Book Review

Adolescent Health Problems: Behavioral perspectives

N Engl J Med 1996; 334:869-870March 28, 1996

Article

Adolescent Health Problems: Behavioral perspectives
(Advances in Pediatric Psychology.) Edited by Jan L. Wallander and Lawrence J. Siegel. 314 pp. New York, Guilford Press, 1995. $35. ISBN: 0-89862-113-5

Although several excellent textbooks on adolescent medicine have been published recently, there are few books that address issues of adolescent health comprehensively. The most recent were published in 1991 (The Health of Adolescents: Understanding and Facilitating Biological, Behavioral, and Social Development. Edited by W.R. Hendee. San Francisco: Jossey–Bass) and 1993 (Promoting the Health of Adolescents: New Directions for the Twenty-First Century. Edited by S.G. Millstein, A.C. Peterson, and E.O. Nightingale. New York: Oxford University Press), leaving those of us who teach graduate courses in adolescent health with no up-to-date textbook for our students. When I saw Wallander and Siegel's new book, Adolescent Health Problems: Behavioral Perspectives, I was very excited at the possibility of a new comprehensive textbook in the field. However, I was soon disappointed when I examined the table of contents. Most of the chapters are well written, but the book fails to address many health problems adolescents experience. In the first chapter, for example, Holden and Nitz point out that accidents, homicides, and suicides are the primary causes of death among adolescents. Although there is a chapter on adolescent suicide that has many good messages for clinicians, violence and the carrying of weapons by adolescents are not addressed. Nor are other important public health problems adequately covered, such as adolescent sexuality, teenage pregnancy, sexually transmitted diseases, and eating disorders. However, the goal of this book, which was sponsored by the Society of Pediatric Psychology, is to provide snapshots of research in pediatric psychology as it relates to adolescent health. Notwithstanding the editors' failure to include the current research in several of the areas mentioned above, many chapters make this book valuable for those who provide health care to adolescents or study adolescent health.

The book has three sections. The first covers general topics, such as the epidemiology of adolescent health problems, developmental influences on adolescent health, risk-taking behavior, and legal issues. Two chapters are particularly useful. Sayer et al. describe the stages of ego development in adolescents and the negative effect that insulin-dependent diabetes mellitus can have on ego development during this period. Clinicians caring for adolescents with any chronic disease will find this chapter useful. To researchers, the description of the cohort-sequential design and the analytic approach used in this research will be interesting. Millstein and Igra provide an excellent overview of the theoretical models used to explain behavior by adolescents that presents a health risk. This short chapter is a “must read” for clinical researchers who have performed research on such behavior from a nontheoretical perspective. Although Millstein and igra provide a good review of Jessor's “problem behavior theory,” they fail to heed Jessor's advice, which recommends differentiating between risky behavior and risk taking. These terms are often used interchangeably, with no acknowledgment that they describe different types of behavior. For example, the first time an adolescent illegally acquires and uses alcohol is often called an episode of risk taking, because the behavior involves taking a chance. However, using alcohol regularly would be considered a risky behavior because it can affect the adolescent's health adversely, including his or her physical, psychological, and social well-being.

The second section deals with research on suicide, the human immunodeficiency virus, tobacco use, alcohol and drug use, and health promotion. The two chapters dealing with substance use, as well as the one on health-promotion research, provide good overviews of the theoretical background of each study and present the findings in a manner relevant to clinicians. Chapter 7 describes a 15-year study of the antecedents of tobacco use. Chapter 8 provides a good review of adolescents' coping styles and skills; their academic, behavioral, and social competence; their response to social stress; and their substance use. In chapter 9, Kelder et al. evaluate several comprehensive programs of disease prevention and health promotion designed for adolescents. Although I would have preferred a more detailed description of these programs, it is useful to have them each reviewed in one place.

The final section includes descriptions of research on adolescents with chronic physical conditions, including two additional chapters on diabetes. Providers of health care to adolescents will find these chapters relevant to their clinical practice and their research.

A few chapters contain no new information, but most of the chapters will be edifying to professionals in adolescent health, particularly physicians specializing in adolescent medicine. This book will be a valuable addition to my library.

Robert H. DuRant, Ph.D.
Harvard Medical School, Boston, MA 02115