Wadee, Ahmed A

Walker, Alexander R P

Walker, Betty F

English

South African Medical Journal (SAMJ)

EDITORIALThe Youth Behavior Surveillance System monitors categories ofhealth-risk behaviours among youth and young adults in theUSA. Arecent study on the young, aged 10 - 24 years,indicated that three-quarters of all deaths were due to onlyfour causes, namely motor vehicle crashes, other unintentionalinjuries, homicide, and suicide.1 High-school students engagein numerous behaviours that increase their likelihood of deathfrom these four causes: during the 30 days preceding thesurvey, 14.1% had rarely or never worn a seat belt, 30.7% hadridden with a driver who had been drinking alcohol, 17.4%had carried a weapon, 47.1% had drunk alcohol, and 23.9% hadused marijuana. During the previous 12 months 8.8% hadattempted suicide. Substantial morbidity and social problemsamong young persons resulted from unintended pregnanciesand from sexually transmitted diseases, including HIVinfection. Among high-school students, 45.6% had had sexualintercourse; 42.1% of sexually active students had not used acondom at last intercourse; and 2.3% had injected an illegaldrug. With regard to other adverse characteristics, 28.5% ofhigh-school students had smoked cigarettes during previous 30days; 78.6% had not eaten the recommended 5 servings per dayof fruits and vegetables during the previous 7 days; 10.5% wereoverweight; and 67.8% did not attend a school physicaleducation class daily.Other aspects of change, reported elsewhere, includeincreasing numbers of smokers among the young, theproportion reaching a third in some parts, 2 despite thewidespread reduction in the practice among adults. Further,physical activity among the young has markedly decreased.Percentages of pupils attending physical education daily fellfrom 42% to 25% between 1990 and 1995; only 19% of pupilswere reported to be active for 20 minutes or more daily.3 Unlikein the past, a doctor’s certificate is no longer required beforeparticipation in school exercise or games is excused. Corporalpunishment at schools, which was previously an accepted formof discipline of scholars, is now forbidden.Before criticising the bad and odd behaviours of today’syouth too severely, four historical quotations provide reasonfor caution.4 First: ‘Our youth loves luxury, has bad manners,disregards authority and has no respect whatsoever for age:our today’s children are tyrants; they do not get up when anelderly man enters the room — they talk back to their parents— they are just very bad.’ Second: ‘I have no longer any hopefor the future of our country, if today’s youth should everbecome the leaders of tomorrow, because this youth isunbearable, reckless — just terrible.’ Third: ‘Our world hasreached a critical stage; children no longer listen to theirparents; the end of the world cannot be far away.’ Finally: ‘Thisyouth is rotten from the very bottom of their hearts; the youngpeople are malicious and lazy; they will never be as youthhappened to be before; our today’s youth will not be able tomaintain our culture.’ You may be surprised to hear that thefirst statement came from Socrates, 470 - 399 BC, the secondfrom Hesiod, circa 720 BC, and the third from an Egyptianpriest about 2000 BC; the last was discovered recently on claypots in the ruins of Old Babylon, and these were more than 3 000 years old.Notwithstanding the above, there are grounds for believingthat conduct in the present generation of youth is more adversethan that in the past, despite a far higher general level ofeducation than ever before, implying greater responsibility.Moreover, leisuretime activities today differ very significantlyfrom those in former times. In the USA, and doubtless in otherdeveloped countries, much of out-of-school time is devoted tolistening to the radio, watching television, and using theInternet. Arecent report stated that ‘one quarter of all USchildren watch > 4 hours of television each day, which ispositively associated with increased body mass index and skinfold thickness’.5 The prevalence of overweight among USschoolchildren between 1973 and 1991 almost doubled; itincreased from 15.4% to 25.61%.How do the lifestyles described relate to recommendedpractices for the avoidance or control of disorders/diseases? Arecent inquiry examined the extent of participation in fourhealth practices.6 The requirements were maintaining a healthybody weight, i.e. having a body mass index between 18.5 and25.0 (an index of 30 or more implies obesity); having adequatefruit and vegetable consumption, i.e. eating the recommended5 or more fruits and vegetables daily; pursuing at least 30minutes of physical activity, 5 or more times a week; and notsmoking. The proportions conforming to the practices wereuniformly extremely low, being 3.1% in the younger age group(18 - 34 years) and 2.7% in the age group 35 - 54 years. Theproportion was only 1.2% for those who had had high-schooleducation, but rose to 4.9% for those with college education.What are the likely ramifications for life expectancy, and,more importantly, for ‘healthy’ life expectancy? Despite thedisappointing situations described, the years of averageexpectation of life have never been longer. While in 1900 inmost Western populations life expectancy was about 50 years,it is now 75 - 80 years in several populations; furthermore, ithas been stated that the number of centenarians is ‘exploding’.7But remember that today’s elderly were young in the 1920s and1930s or thereabouts. Will the present generation of youth fareas well in the 2050s?In contrast to the major rises in life expectancy described indeveloped populations, the desirable years of ‘healthy’ lifeexpectancy are not increasing, and in many countries is adecade or so less than actual years of survival. In a recent125A frightening situation? Youth in the USA todayFebruary 2003, Vol. 93, No. 2  SAMJFebruary 2003, Vol. 93, No. 2  SAMJEDITORIALreview by the World Health Organisation on healthy lifeexpectancy, it was reported that the lengthiest healthy lifeexpectancy now occurs among the Japanese — 74.5 years.8 Insecond and third places are Australia and France. The US isranked 24th with a healthy life expectancy of 70 years. This canin part be explained by the fact that currently about half ofAmericans miss out on preventive services, and moreover,highly importantly, ‘only 20% of patients seeking medical careare ready to change unhealthy behavior’.9In view of the foregoing, the current practices of youth, inthe contexts described, can scarcely fail to lessen subsequentyears of healthy life expectancy. It is believed that the rise inteenage smoking alone threatens to wipe out all progress madein the last few decades, and that ‘if current trends continue,more people will perish annually from tobacco related illnessthan from any other single disease’. 10As would be expected, the health problems facing Americansare also being experienced in other developed countries: inEurope there is evidence of rises in teenage smoking, and thatalcohol consumption by young people has reached alarminglevels.11Since the dangers of the unhealthy practices described arewell understood by both youth and adults, why is avoidingaction not taken? Unfortunately, putting prevention intopractice is a continuing problem worldwide. 9 Interestingly thischallenge was raised over two millennia ago by Confucius,who maintained that ‘the essence of knowledge is, havingacquired it, to apply it’.The outlook for today’s youth is sombre in several respects.The situation is disheartening, especially because the young,and most adults, particularly younger adults, are well aware ofthe lifestyle requirements to ensure good health and long life,yet there is widespread indifference, seemingly impossible toremedy.However, the youth and young middle-aged of the USAandother developed populations are at least being spared themagnitude of the present menace decimating numerous sub-Saharan African populations, cutting life expectancy by aquarter, namely the HIV/AIDS epidemic.12 As an example of itsramifications, in South Africa, black Africans’ previous meanlife expectancy of 62 years,13 probably the highest in the sub-Continent, has been shortened to a mean of 44 years, the youngbeing particularly affected.Alexander R PWalkerBetty F WalkerHuman Biochemistry Research UnitDepartment of Tropical DiseasesSchool of PathologyUniversity of the Witwatersrand, andNational Health Laboratory ServiceJohannesburgAhmed A WadeeDepartment of ImmunologySchool of PathologyUniversity of the Witwatersrand, andNational Health Laboratory ServiceJohannesburg1. Grunbaum JA, Kann L, Kinchen SA, et al. Youth risk behavior surveillance —United States,2001. MMWR 2002; 51(SS4): 1-62.2. Anonymous. Cigarette smoking among high school students — 11 states, 1991-1997. MMWR1999; 48: 686-692.3. United States Surgeon General. Physical Activity and Health: AReport of the Surgeon General.Atlanta, Ga: Centers for Disease Control, 1996.4. Gibson R. The satchel and the early morning shining face. BMJ 1971; 2: 549-552.5. Bar-on, ME. The effects of television on child health: implications and recommendations.Arch Dis Child 2000; 83: 289-292.6. Anonymous. Prevalence of healthy lifestyle characteristics — Michigan, 1998 and 2000.MMWR 2001; 50: 758-761.7. Larkin M. Centenarians point the way to healthy ageing. Lancet 1999; 356:: 1074.8. Mathers CD, Sadana R, Salomon JA, Murray CJL, Lopez AD. Healthy life expectancy in 191countries, 1999. Lancet 2001; 357: 1685-1691.9. Levinson W, Cohen MS, Brady D, Duffy FD. To change or not to change: ‘sounds like youhave a dilemma’. Ann Intern Med 2001; 135: 386-391.10. Sounding Board. The future of the global tobacco treaty negotiations. N Engl JMed 2002; 346:936-939.11. Weber W. Young peoples’ alcohol consumption reaches alarming levels in Europe. Lancet2001; 357: 617.12. Logie D. AIDS cuts life expectancy in sub-Saharan Africa by a quarter. BMJ 1999; 319: 806.13. Kale R. Impressions of health in the new South Africa: a period of convalescence. BMJ 1995;310: 1119-1122.126

A frightening situation? Youth in the USA today

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A frightening situation? Youth in the USA today

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