Toward prevention of morbidity in adolescents

Article Outline

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Two articles in this issue of The Journal expose health-related risks of adolescents. Pileggi et al analyze and interpret questionnaires completed by 894 adolescents in public secondary schools in Italy about their risk-taking behaviors in general and while motorcycling. Their findings are not surprising, but are sobering. Only one-half of drivers and fewer passengers always wear a helmet. Most have driven tired, one-half always talk with their passenger, one-quarter always drive over the speed limit, one-fifth have driven after drinking alcohol, while smoking, or talking on the cellular telephone. They also found increased odds ratios for many “risky behaviors” and receipt of a motor-vehicular violation “ticket.” One important risk was learning about motorcycle use somewhere outside of the family. The authors discuss potential interventions to reduce dangerous behaviors and adverse outcomes.

Salihu et al used a 12-year database of the National Center for Health Statistics to examine absolute and relative risks of pregnancies leading to stillbirths in mothers stratified by ages 10-14 years, 15-19 year, and 20-24 years. The rates of stillbirth for both singletons (12.8/1000) and twins (56/1000) for the youngest age group was approximately twice that of older adolescent and adult mothers. Sequential modeling revealed that pre-term birth rather than small size for gestational age accounted for the excess risk of stillbirth. These data are the first to have adequate sample size for the youngest age group and refute previous studies of pregnant adolescents, which suggested that maternal-fetal competition for calories and small gestational size were pivotal in fetal demise. These findings add hope that bad outcomes are not inevitable and that prenatal care should focus on reducing pre-term delivery.