Jean-Pierre Deschamps

Adolescent health today: contributions and limitations of epidemiology, facts, doubts and uncertainties

Information on adolescent health can be obtained from a variety of sources. Medical practitioners can offer little insight on the subject because adolescence is the period of life in which there is the least number of consultations with a doctor and the lowest rate of hospitalization. Such professionals therefore observe and record little on adolescents. Educators youth workers and some social workers with professions focused upon adolescence could offer insight into adolescent health but they are almost never consulted. Parents have hardly more occasion to say anything on the subject. To obtain a better understanding of adolescents health information must be obtained from adolescents themselves. The role of epidemiologists what is known about adolescents and their health what is being learned and what remains to be discovered are discussed.

An International Look at Adolescent Health Promotion

is completely dedicated to j adolescent and youth health promotion throughout the world, with an emphasis on adolescents in the developing countries of Africa, Latin America, and South east Asia. Several articles present national or local adolescent health promotion programmes. Others are more methodological and focus on health indicators pertinent to adolescents for programming and evaluating health programmes, or are about the search for indicators based on the appreciation of quality of life (E. Joliot et al.). Many similarities appear throughout these articles which are yet very different in their approaches, methods and geographical origins. One similarity concerns the problems observed in industrialised as well as

Les centres de planification familiale en France : Structures de recours aux soins pour les adolescents et les jeunes

The first government sponsored family planning centers were opened in France in 1972 five years after the first family planning law was passed. Family planning centers have educational and medical functions and since 1990 they have had the additional mandate of preventing and treating sexually transmitted diseases. 35% of Frances 1054 family planning centers are located in hospitals. Nonmedical services are financed by departmental maternal-child health budgets and are free. Contraceptive prescription and IUD insertions are free for poor women and adolescents. Services have been available for adolescents without parental permission since 1974. Family planning centers provide treatment for individuals and information for groups. In 1989 135000 adolescents were reached in schools. Adolescents under age 20 constitute 25-40% of the clientele of the centers but only 16% of the potential users. In 1989 nearly 10% of girls under 20 but 1 in 400 boys the same age visited a center. Some centers make special efforts to attract adolescents. In 3 such centers located in medium-size towns in northeast France that were studied 80% of users were under 20. 58% of adolescent clients were 11-17 years old. 88% were still in school. 25% consulted prior to becoming sexually active. 89% sought contraception but many came for more than one reason. 42% came with a friend 11% a partner 2% each the mother or a social worker and 36% alone. The main reasons cited by adolescents for choosing the family planning center were confidentiality (51%) free services (48%) availability of counseling (21%) and nonnecessity of appointment (11%). Family planning centers especially those most actively seeking adolescent clients function as primary care structures providing treatment for gynecological problems or matters not related to sexuality as well as family planning services.

Perspectives : quels besoins de recherche ?

une constante reference explicite ou implicite. Des lors les questions sur les besoins de recherche prenaient une tournure que n’ont pas les debats traditionnels sur la recherche en sante publique. Louise POTVIN l’a clairement exprime: “... La Charte d’Ottawa identifie des valeurs et des principes qui placent l’emancipation et la participation des populations comme un processus aussi important que les resultats recherches. Nous croyons (...) que ces principes et valeurs deviennent des parametres de l’efficacite de l’action”. On ne peut alors plus se contenter des approches habituelles, tres calquees, il faut bien le dire, sur le modele biomedical classique de l’organisation des services et des programmes de sante. Jacqueline DESCARPENTRIES situe sa recherche sur l’intervention educative en sante publique comme sous-tendue par le fait que cette intervention constitue “une realite sociale et historique etroitement liee aux traditions, aux conditions nationales, mondiales, economiques et culturelles des Etats dans lesquels (elle) s’est developpe(e)”. Un point clef du debat concerne la place de l’epidemiologie dans la reflexion et la recherche en promotion de la sante. La encore, Louise POTVIN eclaire la scene des discussions: “...le discours methodologique est largement domine par l’epidemiologie. Situee dans l’univers conceptuel et discursif de la sante publique, la promotion de la sante se trouve astreinte a justifier ses procedures de recherche en fonction des criteres de l’epidemiologie”, mais le paradigme methodologique de la recherche en epidemiologie “est peu compatible avec les principes et valeurs d’emancipation qui sous-tendent la Charte d’Ottawa”. En consequence, ditelle, il existe deux voies pour assurer la rigueur des etudes evaluatives en promotion de la sante. L’une, a l’interieur du paradigme idemiologique,

Perspectives: what are the research needs?

regarding research took a turn from traditional debates on public health research. Louise Potvin referred to it clearly: ‘The Ottawa Charter identifies values and principles that place the population’s emancipation and participation as equally important processes to research findings. We believe … that these principles and values are becoming the parameters for effectiveness of action.’ We cannot just concentrate on traditional approaches, based on the classical biomedical model, to organize health services and programmes. Jacqueline Descarpentries suggests in her article on public health education interventions that intervention is based on ‘the social and historical realities that have been determined by states’ traditions, and national, global, economic, political and cultural factors, to construct the social conditions for health education.’ A key point of the debate concerns the place of epidemiology in health promotion reflection and research. In this regard, Louise Potvin shed light on the discussion: ‘The methodological discourse is largely dominated by epidemiology. In the public health conceptual universe, health promotion is restrained to justifying its research procedures based on epidemiology’s criteria’, but epidemiology’s methodological paradigm ‘is hardly compatible with the emancipation principles and values of the Ottawa Charter.’ As a consequence, she says, there are two ways to ensure the rigour of health promotion evaluation studies: on the one hand, as part of the epidemiology paradigm, by driving analysis on the basis of a strict definition of the evaluator’s range of control; and on the other hand, by moving away from the paradigm and implementing disciplines that aim to establish processes of social transformation.

Perspectivas: ¿cuáles son las necesidades de investigación?

Un punto de partida conceptual y metodologico: la Carta de Ottawa El texto de este documento fundador de la salud publica moderna fue una referencia constante ya fuera de manera explicita o implicita. A partir de ahi, las preguntas sobre las necesidades de la investigacion tomaban un cariz del que carecen los debates tradicionales sobre la investigacion en materia de salud publica. Louise Potvin lo expreso claramente: “...la carta de Ottawa identifica valores y principios que consideran que la emancipacion y la participacion de las poblaciones es un proceso tan importante como los resultados perseguidos. Creemos (...) que estos principios y valores se convierten en parametros para evaluar la eficacia de la accion.” Por consiguiente, no podemos contentarnos con los enfoques habituales, muy calcados, sin duda, del modelo biomedico clasico de la organizacion de los servicios y de los programas de salud. Jacqueline Descarpentries situa su investigacion sobre la intervencion educativa de salud publica en base a que dicha intervencion constituye “una realidad social e historica estrechamente ligada a las tradiciones, a las condiciones nacionales, mundiales, economicas y culturales de los Estados en los que (esta) se desarrolla”. Un punto clave del debate se refiere al lugar que ocupa la epidemiologia en la reflexion y en la investigacion sobre la promocion de la salud. De nuevo, Louise Potvin clarifica el debate: “...el discurso metodologico esta muy dominado por la epidemiologia. Por estar ubicada en el universo conceptual y discursivo de la salud publica, la promocion de la salud se ve obligada a