[Mortality in young adults: international comparisons]. / Mortalidad de los jóvenes adultos: comparaciones internacionales.

In searching for an epidemiological indicator which might reflect the impact of the widespread use of various drugs among California youth in the late 1960s, the customary sources of health statistics were found to be unsatisfactory due to the lack of consensus on diagnosis of drug related problems. Examination of mortality of young adults (persons aged 15-24, YAM) showed marked and paradoxical rises when drug use was rising. Males and Blacks had higher rates than females and Whites; motor vehicle accidents were the largest single overall cause. But the rise, both in California and the US was proportionally greater among women and motor vehicle accidents did not contribute to the rise. Examination of rates during mid-1970s for various countries showed that for countries with per capita income less than about $3,000 per year, YAM due to diseases was very closely correlated with per capita income. Above that external cause, YAM and particularly that due to motor vehicle accidents, increased with per capita income. The increase was steeper in some countries than in others. The difference in these two groups of countries was correlated with fraction of national income spent on education and with ethnic homogeneity. In the US fluctuations in YAM paralleled admissions for heroin use. As part of the Epidemiological Revolution, young adult mortality complements infant mortality, since it is closely related to social health, employment opportunities and appropriateness of education. Further, it is important for the potential development of a country, region, or community. This report examines YAM data for mid-1980s from selected countries and notes major changes during the past decade, most countries having shown striking decreases. In some countries high rates of suicide, homicide and death due to civil disorders provide an incentive for further improvement. In other countries, the high rates for death attributed to motor vehicle crashes compels attention. Involvement of young persons themselves in plans for improvement of their opportunities seems an essential strategy, for which the educational strategies suggested by Freire seem to be appropriate.

Mechanisms of psychosocial effects on health: the role of social integration, coping style and health behavior.

To analyze the mechanisms by which psychosocial factors affect health, this research investigated social integration and indicators of coping style and their relation to health behaviors and health status. The analysis was conducted using the results of a 1977 survey of 854 household interviews from a multi-stage probability sample of adult residents of Washtenaw County, Michigan. Physical-health status was evaluated by two indices: Self-rated global health and self reports of chronic disability. Mental health was assessed with the Center for Epidemiologic Studies Depression Scale. Overall, the effects of the psychosocial factors were stronger for mental health than physical health. Social integration was shown to have direct effects on both physical and mental-health status. Internal locus of control was associated with lower levels of depressive symptoms. Chronic conditions were primarily affected by age, sex, and health behavior. Evidence from the path analyses suggested that part of the health benefit that women accrue from social integration and an active coping style is related to better health behavior. This mediation effect was not found for men.