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The Australian Institute of Health and Welfare recently completed a report examining the health of young Australians, aged 12-24 years (Moon et al. 1999). The report demonstrated a number of very positive trends. Twothirds of young people perceived their health to be excellent or very good, and youth death rates have declined from 85 per 100,000 in 1979 to 60 in 1997, partly attributable to a decline in vehicle accident deaths. Rates of new HIV and syphilis infections have declined since the early 1990s. Teenage fertility has declined from 55 births per 1,000 women in 1971 to 20 in 1988, and has been stable over the remaining decade. 1
Nevertheless, the sexually transmissible disease chlamydia has more than doubled in prevalence during the 1990s from 71 to 196 per 100,000 notifications. Rates of youth mental illness (particularly depression) are higher than for any other population group, and represent the major burden of disease for young people. Youth suicide, self-harm, tobacco use, harmful alcohol use, and illicit drug use each demonstrated significant increases in the youth population over the early 1990s. The National School Survey conducted in 1999 found that by the final year of secondary school (Year 12), 78 per cent of Australian students had tried tobacco, 33 per cent were smoking on a weekly or more frequent basis, and half had tried cannabis (Drug Policy Expert Committee 2000).
Existing information affirms the inter-relationship of health and behaviour problems emerging during adolescence. For example, re-analysis of 1999 Victorian school survey data (Bond et al. 2000) revealed that 26 per cent of Year 9 students reported recent cigarette use. Compared with other Year 9 students, recent smokers were more likely to have: engaged in binge alcohol use (consumed five or more drinks) in the previous fortnight (7 per cent compared to 44 per cent); used one or more illicit drugs (3 per cent compared to 19 per cent); reported some level of unprotected sexual intercourse (4 per cent compared to 13 per cent); reported more than ten symptoms of depression (17 per cent compared to 30 per cent). This "problem behaviour syndrome" (Jessor and Jessor 1977) appears to be due to common determination through both individual characteristics and experiences within the family and the broader community.
Families differ in their capacity to support the adolescent transition. Family breakdown, economic disadvantage, and vulnerability amongst family members (due to mental illness, substance abuse, or disability) can make the transition more difficult. A number of studies has found sole-parent families to be associated with higher rates of youth substance use (for example, Selnow 1987) and mental health problems (for example, Silburn et al. 1996). These associations arise, in part, from a higher likelihood sole-parent families will experience traumatic conflict around family breakdown, lack of supervision due to the parent's work pressures, and limited family income resulting in higher exposure to community risk factors. Over the past two decades, low-cost housing has tended to aggregate sole-parent families in low-income neighbourhoods, where crime and drug use are higher (Gregory and Hunter 1995).
Despite public perceptions to the contrary, Australian research generally suggests that young people born overseas and from at least some non-English-speaking backgrounds are less likely to use drugs (Rissel et al. 2000; Coffey et al. 2000) and are more likely than other young people to complete secondary school and participate in higher education (Marks et al. 2000). These findings from research with community samples stand in contrast to the observations of those working with street drug abusers who observe high proportions of youth from recently migrated families (Louie et al. 1998). The difference may be explained by the fact that many migrant families have a high achievement emphasis, low tolerance for norm violation, and an authoritarian approach to discipline. Youthful transgressors may find themselves cut off from family contact, and therefore particularly vulnerable to recruitment into drug-involved peer groups. Guiding families to a less reactive approach to youth transgression offers an important direction for assistance (Szapocznic et al. 1986; Jenkin and McGuiness 1999).
Family processes through adolescence
Family attachment in adolescence
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