuerda con esta posición al señalar que una conducta juvenil aislada como fumar, puede ser el preanuncio de otras conductas de alto riesgo a corto plazo y sugiere que en tales circunstancias es recomendable assess more carefully the possibility of other drug use, unprotected sex and establish peer groups. He adds that high-risk behaviors occur more frequently in adolescents with a psychological profile "characterized by aggression, excessive emphasis with respect to personal independence and the tendency to deviant activities."
3.4. Predictors of increased vulnerability.
The start of certain activities becomes a more serious risk predictor when it occurs at younger ages. So Weinstein stresses the early entry into employment, job performance marginal, early school dropout, sexual initiation at an earlier age. Bejarano and Jimenez (1993) highlights the start of the drinking career in the early stages of adolescence as a predictor of deterioration of this and other addictions in the future.
Important factors that come directly from their behaviors have been identified as links that increase youth vulnerability that are present in the media or social contexts where the individual is developed and its antecedents of personality. Among the various factors related to risk behaviors in adolescent development, Irwin (1990), like many researchers, emphasizes the child's academic success and behavior problems in school. Literature indicates that agrees to pay particular attention to environmental changes occurring in the school system and highlights the passage from primary to secondary schooling. These and other transitions in school life are particularly stressful nature, which results in frequent disruptive behaviors in adolescence. In Latin America there are various circumstances, such as the fact that in rural areas of some countries there are no secondary schools and migrations occur to swell the ranks of poor urban youth, without further preparation for the cultural and employment needs.
Several studies identified low education or desertion as a factor associated with pregnancy teenager. Krauskopf and Cabezas (1989) found that in the metropolitan area of \u200b\u200bSan Jose, pregnancy occurred mainly in girls who had dropped out of school, which is consistent with other Latin American research and differs from U.S. data, which indicate the dserción pregnancy as a cause of school (although there appears to be associated with previous difficulties in performance). In rural areas, on the other hand, establishing a union is a cause of dropout and dedication to home, which includes the procreation of children (Porras, 1993).
Torres Rivas (1989) reports that, according to the Census of Costa Rican prison population, conducted in 1982, illiteracy remains the property of many young offenders (40% of those under 17 years). In addition 63.4% had incomplete primary and all had no permanent job. Weinstein
highlights some behaviors that are the product of poverty in Latin America as the premature entry to employment, job performance and lower marginal contractualism, which leads to lack of health protection and labor rights, the prolonged unemployment ; conflicts of legal or criminal, especially those that lead to experiences of arrest and detention, the repeated repetition while within the school system and the expulsion for academic or disciplinary reasons, and early dropout from the system, lack of support networks to cope with the difficulties experienced in family, employment, sexuality, addictions, depression, etc. ..
Several authors indicate that the environment of extreme poverty is thus more exposed to serious risks and lower protective resources, the chronic high conflict family environment especially if accompanied by neglect, abuse, expulsion from home, presence of alcoholism, physical abuse and sexual, not having family, peer group membership that focus on social transgression, violence or addiction to drugs, stay in center legal detention, lack of support networks (Blum, 1995; Weinstein, 1992), no study or work, lack of opinions on development of skills that enable self-reliance and social recognition. It is important to recognize that among the risk factors are specific aspects of psychological and social functioning of youth such as low self-esteem and lack of a future project.
4. risky behaviors in the juvenile period.
the juvenile period in the biological, social and psychological staff and rethinking the definition of the human being through a second individuation process of exploration that moves, differentiation the family environment, looking for belonging and meaning of life, anxiety involving transitional and specific vulnerabilities (Bloss, 1981, Ausubel, 1954, Erikson, 1974).
4.1. The context of modernity.
Modernization has brought a weak and often contradictory structure of programming offered at this period of growth. In this context, the everyday becomes a challenge and uncertainty in time through which young people develop their identity. Our society, unlike primitive societies, it is not clear to raise public requirements to engage young people ritually as a member of recognized value.
Larson (1988) notes that "If we seek an equivalent of the adolescent rite of passage in our society we can see that, at present, the brave challenges that are designated to serve as a decisive demonstration prestigious roles in our society, probably not are both physical strength as his own personal independence and ability to think and work. The academic projects, dissertations and theses are closer to this description. " Obviously this option is only available to a small number of young people, and that even for them, these rituals appreciate the intellectual sphere only and do not consider the physical and socio-affective aspects.
may risk behaviors such as smoking, boldly drive cars, drink, equal rites of passage, generated in the youth subculture itself when there are opportunities to prove their passage to adulthood by testing their emerging skills to a society that welcomes them. In this regard, countries that have implemented the delivery of the Youth Card, fill part of the void indicated.
4.2. identity.
The construction of identity can be resolved through the recognition of personal characteristics and exploration of new possibilities from the perspective of a future commitment of its staff and society. When the behavior Risk appears in this direction, may be part of the meeting with the potential and enriching experience. It is increasingly evident in current studies that certain behaviors, even if they involve risks "may also lead to the contrary, becoming a source of learning and a kind of antidote to any damage (Weinstein, 1992:8).
When the bases of identity development are deficient, the claim states lacking teen structuring a compromise that seeks to avoid hazards in order to preserve the present achievements and Furuta. Instead, increase risky behavior who seek instant gratification or affirmation through actions that are fleeting sensations of achievement and recognition.
4.3. options.
satisfaction or dissatisfaction with personal performance has implications for the balance staff (self-image), social integration (social value) and the development of capacities to respond to this and plan ahead. The lack of solution to these problems affect the health and welfare of young people, leading to increased risk behaviors, and contributes to lower their chances of successful social integration. In these circumstances, the youth is vulnerable to obtaining rewards through behavior indiscriminate, short-range, immediate and accessible "to affirm their self-esteem, feelings of success find the same risk, finding emotional support in dangerous activities that do not provide consequences or anesthetized (drugs, mass activities, games that isolate them from reality ) to not feel overwhelming frustration, all of which leads to damage.
opportunities opening expands the range of experience enables the adolescent to have credentials for successful integration and provides goals to which no motivation to postpone pseudosolutions immediate risk. The reduction of negative chain reactions repeat prevents maladaptive responses and does not give the negative attitudes of others.
If the situation in which such perspectives are not offers, adolescents themselves revert to vent their dissatisfaction and anger against the environment, which provides them with the feeling of power. Your vulnerbilidad has increased and consequently increases susceptibility to reactively avoid frustration by risky and fleeting satisfaction of their needs for self-esteem and belonging.
4.4. risk behaviors.
agree with Jessor (1991) when he suggests differences between 1) risk behaviors are those that undertake aspects of psychosocial development or survival of the person during their youth development and even, on occasion, seek the danger in itself and 2) behaviors that involve risks, which are specific to young people who take risk assessments (not very different from adults) aware of it and how part of the commitment and the need for a richer and fuller development. Jessor considered unfortunate tendency to treat all adolescents as people who have risk behaviors, as the generalization leads to risky behavior are explained by occur in adolescents and can not delve into those young people who really have a style of life consistent in risky behaviors (true risk factors), which constitute important vulnerability of target groups to promote their health, welfare and social integration.
psychosocial The reformulation of the concept of risk led to a cost-benefit analysis of behavior, which is particularly important in the approach to be given to youth. Jessor (1991) exemplifies his position with the anti-drug campaigns that teach the teenager to say No. It raises the possibility that teens leave as risky behavior is strongly related to the possibility that astisfacción offered valuable alternative for them.
dissatisfaction and concern that adolescents have for their personal performance (both educational and labor) lack of socio-affective and cognitive nutrients, show their need for a present that will open possibilities for discovery and certainty about their own abilities and value. This is particularly important in the considerations of preventive interventions, because the issues dealt with are of high sensitivity, intimacy and have numerous personal and sociocultural implications.
Jessor (1991:598) notes that "smoking, drinking, dangerous driving of vehicles or early sexual activity can be ways to gain acceptance and respect from peers, to establish autonomy from their parents, in repudiating the conventional authority , its values \u200b\u200band standards in managing their anxiety, frustration and anticipation of failure or to assert their maturity and show the transition from childhood to adulthood. "Jessor's position is not aimed at justifying the continuation of these behaviors but to highlight the complexity of the intervention to be effectively achieved.
5. damage, protective factors and resilience.
In previous issues we have mentioned risk factors, and vulnerability. The picture would not be complete (at least at the current level of contributions on the subject) if resilience considered an important factor that is reflected in the amazing ability shown by many human beings grow and develop in adverse media and competency levels and health that in other cases, not enough individuals were not subjected to severe trauma or negative situations.
5.1. Resilience
The term resilience, which Rutter (1992) conceptualized with important research and theoretical developments, comes from a company identified in metals that can withstand shocks and recover its internal structure. It refers to the ability of humans to recover from adversity and, indeed, transform adversities into an element of encouragement and development. It is the ability to effectively confront adverse events, which may even be a factor for improvement (Smith, 1993).
Resilience provides a lower susceptibility to stress and reduces the potential of being affected by negative events, even some damage. Reflected in the fact that at different times of life of people show greater ability to cope, resist and recover from factors that can be destructive.
factors that increase resilience, Rutter (1992) highlights the previous exposure to psychosocial adversity with a successful coping with stress and danger. Graded doses of coping with difficulties may operate similarly to the immunizations. Conversely, overprotection appears to act in the opposite direction. One possible explanation for this is that in overprotection, decisions and their consequences are in the hands of others, which fosters an external locus of control and individual self-esteem does not consolidate the testing of their skills and personal and social recognition of the outcome of their responsibilities, so which is more at the mercy of external events. On the other hand, are permanently subjected to hardships and stress, seems to greatly reduce the development of resilience (Grottberg, 1992).
5.2. protective factors. Notes
Rutter that the same factor may be at risk and / or protection (for the development of new attitudes and skills) in the circumstances. That is, reducing the impact to vulnerability occurs to understand more fully the meaning of danger have been gradual exposure to this type of situation or ability to respond effectively to have the necessary support and learning to develop alternative non-destructive response, significant adults receive the modeling approaches developmentally appropriate responses to resolve problems that are part of human life. In a small study in Costa Rica it was found that adolescents whose homes they discussed the problems facing any member and usually talking about real alternative solution or confrontation, developed a greater sense of competence to conduct themselves in situations conditions (Krauskopf, 1994).
The possibility of establishing a positive self-esteem based on achievement, performance and recognition of responsibilities, opportunities to develop social skills, cognitive and emotional coping, decision making and anticipate consequences, increasing internal locus of control (ie recognize itself the possibility of transforming circumstances so that they respond to their needs, preservation and aspirations) personal protective factors can be promoted, which are connected with the development of resilience.
family needs to support the adolescent growth, confirm the process of individuation, can analyze the new expressions emerging changes in the juvenile phase without stigma; solve emerging affective dimensions in the context of acceptance of family system dynamics, share the needs of new roles and may, from an empathic perspective, guide, advise, assist, monitor . The protection from physical self-care (nutrition, exercise, safe sex) development of new interests, of rewards through the expression of talent and social participation to reduce the exposure risk free.
are also key external protective factors. It is not like the fate of a teen & Researchers who have the ability to access non-repudiation prenatal care, can continue with their education, with the support and guidance dealing with their situation, a young woman who happens otherwise. Nor will the equally effective AIDS prevention workshops for teens that promote responsible sexual relations with a capacity of assertiveness, internal locus of control and protection through condom use, if desired external protective factors are not consistent. Examples may be: censorship pharmacy clerk at the request of condoms, the difficulty for some staff assigned to training to be convinced of the position on the prevention modality youth sexuality, fear of girls being exposed to condoms by their parents, adult disbelief about the possibility that young people really take precautions in times of both emotion and anguish to accept the existence of youth sexuality.
5.3. factors predisposing to injury.
structuring factors impeding the achievement behaviors are the challenges consumerism, ephemeral offered to the teen sector and greater accessibility of participation in evación cultures of transgression, while opportunities for bonuses and options for constructive social relevance are restricted. Gresham
(1986) points out that teens who have not learned to deal with situations resulting from the tensions of its development and environmental conditions, have been frequently involved in chaotic homes and models devoid of capacity for containment and handling.
If the construction of identity is given to feelings of self worth and efforts to achieve social integration are accompanied by positive recognition and an internal locus of control, increasing the risk protection required in the exploration activities. If, however, identity is constructed so confusing, incomplete, partial, with feelings of personal devaluation and exclusion social vulnerability will be greater and the propensity for risky behaviors to meet the withdrawal at any cost, the more likely.
6. intervention strategies against the risk in the juvenile phase.
not intend to present in this section a comprehensive study of the problems and opportunities involving the development of policies to address youth risk behaviors, but provide some modest reflections that constitute milestones in the complexity of the challenge. The analysis conducted thus far to conclude that most of the causes of mortality and morbidity in the juvenile phase are preventable. To prevent damage and risk behaviors is necessary to adopt appropriate strategies combiene neutralizing risk factors, limits on out of control behaviors, strengthening protective factors and identify not only individual negative aspects, but also personal traits that allow success social integration, positive self-image.
social programs aimed at youth show a strong concern for reducing vulnerability and the damage they are exposed to large numbers of young American. This has been frequently mentioned and look for programs targeting youth at high risk. One difficulty This is the definition and operationalization of the target groups and areas to be identified to assess their vulnerability.
6.1. Instruments juvenile risk assessment.
The assessment of behaviors and risk factors for the justification of intervention and prevention strategies, ways have been opened in operationalizing the problem with the development of instruments to assess the presence of risk behaviors in male and female adolescents. Among these we can point to Hofmann (1990) who has a targeted approach to the detection of psychological and interpersonal aspects. The author develops a psychosocial inventory for performance assessment of health risk that consists of six main sections: home, school, peers, romantic relationships, substance use, antisocial behavior. Consider the performance deterioration as a sign of potential problems and identifies as a key element in the assessment of risk behaviors to health, poor cognitive level and the lack of youth involvement in the learning of the decision-making.
The National Survey on Youth Risk Behavior conducted in the United States in 1992 built a series of interesting indicators that included both high-risk behaviors, factors related to risk and protective factors each properly operationalized for assessment (Department of Health and Human Services, 1994).
This kind of approach needs to be refocused according to the characteristics of both Latin American lifestyles and in relation to the presence of contingents of young people living in exclusion, impoverishment of options for cognitive development, creativity, recognition production and lack of adequate social integration options are recognized as valuable.
Weinstein (1992) provides the construction of a Psychosocial Risk Index in Young that incorporates ten dimensions of vulnerability of recognized value as predictors of psychosocial harm during youth or impact in adulthood. Consider the following dimensions subjected to a weighting of experts: socioeconomic status, family origin, couples, addictions, sexuality, relationship to formal education related to employment, relationship with the legal system and criminal, psychological characteristics, support networks . The dimensions of the highest weighting in the index are the family of origin and relationship to formal education.
6.2. Actions risk reduction and increased protection .
is essential to refer to the role of protective factors in risky youth behavior. As we have said, a major focus is on the opportunities for skills development and social inclusion. Roldán (1994) highlights three fundamental ecological environments in the development of children and adolescents: the womb, the family and school.
Regarding the latter stressed that not all born with equal opportunities to respond to the formal education system. Argentina develops an action research program which aims to detect risk and protective factors for adolescent health in schools and developed a successful training experience for teachers and school authorities and health workers. Specifies the need for early detection of people at risk of being eliminated from the educational system for learning difficulties and discipline and necessary to achieve reduction in the number of students at risk for truancy, poor performance, penalties, exclusion from the system by authorities. Documents
World Health Organization (1989) recognize the importance of school, the role it can play in primary prevention and primary and highlight the need to promote healthy lifestyles among youth. Usually the opposite is analyzed, that is, whether adolescents meet the criteria for success of the educational system. In this case, the possibility of promoting health approach is quite excluded.
6.3. priority target groups.
While no breakdown of the target groups for their exposure to risk or presence of damage, as this requires in each detection area planning and priority strategies, we refer briefly to some groups that have been identified as relevant coincidentally.
Most of the analysis of risk behaviors can be concluded that among the priority target group for prevention of risk behaviors are the teenage dropouts and potential dropouts.
is a factor risk that is associated with many behaviors that lead to injury. Identify, characterize the conditions of their vulnerability to provide action tools to educational institutions through its faculty, seek solutions to promote successful retention of students is important area to develop. Although students can not avoid the drop can be crucial guide them after identifying their resources to developing their life plan and guidance to enable them to constructively redirect the course of their difficulties. Another important area of \u200b\u200bfocus is adolescent sexuality concern is with teen pregnancy are more visible young people and emerge the need to include this segment of the population in the agenda of health planning. However, in reproductive health care is necessary to include more emphatically masculine values \u200b\u200band the role that fits the male (Population Council, 1990). On the other hand, the concern about pregnancy seems to predominate, which when looking antoconceptivos not necessarily considered the prevention of sexually transmitted diseases. This area also involves many other aspects of interpersonal type and sometimes even social pathology: early prostitution, sexual abuse, etc.
rural-urban migration and membership in an extremely poor socioeconomic requiring adolescents to develop coping strategies to satisfy their basic needs: food, housing, and so on., increasing exposure to risk factors. Young people for whom the streets are important needs satisfaction are devoid of many protective factors.
high risk groups are those sectors whose behavior is out of control for belonging to strata with little access to the options and be subject to particularly intense disruptive stimulation for various reasons (economic, political, military, marginality, distorting impact of modernization, lack of employment and education), and pose an urgent challenge to find possible instances give appropriate continence and driving opportunities in their care.
The youth offenders, violent, addicted are important target groups. The experiences based primarily on social control have not proved sufficient to lead to the reduction of these behaviors and subsequent damage, and at times have come to be risk factors. Prevention programs should be All in addition to the level of arrest and detention (when necessary), the more accurate identification teenage problem, the supply of comprehensive models that allow repair missing elements through voluntary admission to these programs, which in turn are articulated with social inclusion pathways that facilitate the independence and productivity. This requires the involvement of developers able to motivate and inform young people in risk areas.
regard to accidents, fundamental cause of juvenile mortality, it should discuss the creation of new approaches to strengthen existing measures. Interestingly, driver's license, is somehow one of the few rites of passage into adulthood that our society offers (the others are achieved by young people entering secondary schooling and the right to vote), which could help to develop preventive programs linked to this.
6.4. Youth involvement in prevention strategies.
One aspect that gains increasing recognition methodology is the need to involve young people themselves to proposals and program implementation. Weinstein (1992:82) recommends that "social programs aimed at psychosocial risk youth should explore communication strategies to consider ways and sources of information that this age group and has social." Emphasizes that the information circulating in the local level, Nearby motivating these young leaders for their information and opinion can influence them. Indeed these strategies have been implemented successfully in several Latin American countries and constitute a form of work promoting the situation of young people at risk for progressing and strengthening comprehensive.
The focus of care involves taking into account the presence of risk factors present in early adolescence. On the other side in the last stage of adolescence -17 to 20 years, the concerns and appear to increase self-care capabilities.
There is increased awareness of risks at both the sexual in the field of drug and psychosocial aspects of development are more clearly perceived. These youth can be trained to promote health in its various aspects and act as multiplier agents because of their strong interaction with peer groups.
7. Final Remarks.
is possible to identify sectors with greater exposure to risk, with various health assessments, with varying development of resources that allow us to provide, promote and enhance the quality of life. Biological and sociocultural differences defined that, besides the health problems shared by men and women, there are manifestations of the prevailing mortality or are unique to either sex, which is present more or less, and even features different in ethnicity, socioeconomic status, rural or urban areas and special very important and critical in the juvenile phase.
preventive interventions for risk behavior and risk factors consider both internal and external security and increased vulnerability to early age (teens: 10 to 15 years) and better self-care ability and leadership in health promotion and social integration in the proper period youth (15 to 24 years).
Youth participation in the design and implementation of strategies is fundamental, the articulation with adults who are trained and convinced of the appropriateness of actions. The existence of capacitated networks, promoters of street groups prioritize circuits embedded in high-risk, rites of passage that value publicly joining adult responsibilities are important support in the development of actions.
Finally, it is important to conclude with Perry and Jessor (1985), when they point out that the promotion of health from risky behavior is not simply a matter of personal responsibility. The immediate context of the lives, the modeling of personality and social roles are related to economic, social and political. Changes in social approaches in the structure of educational opportunities, employment, recreation and personal development are essential for a comprehensive approach to health promotion, all of which can not occur without input from those interested in investigating and acting permanently commitment to overcome the risk aspects of the juvenile phase at all possible levels.
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