ROBERT REISCHAUER: Hello, I'm Bob Reischauer, the president of the Urban Institute, and I'd like to welcome you all to the sixth First Tuesday of the year.
These forums are intended to generate a lively discussion among the panelists and between the panelists and the audience on some important policy topic, one on which Urban Institute research sheds some light.
Today's forum is going to focus on the risk-taking behavior of teenagers and how it's changed over the course of the 1990s.
We are, today, releasing a publication "Teen Risk-Taking: A Statistical Portrait," and the lead author of that report, Laura Duberstein Lindberg, will be one of our panelists. She is a senior demographer here at the Institute, and she will be joined on the panel by Professor Kellam of the Johns Hopkins University, who will provide a more academic perspective. And to make sure our feet are firmly planted in the real world on the ground, Lori Kaplan, the executive director of the Latin American Youth Center, will discuss these issues.
To moderate the panel, we have my good friend, Rich Wolf, who for 13 years has been a reporter with USA Today, covering almost every issue of importance to those of us who follow domestic public policy—the budget, politics, you name it, Congress—he's been there covering it very intelligently over the years.
So, with that, let me turn it over to Rich. I am going to apologize because, in about an hour, I'm going to have to sneak out and catch a plane if the flights are on schedule, and I won't catch the end of the food fight.
Rich.
RICHARD WOLF: Thank you, Bob.
I'm going to be extremely brief so that we can move to the research. I have very few qualifications for being here other than—I was joking with Susan Brown, who isn't here right now, that I was a teenager in the '60s and '70s, so --
(LAUGHTER)
And I'm not going to—no further comments on that.
(LAUGHTER)
I didn't participate in any of these risky behaviors.
(LAUGHTER)
I have a teenager. I have a preteen, so I'm going through a lot of the issues that we're going to be discussing today, and it occurs to me that I'm almost too late if I haven't started to address them at home because it seems to me these need to be addressed at about the age of 10 or younger. My kids are 14 and 11.
And my wife is much more involved with teenagers than I am. She runs community service programs in Northern Virginia that involved the disabled and nondisabled kids in community service projects, so she's very familiar with the aspect of this that involves getting kids involved in positive behaviors instead, and I think Dr. Kellam is going to be talking a little bit about the research into some solutions here, so I guess everyone will be talking about involving kids in positive behaviors.
So I don't get to write this that often, but I do get to live it. And without further ado, why don't we start with Laura, who is going to run us through the research.
LAURA DUBERSTEIN LINDBERG: Good morning.
The research I'm going to talk about today draws from a series of projects that we completed for the Office of the Assistant Secretary of Planning and Evaluation at HHS during the past year. And today, in this publication, we're releasing a synthesis of that research, and I'd like to thank and acknowledge my co-authors, Scott Boggess, Laura Porter, and Sean Williams, and our excellent research help from Karen Alexander, who's here today.
When we started this project, our initial recognition was that the most serious threats to the health of adolescents came from risk behaviors that could be prevented, such as substance use, risky sex, or suicide. And there has been a lot of recent media attention that focused on these behaviors, but the overall picture still remains unclear and confusing.
In the last year or so, one day we saw newspaper headlines that bemoaned increases in marijuana use among teens, and what were we to do about this crisis? And a week later, we saw newspaper headlines that applauded declines in sexual activity among teens, and we must be doing something right if teenagers today were getting better.
And at the same time, among researchers and program providers, there was increasing recognition that risk behaviors tended to cluster together, with teens engaging in more than one risk behavior at a time.
So, while the changes in specific individual risk behaviors among adolescents has been pretty well documented, we didn't have a clear recent picture of teens' overall involvement in risk-taking and how this overall exposure to important health risks might have changed during the last decade.
Because of this, our project was to ask three main questions: How had high school students' overall risk-taking changed during the 1990s? What could we learn about teens' participation in multiple risk behaviors? And how was this risk-taking related to involvement in positive behaviors? And finally, by looking also at this involvement in positive behaviors and other social settings, we wanted to ask: Well, where could we find teens involved in risk-taking if we wanted to connect with them to find ways to reduce their negative behaviors?
Our work was facilitated by the availability of recent, high-quality national data sets, which measured risk-taking among different groups of adolescents. For different parts of the project, we drew from data from the Youth Risk Behavior Survey, commonly known as YRBS; the National Longitudinal Survey of Adolescent Health, called AdHealth, which you may have heard of; and the National Survey of Adolescent Males, or NSAM.
Now, each of these data sets have different strengths and weaknesses and they ask—their question wordings are different, their populations that they interview are slightly different. So there should be no expectation that, across the three surveys, we're going to get exactly the same estimate of any risk behavior. And I want to warn you of that in advance. But taken together, across these recent surveys, I think we get a rich portrait of risk-taking among American adolescents in a recent period.
We started with the knowledge that, during the 1990s, teens' involvement in a range of key health risk behaviors had changed. From 1991 to 1997, data from the YRBS showed us that there were significant increases in high school students' involvement in some risk behaviors, such as marijuana use or cocaine use, but that, during the same period, there were significant decreases in other risk behaviors, such as weapon carrying and sexual intercourse.
Taken together, we focused on 10 risk behaviors, and they were chosen because they represent the major causes of adolescent morbidity and mortality. And when we set up to identify definitions that we wanted to use for these risk behaviors, we focused on regular or established patterns of risk-taking, and not just exploratory levels. So, for example, our measure of tobacco use or regular tobacco use refers to daily use of cigarettes in the last 30 days, and not just infrequent experimentation.
To focus on overall risk-taking, which was our key question, we measured how many of these 10 risk behaviors students were involved in. And here, we report for the first time recent declines in overall risk-taking among high school students among these 10 risk behaviors.
So, if we start over here—here's what I mean by a decline overall. The share of high school students involved in none of the 10 risk behaviors increased from 20 to 26 percent. And at the same time, the share involved in multiple risk behaviors—two or more—declined from 57 to 53 percent. So we have more students doing none, and we have fewer students doing multiple, which is great news. But this decline in the multiple risk-taking occurs totally among students in this moderate risk level—two to four behaviors—and the share of students involved in the highest level of risk-taking, five or more risk behaviors, remained constant during this period.
So, overall, the 1990s were a period of shifting toward less involvement in risk-taking among high school students. We see that the positive changes didn't extend to the highest risk group, those involved in five or more behaviors. Also troubling is another group these changes didn't extend to, which is Hispanic students. And here I'm going to focus on 9th- to 10th-grade Hispanic students, where changes are the most salient.
The increase in the share engaging in no behaviors was smaller than what we saw overall. But most striking is the substantial increase in the share of 9th- to 10th-grade Hispanic students engaging in five or more risk behaviors. So, by 1997, one in five of these Hispanic students was reporting that they engaged in 5 to 10 of these risk behaviors.
What's troubling and what's a limit of data sets of this type is that we have very little other information about these Hispanic students. I don't know their country of origin, I don't know what generation they've been in this country, I don't know their language. So there's probably substantial diversity within Hispanic students, and this is an overall measure. And it would be wonderful if we knew more about it.
We next used the AdHealth data to look more closely at the patterns and nuances, particularly of multiple risk-taking. In 1995, AdHealth interviewed students in grades 7 through 12, which let us look at a broader ranger of students than what was available in the high school studies of the YRBS. And our initial findings, I think, really challenge everyday images that we might have that teens' involvement in multiple risk-taking is the norm. And instead, we found substantial diversity in what middle and high school students tell us their risk-taking behaviors are like.
Almost half of students reported regular involvement in none of the 10 risk behaviors that we looked at. About a quarter reported involvement in only one, and the share involved in multiple risk-taking is really the minority of all of these students. Engagement in two or more risk behaviors—what I'm going to call multiple risk-taking—is the exception and not the rule for 7th- to 12th-grade students. Furthermore, when we looked at more detail in the group of students involved in multiple risk-taking, we found just an incredible range of combinations of which behaviors teens were multiply involved in.
So, it would be really nice at this point to sit back and say, aha, most kids aren't multiple risk-takers. Multiple risk-taking is declining. We don't have much to worry about. The news is good. The direction of change is right. No problem. But unfortunately, it turns out that most of the risk-taking that we tend to be concerned about is concentrated among this minority of students who are multiple risk. While multiple-risk students are the minority of those in 7th through 12th grade, they're the majority of students who are involved in each of the specific risk behaviors that we looked at.
So, for example, 11 percent of 7th- through 12th-grade students were regular smokers. But of that group, 85 percent were engaged in another risk behavior as well. And the patterns for these other risk behaviors are relatively similar.
So, if you're a program provider and the goal of your program is to reduce regular tobacco use among teenagers, it's important to recognize that most of the regular smokers you're going to be talking to are going to be involved in another risk behavior. And if you're a parent who finds out that your teen is a regular smoker, that's a good red flag that they're probably involved in another one of these risk behaviors as well.
So even though the prevalence of most of these risk behaviors is relatively low, most of the risks we see are taken by multiple-risk kids. But multiple-risk kid doesn't necessarily mean bad kid. Nor does multiple-risk necessarily mean good kid. I don't think that's a clear distinction. What we found was that most teens, even those engaging in multiple or many health-risk behaviors, still engaged in positive behaviors. And when we looked at positive behaviors, we were talking about earning good grades, being involved in a school club or team, attending church or another faith-based setting, and just spending time in positive, desirable activities with a parent.
While not all students engaged in each of these desired activities, nearly all engaged in at least one, even among the highest-risk teens. So among teens who engaged in five or more risk behaviors, still more than 80 percent reported at least one positive behavior as well.
These positive behaviors connect students to a range of adults—be it parents, ministers, advisors or coaches—and to a range of social institutions. These connections really need to be thought about as potential points of contact to reduce risk taking among teens, whether it's by providing health education in those settings, by using these kinds of activities as hooks to draw kids into pre-existing health programs, or by just developing positive emotional connections between the adults in those settings and the teens that can protect adolescents from risk taking and its negative consequences.
But opportunities to connect with risk-taking teens don't have to be limited to positive activities. And we especially need to think about out-of-school teens because our data and prior studies have consistently shown that those adolescents who are out of school, whether they're high school dropouts, or they've graduated and haven't continued their education, have higher levels of risk taking. And it's often been thought that out-of-school kids are disconnected, and therefore, very hard to reach. And while I don't want to say that they're easy to reach on a day-to-day basis, there are places where they're involved, that they can be found and connections can be made.
In our NSAM data, we interviewed both in-school and out-of-school teen males, and we found that both groups—among the multiple-risk teen males—both groups, regardless of their school status, were involved in a range of social settings. They were spending time there. Some of these were positive—like sports and clubs. And some were negative, like the criminal justice system. But they're in locations and settings where they can be reached and found, and where there's a lot of missed opportunities for connecting up with these teens.
So the bottom line in these patterns is that, during the 1990s, we see a general shift towards less risk-taking overall among American high school students. There are certainly some behaviors that have been on the incline—increase that we need to be concerned about—but the overall direction of teen exposure is good. And many students—the majority of 7th- to 12th-grade students—do not engage in multiple risk behaviors, and many aren't engaging in any, which is also great news.
Risk and positive behaviors co-occur, and just because a teen is involved in risk behaviors doesn't mean they may not be doing desirable activities. And I think a footnote to that—especially as a parent—is because your teen is involved in positive activities doesn't mean that you have to stop being concerned that they also may be involved in risk taking. These are happening together. But we do need to focus on that concentrated small group of multiple-risk teens, because they account for most of the risk-taking that the nation has set up goals to reduce.
So what do we do about this? What next?
One of the points I want to press home is how we can use these social settings to create opportunities for health promotion, that we can go to where multiple teens are involved. They're not just hanging out on the street corners or in their friends' basements. They're involved in a range of activities that we can tap into.
But prevention efforts, even those that want to address specific risk behaviors, if we want to promote accidents, or we want to reduce school violence, we're going—to be successful with that, we're going to have to change the behavior of multiple-risk teens because they're the majority engaging in those specific behaviors. And we won't be successful without that. And we have many missed opportunities for connecting with multiple-risk teens.
One of the most salient is the use of routine health care. The majority of these kids are talking to a doctor during the year, but the topic of that conversation [is] never ... risk-taking. So that's a—the teens are already there in the office. How can we utilize that opportunity to do more health promotion?
And finally, the trends here among Hispanic students are certainly disturbing. We need more focus on this group, and both from a programmatic side—what should our prevention efforts for Hispanic students look like and are there ways that they need to be different than what we've been doing for their black and white peers?—and from a research side—what's the diversity? Are there particular groups of Hispanic students who have greater need or different patterns here? And then, how do we craft programs to match up with that?
There's new data from the YRBS 1999 survey that should be out in the next month or two. And I think it will be very important to look at what the ongoing trends, particularly among Hispanics, are in that latest round of data collection.
Thank you.
WOLF: Thank you, Laura.
Laura told me before that the one-hour version of that was easier to do than the 12-minute version, so...
(LAUGHTER)
... she should be congratulated for, I think, coming in right around 12 minutes.
(APPLAUSE)
Dr. Kellam, I guess, is going to tell us a little bit about prevention and what your thoughts here are on finding some solutions.
SHEPPARD KELLAM: This is a really quite fascinating study.
The critical point to understand is that risk behaviors, as Laura suggested, have become a major way to orient prevention research and prevention programmings. Aim at the early antecedents of these risk behaviors, and you see if you can change the early antecedent, and if you can, then does it change the developmental trajectory? And that's one major paradigm for prevention science.
And I want to talk for a minute or two about where we are in structuring the field of prevention research.
Over the last 30 years, what's been learned about early antecedents and the risk behaviors that Laura presented is incredibly important. We didn't know 30 years ago that there were any particular antecedents in childhood and early adolescence that predicted later adult pathology or adult problem behaviors. We just didn't have the data.
It's hard to believe that now, but the fact is that, over the last 30 years, we've learned a tremendous amount about early risk factors, early risk behaviors that lead through developmental paths to major problem outcomes in conduct disorders, depressive disorders and the like—alcohol and alcohol abuse, drug abuse, and so on.
There has been a set of prevention science paradigms that have been organized around this increasing knowledge. In the Society for Prevention Research, which is a rapidly growing organizing of scientists, policy-makers, program leaders, and advocates, we can identify at least four major paradigms.
One is the one that we've been discussing a little bit today. You look at early antecedents—for example, early risk behaviors like aggressive-disruptive behavior among first-grade children. Aggressive-disruptive behavior at that early age and probably earlier is an early antecedent of the problem behaviors of conduct problems, violence, and drug abuse in teenagers. And you can look at the trajectories beyond adolescence and find outcomes in adulthood, early adulthood. So these risk behaviors don't begin at a slice in time in adolescence. They begin quite early on and are reinforced by conditions and context, peers, deviant peers, and the like, over time.
One of the major paradigms for prevention science has been to aim at these early antecedents as early as first grade or thereabouts. In rigorous randomized field trials, in our own studies in Baltimore, for example, these involve some 18 schools, elementary schools, all of the first graders. Children are randomly assigned to classrooms that are aimed at improving the early antecedents, such as early aggressive-disruptive behavior.
Another target early on has been poor achievement, which is an antecedent in vulnerable kids for depressive symptoms and depressive disorder. Putting it another way, mastery makes you feel better, and if you're vulnerable to depression, it really matters. So the question is, can you improve achievement and mastery in the classroom and the peer group and in the community that protects kids?
Another prevention paradigm begins at the time of Laura's data and her colleagues' data and asks, "Can you get in early on, just before periods where teenagers begin to reinforce each other's behavior?" Social skills training, it's sometimes called, which helps kids resist peer pressure, deviant peer pressure. And those programs have been aimed at reducing the incidence of tobacco use, drug abuse, and the like, reductions in aggressive behavior associated with those.
A third paradigm that's very common among prevention researchers now aims at total communities so that you deal not only with the teenagers themselves, but the availability of tobacco. As well as social skills training for teenagers, you look at schools and the environments of schools and the attempt to enforce laws about selling tobacco to minors.
The availability around schools, the regulation of driving, and drinking and driving, and so on, are part of the community focus. It's a multiple focus, in other words, not just at the early antecedents.
A fourth paradigm is policy research, which really has to do with major issues like passing laws of drunk while driving, whether those laws are enforced, and people do a lot of simulation modeling, computer modeling to see what the possibilities are if you were to enforce drunk driving laws, publish the names of the perpetrators. What difference does that make in terms of fatalities? And let's be clear, fatalities in auto accidents is one of the major causes of death in kids this age.
So those paradigms are extremely important as ways of approaching the kinds of risk behaviors we're talking about. The field of prevention science depends upon this kind of research. There's one caveat that I have to mention.
This is a picture of the country breaking it down by three very general ethnic groups. It's possible to break this down in a different way. If you take the national data and ask—couldn't we sample some communities in addition that gives us a measure of real variation at the neighborhood level?
To be facetious, when I teach this kind of stuff at the School of Public Health, I often liken the national probability sampling as asking a national probability sample across the nation, on average, is it going to be raining today, which wouldn't tell you a lot about whether you carry an umbrella to work.
The point is that this gives you a barometer of the nation. We also need barometers of variation, barometers at the neighborhood level, which allow us to understand what's going on in one neighborhood compared to another, and what are the conditions that make a difference. There are lots of examples I could tell you about how that variation works—even within one elementary school. Maybe I'll mention one piece of data and then shut up.
In our own studies in Baltimore, one of the things we found was, as I've mentioned, that early aggressive-disruptive behavior, as many people have found, is a predictor of many of these acting-out, externalizing behaviors in teenage years. So we did preventive intervention trials aimed at reducing early aggressive-disruptive behavior. In order to do that, we randomly assigned kids to classrooms with and without intervention and had matched schools and so on.
As you can imagine, by the way, all of this kind of research requires—prevention research—requires enormous partnering with communities, parents and schools. You can't randomly assign your kids, if you have a self-interest in us doing it. So this is a very important characteristic of the prevention field.
In any case, after random assignment, 10 weeks later, when we went to look again at the baseline ratings in first graders in the 18 elementary schools, we found, to our surprise, that in the comparison classrooms, there was an enormous bimodal distribution—we would call it. Half the classrooms were chaotic after random assignment, and the other half were very well-managed.
The result of that led us to look at the impact of being in a chaotic first-grade classroom on these same risk behaviors later. It turns out that, if you're in a chaotic classroom and you're in the top quartile of risky kids in first grade—jumping out of seat, speaking out of turn, fighting, and so on—if you're in a chaotic classroom, the chances of your being severely risk-taking and aggressive in middle school six years later were 59 times the average child.
If you're in a well-managed first grade classroom, the risk was 2.7 times the average child. So that we're talking about social context as influencing the developmental trajectories of risk.
Now, when you put in a classroom management program, it turns out you reduce the 59 times to about 11-to-1 with the program we used, we were testing. Now, what's the lesson in that?
These risk behaviors are not popping up like daisies in the springtime. They're coming out of social, contextual influences interacting with what the child brings to the scene. And prevention means not just dealing with the problem as it's inside the child, but dealing with classrooms and the like—communities. The combination of a chaotic first-grade classroom and being in a poor community means that over 75 percent of such kids are thrown out of school by middle school at least once—the combination of poverty and chaos in first-grade classrooms, irrespective of the child's own risk.
So we're talking about understanding the influences, multiple influences, that can be prevented, that can be, in fact, integrated into thinking about how to promote child development.
So what we're talking about is a rapidly developing field. This kind of research is fundamental. We don't know about risk. We don't even know what we're aiming at. But we then need to move toward community, neighborhood levels, and get serious about understanding how things like training teachers to develop classrooms can be vitally important, getting children socialized to be students in the first few weeks of first grade gets to be really powerful, combinations of poverty and not doing those things can be lethal, and so on. So we could talk some more.
WOLF: Thank you, Dr. Kellam.
Lori Kaplan's going to give us the view from the street, I guess, and how this...
(LAUGHTER)
LORI KAPLAN: Thank you.
Let me frame it a bit differently. I'll give you the view from the neighborhood because I hear that's a more positive way to think of it.
Let me take you up the block to our neighborhood and move us from downtown D.C. to Columbia Heights. Before I comment— and I would like to say some comments specific to Latino kids and specific to the research—but I first want to just give you a feel for my neighborhood, where I live and where I work.
The youth center is only two miles from here, so it's right around your corner. And while the name is Latin American Youth Center, we work with kids from all ethnic groups, although the center was founded over 30 years ago as a product of the neighborhood. So it wasn't just plopped in, it is a result of the people in the community who articulated a need—the recent early immigrants, Latino primarily. And out of that moment, 30 years ago, the Latin American Youth Center was born.
I'm not going to go into all the history, but I will say that 30 years later we are a large, comprehensive, one-stop community, what I would consider youth and family development organization that young people can come to for a variety of reasons. And we have programs in employment training, arts, social services, drug treatment, housing. There's a newsletter out there. I won't go into all that detail. But the picture I'm trying to paint is that it's a home away from home for kids. It's a place that kids feel is theirs. They can come, they have a voice, they're respected, and it's in their neighborhood.
Now, purposefully, at least a third of our staff are former youth from the center. So I think that's supported by research when you look at peer messengers. Also, 50 percent of us who work there can walk to work. So again, it's trying to paint a picture of how it's my community just as much as it's the young people's community.
Our mission is to support youth and families in their determination to live, work, and study with dignity, hope, and joy. So there's nowhere in that mission statement that you hear anything about drugs, or violence, or gangs. It's just not the way we walk in to work every day. Which is in line with our philosophy. It's an asset-based philosophy. It's a strength-based philosophy. It's a recognition that young people have a whole variety of issues. And I'm so glad the research dispels that notion of good and bad kids because it's not the reality. It's exactly as I think Laura articulated it, that kids with many, many multiple risk factors are kids with many, many strengths that neighborhoods can build off of.
I guess the model we would use, it's now been given a name in a lot of the research, which a lot of youth workers knew before the model was given a name, is the Youth Development Model, an asset-based, strength-based resiliency. And much research has been done in that area.
Our clients are first- and second-generation Latino kids; they are Vietnamese kids, Amer-Asians that came after 1990 to our neighborhood, African-American kids who've grown up in the community, Ethiopian kids. It's really a very diverse sector of young people. But the heartthrob and the pulse, I guess, was the Latino community. And I guess I would say we have special expertise in working with Latino kids and families.
My reaction to the research—I have a variety of reactions to it. First, I would say the good news is it included Latinos, because often research doesn't. It's black and white. Of course, the bad news is what Laura found.
Now, within that context I have to strongly echo what Laura already articulated, which is the Latino community nationwide is not a homogenous community. It is very diverse. And to really understand, you know, what's going on here, I think a much more detailed kind of research would have to be done, looking at kids and families who are maybe first generation, or where their home language is not English, versus kids that are eight, nine, ten generations and where sort of institutional barriers—anyway, I'll get into that, the challenges in a minute. But I think much more research has to be done as it relates to Latino kids.
I think, however, even once that's done, the research that I heard today sort of mirrors other things that come across my desk and that I hear, such as Latino kids have the highest drop-out rate. Fewer Latino kids are getting into college. Highest teen pregnancy rate. You know, I'm not a researcher. I don't pretend to have all these national statistics in my head. But often when I glance at something, or read something, or hear it, it seems when Latinos are taken into consideration—which is often not the case—when they are, they don't rank out as well as their black and white counterparts.
One concern I have about the research from a risk, I guess, factor, is that two of the three studies seem to primarily deal with in-school kids. The third study that dealt with out-of-school kids tended to deal with them in their homes, meaning they lived at home. So there's a whole sector of kids that I see every day that are these out-of-school kids that don't live at home, that I think whether they're black or Latino—I don't see too many white kids at my center at all, actually. You know, I think there's some issues there that probably have to be looked at, because those obviously sound to me, from a non-research point of view and from my own work, they're the most at risk. You know, they dropped out, they're not at home. Now, they are at the youth center. So it is confirmed by the research that these kids are going to places in their communities where the possibilities for change are tremendous.
As I said, I think, knocking around somewhat this notion of good and bad kids is really important as we think about positive youth development programs to address these kinds of issues in the communities and neighborhoods where young people live. I think the interventions need to be strength-based, as articulated by the three things that Laura articulated in her research, that health can be integrated into all kinds of programs, in all kinds of venues. It could be job training, it can be arts, it can be leadership development. And that you do that in a way where there's positive youth development relationships with adults and peers that can take place.
And I was so proud to read that in the research because I thought, oh, this is what we do. You know, I can tell you about some neat programs we do. So there's a validation in that the way we're doing things, now I can say is supported by research, which I think is of great value.
I'll talk about a couple of those programs. But first I want to—someone specifically came up and asked me to talk about the challenges for Latino kids. So let my try to address some of that real quickly. I'm going to speak from a neighborhood base, first of all, from D.C., and then I'll say one or two comments about nationally. Particularly the challenge in D.C. obviously is that Latinos and immigrant youth, which tend to be first- and second-generation, there's just a disparity of service in the sectors of the city that are supposed to address some of the educational socioeconomic issues that kids deal with. There's a disenfranchisement. They really are the voiceless. And I think in D.C. that presents a particular set of issues that may not be the case in other parts of the country.
Nationally, I think if you look at funding trends, very little money goes into Latino communities. If you look at HHS or, I don't know, some of the ones that fund—or national philanthropy foundations—and you, you know, just start siphoning it down to what is actually going into Latino communities nationally, philanthropically, and even from the federal government, it's just tiny, tiny percentages of what money is out there to be gotten. And most money that's out there is not asset-based money, or resilient-based. It's once you're already way down the deficit road, you know, it's the intervention, and the treatment, and the youth jails. Now, I don't disagree that youth jails are an opportunity to do some positive youth development work, but the point I'm making is it's harder to get that front-end money to invest in young people prior to all the labels. Once they've got a whole bunch of labels then the money seems to be a little bit easier to get.
I think socioeconomic status—I think you mentioned, Dr. Kellam mentioned poor neighborhoods, poor schools. You know, it's just a formula for disaster. And I think if the research were done—well, I think it speaks for itself. When you're poor you're impoverished in more ways than just economically. There's a certain deprivation of quality of life that kicks in. And while I think the research articulated that violence in general was going down, I'm not particularly feeling that in my neighborhood. And for those of you who live in D.C., I don't—it's just not happening. So we're dealing with a lot of a culture, a very violent culture that we're fighting against.
Now, within that context I think there's youth development organizations all over this city, and particularly in my neighborhood, doing really positive youth development work with Latino kids and with all kids. And I'll talk about two programs real quickly.
In our community, kids weren't going to the doctor. What we were finding is that Latino kids were primarily using emergency rooms as their primary point of contact with the medical system. So about six years ago or seven years ago, we said, "We're going to change this in our neighborhood." And we designed and developed a teen health promoter program where we recruited 15 kids who probably, the majority of them, had three or more of those risk factors, maybe even four or five. And we said, "We're going to train you for a year, you're going to be our cadre of outreach workers, you're going to be our peer leaders, you're going to get a scholarship to participate, and you're going to be our youth outreach staff." And what we designed was, we worked with two different medical facilities to do teen clinic days specific for adolescents in our neighborhoods. The kids recruited them. They also did their medical histories and took blood pressures and whatever. And they did positive youth promotion, health development promotion activities in the waiting rooms while the kids were waiting to be seen.
Those clinics are packed. Every—we do them two Wednesdays—a month, and two Saturdays—and they're always packed. So we now have kids who are connecting to health clinics, we have positive health promotion activities going on while they're waiting, and we have a cadre of kids who are bringing them in. And it's a really solid program.
I also forgot to mention we're open 8 in the morning until 8 at night, and all day Saturday. So you know, you've got to be open at times when the kids need you to be there for them.
The other program that I'll mention is we were seeing a lot of teen parents at the youth center, and a lot of high school dropouts. So to make a very long story short, what we did was design and found a charter school for teen parents and kids who had dropped out. Ours is a small school, but the goal of our school is to prevent unplanned first pregnancies for kids that have never had a child, and to prevent subsequent pregnancies for kids that have had children. And I need a researcher to come tell us we're doing a great job.
(LAUGHTER)
KAPLAN: But I can tell you in two years, if a young person participated for more than six months, we have had one repeat pregnancy, and that's among about a hundred kids. So we're doing something right.
Now, I will tell you that the vice principal of our school has a little notebook that page-by-page for each student talks about what kind of birth control they're on, checks in with them regularly, finds out if they're going, are they using—you know, so it's more than what would happen in a normal school. But our feeling is that the best prevention is education. Birth control is a secondary kind of prevention, but it's education. And if you focus on education and positive youth development —these are kids who have dropped out of high school. These are all kids—in fact, [it was] one of our students that was just stabbed eight or nine times in a gang-related incident a couple of weeks ago—so I'm trying to paint a picture that these are kids with multiple risk factors. However, he's back in school with good attendance, and we will pick up right where we left off.
The last thing I'll say in closing is that these are long-term commitments to working with youth. It's not an ad campaign. It's not—you know, not that ad campaigns are bad, and I think it'd be interesting to see, you know, in Latino communities where there's primary English-speaking households, how these ad campaigns, you know—but what I'm saying is I think from a youth development, resilient, strength-based model, you've got to be in the neighborhoods where the kids are, not give up on them, keep going back to the drawing board. And there's many of the kids who come to the center who don't have any of these risk factors. And they're just as integrated in as the kids that do. You won't see a shingle that says drug treatment program or a shingle that says foster care, or a shingle that says, you know, neglect, runaway, and homeless, although that is the reality of all of the young people that we work with.
So I think I covered most of the things I wanted to speak to. Well, I left a little bit out about who are clients are, but I think you go a feel for it in terms of the diversity of our neighborhood and our community just up the street.
Thank you.
(APPLAUSE)
WOLF: Thanks, Lori.
Let me ask a quick first question. I'm struck by the focus of the report on—and of the research on—positive behaviors, on kids—involvement in positive behaviors. Is there anything that would lead any of you to say that focusing more on getting kids involved in positive behaviors is a better prevention than just saying no to all the negative behaviors? Is there a way of judging one versus the other? Because it strikes me that, you know, trying to get more kids involved in volunteerism in school, in sports, in community service, and stuff like that, to fill their time when they're away from school, away from home may be just as worthy, if not more worthy than trying to prevent negative behaviors once they occur.
Anyone want to take a stab at that?
KELLAM: Well, I believe it's true. As a lay citizen I could say that. What does the science tell us? Well, protective factors are just as important as risk factors. That's what science tells us. And in fact, if you have risk factors, like failing to learn in early grades, and you have a good teacher who comes along and does a better job at raising your achievement test scores, you know, for the children who are at risk for depression, that's an extremely important intervention. That's a prevention/intervention.
But the other kids who are not having problems are having the experience of better achievement also. And the health promotion side of that is extremely important. Are they just opposite sides of the same coin? Well, sometimes they are, but sometimes they're not. For example, if a community has an empowerment zone and there are more jobs available for families, for parents, that's protective, even if you have a teacher who doesn't have training in organizing the classroom. So that these work hand-in-hand, and children are in fact constantly in context where they bring their own strengths and at the same time they may be involved in contexts which are not as good. And these have important counter-opportunities for the children.
One of the big things we learned was that teachers are not trained to set up classrooms in schools of education. So that one of the consequences of learning—that chaotic classrooms occur—about half the first-grade classrooms in Baltimore, for example, we can see epidemiologically are not well run. And teachers, colleges, schools of education are not prepared to teach teachers traditionally how to organize classrooms. Well, for any child, that's a bad idea. And it's the greatest burnout reason that teachers leave teaching. They can't teach because they're not given the tools. It's a gap, in other words, between what families are supposed to do and some may or may not be able to do, and what the teachers, colleges, and schools of education do. And the mental healthers are off somewhere else. I mean, they're not, in fact, involved intimately in schooling.
Some of these factors, in other words, are protective. Having a teacher who knows how to organize a classroom and socialize children early on to be students is enormously protective for all children, and particularly for vulnerable kids. So for the Baltimore kids, it's prevention, for the kids vulnerable to acting up or jumping out the seat, for whatever reasons. But it's always an important balance. There are multiple influences, including what the kid brings, some of the things that the kid experiences are protective. And what you were talking about, Lori, is enhancing that protection, enhancing the positive, promoting a sense of well-being and mastery. But in fact, at the same time, doing that you're preventing, in fact, bad outcomes for children who are vulnerable. And there are lots of different kinds of vulnerability.
WOLF: This section over here.
JACK CALHOUN: Jack Calhoun, head of the National Crime Prevention Council. I really appreciated the remarks.
I think the obvious question is why. We've been involved in a lot of comprehensive community crime reduction programs, and the pundits to us will say it's these great objective engines of history: demographics, healthy economy, and maybe getting the most violent off the street. And yet we've seen in some cities where entire communities have pulled together—one of you referenced that. Fort Worth, a dramatic diminution. Instead of the 7 percent drop in crime, Ft. Worth, 42 percent, San Diego, 59, Boston, 30, where cities have been intentional. So I guess the bottom line question is, what is your theory about this diminution?
And thank you for your comments, Lori. I like the fact that you're involving kids in that health situation, because we do a lot of work with involving kids. And I was fascinated by the absence of a program stuff. You were talking a lot about connection, involvement, and socializing. So, enough from me.
LINDBERG: If why is the question you always have to ask, I think you should always expect the researcher to say, well, we're not quite sure.
(LAUGHTER)
LINDBERG: I can point to some hypotheses and some common threads, and some places where the patterns are so different we need to really think some more about what's going on. I'm very struck, when we look at the individual behaviors, that in the same time period, some of them are increasing and some of them are decreasing—even some that you think should be very highly interrelated. The cherub kids with suicidal thoughts decline during the 1990s, but the cherub with suicide attempts and actual suicidal deaths among teenagers remain constant. So I don't think there was any magic bullet that worked just for the suicidal thoughts and didn't work for the attempts and the actual successful completions. So I don't think there's one magic thing out there.
The strong economy I think we do really have to look at. Hope for the future and opportunity makes a great difference in students' decision making.
The other thing that really happened during the 1990s is schools and families and communities stepped up to the bat, stepped up to the plate and said students, health—and these risk behaviors in particular—is something we have to take a part in. There's been an incredible expansion of school-based health education, which is the formal education, and a lot more work on the informal places that these behaviors are being discussed.
Finally, we do have some evidence that overall, teenagers are reporting a shift towards more conservative attitudes. And while those attitudes may not be specifically risk—attitudes about risk-taking—they are attitudes about broader life decisions. And I think that conservatism, growing conservatism, combined with this hope and opportunity which comes from the strong economic conditions, maybe together are reducing risk-taking. But we're talking about this a lot more. There's topics at the dinner table. We may say this is on the media too much and you know, we're tired of it and we don't want our kids to see the violence on TV, but the fact is we've opened up channels of communication between teachers and students, and parents and their teens, that we didn't have at our dinner tables 10 years ago.
WOLF: Did you want to jump in on the economy?
KELLAM: I did, but Laura has made, I think, an important comment about it.
We were shocked, to tell you the truth—about six weeks ago we did an analysis that looked at the impact of the Baltimore prevention program on risk behaviors, aggressive, disruptive behaviors, and drug-taking, and so on, as well as positive outcomes in teenagers. And I was struck. I mentioned earlier that, you know, poverty at the community, in contrast to poverty in the child's own family, at the community level poverty was directly related for both genders to the level of aggressive, disruptive behavior in the kids. And when you measure it by the child's own perception of poverty, it comes out that way. If you measure it by the percentage of families in a school that gets free lunch, it comes out that way. Or you can take the Census data and look at the job opportunity level—employment, unemployment, economic health indices at the neighborhood level —and you get also this striking relationship, a strong relationship to aggressive, disruptive behavior among teenagers.
Now, the best hypothesis is, if you make things better in an economic sense in a neighborhood, things get generally better. We don't know what mediates that possibility. And on the other hand, in the Society for Prevention research meeting, which was last week, we talked a great deal about getting to be partners with community economic developers, looking at the data on trends and job opportunities by neighborhood, and seeing whether those trends wouldn't give us a hint. The best bet is that if we join up with the community empowerment zone planning and look at child outcomes in the community empowerment zone, that's a kind of new partnering that might give us some ideas. But I think that economic health at the community level is extremely actively involved with the child development. It interacts some with families, but it's a separate issue in its own right.
KAPLAN: Let me just add a couple of things. When Laura articulated why things might be better, I was asking myself, okay, is the Latino community being able to take advantage of that, the economic moment we're in? Are all the schools that may be developing health clinics, do they say they're bilingual, which means maybe they had someone with Spanish in high school? Are they really are creating an environment that respects and celebrates the diversity of all the kids coming into that clinic?
Look at what the schools look like that a lot of our kids walk into. I mean, they are really demoralizing.
WOLF: It's a disaster.
KAPLAN: It's a disaster. And I don't—some of you, I see some friends in the audience. The youth center in our community took an abandoned building and renovated it, and it is beautiful. I'm saying that with great pride. It is colorful, it is full of art, it is state-of-the-art.
Now, we had a shooting out front, but you come in, and at least there's some safe haven. It is really—so on one hand, I want to say I think there's, you know, the Clintons had a White House thing on risk and teens a few months ago. Some of you are shaking your heads, so you know about it. The good news is I think we're having a national dialogue, but what's beyond the dialogue? You know, it's nice to have words, but words can be cheap. And I think if we want to take this past a dialogue it means an investment in the quality of schools, and renovating these schools, and actually tearing them down and rebuilding them. It's cheaper, quite frankly, to do it that way. But you know, kids spend their time in their families. So if their family's home is run down, they're going into a school that's run down, and then the rest of their nonschool hours is what's left for this extracurricular stuff, much of what is school-based, or community center-based, or, you know, youth development-based—Boys Clubs, Girls Clubs—we really need to look at the environments young people spend their day in. And when kids in our community walk into our center, I want them to say, "God, this is great, I'm proud of being a part of this, and I deserve to have—why do low-income kids always have to go to run-down, dumpy places?" You know, and I just want to put that in a context of a positive moment, yet we still have a lot of work to do.
LINDBERG: I don't want anyone to think, however, that suburban kids and kids from high-income families aren't engaged in risk-taking. This is spread across. And there may be different combinations, and kids from more well-to-do families may have a better safety net underneath them to keep them from some of the escalation of extreme risk-taking or the negative consequence. But when we looked at, like, the location of the school from suburban to rural to city, we saw very little variation in the number of risks that kids were involved in. This is a widespread problem. But the kids who have fewer supports in place, whether that's at home or in the neighborhood, are the ones who are going to be more vulnerable to the consequences.
WOMAN: One brief—and I—the other thing we see a lot of, kids are depressed. And I would be interested in, you know, that wasn't one of the ten factors looked.
WOLF: Other than suicide.
WOMAN: Yeah. And it's hard. It's really hard. Urban or suburban. I think kids have tremendous complexity in their lives these days.
MAN: Is depression something that would be difficult to self-report if you asked it on a survey?
WOLF: The question was is depression hard to get by asking kids, you know, self-report. And I'm sitting here mumbling no, it's not hard at all. We do it to first graders. Some of the developmental research in years gone by said that kids really couldn't answer such things until they're eight or nine. That's wrong. Ask your own children. When we do it systematically and get kids to report on the child depression inventory, which is a multi-item—I feel said, I don't have hope, and things like that—kids give a very reliable answer in first grade at the classroom. The whole classroom can answer questions like that systematically when you want to see how kids are feeling about themselves.
Now, the interesting thing is, in the fall of first of first grade, if you look at those reports they are high correlated to their achievement test scores. Fall of first grade. Now, you can get some idea then of what a run-down school with bad curriculum is doing to kids who are vulnerable to depression. Indeed, if you improve the curriculum and get—you can get achievement test scores up, kids in fact who report depression early on are indeed less depressed. That's particularly true in girls. You get less aggression in boys, the same kind of thing. Even in first grade there are gender differences in how kids express distress. Not that there isn't depression in males also, by the way.
LINDBERG: My co-author, Laura Porter, has been doing some really interesting work around service provision. If we look in at the kids who tell us that they had suicidal thoughts or a suicide attempt, which is a behavior outcome to depression, a share of those kids who also said that they received any type of psychological or mental counseling is the minority. A third of the kids with a suicidal thought said they received psych counseling, and only 40 percent of the kids with a suicide attempt say they received any kind of counseling services in that same year. So we have such missed opportunity to provide any kind of necessary service to the kids at the most extreme ends with important consequences.
JACKIE NEWMEYER: I'm Jackie Newmeyer from the L.A. Times.
I was wondering, Miss Lindberg, as someone with access to the survey data, do you have any sense of the underlying factors behind the Latino exception we heard from Miss Kaplan, what it's like in the real world? And also, whether there's a regional correlation? I don't know if you broke it down by region, but...
LINDBERG: We didn't look at region. There's a couple, again, hypotheses about the Hispanics, and then some other research I would point out about the diversity there. I think one of the things we need to be very concerned about is that when we look at those programs, health promotion programs that have been evaluated, that have been shown to work, and that are being promoted for use of communities around the country, almost none of them have actually been tested and worked on a Latino population. So if you need to be doing something different to reach Latino kids, we haven't quite figured out or evaluated what it is. So the idea that there's less money going into these communities—but we have less research and knowledge about to do if we had the money and how to do it well. I think it's a major issue.
One of the caveats on the Hispanic trends is that what we looked at was students. And if we looked at all teens, I think the Hispanics would look much worse because their dropout rates are higher, and the teens who are out of school look worse. And you add that together and the Hispanics are going to be very troubling.
There's some other research that has looked at differences by generation that you've been in the country. So, first generation, second—you were born outside the country; your parents were born outside the country, but you were born here; or you and your parents were born here. And generally, risk-taking increases the later the generation you are. So we may be seeing some shift in the composition.
But I want to say that that's general. Some risk-taking behaviors actually decline the later generation you are. For example, contraceptive use tends to go up among Hispanic kids as they move from being first to second to third generation. So there's not the easy answer on what it is. But the diversity is certainly the troubling issue. I don't want to think—you know, it's hard to imagine that the behavior of Cuban-American kids and recent immigrants to Texas from across the Mexican border are going to look very similar here.
Lori was talking about lack of access to health care. One of the differentials that shows up time and time and time again is that Hispanic children and teenagers have less utilization of routine and preventive health care. Controlling for their household income, controlling for insurance status, they're using these services less. And they do end up in the emergency room, and they don't have a care provider that they can go to with problems and develop a relationship with. And they're not in schools or school-based health centers. So they're missing out from the prevention and health side also.
LIZ SCHILLER: Liz Schiller for Institute for Women's Policy Research.
Some of the risk behaviors, like tobacco use, binge drinking, marijuana, illegal drugs, risky sexual activity, are also engaged in by many adults. Obviously kids are very strongly influenced by their peers, but they're also influenced by adults. Do you have a sense the proportion in the adult population compared with the proportion among the teen population? Whether more adults engage of some of these behaviors, or more teens?
LINDBERG: I don't have a sense in my head. We could go to my office and look it up. I mean, it's a measurable question, with some caveats there that, well, it's more sensitive for teenagers to report, maybe; do we believe our measures. I mean, I could go on for an hour about measurement issues. But I think, from the structure of this project, what may be the most salient is the important role that these risk behaviors have for teenager illness and mortality. And as you look at older ages—and that's true also for the 20 to 24 range—but as you look at older ages, instead of death from AIDS and accidents, and drug overdoses, and violence, you see a switch to death from cancer and heart attacks. So in measurable health outcomes I think these risk behaviors matter more for teenagers than they do for adults.
The other issue, what is looked at here, is a snapshot, one point in time. We asked kids, "What are you doing today, what did you do in the last 30 days, what did you do in the last 12 months?" And I'm showing you a portrait of that. And as was pointed out, these are developmental, and kids are changing over time. And I'm not describing any of that change here. And many, many more kids than what I've shown here are experimenting and are involved in this risk behaviors at lower levels. And they don't escalate; they stop. And as adults they're engaging in them at something that's a safer or more experimental level, but not at the routine, regular way that it interferes with the ability to perform life roles. And what we're concerned about are the handful of kids who do that escalation as they get older into more severe risk-taking.
WOLF: A question back here, and then I'll come over here.
PETER BOUSWOOD: Peter Bouswood from the Urban Institute.
In your studies you focus on whites, blacks, and Hispanics. Do you also focus on Asians, too?
LINDBERG: We haven't done that here. In theory, you could do it in the AdHealth data. There are enough Asian students to look at, which is an unusual thing to find in a data set at all. Usually there's only a handful. Even here, though, the problem is that once you know Asians, the diversity there is extreme. And we were grouping together such different kids that it wasn't clear how to interpret the results. We have some descriptive work that wasn't incorporated here that did look at Asian students differently.
There's also some interesting research that's going on that's looking at kids who report themselves as biracial. You know, here I'm saying you're one. Well, what happens to a teen who says I'm two categories, or I'm three categories, and how their risk-taking looks.
WOLF: There were a couple of questions in here. Yeah. Hang on one second. We have the microphone. Okay.
CARMEN DELGADO: Carmen Delgado, Voter Alliance for Children and Families.
Can you tell us a little bit about whether mentoring plays a role in avoiding risk-taking? None of you mentioned it. So I wonder if that's a variable.
And then I have another question to follow up on Lori's comment about how few resources go into the Hispanic kids. And is there any explanation for that, or anything we can do to ensure that the resources from foundations and government are spread more evenly?
KAPLAN: One of the most important aspects, I think, from a youth development model is that young people develop positive relationships with adults who aren't their parents, or aren't their guardians, or aren't their caretakers. It can be a teacher. It can be a Big Brother, a Big Sister, a counselor, a youth outreach worker, me, you know. So I think absolutely mentoring, a long-term commitment of mentoring over time. We do a lot of mentoring for the teen parents so that they have an adult mom who's not their mother. Because what most often happens is that when a teen, a young teen, gets pregnant, there's great conflict and chaos in the family. Many of the young people get kicked out of their houses.
Sometimes once the child is born, there's some opportunity there to reengage family members, because there's a real, live, cuddly, precious child. But I would say absolutely mentoring. Now, I don't have it from a research point of view. But on a day-to-day basis, I just see. You know, I'm fortunate. I've worked at the youth center now for 20 years. And I have a whole cadre of kids who just keep in touch with me year after year after year, as well as they're in and out of the office all the time.
And so a more specific relationship with a mentor I think absolutely is of great value.
KELLAM: Yeah. I want to—maybe this is controversial. I want to say something scientific. I think that we—I just heard at the last Society of Prevention Research meeting the first reports I had heard about a systematic trial of mentoring programs in which the duration, the age of the mentors, the context in which they occurred were actually serious points of a study. And there were positive results. The point I want to make more generally is that the area of prevention science and health promotion science is dramatically more rigorous than it was 30 years ago, so much so that my conviction at this point is that the kind of research that we do on efficacy of drugs is not as sophisticated as the better, more rigorous preventive trials on some of the behavioral risk factors we've been talking about.
And what that means is that we have an opportunity from our experience in programs to frame research questions, and indeed to expect that the prevention science will give us answers, as to what works for which children under what circumstances. And that's a new stage of work. It's enough so that the Center for Mental Health Services, the Department of Education, Office of Juvenile Justice are partners now in a program that gives 50 school districts a fair amount of money, several million dollars, to develop prevention and promotion programs within schools, safe schools. Many of you no doubt know about it. And they require evidence-based prevention programs to be used in that large-scale program. And by evidence-based, we can expert very serious measurement. We can expect very serious comparisons, rigorous comparisons of those with the intervention, those without. And we can expect various longitudinal outcomes to be reported. And we should expect the specification as to for whom it works and under what circumstances, because Laura was pointing out one of the frontiers we haven't addressed is how even the measurement, let alone the impact, of interventions can vary by culture, by social class, and certainly by gender. Most of the programs we're talking about may work for males and not females. In fact, many do. We know less about female antecedents than we do about male antecedents of risk behaviors. The gender differences in these risk behaviors are enormous, two- or three-fold greater numbers of males than females in many of the behaviors we're talking about.
So all of these are part of a new frontier of bringing science to bear in colleagueship with people running programs and with parents and community groups. We know that we're going to be addressing schooling. Schooling is so central to many of these risk behaviors and the avenues in. And we'd like to see programs like the one Lori described connected up very closely to schools so that the kids who are eligible are known and the kids who actually come can be assessed and who is missing can be looked at. You know, who doesn't come to programs. It's always been a problem in Head Start and throughout.
So it's a new generation. It's a very optimistic time.
KAPLAN: Just one very brief comment. I appreciate all of the need—right. But on a very basic qualitative level, if you ask a young person who may be five—let's say we had a room of five or more at-risk kids, and you say, "What made a difference in your life?" what they're going to say is, "It was a person." They probably won't say it was that DARE class I took, or it was that teen—
KELLAM: I hope they don't.
KAPLAN: Well, I'm just saying. Or they probably won't say it was the Latin American Youth Center, or the teen health promoter program. What they're going to say is, "It was Christina," or, "It was Pablo," or, "It was Eric," or, "It was...," you know. And I think that's just an important little something that's not based in research, but just based in human development, is that it's all about relationships and development of people.
LINDBERG: But it is based in research, Lori. And look at the elderly. Do you have someone in your life you can go to with problems? Do you have someone you feel close to?
KAPLAN: Right. It's the same question.
LINDBERG: It has positive effects on their health, their well-being, their longevity. This happens throughout the life course.
KAPLAN: That's it. Thank you. Thank you.
I wanted to get back, Carmen, to the funding issue. And I wasn't—you know, what I was saying was also funding for research. You know, it's only been, I think, in the last few years that I'm seeing coming out of HHS and, you know, some of their really neat campaigns now they're doing in Spanish. And, you know, Laura said something about even if we knew what the funding was for, we don't know where to put it. And I think that's the problem, you know, that we're not—there's not been a national mandate to invest in Latino communities, I think, enough. And I don't know if that's political.
And again, I started off by saying I think, on some levels, Latinos are voiceless. And politically, you'll see more funding going into those regions of the country where there's more political power, elected officials, you know, or congressmen, or whatever.
WOLF: We have time for one more question. Over here. Microphone.
QUESTION: Laura, what do you ask me to do with the data? What's the next step in a policy sense?
LINDBERG: I think certainly one of the next steps is to look critically at funding streams and program development and to try to identify ways to say, instead of having the risk behavior of the week that we're suddenly to motivated to reduce, how do we step in earlier to aim our money and our programs more broadly to make a difference in the lives of the teens?
WOLF: Any final thoughts.
Thank you all for coming. Appreciate it.
(APPLAUSE AND END OF EVENT.)
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