Over the past 30 years, adolescents have been the only population in the United States who have not experienced improvement in their health status. Violence has replaced communicable diseases as the primary cause of juvenile mortality and, currently, over 77% of adolescent deaths are caused by accidents, suicide, and homicide. Increasingly, poverty, life-style, and risk-taking behaviors are influencing the morbidities of youth, with associated sequelae of trauma, adolescent pregnancy, substance abuse, physical/sexual abuse, and most other major health problems of adolescents. Clinicians seem to be interested in addressing the shifting nature of adolescent morbidity, yet are insufficiently trained to be effective. The physician must go beyond traditional clinical medicine and address the social, environmental, and behavioral factors that underlie current morbidity.
(JAMA 1987;257:3390-3395)