An Analysis of Les Miserables’ Bring Him Home Essay

One of the most popular songs in Les Miserables is the song entitled Bring Him Home. It is sung by Jean Valjean in Act II of Les Miserables as a form of prayer to God in order for a young man named Marius to be able to return home to the woman he loves, Cosette (Guy & Llewelyn-Jones, ). The story behind the song is that Cosette was an orphan whom Jean Valjean had cared for who fell in love with the young man named Marius. However, Marius had become involved in a series of anti-government riots, which puts her relationship with Cosette in a very awkward position. Jean Valjean decides to help Marius get back to Cosette, and this song was his prayer (Guy and Llewelyn-Jones, ). The prominent theme in the song is the longing for the safety of another individual. It was, in a sense, finding happiness in the happiness of another, and the singer, Valjean, indicated that he wanted the young boy named Maruis to be able to be brought home safely, back to the arms of Cosette. Valjean sings to the Lord, appealing to Him, and trying to reason to Him, that Marius deserved to be able to go home. He sings: â€Å"He is young, he’s afraid, let him rest, heaven blessed. Bring him home. Bring him home. Bring him home† (NIEHS, n. d. ). Valjean goes on to sing that if he had a son, it would have been Marius, and despite the anti-government riots Marius had participated on, Valjean believes that he is a good man and he deserves to be able to have a shot at life for he is very young. In fact, Valjean even sings that: â€Å"You can take, you can give, let him be let him live. If I die, let me die. Let him leave, bring him home† (NIEHS, n. d. ). If one is to read this carefully, it would mean that Valjean’s song is saying that, it does not matter if he dies, as long as God spares this young man who is in love with Cosette and brings him home. References NIEHS. (n. d. ). Bring Him Home. Retrieved from http://kids. niehs. nih. gov/lyrics/bringhom. htm. Guy, A. & Llewelyn-Jones, I. (2004). A student’s guide to GCSE music: For the WJEC specification. London: Rhinegold Publishing Ltd.

Adolescent Pregnancy Compilation Notes

Adolescent pregnancy – Overview Alternative Names Teenage pregnancy; Pregnancy – teenage Definition of Adolescent pregnancy: Adolescent pregnancy is pregnancy in girls age 19 or  younger. Causes, incidence, and risk factors: The rate of adolescent pregnancy and the birth rate for adolescents have generally declined since reaching an all-time high in 1990, mostly due to the increased use of condoms. Adolescent pregnancy is a complex issue with many reasons for concern. Younger adolescents (12 – 14 years old) are more likely to have unplanned sexual intercourse and more likely to be coerced into sex. Adolescents 18 – 19 years old are technically adults, and half of adolescent pregnancies occur in this age group. Risk factors for adolescent pregnancy include: * Younger age * Poor school performance * Economic disadvantage * Single or teen parents Adolescent pregnancy Teenage pregnancy; Pregnancy – teenage Last reviewed: September 12, 2011. Adolescent pregnancy is pregnancy in girls age 19 or  younger. Causes, incidence, and risk factors Adolescent pregnancy and babies born to adolescents have dropped since reaching an all-time high in 1990. This is mostly due to the increased use of condoms. Adolescent pregnancy is a complex issue with many reasons for concern. Kids age 12 – 14 years old are more likely than other adolescents to have unplanned sexual intercourse . They are more likely to be talked into having into sex. Up to two-thirds of adolescent pregnancies occur in teens age 18 – 19 years old. Risk factors for adolescent pregnancy include: * Younger age * Poor school performance * Economic disadvantage * Older male partner * Single or teen parents Symptoms Pregnancy symptoms include: * Abdominal distention * Breast enlargement and breast tenderness * Fatigue * Light-headedness or actual fainting Missed period * Nausea/vomiting * Frequent urination Signs and tests The adolescent may or may not admit to being involved sexually. If the teen is pregnant, there are usually weight changes (usually a gain, but there may be a loss if nausea and vomiting are significant). Examination may show increased abdominal girth, and the health care provider may be able t o feel the fundus (the top of the enlarged uterus). Pelvic examination may reveal bluish or purple coloration of vaginal walls, bluish or purple coloration and softening of the cervix, and softening and enlargement of the uterus. A pregnancy test of urine and/or serum HCG are usually positive. * A pregnancy ultrasound may be done to confirm or check accurate dates for pregnancy. Treatment All options made available to the pregnant teen should be considered carefully, including abortion, adoption, and raising the child with community or family support. Discussion with the teen may require several visits with a health care provider to explain all options in a non-judgmental manner and involve the parents or the father of the baby as appropriate. Early and adequate prenatal care, preferably through a program that specializes in teenage pregnancies, ensures a healthier baby. Pregnant teens need to be assessed for smoking, alcohol use, and drug use, and they should be offered support to help them quit. Adequate nutrition can be encouraged through education and community resources. Appropriate exercise and adequate sleep should also be emphasized. Contraceptive information and services are important after delivery to prevent teens from becoming pregnant again. Pregnant teens and those who have recently given birth should be encouraged and helped to remain in school or reenter educational programs that give them the skills to be better parents, and provide for their child financially and emotionally. Accessible and affordable child care is an important factor in teen mothers continuing school or entering the work force. Expectations (prognosis) Having her first child during adolescence makes a woman more likely to have more children overall. Teen mothers are about 2 years behind their age group in completing their education. Women who have a baby during their teen years are more likely to live in poverty. Teen mothers with a history of substance abuse are more likely to start abusing by about 6 months after delivery. Teen mothers are more likely than older mothers to have a second child within 2 years of their first child. Infants born to teenage mothers are at greater risk for developmental problems. Girls born to teen mothers are more likely to become teen mothers themselves, and boys born to teen mothers have a higher than average rate of being arrested and jailed. Complications Adolescent pregnancy is associated with higher rates of illness and death for both the mother and infant. Death from violence is the second leading cause of death durig pregnancy for teens, and is higher in teens than in any other group. Pregnant teens are at much higher risk of having serious medical complications such as: * Placenta previa * Pregnancy-induced hypertension * Premature delivery * Significant anemia * Toxemia Infants born to teens are 2 – 6 times more likely to have low birth weight than those born to mothers age 20 or older. Prematurity plays the greatest role in low birth weight, but intrauterine growth retardation (inadequate growth of the fetus during pregnancy) is also a factor. Teen mothers are more likely to have unhealthy habits that place the infant at greater risk for inadequate growth, infection, or chemical dependence. The younger a mother is below age 20, the greater the risk of her infant dying during the first year of life. It is very important for pregnant teens to have early and adequate prenatal care. Calling your health care provider Make an appointment with your health care provider if you have symptoms of pregnancy. Your health care provider can also provide counseling regarding birth control methods, sexually transmitted disease (STD) prevention, or pregnancy risk. Prevention There are many different kinds of teen pregnancy prevention programs. * Abstinence education programs encourage young people to wait to have sex until marriage, or until they are mature enough to handle sexual activity and a potential pregnancy in a responsible manner. * Knowledge-based programs focus on teaching kids about their bodies. It also provides detailed information about birth control and how to prevent sexually transmitted infections (STIs). Research shows knowledge-based programs help decrease teen pregnancy rates. Abstinence-only education without information about birth control does not. * Clinic-focused programs give kids easier access to information, counseling by health care providers, and birth control services. Many of these programs are offered through school-based clinics. * Peer counseling programs typically involve older teens, who encourage other kids to resist peer and social pressures to have sex. For teens who are already sexually active, peer counseling programs teach them relationship skills and give them information on how to get and successfully use birth control. Teenage pregnancy Teenage pregnancy refers to pregnancy in a female under the age of 20 (when the pregnancy ends). It generally refers to a female who is unmarried and usually refers to an unplanned pregnancy. A pregnancy can take place at any time after puberty, with menarche (first menstrual period) normally taking place around the ages 12 or 13, and being the stage at which a female becomes potentially fertile. Teenage pregnancy depends on a number of societal and personal factors. Teenage pregnancy rates vary between countries because of differences in levels of sexual activity, general sex education provided and access to affordable contraceptive options. Worldwide, teenage pregnancy rates range from 143 per 1000 in some sub-Saharan African countries to 2. 9 per 1000 in South Korea. Pregnant teenagers face many of the same obstetrics issues as women in their 20s and 30s. There are however, additional medical concerns for mothers age 14 or younger. For mothers between 15 and 19, risks are associated more with socioeconomic factors than with the biological effects of age. However research has shown that the risk of low birth weight is connected to the biological age itself, as it was observed in teen births even after controlling for other risk factors (such as utilisation of antenatal care etc. ). In developed countries, teenage pregnancies are associated with many social issues, including lower educational levels, higher rates of poverty, and other poorer â€Å"life outcomes† in children of teenage mothers. Teenage pregnancy in developed countries is usually outside of marriage, and carries a social stigma in many communities and cultures. Many studies and campaigns have attempted to uncover the causes and limit the numbers of teenage pregnancies. In other countries and cultures, particularly in the developing world, teenage pregnancy is usually within marriage and does not involve a social stigma. Among OECD developed countries, the United States and United Kingdom have the highest level of teenage pregnancy, while Japan and South Korea have the lowest. Teenage pregnancy rates In reporting teenage pregnancy rates, the number of pregnancies per 1000 females aged 15 to 19 when the pregnancy ends is generally used. The rates look at the age at which a pregnancy ends, and not the age when the woman conceives, so that if a woman aborts her pregnancy or misscarries while she is 19, she would be counted, while if she went full term and gave birth at age 20 she would not be counted. According to a 2001 UNICEF survey, in 10 out of 12 developed nations with available data, more than two thirds of young people have had sexual intercourse while still in their teens. In Denmark, Finland, Germany, Iceland, Norway, the United Kingdom and the United States, the proportion is over 80%. In Australia, the United Kingdom and the United States, approximately 25% of 15 year olds and 50% of 17 year olds have had sex. In a 2005 Kaiser Family Foundation study of US teenagers, 29% of teens reported feeling pressure to have sex, 33% of sexually active teens reported â€Å"being in a relationship where they felt things were moving too fast sexually†, and 24% had â€Å"done something sexual they didn’t really want to do†. Several polls have indicated peer pressure as a factor in encouraging both girls and boys to have sex. The increased sexual activity among adolescents is manifested in increased teenage pregnancies and an increase in sexually transmitted diseases. The rates of teenage pregnancy vary and range from 143 per 1000 girls in some sub-Saharan African countries to 2. 9 per 1000 in South Korea. The rate for the United States is 52. 1 per 1000, the highest in the developed world – and about four times the European Union average. Care must also be taken of the common actual marriage age in different countries, as in countries where teenage marriages are common can expect to also experience higher levels of teenage pregnancies. In an attempt to reverse the increasing numbers of teenage pregnancies, governments in many Western countries have instituted sex education programs, the main objective of which is to reduce such pregnancies and STD's. Save the Children found that, annually, 13 million children are born to women under age 20 worldwide, more than 90% in developing countries. Complications of pregnancy and childbirth are the leading cause of mortality among women between the ages of 15 and 19 in such areas. The highest rate of teenage pregnancy in the world is in sub-Saharan Africa, where women tend to marry at an early age. In Niger, for example, 87% of women surveyed were married and 53% had given birth to a child before the age of 18. In the Indian subcontinent, early marriage sometimes means adolescent pregnancy, particularly in rural regions where the rate is much higher than it is in urbanized areas. The rate of early marriage and pregnancy has decreased sharply in Indonesia and Malaysia, although it remains relatively high in the former. In the industrialized Asian nations such as South Korea and Singapore, teenage birth rates are among the lowest in the world. The overall trend in Europe since 1970 has been a decreasing total fertility rate, an increase in the age at which women experience their first birth, and a decrease in the number of births among teenagers. Most continental Western European countries have very low teenage birth rates. This is varyingly attributed to good sex education and high levels of contraceptive use (in the case of the Netherlands and Scandinavia), traditional values and social stigmatization (in the case of Spain and Italy) or both (in the case of Switzerland). The teenage birth rate in the United States is the highest in the developed world, and the teenage bortion rate is also high. The U. S. teenage pregnancy rate was at a high in the 1950s and has decreased since then, although there has been an increase in births out of wedlock. The teenage pregnancy rate decreased significantly in the 1990s; this decline manifested across all racial groups, although teenagers of African-American and Hispanic descent retai n a higher rate, in comparison to that of European-Americans and Asian-Americans. The Guttmacher Institute attributed about 25% of the decline to abstinence and 75% to the effective use of contraceptives. However, in 2006 the teenage birth rate rose for the first time in fourteen years. This could imply that teen pregnancy rates are also on the rise, however the rise could also be due to other sources: a possible decrease in the number of abortions or a decrease in the number of miscarriages, to name a few. The Canadian teenage birth has also trended towards a steady decline for both younger (15–17) and older (18–19) teens in the period between 1992 and 2002. The age of the mother is determined by the easily verified date when the pregnancy ends, not by the estimated date of conception. Consequently, the statistics do not include women who became pregnant at least shortly before their 20th birthdays, but who gave birth, experienced a miscarriage, or had a voluntary abortion on or after their 20th birthdays. Similarly, statistics on the mother's marital status are determined by whether she is married at the end of the pregnancy, not at the time of conception. Impact Maternal and prenatal health is of particular concern among teens who are pregnant or parenting. The worldwide incidence of premature birth and low birth weight is higher among adolescent mothers. In a rural hospital in West Bengal, teenage mothers between 15–19 years old were more likely to have anemia, preterm delivery, and low birth weight than mothers between 20–24 years old. Research indicates that pregnant teens are less likely to receive prenatal care, often seeking it in the third trimester, if at all. The Guttmacher Institute reports that one-third of pregnant teens receive insufficient prenatal care and that their children are more likely to suffer from health issues in childhood or be hospitalized than those born to older women. Young mothers who are given high-quality maternity care have significantly healthier babies than those that do not. Many of the health-issues associated with teenage mothers, many of whom do not have health insurance, appear to result from lack of access to high-quality medical care. Many pregnant teens are subject to nutritional deficiencies from poor eating habits common in adolescence, including attempts to lose weight through dieting, skipping meals, food faddism, snacking, and consumption of fast food. Inadequate nutrition during pregnancy is an even more marked problem among teenagers in developing countries. Complications of pregnancy result in the deaths of an estimated 70,000 teen girls in developing countries each year. Young mothers and their babies are also at greater risk of contracting HIV. The World Health Organization estimates that the risk of death following pregnancy is twice as great for women between 15 and 19 years than for those between the ages of 20 and 24. The maternal mortality rate can be up to five times higher for girls aged between 10 and 14 than for women of about twenty years of age. Illegal abortion also holds many risks for teenage girls in areas such as sub-Saharan Africa. Risks for medical complications are greater for girls 14 years of age and younger, as an underdeveloped pelvis can lead to difficulties in childbirth. Obstructed labour is normally dealt with by Caesarean section in industrialized nations; however, in developing regions where medical services might be unavailable, it can lead to eclampsia, obstetric fistula, infant mortality, or maternal death. For mothers in their late teens, age in itself is not a risk factor, and poor outcomes are associated more with socioeconomic factors rather than with biology. Psychosocial Several studies have examined the socioeconomic, medical, and psychological impact of pregnancy and parenthood in teens. Life outcomes for teenage mothers and their children vary; other factors, such as poverty or social support, may be more important than the age of the mother at the birth. Many solutions to counteract the more negative findings have been proposed. Teenage parents who can rely on family and community support, social services and child-care support are more likely to continue their education and get higher paying jobs as they progress with their education. In the mother Being a young mother in an industrialized country can affect one's education. Teen mothers are more likely to drop out of high school. Recent studies, though, have found that many of these mothers had already dropped out of school prior to becoming pregnant, but those in school at the time of their pregnancy were as likely to graduate as their peers. One study in 2001 found that women who gave birth during their teens completed secondary-level schooling 10–12% as often and pursued post-secondary education 14–29% as often as women who waited until age 30. Young motherhood in an industrialized country can affect employment and social class. Less than one third of teenage mothers receive any form of child support, vastly increasing the likelihood of turning to the government for assistance. The correlation between earlier childbearing and failure to complete high school reduces career opportunities for many young women. One study found that, in 1988, 60% of teenage mothers were impoverished at the time of giving birth. Additional research found that nearly 50% of all adolescent mothers sought social assistance within the first five years of their child's life. A study of 100 teenaged mothers in the United Kingdom found that only 11% received a salary, while the remaining 89% were unemployed. Most British teenage mothers live in poverty, with nearly half in the bottom fifth of the income distribution. Teenage women who are pregnant or mothers are seven times more likely to commit suicide than other teenagers. Professor John Ermisch at the institute of social and economic research at Essex University and Dr Roger Ingham, director of the centre of sexual health at Southampton University – found that comparing teenage mothers with other girls with similarly deprived social-economic profiles, bad school experiences and low educational aspirations, the difference in their respective life chances was negligible. Teenage Motherhood may actually make economic sense for young women with less money, some research suggests. For instance, long-term studies by Duke economist V. Joseph Hotz and colleagues, published in 2005, found that by age 35, former teen moms had earned more in income, paid more in taxes, were substantially less likely to live in poverty and collected less in public assistance than similarly poor women who waited until their 20s to have babies. Women who became mothers in their teens — freed from child-raising duties by their late 20s and early 30s to pursue employment while poorer women who waited to become moms were still stuck at home watching their young children — wound up paying more in taxes than they had collected in welfare. Eight years earlier, the federally commissioned report â€Å"Kids Having Kids† also contained a similar finding, though it was buried: â€Å"Adolescent childbearers fare slightly better than later-childbearing counterparts in terms of their overall economic welfare. One-fourth of adolescent mothers will have a second child within 24 months of the first. Factors that determine which mothers are more likely to have a closely spaced repeat birth include marriage and education: the likelihood decreases with the level of education of the young woman – or her parents – and increases if she gets married. In the child Early motherhood can affect the psychosocial development of the infant. Developmental disabilities and behavioral issues are increased in children born to teen mothers. One study suggested that adolescent mothers are less likely to stimulate their infant through affectionate behaviors such as touch, smiling, and verbal communication, or to be sensitive and accepting toward his or her needs. Another found that those who had more social support were less likely to show anger toward their children or to rely upon punishment. Poor academic performance in the children of teenage mothers has also been noted, with many of them being more likely than average to fail to graduate from secondary school, be held back a grade level, or score lower on standardized tests. Daughters born to adolescent parents are more likely to become teen mothers themselves. A son born to a young woman in her teens is three times more likely to serve time in prison. In other family members Teen pregnancy and motherhood can influence younger siblings. One study found that the younger sisters of teen mothers were less likely to emphasize the importance of education and employment and more likely to accept human sexual behavior, parenting, and marriage at younger ages; younger brothers, too, were found to be more tolerant of non-marital and early births, in addition to being more susceptible to high-risk behaviors. If the younger sisters of teenage parents babysit the children, they have an increased risk of getting pregnant themselves. Causes In some societies, early marriage and traditional gender roles are important factors in the rate of teenage pregnancy. For example, in some sub-Saharan African countries, early pregnancy is often seen as a blessing because it is proof of the young woman's fertility. In the Indian subcontinent, early marriage and pregnancy is more common in traditional rural communities compared to the rate in cities. The lack of education on safe sex, whether it’s from parents, schools, or otherwise, is a cause of teenage pregnancy. Many teenagers are not taught about methods of birth control and how to deal with peers who pressure them into having sex before they are ready. Many pregnant teenagers do not have any cognition of the central facts of sexuality. Some teens have said to be pressured into having sex with their boyfriends at a young age, and yet no one had taught these teens how to deal with this pressure or to say â€Å"no†. In societies where adolescent marriage is less common, such as many developed countries, young age at first intercourse and lack of use of contraceptive methods (or their inconsistent and/or incorrect use; the use of a method with a high failure rate is also a problem) may be factors in teen pregnancy. Most teenage pregnancies in the developed world appear to be unplanned. Sexuality In most countries, most men experience sexual intercourse for the first time before their 20th birthdays. Men in Western developed countries have sex for the first time sooner than in undeveloped and culturally conservative countries such as Sub-Saharan Africa and much of Asia. Countries with low levels of teenagers giving birth accept sexual relationships among teenagers and provide comprehensive and balanced information about sexuality. However, in a Kaiser Family Foundation study of US teenagers, 29% of teens reported feeling pressure to have sex, 33% of sexually active teens reported â€Å"being in a relationship where they felt things were moving too fast sexually†, and 24% had â€Å"done something sexual they didn’t really want to do†. Several polls have indicated peer pressure as a factor in encouraging both girls and boys to have sex. Role of drug and alcohol use Inhibition-reducing drugs and alcohol may possibly encourage unintended sexual activity. If so, it is unknown if the drugs themselves directly influence teenagers to engage in riskier behavior, or whether teenagers who engage in drug use are more likely to engage in sex. Correlation does not imply causation. The drugs with the strongest evidence linking to teenage pregnancy are alcohol, â€Å"ecstasy†, cannabis, and amphetamines. The drugs with the least evidence to support a link to early pregnancy are opioids, such as heroin, morphine, and oxycodone, of which a well-known effect is the significant reduction of libido – it appears that teenage opioid users have significantly reduced rates of conception compared to their non-using, and alcohol, â€Å"ecstasy†, cannabis, and amphetamine using peers. Amphetamines are often prescribed to treat ADHD – internationally, the countries with the highest rates of recorded amphetamine prescription to teenagers also have the highest rates of teenage pregnancy. 2][12][51][52], Leonard Sax, M. D. , Ph. D. , 2005, Doubleday books, p. 128. Lack of contraception Adolescents may lack knowledge of, or access to, conventional methods of preventing pregnancy, as they may be too embarrassed or frightened to seek such information. Contraception for teenagers presents a huge challenge for the clinician. In 1998, the government of the United Kingdom set a target to halve the under-18 pregnancy rate by 2010. The Teenage Pregnancy Strategy (TPS) was established to achieve this. The pregnancy rate in this group, although falling, rose slightly in 2007, to 41. 7 per 1000 women. Young women often think of contraception either as ‘the pill' or condoms and have little knowledge about other methods. They are heavily influenced by negative, second-hand stories about methods of contraception from their friends and the media. Prejudices are extremely difficult to overcome. Over concern about side-effects, for example weight gain and acne, often affect choice. Missing up to three pills a month is common, and in this age group the figure is likely to be higher. Restarting after the pill-free week, having to hide pills, drug interactions and difficulty getting repeat prescriptions can all lead to method failure. In the United States, according to the 2002 National Surveys of Family Growth, sexually active adolescent women wishing to avoid pregnancy were less likely than those of other ages to use contraceptives (18% of 15- to 19-year-olds used no contraceptives, versus 10. 7% average for women ages 15 to 44). More than 80% of teen pregnancies are unintended. Over half of unintended pregnancies were to women not using contraceptives, most of the rest are due to inconsistent or incorrect use. 23% of sexually active young women in a 1996 Seventeen magazine poll admitted to having had unprotected sex with a partner who did not use a condom, while 70% of girls in a 1997 PARADE poll claimed it was embarrassing to buy birth control or request information from a doctor. In a study for The Guttmacher Institute, researchers found that from a comparative perspective, however, teenage pregnancy rates in the United States are less nuanced than one might initially assume. Since timing and levels of sexual activity are quite similar across [Sweden, France, Canada, Great Britain, and the U. S. ], the high U. S. rates arise primarily because of less, and possibly less-effective, contraceptive use by sexually active teenagers. † Thus, the cause for the discrepancy between rich nations can be traced largely to contraceptive-based issues. Among teens in the UK seeking an abortion, a study found that the rate of contraceptive use was roughly the same for teens as for older women. In other cases, contraception is used, but proves to be inadequate. Inexperienced adolescents may use condoms incorrectly, forget to take oral contraceptives, or fail to use the contraceptives they had previously chosen. Contraceptive failure rates are higher for teenagers, particularly poor ones, than for older users. Long-acting contraceptives such as intrauterine devices, subcutaneous contraceptive implants, and contraceptive injections (such as Depo-Provera and Combined injectable contraceptive), which prevent pregnancy for months or years at a time, are more effective in women who have trouble remembering to take pills or using barrier methods consistently. Age discrepancy in relationships According to the conservative lobbying organization Family Research Council, studies in the US indicate that age discrepancy between the teenage girls and the men who impregnate them is an important contributing factor. Teenage girls in relationships with older boys, and in particular with adult men, are more likely to become pregnant than teenage girls in relationships with boys their own age. They are also more likely to carry the baby to term rather than have an abortion. A review of California's 1990 vital statistics found that men older than high school age fathered 77% of all births to high school-aged girls (ages 16–18), and 51% of births to junior high school-aged girls (15 and younger). Men over age 25 fathered twice as many children of teenage mothers than boys under age 18, and men over age 20 fathered five times as many children of junior high school-aged girls as did junior high school-aged boys. A 1992 Washington state study of 535 adolescent mothers found that 62% of the mothers had a history of being raped or sexual molested by men whose ages averaged 27 years. This study found that, compared with nonabused mothers, abused adolescent mothers initiated sex earlier, had sex with much older partners, and engaged in riskier, more frequent, and promiscuous sex. Studies by the Population Reference Bureau and the National Center for Health Statistics found that about two-thirds of children born to teenage girls in the United States are fathered by adult men age 20 or older. Sexual abuse Studies from South Africa have found that 11–20% of pregnancies in teenagers are a direct result of rape, while about 60% of teenage mothers had unwanted sexual experiences preceding their pregnancy. Before age 15, a majority of first-intercourse experiences among females are reported to be non-voluntary; the Guttmacher Institute found that 60% of girls who had sex before age 15 were coerced by males who on average were six years their senior. One in five teenage fathers admitted to forcing girls to have sex with them. Multiple studies have indicated a strong link between early childhood sexual abuse and subsequent teenage pregnancy in industrialized countries. Up to 70% of women who gave birth in their teens were molested as young girls; by contrast, 25% for women who did not give birth as teens were molested. In some countries, sexual intercourse between a minor and an adult is not considered consensual under the law because a minor is believed to lack the maturity and competence to make an informed decision to engage in fully consensual sex with an adult. In those countries, sex with a minor is therefore considered statutory rape. In most European countries, by contrast, once an adolescent has reached the age of consent, he or she can legally have sexual relations with adults because it is held that in general (although certain limitations may still apply), reaching the age of consent enables a juvenile to consent to sex with any partner who has also reached that age. Therefore, the definition of statutory rape is limited to sex with a person under the minimum age of consent. What constitutes statutory rape ultimately differs by jurisdiction. Dating violence Studies have indicated that adolescent girls are often in abusive relationships at the time of their conceiving. They have also reported that knowledge of their pregnancy has often intensified violent and controlling behaviors on part of their boyfriends. Women under age 18 are twice as likely to be beaten by their child's father than women over age 18. A UK study found that 70% of women who gave birth in their teens had experienced adolescent domestic violence. Similar results have been found in studies in the United States. A Washington State study found 70% of teenage mothers had been beaten by their boyfriends, 51% had experienced attempts of birth control sabotage within the last year, and 21% experienced school or work sabotage. In a study of 379 pregnant or parenting teens and 95 teenage girls without children, 62% of the girls aged 11–15 years and 56% of girls aged 16–19 years reported experiencing domestic violence at the hands of their partners. Moreover, 51% of the girls reported experiencing at least one instance where their boyfriend attempted to sabotage their efforts to use birth control. Socioeconomic factors Teenage pregnancy has been defined predominantly within the research field and among social agencies as a social problem. Poverty is associated with increased rates of teenage pregnancy. Economically poor countries such as Niger and Bangladesh have far more teenage mothers compared with economically rich countries such as Switzerland and Japan. In the UK, around half of all pregnancies to under 18s are concentrated among the 30% most deprived population, with only 14% occurring among the 30% least deprived. For example, in Italy, the teenage birth rate in the well-off central regions is only 3. 3 per 1,000, while in the poorer Mezzogiorno it is 10. 0 per 1,000. Similarly, in the United States, sociologist Mike A. Males noted that teenage birth rates closely mapped poverty rates in California: County| Poverty rate| Birth rate*| Marin County| 5%| 5| Tulare County (Caucasians)| 18%| 50| Tulare County (Hispanics)| 40%| 100| * per 1000 women aged 15–19 Teen pregnancy cost the United States over $9. 1 billion in 2004. There is little evidence to support the common belief that teenage mothers become pregnant to get benefits, welfare, and council housing. Most knew little about housing or financial aid before they got pregnant and what they thought they knew often turned out to be wrong. Childhood environment Women exposed to abuse, domestic violence, and family strife in childhood are more likely to become pregnant as teenagers, and the risk of becoming pregnant as a teenager increases with the number of adverse childhood experiences. According to a 2004 study, one-third of teenage pregnancies could be prevented by eliminating exposure to abuse, violence, and family strife. The researchers note that â€Å"family dysfunction has enduring and unfavorable health consequences for women during the adolescent years, the childbearing years, and beyond. When the family environment does not include adverse childhood experiences, becoming pregnant as an adolescent does not appear to raise the likelihood of long-term, negative psychosocial consequences. Studies have also found that boys raised in homes with a battered mother, or who experienced physical violence directly, were significantly more likely to impregnate a girl. Studies have also found that girls whose fathers lef t the family early in their lives had the highest rates of early sexual activity and adolescent pregnancy. Girls whose fathers left them at a later age had a lower rate of early sexual activity, and the lowest rates are found in girls whose fathers were present throughout their childhood. Even when the researchers took into account other factors that could have contributed to early sexual activity and pregnancy, such as behavioral problems and life adversity, early father-absent girls were still about five times more likely in the United States and three times more likely in New Zealand to become pregnant as adolescents than were father-present girls. Low educational expectations have been pinpointed as a risk factor. A girl is also more likely to become a teenage parent if her mother or older sister gave birth in her teens. A majority of respondents in a 1988 Joint Center for Political and Economic Studies survey attributed the occurrence of adolescent pregnancy to a breakdown of communication between parents and child and also to inadequate parental supervision. Foster care youth are more likely than their peers to become pregnant as teenagers. The National Casey Alumni Study, which surveyed foster care alumni from 23 ommunities across the United States, found the birth rate for girls in foster care was more than double the rate of their peers outside the foster care system. A University of Chicago study of youth transitioning out of foster care in Illinois, Iowa, and Wisconsin found that nearly half of the females had been pregnant by age 19. The Utah Department of Human Services found that girls who had left the foster care sy stem between 1999 and 2004 had a birth rate nearly 3 times the rate for girls in the general population. Media influence A study conducted in 2006 found that adolescents who were more exposed to sexuality in the media were also more likely to engage in sexual activity themselves. According to Time, â€Å"teens exposed to the most sexual content on TV are twice as likely as teens watching less of this material to become pregnant before they reach age 20†. Prevention Many health educators have argued that comprehensive sex education would effectively reduce the number of teenage pregnancies, although opponents argue that such education encourages more and earlier sexual activity. United Kingdom In the UK, the teenage pregnancy strategy, which was run first by the Department of Health and is now based out of the Children, Young People and Families directorate in the Department for Children, Schools and Families, works on several levels to reduce teenage pregnancy and increase the social inclusion of teenage mothers and their families by: * joined up action, making sure branches of government and health and education services work together effectively; * prevention of teenage pregnancy through better sex education and improving contraceptive and advice services for young people, involving young people in service design, supporting the parents of teenagers to talk to them about sex and relationships, and targeting high-risk groups; * better support for teenage mothers, including help returning to education, advice and support, work with young fathers, better childcare and increasing the availability of supported housing. The teenage pregnancy strategy has had mixed success. Although teenage pregnancies have fallen overall, they have not fallen consistently in every region, and in some areas they have increased. There are questions about whether the 2010 target of a 50% reduction on 1998 levels can be met. United States In the United States the topic of sex education is the subject of much contentious debate. Some schools provide â€Å"abstinence-only† education and virginity pledges are increasingly popular. A 2004 study by Yale and Columbia Universities found that 88% of those who pledge abstinence have premarital sex anyway. Most public schools offer â€Å"abstinence-plus† programs that support abstinence but also offer advice about contraception. A team of researchers and educators in California have published a list of â€Å"best practices† in the prevention of teen pregnancy, which includes, in addition to the previously mentioned concepts, working to â€Å"instill a belief in a successful future†, male involvement in the prevention process, and designing interventions that are culturally relevant. On September 30, 2010, The U. S. Department of Health and Human Services approved $155 million dollars in new funding for comprehensive sex education programs designed to prevent teenage pregnancy. The money is being awarded â€Å"to states, non-profit organizations, school districts, universities and others. These grants will support the replication of teen pregnancy prevention programs that have been shown to be effective through rigorous research as well as the testing of new, innovative approaches to combating teen pregnancy. † For teens who choose to engage in sexual activity, the primary mode of preventing teen pregnancy becomes correct use of contraceptives. In the States, one policy initiative that has been used to increase rates of contraceptive use is Title X: Title X of the 1970 Public Health Service act provides family planning services for those who do not qualify for Medicaid by distributing â€Å"funding to a network of public, private, and nonprofit entities [in order to provide] services on a sliding scale based on income. Studies indicate that, internationally, success in reducing teen pregnancy rates is directly correlated with the kind of access that Title X provides: â€Å"What appears crucial to success is that adolescents know where they can go to obtain inf ormation and services, can get there easily and are assured of receiving confidential, nonjudgmental care, and that these services and contraceptive supplies are free or cost very little. In addressing high rates of unplanned teen pregnancies, scholars agree that the problem must be confronted from both the biological and cultural contexts. Netherlands The Dutch approach to preventing teenage pregnancy has often been seen as a model by other countries. The curriculum focuses on values, attitudes, communication and negotiation skills, as well as biological aspects of reproduction. The media has encouraged open dialogue and the health-care system guarantees confidentiality and a non-judgmental approach. Developing world In the developing world, programs of reproductive health aimed at teenagers are often small scale and not centrally coordinated, although some countries such as Sri Lanka have a systematic policy framework for teaching about sex within schools. Non-governmental agencies such as the International Planned Parenthood Federation and Marie Stopes International provide contraceptive advice for young women worldwide. Laws against child marriage have reduced but not eliminated the practice. Improved female literacy and educational prospects have led to an increase in the age at first birth in areas such as Iran, Indonesia, and the Indian state of Kerala. Teenage fatherhood In some cases, the father of the child is the husband of the teenage girl. The conception may occur within wedlock, or the pregnancy itself may precipitate the marriage (the so-called shotgun wedding). In countries such as India the majority of teenage births occur within marriage. In other countries, such as the United States and the Republic of Ireland, the majority of teenage mothers are not married to the fathers of their children. In the UK, half of all teenagers with children are lone parents, 40% are cohabitating as a couple and 10% are married. Teenage parents are frequently in a romantic relationship at the time of birth, but many adolescent fathers do not stay with the mother and this often disrupts their relationship with the child. Research has shown that when teenage fathers are included in decision-making during pregnancy and birth, they are more likely to report increased involvement with their children in later years. In the U. S, eight out of ten teenage fathers do not marry their first child's mother. However, â€Å"teenage father† may be a misnomer in many cases. Studies by the Population Reference Bureau and the National Center for Health Statistics found that about two-thirds of births to teenage girls in the United States are fathered by adult men age 20 or older. The Guttmacher Institute reports that over 40% of mothers aged 15–17 had sexual partners three to five years older and almost one in five had partners six or more years older. A 1990 study of births to California teens reported that the younger the mother, the greater the age gap with her male partner. In the UK 72% of jointly registered births to women under the age of 20, the father is over the age of 20, with almost 1 in 4 being over 25. History Teenage pregnancy was normal in previous centuries. Perhaps the most famous teenage pregnancy in history was Mary, Mother of Jesus. She is generally believed to have been 13 years old when she gave birth to Jesus. Other sources place her age as high as 15 years. Hildegard of Vinzgouw, the wife of Charlemagne was about 14 years old when she gave birth to her first son in 772 CE. The mother of Henry VII of England was 13 years old when she gave birth to him in 1457. Maria of Tver, the wife of Ivan the Great of Russia, gave birth to her first son when she was about 16 years old, in 1458. Empress Teimei of Japan was 16 years old when she gave birth to Hirohito in 1901. Lina Medina of Peru holds the world record for youngest live birth: She was five years, seven months old when she gave birth in 1939. Society and culture Teenage pregnancy has been used as a theme or plot device in fiction, including books, films, and television series. The setting may be historical (The Blue Lagoon, Hope and Glory) or contemporary (One Tree Hill). While the subject is generally treated in a serious manner (Junk), it can sometimes play up to stereotypes in a comic manner (Vicky Pollard in Little Britain). The pregnancy itself may be the result of sexual abuse (Rose in The Cider House Rules), a one-night stand (Amy Barnes in Hollyoaks), a romantic relationship (Demi Miller in EastEnders); (Ronnie Mitchell in EastEnders); or a first time sexual encounter (Sarah-Louise Platt in Coronation Street) unusually, in Quinceanera, the central character becomes pregnant through non-penetrative sex. The drama often focuses around the discovery of the regnancy and the decision to opt for abortion (Fast Times at Ridgemont High), adoption (Mom at Sixteen, Juno, Glee), marriage (Sugar & Spice, Reba and Jeni, Juno) or life as a single mother (Saved! , Where the Heart Is, Someone Like You). In the German play Spring Awakening (and the Broadway musical based upon it), the central female character gets pregnant and dies from a botched abortion. Stephanie Daley deals with the aftermath of a teenage pregnancy that ends with a dead newborn baby. While the pregnant girl herself is normally the chief protagonist, Too Young to Be a Dad centers on a 15-year-old boy whose girlfriend becomes pregnant, while The Snapper focuses on the reactions of the family, particularly the soon-to-be grandfather. Other fiction, particularly in a long-running television series, looks at the long-term effects of becoming a parent at a very young age (Degrassi Junior High). In Gilmore Girls, because Lorelai Gilmore is only 16 years older than her daughter Rory, the two are more like sisters than parent and child. Looking for Alibrandi also features the teenage daughter of a woman who was herself a teenage mother. In The George Lopez Show, Benny Lopez, gave birth to George at 16. In the ABC Family television show The Secret Life of the American Teenager centers on Amy Juergens, a 15-year-old who becomes a teenage mother after a one night stand. In the popular Comedy Central television show South Park the character Carol McCormick was said to have had her sons Kevin McCormick at 13, and Kenny McCormick at 16. In the Japanese drama 14-sai no Haha: Aisuru tame ni Umaretekita, the protagonist Miki Ichinose becomes pregnant with her boyfriend's child at age 14. The show examines the impact of her pregnancy on her, her family, her school life, the life of her boyfriend and his family, and the society in which she resides. Additionally, reality television shows have featured teenage pregnancy stories. MTV launched two reality shows about the topic, 16 and Pregnant and Teen Mom, in 2009. Each show depicts the gritty reality that pregnant teens face from friends and family while going through this life changing event, allowing teens to see what actually happens in this scenario through an outlet other than a scripted plot. Autobiographies that look at the author’s own experience of teenage motherhood include I Know Why the Caged Bird Sings and Gather Together in My Name by Maya Angelou, Coal Miner's Daughter by Loretta Lynn, and Riding in Cars with Boys by Beverly D'Onofrio. Songs about teenage pregnancy include downbeat tales of abuse (â€Å"Brenda's Got a Baby†), poverty (â€Å"In The Ghetto†) and back-alley abortion (â€Å"Sally's Pigeons†), as well as upbeat and defiant tunes such as â€Å"Papa Don't Preach†. American pop singer Fantasia Barrino, who was 17 when she gave birth to her daughter, released a controversial song about single motherhood titled â€Å"Baby Mama†, describing the difficulty of raising a child alone with limited financial and family support. (Many U. S. adio stations would not play the song, ostensibly because it contains a profanity. ) â€Å"There Goes My Life†, a modern country song by Kenny Chesney, focuses on the reaction of the father, who rhetorically asks, â€Å"I'm just a kid myself; how am I going to raise one? † As the daughter grows up, his attitude changes, and the song ends with his tearful farewell as she leaves for college. Due to its implied pro-life message, â€Å"There Goes My Life† was sung at the inauguration of George W. Bush in 2005 Teen pregnancies in the Philippines By Rebecca B. Singson Philippine Daily Inquirer First Posted 00:55:00 06/14/2008 Filed Under: Health, Lifestyle & Leisure, Gender Issues (First in a series) MANILA, Philippines? The sexual revolution has ushered in a period in which the average adolescent experiences tremendous pressures to have sexual experiences of all kinds. Filipino teens get a higher exposure to sex from the Internet, magazines, TV shows, movies and other media than decades ago, yet without any corresponding increase in information on how to handle the input. So kids are pretty much left to other kids for opinions and value formation when it comes to sex. Sexual misinformation is therefore equally shared in the group. Parents at home and teachers in school feel equally inadequate or uneasy to discuss the topic of sex with youngsters. The problem mounts because the barkada (gang) has a more profound influence than parents do and they exert pressure and expect the adolescent to conform to the rest of them. In fact, female adolescents whose friends engage in sexual behavior were found to be more likely to do the same compared to those who do not associate with such peers. If the teen perceives her peers to look negatively at premarital sex, she was more likely to start sex at a later age. Numbers Statistics in the United States show that each year, almost 1 million teenage women? 10 percent of all women aged 15-19 and 19 percent of those who have had sexual intercourse? become pregnant and one-fourth of teenage mothers have a second child within two years of their first. In the Philippines, according to the 2002 Young Adult Fertility and Sexuality Study by the University of the Philippines Population Institute (Uppi) and the Demographic Research and Development Foundation, 26 percent of our Filipino youth nationwide from ages 15 to 25 admitted to having a premarital sex experience. What? s worse is that 38 percent of our youth are already in a live-in arrangement. The 1998 National Demographic and Health Survey (NDHS) reveals that 3. 6 million of our teenagers (that? s a whopping 5. 2 percent of our population! ) got pregnant. In 92 percent of these teens, the pregnancy was unplanned, and the majority, 78 percent, did not even use contraceptives the first time they had sex. Many of the youth are clueless that even on a single intercourse, they could wind up pregnant. Risks There are many reasons teen pregnancies should be avoided. Here? s a low down on the facts: ? Risk for malnutrition Teenage mothers tend to have poor eating habits and are less likely to take recommended daily multivitamins to maintain adequate nutrition during pregnancy. They are also more likely to smoke, drink or take drugs during pregnancy, which can cause health problems for the baby. ? Risk for inadequate prenatal care Teenage mothers are less likely to seek regular prenatal care which is essential for monitoring the growth of the fetus; keeping the mother? s weight in check; and advising the mother on nutrition and how she should take care of herself to ensure a healthy pregnancy. According to the American Medical Association, babies born to women who do not have regular prenatal care are 4 times more likely to die before the age of 1 year. ? Risk for abortion Unplanned pregnancies lead to a higher rate of abortions. In the United States, nearly 4 in 10 teen pregnancies (excluding those ending in miscarriages) are terminated by abortion. There were about 274,000 abortions among teens in 1996. In the Philippines, although abortion is illegal, it would shock you to know that we even have a higher abortion rate (25/1,000 women) compared to the United States where abortion is legal (23/1,000 women). For sure, there are more abortions that happen in our country that are not even reported. Backdoor abortions are resorted to with untrained ? hilots? with questionable sterility procedures, increasing the possibility for tetanus poisoning and other complications. Risk for fetal deaths Statistics of the Department of Health show that fetal deaths are more likely to happen to young mothers, and that babies born by them are likely to have low birth weight. ? Risk for acquiring cervical cancer The Human Papillomavirus (HPV) is a sexually-transmitted, w art-forming virus that has been implicated in causing cancer of the cervix. This is the most common cancer in women secondary to breast cancer. Women who are at increased risk for acquiring this are those who engage in sex before 18, have a pregnancy at or younger than 18, or have had at least 5 sexual partners, or have had a partner with at least 5 sexual partners. If you start sex at an early age, you have a higher likelihood of going through several sexual partners before you settle down, thus increasing your exposure to acquiring the virus and acquiring cervical cancer. The men can get genital warts from this virus and can certainly pass it on to their partners, thus increasing her risk for cervical cancer. Is that something you would want to gift to your wife with on your honeymoon? There is a way to test women (HPV Digene test) but no test for the man so you can? t know if you have it. Using the condom does not confer protection against acquiring this virus since the condom cannot cover the testes where the warts can grow and proliferate. Adolescent Pregnancy: Current Trends and Issues Abstract The prevention of unintended adolescent pregnancy is an important goal of the American Academy of Pediatrics and our society. Although adolescent pregnancy and birth rates have been steadily decreasing, many adolescents still become pregnant. Since the last statement on adolescent pregnancy was issued by the Academy in 1998, efforts to prevent adolescent pregnancy have increased, and new observations, technologies, and prevention effectiveness data have emerged. The purpose of this clinical report is to review current trends and issues related to adolescent pregnancy, update practitioners on this topic, and review legal and policy implications of concern to pediatricians. INTRODUCTION Adolescent pregnancy in the United States is a complex issue affecting families, health care professionals, educators, government officials, and youths themselves. Since 1998, when the last statement on this topic was issued by the American Academy of Pediatrics (AAP), efforts to prevent adolescent pregnancy have increased,and new observations, technologies, and prevention effectiveness data have emerged. The purpose of this clinical report is to provide pediatricians with recent data on adolescent sexuality, contraceptive use, and childbearing as well as information about preventing adolescent pregnancy in their communities and in clinical practice. This report does not address diagnosis of pregnancy or management of the transition to prenatal care. Information about counseling pregnant youth is provided in the AAP policy statement â€Å"Counseling the Adolescent About Pregnancy Options,† and from the Alan Guttmacher Institute, and information about early prenatal care is available from the American College of Obstetricians and Gynecologists SEXUAL ACTIVITY The proportion of American adolescents who are sexually active has decreased in recent years; however, rates are still high enough to warrant concern. Currently, more than 45% of high school females and 48% of high school males have had sexual intercourse. The average age of first intercourse is 17 years for girls and 16 years for boys. However, approximately one fourth of all youth report having had intercourse by 15 years of age. Younger teenagers are especially vulnerable to coercive and nonconsensual sex. Involuntary sexual activity has been reported by 74% of sexually active girls younger than 14 years and 60% of those younger than 15 years. Sexually active youth, similar to older unmarried adults, usually have monogamous, short-lived relationships with successive partners. Current surveys indicate that 11% of high school females and 17% of high school males report having had 4 or more sexual partners. In addition to intercourse, many adolescents report having had oral sex or engaging in kissing, touching, or other mutual stimulation; however, data on these other behaviors are reported rarely. There are several predictors of sexual intercourse during the early adolescent years, including early pubertal development, a history of sexual abuse, poverty, lack of attentive and nurturing parents, cultural and family patterns of early sexual experience, lack of school or career goals, substance abuse, and poor school performance or dropping out of school. Factors associated with a delay in the initiation of sexual intercourse include living with both parents in a stable family environment, regular attendance at places of worship, and higher family income. Recently, parental supervision, setting expectations, and parent/child â€Å"connectedness† have been recognized as clearly associated with decreasing risky sexual behavior and other risky behaviors among adolescents. CONTRACEPTIVE USE Despite increasing use of contraception by adolescents at the time of first intercourse, 50% of adolescent pregnancies occur within the first 6 months of initial sexual intercourse. The human immunodeficiency virus (HIV) epidemic and public health education efforts have led more adolescents to use barrier contraceptives; nonetheless, in 2003, among high school students who reported that they had ever had sexual intercourse, only 63% reported having used a condom the last time they had intercourse. Despite HIV prevention guidelines, initiation of prescription contraceptives is often accompanied by decreased condom use, especially among adolescents who do not perceive themselves to be at risk of sexually transmitted diseases (STDs). Many adolescents who currently report using prescription contraceptives delayed seeing a clinician for a contraceptive prescription until they had been sexually active for 1 year or more. Adolescent women, similar to adult women, have changed contraceptive methods in recent years, with decreases in pill use and increases in injectable contraceptive use. Factors associated with more consistent contraceptive use among sexually active youth include academic success in school, anticipation of a satisfying future, and being involved in a stable relationship with a sexual partner. The Centers for Disease Control and Prevention unambiguously recommends both abstinence and the use of barrier contraceptives for individuals who choose to be sexually active. However, some groups continue to question the effectiveness of condoms. Youth who participated in programs that provided information about abstinence, condoms, and/or contraception; who were engaged in one-on-one discussions about their own behavior; who were given clear messages about sex and condom or contraceptive use; and who were provided condoms or contraceptives have been found to increase consistent condom and contraception use without increasing sexual activity. TRENDS IN ADOLESCENT CHILDBEARING Each year, approximately 900000 teenagers become pregnant in the United States, and despite decreasing rates, more than 4 in 10 adolescent girls have been pregnant at least once before 20 years of age. Most of these pregnancies are among older teenagers (ie, those 18 or 19 years of age). Approximately 51% of adolescent pregnancies end in live births, 35% end in induced abortion, and 14% result in miscarriage or stillbirth. Historically, the highest adolescent birth rates in the United States were during the 1950s and 1960s, before the legalization of abortion and the development of many of the current forms of contraception. After the legalization of abortion in 1973, birth rates for US females 15 to 19 years of age decreased sharply until 1986. Rates increased steadily until 1991; since then, the birth rate among teenagers has decreased every year since 1991. Since 1991, the rate has decreased 35% for 15- to 17-year-olds and 20% for 18- to 19-year-olds. Rates for 10- to 14-year-olds were 1. 4 per 1000 in 1992 and have gradually decreased to 0. 7 per 1000 in 2002. Although birth rates have been decreasing steadily for white and black teenagers in recent years, 1996 is the first year that birth rates decreased for Hispanic teenagers; Hispanic adolescents also have had the highest overall birth rates and smallest decreases in recent years. Once a teenager has had 1 infant, she is at increased risk of having another. Approximately 25% of adolescent births are not first births. ADOLESCENT PARENTS AND THEIR PARTNERS Adolescent childbearing is usually inconsistent with mainstream societal demands for attaining adulthood through education, work experience, and financial stability. Poverty is correlated significantly with adolescent pregnancy in the United States. Although 38% of adolescents live in poor or low-income families, as many as 83% of adolescents who give birth and 61% who have abortions are from poor or low-income families. At least one third of parenting adolescents (both males and females) are themselves products of adolescent pregnancy. Although it is difficult to establish causal links between childhood maltreatment and subsequent adolescent pregnancy, in some studies as many as 50% to 60% of those who become pregnant in early or midadolescence have a history of childhood sexual or physical abuse. The problem of adolescent pregnancy is often assumed to be both an adolescent and an adult problem, because many partners of childbearing youth are adults. The percentage of adolescent pregnancies in which the father is an adult is unclear; studies report a range from 7% to 67%. Adult men having sexual relationships with adolescents is problematic, because many of these relationships may be abusive or coercive. Adolescents who have sex with older men are also more likely to contract HIV infection or other STD. Although more than two thirds of adolescent girls' sexual partners are the same age or within a few years older and the sexual activity is consensual in nature, some partners are more than 4 years older. Sexual relationships between adults and minors may be coercive or exploitative, with detrimental consequences for the health of both the teenager and her children. Although some states and local jurisdictions have changed statutory rape laws and their enforcement, mandated reporting of all sexual activity as statutory rape or as child abuse has not been effective at changing behavior, does not allow for clinical judgment, and has the effect of deterring some of the adolescents most in need from seeking health care. Adolescent fathers are similar to adolescent mothers; they are more likely than their peers who are not fathers to have poor academic performance, higher school drop-out rates, limited financial resources, and decreased income potential. Some fathers disappear from the lives of their adolescent partners and children, but many others attempt to stay involved, and many young fathers struggle to be involved in their children's lives. Current programs in adolescent pregnancy and parenting are exploring ways to r

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Come up with a topic for me - Essay Example For Japan to get involved in international politics on the same platform as Western powers, she had to extend her territory with Taiwan. The Sino-Japanese War won by Japan helped the country acquire Taiwan, which was initially under Japanese rule. China’s defeat in the hands of Japan compelled Qing Empire cede Taiwan to Japan (Ching 7). A group of Taiwanese refused to accept the takeover, and Japan spent six months fighting local guerilla armies. Japan lost many soldiers to diseases, not bullet wounds. The Japanese imperial powers recognized that tackling disease had to be a primary concern. In the initial two decades of the Japanese rule, significant progresses were made in public health (Jacobs 47). The Japanese rule built health centers and equipped them with facilities to help in fighting disease. The development of the health sector in Taiwan is attributed to Japanese rule that invested a lot of resources in the sector. Even though there were many political groups agitating for reforms and a parliament in Taiwan during the time of Japanese rule, these did not signify an anti-Japanese attitude among the people of Taiwan. The industrial and economic development caused by the Japanese administration led to the improvement of the living standards of the Taiwanese (Jacobs 47). There were a lot of pro-Japanese emotions on the part of many Taiwanese people of that time. Some people were skeptical of the Japanese rule since they appeared to push for their interests more than that of Taiwan. As the Japanese improved Taiwanese exports and commerce, the Taiwan economy boomed to an unprecedented height (Fell 16). The Japanese built roads, harbors, rail, power plants, factories, and a sewage system for the people of Taiwan. There was an introduction of capitalism where the Japanese enterprises competed in the production of sugar and rice with small-scale farmers. The Japanese government played a critical role in improving the economy

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How can international human resource management respond to the need for global integration yet also local responsiveness in transnational corporations - Essay Example Multinationals often learn the hard way when it comes to integrating HR systems to function optimally across the world, and some have spent enormous sums of money to solve this problem. Even for the biggest and most innovative companies, this problem still worries them because the transition requires time to manage successfully. Time is something multinationals do not have. For most international corporations, the question is not an option between globalisation and localisation, but the delicate balance between the two. On one hand, business resembles an organism; it must build a global brand to maintain its organisational attributes in international expansion (Badie, 2011:39). On the other hand, global variation in cultural and institutional settings demands multinationals to establish local responsiveness. Overemphasis on global control and consistency can only impede domestic vitality and result in what is commonly referred to as the â€Å"headquarters syndrome.† This paper will examine how multinationals can implement and practice glocalisation – â€Å"think globally, act locally† – to balance its local HR needs with global HR system s so that overemphasis on one does not cause negative consequences for them (Kaynak and Fulmer, 2013:11). Glocalisation requires HR managers to combine both global and local strategies. When implemented correctly, the rewards can spread evenly between local divisions and the multinational headquarters based abroad. Despite the global recession that followed the 2008 financial downturn, glocalisation surges on steadily. Scholars have argued that the core driver of glocalisation today is international corporations, which is true because they are the ones who need it the most. According to Drori (2013:18), as many large companies set up local or regional divisions in emerging and culturally rich markets, HR practitioners are required to implement sustainable HR practices that respond to local needs. HR

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Cigarettes and Lungs Cancer - Research Paper Example Lung cancer is one of the leading causes of cancer-related mortality all over the world. There are basically 2 predominant types of lung cancer and they are small cell lung cancer or SCLC and non-small cell lung cancer or NSCLC. The latter constitutes 85% of all lung cancer cases. NSCLC is further divided into large cell carcinoma, squamous cell carcinoma, and adenocarcinoma (Molina et al, 2008). All these types of lung cancers are different in terms of clinical presentation and histopathological characteristics. But management plans and prognoses are similar. The most frequently encountered NSCLC is adenocarcinoma arising from the mucosal glands of the bronchi. It represents 35-40 percent of all lung cancers. It is mostly seen in the peripheral portion of the lung. It is the most common histologic subtype. It can also manifest as scar cancer. This subtype is mostly seen in non-smokers and may present as a bronchoalveolar form of multifocal tumors. Squamous cell carcinoma accounts fo r about 25 percent of lung cancers. Unlike adenocarcinoma, the cancers are mainly seen in the central parts of the lungs with the classical clinical presentation being proximal bronchus cavity. It is characterized by keratin pearls and has the tendency to exfoliate. It is often associated with hyperkalemia. 10-15 percent of lung cancers are caused due to large cell carcinoma that is easily diagnosable by chest X-ray. Lung cancer metastasis to liver, bones, adrenal glands, brain, spinal cord, and pericardium.... Unlike adenocarcinoma, the cancers are mainly seen in the central parts of the lungs with classical clinical presentation being proximal bronchus cavity. It is characterized by keratin pearls and has the tendency to exfoliate. It is often associated with hypercalemia. 10-15 percent of lung cancers are caused due to large cell carcinoma that is easily diagnosable by chest X-ray. Lung cancer metastatises to liver, bones, adrenal glands, brain, spinal cord and pericardium (Molina et al, 2008). Regional incidence pertaining to lung cancer is actually variable and it predominantly depends on the prevalence of cigarette smoking. For instance, in Utah, the incidence of lung cancer is lowest and smoking is lowest there (Molina et al, 2008). On the other hand, in Kentucky, the incidence of smoking is highest and so is the case with lung cancer (Molina et al, 2008). Another interesting aspect is, with the decline in the prevalence of smoking, the incidence of lung cancer is predominant in form er smokers than in current smokers. For example, according to a study by Yang et al (2005), "more than 5000 patients whose lung cancer was diagnosed between 1997 and 2002, only 25% were current smokers and more than 60% were former smokers" (cited in Molina et al, 2008). The epidemic of lung cancer in the 20th century is undoubtedly caused by cigarette smoking. The development of lung cancer secondary to smoking is directly related to the number of cigarettes smoked per day and the duration of smoking. The nicotine content and tar content also influence the development of lung cancer. Tobacco contains about 300 substances that are harmful of which more than 60 are potent carcinogens (Lee, 2001). Nitrosamine-NNK and poly-aromatic hydrocarbons for DNA

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Case problem Essay Example | Topics and Well Written Essays - 250 words - 1

Case problem - Essay Example It can be concluded that though a minor, he voluntarily accepted the risk involved in skiing. There was thus an express assumption of risk. That is supported by what was decided in Murphy vs. Steeplehouse Amusement Company, 250 N.Y. 479. The court ruled that one is solely responsible for outcomes of an activity in which the person takes part if the dangers are obvious and necessary. Contributory negligence makes the defendants not entirely liable. Neal’s’ conduct of skiing while being inexperienced and besides too young falls below a certain standard necessary for his own protection, and this conduct cooperated with the defendants negligence of selling the skies to a minor who was also inexperienced. That eventually harmed Neal. Neal would have avoided the injuries had he gone for lessons. That leads to another defense available to the defendants. It is comparative negligence, which in other words would be non-absolute contributory negligence. With this type of defense, Neal would not recover by percentage in which he was at fault for his damage. In this way, the damages are shared between parties according to their

Grades inflation in the US Annotated Bibliography

Grades inflation in the US - Annotated Bibliography Example Students and the citizens have been worried about the criteria the professors use when they are grading different students from different races. The problem has been noted since many students have graduated and only a few numbers haven’t. This has been noted. In this article they explain further about grade inflation and the problems that it has caused to the students. The article talks of the act of discrimination in the grading process. You will also find the comparison between different institutions and the policies put in place for the grading process. The article also presents its argument in a diagrammatic way and gives statistics of the same. The article broadly explains on the issue of the grades but for this one is deeper. It tries to overlook the problem and the reasons behind it. It also has a diagram that helps the learner even understand more. The article is very interesting and gives the learner a good experience. It tries to see through the possibilities and the impossibilities of schools applying grade inflation as a way of competition. The article also tries to lay the differences link between school choice and grade inflation. It also goes ahead and talks about empirical strategy The article goes straight to discuss the matter and in this case the article talks about the parents in another dimension where they get to choose the best schools for their children without having in mind the gradation process. The source is very relevant and has good arguments on the matter. This is an article that tries to review whether the credibility of data would affect the data inflation.They get their research from the US law schools admissions. They base their argument onthe reliability and the sincerity of the data that they get. They also give prior research and also have diagrammatic explanations to explain further with the use of examples. There is a lot of data analyzing in this case

Marketing Plan for Breads and Bakes Essay Example | Topics and Well Written Essays - 1000 words

Marketing Plan for Breads and Bakes - Essay Example The experience and the knowledge of B&B owners, product variety, and skilled workers are the strengths of the enterprise. The weakness of the firm arises from its dearth of knowledge regarding the taste and preference of the local clientele. The firm has a prospect of benefiting from the mild competitive rivalry and the large consumer base in the locality. The competition arising from the well-established and prominent cafes are a major threat.The retail industry for food and beverages in the US is swelling rapidly. The increased demand for the freshly baked products, including muffins, bread, and beverages such as coffee arises from the cool business climate of Seattle. The low competition in the locality also increases the demand for products (U.S Department of Commerce, 2008). Large coffee chains and espresso bars are the main rivals of B&B. Nonetheless, the cafes often have limited clients because of the higher outlays with which they are associated. B&B is economical in its comp etitive price, acquiring more clients (Langlois & Csontos, 1993).The firm’s products are a variety of coffee, espresso, and freshly baked products. The firm will market the products to the locals, tourists, and travelers in the town.The local residents aged between 15 and 50 years are the target market of the firm. The firm also targets the tourists and the frequent travelers in the town.B&B will be different from other firms in terms of a wide variety of provisions and competitive pricing.

Woody Contruction Company Essay Example for Free

Woody Contruction Company Essay The Custom Woodworking Company is a small-to-medium sized custom furniture and cabinet making company located in Someplace, British Columbia. It is represented by Ron Carpenter, CEO, his wife Emelia Carpenter, the president and their son John Carpenter, the director. The company is privately held with approximately 850 employees. Throughout the years, they quickly gained reputation for attractively designed and well-constructed furniture and built up a loyal staff and work force. Woody 2000 project started in 1989, as a result of a boom in the commercial construction activities and the intentions of the management. The production floor of The Custom Woodworking Company was to expand by 25% with an estimated budget of 17 million dollars. The timeframe for this would be approximately 18 months. This expansion would include an equipment installation of semi-automatic woodworking trains, which requires both software and hardware to operate the system. Introduction: A Project Manager is a person responsible for accomplishing project objectives. These objectives include initiating, planning, executing, monitoring and controlling and closing of the project. Project Management can be defined as being an art of controlling the cost, time, manpower, and hardware and software resources involved in a project. A Guide to the Project Management Body of Knowledge Guide (PMI 2008) define project management as â€Å"the application of knowledge, skills, tools and techniques to project activities to meet project requirements†. Successful organizations have some sort of project some time or another throughout the lifetime of the project. The owners and contractors have different ideas of what they want done. In the construction world the common bond is to create a successful project with high quality, desired completion date and the actual costs While reading through the Woody 2000 Project there were a few things that I discovered that could have been done to maybe enhance the project. Scope is very important in the definition of project requirements at the start of the project and if a portion of this is missed it can cause unforeseen extra cost and variation of cost and the final product. Defining the project scope is to identify all the work in details that the project will accomplish in order to achieve its final goal. The work includes the activities in which the project members have identified will be necessary to support the project and all the other instances surrounding delivery of the project. There was a lack of planning. The expansion was based on a mini boom in the construction industry, but no one took the time to conduct a statistical plan as to whether or not the boom was going to last and for how long. It may have been defined to the key players, but not to the actual people that need to know. In my opinion the project was not carefully planned out. Vice President of Finance and Administration, Spencer Moneysworth did not have the project management skills that was needed for this project. The fact that he decided not to involve the production people was a mistake. He should have included all key players from every section whether they were at management level or not. Because of the short suspense, and he did not want to waste any unnecessary time, he immediately invited the Expert Industrial developers (EID) to get a quote. There were poor management, VP Moneysworth may be good at Finance and Administration, but he lacked the management skills to make this project successful. There was not an actual project manager, which was needed because of the estimated cost for the project was given a cash flow versus working out the necessary details that was required and breaking down every section that was to be expanded, materials, resources and supplies. Timelines and budget were set without considering any internal or external problems. The initial objective was to increase production efficiency and keep up with the current demands, but the expansion quickly turned into an expansion of the current facility to an upgrade in offices. The completion date of the project and the amount were somewhat unrealistic. The company did create a monthly cash flow chart for the project. Another issue is that there was not an evaluation process that states when there would be another meeting or to check on progress of the project. Communication management which is also a vital part of any project was a flaw in this project. Having good communication will determine the flow of information. Effective communication can lead to a successful project and should be frequent and relevant. Another reason they should have communicated is because after they realize the price and time of the project they should have relook their approach. In conclusion the biggest problem that I see with Woody’s 2000 project is the planning and communication phase. They did not effectively plan and implement what they wanted to do and there was no communication between department heads and contractors. If they had planned properly and involved the right personnel they would have been more successful.

Virginia Woolfs The Death Of The Moth

Virginia Woolfs The Death Of The Moth In Virginia Woolfs The Death of the Moth, she wrote about a pathetic moths death process. Although its struggling and fighting against death moved her, the moth died in the end. The Death of the Moth reveals a world filled up with common objects: the moth, downs, sunlight, rooks, men etc. The connection between them, however, is extraordinary. The center of this world is frozen on a moribund moth and everything else is background. They are here to see and to contrast the death of the moth. In this world, life and death changed in a wink and this death process is released in a condensed way, striking us readers simple and quiet life. Woolf was a person who suffered mental illness throughout her life. In this essay, she commonly used personification. She considered the moth as herself. By condensing the human lifetime to a day life of a hay-colored moth, she demonstrated that death was inevitable. Even though due to the true nature of life, living beings tend to fight against the oncom ing doom (107), any effort against the power will fail eventually. Surprisingly, Woolf created a window that separated the moth and her from the outside world. At the beginning of this essay, she wrote about the pleasant summer morning. Everything outside was inspired by the vigor. The keener smell of air, the early work in the field, the utmost clamor and vociferation of rooks shows us this scene of vitality (106). In addition, she chose to write many big, strong and significant things on purpose, such as the scoring plough, the horses, the ploughmen, the rooks etc. She aimed to foreshadow the contrast between the moth and outside living beings: That was all he could do, in spite of the size of the downs, the width of the sky, the far-off smoke of houses, and the romantic voice, now and then, of a steamer out at sea (106, 107). Compared to the world outside the window, the moth was pathetic and little or nothing but life (107). The universe was larger than the moth can notice. However, compared to the oncoming doom, even the large and strong outsid e world was fragile and insignificant, let alone the little moth: as long as it chose to, the oncoming doom could submerge an entire city, not merely a city, but masses of human beings; nothing, I knew, has any chance against death (108). The world inside the window was individual and different from the world outside. Woolf wrote about the moth flying around the window, from one corner to another, or across them. Not only the moth was tiny, but also its life, though somehow vigorous at that moment, was actually boring. There was nothing else left for it to do besides flying. Outside world was bright and colorful, but the moth was somewhat lonely, just like Woolf herself. The window was like a barrier, keeping her away from enjoying the optimistic and positive life. She felt pity for the moth, just as if she felt sympathy for herself. Eventually, the moth settled on the windowsill, maybe because it was tired. It wanted to fly again, but failed. It seemed that this little creature was exhausted. Its movement and struggling was awkward. It failed several times and finally fell down and lay on its back. Death crept up on this poor and pathetic moth. Woolf tended to help it, but suddenly realized that this was the token of death. She knew death was inevitable, and she accepted that. In her mind, nothing people can do to stop the power of death. Hence, she chose not to interfere with the natural process. The moth was struggling. She was moved by its extremely strong will to live. Its tiny little legs fluttered repeatedly. The last protest was a success, but this instant victory did not save it from taking away by death. At the last few sentences of the last paragraph, she repeated the word death for six times, trying to emphasize that nothing can win the battle against oncoming doom. Except using repetition here that adds force, the whole passage was trying to avoid this. Synonyms were commonly seen in her words, such as pity, pathetic, sympathies; also useless, helplessness, futile, vainly and failure; death, oncoming doom, the power, fate etc. From her words it was superb this last protest, ones sympathies, of cause, were all on the side of life, moved one strangely etc., we can see that Woolf admired, respected and praised the life (108). Thus, she utilized personification throughout her essay. The moth is she, and she is the moth, struggling and fighting all her life. Virginia Woolf suffered mental illness during her lifetime. Actually, the date when she wrote this essay was very close to her suicide. As she said in the end of the essay death is stronger than I am, her illness was torturing her and she wanted an end (108). The moths life is actually her life. She condensed it to a day. Her life is not colorful and interesting like the world outside the window, but boring, plain and dull. She had a same window deep down in her mind. A barrier, through which she could see the world, but she fail to blend in it. Maybe for the reason of her mental illness, she can see the world differently than common people and can understand her inner thoughts more thoroughly, thus creating her magnificent achievements in mastering the technique stream of consciousness. She can write complex sentences as her wish, and mix her true feelings into her words: Yet, because he was so small, and so simple a form of the energy that was rolling in at the open window and driving its way through so many narrow and intricate corridors in my own brain and in those of other human beings, there was something marvelous as well as pathetic about him (107). In this essay, Virginia Woolf seemingly wrote about the moth, while actually she wrote about herself. Pessimistic emotion flooded this essay. No one can stop the natural process. No one can escape from death.

Three ways that stress is conceptualised by psychologists

Three ways that stress is conceptualised by psychologists Researchers define stress as a physical, mental, or emotional response to events that cause bodily or mental tension. Therefore, stress is a disruptive condition that occurs in response to internal or external environments and affects the body or mind. Depending on the stressors and the types of events being dealt with, stress can manifest itself physically, emotionally or mentally. Physical stress occurs when the body starts to suffer resulting from stressful situation and symptoms show in a range of ways and vary in their seriousness. Emotional stress is a response by the mind when affected by things like anxiety, anger, depression, irritability, frustration or over-reaction to everyday problems. Psychological stress result when an individual is exposed to long-term stress and the symptoms may include withdrawal from society, phobias, compulsive behaviours, eating disorders and night terrors. The concept of stress has been viewed in different ways: An internal body response nonspecific response of the body to any demand made upon it. This is a state of psychological and physical tension produced when there is a mismatch between the perceived demands of a situation and an individuals perceived ability to cope. This leads to either adaptive or maladaptive state of tension. An external stimuli This is an event that triggers the stress response as it throws the body out of balance and forces it to respond. It can be a life event or a set of circumstances that arouses physiologic reactions that may increase an individuals vulnerability to illness. A transaction includes a set of cognitive, affective and adaptive (coping) responses that arise out of person environment transaction. People perceive threats to their well-being which they may be unable to meet. There are several ways in which the term stress is conceptualised by psychologists: The general adaptation syndrome (GAS) Hans Selye (1936, 1950) conducted a research on stress. He reported that the rats that he was experimenting on showed physiological changes that were directly related to the injections they received during the experiments, but what was actually being injected was less important than the fact that they were being injected. The rats were then exposed to harmful agents like cold, surgical injury, excessive exercise, severing the spinal cord or doses of drugs. A typical syndrome appeared and the same symptoms appeared in response to all of the stimuli including (over time), development of stomach ulcers. He argued that stress can be adaptive in the short term because it enables one to cope with environment demands (fight or flight) but long term stress can be damaging. This led him to make the statement that stress is the non-specific response of the body to any demand. Selye noticed that rats and hospital patients all seemed to show a similar pattern of bodily response which he called General Adaptation Syndrome (GAS), because it represented the bodys attempt to cope in an adaptive way with stress. He argued that GAS consisted of three stages; alarm reaction, resistance and exhaustion. After alarm reaction, the individual adapts and returns to normal functioning but after prolonged stress exhaustion occurs which can lead to development of stress-related illnesses. Alarm reaction stage: This stage deals with acute stressors and involves part of the sympathetic branch of the autonomic nervous system (ANS). The activity in sympathetic adrenal medullary system (SAM) and hypothalamic-pituitary-adrenocortical axis (HPA) increases. This is controlled by electrical impulses through nerves. Selye however emphasized the role of HPA in his account and argued that the alarm reaction develops 6-48 hours after stress and includes muscular tone loss, drop in body temperature and decrease in liver and spleen size. Resistance stage: In this stage the body adapts to the demands of the environment. As it proceeds however, the parasympathetic nervous system requires more careful use of body resources in order to cope. This stage is initially marked by an increase in the size of the adrenal glands and a decrease in some pituitary activity like the production of growth hormone. If the stress is not too much then the body returns to a near-normal state. Exhaustion stage: If the stress is prolonged, the physiological systems used in alarm reaction and resistance stage become ineffective and the initial symptoms like increased heart rate, and sweating re-appear. In extreme cases, the damaged adrenal cortex leads to failure of the parasympathetic system and collapse of the bodys immune system leading to likelihood of stress related diseases like high blood pressure, asthma and heart disease. Selyes research identified major components of stress response and he alerted medicine to the importance of stress and disease. Previous researchers had not properly appreciated the damaging effects of prolonged exposure to stress. There are limitations with this research however, as Selye did not pay much attention to SAM system, and he did not understand fully the relationship between HPA and SAM systems. He also exaggerated when he stated that stress always produces the same physiological pattern. Selye has been criticised for using animals to support his research on human responses to stress. He also assumed that people respond in a passive way to stress but Mason (1975) argued that there is an active process of psychological appraisal when people confront a stressor. Workplace stress Marmot et al.s (1997) study aimed to investigate the negative correlation between job control and stress-related illness in male and female civil servants. It was assumed that job control is negatively correlated with stress-related illnesses. 10,308 civil servants between 35 and 55 years were investigated over three years and job control was measured through self-report survey and independent assessment by personnel managers. Job control was assessed on two occasions, three years apart and records of stress related illnesses kept and then a correlational analysis carried out. It was found out that those with low jobs control were four times likely to die of heart attack than those with high job control. They were also more likely to suffer from other stress-related disorders. On both occasions that job control was measured, the findings were consistent and there was a considerable association even after other factors like job demands, social support employment grade and risk factors for coronary heart disease had been accounted for. As indicated by the number of stress-related illnesses, it shows that low job control is associated with high stress. As the job control decreases, the illness increases, that is, there is an opposite social gradient in stress-related illness (negatively correlated). This however does not fully support the job-strain model because it does not show that high demand is linked to illness and the jobs performed by those high and low in job control also differed in several ways other than simply control. The self-report method is vulnerable to investigator effects and participant reactivity bias and also weaknesses of the correlational method mean that there is no control over job control as a variable and this makes interpretation difficult as the cause and effect cannot be inferred. Personality factors, including Type A behaviour Friedman and Rosemans (1974) carried out a study to test if there was any association between Type A behaviour and Coronary heart disease (CHD). They wanted to test their observations as cardiologists that their patients displayed a common behaviour pattern consisting of impatience, competitiveness and hostility. Around 3200 healthy men of 39-59 years from California were selected and assessed over 8 Â ½ years. They were interviewed, observed and personality type and current health status assessed. There was a follow-up 8 years later when CHD was recorded and a correlation analysis was carried out. 257 participants of the original sample of 3200 had developed CHD during the 8 Â ½ years 70% of whom had been classified as type A, nearly twice as many as Type Bs. This remained the same even when other factors associated with heart disease like smoking, obesity and blood pressure were taken into account. This research shows that the Type A behaviour pattern is linked to CHD and they concluded that this pattern increases the individuals experience of stress which increases physiological reactivity hence high vulnerability to CHD. The high levels of stress hormones indicate that Type A person experience more stress than Type B. The evidence has successfully been applied for example Friedman, Tordoff and Ramirez (1986) reported on the Recurrent Coronary Prevention project which aimed to modify type A behaviour and so reduce CHD in participants who had experienced a heart attack. This study has a limitation however, in that it was an experimental study and so the cause and effect cannot be established; other studies have failed to show the link between Type A and CHD. It has also proved fairly difficult to repeat the findings of Friedman and Rosenman (1974). All the above three areas show that there is a direct link between stress and illness. Stress affects people through cognitive and behavioural which lead to physiology of stress in the body hence weakened immune system and likelihood of illnesses.