A W O R L D B A N K C O U N T R Y S T U D Y Caribbean Youth Development Issues and Policy Directions 25955 May 2003 ~~ THE, WOL BANK ,|fi,- v~~~~A THE WORLD BANK Copyright C) 2003 The International Bank for Reconstruction and Development / The World Bank 1818 H Street, N.W. Washington, D.C. 20433, U.S.A. All rights reserved Manufactured in the United States of Amzrica First printing: May 2003 1 2 34 05 0403 World Bank Country Studies are among tl1e many reports originally prepared for internal use as part of the continuing analysis by the Bank of the economic and related conditions of its develop- ing member countries and to facilitate its dialogues with the governments. Some of the reports are published in this series with the least possible delay for the use of governments, and the academic, business, financial, and development commnunities. 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CONTENTS Foreword .............................................................. vii Preface .............................................................. ix Acronyms .............................................................. xi Executive Summary ...................................................... xii 1. Introduction ..1............................... Background and Justification ................................................ 1 Objectives, Approach, and Data Sources ........................................ 2 Caribbean Context ........................................................ 3 Report Organization ....................................................... 4 2. Framework for Analyzing Caribbean Youth ................................. 7 Definitions .............................................................. 7 Conceptual Framework ..................................................... 9 3. Negative Behaviors and Outcomes Observed among Caribbean Youth ........... 15 Early Sexual Initiation and Pregnancy ......................................... 15 Risky Sexual Behavior and HIV/AIDS ........................................ 17 Physical and Sexual Abuse .................................................. 17 School Leaving .......................................................... 19 Unemployment .......................................................... 20 Crime and Violence ....................................................... 21 Substance Abuse and Drug Dealing .......................................... 23 Social Exclusion ......................................................... 24 4. Sources of Positive and Negative Youth Outcomes ........................... 27 Individual .............................................................. 28 Microenvironment . ....................................................... 30 Macroenvironment ....................................................... 37 Interconnectedness of Factors ............................................... 41 Final Thoughts .......................................................... 42 5. The Costs of Risky Adolescent Behavior ................................... 43 Crime and Violence ....................................................... 44 Risk-Taking Sexual Activity: Adolescent Pregnancy ............................... 47 Risk-Taking Sexual Activity: HIV/AIDS ....................................... 50 Unemployment .......................................................... 5 3 School Leaving .......................................................... 55 Final Thoughts .......................................................... 58 6. Youth Development Policies and Programs ................................ 59 Caribbean Youth Policies ............................................... 59 Youth Services and Programs in the Caribbean Region ............................ 59 Regional Programs ....................................................... 65 iii IV CONTENTS Youth Policies and Programs: The International Context .......................... 68 Final Thoughts ......................................... 70 7. Conclusions and Recommendations ............................ 73 The House Is on Fire .............................. 73 Moving Forward-Youth Development Principles anid Actions ..................... 76 Appendix 1 Methodological Description for Chapter 4 ......................... 83 Appendix 2 Lifetime Earnings Figures ...................................... 89 Appendix 3 Methodology for Cost Calculations, Chapter5 ..................... 93 Appendix 4 Caribbean Youth Policies and Prognums .......................... 103 Bibliography ........ 123 LIST OF TABLES 1-1: Total Population by Age Group for Selected Carib bean Countries . 3-1: Fertility Rates per 1,000 Women, Age 15-19 .16 3-2: Reported Cases of AIDS by Age Group, Caribbean Region .18 3-3: Youth and Adult Unemployment in the Caribbean .20 3-4: Unemployment levels in the Dominican Republic by Age Group, Urban or Rural Residence, and Sex .21 3-5: Prosecuted Crime in Jamaica by Age Group .22 4-1: The Relationship Between Experiencing Abuse and Emotional Distress .30 4-2: Predicted Probabilities that a Caribbean Youth will be Violent Based on degree of Protective Factors, by Gender .................................. 42 5-1: Victim Compensation of Tangible and Intangible Costs of Crimes, United States ... .45 5-2: Estimated Economic Cost of Youth Crime, in Local Currency .................. 46 5-3: Estimated Increase in Tourist Flows and Expenditures ........................ 47 5-4: Estimated Social Costs of Adolescent Pregnancy Relative to Young Adult Pregnancy .49 5-5: Per Capita US$ Costs of HIV/AIDS and Program Costs as a Proportion of Current Health Spending ................................... 51 5-6: Forgone Economic Output due to AIDS .................................. 51 5-7: Orphans Whose Parents Died of AIDS-Related Illnesses ....................... 52 5-8: Higher GDP (%) if Youth Unemployment Rate is Lower ...................... 54 5-9: Net Discounted Lifetime Earnings Relative to Primary School per School Leaver .... 56 Al-1: Factors Associated with Risk Bebaviors, by Risk Behavior and Country ............... 85 Al-2: Population Estimates and Sample .Size from Participatizg Caribbean Countries ...... 87 A3- 1: Annual Prosecution of Youth ................................................ 94 A3-2: Classification of Cost Components ofAdolescent Motherhood ....................... 97 A3-3: Relevantyears of unemployment rate ......................................... 99 A3-4: Number of Students Who Did Not Finish the .Respectipie Grade Level ............ 101 A4- 1: Overview of National Youth Programs, Policies and Laws Related to Youth in Select Caribbean Countries . 104 CONTENTS V A4-2: Human Rights Instruments Ratified or Acceded Related to the Rights of Youth .... 108 A4-3: Main Organizations Providing Services to Youth-At-Risk, St. Lucia ............. 110 A4-4: Selected Public Agency/NGOs Providing Services to Youth-At-Risk, Caribbean . . .112 A4-5: Selected NGOs Providing Services to Youth-At-Risk in Jamaica ................ 113 A4-6: Jamaica Public Programs for Youth, Fiscal Year 1999/2000 ................... 114 A4-7: Trinidad and Tobago Skills Training and Employment Programs ............... 115 A4-8: Jamaica Safety Net Programs Benefiting Youths, 1998 ....................... 116 A4-9: Trinidad and Tobago Safety Net Programs Benefiting Youths ..... ............. 117 A4-10: Overview of Youth Serving Donor Programs in the Caribbean ................. 118 LIST OF FIGURES 2-1: Caribbean Frameworks of Risk and Protective Factors for Adolescent and Subsequent Adult Development .............................. 10 4-1: Predicted Probability of Risk-Taking Behaviour by Degree of Rage of Boys ......... 29 4-2: Predicted Probability of Risk-Taking Behaviour by Degree of Rage of Girls ......... 29 4-3: Predicted Probability of Engaging Risk-Taking Behaviour by Level of Parental Connectedness, Boys .31 4-4: Predicted Probability of Engaging Risk-Taking Behaviour by Level of Parental Connectedness, Girls .31 4-5: Probability of Engaging in Risk-Taking Behaviour by degree of Parental Abuse, Boys .32 4-6: Probability of Engaging in Risk-Taking Behaviour by degree of Parental Abuse, Girls .33 4-7: Probability of Engaging in Risk-Taking Behaviour by degree of School Connectedness, Boys .35 4-8: Probability of Engaging in Risk-Taking Behaviour by degree of School Connectedness, Girls .36 4-9: Probability of Engaging in Risk-Taking Behaviour by degree of Religious Attendance, Boys .............................................. 36 4-10: Probability of Engaging in Risk-Taking Behaviour by degree of Religious Attendance, Girls .............................................. 37 LIST OF BOXES 2-1: Elements of Adolescent Development ............................., 8 4-1: Boys in the Drug Trade-their stories ............................ 38 6-1: Youth policy in Jamaica ............................ 60 6-2: Perspectives on National Youth Councils in the Caribbean ....................... 66 6-3: Cost Benefit Analysis of Programs to Reduce Teen Crime ........................ 69 6-4: Classification of Youth At Risk for Targeting and Programming Purposes ............ 70 FOREWORD Young people are the custodians of our society and the trustees of prosperity for future genera- Y tions. Nowhere is this more apparent than the Caribbcan region, where two-thirds of the pop- ulation is under the age of 30. This "youthful profile" of the Caribbean nations presents both opportunities and challenges in the years ahead as the important role that young people play in national and regional development becomes increasingly apparent. Experience has taught us that young people can play an important role in national develop- ment if provided the right tools, the learning and empowerment to employ those tools and a sup- portive environment in which to use them. Young people can and should lead the way in economic growth and poverty reduction. By the same token, however, that same energy and vitality, if left unharnessed or if marginalized can have a dramatic negative effect on social and economic stability. This study, undertaken at the request of our clients, could not be more timely or relevant for our work in the Caribbean Region, where we have witnessed a worrying upward trend in youth- associated issues of drug trafficking, HIV/AIDs infection, adolescent pregnancies, and other risky behavior. Set against a backdrop of regional and international instability, the urgency of grappling with this vital component of society has pushed the Bank to explore innovative measures to address and include youth as an integral part of our work. The study is the first work of its kind to present quantitative evidence that investing in youth is an economically sound approach for Governments to take. The authors recognize, however, that the area of youth and development is an often complex and uncomfortable one to address, as many of the possible solutions entail behavioral changes that challenge long-established and accepted norms. This study will, we hope, encourage anid stimulate the dialogue on youth in the region and assist those working in this critical area-Governments, Youth Organizations, NGOs, the donor community and young people themselves-in framing workplans for breaking the cycle of inter- generational poverty. Orsalia Kalantzopoulos Director, Caribbean Country Management Unit Latin America and the Caribbean Region vii PREFACE T his report examines youth development in the Caribbean today. Organized into seven chap- ters, the report provides an overview of the risks Caribbean youth are facing, evidence of the protective and risk factors underlying the problems youth are facing, an estimation of costs of risky youth behaviors, and an overview of the policy framework and the types of programs in place that target youth. The report responds directly to a request by the Caribbean Group for Cooperation and Economic Development at its 2000 consultative meeting for the World Bank to analyze the situation of Caribbean youth. It also provides an important input into the Bank's strategic social agenda for the Caribbean. The report also follows on other World Bank economic and sector work prepared in the Caribbean, including "A Review of Gender Issues in the Dominican Republic, Haiti and Jamaica" report (21866-LAC, May 2001), the "Dominican Republic Poverty Assessment" (21306-DR, January 16, 2001); the "Trinidad and Tobago Youth and Social Development" report (20088-TR, June 2000), the "HIV/AIDS in the Caribbean: Issues and Options" report (20491-LAC, June 2000); and the "Violence and Urban Poverty in Jamaica: Breaking the Cycle" report (15895-JM, January 1997). The report was based on a multistage process, which involved carrying out consultations with government and civil society representatives in Barbados and St. Lucia in March 2002, carrying out focus groups and semi-structured interviews with key experts in St. Lucia and the Dominican Republic in February and March 2002, conducting an authors' meeting in the Dominican Repub- lic in April 2002 to identify key lessons and policy recommendations, and carrying out consulta- tions on key findings and main messages with government and civil society stakeholders in the Dominican Republic and Jamaica (including youth groups in both countries) in April and May 2002, respectively, and with youth representatives and government officials from the English- speaking Caribbean at the Commonwealth Youth Programme's (CYP) regional forum in the British Virgin Islands in October 2002. Wendy Cunningham and Maria Correia (World Bank) wrote this report based on background papers prepared by Robert Blum, Lincoln Williams, David Luther, Julia Hasbuin, and Arlette St. Ville (consultants) and Wendy Cunningham and Enrique Hennings (World Bank); expert advice from Patrice Lafleur and Armstrong Alexis (CYP); and invaluable peer review from Gary Barker (consultant). The country director is Orsalia Kalantzopoulos, the lead economist is Antonella Bassani, the sector director is Ernesto May, the chief economist is Guillermo Perry, and the vice president is David de Ferranti. The authors give special recognition to Andil Gosine, whose critical eye, knowledge of the Caribbean and endless patience were critical in bringing this report to publication. We thank the many men and women from the Caribbean who made this report a truly regional undertaking, including members of the National Youth Council of St. Lucia, and of Addiction Alert in Jamaica. And most important, we thank the young people from the Caribbean who shared their stories, successes, and frustrations with us with the hope that we would dissemi- nate their word to our audience. We hope that we have met your expectations. ix ACRONYMS AIDS acquired immune deficiency syndrome AZT azidovudine CAREC Caribbean Epidemiology Center CARICOM Caribbean Community CEE Common Entrance Exam CGCED Caribbean Group for Cooperation and Economic Development CIDA Canadian International Development Agency COSHSOD Commission for Human and Social Development CPI Consumer Protection Index CXC Caribbean Examinations Council CYP Commonwealth Youth Programme DFID Department for International Development (United Kingdom) ECLAC Economic Commission for Latin America and the Caribbean GDP gross domestic product HEART Human Employment and Resource Training HIV human immunodeficiency virus ILO International Labour Organisation IMF International Monetary Fund LAC Latin America and the Caribbean LSMS Living Standards Measurement Study MLG Ministry of Local Government (Jamaica) NGO nongovernmental organization NTA National Training Agency NYC National Youth Council OECS Organization of Eastern Caribbean States PAHO Pan American Health Organization PIOJ Planning Institute of Jamaica SERVOL Service Volunteered for All STI sexually transmitted infection U.N. United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNDCP United Nations International Drug Control Programme UNDP United Nations Development Programme UNESCO United Nations Educational, Scientific, and Cultural Organization UNFPA United Nations Population Fund UNICEF United Nations Children's Fund USAID United States Agency for International Development xi EXECUTIVE SUMMARY Introduction This report responds to the growing concern over issues facing Caribbean youth today and, specifi- cally, to a request made by the Caribbean Group for Cooperation and Economic Development (CGCED) to report on the subject of youth at the Sixteenth CGCED Conference held in June 2002. Much has been written about the problems plaguing Caribbean youth, but much less is knowni about the underlying causes of those problems and what should be done about them. This report attempts to contribute to the debate and discussion on these questions. Caribbean youth are generally happy and healthy. They attend school, participate in social and cultural events, enjoy the loving support of a family and peers, and plan for the future. Youth played a critical role in the birth of the politically independent Caribbean, and very many of them continue to overcome remarkable odds to achieve lofty personal and professional goals. However, factors are present in the Caribbean that have the potential to disrupt the process of positive youth development. This report focuses on those who are at risk of deviating or who have already devi- ated from healthy behaviors. The objectives of this report are threefold. It aims to (1) identify the risk and protective factors and deterninants of youth behaviors and development, (2) demonstrate that the negative behaviors of youth are costly not only to the youth themselves but to society as a whole, and (3) identify key intervention points for youth development, taking into account identified risk and protective factors for the Caribbean. The report is based mainly on the following data sources: a Pan American Health Organization (PAHO) dataset (1997-99) on the behaviors of school-going adolescents from nine Caribbean Community (CARICOM) countries; focus groups and in-depth interviews carried out in the Dominican Republic and Saint Lucia in 2002; household or labor force surveys (1995-99) for Saint Lucia, Guyana, the Dominican Republic, and Jamaica; and consultations on study findings with stakeholders from the Dominican Republic and the English-speaking Caribbean. This report relies on data sources and studies from as many Caribbean countries as possible, but it focuses on the Bank's client countries, these being the Organization of Eastern Caribbean xiii XIV EXECUTIVE SUMMARY States (OECS), Belize, the Dominican Republic, Guyana, Haiti, Jamaica, Suriname, and Trinidad and Tobago. It places less focus on Haiti because of socioeconcomic disparities between Haiti and its neighboring Caribbean countries. Conceptual Framework For the purposes of this study, youth is defined as spanning the ac[olescent period from 10 to 24 years of age. Youth or adolescent development thus refers to the physical, social, and emotional processes of maturation that occur during the 10- to 24-year age periocl. The adolescent period represents the transition from childhood to adulthood, with biological processes riving the initiation of adolescence and societal factors largely determining the initiation of adulthood. This study uses an "ecological" framework to demonstrate the linkages between (a) the under- lying risk and protective factors of youth behaviors, (b) youth outcomes, and (c) subsequent adult outcomes. It is termed "ecological" because the framework shows the relationship between the individual adolescent and his or her environment. Risk factors are those factors that increase the likelihood of experiencing negative outcoines. Protectivefactors counterbalance the risk factors. Risk and protective factors exist at three levels: at the level of the individual, the microenviron- ment (comprising family, social networks, peers and role models, community, and neighborhood), and the macroenvironment (including mass media, the economy, public institutions, cultural and historical background, and social norms on gender). A simplistic version of the framework shows that risk and protective factors affect youth outcomes, which in turn shape the kind of adults the youth will become. Negative risk outcomes can, in tumr, become risk factors. Risk and Protective Factors * Macro-environment Risky Youth * Micro-environment t Behaviors __ Youth Outcomes * Individual _ _ Adult Outcom0s Key Findings Although the Caribbean Is Culturally Diverse, Many .Negative Youth Outcomes Are Common Across Countries and Particular to the Caribbean Region. Despite historical, political, cultural, and linguistic diversity. the negative outcomes observed among Caribbean youth are quite similar. These include early sexual initiation, HIV/AIDS, sexual and physical abuse, school leaving (dropout and exit), unemployment, crime and violence, sub- stance abuse and drug dealing, and social exclusion. Negative outcomes that are particular to Caribbean countries are briefly described below. Sexual and physical abuse is high in the Caribbean and socially accepted in many Caribbean countries. Corporal punishment conitinues to be widespread in Caribbean schools and homes, particularly among boys. Arnd according to the nine-country CARICOM study, 1 in 10 school-going adolescents have been sexually abused. The high incidence of sexual abuse among Caribbean boys stands out in comparison to other countries. Even more noteworthy is the "disturbing pattern of cultural 'normalcy' in child and physical and sexual abuse" in the Caribbean (Barrow 2001). :The onset of sexual initiation in the Caribbean is the earliest in the world (with the exception of Africa, where early sexual experiences take place within marriage). Early sexual debut is known to predispose young people to early pregnancy, HIV/AIDS, and other sexually transmitted infections (STIs). EXECUTIVE SUMMARY XV The region has the highest incidence of HIV/AIDS outside of Africa-and youth are an at-risk group. Among other things, HIV/AIDS is linked to cultural values about sexuality that are particular to the Caribbean. The incidence of rage among young people is extremely high: 40 percent of school-going CARICOM students reported feelings of rage. High rates of sexual abuse and physical abuse among children likely play out in rage among young people, which can affect their school performance and lead to violence. Youth unemployment is especially elevated in some Caribbean countries. According to World Development Indicators from 1996 to 1998, St. Lucia had the highest youth unemploy- ment rate in the Americas, followed by Jamaica. In the Caribbean, St. Lucia, followed by Dominica, St. Vincent and the Grenadines, and Jamaica, have the highest youth unemploy- ment rates. In contrast to the United States, which has high levels of youth violence, the proportion of Caribbean adolescent males who carry firearms is extremely high. Fully one-fifth of students had carried a weapon to school in the 30 days previous to the survey, and nearly as many had been in a fight using weapons. Gang violence is also high in the Caribbean, with 20 per- cent of male students and 12 percent of female students at one point having belonged to a gang. Although data on drug use are scanty, anecdotal evidence suggests a widespread social acceptance of alcohol and marijuana in some Caribbean countries, among both in-school and out-of-school youth. Out-of-school youth aged 13 to 19 years are most at risk of substance abuse as well as drug dealing (Barker 1995). Further complicating the situation, the Caribbean is a major trans-shipment point for drugs entering the United States and Europe. Costs of Risky Adolescent Behavior Are High. Problems plaguing Caribbean youth are costly. Although it is impossible to put a value on a human life or on the range of positive and negative externalities generated by youth, rough estimates show that losses to society from risky youth behaviors such as teen pregnancy, school leaving, crime, and HIV/AIDS-both in terms of direct expenditures and forgone productivity-reach into the bil- lions of dollars. Some rough calculations are as follows: A single cohort of adolescent mothers is estimated to cost society, in terms of forgone ben- efits from alternative uses of resources, more than US$2 million in St. Kitts and Nevis. School leavers in Guyana forgo hundreds of thousands of dollars in net earnings over their lifetimes, costing the state thousands of dollars in lost income. Youth crime and violence in St. Lucia generates more than US$3 million in lost benefits to society and US$7.7 million in lost benefits to private individuals annually. A 1 percent decrease in youth crime would increase tourist receipts by 4 percent in Jamaica and by 2.3 percent in the Bahamas. The financial loss to society due to AIDS deaths among those who contracted AIDS during adolescence ranges from 0.01 percent of gross domestic product (GDP) in Suriname and Antigua and Barbuda to 0.17 percent of GDP in the Bahamas in just the year 2000. If female youth unemployment were reduced to the level of adult unemployment, GDP would be higher by a range of 0.4 percent in Antigua and Barbuda and 2.9 percent in Jamaica. Youth Are Not the Problem. Youth are not the problem but a product of their micro- and macroenvironments. For the most part, they rationally react to the situation in which they find themselves. Drug dealing, for example, would be rational for a young person if no other forms of employment existed, the family needed XVI EXECUTIVE SUMMARY money, and the drug lord provided protection and a sense of belonging. Evidence from this study suggests that in the Caribbean, the following factors are the most important in determining the outcomes of youth: Family: The family is both the strongest protective factcr and the strongest risk factor for youth behavior and outcomes. It is protective in that farnily connectedness, appropriate lev- els of parental discipline, moral guidance, protection from dangers in the adult world, and economic support allow young people to acquir-e personal and social skills while young. Conversely, parental displays of negative behaviors (substance abuse, violence); physical, sexual, and emotional abuse by family members; and the absence of parental guidance and support are risk factors. Schools: Connectedness to schools is highly protective against all risky behaviors, including using drugs and alcohol and engaging in violent or sexual activity. For example, among school-going adolescents, the probability of sexual behavior falls by 30 percentage points for boys and 60 percentage points for girls if they are connected to schools. Conversely, the school system can have devastating effects on those youth with low academic achievement by not granting them a place in school and, as a corollary, making them feel socially excluded and "worthless." Poverty: Young people in disadvanitaged situations are often forced to find work and have few options except informal sector work, drug trade, or prostitution. Parents- particularly single parents-are more likely to be absent from the household and fre- quently leave youth and children unattended and unsupervised. Young girls in some countries-sometimes at the encouragement of their mothers-will engage in oppor- tunistic sex to relieve poverty and contribute to household income. And childbearing is still used a strategy for gaining economic support in countries like Jamaica. Last, income inequality-which is demonstrated by the presence of drug dons, foreign tourists, ancl the media-encourages the engagement of youth in "easy money" activities, including drugs and commercial sex work. Gender: Gender is a central risk factor in Caribbean societies. Almost all children in Jamaica and St. Lucia, for example, are born out of wedlock, which means that many fathers are absent from the lives of their children. The exclusionary nature of fathering dates back to slavery, when men were not permitted to play the role of spouse and father. At the same time, social norms promote sexual prowess and multifathering among men. These norms have important intergenerational effects. Children of absent fathers are more likely to fare poorly in school. And men's inability to providle economic support means that women often raise children on their own, leading to greater leve[s of poverty and vulnerability among these women and their children. A key message that arises out of research fi:ndings is the interconnectedness offactors that predispose risky behavior and outcomes. Empirical anal,sis of risk and protective factors carried out using the nine-country CARICOM data demonstrates the complex interrelations among family, school, and community factors in the microenvironment. Study results also show that changing any one of the risk factors will improve outcomes. These findings are consisten': with the international evidence. Many Youth Programs Exist, but Little Is Known about Their Effectiveness. Much is being done in the area of youth development, with government and the nongovernmental organization (NGO) sector both active in different ways. Innovative private sector and private- public sector initiatives for youth also look promising. At the regional level, CARICOM's Regional Strategy for Youth Development represents an important step in placing youth on the regional agenda. The CYP has also made significant progress in assisting Caribbean countries to develop youth policies and building a cadre of youth and professional staffqualified to work on youth EXECUTIVE SUMMARY XVII issues. As for international donor support, the United Nations Children's Fund (UNICEF) is play- ing a leading role in youth development. In particular, its strategy to promote cross-institutional collaboration through community multipurpose youth hubs appears to be promising. But limited information on the situation of youth themselves-particularly out-of-school youth who are unat- tached to formal institutions-and on the nature and effectiveness of the multitude of programs that exist makes evaluation and informed planning difficult. The cross-cutting nature of youth, which implies a need for effective coordination across institutional lines, presents an additional challenge. Moving Forward: Youth Development Principles and Actions Although the transitional period from childhood to adulthood is unquestionably a challenge for many, the majority of Caribbean youth make the transition unencumbered. Yet the report demon- strates that there are serious social and economic consequences associated with not addressing the minority group of youth who are at risk of negative behaviors or are suffering the impact of their negative circumstances-not only for the youth themselves and their families, but for society at large. This situation thus calls for decisive action of the part of Caribbean policymakers and govern- ments in the area of youth development. Building on available research and practice, the report puts forward a set of principles to guide youth development efforts in Caribbean states in both the macro- and microenvironments. These include (a) taking a life-cycle, age-specific approach; (b) ensuring selectivity and focus; (c) taking an asset-based approach; (d) establishing comprehensive long-term supports for youth; and (e) taking intersectoral integrated approaches to youth development. As for specific policy recommendations, programs and policies as well as specific actions must be context specific, that is, based on the nature and acuteness of the youth issues faced by each country as well as the institutional context. But some specific recommendations pertaining to the Caribbean include: Reforming the education system and maximizing the protective effects of schools by improving access and retention, improving the quality of education, eliminating corporal punishment, using educational activities and campaigns to reduce violence and promote conflict resolu- tion, and institutionalizing permanent, school-based information and education campaigns on sexual abuse and exploitation. Upgrading the public health care system by establishing new protocols, tools, and techniques for reaching youth and their families, including: developing mental health approaches, upgrading the skills of existing health professionals, training graduates on new protocols, and ensuring that protocols include confidentiality and gender-differentiated services. It is important to ensure that the nursing and medical professions play a role in condemning sexual and physical abuse of children and adolescents and putting the issue on the public health agenda. Institutionalizing national-level mentoring systemsfor at-risk youth by identifying existing effective programs and creating incentives for NGOs and the private sector to expand these programs to the national level. - Reforming and strengthening legal, judicial, and policing systems by improving juvenile jus- tice (review and harmonization of laws, strengthening of family courts, training of legal practitioners, modernizing of the courts, and use of alternative custodial sentences), increas- ing the control of weapons, and reforming the police. Using the media and social marketing to change norms and values related to the following key risk areas for youth: sexual abuse and exploitation, early sexual initiation, corporal pun- ishment and physical abuse, and alcohol consumption and drug use. Use social marketing techniques(which draw on commercial marketing principles) to increase the effectiveness of communication and education techniques. xviii EXECUTIVE SUMMARY I Making families and fathers a top public policy, issue: Put in place incentives to make parents accountable for their children (legal measures, tax breaks) and use the education system, the public health system, and the media to teach at-risk parents fundamental parenting skills; put in place incentives to increase fathers' rights to and responsibilities for their children. Strengthening community and neighborhood supports to adolescents and their families by establishing competitive "youth funads" to finance innovative NGO and community-based initiatives for youth (e.g., as part of social development liunds). INTRODUCTION Background and justification There is a growing concern among the public and policymakers alike over the situation of Caribbean youth today. Most youth are doing well; the majority of young people in the Caribbean do not engage in violent activities, participate in illicit drug trade, or drop out of school. But there is increasing recognition of those who are not able to overcome the challenges presented to them by their environment. Terms such as "in crisis," "plight," and "in peril" are commonly used in reference to Caribbean youth (1997, Williams 2002). The concerns that have been raised over and over again in the discourses and literature on youth in the Caribbean include the spread of AIDS among young people, the threat to well-being by early initiation into sexual activity and teenage pregnancy, the pervasive youth unemployment, the inequality of education, the involvement of youth in drug trade and crime and violence as an alternative to unemployment and poverty, and the social exclusion of youth. The CYP's publication "Tomorrow's Adults: A Situational Analysis of Youth in the Commonwealth Caribbean" notes that although youth would legally be adults from the age of 18 in most countries, many young people in the Caribbean are denied passage into adulthood as a result of labor market constraints, lack of participation in decisionmaking processes, constraints to ownership of property and goods, and lack of status and role in society (Danns, Henry, and LaFleur 1997). Caribbean youth issues have emerged during volatile macroeconomic conditions. Over the last two decades, many Caribbean nations experienced economic decline and stagnation resulting from a loss of their preferential treatment in agriculture markets, depressed market for minerals, losses due to lack of market diversification, stagnation of the manufacturing sector in the face of increased competition, and increasing vulnerability of the tourism sector. Several countries thus have imple- mented structural adjustment and stabilization programs, with corollary cutbacks in health, educa- tion, housing, and social welfare programs. More recently, global economic recession, debt service obligations, and declines in development assistance have prevented many Caribbean nations from economic recovery and growth. 2 WORLD BANK COUNTRY STUDY Is it true that many youth in the Caribbean are at risk? Is the situation of Caribbean youth sig- nificantly different from that in other cour.tries in the face of economic downturn and stagnation? Although a broad term, at risk generally rcfers to youth who face "environmental, social and family conditions that [potentially] hindcr their personal devclopment and their successful integration into society as productive citizens" (Barker and Fontes 1996). For most youth worldwide, the crit- ical transition period from childhood to young adulthood is delicate and challenging, and it hinges on the adequate support and guidance from family, schools, andi society at large (Feldman and Elliott 1997). The literature on youth in the Caribbean and the findings of this report suggest that negative youth outcomes are a result of failures on the part of fimilies, government, and society as a whole to provide the appropriate and adequate supports for young people to grow into responsi- ble and productive adults. There has been much debate and discussion on the challenges Caribbean youth face, but rela- tively little has been done to gain an understanding of the nature of their problems, the underlying causes of youth risks and behaviors, and the corollary policies and programs required to address the issues. Youth development and youth at risk have been on the agendas of most Caribbean govern- ments for some time. According to Huggins (1998), mrost Caribbean countries have identified youth as a target for social development and welfare planning, having set up youth desks and departments in government, assigned public resources For youth, and funded programs specifically for youth (cited in Alexis 2000). However., although attention has been dedicated to youth, lim- ited empirical analysis and evaluation have been carried out to underpin these programs (Alexis 2000). The focus of youth programs has been on leisure and service to the community rather than developing a good understanding of the needs of and challenges faced by youth and how meeting these needs and addressing these challenges can lead to the overall economic and social develop- ment of societies as a whole in the Caribbean. Recognizing the importance of youth issues and the need for an improved empirical basis for youth programs, governments in the Caribbean have requested the Bank's assistance to better understand the nature of youth issues and what needs to be done to improve the conditions for youth; examine the costs of not investing in youth, given competing demands for resources; and identify the role of the state and other actors in providing services to vouth. Specifically, in 2000, the Caribbean Group for Cooperation and Economic Developnient (CGCED) selected "youth" as one of the featured topics at its June 2002 meeting. This report serves as the World Bank's main contribution to youth development for the June meeting. Objectives, Approach, and Data Sources Objectives This document has three specific research objectives: (1) to identify the risk and protective factors that affect youth development in the Caribbean, (2) to demonstrate that the issues facing Caribbean youth are costly not only to themselves but to society as a w hole, and (3) to identify key intervention points for youth development, taking into account identified risk and protective factors Data and Methodology A youth development framework, based on the public health literature and adapted to the Caribbean, serves as the organizing structure to the report. This framework organizes the influ- ences of youth development by identifying risk and protective factors within the macroenviron- ment, the microenvironment (peers, family, and comn-m1nity), and the individual him- or herself. For the analysis, the report draws on both original data collection and analysis and a review of existing literature. The primary data sources were Pan Arnerican Health Organization (PAHO) health data (1997-99): A cross-sectional dataset from nine Caribbean Community (CARICOM) countries (Antigua and Barbuda, the Bahamas, Barbados, British Virgin Islands, Dominica, Grenada, Guyana, Jamaica, and CARIBBEAN YOUTH DEVELOPMENT 3 St. Lucia') that includes information on youth behaviors and their causes (hereafter referred to as the nine-country CARICOM study). Statisticians at the ministries of health in each country collected the school-based data. Sample size was representative of school-going teenagers within each country, which does not represent all youth because many leave school before graduation. Focus,groups and in-depth interviewsfrom the Dominican Republic and St. Lucia (2002): Qual- itative data were collected from 26 focus group discussions with young men and women and 27 in-depth, semistructured interviews with youth experts in the Dominican Republic and St. Lucia. Sixteen focus groups were made up of 6 to 10 youth aged 14 to 24 years who were considered at risk of engaging in unhealthy behaviors or who currently do engage in such behaviors. The samples were drawn from juvenile detention centers, church groups, commu- nity groups, schools, and a wide range of youth in both rural and urban areas of the countries. The remaining focus groups were youth not at risk (control groups) and adult parents or peers of youth. Discussions with all the focus groups emphasized preconditions that lead to unhealthy youth behavior and the motivation for participation in such behavior. In St. Lucia, focus groups were also held with the parents and adult peers of the at-risk youth. The struc- tured interviews with youth experts served for triangulation and to better understand the breach between the understanding of those who work with youth and the youth themselves. Household or laborforcesurveys (1995-99): Household or labor force surveys for St. Lucia (1995), Guyana (1999), the Dominican Republic (1998), and Jamaica (1998) were used to cost-out the youth behaviors. Country selection was based solely on the availability of data. Datasets are used for different purposes throughout the report. The analysis of risk and protec- tive factors was based on the qualitative data and econometric analysis of the PAHO data. The analysis of the cost of risky youth behavior relied on household and labor force surveys as well as databases of international organizations including PAHO, the International Labour Organisation (ILO), and the United Nations (U.N.). The review of programs and the existing network for youth support in the Caribbean relied on the semistructured interviews. All sections were heavily supported with existing literature. Caribbean Context Territorial Scope Definitions of the territorial scope of the Caribbean vary. According to the World Bank (2000a), the "wider" Caribbean region includes the sovereign-state members of CARICOM, including both island-nations (Antigua and Barbuda, the Bahamas, Barbados, Dominica, Grenada, Haiti, Jamaica, Montserrat, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, and Trinidad and Tobago) and the mainland countries of Belize in Central America and Guyana and Suriname in South America; Spanish-speaking Cuba and the Dominican Republic; the semiautonomous states of the Kingdom of the Netherlands (Aruba and the Netherlands Antilles islands of Bonaire, Curaqao, St. Martin, St. Eustatius, and Saba); the British Overseas Territories, that is, Anguilla, Bermuda, the British Virgin Islands, the Cayman Islands, and the Turks and Caicos Islands; the U.S. commonwealth of Puerto Rico and territory of the U.S. Virgin Islands; and The territories of the French Republic consisting of French Guyana, St. Martin, Saint-Pierre and Miquelon, Guadeloupe, and Martinique. 1. The survey was a collaborative effort between the ministries of health in the nine countries, PAHO, and the World Health Organization (VHO) Collaborating Center in Adolescent Health at the University of Minnesota, Minneapolis. 4 WORLD BANK COUNTRY STUDY The Caribbean is a multiethnic region wvith many cultural differences. There are English-speaking countries (e.g., Trinidad and Tobago), Spanish-speaking countries (e.g., the Dominican Republic), French-speaking countries (e.g., Haiti), and Dutch-spcaking couitries (e.g., Suriname). The majority of the population is of African descent, althouglh there are also people of European, Hispanic, and East and South Asian ancestry (e.g., Indians in Trinidad and Tobago and Guyana). The mainland states of Belize, Guyana, and Suriname, which by virtue of language and her- itage form part of the Caribbean region, are much larger in land mass than the island states of the Caribbean: Belize (29,963 square kilometers; population, 215,000), Guyana (219,470 square kilo- meters; population, 813,000), and Suriname (163,820 square kilometers; population, 437,000). The island states of the Caribbean vary in size and population from Anguilla (91 square kilometers; population, 8,000) to Jamaica (11,424 square kilometers; population, 2,447,000). Historically, the Caribbean region has been strongly influenced by Europe and the United States. Many of the English-speaking Caribbean countries have modeled their educational, legal, and political systems on those of the Unitcd Kingdom. The countries of the English-speaking Caribbean have a combined population of around 6.7 million scattered over the Caribbean Sea, whose farthest points span about 3,500 kilometers betwveen the coast of Belize and Guyana. The Bahamas and the Dominican Republic are economically reliant on the United States. France and the Netherlands also have strong links with some of the non-English speaking countries, for example Martinique and Curagao. Therefore, there has been much migration from these coun- tries to the Caribbean. The Caribbean is a major tourist destination, attracting visitors from many parts of the world. Similarly, over the past 40 years, for economic reasons, many Caribbean citizens havc migrated, primarily to the United States, Canada, and the United Kingdom. There is also much business travel within and outside the Caribbean. For the purposes of this report, the Caribbean area of focus includes the Bank's client coun- tries: these being the Organization of Eastern Caribbean States 'OECS) (Anguilla, Antigua and Barbuda, the British Virgin Islands, Dominica, Grenada, Montscrrat, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines), as well as Belize, the Dominican Republic, Guyana, Haiti, Jamaica, Suriname, and Trinidad and Tobago. However, given the disparity in socioeconomic conditions between Haiti and its Caribbeaji neighbors, limited fbcus is placed on that country. Demographics of Caribbean Youth Caribbean youth make up about 30 percer.t of the population (see table 1.1), with data for avail- able countries indicating that St. Lucia has the highest proportion of youth aged 10 to 24 years (34 percent) and St. Kitts and Nevis having the lowest proportion (24 percent). REPORT ORGANIZATION The report is organized as follows: Subsequent to this introductory chapter, Chapter two provides a framework for analyzing youth development, presenting an integrative model of risk and protec- tive factors for youth development and subsequent adult health and well-being in the context of the Caribbean. Chapter three reviews negative outcomes observzd among Caribbean youth. Chap- ter four presents findings of the analysis of risk anid protective factors of negative youth outcomes based on qualitative and quantitative analysis of Caribbean data and information, as well as other sources. Chapter five puts forward an argumcnt for investing in youth by presenting an analysis of cost estimations of the risky behaviors associated with youth. Ch apter six presents a discussion on policies and programming related to youth in the Caribbean. And finally, chapter seven provides conclusions, a proposed strategy, and key policy entry points. St. Vincent and St. Kcitts Dominican the Grenadines and Nevis Grenada Republic Jamaica Guyana St. Lucia Barbados Year 2000 Year 2000 Year 2000 Year 1998 Year 1997 Year 1999 Year 1995 Year 1995 Population Population Population Population Population Population Population Population % of total by age % of total by age % of total by age % of total by age % of total by age % of total by age % of total by age % of total by age Age group population group population group population group population group population group population group population group population group 0-4 11.7 13,455 7.8 3,198 10.0 9,800 11.7 968,218 11.5 293,199 12.1 103,909 9.1 13,235 7.5 19,899 5-9 13.9 15,985 9.9 4,049 11.9 11,662 13.0 1,073,871 11.7 298,052 12.3 105,193 12.4 18,035 8.2 21,742 10-14 12.4 14,260 9.3 3,823 13.4 13,132 11.6 953,360 11.5 293,965 11.2 96,120 12.7 18,471 8.3 22,022 15-19 11.2 12,880 8.2 3,352 11.2 10,976 10.6 876,596 9.6 243,907 10.0 85,849 12.2 17,744 9.1 24,205 20-24 8.8 10,120 6.6 2,686 7.6 7,448 8.9 735,449 8.4 214,281 8.6 73,609 9.1 13,235 8.6 22,726 25-29 6.9 7,935 7.4 3,045 6.5 6,370 7.8 644,653 8.6 219,389 8.6 73,951 8.4 12,217 9.3 24,539 30-34 7.4 8,510 7.6 3116 6.4 6,272 7.4 609,985 7.3 185,420 7.2 61,198 6.2 9,017 8.8 23,350 35-39 5.9 6,785 8.9 3,659 7.4 7,252 5.9 488,649 6.2 157,837 7.4 63,252 7.1 10,326 7.4 19,524 40-44 5.0 5,750 5.8 2,358 5.1 4,998 5.0 409,408 4.5 115,952 6.3 53,666 3.9 5,672 5.9 15,553 45-49 1.7 1,955 6.4 2,624 3.5 3,430 4.1 340,073 3.8 980,74 4.6 38,944 3.7 5,381 4.2 11,078 50-54 3.4 3,910 3.3 1,343 2.9 2,842 3.5 290,548 3.1 79,429 3.3 28,588 3.3 4,800 3.8 10,152 55-59 2.5 2,875 2.8 1,138 2.8 2,744 2.6 215,435 3.1 79,940 2.3 19,601 2.2 3,200 3.4 8,927 60-64 3.5 4,025 3.8 1,538 3.3 3,234 2.6 213,784 3.0 76,620 2.0 17,461 2.5 3,636 3.9 9,157 65+ 5.7 6,555 12.4 5,084 8.0 7,840 5.3 434,171 7.8 197,935 4.0 34,579 7.2 10,472 11.8 3 1,264 Total 100.0 115000 100.0 41,010 100.0 98,000 100.0 8,254,200 100.0 2,554,000 100.0 855,920 100.0 145,440 100 264,137 Sources: World Development Indicators (World Bank 1997), PAHO Core Health Data System 2000, Living Standards Measurement Study (LSMS) (World Bank 1997-99) 2 FRAMEWORK FOR ANALYZING CARIBBEAN YOUTH Definitions Youth The literature is replete with caution on the use of a chronological age to distinguish phases of the life cycle. The definition of youth depends on the sectoral and cultural context; for example, health specialists may refer to youth as the pubescent period, which begins at different ages in different countries, and labor ministries may use the minimum work age as the age when youth begins. The U.N. definition of youth is 15 to 24 years old. The majority of youth policies in the Caribbean, however, see youth as beginning at age 15 and ending at 30 years (Alexis 2000). The reason for this extended period of youth in the Caribbean is the extremely high rate of youth unemployment that prevents young people from attaining adult status (Danns, Henry, and LaFleur 1997). For the purposes of this study, youth is defined as spanning the adolescent period between 10 and 24 years of age, with "youth" and "adolescents" being used interchangeably.2 Adolescence encompasses the transition from childhood to adulthood. Biological processes drive the initiation of adolescence, its onset being defined by puberty (Feldmen and Elliott 1997). In contrast, societal factors largely determine the initiation of adulthood. Because of the broad period it encompasses, adolescence can be divided into three subcategories: early adolescence (ages 10 to 14), during which intense physical and social changes corresponding with puberty take place; middle adoles- cence (ages 15 to 17), during which young people become increasingly independent; and late ado- lescence (ages 17 to mid-20s), which applies to those who for social or other reasons delay entry into adulthood (Feldmen and Elliott 1997). 2. The definition of youth used in this report deviates from that of the U.N. and the Caribbean by lower- ing the onset of youth to age 10. This is necessary because of the ecological approach of the model, which identifies influences of youth behavior that begin as early as age 10. 7 8 WORLD BANK COUNTRY STUDY Youth Development Youth or adolescent development refers to the physical, social, and emotional processes of matura- tion that occur during the 10- to 24-year age period. The elements of this developmental period include pubertal maturation, cognitive dev elopment, ability to understand a future time perspective, ability to extrapolate, experimentation (including gender role experimentation), and moral devel- opment (see box 2-1). Engaging in prosocial behaviors and avoiding health-comj?romising and future jeopardizing behaviors lead to positive youth developrnent (Roth et al. 1998). A sense of industry and compe- tency, a feeling of connectedness to others and sociery, a belief in controlling one's fate, and a stable identity are elements of positive development in adolescence. Risk-taking behaviors predis- pose youth to negative outcomes (e.g., unprotected intercourse is a health risk behavior that pre- disposes to sexually transmitted infections [STIsJ and unwanted pregnancy). The outcomes of these risk behaviors (e.g., early, nonmarital childbearing; early school leaving; drug addiction; violence; etc.) compromise a young person's future and can have high societal costs in the short and long term. Factors Contributing to Youth Development While research and policy on youth have tended to foc-as on the behavioral aspects of youth devel- opment, recent work has shifted to the underlying causes of these behaviors (World Bank 2000b). Risk factors, also referred to as risk antecedents, are those factors that increase the likelihood of experiencing negative outcomes (Resnick and Hojat 1997). Factors predisposing negative out- comes may be individual (e.g., aggressive temperament), familial (e.g., substance-abusing families, familial mental illness), or environmental (e.g., high crime and violence neighborhoods). _ _DS P a. Pubertal Maturation, which include three key changes: (a) the development of adult reproductive capabili- ties; (b) the establishment of sexual dimorphism; and (c) the completion of organ system maturation. Cognitive development, including a shift in cognition from concrete thinking to the formal operations of ado- lescence, which allow for abstract reasoning skills as well as a capacity for future time perspective, and thus the capability of understanding the long-as well as short-ter-n consequences of one's behavior. Extrapolation and Experimentation, which represents a shift from concrete to abstract operational thought, and the increased ability to apply the lessons of daily life. Extrapolation is the capacity to take the lessons learned from past experiences and apply them to new situations. The mechanism by which this aspect of cognition develops is through experimentation. Whether it is through cigarette smoking, provocative clothing, a new hairstyle, or sexual behavior, experimentation is a concrete, experiential way of learning compared, for example, to information learned at school whiich is more abstract when one studies the expe- riences of others. It is through a similar process of role experimentations that one learns and internalizes gender appropriate behavior. Moral development: Moral development represents a process thrcugh which individuals mature in dealing with complex value-based decisions. Kohlberg (1981) defined six stages through which individuals progress as they move from early childhood to adulthood: (a) the first stage being "punishment/obedience", in which a child is motivated to behave in a certain way because he believes that if he does not do so he will be pun- ished; (b) a second in which a child's actions aire is motivated by self-gain; (c) a third stage, in which behavior is based on a desire to be liked; (d) a fourth stage in which maintenance of social order, fixed rules, and authority are the major motivations for behavior; (e) a fifth stage in wliich moral reasoning is based on a notion of social contract "the greatest good for the greatest number."; and (f) the last and highest level in which decisions are based on a "universal ethical principle" or jlustice. CARIBBEAN YOUTH DEVELOPMENT 9 Counterbalanicing such risks are the protective factors (Blum 1998) that likewise arise from the individual, familial, and social environments in which a young person lives.3 For example, individ- ual characteristics that have been repeatedly found to be protective include social skills, intelli- gence, and a belief in a higher power beyond oneself. Protective family characteristics include a caring parent, an authoritative parenting style, and smaller family size. Likewise, social environ- ments associated with reduced risk include caring nonfamilial adults, collective self-efficacy, and neighborhood engagement. Thus, as a dynamic process, one must concurrently consider both the factors that predispose to vulnerability an-d those that protect (direct effect) or buffer (indirect or mediated effect) a young person from harm. It is important to note, howvever, that although risk and protective factors aid in understanding underlying causes of behaviors, the subjective experiences of adolescents and youth are tremendously varied. Although the odds of negative behaviors are much higher for those individuals who have many risk factors, not all succumb. The concept of resilience may help to explain the reasons why youth outcomes are not foreordained. Resilience refers to the self-righting capacity of an individ- ual to bounce back and keep going. It implies resistance to threat but not invincibility (Garmezy 1991) or invulnerability (Garmezy 1985). Rutter (1993) suggests that resilience is interactive with vulnerabilities. That is, resilience is developmental in nature, stemming from biology and experiences earlier in life, and protective factors may operate in different wvays at different stages of development. Conceptual Framework Figure 2-1 provides the conceptual framework used in this report to discuss underlying protective and risk factors associated with youth outcomes and behaviors and their subsequent adult out- comes. It is based oni an "ecological" model of human development that sees human development and youth development taking place in overlapping interrelated spheres that include home, family, school, and community (Blum 2002). The framework, which was constructed for the Caribbean based on what is known about the risks Caribbean adolescents face and their probable underlying causes, outlines risk and protective categories at three levels: the macroenvironment, the micro- environment, and the individual. Macro-level factors are the macro systems and institutions that affect an individual but with which the individual does not have direct contact, whereas the microcnvironment refers to institutions and individuals with which the adolescent interacts on a personal basis-it refers to his or her space or sphere of interaction. The inherent and learned char- acteristics that an individual possesses also act as protective or risk factors independently or by intcraction with micro- and macroenvironmental factors. Risk and protective factors are those forces that underlie or determine adolescent behavior. Adolescent behavior, risk-taking or other- wise, determines adult outcomes later in life. All of these concepts are briefly discussed in turn. Macroenvironmental Factors The macroenvironment represents the "distal contexts of adolescence" (Feldman and Elliott 1997), that is, the adolescent's macroenvironment or context that is detached from him or her. Risk and protective factors related to the macroenvironment include the state of the national economy, poverty and inequality levels, the institutional framework (public institutions, policy and legal framcworks), political realities, the cultural and historical background, the media, gender (values, behavioral norms, and customs), and social exclusion. For example: The mass media, including television, radio, videos, movies, music, newspapers, and maga- zines, play formative roles in the lives of youth worldwide (Feldman and Elliott 1997), and the Caribbean is no exception. The media serve to teach youth and influences their beliefs, values, social and political views, attitudes, and behaviors, both positive and negative. 3. Patterson and Blum (1996) refer to "resources," Benson (1997) refers to "assets," and Masten and Reed (2000) refer to "resilience" as countering the risk factors. FIGURE 2-1: CARRIBBEAN FRAMEWORK OF RISK AND PROTECTIVE FACTORS FOR ADOLESCENT AND SUBSEQUENT ADULT DEVELOPMENT 0 NVimX _ wE S~vvaus I z At-risk youth behaviors 7 4Early sexual Initiation 0n &" Unsafe/unprotected sex Z Peers, _-~~~~~~~~~~~~~~~~~~~~~~4p /School leaving - t roliemoiln°edtelS'ris, | l _ | V Crime and violence EE Family V | v Substance abuse and drug dealing | ProtKtivetOk | vA_"W_ |Negaitive youth outcomes i/ Low human capital Athpto- | i | VrreSeNtaMn* | Unemployment, underesnploymnent hIs4~~~~ssj~~~~rns ~~VPoor physical and mental health ~~ ~''"' StSitls:edossli S>otsi } ~~~~~V Teen wrgnti| \ tss.41,.oEdbow / _'Fli4/w _ _ | Incarceration 4 /Social exclusion Negative adult outcomes v Gi-W e lifta | V4Low human capital 4/Unemployment Vsd.h"di0.dtT V~~~~~~~~~~~~~~~4 Poverty, low earnings Neighborhood 61~~~~~~~~~~~~~~~~4 Poor physical and menial health j Sexual abuse 4/ Substance abuse 4/Violence, including domestic violence | Uninvolved parent 4/Incarceration 4/ unhealthy relationkships with spouse, partner, friends, and others _ Social exclusion I !~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ CARIBBEAN YOUTH DEVELOPMENT I I Examples of risk-related factors related to mass media include portrayals of violence, risk- taking behavior, and sex-role stereotypes. Mass media can also be a risk factor by impeding other activities, such as schoolwork and academic performance. The state of the national economy is important in the lives of youth because it is a primary source of opportunities for youth and their families. It serves as a protective factor when it is a source of well-paid job opportunities, financial resources, and tax revenues, which pro- vide resources for social services. However, the economy is a risk factor when it does not provide opportunities or is highly volatile and introduces high uncertainty and vulnerabil- ity into the lives of young people and their parents. This lack of opportunities, for exam- ple, is identified as a primary cause for high migration and increased involvement of young people in the drug trade. The economy is a larger challenge for youth in the Caribbean than in many other countries because of the small, island state nature of most countries in the region. Economies that are small and relatively undiversified have more difficulty smoothing exogenous economic and natural shocks and thus have a higher potential for economic contractions, job loss, and slow job creation. The nature of public institutions is another important risk/protective category operating at the macro level. Broadly, institutions are protective if they are transparent, efficient, effective, and responsive. Conversely, they present macro risk factors if they are corrupt, inefficient, and unresponsive to the needs of the populace. Education systems, health care systems, and law enforcement and judicial systems in particular are public institutions that play an impor- tant role in the lives of adolescents in that they influence access to education and academic performance, morbidity and mortality, access to reproductive and sexual health care services, and safety and security. Specific risk factors related to the health care system for adolescents, for example, include lack of access to appropriate health care services, problems regarding confidentiality of care, and lack of health care providers who specialize in serving adolescents. Protective factors related to schools include providing relevant curricula for learning acade- mics, technical skills, and life skills; and access to peer groups, friends, mentors and orga- nized activities for social development and emotional connection. In the area of cultural and historical background, many have argued that the British colonial legacy of many Caribbean countries has indirectly affected the youth of today by influenc- ing family structure and maternal and paternal roles in child rearing. Weak and exclusionary public institutions are also blamed on the history of British colonialism (Trouillot 2001). The education system is a case in point: It is an example of a national institution that does not provide equal services to the majority and contributes to excluding a large segment of the youth population.4 Gender, in the context of risk or protective factors, refers to the values, customs, and behav- ioral norms that account for sexual differentiation in identity and behavior. Gender is thus included as a macroenvironmental factor in that values, behavioral norms, and customs related to the differentiation of the sexes are shaped by society broadly. Gender is a risk fac- tor, for example, if societal norms that dictate male behavior (e.g., men should be sexually promiscuous and bear many children) or female behavior (e.g., women should not enter the labor force) predispose youth (and subsequently adults) to negative outcomes. Gender is a protective factor if societal norms or culture dictate female behavior (girls should study hard) or male behavior (men should be responsible for providing for their children) pre- dispose youth to positive outcomes. Risk factors in the macroenvironment can act collectively to socially exclude youth as a group. Social exclusion is a multidimensional concept that has at least four characteristics: (1) exclusion from economic means, including unequal access to goods and services that determine human capital; 4. See chapter 4 for more details on this issue. 12 WORLD BANK COUNTRY STUDY (2) unequal access to labor markets anid social protcction programs from both formal and informal institutions; (3) exclusion from participatory mechanisms that af:ect public service programs; and (4) unequal access to political rights and civil liberties ,Gacitfia. Soto, and Davis 2001). Microenvironmental Factors The micro-level environment represents one's interpersonal proximal contexts. They include the structure and dynamics of the family; the values and social influences of peer groups, role models, and social networks; and the community and neighborhood in which youth live and interact, including schools, churches, health centers; and the physical environment. Families are critical in the lives of youth in that they are responsible for material care, socializing children, and providing psychological supports of solidarity and cooperation, acceptance, comfort, anld lovc (Barrow 2001). Parental expectations, evaluations, and encouragement or pressure also play a role in defining youth behaviors and outcomes (Feldman and Eliott 1997). Risk and protec- tive factors are related to family dynamics and structure, with protective factors including: "connect- edness," discipline (Hawkins et al. 1999), family resources (time, money, housing, and so forth), extended family (Burton, Allison, and Obeidallah 1995), two biological parents (Coleman 1988), parental presence (physical), family cohesion, and egalitarian gender roles and decisionmaking. "Connectedness" refers to a perception of closeness a young person has with a parent or family member; it is not based on doing things together but firom a parent or family conveying psychologi- cal availability. Conversely, risk factors include low parental skills and education; scarce family resources; parental absence due to migration, job demands, or abandonment; abuse and violence in the household (physical, sexual, and emotional); parental mental health; parental substance abuse; and the presence of a nonbiological parent (World Bank 2001b, Furstenberg and Hughes 1995). Social netwvorks and supports are thosz friends, neighbors, friends of parents, and so forth on whom youth can rely to help cope with stresses and problems and decide on actions and behaviors. Likewise, peer groups-groups of the same age cohort or generation, groups with whom the youth "hangs out," or groups of similarly stereotyped individuals'-serve as an important source of val- ues, directives, feedback, and social comparison (Feldman and IElliott 1997). Finally, role models are those persons that youth choose to emulate. Protective factors include having peers, social net- works, and roles models that are positive and provide connectedness; peers and role models with prosocial norms; low-risk friends; and being treated fairly by peers. Conversely, risk factors include participation in deviant culture ("the bad boys"), perception of threat by peers, and prejudice. The dynamics, structure, and organization of communities and neighborhoods help shape the lives, behaviors, and outcomes of adolescents. Their influences range from the provision of trans- portation systems, to the perceived degree of physical risk and safety, to community spirit and sup- port. Churches, schools, sports and health centers, and other social organizations, which can provide a range of activities and supports to youth, are also part of the community and neighborhood infra- structure. Protective factors related to community and neighborhoods include well-functioning infrastructure, safe and secure spaces, trustworthy law enforcement officers, connectedness with organizations, and a clean physical environrnent. Conversely, risk factors associated with community include crime and violence; uncaring healtlE center stafl, the presence of alcohol and firearms; the lack of basic infrastructure, such as safe transportation; and corrupt local police officers. Individual Factors Individual risk and protective factors are those related to the physiological, cognitive, behavioral, social, and environmental systems. The physiological system is critical in that it determines physical health and growth; the cognitive system determines how indivicduals assimilate information, inter- pret it, and use it to make decisions; the behavioral system is key in that mortality and morbidity in 5. For example, typical stereotyped groups among students in the United States and Canada include "jocks, brains, loners, nerds," and so forth. CARIBBEAN YOUTH DEVELOPMENT 13 adolescence is mostly behaviorally based; the social system affects youth outcomes by establishing a social climate that favors specific behaviors; and social networks influence how adolescents deal with stressful events. Some important risk factors at the individual level include having a physical or mental disability (Rutter 1993, Garmezy 1985, Werner 1982), aggressive behavior or rage, having a learning disabil- ity, and behaving in an ambivalent and unmotivated fashion. Protective factors at the individual level include spiritual belief (believing in a higher power beyond oneself), social skills, positive self-image and self-concept, self-confidence, having a positive and determined outlook, and being enterprising and hard-working. Perceived parental status is also a protective factor. Risk-Taking Behaviors Risk-taking behaviors are those actions taken by youth that hinder their personal development and successful integration into society (Barker and Fontes 1996). Such behaviors include not attending school, working in settings that are damaging to health and development (including working in illicit activities against one's will-e.g., prostitution), spending a large proportion of time on the streets (Barker and Fontes 1996), having unprotected or unsafe sex or engaging in sexual activities at an early age, being violent and participating in criminal behavior, and drug dealing and abusing drugs or other mind-altering substances. And given that societal systems affect at-risk behaviors, these can be gender differentiated. Negative Youth Outcomes Negative outcomes from risk-taking behaviors decrease the likelihood of having a healthy, happy, productive adult life. For example, adolescent pregnancy may predispose a person to low levels of education; school dropout or exit influences the attainment of human capital, which in turn affects job opportunities and earnings; youth unemployment affects a person's ability to gain experience, which in turn limits future job opportunities, earnings, and advancement; crime and violence lead to incarceration, which in turn affects one's ability to get a job, earn income, and marry, and so on. It should be noted that negative outcomes can also be risk factors in and of themselves. For example, low human capital is a negative outcome of early school leaving, but it is also a risk factor because low levels of human capital predispose youth to other negative outcomes, such as un- employment, low earnings, and crime and violence. Similarly, sexual and physical abuse are a nega- tive adult outcome, but they are also a risk factor in that they can predispose young people to mental health problems, risky sexual behavior, and crime and violence. Adult Negative Outcomes Low levels of education, poor work experience, low earnings, unemployment, poor physical and mental health, substance abuse, violence (including domestic violence), and unhealthy relation- ships with spouse, partner, friends and others are all adult outcomes that are influenced by negative youth outcomes. 3 NEGATIVE BEHAVIORS AND OUTCOMES OBSERVED AMONG CARIBBEAN YOUTH D espite the Caribbean's historical, political, cultural, and linguistic diversity, the negative behaviors and outcomes observed among Caribbean youth are quite similar. These include early sexual initiation and pregnancy, HIV/AIDS, sexual and physical abuse, school leav- ing (dropout and exit), unemployment, crime and violence, substance abuse and drug dealing, and social exclusion. These outcomes and behaviors are discussed briefly in turn. Early Sexual Initiation and Pregnancy Early Sexual Initiation Thc Caribbean region is characterized by a very early onset of sexual activity. Although other coun- tries in the world (e.g., the United States) have a large proportion of sexually active adolescents, no other region in the world for which data are available have such an early age of sexual initiation (Blum 2002).6 According to the nine-country CARICOM study, one-third of school-going young people were sexually active. Of these, more than half of boys and about a quarter of girls stated that the age at first intercourse was 10 years or younger, and almost two-thirds reported sexual initiation before the age of 13. In Jamaica, according to the reproductive health survey for 1997 (RHS-97), by age 11 to 12, about 20 percent of boys and girls in the general population have had sexual intercourse. In St. Lucia, almost 45 percent of sexually active adolescents engaged in first intercourse before the age of 10, according to the PAHO-funded St. Lucia 2000 adolescent health survey.7 Early age of sexual initiation predisposes young people to early pregnancy, STIs, and HIV infection (Blum 2002). Another issue particular to the Caribbean is that of forced intercourse. In the nine-country CARICOM study, of the one-third of adolescents who had had sexual intercourse, almost half 6. Sub-Saharan Africa is also characterized by early sexual initiation, but in contrast to the Africa region, most early sexual experiences in the Caribbean take place outside marriage. 7. The PAHO study, a school-based survey focused on age groups 10 to 19, surveyed 1,526 students from 29 primary and secondary schools island-wide. 16 WORLD BANK COUNTRY STUDY reported that their first sexual experience had been forced. The proportion was high for both girls and boys: 48 percent and 32 percent, respectively. Although th2 problem of forced intercourse among girls is also problematic in other countries (such as the UJnitcd States), the high incidence among boys is not common (Blum 2002) Adolescent Pregnancy Only four countries in the Americas have birth rates of more than 100 births per 1,000 women aged 15 to 19 years, and two of these are in the Caribbean (table 3-1). Antigua and Barbuda has lq~ 11011194M II l Country 1996 1998 2000 Antigua & Barbuda 116.0 120.2 116.0 Argentina 66.3 62.6 58.8 Bahamas 62.5 62.9 57.8 Barbados 52.1 50.5 49.0 Belize 110.9 103.6 96.4 Canada 24.3 22.9 22.4 Chile 63.0 55.1 48.2 Colombia 58.6 55.6 52.6 Costa Rica 86.0 76.7 69.4 Dominica 28.9 27.4 25.8 Dominican Republic 110.4 105.9 101.4 Ecuador 82.9 76.8 70.7 El Salvador 115.5 110.2 104.8 Grenada 92.9 90.5 83.4 Guatemala 108.1 103.6 99.0 Guyana 27.3 25.7 24.0 Haiti 75.4 71.9 68.3 Honduras 127.2 118.2 109.3 Jamaica 66.2 53.5 40.9 Mexico 55.8 50.7 45.7 Panama 63.9 55.9 48.0 Peru 67.8 61.3 54.7 St. Kitts & Nevis 77.2 70.5 63.8 Saint Lucia 65.9 58.5 51.1 St. Vincent and the Grenadines 77.2 46.4 34.6 Suriname 36.9 34.5 32.0 Trinidad & Tobago 20.8 18.7 16.7 United States 55.6 61.5 58.2 Uruguay 52.0 51.1 50.2 Venezuela 74.6 65.0 55.3 Source: www.paho.org/English/SHA/coredata * The ratio between the number of live births born to mothers aged I5 to 19 years during a given year and the mid-year female population 15 to 19 years of age, usually multiplied by 1,000. CARIBBEAN YOUTH DEVELOPMENT 17 the highest adolescent pregnancy rates in the Americas, followed by Honduras, El Salvador, and the Dominican Republic. But rates vary widely in the Caribbean. At the other end of the spectrum, Trinidad and Tobago has the lowest ratc in the Americas (16.7 per 1,000 women aged 15 to 19). Only seven countries in the Americas have rates lower thani 45 births per 1,000 women aged 15 to 19 years, and six of these are in the Caribbean (Trinidad and Tobago, Guyana, Dominica, Suriname, St. Vincent and the Grenadines, and Jamaica). Belize and Grenada have fairly high rates of teen pregnancy (96.4 and 83.4, respectively), and the other five countries fall somewhere in the middle (Haiti, St. Kitts and Nevis, the Bahamas, Barbados, and St. Lucia). In terms of pregnancies, the CARICOM survey revcaled that about 10 percent of school-going adolescents had been preg- nant or had gotten someone regnant (7 percent in the case of girls and 12 percent in the case of boys). The proportion is probably higher among school leavers. Despite high levels of sexual activity among adolescents, contraceptive use remains low. Only a quarter of CARICOM's school-going, sexually active sample were using some form of birth control, and only slightly more worry about getting pregnant or causing a pregnancy. In Jamaica, more than 40 percent of sexually active adolescent girls reported that they had not used, a contraceptive at last intercourse, and 87 perccnt of teenage pregnancies had not bcen planned (World Bank 2001b). Risky Sexual Behavior and HIV/AIDS After Sub-Saharan Africa, the Caribbean region currently has the highest HIV/AIDS prevalence rate in the world-and data suggest that for one-third of all new cases, the disease was contracted when the individual was aged 15 to 24 years.8 Out of the 12 countries with the highest HIV prevalence in the Latin America and the Caribbean (LAC) Region, nine are from the Caribbean (World Bank 2000a). HIV/AIDS has reached epidemic proportions in countries such as Haiti, the Bahamas, and Guyana. Jamaica and Trinidad and Tobago have concentrated HIV/AIDS epidemics.9 About 83 percent of AIDS cases are diagnosed in people between the ages of 15 and 54; one-third of all new cases are in the 25- to 34-year-old age group (see table 3-2). Given an estimated 8- to 10-year incubation period, about one-third of those who have new AIDS cases contracted the disease wvhen they were 15 to 24 years old. The high incidence of HIV among youth has been linked to early sexual initiation and low condom use among young people. According to the nine-country CARICOM study of school- attending adolescents, almost half (47 percent) of sexually active youth reported not using a con- dom. The majority of St. Lucia at-risk youth interviewed for the qualitative study indicated that they were worried about HIV/AIDS-however, the use and knowledge of contraception was low. In Jamaica, the level of knowledge about sexuality and contraception is reportedly high among adolescents, but it does not translate into preventive behavior, according to the RHS-97 (World Bank 2001b). Physical and Sexual Abuse Physical Abuse Many of the young people surveyed in the nine-country CARICOM study report a history of abuse in their lives. About one-sixth state that they have been physically abused, with most of the abuse being attributed to an adult in their home. Evidence from Jamaica, Barbados, and Dominica sug- gests that parents' use of harsh disciplinary action on children is common. A quantitative study on 8. Among women, the majority of cases are in the 25- to 29-year-old age bracket, followed by the 30- to 34-year-old age group; among men, the majority of cases are in the 30 to 34 and 25 to 29 age cohort (PAHO/WHO 1998, cited in World Bank 2000a). 9. According to World Bank (2000a), a generalized epidemic means that HIV has spread far beyond the original subpopulations with high-risk behavior (defined as engaging in unprotected sexual intercourse with many partners or sharing unsterilized needles or other injecting equipment); a concentrated epidemic means that HIV/AIDS is still primarily affecting population groups practicing high-risk behaviors (among whom infection rates exceed 5 percent) but are set to spread more widely in the rest of the population. 11.':.* * .A A * p!il1l! !i zE , . _~~~~~~~~~- M.ANI m m r P Agegroup C<1990 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 1982-2000 % <1 78 21 29 34 37 47 33 39 44 32 43 32 469 3 1-4 47 14 13 25 17 28 36 69 41 49 63 61 463 3 5-14 5 6 4 6 7 12 14 ls 11 8 22 23 136 1 15-19 34 13 14 11 20 25 21 43 21 23 49 24 298 2 20-24 !86 74 80 87 70 88 i28 IHI ! 00 iO8 166 09 i,307 8 25-29 329 110 120 165 195 209 234 242 244 218 314 240 2,620 15 30-34 315 120 152 182 192 210 312 299 286 360 389 280 3,097 18 35-39 195 87 132 159 20i 269 256 275 294 295 368 293 2,824 16 40-44 140 57 96 93 124 124 192 222 220 209 292 220 1,989 12 45q49 89 46 69 65 85 123 129 140 93 150 167 204 1,360 8 50-54 71 20 50 34 67 54 87 107 90 103 122 III 9!6 5 55-59 43 22 23 35 33 59 41 69 67 81 87 75 635 4 >60 48 22 33 38 44 35 73 78 59 80 77 80 667 4 Unknown 121 50 49 89 25 15 26 16 33 30 27 54 535 3 Total (all ages) 1,701 662 864 1,023 1,117 1,298 1,582 1,728 1,603 1,746 2,186 1,806 17,316 100 Source: Quarterly AIDS surveillance reports submitted to CAREC's Epidemiology Division by CAREC member countries. CARIBBEAN YOUTH DEVELOPMENT 19 sexual decisionmaking in Jamaica revealed that 50 percent of all respondents had reportedly been scverely punished as children (beaten, punched, pinched, or hit with a heavy object [Wyatt et al. 1993, cited in Le Franc 2001]). Another study carried out in Jamaica, Barbados, and Dominica suggested similar harsh disciplinary patterns, with the physical punishment of boys being particu- larly severe (Lc Franc 2001). Making boys tough and controlling boys is typically the justification for the harsher punishment of the male child. Cultural norms sanction the practice of corporal punishment to discipline children. Schools, for example, continue to use corporal punishment to impose discipline (Rock 2001, Meeks-Gardener 2001). A study of 29 schools in primary and all-ages schools in Jamaica showed that in 27 of the 29 schools, 87 percent of teachers and children reported that beatings occurred as an act of punish- ment, with teachers using a strap, belt, or ruler (Meeks-Gardener 2001). Boys tend to be treated more harshly than girls within the school environment (Rock 2001). Corporal punishment is also used widely by parents to teach their children to be compliant in countries such as Barbados (Rock 2001) and Jamaica (World Bank 2001b). Sexual Abuse Similarly, many of the young people surveyed in the nine-country CARICOM study report a history of sexual abuse in their lives. One-tenth report having been abused sexually, most frequently by adults outside the home or other teens, but many report abuse by adults in the home and siblings. There is remarkably little gender difference between males (9.1 percent) and females (10.5 percent) reporting sexual abuse. About one in eight reports that they worry they will be sexually abused. A 1993 study in Jamaica suggests a certain "normalcy" attached to the act of child sexual abuse (Rock 2001). The study, however, challenges popular beliefs about the abuse of children by stepfathers and mothers' boyfriends,'° instead finding that a greater level of abuse was taking place in two-parent households or in households where the relatives of the father were raising the child. Rock's more recent (2001) study of child abuse in Barbados supports this assertion. According to study findings, parents were reportedly the main perpetrators of child abuse in all categories except sexual abuse: Mothers made up the majority of perpetrators of physical abuse (49.4 percent), non- family members made up the majority of sexual offenders of children (55.5 percent),'1 and mothers made up the majority of those who neglect their children (68.0 percent). Rock also found that the reported cases of child abuse and neglect were increasing in Barbados. 12 School Leaving As with other indicators, the number of out-of-school youth varies significantly across Caribbean countries. According to data compiled by the CYP, the proportion of youth whose highest level of education is primary school is as high as 58 percent in Dominica, 54 percent in Belize, and 53 percent in St. Vincent and the Grenadines (Danns, Henry, and LaFleur 1997). In Jamaica in 1999, 2.5 percent of 12-to 14-year-olds were not in school, but by the age of 15 to 16 years, the propor- tion of school leavers was almost 17 percent, which reflects a significant dropout rate at the sec- ondary education level (Samms-Vaughan 2001). Secondary enrollment rates also remain low in the Dominican Republic. In 1998, net secondary enrollment was 17 percent for boys and 36 percent for girls; in urban areas, the rates were 40 percent for boys and 47 percent for girls (World Bank I0. Indeed, according to perceptions of St. Lucia key informants of this study, the preponderance of loosely attached males within most single-parent families leads to a high level of sexual abuse of female adoles- cents within the home setting. It is so commonly perceived that stepfathers are acting as sexual predators on female youth that in 2001, a calypso was written on this social problem. 11. The data indicated that 19.8 percent of sexual offenders were the children's fathers, 13.8 percent were the stepfathers, and 10.9 percent were other family members. 12. A total of 763 cases were referred to the Child Care Board between April 1989 and March 1990; from April to March 1997-98, the cases reported were 1,132, and 1,113 from April to March 1998-99 (Rock 2001). Underreporting of cases is suspected, however, given that reporting is not mandatory. 20 WORLD BANK COUNTRY STUDY 2001b). Not surprisingly, net enrollment rates are significantly higher among the nonpoor than the poor (World Bank 2001b). Also, the proportion of boys who do not attend secondary school is similar for the nonpoor and the poor after controlling For wealth variables. Across the Caribbean, more boys than girls tend to fall behind and leave school. In the case of Jamaica, in 1996-97 and 1999-2000, a slightly higher proportzon of boys than girls were enrolled at the early childhood and primary school levels; at grades 7 to 9, females accounted for just over 50 percent of enrollment; and at grades 10 to 11, the gender gap widened in favor of females, with a percentage gap of 8.8 and 5.2 between rnale and female enrollment in 1996-97 and 1999-2000, respectively. In St. Vincent and the Grenadines, for thie 1991-92 school year, the ratio of female to male students was nearly 1.5 to 1 (Barker 1995). And gender gaps in grade repetition and dropout in the Dominican Republic are among the widest in Latin America (World Bank 2001b).13 Unemployment As in other parts of the world, unemployrnent in the Caribbean is primanily a youth phenomenon (see tables 3-3 and 3-4). Across countries in the Caribbean and elsewhere, youth unemployment rates-that is, the number of 15- to 24-year-olds looking for work as a proportion of the sum of 15- to 24-year-olds that are either working or looking for work-are double to quadruple the adult rates. International comparisons, however, indicate that some Caribbean countries have particularly high youth unemployment rates. According to the World Development Indicators, from 1996 to 1998, St. Lucia had the highest rate in the Americas and the Caribbean, followed by Jamaica (among those countries for which data were available).'4 Caribbean-wide data indicate Youth (I 5-24 years) Aclult Youth as share of unemploymient (%) unemployment (%) unemployed (%) Country Year All Male Female All Male Female All Male Female Antigua and Barbuda 1991 13.0 13.1 12.8 4.2 4.0 4.4 47.0 47.5 46.0 Anguilla 1992 13.7 14.1 13.0 4.0 4.0 3.9 55. 1 56.3 52.9 Barbados 1999 17.9 15.2 20.9 7.4 5.2 9.6 36.6 41.8 33.3 Belize 1999 18.4 13.4 25.8 8.2 6.1 12.1 50.8 47.7 53.5 Dominica 1997 28.1 28.9 26.7 14.4 15.3 12.6 40.9 39.5 43.8 Grenada 1998 23.9 21.1 28.2 9.2 5.3 13.5 49.0 59.8 43.8 Guyana 1992 21.I 17.2 27.7 5.2 3.2 8.8 66.9 72.0 62.3 Jamaica 1999 25.4 19.1 31.8 8.9 5.4 12.8 52.6 57.2 50.1 St. Lucia 1998 30.6 27.7 34.0 12.5 9.9 15.4 50.0 54.2 46.4 St. Vincent and the Grenadines 1991 26.7 24.7 30.0 11.2 10.8 11.9 55.3 54.2 57.1 Trinidad and Tobago 1999 20.2 17.9 23.6 8.8 7.2 11.2 42.8 44.1 41.6 Source: ILO 1999. 13. Completion rates for boys from the richest 20 perceni: of households are higher than for girls, and completion rates for girls from poorer households are higher than for boys. This suggests that poor boys are left behind or are pressed to drop out of school to provide income support to the family, whereas traditional domestic work typically carried out by poor girls is more compatible wVth schooling. 14. See http://www.worldbank.org/data. Countries for which data were available included the Bahamas, Barbados, Brazil, Canada, Chile, Colombia, Costa Rica, Ecuador, Hon-duras, Jamaica, Mexico, Panama, St. Lucia, Suriname, the United States, Uruguay, and Venezuela. Follcwing St. Lucia and Jamaica, Panama, Trinidad and Tobago, and Barbados had the highest rates, in that order. CARIBBEAN YOUTH DEVELOPMENT 21 I ABLE 3-4: UNEMPLOYMENT LEVELS IN THE DOMINICAN REPUBLIC BY AGE GROUP, URBAN OR RURAL RESIDENCE, AND SEX Urban Youth relative to total 15-19 20-24 25-34 35-44 45-54 55-70 Total (15-19) (20-24) Male 29.4 19.6 8.4 5.0 5.2 5.8 11.2 2.63 1.75 Female 53.1 40.5 22.2 17.8 14.4 13.8 25.3 2.10 1.6 Rural Youth relative to total 15-19 20-24 25-34 35-44 45-54 55-70 Total (15-19) (20-24) Male 17.2 9.0 5.0 1.1 1.1 6.1 6.2 1.54 0.80 Female 49.8 33.9 23.2 19.4 14 8.9 24.4 1.97 1.34 Source: World Bank (2001 b) based on Encuesta Nadonal de Gastos e lngresos del Hogar, 1998. St. Lucia, followed by Dominica, St. Vincent and the Grenadines, and Jamaica have the highest youth unemployment rates (see table 3-3). In those Caribbean countries where all unemployment is high, many youth are "discouraged workers," meaning that they would like to work but do not even bother looking for a job because they know that they will not find it. Thus, youth unemployment is likely to be underestimated in high unemployment economies. Nonetheless, youth in the Caribbean make up 20 to 30 percent of the labor force but represent 40 to 60 percent of the unemployed (with the exception of Barbados). Youth unemployment rates are higher for females than males, although their proportion of the total unemployed labor force tends to be less (see tables 3-4 and 3-5). This means that fewer young women than young men are in the labor force, but within their respective gender groups, a larger share of young females is unemployed. In the English-speaking Caribbean, the gender differential is greatest in Belize, followed by the Bahamas, Jamaica, and Guyana. Gender differentials in the Dominican Republic are even greater, with rates for young rural women aged 20 to 24 years being almost triple those of rates for young rural men. Last, as the Dominican Republic data indicate (table 3-5 ) unemployment is primarily an urban problem, and male urban youth have the highest share of total unemployment (concentration factor of 2.63). Crime and Violence Based on homicide rates, the LAC Region as a whole is the most violent region in the world. At 22.9 per 100,000 people in 1990, homicide rates for the Caribbean are almost double the world aver- agc of 10.7 per 100,00015-and as in the rest of the LAC Region, available data indicate that homi- cide victims and perpetrators are disproportionately young men.16 Within the Caribbean, Jamaica's homicide rates are the highest (35 homicides per 100,000) and levels for the Dominican Republic and Trinidad and Tobago exceed the world average (11.7 and 12.6 homicides per 100,000, respectively) (Ayres 1998). Violence also appears to be mounting in the larger islands; for example, it increased sixfold in Trinidad and Tobago from the early 1980s to the early 1990s. Violent crimes tend to be geographically concentrated in poor urban communities (Ayres 1998), with Kingston, Jamaica, reportedly having one of the highest murder rates in the world.'7 15. Rates are for 1990, which was the last year for which subregional Caribbean data were available. 16. Homicide victims and perpetrators in the Americas are disproportionately men aged 15 to 24 years (PAHO 1993, cited in Barker 1998). 17. Sunday Gleaner, October 17, 1998. 22 WORLD BANK COUNTRY STUDY JAges 17 to -25, Ages 17 29, as share of all crimes as share of all crimes Offense (%) (%) Murder 47.8 84.8 Manslaughter 44.4 80.0 Felonious wounding 32.1 64.1 Sex offenses 38.9 74.4 Burglary 41.7 64.1 Robbery 55.1 74.6 Breach of firearrns act 64.0 81.3 Shooting with intent 100.0 100.0 Larceny 67.4 84.7 Arson 33.3 33.3 Forgery 49.3 77.5 Unlawful possession 83.3 100.0 Breach of drug laws 62.1 85.3 Other offenses 60.9 84.2 All crimes 55.7 79.6 Source: Pantin 2000. Department of Corrections data for Jamaica show that young people (aged 17 to 30) comI- mit most offenses, with youth (aged 15 to 24) contributing significantly to crime and violence (table 3-5). Youth aged 17 to 25 commit 56 percent of all crirnes, almost 50 percent of murders, 44 percent of manslaughters, and 42 percent of burglaries. Available information for Jamaica indicates that perpetrators of crime tend to be young rnen. In 2000, 20- to 25-year-old males were the principal offenders in all types of major crimes in Jamaica and accounted for 37 percent of all murders committed in that year, according to the Planning Institute of Jamaica (PIOJ) Economic and Social Survey ofJamaica (1999) Young men also tend to be the main Nrictims of hornicides. ]3ased on 1990 data, a 1993 Com- mission on Youth in Barbados found that youth were much more likely to die from homicide and purposefully inflicted injuries than any other age group. Young people made up nearly two-thirds of those found guilty of crimes; males were four times more likely than females to be found guilty of a crime, with the sex differential having increased every year since [960 (Braithwaite 1993, cited in Pantin 2000). In Jamaica, among patients seen in emergency units of public hospitals with trauma and injuries related to acts of violence in 2000, the highest proportion of patients were 20- to 29-year-olds (31.6 percent), followed by 30- to 39-year-olds (29.8 percent) and 10- to 19-year-olds (22.3 percent) (PIOJ, based on Ministry of Health data, cited in World Bank 2001b).'8 18. It is important to note that whereas young people are more likely to be victims of violence, most Caribbean countries tend to have youthful populations, thus explaining the concentration of homicides among youth. Comparing trends of homicide v, ctims for the United States and Trinidad and Tobago, for example, shows that as the population ages in Trinidad and Tobago, the risk of dying by homicide decreases. This is not the case in the United States, where the share of homicide victims tends to be concentrated among youth despite an aging population. CARIBBEAN YOUTH DEVELOPMENT 23 The nine-country CARICOM study of school-age youth, as well as the qualitative information from the Dominican Republic, confirms the presence of violence in the lives of youth. One-fifth of males in the CARICOM sunrey had carried weapons to school in the previous 30 days of the survey, and nearly as many had been in a fight using weapons. Also, the gang violence rate is high, with one in five school-going boys and one in eight school-going girls indicating that they had at some timc belonged to a gang. Out-of-school youth interviewed in the Dominican Republic substantiate the presence of gangs and violence in their communities. Youth tend to join criminal and drug- dcaling gangs to compensate for lack of formal employment opportunities or as a strategy for con- fronting the violence in their communities. Ganigs and political parties were the organizations with whom youth mostly identified. Ragc is apparently a common sentiment among Caribbean youth, with more than 40 percent of teenagers reporting such emotions, according to the CARICOM survey of school-going youth. Two out of five report that sometimes or most of the time they think about hurting or killing someone else, and almost 5 percent report that they almost always think about hurting or killing others. Males consistently report rage significantly more often than their female counterparts in every age group of teens. About one in eight of youth surveyed have tried to kill themselves, with no appreciable differences between males and females or different age groups. Substance Abuse and Drug Dealing According to a United Nations International Drug Control Programme (UNDCP)-funded study, drug and substance abuse and youth involvement in drug dealing are significant problems facing at-risk youth in the Caribbean (Barker 1995). Although data and information are scanty, the study-which involved St. Vincent and the Grenadines, Trinidad and Tobago, St. Martin and Jamaica-summarized the situation as follows: Both among in-school and out-of-school youth, there is a widespread social acceptance of alcohol and marijuana in the Caribbean. Youth interviewed in focus group discussions tended to rank drugs according to their acceptability, with alcohol being the most heavily used and accepted, marijuana second and cocaine last. Both marijuana and alcohol were seen as socially acceptable, while cocaine and crack were seen as more dangerous and more extreme in their side effects and their implications. The study also found that the group most at risk of substance abuse and involvement in drug dealing were out-of-school youth aged 13 to 19, particularly male youth. By country examined, the study revealed the following: St. Vincent and the Grenadines: Statistics from 1990 to 1994 found that about 12 to 16 per- cent of all inmates had been imprisoned for drug-related charges; other theft and larceny charges are also likely to be drug related. The majority of the inmates were 16- to 30-year- olds. Although there are no statistics on substance abuse among out-of-school youth, a 1993 survey of 1,428 students in St. Vincent and the Grenadines (representing 81 percent of 11 - to 16-year-olds) found that alcohol was the most widely used substance, with 89.9 percent say- ing they had used alcohol, and 34 percent had used in the past 30 days. Only 11.5 percent reported they had used marijuana, and fewer than 1 percent had ever used cocaine. Trinidad and Tobago: Recent studies have found fairly high rates of substance use among in-school youth, as well as widespread access. In general, alcohol and marijuana are the most widely accepted and the most widely available. One 1992 study of youth in primary and secondary schools found that 14 percent of youth in primary schools said that mari- juana was easy to obtain, and 12 percent said the same for cocaine. At the secondary level, 38 percent said marijuana was easy to obtain, and 13 percent said cocaine was easy to obtain. In terms of substance abuse in schools, various studies carried out between 1985 and 1988 found that among 11 - to 19-year-olds, between 80.4 percent and 91.1 percent 24 WORLD BANK COUNTRY STUDY had uscd alcohol, betwcen 6.3 pcrccnt and 10.6 percen-: had used marijuana, and between 1.1 pcrcent and 3.3 percent had used cocaine. Jamaica: Although no data were available, anecdotal evidence points to a major problem in substance abuse and drug dealing among out-of-school youth in Jamaica. The most recent survey on drug use among in-school youth was carried out by the Jamaican gov- ernment in 1997, and it found that 71 percent had used alcohol, 27 percent had smoked ganja (marijuana), and 2 percent had tried cocaine. Higher percentages appear to drink marijuana brewed as tea. Various qualitative studies have concluded that young out-of- school males from low-income families are the group most likely to use drugs. Similarly, anecdotal evidence suggests that rnany youth are involved in drug trafficking and drug dealing. Some youth report that drug dealers are currently role models for many youth, especially males. Both at-risk and control youth groups in the St. Lucia qualitative study suggested that alcohol use was widespread and in most cases began in the early to preteen years. According to the 2000 PAHO adolescent health study for St. Lucia, 63.3 percent of in-school teens surveyed had taken an alcoholic drink in the year preceding the study, and alrmost 10 percent drank alcohol on a monthly or more frequent basis.19 Social Exclusion Numerous authors and researchers have described or referred to Caribbean youth and at-risk youth as feeling powerless and excluded from the mainstream of Caribbean societies (Danns, Henry, and LaFleur 1997; James-Bryant 1992; Deosaran 1992; Lewis 1995; West Indian Commission 1992; Barker 1995). This is not surprising, given that the social integration of youth involves the insertion into the workforce and political, social, and cultural life, as well as a smooth transition from dependence on the family to independence (Morales 2001). In the case of many Caribbean nations-with their inequality of educatiornal opportunity, high levels of youth unemployment, and precarious employment-many youth face extreme difficulties in completing this passage, which is a key component of future healthy adult life and well-being (Danns, Henry, and LaFleur 1997). According to the St. Lucia qualitative data, a large number of at-risk youth feel excluded from decision making in the development of the country ancl even from their own communities. In addition, at-risk youth-especially males from ghettos--are branded and socially excluded because of the communities in which they reside, ffirther promoting their isolation. Qualitative data col- lected among at-risk youth in the Dominican Republic suggest similar patterns. Interviews there revealed the following: This youth's social life takes place in an atmosphere that lacks such minimum services such as electricity, water, adequate homes, clubs, sports facilities, libraries, health services. While neigh- borhoods have schools, these are few and do not meet demand. Thus the social life of youth is extremely deficient. Even when community-based organizations existed in their neighborhoods, the youngsters were excluded. For example, in rural areas, young women who are pregnant or have children, cannot access cultural community groups that offzr technical education because these groups are targeted to young female virgins with no sexual experience. The strongest organizations (drug dealers and gangs) dominate the environment in many poor communities. They are the ones that set the rules of the game in these settlements. 19. The 2000 PAHO-funded St. Lucia adolescent health survey surveyed 1,526 students from 29 primary and secondary schools island-wide. CARIBBEAN YOUTH DEVELOPMENT 25 Youth played an active role in the birth of politically independent Caribbean (Lewis 1995), but disillusion among youth followed.20 Postcolonial Caribbean youth have found themselves in societies in which "thc rhetoric of self-reliance2 of ncw visions for youth, of education as a vehicle for democ- racy, of youth entrepreneurship, all thesc promises did not materialize in viable amounts" (Deosaran 1992). Youth had come to realize that they werc living in a political culture where "nepotism crowns geriatric politics" (Deosaran1 1992). Indeed young pcople found that " in large measure, the politics of colonialism have given way to a political independencc which provides its owIn entrenched elites, leaving a blockade against change and youthful succession" (Deosaran 1992). Disillusion and distrust appear to have led to indifferenice. According to Barker (1995), many youth-particularly at-risk youth-do not use thc programs set up for them by government and non- governmental organizations (NGOs) because these youth have lost trust in institutions. Dominican Republic informants suggest that youth indifference is a major problem among those faced with the most risk factors. According to these sources, attracting youth to community organizations is increas- ingly difficult because of disinterest among youth. Similarly, St. Lucian at-risk urban youth who were intenriewed voiced disinterest in and negativity toward community activities. The data indicate that, as in other parts of the world, those youth who most need special services and supports are those youth most reluctant or least likely to use these services. 20. "Throughout the Caribbean during the 1930s it was the bulk of the young people who were among the chief architects of the labour revolts of that time" (Lewis 1995, 9). The social unrest of the 1930s not only gave birth to the labor movement in the Caribbean but also provided the political leadership for the independence movements in the region. In the 1970s, many young people-particularly students-across the region supported the black power movement in an attempt to realize Bob Marley's call to emancipate black people from mental slavery and as a response to the residue of racism still embedded in the social structures of the region. Young people played an active role in both the attempted coup in Trinidad and Tobago in 1990 and the Grenadian revolution in 1979. 4 SOURCES OF POSITIVE AND NEGATIVE YOUTH OUTCOMES T his chapter identifies primary risk and protective factors associated with youth development in the Caribbean, which may be thought of as policy intervention points. Although the problems facing youth in the Caribbean are well known and often discussed, the causes behind the observed risk-taking behavior and negative youth outcomes remain a mystery. A better understanding of those factors associated with risk-taking behaviors is necessary for appropriate program design and policy. The quantitative data in this chapter provide an estimate of the correlation between risk or protective factors and risk-taking youth behavior or outcomes, and the qualitative data are used to explain the quantitative findings and suggest causality. Because of the cross-sectional nature of the quantitative data, it is not possible to identifv a particular risk factor as the cause of an observed behavior or if other unobservable characteristics are responsible for the correlation. For example, statistics show that youth who attend religious services are also those who have a lower tendency for substance abuse. This finding does not allow one to deduce that religious service attendance leads to lower substance abuse or that lower substance abuse leads to religious service attendance. The causation may go in either direction, or a completely different factor may be affecting both behaviors, causing the observed correlation, such as a supportive family structure that leads to both lower substance abuse and religious service attendance. Because causal relationships caunot be determined by the quantitative data, the qualitative data are exploited, where appropriate, to suggest causal relationships. The most pertinent risk and protective factors in each of the categories in figure 2-1 are dis- cussed here. Although each category of risk or protective factor is discussed independently, it is important to note that there is a high degree of interconnectedness among the risk or protective categories. Most of the supporting evidence in this chapter is drawn from three sources: Blum (2002); Luther, St. Ville, and Hasbun (2002); and Barker (1995). The first source is a background paper prepared for this study that uses data collected from schoolchildren in nine CARICOM countries to examine the connection among family, school, community, self, and risk-taking 27 28 WORLD BANK COUNTRY STUDY behaviors.2' The paper by Luther, St. Ville, and Hasbiun (2002), which was also prepared specifically for this study, reports findings from focus groups and youth exp,-rts in St. Lucia and the Dominican Republic who discussed the factors that leod to the challenges fazing youth today. Finally, Barker's study (1995), wvhich was prepared for the 1J.N., reports discussions with focus groups and youth experts about the use and sale of drugs in St. Martin, Jamaica, St. Vincent and the Grenadines, and Trinidad and Tobago. The methodology used in the background papers prepared for this report is discussed in appendix 2; the methodology for Barker (1995) can be found in the source. The termi- nology used in this chapter is given in appcndix 2. Individual Youth who display low self-esteem, rage, arnbivalence, or hopelessness are also those who are exposed to risk factors and engage in risk-taking behaviors. These negative dispositions may be biological, the propensity for the behavior may be biological but is triggered by the environment, or they may be purely learned. Regardless of whether these are truly exogenous feelings or a result of the environ- ment, they are correlated with unfavorable activities. Self-esteem: A positive self-image is a filndamental factor in protecting youth from consuming drugs or alcohol, engaging in violence, or initiating sexual activ; ty. Risk factors correlated with low self-esteem among Caribbean youth are primarily found in the household: maternal emotional abandonment,22 an absence of parental nurturing (connectedness), unskilled parents, and sexual abuse in the household that is known and accepted by other adults. Additionally, the exclusionary nature of the school system-both in expelling children from school who do not pass the entrance exams and the social ranking in secondary schools by the color of uniform worn23-and poverty that includes coming from the "wvrong" neighborhood were identified by St. Lucian youth as negative influences on self-esteem. Rage: Feelings of rage are prevalent among youth who use tobacco, alcohol, and drugs; under- take violent activity; and prematurely engage in sexLual activity.24 Holding all else constant, fewer than 10 percent of school-going boys and 5 percent of school-going girls who do not feel rage smoke tobacco or consume alcohol, and fewer than 20 percent use drugs. Conversely, among those school- going youth who do express feelings of rage, the use of tobacco and alcohol doubles for boys and triples for girls, and drug use approaches 30 percent (figures 4-1 and 4-2). Although the data do not allow us to test for causality, it is likely that tobacco use is a result of rage rather than a cause of it. Similar increases are seen with violence and sexual experience, where 22 percent of boys and 9 percent of girls who are happy engage in violence cornpared with 70 percent of boys and 40 per- cent of girls who feel rage. Sexual experience, which is a high 35 percent for boys and 13 percent for girls who attend school, nearly doubles with male rage and increases 2.5 times for girls who feel rage. When controlling for age, these same: propensities emerge With respect to suicide, feelings of rage increase suicide thoughts or attempts by 14.6 percent, especially among boys (Blum 2002). The sources of rage may include family, institutions, and limited economic opportunities. An aggressive family is a key correlate with rage, and connectedness with parents is a key correlated 21. Because of an agreement with the partfcipating countries, country-by-country results cannot be presented. However, able Al.1 found in appendix 1 shows that the regression results are very similar across countries, allowing us to generalize across the sample countries. 22. Maternal emotional abandonment alludes to mothers giving up on their children and holding them responsible for their own failings, thus contributing to low self-esteem (Luther, St. Ville, and Hasbun 2002). 23. In many countries, youth are assigned to secondary schools based on their performance of the Com- mon Entrance Exams. Each school has its own uniform, thus, attendance at a more prestigious secondary school is clearly signalled by the uniform worn by the young person, w..nich also speaks loudly about his or her ranking on the CEEs. 24. Nearly 40 percent of girls and 47 percent of boys in the English-speaking Caribbean countries think about hurting or killing someone-a proxy for rage. This propensity increases and deepens with age (Blum 2002). The estimated odds ratio betveen rage and risky behaviors is significant at the 1 percent level as fol- lows: violence (2.44-3.23, higher for boys), sexual initiation (1.7-1.8), and substance abuse (1.24-1.63 for ages 13 to 15 and 16 to 18) (Blum 2002). CARIBBEAN YOUTH DEVELOPMENT 29 80% 60% 40% 20% 0% Smoking Alcohol Drug use Violence Sexual expenence 0 Low rage U High rage Source: Blum 2002. 80% - 70% - 60% - 50% - 40%- 30%- 20% 10% 0% Smoking Alcohol Drug use Violence Sexual experience DLow rage D High rage Source: Blum 2002. protective factor.25 More than half of school-going youth who feel rage have been physically or sex- ually abused by family members, and 38 percent of those who feel rage have not suffered abuse (table 4-1). Those who feel connected to their families are only half as likely to feel rage, especially among girls (Blum 2002). This is constant across age. Connectedness to other adults and religious institutions also is associated with lower rage, but the school and justice systems are correlated with higher levels of rage. Qualitative evidence sug- gests that these institutions create rage. For example, young people in St. Lucia report that expul- sion from school as a result of failing entrance exams or wearing the uniform of a less prestigious school instills anger toward the system in young people. This is exacerbated in poor areas, where the interviewed youth (in the Dominican Republic and St. Lucia) feel that police authorities are 25. The estimated odds ratio when regressing the probability of feeling rage on the parental abuse variable ranges from 1.27 to 1.53, with a higher value for younger children (ages 10 to 12). This is significant at the 1 percent level. The family connectedness estimate ranges from 0.44 to 0.51, again with the largest effects for the youngest children (Blum 2002). 30 WORLD BANK COUNTRY STUDY Emotional distressa No abuse (%) Physical abuse (%) Sexual abuse (%) Both (%) Depression (50.4%) 45.7 65.4 61.9 69.7 Rage (40.1%) 37.8 54.7 53.5 51.2 Suicide attempt (12.1 %) 9.1 20.1 23.1 28.9 a. Percent of total sample reporting. Source: PAHO Adolescent Health Survey 2000. aggressive and prejudiced. Finally, the lack of job opportunities in a stagnant economy was identi- fied as a source of youth anger (Barker 1995; Luther, St. 'v'ille, and Hasbun 2002). Ambivalence: A key observation of those who work with youth is that young people are less willing to be proactive in support of the public good, instead preferring to put their energies toward personal needs. Many youth programs dep,-nd on the participation of young people, who were key to political struggles in the 1970s (Williams 2002, Alexis 2000) anid to putting youth on the agenda in the 1980s (Williams 2002, National Yoi:.th Council--St. Lucia). Increased individualism and con- sumerism, which both youth experts and young people themselves trace to U.S. media images and inequality that is highlighted by the tourist and drug trades, teach young people to put energies into themselves (Barker 1995). When voluntary community action takes place, the motivations are often personal, rather than collective. This is clearly expressed by a young man in the Dominican Republic who said, "We fight so that they can fix our streets because you buy a pair of new sneakers and this street with all the dirt damages them." (Lu-her, St. Ville, and Hasbuin 2002). Hopelessness: Ambivalence may be a reaction to the hopelessness felt by young people who believe that they have no chance for happy, productive lives because the institutional and economic systems do not offer any chances for advancement (Bariker 1995). In particular, youth reported that corruption in public institutions leads to inefficient use of resources and a failure of the state to respond to their needs, whether medical, security, educational, or social protection. Additionally, the exclusionary nature of the school systern denies many childrzn the opportunity for secondary or college-level education, which youth identify as a key input to finding good jobs in the future. Even those who do obtain education will enter a highly competitive job market where jobs are scarce and well-paying jobs are even more difficult to find. Microenvironment The microenvironment-those institutions and influences that the young person confronts daily-are a source of both risk and protective factors, as discussed in chapter 2. The microfactors differ from the macrofactors in that the former are those influences that are confronted on a very close, personal level, and the latter are shared across all youth on a national level. In the context of the Caribbean, the research reveals the importance, first and foremost, of the family and the high correlation between familial protective factors and positive youth behaviors, on the one hand, and familial risk factors and youth risk-taking behaviors, on the other hand. Other important micro- environmental forces are peers, roles model.,, social networks, and the community or neighborhood. Family Familial behavior is both the strongest protective factor and a risk factor in youth development. It is a protective factor in that family connectedness (Resnick anid Hojat, 1997; Blum and Rinehart 1997), appropriate levels of parental discipline (Barker 1995), moral guidance, protection from dangers in the adult world, and economic support allow young people to acquire personal and social skills while young (Luther, St. Ville, and Hasbun 2002). However, parental displays of negative behaviors (drug use, alcohol abuse, violence, low commitment to family); physical, sexual, and emotional abuse by family members or within the home; and the absence of parental guidance and support CARIBBEAN YOUTH DEVELOPMENT 31 FIGURE 4-3: PREDICTED PROBABILITY OF ENGAGING IN RISK-TAKING BEHAVIOR BY LEVEL OF PARENTAL CONNECTEDNESS, Boys 80% 70%- 60%- 30% - 20%- 10% 0% Smoking Alcohol Drug use Violence Sexual experience |OHigh I3Low | are risk factors. These can damage self-esteem; truncate a young person's personal, academic, and social development; and teach youth to perpetuate these same behaviors. Parental connectedness: School-going youth who feel close to their parents have lower participa- tion in substance use, violence, and sexual activity (Blum 2002). Both girls and boys who feel close to their families are about 10 percent less likely to engage in these risk-taking behaviors (figures 4-3 and 4-4). Regression results show that this is the most consistently important protective factor of those in the analysis, being positively correlated with all risk-taking behaviors (Blum 2002). Parental connectedness is likely to directly and indirectly influence young people's decision to engage in negative behaviors. The direct influence may be a desire of the child to not disappoint caring parents. For example, young people who perceive that their parents have expectations that FIGURE 4-4: PREDICTED PROBABILITY OF ENGAGING IN RISK-TAKING BEHAVIORS BY LEVEL OF PARENTAL CONNECTEDNESS, GIRLS 100% - -- --. . . . --- -.- -_. _ . 80% - 60% - 40% - 20%/ 0% Smoking Alcohol Drug use Violence Sexual experience |OHigh E Low 32 WORLD BANK COUNTRY STUDY FIGURE 4-5: 3:; ii I - 8EeE I I _ PARENTAL ABUSE, Boys 50% - 45% 40% - 35%- 30% - ______________________ ____________ 25%- 20%- 15%- 10%- 5% Smoking Alcohol Drug use Violence Sexual experience | OHLow igh they can complete school not only do better in school but also participate less than others in risky behaviors (Resnick and Hojat 1997, Luther, St. Ville, and Hasbun 2002). Furthermore, young people who believe that their parents would be opposed to the early onset of intercourse are less likely than their peers to become sexually active.26 Conrversely, a lack of parental connectedness leads to more rage and lower self-esteem, wvhich drive young people toward risky behaviors. The building blocks of parental connectedness include adult parents and resources. Interviews with youth consistently report that adolescent mothers have limited skills in being a good parent (Barker 1995, Luther, St. Ville, and Hasbtin 2002) because of their inexperience in adulthood. Adolescent fathers face the same limitations as the women, but in addition, young childfathers (the father of the child of the adolescent mother) are less present and supportive than are older fathers (Russell-Brown, Engle, and Townsend 1994). Poverty also lowers parental connectedness because parents may need to spend the time working or compensating fDr absent public services (poor pub- lic transportation, absence of running water, absence of electricity), which precludes spending time with one's child and building a relationship. Physical, sexual, and emotional abuse in the home: A primary risk factor that is correlated with risk-taking youth behavior is physical, sexual, and emotional abuse by parents or by nonfamily members who have access to the household. Parental abuse is correlated with higher use of alcohol and tobacco by both boys and girls, and it is even more strongly correlated with drug use, violence, and early sexual initiation. For example, 16 percent of school-going boys who are not abused by their parents use drugs, but 28 percent who are abused use drugs; for girls, drug use increases from 13 percent to 18 percent with parental abuse (figures 4-5 and 4-6). Among school-going girls, sex- ual experience doubles if they are abused in the home. Child abuse can be attributed to poor parental skills, poverty, and culture. Poor parenting skills are especially relevant among adolescent parents, who have not developed as adults themselves and are unable to cope with their own children. Violence is a common response to stress and anger in Caribbean countries, feelings that may be accentuated by pover-y. Moreover, scholars suggest that 26. Recent research suggests that most of these perceptions come from nonverbal rather than direct verbal messages (McNeely et al. forthcoming). Parental behaviors and interactions, rather than words appear to be more effective. CARIBBEAN YOUTH DEVELOPMENT 33 FIGURE 4-6: PROBABILITY OF ENGAGING IN RISK-TAKING BEHAVIORS BY DEGREE OF PARENTAL ABUSE, GIRLS 25% 15% 10% Smoking Alcohol Drug use Violence Sexual experience |OLow MHigh the acceptance of violence is reinforced through culture. Caribbean researchers hypothesize that the colonial history in the English-speaking Caribbean has institutionalized the culture of physical and mental abuse (Patterson 1975, Barrow 2001). They report that slave mothers were tradition- ally abusive of their children to better prepare them for their future life as slaves; sociologists sug- gest that this behavior is the basis of the abuse that persists today. These authors also hypothesize that men were not family fathers, serving only as biological fathers, during the slave period, so they did not feel connectedness to their own children or partners. This, in turn, lowers inhibitions against abuse by the father, making the behavior more common. Risk-taking behavior by parents: Parental involvement in substance abuse and violence has negative demonstration effects on youth. One of the primary correlates of youth substance abuse and sexual initiation, particularly among children aged 10 to 12, is parental substance abuse(Blum 2002). The early sexual initiation may result from abusive behavior of intoxicated parents or parental friends (Barker 1995). Both violence against others and self-inflicted violence (suicide) are correlates in youth violence and suicide, especially among young children (Blum 2002). The likely sources of risk-taking behavior by parents are from their own experiences as youth and from poverty. The intergenerational transfer of risk-taking behaviors is well known as one group of youth becomes tomorrow's problem adults and teachers of tomorrow's youth. Poverty exacerbates the situation by increasing anger and hopelessness within adults as well. Presence of two biological parents27: Two-parent families have more economic and emotional resources, as well as time and energy, to devote to their children than do single parents. Single par- ents must both work and provide for their children's basic needs, leaving little time for deeper time and emotional investments in their children.28 However, the presence of twvo adults will allow a 27. Access to extended family has also been found to be highly protective (Burton, Allison, and Obeidal- lah 1995). In many African tribes, it is clear to whom (other than mother or father) a young man or woman will turn in trouble. In many clans around the world, aunts and uncles are often referred to as mother and father. In highly mobile Western and migratory societies of the developing world, where young men and women leave their villages for large urban centers, this source of protection is becoming less available. 28. The youth in the focus groups and in more general consultations reflected that their mothers were their "closest friends" or had made great sacrifices for their children. Thus, this report should not reflect that women without partners are not good parents, nor should it suggest that their achievements are underrecog- nized. The report only intends to point out that the challenges are greater for a single parent and that children of single parents, even when levels of poverty are controlled for-have more difficulties than do children from two-parent households. 34 WORLD BANK COUNTRY STUDY division of labor, resulting in higher overall family income and more time directed toward child- care.29 This increases connectedness and thus decreases engagement in risky behaviors. According to Samms-Vaughan (2001), children have higher academic anc cognitive scores when both biolog- ical parents are present, followed by two surrogate parents, and one biological parent; having a bio- logical parent combined with a surrogate parent is associated with children's poorer academic and cognitive scores, especially when the surrogate parent 1s tne father.30 Samms-Vaughan hypothesizes that children's higher achievement with both biological and surrogate parents may be a result of the stability of these unions, which is transferred into the child's emotional stability. Finally, "barrel children," whose parents have both migrated, are at a particular risk because they do not have the protection of either parent. Migration of parents is common because of better economic opportunities in other countries. Children are left behind with relatives or friends who receive payment from the parents until the parents are able to pay for passage for the children to join them. However, payment is not guaranteed and the waiting period may be very long, thus exposing young people to the influences of nonparental adults. The abandonment may lead to rage toward one's own parents, and the foster family's treatment of guest children may be particularly abusive. Household poverty: Although higher household income does not guarantee that youth will not engage in risky behaviors, it does alleviate some of the factors that lead to the behaviors or allow fami- lies to compensate for poor choices made by the adolescent. As ciscussed above, poverty may lead to absent parents (either working long hours or migrants), thus breaking family connectedness. The desire to help bring resources into the household leads some youth to engage in the drug trade and the drug use and violence associated with it In the Dominican Republic, the primary reason that poor youth cite for school dropout is to work to support the family (Luther, St. Ville, and Hasbuin 2002). Even if they do not work in the drug business, youth from poor families live in neighborhoods that are drug sale points (Luther, St. Ville, and Hasbun 2002), thus surrounding youth with the negative influ- ences. Finally, if a young person does become addicted to drugs or pregnant, poor families have few resources, especially because public services are scarce. Thus, poor youth are permanently scarred, and those from wealthier families have the resources to compensate for the negative events. Peers, Role Models, and Social Networks Peers, role models, and social networks cani be supports to or su bstitutes for absent family supports. Youth choose to spend the majority of their free time with their friends. Most of these relationships are positive, but youth also identify friends and role models or protectors who lead them into risky behaviors. Peers and social networks: Because poor (urban) youth live in violent communities where par- ents are often not present, gang membership was identified as a support structure, in terms of per- sonal safety, identity, and companionship (Luther, St. Vlille, and Hasbitn 2002; Barker 1995). In violent neighborhoods in the Dominican Republic, for example, young people say that they are largely confined to their homes out of fear of walking in the street-simply associating with a gang provides some level of protection. Gang activities, such as drug use and sale, also give a sense of identity as a "bad boy," as they say in the 'Trinidad and Tobago (Barker 1995). Out-of-school boys identified peer pressure as the primary reason for their involvement in drug sales. Finally, as stated by a young man in Jamaica, "the boy does not have anyone to talk to ... so, these youth may be bad, but at least they talk to him." (Barker 1995). Social exclusion drives one to turn inward to one's neighborhood and social networks. As a Jamaican youth explained, "You get labeled 'inner city' . . . 'ghetto' . . . a lot of people think that ghetto is only crime and violence" (Barker 1995). Thiis prejudice toward those who live in the poorer neighborhoods is clear in the labor market, where being from the wrong neighborhood precludes one from obtaining a job; leading to even more dependence on one's own community 29. Two-parent families are associated with less poverty than single-parent, mother-headed households- usually one-half to two-thirds less (Patterson and Blum 1996, Blum et al. 2000). 30. All findings were highly significant (P<.001) even when social class was controlled for. CARIBBEAN YOUTH DEVELOPMENT 35 (Luther, St. Ville, and Hasbun 2002). However, the community is not a stable source of support as migration continuously changes the structure of the local networks (Barker 1995). Role models: Role models may be a protective factor, but negative role models are a risk fac- tor. Most youth identified parents, entertainers, or teachers as role models, but drug dons are also admired for their wealth (Luther, St. Ville, and Hasbuin 2002). The drug don, and his approacha- bility and interest in recruiting children, is a particularly dangerous role model because youth eas- ily become engaged in his business, with clear negative implications for youth behavior. Political figures were not identified as role models, instead they were identified as being "corrupt," "only for themselves," or "unworthy of their positions" (Luther, St. Ville, and Hasbun 2002). Community and Neighborhood The physical environment in which youth live and the institutions that they confront daily are very powerful influences on their lives. The most relevant community institutions identified are schools, the church, community organizations, and the physical neighborhood. Schools: Similar to the finding about parental connectedness, feeling connected to school is a very powerful protective factor. Boys and girls who feel connectedness to school-through a teacher or by working hard-are 25 to 80 percent less likely to engage in risk-taking behavior than are those who do not have any connectedness. Among boys and girls without school connectedness, their participation in risky activities is as follows: 55 percent and 30 percent (respectively) use drugs, 60 and 80 percent (respectively) use alcohol, 70 percent of boys and girls are engaged in violent activity, and 80 percent of boys and girls are sexually active. Among girls and boys who feel connected to school, the probability of sexual activity falls by 30 percent for boys and 60 percent for girls (figures 4-7 and 4-8). The good school performance may not solely be due to the education system, but it is likely to also capture positive home and community support; youth say that their school attendance and performance is highly contingent on their parents' interest in their success and in monitoring their school attendance (Luther, St. Ville, and Hasbuin 2002). To give credit to the school system, though, 88 percent of students feel connected to a teacher who also gives positive reinforcement. Finally, students who perform well may feel good about themselves and their future and may not want to jeopardize either by undertaking risks that may have long-term effects. Religious organizations: Religion was identified by many youth as an important protective fac- tor in their lives. Several interviewees in a juvenile detention center in St. Lucia identified God as FIGURE 4-7: PROBABILITY OF ENGAGING IN RISK-TAKING BEHAVIOR BY DEGREE OF SCHOOL CONNECTEDNESS, BoYs 90% 80% 70% 60% 50% - 40% - 30% - 20%- 10% 0% J Smoking Alcohol Drug use Violence Sexual experience O aHigh * Low| 36 WORLD BANK COUNTRY STUDY FIGURE 4-8: i _ Its 90% 80% . 670°%%l*1 60% 50% 40% 30% 20%E__l 10% 0% Smoking Alcohol Drug use Violence Sexual experience l3High Log FIGURE 4-9: 90% 80% 70% 60% 50% 40%% 1lt | 300%%-lI = X*9 10%- I-- 1 - -T - 1 Smoking Alcohol Drug use Violence Sexual experience [3High MiLow their primary role model, and church attendance is identified as an important activity (Luther, St. Ville, and Hasbun 2002). Thus, both individual spirituality and the act of belonging to a church community are important influences. This is supported statistically by the strong negative correlation between religious beliefs and church attendance on the one hand and substance use, violence, and sexual initiation on the other.3' Although the magnitude of the prevention is not large, averaging a decrease of male risky behavior by 5 tD 10 percent, the role of religion as a pro- tective factor against youth negative behaviors may play a small role (figures 4-9 and 4-10). This 31. The odds ratios for the correlation between religious beliefs ancl behaviors are 0.92 for violence, 0.90 for sexual initiation, and 0.86 for substance abuse. These are particularly significant (at the I percent level) for those aged 13 to 15. CARIBBEAN YOUTH DEVELOPMENT 37 FIGURE 4-10: PROBABILITY OF ENGAGING IN RISK-TAKING BEHAVIOR BY DEGREE OF RELIGIOUS ATTENDANCE, GIRLS 100% 80% 60% 40% 20% 0% Smoking Alcohol Drug use Violence Sexual experience 01High ELow may occur directly, because membership in an association is likely to be contingent on not engag- ing in these behaviors, or perhaps through the decreased feelings of rage in religious people.32 Community organizations: Youth groups and community groups are also important in the Caribbean, forming the basis of youth organization in some countries, such as the National Youth Council of St. Lucia. Although these groups play important roles in community cohesion (such as the sports club in Barbados), education (the community youth groups in Saint Lucia), or advocacy, they also have the potential to be exclusionary (Luther, St. Ville, and Hasbun 2002). For example, in the Dominican Republic, some club memberships are based on personal characteristics, such as virginity, which necessarily excludes those already at risk. Physical environment: The neighborhood environment in which young people live can predis- pose them to risky behavior. For all the reasons previously expressed by the interviewees, they perceive that the environment that surrounds young people in poor communities is violent, and survival is determined by the rules of the strongest, who are usually involved in criminal activities: "Groups go about like Rambo with a knife in their mouth, trying to survive." Youth values are then distorted, and survival becomes their strongest mandate. They state that the distribution and use of drugs are common activities. Poor neighborhoods are drug distribution points that are dangerous but conducive to fast money. Gangs in these areas reign free and unhampered, always imposing rules by force. Everyone fears their actions and aggressions, and negotiations like these usually take place: "We won't tell, but don't hurt us" (Luther, St. Ville, and Hasbun 2002). Macroenvironment Finally, the larger environment that surrounds youth has strong influences over them that interact with the risk and protective factors at the individual and microenvironment levels. The categories of most importance for the Caribbean region, as identified by the research, are the economy; poverty and inequality; legislation and institutions; law enforcement and the judicial system; culture and history; and gender. Economy The nature of the small economies in many Caribbean countries is a source of risk for youth. Smaller countries cannot diversify production, so jobs are concentrated in a few industries, namely agriculture, tourism (both of which are very susceptible to international market forces), and 32. The odds ratio estimate of the correlation between religious beliefs and rage is 0.91 and significant at the 1 percent level. 38 WORLD BANK COUNTRY STUDY *97_9:1M p. _ - . I had a good home ... it's hard to get work, you need a lot of subjects in school . . . the only thing you can do is sell ... you know, for whatever fast money.' (youth, Trinidad) "When there is . .. loss of a job (by someone at home), you see some fiiend out there and he has a new pair of sneakers and so you think about the easy way out. So you sell (drugs) to satisfy your ego" (youth, Trinidad) "The standard of living may be low at home ... and marijuana (cultivatirg) is a quick way of getting money" (youth, St. Vincent) Source: Barker (1995) services. This presents two challenges for youth. First, limited demand for highly skilled workers means that labor market specialization is rare and wages do not rise (Barker 1995).33 Second, unemployment is high and job creation is low, so youth have a more difficult labor force entry experience than do youth in countries where a greater quantity and diversity of jobs exist. Even the larger, more diversified economies-like Jamaica, Trinidad and Tobago, and the Dominican Republic-have difficulties producing jobs with a living wage, leading to high youth unemploy- ment there as well. A clear alternative is employment in the low-skilled informal sector, which is undertaken by many youth, but the market cannot absorb all labor, wages anld future prospects are limited, and there is little access to financinig to start one's own business, particularly for young people who have few assets to offer as coliateral.34 As a result of these structural problems in finding jobs, the culture of migration continues. With jobs scarce and limited opportunities for higher education, the skilled labor force leaves to search for education or job opportunities elsewhere. Wihen a young migran- with a master's degree in econom- ics was asked why he chose to live in the United States rather than St. Lucia, his response was, "What would I do there?" Youth are giving up on their countries, searching elsewhere for the support and the lifestyles they cannot get at home. Some youth who do not migrate find .he combination of youth unemployment and poverty pushing them to work in the drug trade, which has a high demand for unskilled labor. The Caribbean region is increasingly used as a drug transshipment port between Latin America and the United States or Europe (UNDCP 1997). The scarcity and low pay of legal jobs, the attraction of the "easy money," laws protecting those under age 18 from prison (Luther, St. Vil.le, and Hasbiin 2002), and the marketing to youth by drug dons (Barker 1995) make this job opportunity very attractive to youth. Poverty and Inequality Youth from poor areas identify poverty as a key source of risky behaviors. Interviews reveal that young men and women feel that they need to work to support their families (Luther, St. Ville, and Hasb(in 2002). Given their low levels of education, especially if they have been excluded from the education system by earning low examination marks, they have few options except informal sector work, the drug trade, or commercial sex work or sexual exploitation (Barker 1995).35 Also, the lack of income leads to parental absence and aggression, which has implications for youth behaviors. 33. Jobs do exist, but youth do not feel that they are fairly remunerated. For example, a young unem- ployed man in Jamaica explained, "There are lots of places that want to pay you nothing [for working]. They use and abuse you" (Barker 1995). 34. The difficulty of access to financing to start small firrms is recogrnized by many organizations in the region. Efforts are being made by international organizations (such as the Comrnonwealth Youth Programme, Caribbean Region) and local NGOs (such as the Barbados Youth Business Trust) to provide low-interest loans and support services to young entrepreneurs. 35. Increasingly, the public health field refers to prostitution of adults as sex work or commercial sex work and prostitution of children and adolescent younger than age 18 as sex exploitation. CARIBBEAN YOUTH DEVELOPMENT 39 Interviews with young, uneducated, poor women in Jamaica reveal that they fully understand reproductive health, but their best income prospects are from pregnancy and child support (Barker 1995). Finally, the income inequality demonstrated by drug dons, foreign tourists, and the media encourages the engagement in the "easy money" activities, including drugs and prostitution (Barker 1995; Luther, St. Ville, and Hasbuin 2002). Public Policy and Institutions The education system: The existing education system in the English-speaking Caribbean countries was inherited from the British colonial education system in both structure and content. Students are exposed to technical and vocational subjects only when they are deemed as unable to perform academically, effectively categorizing technical-vocational students as an underclass. The structure of the educational system directly induces risky behavior. The Common Entrance Examinations (CEEs) in most English-speaking countries of the Caribbean are a clear threat to young people because their performance on these exams determines their worth to soci- c-v. Those who pass the exam-a term that is not entirely correct because the passing score is a fu -ction of the number of places available in secondary school, not necessarily a minimum level of cor.- oetency-are implicitly told that they are valuable to society and are permitted entrance to the next icvel, which improves their probability of success later in life, thus having a positive effect on self-es.-em and discouraging risk-taking behaviors.36 However, those who enter secondary school are not '-ee from judgment because school placement is based on the points achieved from the CEEs. C-.nsequently, youth define themselves and each other based on the uniform they wear and the sc. ool they attend.37 The sense of achievement of having made it through this competi- tive process dds to their self-worth, and conversely it hurts those who do not pass. Students from the focus grc os with the highest sense of self-worth and confidence were those who had achieved tertiary-level e. ucation. Thus, the system induces risk-taking behavior by forcing children to leave. Those who do l it pass the exams are effectively told that they do not have value and that the gov- ernment's investr. ent in them, and in their futures, ends at a young age. This rejection and denial of opportunities ti- t will lead to a successful life understandably lead to rage, depression, and neg- ative behaviors. Thi. is particularly acute among youth from poor families, who have fewer resources and opport!nities for adequate preparation to perform well on the CEEs. In both the Dominican Republic and the English-speaking Caribbean, youth felt that the school curriculum was not appropriate to prepare them for the labor market. A Youth Senator in Saint Lucia describes the :urriculum as having an academic bias that develops no talent or skill in students and does not nurt are them so that they can make a meaningful contribution to the soci- ety. He described the quality and the dimensions of education now on offer as unsuited for the economic and social realities of our time. Students are taught academics to prepare them for the future without them having tar gible employment prospects, and with them also lacking any mar- ketable skills or any entrepreneu-ial spirit. Further, academically strong youth are confronted by the inability of their impressive academic certificates to ease their entry into a good job. Activities like drug dealing and other profitanle criminal activities, as well as migration, become viable options to meet their expectations ocpersonal success. Classrooms are sources of violent conflict. At-risk youth, especially males, voiced negative views of teachers and authority figures within the education system. Even though most youth (88 percent [Blum 2002]) feel connected to a teacher, youth report the unfairness of corporal punishment and physical fights with teachers (Williams 2001). Males, in particular, felt that they were being ostracized and were not provided with adequate support by teachers. Of greatest con- 36. The system is perhaps more egalitarian but also damaging in the rLral Dominican Republic, where there are not enough spaces for all secondary school-age students. This is solved by some stLdents leaving school on their own choice (Luther, St. Ville, and Hasbun 2002). 37. All St. Lucian secondary students wear different school uniforms that allow societal differentiation of students and further aids the development of academic elitism and discrimination. 40 WORLD BANK COUNTRY STUDY cern was the teachers' ability to arbitrarily punish and rzport to parents. Another issue that further alienates at-risk youth is the holding back of low-achievers. The students are held up to ridicule by their peers, leaving youth prone to truancy and eventual dropou.t from the educational system (Luther, St. Ville, and Hasbun 2002). Immigrant children are systematically zxcluded from the school system. In the Dominican Republic and St. Martin, for example, the requirement of national birth certificates for school enrollment and under provision of schools in immigrant neighborhoods completely exclude these most vulnerable children and youth from the system. When this is combined with unstructured free time, poverty, and absent parents, these youth are ?articulai-ly vulnerable to risky behaviors (Barker 1995, World Bank 200 la). The health care system: Youth interviewed cite lack of confic.entiality as a key risk factor in seeking health care services. Problems related to the health care facilities are particularly impor. tant, given high levels of HIV/AIDS, low contraceptive use among sexually active adolescents, and teenage pregnancy. According to a review of international experiences in the provision of ser- vices to at-risk youth, health care programs tended to lack youth-sensitive services (Barker and Fontes 1996). Given that many of the health problems youth face are sensitive (e.g., sexuality), having primary and secondary health care professionals who understand the needs of youth is crit- ical to reducing risky behavior related to adolescent health. Law Enforcement and the Judiciary Youth in the Dominican Republic and St. Lucia are unmrusting of the legal and judicial systems in their neighborhoods. They report that police are prejudiced against youth and treat therr. badly. This is particularly the case in poor neighborhoods, where policz assume that all vouth are engaged in the drug trade or crime. Youth feel that police fail at their jobs of providing securitx'-instead, drug dons run the neighborhoods, especially after dark. A similar distrust is felt of th z judicial and more general political system, where youth feel that all authorities are corrupt and untrustworthy. Culture and History Aggression, substance use, and adolescent childbirth in the contemporary Caribb2an region are the legacy of colonialism and the system of slave labor that fiuelled its sugarcane-basLd plantation econ- omy. Attitudes toward alcohol, violence, and family continue to be informed by social norms formed during the colonial era. For example, now as then, alcohol is not seen as a drug (Luther, St. Ville, and Hasbun 2002), and many consider its consumption an integral cultural activity. As one Barbadian said, "We grow sugarcane here; everyone drinks rum-they always have." Marijuana is similarly seen as a social drug that is medicinal and not harmrful or immoral (Barker 1995).38 Physical violence, whether in the homes or schools, may also be attributed to the colonial experience, especially in the English-speaking Caribbean countries. As discussed above, the school system is based on the English system, in which corporal punishment is an element of school disci- pline. This system survived colonialism and. institutionalized certain forms of violence that are often not questioned today. Violence in the horr; e by the mother is al!3o identified as a form of discipline. Some historical anthropologists attribute it to the slave mother, iisciplining her children in the manner in which they would be disciplined when they began working. Finally, domestic violence by men is accepted as a gender role. The structure of the household in the English-speaking Caribbean is also traced back to condi- tions of slavery. Families were discouraged because they would be broken up in the sale of slaves, but women were encouraged to bear many children (capital production for the slave owner). Thus, 38. Despite the cultural acceptance of marijuana, it is illep,A in the Caribbean region. In the 13-country data collection exercise by PAHO, marijuana use was reported by rewer than 2 percent of school-going children-a very unlikely statistic. The researcher opined that the respondents may have underreported use because of the illegality of the narcotic. CARIBBEAN YOUTH DEVELOPMENT 41 men were excluded from the family and were not encouraged to be participating fathers. The high number of out-of-wedlock births, the propensity for men to float among several partners, and the abscnce of expectations for men to be responsible partners and fathers persists today and leads to unstable family situations. The many challenges faced by women without a partner often set up conditions for children to engage in risky behaviors. The household in the Dominican Republic is very different, with a single, tight family in which family honor is paramount. This does not imply that single-mother households do not exist, but the incidence of men wvho float among many households is less prevalent. However, single mother- hood is more of a stigma in this highly Catholic country, where pregnant, unmarried daughters are regularly expelled from the household or treated as domestic servants in return for living with their children in their parents' house. This familial exclusion leads to risky conditions for young mothers (Luther, St. Ville, and Hasbun 2002). Gender Gender is a risk factor for Caribbean male and female adolescents, as evidenced by the differenti- ated outcomes realized by boys and girls. For example, male school-going students were much morc likely to report violence involvement than females (odds ratios for 10- to 12-year-olds: 2.37; for 13- to 15-year-olds: 2.96; and for 16- to 18-year-olds: 3.03). Boys were also twice as likely as girls to report having had sexual intercourse, less likely than girls to report suicide attempts, and consistently more likely to report rage for every age group of teens (Blum 2002). Gender norms and values may lead to negative outcomes. Men's masculinities are often mea- sured by their abilities to provide economically for their partners and children, a challenge made more difficult in recent years by continued high unemployment in many countries, feminization of certain sectors (e.g., manufacturing), and a general cynicism about prospects for future work (Lewis forthcoming). Although these changes have sometimes worked to dislocate dominant gender roles-providing some avenues for increased participation by women in the public realm, for example-they have often resulted in the ostracizing of some fathers by their children for fail- ing to meet their responsibilities and pushed other men to look to illicit activities (violence and drug dealing) as a means of earning an income. As fathers hold enormous influence over their children's choices-as one study on the effects of early childbearing in Barbados showed, fathers' close relationship with children was associated with higher academic achievement (Russell-Brown, Engle, and Townsend 1994)-and both fathers' absence and their involvement in high-risk activities can fundamentally shape young peoples' lives. Caribbean men's masculinities are also often tied to display of physical bravado, engagement in violence (Barker 1998), and sexual prowess (Barriteau 2001), thus providing an unhealthy tem- plate of high-risk behavior for younger adolescents. For example, some Jamaican men have rejected condom usc on the grounds that "real men" prefer to "ride bare back" (World Bank 2001b). Gender norms are also a risk factor for women. For example, higher rates of sexual abuse of girls represent a fundamental risk factor for females. Moreover, men's inability to meet the expecta- tion of being an economic provider means that a large proportion of women raise children on their own, leading to greater lcvels of poverty and vulnerability among these women and their children. The children of single mothers are also more likely to go unsupervised and be exposed to negative peer groups that prey on children (e.g., gang leaders). The expectation that women will be more passive than men means that women have a more difficult time negotiating condom use, thereby exposing them to HIV/AMDs and other STIs. Interconnectedness of Factors Risk-taking behaviors are highly correlated, meaning that individuals who engage in one type of risk-taking behavior are likely to engage in several risk-taking behaviors. Although this analysis did not explicitly test for a bundling of risk-taking behaviors, the repeated influence of the same factors and the high participation in risk-taking behaviors of youth without any protective factors (or with 42 WORLD BANK COUNTRY STUDY TABLE 4-2: _ 1 - Number of Family Religious School protective factors connectedness attendance connectedness Males (%) Females (%) 0 Low Low Lowv 68.1 71.9 I High Low Lowv 61.9 63.9 Low High Lowv 60.7 64.1 Low Low High 39.9 11.6 2 High High LoNw 54.0 55.2 Low High High 32.4 8.4 High Low High 33.6 8.3 3 High High High 26.7 5.9 multiple risk factors) suggests that bundling of risk-taking behaviors occurs in the Caribbean region. Thus, public policy that focuses on reducing a single risk factor will have wide-reaching implications for several different types of behaviors, and focusecd preventive measures may be an efficient means to simultaneously address several different types of risk-taking behavior. However, it is unclear which preventive measure to invest in because the marginal impact of each factor cannot be disentangled. Multiple protective factors decrease the propensity for a young person to engage in risk-taking behavior, but it is difficult to identify the exact impact of each factor.39 For example (table 4-2), 72 percent of girls with low family, religious, and school connectedness are violent. Violence among girls falls to 64 percent if family connectedness is high, to 64 percent if religious attendance is high, and 12 percent if only school connectedness is high. However, among girls with all three types of connectedness, only 6 percent are violent. The result that the total effect is not the sum of the individual effects suggests that there are correlated underlying influ- ences among the three types of connectedness. From a po [icy perspective, focusing on enhancing a single protective factor will have great impacts. It may riot be necessary to address all protective and risk factors initially, but instead to identify those bundles that are most successful at lowering the risk. Final Thoughts Youth respond to the incentives and environments that are taught and presented to them, suggest- ing that youth themselves are not the problem. Instead, the environment in which they exist and their support structures either force risky conditions upon them, such as school leaving for young, English-speaking Caribbean students who do not do well on their CEEs, or set up conditions where engagement in risky behavior is a reasonable option, such as the case of the drug trade when unemployment is rampant. There is also a high degree of interconnectedness among the different risk or protective categories, suggesting the potential value of a more holistic approach to working with youth to improve their situations. However, parental involvement, both emotional and a physical presence, is one of the most important protective factors. Unfortunately, as a result of the changing economy, migration, and socialization, this resource is even scarcer. 39. Ideally, this would be accomplished in a multivariate regression. but high collinearity among the fac- tors precludes this option. s THE COSTS OF RISKY ADOLESCENT BEHAVIOR T he negative outcomes of risky youth behaviors impose costs not only on young people and their families, but also on the economy and society at large. This chapter estimates the cost to individuals and society of school dropouts, risky sexual behavior resulting in adolescent pregnancy, risky sexual behavior resulting in youth HIV/AIDS, youth unemployment, and youth crime and violence in as many countries as the data permit.40 The numbers presented in this chap- ter are, at best, rough and conservative estimates of the costs of risky adolescent behavior to society because full measurement would require impossible tasks of putting a price on life, quantifying the psychological and social costs of risky behavior, and identif-ying and measuring all the externalities of the behaviors in both observed and future periods.4' Furthermore, missing or unavailable data result in underestimates of those costs that should be measurable. Thus, the costs presented are only a lower bound; the total costs of the behaviors are much higher. Despite these underestimates, it is clear that costs to individuals and society reach into the billions of dollars. Social and private economic and financial costs for each behavior are estimated and/or discussed: Financial costs are those line items in government or private budgets. However, these may not be a cost to society as a whole because they are a transfer from one individual to another, with no net loss of resources to society. Economic costs are those costs that create a net loss to society through the forgone value of the productive input, also known as the opportunity cost of the resource. In other words, economic 40. Cross-country comparisons should not be made because the sources of the data used for each country differ, thus not making them comparable. 41. Placing a monetary cost on the outcomes of human behavior may be distasteful because it collapses complex human behaviors into prices and uses labor productivity to put a value on a person's life. Ideally, some measure of happiness would be used, but such a metric does not commonly exist, so currency values, though imperfect, are used instead. 43 44 WORLD BANK COUNTRY STUDY costs are measured as the benefits not realized either as a result of direct actions, such as lost family income because the primary breadwinner is in prison, or as a result of an alternative use of resources, such as better child nutrition that is not realized because resources are spent on drug treatment programs for adolescents rather than for school lunches.42 The methodology for this chapter is to measure the productive value of the human and mone- tary resources and the measurable costs associated with various behaviors. The chapter differenti- ates between social costs-those that are borne by society as a whole-and private costs that are borne only by the young person him- or herself. The methodoJogy for the cost estimates is given in appendix 2. This chapter does not generate cost-benefit estimates. To carry out a cost-benefit analysis, spe- cific program costs and outcomes from the program are iieedecL. This chapter does not consider the program costs, but instead calculates only the resources that are lost to negative outcomes from risk-taking behaviors by youth. The chapter also does not estimate all the individual and social costs of youth behaviors, nor does it generate estimates for all countries zonsidered. ODnly a subset of behaviors is analyzed; these behaviors were selected based on data availability. This is not to suggest that drug use, early mar- riage by women, child labor, poor nutritional status, sexual activity that results in STIs, and physical or sexual abuse of youth, among others, are not important costs, only that they are more difficult to measure. Additionally, the choice of countries was solely based on data availability and is not a judg- ment of the prevalence of the costly outcomes or the extent and manner in which the countries are addressing the issue. Crime and Violence The total cost of crime committed by youth cannot be accurately estimated because many of the crimes include immeasurable losses, such as those resulting from murder, sexual offenses, and drug trafficking. Furthermore, criminal activity at a young age has long-term implications for a person's future criminal activity and his or her integration into society. However, some rough tools can be used to conservatively estimate the social and private costs of crime and violence. At a minimum, the following would bz needed to conserva bvely calculate the financial and economic costs of juvenile crime and violence: Arrest, prosecution, and detention ojfcriminals: T he total expenditure on these activities would enumerate the financial costs to society. jEconomic costs will differ, being measured as the forgone benefits from spending these resources on arrest, prosecution, and detention of criminals rather than on alternative government investments. Property loss and damage: This is a clear financial cost. The economic costs differ, though, because robbery may be considered a transfer of goods fi-om one individual to another, thus not having social costs. However, property datmage or the psychological costs of being robbed do impose real costs on society (Roman and Farrell 2001). Medical costs, public programsfor victims, and lo.t income of the victim: resources to aid the victims of crimes are both a financial and an economic cost to society, the individual victim, or the family of the criminal. Measurement of these costs is difficult, particularly the value 42. For example, economic costs include the forgone labor market output of youth who are in prison, and financial estimates would not include this as a cost. Altematively, goverr. ment transfers to teenaged mothers would be a financial cost (which would show up on government accounts), but they are not economic costs because society as a whole does not gain or lose--the benefits simply move from one person to another (assum- ing that the joy in the goods purchased by the teenaged mother with thds money is equal to the unhappiness of the person whose taxes paid for the transfer). Instead, the economic cost of the transfer is the lost effects of the alternative use of the transfer-for example, an additional healthy day for a person with HIV if the transfer were used instead to treat an opportunistic infection. CARIBBEAN YOUTH DEVELOPMENT 45 of a lost life, but average victim compensation values, based on jury awards in the United States, allow a conservative estimate (Roman and Farrell 2001), as given in table 5-1. Intangible costs (pain, suffering, and quality of life): Courts recognize the nonpecuniary costs of a crime by awarding damages to compensate for pain and suffering. Although these pri- vate costs are difficult to quantify, estimates derived from victim compensation court awards place a conservative value on the psychological damages caused by crime. The large magni- tude of these estimates demonstrates the large private cost to the victim or to the victim's family (in the case of murder), which may be interpreted as the net cost to social well-being. Security costs: Expenditures on deterrence mechanisms clearly divert resources from other productive uses. The government and private expenditures on security are clearly identifi- able. However, forgone benefits are also real costs of investment in personal and public security. Financial support of a police force, monitoring cameras, urban street lights, and other security measures divert resources from other productive uses. Similarly, private expenditures on security guards, fences to surround property, and security systems do not return rewards from alternative uses of the resources. Lower tourist receipts: Unquestionably, the Caribbean region benefits from tourism, but crime and violence decrease the demand for this service by potential tourists (Levantis and Gani 2000). The forgone tourist earnings are quite costly for the government as tax receipts from tour ships, airports, and tourist services decrease. The economic costs at the level of the individual are also quite high because lower demand in the tourist sector leads to unem- ployment and a lower standard of living. Lost income: While a juvenile delinquent is in the legal system or prison, he or she cannot provide income to his or her family, which is likely to have made an investment in the young person. This forgone income may be costly to the individual's family (though the degree is likely to be low because unemployment is so high among young people). Additionally, the state loses the taxes from the labor income and/or consumption of the juvenile delinquent. Lost social capital: A person who is known as a criminal is likely to have less social capital in mainstream society but more in the less savory sectors of society. A loss of social capital sug- gests a difficult time finding work, obtaining credit (formal or informal), starting a legitimate business, being a neighbor, participating in community activities, and contributing to general society. However, social capital with those engaged in criminal activity is likely to increase, offering opportunities that involve more serious risk-taking behaviors. Quantification of the many costs is impossible because of the difficulty of measuring some of the concepts or missing data. However, pulling together data from various countries will allow some rough, conservative estimates of the private and social economic costs of crime and violence. TABLE 5-1: VICTIM COMPENSATION FOR TANGIBLE AND INTANGIBLE COSTS OF CRIMES, UNITED STATES Crime Tangible costs, Intangible CoStSb Murder - $1,910,000 Rape and sexual assault $5,100 $81,400 Robbery or attempt with injury $5,200 $13,800 Assault or attempt $1,500 $7,800 Surglary or attempt $1,100 $300 a. Tangible costs include medical costs, lost earnings, and public programs for victims. b. Intangible costs include pain, suffering and quality-of-life compensation. Source: Roman and Farrell 2001. 46 WORLD BANK COUNTRY STUDY WILs $SslIDM* I[ I I 160 1c Le I Jamaica St. Lucia Social Private Social Private Total cost of youth crime J$96 million J$2.5 bil ion EC$8.5 million EC$208 million Cost of youth crime as % of GDP 0.04% 0.92%, 0.45% 11.01% Marginal cost of youth crime (burglary) J$2 1,000 $6I ,000 EC$2,000 EC$7,000 Marginal cost of youth crime (sexual assault) J$30,000 J$3 million EC$2,700 EC$226,000 Source: Author's calculations; see appendix for data sources of each component. Social financial costs: Data for Trinidad and Tobago show that the most basic social financial cost of a crime amounts to TT$31,500 (about US$5,000) per .erson arrested, which can be dis- aggregated into arrest (TT$11,196), court appearances (TT$ 1,104), and six months of incarcera- tion ($TT9,205) (World Bank 1996). Additional data from the United States, which estimates the victim compensation values of medical carz, public programs for victims, and lost earnings (although the last item is not a social cost, it could not be extracted from the total sums), suggest that another US$1,100 to $5,100 is spent in public funds per crime committed (table 5-1). Using youth crime data from Jamaica and St. Lucia, a conservative estimate of annual government expendi- tures in tangible costs amounts to approximately US$33 million for Jamaica and US$25 million for St. Lucia. Assuming that arrest, court appearances, and detentior costs and durations in St. Lucia and Jamaica are similar to those in Trinidad and Tobago, the total social financial cost from youth crimes, even before including the cost of the police force, is approximately US$39 million in Jamaica and US$46 million in St. Lucia.43 Privatefinancial costs: Using data from Trinidad and Tobago, rough estimates of out-of- pocket private financial costs may be estimated. Expenditures by citizens to protect themselves from being victims of the crimes is estimated to be US$3,696 per household per lifetime in fixed costs and an additional annual expenditure of US$1,200 to US$30,000. The cost of property loss or damage could not be estimated from the available data Social economic costs: The absence of arrest and prosecution data for Trinidad and Tobago does not permit the calculation of the annual economic costs oFyouth crime to Trinidadian and Tobag- onian citizens and taxpayers, but prosecution data fromrr Jamaica and Barbados allow a rough esti- mate. The total social economic cost of youth crime is more than J$96 million dollars in Jamaica and more than EC$8.5 million in St. Lucia (columns 1 and 3 in table 5-2), equivalent to 0.04 per- cent of gross domestic product (GDP) in Jamaica and 0.45 percent of GDP in St. Lucia.44 How- ever, it should be remembered that these are underestimates of the true social costs because the they do not include such items as forgone social capital, underinvestment in youth, impacts on the children of criminals, depletion of the juvenile delinque nt's human capital, and mental health implications, for example. 43. The difference in estimates between these two countr:es i,s due to higher tangible costs in Jamaica but a larger number of youth prosecuted and incarcerated in St. Lucia. This is not to suggest that St. Lucia is more violent than Jamaica, but only that the prosecution rates of youth in St. Lucia exceed those of Jamaica. The prosecution rates for Jamaica are from Pantin (2000) and those for St. Lucia are from Social Policy in St. Lucia (2000). 44. The social economic cost is the sum of forgone taxes of the young person while he or she is in prison; forgone use of resources for prosecution, arrest, and detentiona (assuming that these are of a similar magnitude as in Trinidad and Tobago); and forgone benefits of resources used for victm assistance (assuming the magnitudes are similar to victim compensation in the United States). CARIBBEAN YOUTH DEVELOPMENT 47 I ABLE 5-3: ESTIMATED INCREASE IN TOURIST FLOWS AND EXPENDITURES DUE TO A I PERCENT DECREASE IN YOUTH CRIME Jamaica Bahamas Number of new tourists 45,920 36,340 Total new earnings due to more tourists US$40,680,91 I US$3 1,943,672 New earnings as % of tourism receipts 4.01 2.34 Source: Tourist flows and receipts from the Caribbean Tourism Organization; number of crimes from the U.N.; author's calculations. An additional item that is not included in table 5-2 is the cost of crime to the tourist industry. Crime is a deterrent to tourism, one of the most important industries in many Caribbean countries. Recent research shows that a 1 percent increase in the crime rate reduced tourist flows by one-half to three-quarters percent (Levantis and Gani 2000). Applying these parameters to youth crime, if youth crime decreases by 1 percent, the tourist flows to Jamaica and the Bahamas will increase by more than 45,000 and 36,000 tourists per year, respectively. This is equivalent to more than US$40 million in Jamaica and US$31 million in the Bahamas, a 4.0 percent and 2.3 percent increase in tourist revenues, respectively (table 5-3). Private economic costs: The private economic costs of crime far outweigh the social costs.45 The total private economic costs to citizens of juvenile crime are EC$208 million in St. Lucia and J$2.5 billion in Jamaica each year(columns 2 and 4 of table 5-2). This is equivalent to 11 percent and 0.92 percent of GDP, respectively. The private costs far exceed the public costs for two pri- mary reasons. First, victims realize the fall, intangible, private economic costs, which are particu- larly high, and the state only realizes the benefits of an alternative use of tangible resources. For example, the J$2.9 million difference in the private costs between a burglary and a sexual offense in Jamaica, as given in table 5-2, is solely due to the different value placed on the pain and suffering by the victim of each type of crime. The marginal private cost betwveen burglary and sexual offenses differs by EC$219,000 in St. Lucia. Second, the family of the juvenile delinquent experiences the full loss of income, and the state realizes only a portion of that in lost tax revenues. However, it should be noted that the state costs of crime are likely to be severely underestimated because of the lack of data on the cost of police protection and other preventive measures Risk-Taking Sexual Activity: Adolescent Pregnancy46 The cost of adolescent pregnancy includes not only the immediate needs of the mother and child, but also the costs to their family, the father and his family, taxpayers, and society. These costs are not limited to the birth period, but include both financial costs-which are paid by the mother, family, or taxpayers over the life of the mother and child-and economic costs in the form of forgone earnings of the mother and the child when he or she becomes an adult and the loss of the benefits of alternative uses of the transfers to support adolescent mothers and their children. The additional costs incurred by a new mother who is an adolescent, rather than and adult, may include: Lower lifetime earnings of the mother: Lifetime earnings may be lower for adolescent mothers as a result of early school dropout, fewer opportunities for advanced education because of 45. The private costs presented in table 5-2 are the sum of the psychological (intangible) costs of crime and the forgone income from an alternative use of money spent on security (assuming that the fixed and vari- able costs are paid once someone has been a victim)-both of which accrue to the victim-and the forgone earnings of the juvenile delinquent, which is a cost to the family of the criminal. 46. The method for calculating costs in this section was developed by Maynard (1996). 48 WORLD BANK COUNTRY STUDY to poverty (single mothers tend to be poorer) and childcare demands, fewer employment options because of childcare demands, and less accumulated job market experience because mothers exit the labor markct often, thus slowing down i:heir human capital accumulation. Evidence from the United States shows that tecnaged mothers have higher lifetime earnings than women who are in their early 20ss when they bear children; this is attributed to longer work hours of young mothers because they are often the sole provider for the child (Maynard 1996). However, evidence from Barbados suggests the opposite: Adolescent mothers earn 22 percent less than do women vAio have children at an older age, primarily because of earlier school dropout of'adolescent rnothers i'Russell-Brown, Engle, and Townsend 1994).47 They are as likely to be employed. T.iis is largely a private cost. Lower tax revenues: The parallel social cost to lower income among adolescent mothers is the forgone tax revenue that would have been collected from a woman who delayed child- birth. The lost tax revenue may have been collectedL through income or consumption taxes. Fewer remarriage possibilities: Virginity before marriage is valued in some countries, thus adolescent pregnancy may decrease the likelihood of ever marrying, which increases house- hold poverty. An opinion survey from the Dominican Republic shows that 65 percent of youth believe that a woman should be a virgin upon marriage (Tejada, Herold and Morris 1992). However, this does not necessarily disproportionately affect union formation by adolescent mothers in all countries; in Barbados, for exarnple, teenaged mothers were no less likely to form a union than were older women (Russell-Brown, Engle, and Townsend 1994). Again, this cost largely accrues to the mother and her child-a private cost-but society may pay a financial cost in the form of transfers to the poor households or an economic cost in forgone benefits to alternative transfer programs. Child support: Teen mothers are less likely to receive child support from the childfathers than are mothers of older children because the adolescent fathers are more likely to be absent, which increases household poverty. Adolescent women tend to have young part- ners, whose earnings ability is low and who are likely to form unions elsewhere (in the Dominican Republic, nearly 30 percent of adolescent bors have more than one sex partner [Tejada 1992]). In Barbados, 44 percent of fathers of children whose mother was an ado- lescent when she gave birth pay child support, com,pared with more than 60 percent of men whose children have older mothers (Russell-Brown, Engle, and Townsend 1994). The mother, her family, and society thus share the burden of supporting the child. Because child support is a transfer, it carries clear financial costs, but the economic costs are confined to the forgone benefits of the resources that are spent in the legal system to assign and moni- tor child support payments. This is likely to be a small value, though, because monitoring is a rare activity in most Caribbean countries. Higher health care costs: Complications in births to teenaged mothers are more common because young women's bodies are tess developed to cope with the stress of childbirth. Also, children of adolescent mothers tend to have mnore health problems (Maynard 1996). This imposes financial costs not only on the mother and her family, but also on the public health system. Economic costs are again measured by the forgone benefits of the alternative use of the private and public funds that are used to administer and provide health care to adolescent mothers and their children. Disadvantaged children: As a result cf the higher poverty rate among teen mothers and the absence of a father figure, many children of teenaged parents tend tohave more behavioral problems (Russell-Brown, Engle, and Townsend 1994), less educational attainment (Russell- Brown, Engle, and Townsend 1994), a higher likelihood of being teenaged parents them- 47. The results for Barbados should be taken as a rough estimate because the analysis did not control for the age difference between adolescent mothers and nonadolescent mothcrs, which will affect earnings, and characteristics that decrease earnings and are cocrelated with adolescent pregnancy. CARIBBEAN YOUTH DEVELOPMENT 49 TABLE 5-4: ESTIMATED SOCIAL COSTS OF ADOLESCENT PREGNANCY RELATIVE TO YOUNG ADULT PREGNANCY, US$ Annual per birth, Annual per cohort, Lifetime per cohort, US$ thousands of US$ millions of US$ Type of cost Financial Economic Financial Economic Financial Economic Barbados 262 303 118 137 4.6 6.4 Dominican Republic 60 165 2,595 7,130 85.8 336.3 Guyana 28 33 28 34 1.0 1.6 Jamaica 122 167 587 805 22.2 38.0 St. Kitts and Nevis 234 363 33 51 1.1 2.4 St. Lucia 98 162 55 91 1.8 4.3 Trinidad and Tobago 130 216 156 260 5.0 12.6 Note: Excludes the forgone earnings of the child when he or she is an adult in the labor force; adding this cost was too subjective. Source: Wages from the ILO, cost of social programs from the World Bank (1996), cost of incarceration from the World Bank (1996), incarceration rates from the U.N., health care costs from PAHO (1999) and teen pregnancy totals from PAHO (1999). selves (Maynard 1996), and a higher likelihood of engaging in violent crime (Grogger as cited in Maynard 1996, World Bank 1996). These contribute to higher poverty for the child when he or she becomes an adult-a private financial and economic cost-as well as lower productivity in society, lower tax revenues, higher crime costs, and fewer contribu- tions to society at large, which affect both government balance sheets and economic costs. Furthermore, the higher poverty rate will likely result in a transfer of these behaviors to their own children, thus repeating the cycle of high financial and economic costs. Higher demands on the social system: The poverty associated with teen pregnancy and the expulsion of young mothers from their family households lead to an increased demand for foster care, government transfers, children's nutritional programs, food programs, and gov- ernment housing (Maynard 1996). These transfers are clear financial costs, but they also create economic costs through the forgone benefits of alternative program supports. Social exclusion and poor mental health: Young, unmarried women who give birth may be cast out of their household and community, such as has been noted in the Dominican Republic, which makes them less successful in integrating into productive society, creating both private and social economic costs. To estimate the cost of adolescent childbirth, the above concepts are categorized into four groups: private financial costs, social financial costs, private economic costs, and social economic costs.48 Only social costs are presented in table 5-4 because few measures of private costs were available. Three estimates are presented for each economic (or financial) cost by country: annual cost per birth, annual cost for all births in a year, and lifetime costs for all births in a single year. The costs are estimated for the mother's age (15 to 19 years) compared with new mothers in their early 20s, thus these costs are not the total cost to the young women of raising their chil- 48. Social financial costs are the sum of the additional health costs of adolescent mothers and their chil- dren, the value of government transfers, the expected financial costs of crime committed by the children, and the cost of child support. The economic social costs are given by the forgone tax revenue and the forgone benefit of alternative uses of resources spent on health care, transfers, and criminality of adolescent mothers and/or their children. A discount rate of 6 percent is used in the calculation of lifetime costs. 50 WORLD BANK COUNTRY STUDY dren but instead are the additional costs that accrue to the mothers because they gave birth during adolescence. The net social financial cost over the lifetime of a single cohort of adolescent mothers in the Caribbean region ranges from US$1 million in Guyana to US$S6 million in the Dominican Republic. These costs are particularly large in the Dominican Rzpublic and Jamaica because of the larger size of the population in these countries and the higher number of teen births. However, the cost per pregnancy is highest elsewhere. The social financial costs, which include health care, gov- crnment transfers, financial costs of crime committed by the children, and child support, average from US$28 per year per birth to US$262 per year per birth. The high costs in Barbados and St. Kitts and Nevis are attributable to highier child support payments by the father (which are a function of wages), more generous government transfers, and tie higher cost of healthcare; these costs are low in Guyana. The net social economic cost over the lifetime of one cohort of adolescent mothers ranges from US$1.6 million in Guyana to more than US$335 million :n the Dominican Republic (table 5-4). The sum of forgone rax revenues, the opportunity cost of the criminality of the children when they become adults, and the forgone benefits from spending government transfers and health care on others averages from US$33 annually in Guyana to USS363 annually in St. Kitts. Again, the large disparity is due to differences in wages and generosity of government expenditures among Caribbean countries. But as in the financial cost estimates, thosc countries with the largest popula- tions have the largest total bill because of higher numbers of teen pregnancies. It should also be noted that the economic costs are much higher than the financial costs, but most of the cost of adolescent childbirth is privately born, so the social costs presented here, although large, far under- estimate the cost to mothers and families. Risk-Taking Sexual Activity: HIV/AIDS The cost of HIV/AIDS attributable to youth is difficult to measure because the period between contraction of the illness and appearance of symptoms may be anywhere from 5 to 10 years. The majority of new HIV/AIDS cases are not reported by youth, bui: rather are reported by those in the age group 25 to 39 (CAREC member countries 2000). Given the incubation period, these individ- uals are likely to have contracted HIV during their years as youth, primarily as a result of unsafe sex- ual activity. Thus, in measuring the cost to society of youth behavior that results in HIV/AIDS, both the youth themselves and those who contracted HIV during youth should be considered. The financial costs attributable to HIV/AIDS vary because there is no cure. Instead, costs may simply be incurred from treating other illnesses that afflict an individual with AIDS, estimated as US$200 per year per AIDS patient in Jamaica, for cxarrmple, to the full "cocktail" that may cost $7,000 per patient per year (World Bank 2000a). Table 5-5 shows the per capita financial costs of HIV/AIDS programs, where the costs are a transfer frc,m the whole population to those who require treatment (because treatment of HIV/AIDS patients in the latter twvo categories is paid through taxes), ranges from US$11 to USS61 per year for basic care programs to a range of US$85 to US$212 per year for basic care and aggressive treatment. Providing aggressive treatment to all HIV/AIDS patients would require an increase in health spending of 27 percent (Bahamas) to 1,111 percent (Haiti). Although table 5-5 accrues to the whole population, not just youth, it suggests how costly prevention and care is :For those who contract HIV while young. Forgone labor market productivity, under the worst case scenario where no HIV/AIDS treat- ment is given, is as high as 0.5 percent of GDP. If all new AIDS patients do not receive any treat- ment and die within one year (a very liberal assumption because AIDS patients are treated in many countries and the World Bank's new HIV/AIDS lending programs will further spread prevention methods and treatments) the loss to productivity of new AIDS cases in one year is less than 0.1 per- cent for most countries in the sample (table 5-6). The total forgone benefit to society, and especially to the family and friends of the AIDS patient, is clearly much higher. When measuring the loss of labor productivity in the year 2000 for all AIDS patients since 1982, under the assumption that all CARIBBEAN YOUTH DEVELOPMENT 51 PER CAPITA US$ COSTS OF HIV/AIDS AND PROGRAM COSTS AS A PROPORTION OF CURRENT HEALTH SPENDING (ANNUAL) Basic care program Basic care + HEART (at $7,000) Increase in Increase in Per capita per capita health Per capita per capita health cost expenditures (%) cost expenditures (%) Bahamas $61 8 $212 27 Haiti $12 67 $200 1,111 Dominican Republic $11 12 $113 124 Guyana $16 36 $198 440 Jamaica $11 7 $85 57 Trinidad and Tobago $12 6 $87 44 Source: World Bank 2000a. men and half of the women would have been in the labor force (a safe assumption because the illness primarily affects people in their productive years), the loss to GDP in 2000 due to youth- contracted HIV since 1982 ranges from 0.1 to 0.37 percent of GDP. Private economic costs: The forgone earnings given in table 5-6 largely accrue to the family of the income earner who died prematurely. Because a large portion of earnings of the individual would have been shared with the household, if the person passes away, a part of this is simply lost because other household members will not compensate for the full amount. Other private costs, which are less measurable, include: Nonmonetary contributions to households in which the primary breadwinner or caregiver con- tracts HIV. Among youth who contract HIV, most will have families by the time of onset _5 * 1 01610 Forgone output due to Forgone output in 2000 due to AIDS deaths in 2000 all AIDS deaths since 1982 Local currency, Local currency, in thousands As % of GDP in thousands As % of GDP Antigua and Barbuda 1,32.3 0.0074 1,092.0 0.061 Bahamas 1,668.8 0.037 16,496.9 0.37 Barbados 8,591.3 0.17 6,443.5 0.13 Dominican Republic 13,187.0 0.0041 139,680.6 0.043 Guyana 5,110.0 0.0044 132,890.0 0.12 Jamaica 69,350.0 0.022 316,407.5 0.099 St. Kitts and Nevis 791.4 0.089 593.6 0.067 St. Lucia 13.4 0.0007 675.1 0.036 Suriname 8,740.2 0.0025 139,843.2 0.040 Trinidad and Tobago 9,158.8 0.023 83,155.9 0.21 Note: Only those countries that reported wages were included in the calculations. Source: ILO unemployment and wage data; Joint United Nations Programme on HIV/AIDS (UNAIDS) HIV/AIDS rates by age, 1982-2000. 52 WORLD BANK COUNTRY STUDY of AIDS. When a young householcd member dies, his or her family suffers greatly as a result of the loss of income, the additional burden on the remoining partner and children, and the emotional costs to the household. Loss of returns to thefamilyfirom private investinmt in the individual: Forgone returns to private investments are also a casualty of AIDS-related d,aths. Parents and communities invest in their young people by providing resources for childrearing and human capital accumulation, with the expectation that the child or youth will give back to his or her com- munity. Premature death from AIDS -related illnesses wi l necessarily eliminate the return on this investment, leading to parents who are less secur, in their old age and communities that are less developed and secure. Social economic costs: The measurement of the social economic costs of HIV infection of youth include the following items: Loss of returnsfrom state investment in the individual in terms of tax revenue: Forgone GDP overestimates the cost to the state of AIDS deaths. Instead, the financial loss to the state is in terms of the forgone return to thLe state's investment in the individual before his or her death. Given the gestation period cf HIV, many youth who contract the illness will have completed their (often) state-sponsored education and are just beginning their productive lives, in which they will "return" to the state by the payment of taxes and other nonpecu- niary benefits. If the individual consumes from the state all that he or she pays in terms of taxes, the net social gain or loss is zero. However, because these are young individuals, who are likely to demand less from the state, they are likely to consume less than their share of' taxes, thus creating a net loss for the state. Forgone benefits ofpublic investment in treatment of HIV/AIDSpatients: The (largely public) costs of treating HIV/AIDS indicate that resources are directed away from other possible productive uses. Thus, the benefits from using the resources in this alternative program- such as drug prevention among youth, nutrition programs for children, and old-age bene- fits-are not realized, increasing the economic costs of the illness. Infection of others: A study of HIV in Honduras (World Bank 2002) estimates that each HIV infection results in the infecticn of 0.1 additional individuals through sexual contact. Additionally, children (ages 0 to 4 years) with HIV/AIDS make up 3 percent to 4 percent of all reported AIDS cases (CAREC member countries 2000). These children are most likely to have contracted the disease from their mothers. Thus, cost estimates here per indi- vidual with HIV have much wider consequences. Orphans: Most individuals who contract HIV while youth will be parents of young children when AIDS-related death occurs, leaving a generation of children with one parent or no parents. Estimates from PAHO suggest that since 1982, the number of orphans per AIDS- related death range from 0.1 in Barbados to 3.2 in 'Haiti (table 5-7). Orphans, whether cared 6". _ *'' .P me P * m Orphans whose parents died Orphans per AIDS- Country of AIDS-related causes AIDS-related deaths related death Barbados 190 1,800 0.11 Dominican Republic 7,900 4,900 1.6 Haiti 74,000 23,000 3.2 Jamaica 1,200 650 1.8 Trinidad and Tobago 930 530 1.7 Source: PAHO (1999). CARIBBEAN YOUTH DEVELOPMENT 53 for by the state or other family or community members, will accumulate less education over their lifetimes, have lower carnings, have a higher propensity to engage in criminal activity, be less healthy, be more likely to engage in child labor, and bc socially excluded, all of which lead to a less happy, healthy, and productive next generation, which imposes private costs (less income, less integration with society, poorer health) and social costs (transfers directed toward these adults rather than others in need, less government tax revenue, higher crime costs). Forgone nonmonetary contributions: Individuals not only contribute taxes to the common good, they also help to build a society. Premature deaths of prime-aged men and women will deny their societies of the contributions that they would have made to culture, democ- racy, and society, costs that are difficult to quantify. Underinvestment in future generations: As HIV infection rates increase, the incentive to invest in the future generation decreases because the likelihood that they will survive to realize those investments is shrinking. The implications of this for society are enormous because those who do not succumb to HIV/AIDS will be less productive (in monetary and nonmonetary senses) members of society as a result of less human and social capital accu- mulation while they were young. Social exclusion: Those with HIV/AIDS are still commonly excluded from society, as are their families, resulting in fewer contributions enjoyed by society and the individual. Lower costs to government expenditures: Although young people who die of AIDS-related ill- nesses are likely to have been net contributors to the state during their productive years, they are also likely to have been net debtors later in their lifetimes. Thus, early death from the ill- ness will decrease the demands on the state, thus lowering financial and economic costs. In addition to the financial costs to the state and family of treating a person with HIV/AIDS, the economic cost to the individual, his or her family, future generations, and society is enormous. Existing data and measurement techniques do not allow us to closely estimate the costs, but even the lower bound estimates are astronomical. Unemployment Youth unemployment is more costly to society than adult unemployment because, in the case of youth, human capital accumulation is interrupted early in the work life. On average, youth un- employment is three times higher than adult unemployment (see chapter 3), thus leading to larger forgone productivity. However, unemployed youth, as discussed in chapter 4, are active in violence, substance abuse, and risky sexual behavior, so these costs from other behaviors correlated with (and possibly caused by) unemployment may also be considered a cost of unemployment.49 The forgone productivity due to an idle factor of production-youth unemployment-ranges from zero to more than 7 percent of GDP in various Caribbean countries. If youth unemployment were eliminated, the increase in GDP would range from 1.1 percent in Barbados, to 5.7 percent in Jamaica, where 2.6 percent is due to additional male labor and 3.1 percent is due to additional female labor (table 5-8). The addition to GDP in the other countries in the sample falls between these extremes. Table 5-8 also presents the forgone output by youth if their unemployment rate were equal to the adult rate and if it were equal to the youth unemployment rate in the United States, an alternative job market for many Caribbean youth. These estimates suggest that if the unemployment rate of 49. Few studies show that unemployment causes individuals to engage in these risk-taking behaviors, though focus group interviews suggest that unemployment combined with other factors (such as social exclusion) may lead to violence or substance abuse. Thus, adding the costs of risky sexual behavior, crime and violence, or substance use to the total cost of unemployment may be premature until further research corroborates the causal relationship. 54 WORLD BANK COUNTRY STUDY TABLE 5-8: "ORNEW__111__ DEMAND ELASTICITY= - Youth Caribbean and unemployment U.S. youth Zero youth equal to adult unemployment unemployment unemployment rate equal Boys Girls Boys Girls Boys Girls Antigua and Barbuda 1.14 ().50 0.80 0.35 0.60 0.26 Barbados 0.56 0.54 0.30 0.42 0.40 0.45 Dominican Republic 1.68 1.50 0.85 1.34 1.33 1.49 Guyana 1.17 (.85 0.84 0.76 0.71 0.67 Jamaica 2.60 1.14 1.45 2.69 2.07 2.89 Saint Lucia 2.18 1.73 1.28 1.29 1.95 1.63 Trinidad and Tobago 1.50 1.05 0.80 0.76 1.17 0.9 Source: ILO unemployment rates and wage data (see Table A3-3 (Appendix 3) for years; author's calculations. youth were equal to that of adults, GDP would still be 0.7 to 4 percent higher. If it were the same as in the United States, GDP in the Caribbean region woulld be 0.8 to 5 percent higher (table 5-8). Economic costs: The forgone earnings in table 5-8 largely reflect economic costs of unemploy- ment to the individual. Additionally, a por:ion of those lost earnings is economic costs to the state in the form of forgone tax revenue (firm or export taxes). However, additional indirect costs, some of which are costly to reverse, are also imposed, including: Lowerfuture income: Labor productivity is rewarded in the labor market. An unemployed individual is not accumulating human capital to increase his or her labor productivity while unemployed, and he or she may even lose existing skills during the job search process.5' The stagnation or destruction of skills will result in lower earnings when the individual does find a job, having negative implications at the private level (well-being of self and family) and the public level (lower tax revenues). Migration: An absence of jobs results in migration to more dynamic labor markets. Despite the assumption that only the well-to-do migrate, focus group interviews reveal that migra- tion is a reality for youth across all socioeconomic classes. This is a loss to society because investments in these young people are realized in other countries and they are not generat- ing the nonpecuniary benefits in their home societies, but some of this may be recovered in the form of remittances. Migration may lead to f amily and community breakdown and a generation of barrel children, who have few opportunities to be productive citizens, to the detriment of themselves and their countries. Underinvestment infuture,generations: If jobs are scarce, parents either cannot afford to send their children to school or they choose not to make this investment because of low expected returns. Although data do not exist to corroborate this claim, it is an issue that is worth monitoring because of the fu-ure private and public costs associated with a less skilled population. 50. A demand elasticity of wages of-2 is applied because as employment is created, the wage rate should fall (Maloney and Arango 2003). 51. Although unemployed individuals may maintain their human capital by volunteering or attending job training programs, these activities are increasing.y rare in the Caribbean region. CARIBBEAN YOUTH DEVELOPMENT 55 Social exclusion: The fact of being unemployed is a type of social exclusion, but activity in illegal labor markets is an alternative that is chosen more often by youth, further excluding them from mainstream society. Secondary costsfrom criminality, substance use: Unemployment is correlated with other youth behaviors that impose costs on the individual and society Financial costs: Although the financial costs of unemployment primarily accrue to the individ- ual, there are social financial costs as well. An unemployed person may collect unemployment insurance (as in Barbados) or be more dependent on the state for social services because he or she cannot support him- or herself. These public costs are likely to be minimal, though, because young people are still dependent on their parents, so the costs are privately born by the families. However, direct costs to both the state and the individual are imposed by the behaviors that tend to be asso- ciated with unemployment, such as increased drug and alcohol use or crime and violence. School Leaving Early school desertion imposes a high cost on the Caribbean region. As discussed in previous chap- ters, school not only provides the human capital that can be sold in the labor market, it also is the source of more general education, such as social interactions, building social capital, and identify- ing guiding principles for one's life. The discussion in chapter 4 suggests that simply being in a school environment is largely a positive force. Thus, early school departure may not impose large direct costs on society (holding constant the other negative behaviors that school leavers tend to engage in) but also impose high indirect costs in the form of forgone labor earnings for the indi- vidual, lower tax revenues for the state, and secondary costs of the risk-taking youth behaviors that result from either having less education or not being in school at a young age. The personal and economy-wide gains to a population with a postsecondary education are far greater than for those with only a primary or secondary education. The marginal lifetime earnings from a university education, relative to a secondary education, are represented in appendix 3.52 The differences are large for men and women in all countries presented. However, the graph also shows that the benefit to lifetime earnings of a secondary school education, relative to only a primary school education, is not as distinct. First, the gap between the middle line and the bottom line- comparing secondary school education lifetime earnings to primary school education-is not as large as the comparison between secondary and postsecondary, implying that the net gains are not as large. Second, the marginal benefit to women seems to exceed that of men, because women in all countries receive a higher primary to secondary education than do men, though it may not emerge until late in their work life. Finally, for some Guyanese, Jamaican, and St. Lucian men, the lifetime earnings from a secondary school education do not differ from those from just a primary school education. This may reflect the inability of secondary school to prepare young people for the labor market: Perhaps all skills that are valuable to the labor market are learned during primary school, and skills learned while working as a teenager earn a higher premium in the labor market than do skills learned during secondary school. The discounted lifetime cost of early school leaving in terms of forgone earnings at the individual level, which may also be understood as forgone GDP for the country, reaches into the hundreds of 52. The top line in each graph is the amount of earnings at each age that an individual with university education receives at each stage of his or her life. The second line is the total earnings of a person with a sec- ondary school education, and the bottom line is the earnings per year of an individual with only a primary school education. The area between each line is the net benefits to lifetime earnings of the next higher level of education. An alternative measurement is to estimate returns to each level of education and use the coeffi- cients from a linear regression to estimate earnings. The weakness of this approach is that it assumes that the returns to experience for each education level are constant, which is clearly not the case, as shown by the graphs. The graphs are used because education and experience are the primary explanatory variables in a Mincerian wage equation and all the information from these variables is captured in the graphs. 56 WORLD BANK COUNTRY STUDY TABLE 5-9: IEP . 3* . "IMpP_ I6_11_1 - * . * iil THOUSANDS OF US$)56 Dominican Trinidad and Republic Guyana Jamaica St. Lucia Tobago 1998 1999 1997 1995 1992 Secondary $5.2 Men $27.4 -- 11.4 - Women $16.9 $23E.6 $20.6 $279.3 University $14.5 Men $137.0 $660.6 $156.9 $420.4 Women $86.9 $1,036.3 $115.4 $1,562.7 -Net difference in lifetime earnings is zero or negative. Source: Household surveys for the first four countries; World Bank (2000b) for Trinidad and Tobago. thousands of dollars per individual.53 Table 5-9 shows tie benefits of a secondary education in the Dominican Republic, Jamaica, and Trinidacl and Tobago.54 For example, in the Dominican Republic, the net lifetime earnings of secondary education relative to only primary education are US$27,400 for a boy and US$16,900 for a girl. This implies that the productive capacity of the economy is severely underused as a result of secondary school leaving. The benefit of postsecondary education is even more dramatic, where the net earnings (productivity) are in the millions of dollars, such as for Guyanese anld St. Lucian girls.55 Economic costs: The estimates in table 5-9 can be interpreted as a conservative estimate of the private indirect costs of accumulating less education, but a fraction of the totals is an economic cost to society. A man or woman is givin-g up the additional happiness that may come from having more income, whether to spend on oneself or one's family. Hovever, income and consumption are taxed, so tax revenues that would have acciued to the state are rot collected as a result of the lower level of investment. The value of forgone productivity is a clear underestimate of the total cost to the individual and society of education that is attributable to the importance of education in determining other 53. Because the marginal dollar earned by the young man or woman today is not equivalent to a dollar earned in the year 2045, at the end of the young person's wor k life, it i. necessary to discount the net lifetime earnings to take into consideration the lower value that a dollar eamed in 45 years has relative to one earned today. These discounted values are also useful in a cost-benefit analysis when considering whether or not to implement programs to lower school leaving. 54. The estimates assume that the wage elasticity of demand is zero. 55. This is an overestimate because it is unli. I = risk; < I = protective. Source: PAHO Adolescent Health Survey (1999). 88 WORLD BANK COUNTRY STUDY Nine predictor (independent) variables were used: how hard the person tries at schoolwork, attendance at religious services, thinks about hurting or killing sormeone, parents' problems with violence, parents with mental health problerns, friend or family member who has committed suicide, parental and family connectedness (a composite variabl' of feeling that parents care, can tell parents about problems, other family members care, people in the family understand, family pays attention to the young person), victim of physical or sexual abuse, and parental substance abuse (alcohol or drugs). The coefficient estimates show how well having a particular risk or protective factor explains the variance of the dependent variable, that is, how closely correlated they are. It does not show the magnitude of the effect or causality. The second methodology uses nonparametric methods to identify the powerful effects of the presence of multiple protective or risk factors. The top three protective (or risk) factors were taken for each outcome. Selecting protective factor pi, the likelihood of engaging in the risky behavior for youth with a high amount of pi, but a low amount of characteristics p2 and p3, was measured. A similar exercise was done for p2 and p3. This exercise showed the marginal effects by protective fac- tor. Next, the proportion of youth with various combinations of two of the three protective factors was calculated. Finally, the proportion of youth with all three protective factors and who engage in the risky behavior is calculated. A similar exercise was carried out for the risk factors. A ppendix 2 LIFETIME EARNINGS FROM AN ADDITIONAL LEVEL OF EDUCATION FOR SELECT COUNTRIES BY SEX 89 90 WORLD BANK COUNTRY STUDY 1200 1200 1000 1000 - 8) 500 Bo c 00 2E C U 600 c 600 c0 - 400 . 400o- 200 - 200 0'I . 15 20 25 30 35 40 45 50 55 60 65 15 20 25 30 35 40 45 50 55 60 65 Age Age Dominican Republic: Boys Dominican Republic: Girls 60000 - 6C000 - 50000 - /coQo < 40000 - c 4D000 w w it 30000 - 30000 - < 20000 < 20000 - 10000 10000 0 , _ _ _ _ _ _ _ _ _ _ 0 ,_,_, ,_,_ _,_C ._._. ._._ _._. . _ . _ 10 15 20 25 30 35 40 45 50 55 60 65 10 15 20 25 30 35 40 45 50 55 60 65 Age Age Guyana: Boys Guyana: Girls ^Eamings are given in local currency in the year of the survey. Mean earnings from a post-secondary education Mean earnings from a secondary education Mean earnings from a primary education CARIBBEAN YOUTH DEVELOPMENT 91 300 300 250 250 c 200 G 200 E E 0 0 w 15o W 150 100 ioo c 10< 0 50 50 0 0 l_,_._,_,_,_,_O -_l 15 20 25 30 35 40 45 50 55 15 20 25 30 35 40 45 50 55 Age Age Jamaica: Boys Jamaica: Girls 30 25 - ~~~~~~~~~~~~~~30 2525 - 20 25 E 20 -) W 15 -0- w 6 5 _ 10 15 <~~~~~~~~~~~~~ 55 0 _ _ _ _ _ _ _ _ _ _ _ _ _0 _ _ _ _ _ _ _ _ _ _ _ _ _ 15 20 25 30 35 40 45 50 55 60 65 15 20 25 30 35 40 45 50 55 60 65 Age Age St. Lucia: Boys St. Lucia: Girls *Eamings are given in local currency in the year of the survey. Mean earnings from a post-secondary education Mean earnings from a secondary education Mean earnings from a primary education A.ppendix 3 METHODOLOGY FOR COST CALCULATIONS, CHAPTER 5 B ecause of the scarcity of data in the Caribbean region, the methodology to estimate the costs in chapter 5 uses the country-specific numbers that could be obtained, but we also make bold assumptions that cost structures are similar across the Caribbean. These estimates can be further refined as additional data become available. Crime and Violence The costs of crime are difficult to estimate because of the scarcity of data on criminal activity and arrest, judicial, and incarceration rates and costs. However, enough data were available for five exercises that measure the financial social costs of youth criminal activity, the private social costs of youth criminal activity, the economic social costs of youth criminal activity, the increase in tourist receipts from a 1 percent decrease in youth crime, and the private social costs of youth criminal activity. Various calculations are carried out for Jamaica, St. Lucia, Trinidad and Tobago, and Barbados, depending on data availability. Financial Social Costs of Youth Criminal Activity The generation of this statistic requires the sum of two types of costs: 1.The product of the tangible costs of each crime type and the number of those crimes com- mitted by youth that were reported in a country at that time was generated for each type of crime for which data were available. The sum across all crime types gives the total value of tangible crime costs annually. 2. The cost of arrest, prosecution, and (average) detention is multiplied by the number of youth crimes committed annually. 93 94 WORLD BANK COUNTRY STUDY The exercise is carried out for Jamaica and St. Lucia, with thc following assumptions: The victim compensation cost of the tangible costs by type of crime estimated in the United States (Roman and Farrell 2001) is a rough estimate of the tangible costs of these same crimes in St. Lucia and Jamaica, given in table 5-1 of the report. The tangible costs of possession of firearms (Jamaica) and drug offenses (Jamaica and St. Lucia) are zero. The cost of arrest, prosecution, ana detention of an average criminal in Trinidad and Tobago approximates the costs in Jamaica and St. Lucia, and is equal to US$5,000 per crime (World Bank 1996). Youth crime data are given for Jamaica but not for St. Lucia. However, in Jamaica, approximately one-tenth of all crimries are prosecuted and 55 percent of all crimes are com- mitted by youth so # crimes * (1/10) * (0.55) gives the total number of prosecuted youth criminals in St. Lucia. The annual prosecution of youth for each type of crime is as follows: _ A _0 El St. Lucia Jamaica Number of youth convicted, by crime 4,140 1,266 Sexual assault 1.1% 2.8% Murder and manslaughter 0.3% 2.34% Grievous harm 16.0% 8.0%_ Assaults 15.4% - Theft, robbery, larceny, extortion 35.2% 32.5% Illegal firearms - 7.6% Dangerous drugs 7.7% 26.6% Source: Data for St. Lucia are from ECLACICDCC (2001), and data for jarnaica are from Pantin (2000). The costs missing from these calculations are the value of the property damage, expenditure on police force, and costs of all crimes, not just those that are prosecuted. Private Social Costs The cost of private security measures for Tjinidad and Tobago ranges from US$5,036 to US$34,000 peryear, of which US$3,969 are fixed costs and the remaining are annual recurrent costs. The fixed costs include installing security cameras, installing barriers to the house, or improv- ing the safety of one's car, and the recurrent costs are primarily due to hiring a 24-hour guard. The total value of the security industry in the countries of study cannot be estimated, so we can only note that the figures generated omit this category, which will substantially underestimate the two costs. These values are derived from World Bank (1996). Economic Social Costs These costs are estimated for Jamaica and St. Lucia. The economic social costs are given by the sum of three components: 1. The forgone tax revenue of juveniles who are in prison: Assuming that those who are in prison would otherwise be employed or unemployed (not idle), the following equation is calculated for this component: [mean annual wage/2 * 0.8 * (1-male youth unemployment rate)] * 0.2 CARIBBEAN YOUTH DEVELOPMENT 95 The mean annual wage is divided by 2 to account for the average six-month prison stay. The wage is multiplied by 0.8 to account for the lower wages of youth relative to adults. Finally, it is adjusted by the youth unemployment rate. The male wage and unemployment rates are used because most juvenile prisoners are men. A tax rate (income and consump- tion) of 20 percent is assumed. 2. The opportunity cost of resources used for prosecution, arrest, and detention: Assuming a return of 6 percent on an alternative use of investments, the total expenditures on pros- ecution, arrest, and detention (World Bank 1996) are multiplied by 0.06. This requires the assumption that the costs for Trinidad and Tobago approximate those in St. Lucia and Jamaica. 3. The opportunity cost of the tangible costs: Similarly, the total spent on tangible costs is multiplied by 0.06 to estimate the opportunity cost of the resources. The tangible costs are those outlined in table 5-1. The Increase in Tourist Receipts from a I Percent Decrease in Youth Crime To estimate the gain in tourist dollars due to a decrease in youth crime, we use the elasticities found in Levantis and Gani (2000), 1994 tourist flows and expenditures as reported by the Caribbean Tourism Organization, and 1994 crime rates as reported by the United Nations. A 1 percent decrease in youth crime was estimated to decrease the total crime rate by 6 percent. Applying the elasticity to this measure, total tourist flows were estimated to increase and, assuming that demand for tourist goods and services is perfectly elastic, the corresponding increase in tourist expenditures was generated. This was presented as a proportion of current tourist flows. Private Economic Costs Three components are estimated in this section: 1. Psychological costs of all crimes (cost to victim): Using the data from table 5-1 and apply- ing the number of times the crime occurs from the above table, the intangible costs of crimes in Jamaica and St. Lucia are generated 2. Forgone benefits of resources spent on security (cost to victim): Similar to the opportunity cost of public expenditures, the total value of resources spent on security is multiplied by 0.06 to estimate the opportunity cost. 3. Forgone income of prisoner (cost to juvenile delinquent's family): The cost of forgone earnings is assumed to be equal to the youth annual wage (equal to 80 percent of the adult wage), discounted for the level of youth unemployment and multiplied by the average number of years of incarceration. In Trinidad and Tobago, the average prison stay was six months, so the same is assumed for St. Lucia and Jamaica. The data sources used in these calculations are Direct cost of crime in terms of arrest, prosecution, and incarceration is US$5,000 per arrest (World Bank 1996) The number of youth and adult crimes convicted in Jamaica is from Pantin (2000) Mean wages were generated using the Jamaica labor force survey and the St. Lucia Living Standards Survey. The total number of crimes by country is given by the United Nations. The youth unemployment rate is from the International Labour Organisation Adolescent Pregnancy The costs of adolescent pregnancy reach far beyond the hospital cost of a young woman giving birth. Instead, they include all the additional costs over the lifetime of the adolescent mother and 96 WORLD BANK COUNTRY STUDY her child that are born privately or by society at large and that viould not have occurred had the childbirth been postponed until thc woma.n was 18 ye,rs old or older. The costs estimated for this exercise may be broken into six general areas, discussect below. Mother's Forgone Annual Earnings and Tax Revenues To measure the net loss to the mother's lifetime earnings that rzsult from early school dropout and entry into less competitive or less lucrative jobs (in order to care for her child), the annual value of forgonc earnings is given by (mean adult earnings * adult unemplcyment rate -- mean youth earnings * youth unemployment rate ) * (80/100) where the first term is the net loss to the adolescent mother's earnings because she earns only a portion of the wage that she would have ealrned had she finished her education. This is multiplied by 0.8 to account for the gender wage gap that makes the net a,dult earnings rate an overestimate for women. Tax revenues are assumed to be 20 percent: of incorne, whether collected through income or sales tax. Annual Child Support Adolescent mothers are shown to collect 32 percent less in child support from the childfathers than do nonadolescent mothers. The value of child support is approximately 18 percent of wages (Maynard 1996).' These private costs are born by society where annual forgone child support = (annual wage * 0.18) - (annual wage * 0.18 * 0.32) Govemment Income Transfers, Rent Subsidies, Food S:tamps Because young mothers will have lower earnings and le;s support from the childfathers, they will have a higher demand for public transfers than would other mothers. For several countries, the cost of these government benefits could not be measured. Given the scarcity of wide-reaching public assistance programs and the even rarer targeting of the programs toward young mothers (instead often targeting the elderly), an estimate of the value of government transfers that may be received by young mothers is derived from World Bank (1996). The following assumptions were made: For Jamaica, the weekly value of food stamps was assumed to be equal to one-half of the basic food basket adjusted for 11 percent of the populalion as recipients; for St. Lucia, no benefits were accrued to adolescent mothers because most benefits seem to reach one-person households (namely, the elderly); and for Trinidad and Tobago, the social benefits were assumed to accrue with equal probability to the whole population (World Bank 1996). Medical Care Adolescent mothers and their children require more health care than do older mothers and their children. The net additional cost is estimated to be 28.8 percent higher for the adolescent mother and her child than for the average citizen. T-hus, the value used for the annual additional cost of medical care for the young mother and her child is 28.8 percent of the mean health care expendi- ture per person in each country. Foster Care, Incarceration of Young Men, Productivity of Young Adults Foster care programs are not well developed in the Caribbean region, so this was given a cost of zero. Crime costs were estimated as: Cost of arrest, deterrence, anid prosecution * probab:lity of being arrested * Pr (commit a crime) 1. Child support is estimated to equal 18 percent of the average wage. CARIBBEAN YOUTH DEVELOPMENT 97 where the probability of being arrested is 4.3 percent (from the Jamaican data) and the probability of committing a crime is 25,000 per 1.5 million males (from the Jamaican data). Finally, the pro- ductivity of the child when he or she grows to adulthood is not included because it is difficult to put a pricc on a life. Forgone Benefits of Altemative Use of Transfers and Health Costs This is estimated by multiplying the net expenditures on transfers and health costs by 0.06, which is a healthy return to an investment. To generate the marginal cost of adolescent motherhood, the above cost components are summed according to their classification as given in the table below: To estimate the lifetime costs, those costs that accrue to children (such as child support) are multiplied by 18 and those that accrue to the mother are multiplied by 50 (assuming that she lives until age 65, on average). The total is discounted at 6 percent. The formulas used to generate table 5-4 are Annual per birth-financial: financial health costs of mother and child + child support pay- ments + government transfers + financial costs of crime Annual per birth-economic: forgone tax revenue from mother + alternative use of government transfers and health expenditures Annual per cohort-economic or financial: (annual per birth) * number of new adolescent mothers each year Lifetime per cohort-economic orfinancial: [(annual child and mother costs per year while the child is dependent * 18) + (annual mother costs per year * (65-18-15))] *number of adoles- cent births in a cohort. A discount rate of 6% is applied to each term. W-1_ z_0I*I mc_anel Financial costs Economic costs Private Health costs of mother and child Mother's forgone earnings Forgone consumption from not marrying Lower income and happiness of children who grow up poor, have health prob- lems, have less education Social exclusion Social Child support from the childfather Forgone tax revenue from lower future L Health costs of mother and child paid income of mother publicly Lower tax revenue from lower future E Government transfers for aid to poor income of child families, foster care Forgone use of administrative resources Crime prevention, legal and justice system for transfers and health care to adoles- cent mothers and their children L Forgone benefits of alternative uses of health care and transfers to adolescent mothers and their children - Economic costs of crime Loss to society of the marginal nonpecu- niary contributions to society by the child and adolescent mother 98 WORLD BANK COUNTRY STUDY HIV/AIDS The cost to society of youth AIDS deaths and the deaths of thcse who contract HIV while young is measured as forgone earnings in this report. These wvould be the cost to society of not spending any money on drug regimens such as zidovudine (AZT) or HEART, instead relegating the individ- ual to home care for the period of a year until death occurs (World Bank 200 lb). Two measures are presented in chapter 5: (1) the cost to the country of AIDS deaths in the year 2000, the most recent year for which data on AIDS are available (PAICM); and (2) the total output forgone in the year 2000 due to all individuals who have died of AIDS since 1982, the first year for which PAICO provides data. The following equation is used to generate the cost of forgone earnings attributable to AIDS deaths in the year 2000: (# AIDS deaths ages 16-24 * mean anrnual wage * 0.8 * youth unemployment rate) + (# AIDS deaths ages 25-39 * mean annual wage * adult unemployment rate) where the number of deaths for each age group is given by PAHIC statistics on newly reported HIV/AIDS cases in 2000. The mean annual wage and youth and adult unemployment rates are derived from ILO statistics. The assumptions in this calculation are 7 The period between contraction of HIV and diagnosis cf AIDS is 10 years. An individual with untreated AIDS dies within one year. The opportunity cost of the AIDS- related death is the total value of forgone income, which includes taxes paid. It underestimates the true cost because it does not consider AIDS orphans, psychological [costs, or other related negative externalities of the early death. The number of reported cases of HIV/AIDS is a proxy for the number of AIDS cases that develop per year. The number of HIV cases is unkLnown. A person with HIV is as productive as a healthy person; once HIV evolves into AIDS, the person's productivity falls to zero. No treatment. Youth earn 80 percent of adult mean wages. The wage elasticity of demand is zero. To estimate the total losses in 2000 from all AIDS deaths of youth or of individuals who con- tracted HIV during their youth, the following is estimated: (# AIDS deaths ages 16-24 in 2000 * mean annual wage * 0.8 * youth unemployment rate) + (#AIDS deaths ages 16-24 for 1982-1999 * mean annual wage * adult unemployment rate) + (#AIDS deaths ages 25-39 for 1982-2000 * mean annual wage * adult unemployment rate) where the first term is the forgone earnings of youth who died of AIDS in 2000, the second term is the forgone adult earnings of youth who died of AIDS in previcus years who are not contributing to productivity in 2000, and the third term is the value of forgone earnings attributable to all adult AIDS deaths since 1982 that are not contributing to gross domestic product (GDP) in 2000. Unemployment The unemployment section estimates the increase in GDP if youth unemployment were set equal to zero, equal to adult unemployment, or equal to youth unemployment in the United States. The assumptions in this exercise are The wage elasticity of supply is set equal to 0 in the firsr column but equal to 2 in the sec- ond to estimates. The e=2 is derived from Arango and Maloney (2001), who generate wage elasticities for the manufacturing sector in Mexico and Argentina. The elasticities CARIBBEAN YOUTH DEVELOPMENT 99 for youth in the Caribbean region are likely to be higher because they are primarily employed in services. The unemployment rate is a random walk with a mean of 0. The year represented in the cal- culation for each country is assumed to be an average year. Because the years differ (based on the availability of unemployment data), world economic conditions will also differ Real wages are constant. The wages are adjusted by the rate of inflation (CPI) to bring them to the year for which unemployment is measured. Youth wages are 80 percent of adult wages because youth have less experience but higher levels of completed education. Boys and girls earn the same real wages. Women earn 80 percent of men's wages. The relevant years of the unemployment rates used are shown in table A3-3. Only those countries for which wages and unemployment rates were available are included in the sample. Wages were missing for Grenada, Dominica, Belize, St. Vincent and the Grenadines, and St. Kitts and Nevis. Higher youth employment does not crowd out adult employment. To calculate the percent increase in GDP due to a decrease of youth employment, the follow- ing equation was used: {[(youth unemployment rate - target youth unemployment rate) * number of youth labor force participants] * [adult wage * 0.8])/GDP where the term in square brackets is the increased number of youth due to higher youth employ- ment and the second term in square brackets is the youth wage. Multiplying these terms together is the total additional output due to productively employing more of the youth labor force. Finally, the total product is divided by the GDP to estimate the increase in GDP due to higher youth employment. The exercise is repeated three times for girls and boys, where the target youth unemployment rate is set equal to: 1. Zero: This would be an ideal situation, though highly unrealistic. Thus, it should be inter- preted as the upper bound of lost productivity. Country Survey Year Antigua and Barbuda 1991 Barbados 1999 Dominican Republic 1996 Guyana 1992 Jamaica 1999 St. Lucia 1998 Suriname 1998 Trinidad and Tobago 1999 Source: ILO 1999. 100 WORLD BANK COUNTRY STUDY 2. The adult unemployment rate: This may be a feasible target if thc productivity of the more educated young labor force rises to the level of the procluctivity associated with the higher productivity of adults. The demand elasticity of wages i:3 set equal to -2 (Maloney and Arango 2003). 3. T7he youth unemployment rate in th6 United States: GiverL the high degree of migration to the United States, the two labor markets may rnove toward convergence. With perfect con- vergence, the youth unemployment rates should be equal. The demand elasticity of wages is set equal to -2. The data are drawn from the following sources: wages: ILO adult wages, unemployment rate: ILO youth and adult unernployment rates, number of youth in the labor force: ILO, Li GDP: International Monetary Fund (IMF) international financial statistics reported in local currency, and i inflation rate: IMF international financial statistics based on the CPI. School Leaving The measurement of net and total productivity loss due to early school leaving is a two-step process. First, an age earnings profile is constructed to measure the forgone earnings attributable to not completing an additional year of education. Using household and labor force surveys from Jamaica (1997), the Dominican Republic (1998), St. Lucia (1995), and Guyana (1999), average nonzero income by age group (in five-year intervals) and education group (by education level) are generated. The wages are multiplied by the probability of working at each age and education level to find an average wage per age and educa':ion group. These are used to construct age earnings profiles, which are the graphs of total earnings based on education level, given in appendix 2. Five-year intervals are used because the sarmple sizes are: too small to robustly generate mean earn- ings per age group, and the education group is used because the surveys do not report grade level. The following assumptions are made: L Earnings of a 60-year-old today are a proxy for real earnings of a 20-year-old today when he or she is 60 years old. Reported monthly wages are multiplied by 12 to estimate annual wages (Jamaica and Guyana), and weekly wages are muLitiplied by 4.3 and by 12 (St. Lucia). Wage earning begins at age 16 for primary and secondary school dropouts because the legal work age is 16 in most countries and work younger than age 16 is usually unpaid and in small businesses. Wage earnings begin at age 22 for post3econdary-educated individuals. L Individuals are in the labor market until age group 45-5 5, depending on the country. The upper age is determined by data availability. iu The number of boys and girls who do not finish each gra de level is equal. This is a bold assumption because girls have higher education rates than boys, especially in urban areas. L: The social rate of return is 6 percent. This method is used rather than estimating a Mincer earnings equation and then using the esti- mates to plot the earnings path because that would constrain the returns to each level of education to be linear, which they clearly are not. The forgone earnings from not completing the higher level of education are generated by summing the total lifetime earnings from education level E+1 and subtracting from it the total life- time earnings from leaving school with education level .E. The exercise is carried out for primary CARIBBEAN YOUTH DEVELOPMENT 101 versus secondary education level and for secondary versus tertiary education and separately for men and women. These values are converted to U.S. dollars. Finally, to calculate the lost productivity of all youth who were not in school in the observa- tion year, the marginal rates are multiplied by the number of youth who were not in each level of school. Thus, the marginal gain from secondary education relative to primary education is multi- plied by the percentage of students who did not enter secondary school and the marginal gain to postsecondary education relative to secondary education is multiplied by the number of secondary students who did not go on to postsecondary school. The number of students who did not enter each respective level of school is given in table A3-4. The data are drawn from the following sources: Wages by age and education level: Jamaica Survey of Living Conditions (1997), Guyana Survey of Living Conditions (1999), National Survey of Income and Expenditure (Central Bank, Dominican Republic 1998), Living Standards Measurement Study for St Lucia (1995); Number of students who did not finish each grade level: World Development Indicators (World Bank, 1998-99); and Proportion of the employed labor force: household and labor market surveys. Dominican Republic Guyana Jamaica Primary 54,824 3,550 5,460 Secondary 267,453 21,007 22,526 Postsecondary 3,028,507 377,609 1,174,15 Source: World Development Indicators (World Bank 1998-99) A ppendix 4 CARIBBEAN YOUTH POLICIES AND PROGRAMS 103 WO 4NIA012 'N AK=J-1111 OII S .. 3* *6 . " 0 ' Programmes/ Responsible Separate Links to Other Country Government Agency Youth Policy Thematic Thrust Services Programmes Comments Antigua and Barbuda Youth Department, No Drugs, study skills, j/ unior achievement Ministry of Education, AIDS, career develop- / Peer counseling Youth, Sports and Com- ment, teen pregnancy, / National summer munity Development family and school rela- camps tions, school leavers / Drug busters / Continuing education The Bahamas Youth Department, Yes Youth leadership, safe / National youth Ministry of Youth and physical spaces, labor research and Culture market preparation, resource center citizenshin, cultiure and , Ndtiorlal media history, literacy campaign / Youth leadership training and organiza- tion, strenghenirg family / Job readiness and enterprisc schcr; / Personal develop- ment seminar / Health, sports and recreation pro- gramme Barbados Youth Affairs Division, No Citizenship, culture, / Youth Service Considered highly effective Ministry of Education, employment, nation / Youth Develop- due to: political will and Youth Affairs and building ment Programme support; autonomous Culture / Youth Entrepre- nature of the division; and neur Programme effective information and research system. Belize Ministry of Human Yes Disaffected youth, / National Youth Resources, Women's gang violence and Council Affairs and Youth street crime Development Dominica Ministry of Education, In draft Drug prevention Effective processes to Sports and Youth education identify youth needs and Affairs tailor programs through cadre of youth officers working at the local and municipal levels. Grenada Ministry of Youth, In draft . National Youth Interest has not yet trans- Sports and Community Council of Grenada lated into effective pro- Development gramming. CYP currently advising on improving the organizational structure of the youth unit. Guyana Youth Department, Yes Leadership, anti sex dis- / National Youth Hindered by size of the Ministry of Labour, crimination, citizenship Council country and large geo- Human Services and / Youth Service graphical distribution of Social Security Scheme the population; weak pub- / Youth Employ- lic service structure affects ment Scheme overall effectiveness of pub- lic service (including youth). Jamaica Youth Unit, Ministry of Yes (currently Education and train- / Special Training Effective at the national Education and Culture under revision) ing, employment and and Empowerment level due to the success of empowerment strate- Programme (STEP) the National Center for gies, health (including / Human Employ- Youth Development; weak responsible parenting), ment and Resource at the field level; active drug abuse, recreation Training (HEART) NGO sector. and leisure, values, atti- / National Youth tudes and anti-social Service Programme behavior, youth in / National Youth community and nation Council building (continued) A|1 i - *- __ ,*~ ., * * * Programmes/ Responsible Separate Links to Other Cn.unty ~ "Government Agency Youth Policy Themr.atic Thrust Services Programmes Comments St. Lucia Department of Youth Draft Youth economic par- National Youth Considered to be highly and Sports, Ministry of (approved by ticipation, youth edu- Council effective due to long his- Education, Human Cabinet) cation and training, tory of voluntary youth Resource Develop- crime prevention. sub- organizatins (under the ment, Youth and Sports stance abuse religious National Youth Council). values, sports and recreation, culture, teen pregnancy, partic- ipation, health St. Vincent and Department of Youth, Draft Group development Development education / National Youth Continues to maintain a Grenadines Ministry of Housing, and dynamics, leader- and training, outreach, Commission traditional welfare Local Government ship and communica- communications and / National Commis- approach to youth rather and Community tions, health and family information, project sion for Juveniles than moving to youth Development life education, conflict support / Youth Exchange development. ?Ministry of Housing, resolution, peer coun- Community Develop- seling, parent educa- ment, Youth and Sports tion, drugs and alcohol abuse, small business development Trinidad & Tobago Department of Youth, Draft Training and District youth services, / Youth Training and Active NGO sector, of Ministry of Sport and employment youth centers, youth Employment Part- which SERVOL is exem- Youth Affairs placement service, nership Programme plary; Public sector has a youth resource and / Apprenticeship large staff but tend to be information service Programme desk bound. / Apprenticeship for Industrial Mobilization / Socially and Eco- nomically Dis- advantaged Areas / National Youth Council Source: Danns, Henry and LaFleur (I 997); Youth of the United Nations; Country Profiles on the Situation of Youth; National Youth Policy (http:l/esa.un.org/socdevlunyin/comparea.asp) *Sectors: education, labor, health, economy, justice, commerce/industry, culture/national affairs 108 WORLD BANK COUNTRY STUDY TABLE A4-2: Country Number lnstruments Ratified or Acceded Antigua and Barbuda 3 / Abolition of Slavery, the Slave Trade, and Institutions and Prac- tices Similar to Slavery (LIN/ 1956) / Consent to Marriage, Minimum Age for Marriage and Registration of Marriages (UN 1962); / Convention on the Minirr um Age for Admission to Employment (ILO/1973). Bahamas I / Convention on the Abolit.ion of Slavery, the Slave Trade and Irtstitutions and Practices Similar to Slavery (UN/1956) Barbados 6 N/ ight Work of Young Persons: Industry (ILO/ 1948) / Abolition of Slavery, the Slave Trade and Institutions and Practices Similar to Slavery (UN/ 19.;6) / Discrimination in Education (UNESCO/1960) / Consent to Marriage, Min mum Age for Marriage and Registration of Marriages (UNIJ/ 1962) ./ Civil and Political Rights (UN/ 1966) / Economic, Social and Culiural Rights (UN/1966). Belize 3 / Medical Examination of Young Persons: Sea (ILO/1921) / Discrimination in Education (UNESCO/1960) / C:ivil and Political Rights (IJN/ 1966). Dominica 6 / Medical Examination of Young Persons: Sea (ILO/1021) / Abolition of Slavery, the Slave Trade, and Institutions and Practices Similar to Slavery (LJN/1956) ,/' Discrimination in Education (UNESCO/1960) / C'ivil and Political Rights (UN/1966); Economic, Social and Cultural Rights (UN/1966) / Minimum Age for Admission to Employment (ILO/ 1973). Dominican Republic 9 / Nlon-Industrial Occupatiols (1L0/11946) / Night Work of Young Persons: Industry (ILO/1948) / Abolition of Slavery, the Slave Trade and Institutions and Practices Similar to Slavery (UN/1956) / Discrimination in Educaticn (UNESCO/1960) / Consent to Mari-iage, Minimum Age for Marriage and Registration of Marriages (I.JN/1962) / Civil and Political Rights (UN/ 1966) / Economic, Social and Cultural Rights (UN/1966) Grenada 3 / Medical Examination of Young Persons: Sea (ILO/ 1921) / Civil and Political Rights (UN/1 966) / Economic, Social and Cultural Rights (UN/1966) Guyana 4 / Civil and Political Rights (UN/1966) / Economic, Social and Cultural Rights (UN/1966) / Minimum Age fcr Admission to Employment (ILO/ 1973) / Vocational Guidance and Vocational Training Human Resources Development (ILO/ 1975) CARIBBEAN YOUTH DEVELOPMENT 109 I ABLE A4-2: HUMAN RIGHTS INSTRUMENTS RATIFIED OR ACCEDED RELATED TO THE RIGHTS OF YOUTH (CONTINUED) Country Number Instruments Ratified or Acceded Haiti 6 Medical Examination of Young Persons: Industry (ILO/1946); Medical Examination of Young Persons: Non-Industrial Occupations (ILO/1946); Night Work of Young Persons: Industry (ILO/1948); Suppression of the Traffic in Persons and of the Exploitation of the Prostitution of Others (UN/ 1949); and Abolition of Slavery, the Slave Trade and Institutions and Practices Similar to Slavery (UN/1956); and Civil and Political Rights (UN/1966). Jamaica 4 Medical Examination of Young Persons: Sea (ILO/1921); Abolition of Slavery, the Slave Trade and Institutions and Practices Similar to Slavery (UN/1956); Civil and Political Rights (UN/1966) and Eco- nomic, Social and Cultural Rights (UN/1966). St. Lucia 2 Medical Examination of Young Persons: Sea (ILO/1921); and Aboli- tion of Slavery, the Slave Trade and Institutions and Practices Similar to Slavery (UN/1956). St. Vincent and Grenadines 4 / Abolition of Slavery, the Slave Trade and Institutions and Prac- tices Similar to Slavery (UN/ 1956) / Discrimination in Education (UNESCO/1960) / Civil and Political Rights (UN/ 1966) / Economic, Social and Cultural Rights (UN/1966). Surinam 3 / Abolition of Slavery, the Slave Trade and Institutions and Practices Similar to Slavery (UN/ 1956); / Civil and Political Rights (UN/ 1966) / Economic, Social and Cultural Rights (UN/ 1966) Trinidad & Tobago 5 / Medical Examination of Young Persons: Sea (ILO/1921) / Abolition of Slavery, the Slave Trade and Institutions and Practices Similar to Slavery (UN/ 1956) . Consent to Marriage, Minimum Age for Marriage and Registration of Marriages (UN/ 1 962) / Civil and Political Rights (UN!1966) / Economic, Social and Cultural Rights (UN/!1966) Source: Youth of the United Nations; Country Profiles on the Situation of Youth; Human Rights Instruments (http://esa.un.org/socdev/unyin/comparea.asp) 110 WORLD BANK COUNTRY STUDY TABLE A4-3: * 0 S Sm - Name of Organization Type of Organization T,arget Group Description Of Program National Youth Council NGO Youthi Umbrella organization of 162 youth volunteer organizations from 18 braches in St. Lucia (17 community-based, one comprising student councils from around the island) St Lucia Crisis Center NGO Females Hotline, counseling and legal (20-39 years) services for abused and battered women; public outreach program Archdiocesan NGO Catholic youth Faith-based activities and Youth Council (nationwidel retreats, retreats for youth Center for Adolescent NGO (Catholic Church) Youth withcut Five centers in both urban and Rehabilitation and a 2nd school rural areas; vocational courses Education placement as well as like skills, public speaking, rap sessions, and stress management Junior Achievement Private Sector School-going Teaches entrepreneurship, youth economic self-determination, business skills development; school-based program funded by Hewlett Packard; 1000 students trained in schools of which only 10-I5 percent are male Charterhouse High Private Youth who Secondary school preparation, School and College of failed to get a self-esteem and self-employment Continuing Education 2nd school training; affiliated with Institute place of Counseling, which has a hot- line for abused and marginalized youth Uptown Gardens' Public (quasi) (St. Lucia Female youth Rehabilitation program for Schools Center Women's Council) (I12- IS years) abused, neglected or abandoned girls who are on the verge of delinquency; services include counseling, career guidance, computer literacy, creative arts, language and technical skills training, family support and counseling, home management, physical fitness, job placement CARIBBEAN YOUTH DEVELOPMENT III i ABLE A4-3: MAIN ORGANIZATIONS PROVIDING SERVICES TO YOUTH-AT-RISK, ST. LUCIA (CONTINUED) Name of Organization Type of Organization Target Group Description Of Program National Skills Training Public (in cooperation Youth Job training to assist youth make Center Inc. with private sector) a transition to the working envi- ronment; training in agriculture, business, construction, crafts and furniture making, hospitality ser- vices and information technol- ogy; day care services available In collaboration with the Belfund,' provides access to start up capital for small businesses Boys Training Center Public Males Home for underprivileged, delin- (I12-16 years) quent boys who are referred through the juvenile court sys- tem; boys remain until their 1 th birthday; services include training in basic numeracy, literacy skills and vocational subjects as well as social activities Bureau of Health Education Public (Ministry of Health) Youth Education and sensitization pro- grams to reduce teen age preg- nancy and deal with women's health issues. Dept of Youth and Sports Public Youth (10- Development of youth sporting 35 year olds) facilities and initiatives to deal directly with youth issues Drug Abuse Resistance Public Children and School based extension program Education youth (5-12 to teach drug prevention; pro- years) gram promotes self-esteem, stress management, peer pres- sure management, self-motivation Substance Abuse Secretariat Public Youth Public awareness programs; for- mation of drug prevention clubs, and support workshops, semi- nars, and outreach programs Belfund, formally titled as the James Belgrave Memorial Fund has a focus on community development and youth development. It is an initiative of the Poverty Reduction Fund, which was established on the model of Social Investment funds in Latin America and The Caribbean with a broad holistic approach to poverty alleviation. I 12 WORLD BANK COUNTRY STUDY TABLE A4-4: - Name of Organization Type of Organization Target Group Description Of Program National Youth Council, NGO Youth Membership organization of 57 St. Vincent and the member youth associations and Grenadines* clubs founded in 1966, which provides income generation, sports, housing support, commu- nity development projects, and vocational training at the com- munity level Supported by dues, fees and some limited governmental and international funding Marion House, St. Vincent NGO Youth Parenting education for teen par- and the Grenadines* ents; youth assistance for school drop-outs (vocational training in hairdressing, child care, sewing, etc); counseling, including sub- stance abuse counseling; adult education; backyard gardening interpersonal skills Liberty Lodge, St Vincent NGO Male youth Residential care, remedial educa- and the Grenadines* (7-15 years) tion and vocational training (fur- niture making) for 25 youth (max. 2 year stay) Youth Guidance Center, Public (Ministry cf Health) Youth Two Youth Guidance Centers St. Vincent and the (Barrouallie and Greggs Village) Grenadines* provide skills training for youth; Family life education in Owia National Skills Training Public Unemployed Training for self-employment, Programme, St. Vincent and youth 350 youth trained per year the Grenadines* (15-315 years) (65% female) Youth Peer Education, NGO Youth Train youth volunteers to be Dominican Republic (I 6- 19 years) peer educators in sexual and reproductive health services for youth (with an emphasis on STIs and HIV prevention); 150 youth trained annually, 600 currently active; in 2000 peer educators worked with 6,879 direct benefi- ciaries and reached 48,641 indi- rect youth beneficiaries through presentations made Youth Entrepreneurship Public (Division of Youth Mentoring, training, technical and Scheme, Barbados Youth Affairs) (I15-30 years) financial assistance to assist youth to start their own businesses I ABLE A4-4: SELECTED PUBLIC AGENcY/NGOs PROVIDING SERVICES TO YOUTH-AT-RISK, CARIBBEAN (CONTINUED) Name of Organization Type of Organization Target Group Description Of Program Barbados Youth Service, Public (Division of Youth 12-month training on self esteem, Barbados Youth Affairs) (I16-22 years) team building, academic training, including a 19 week job attach- ment program with private sector firms and public sector agencies *Source: Barker ( 1995) Name of Organization Target Group Description Of Program YMCA Street Children Academic program for street children and other programs Children First Street Children YWCA Unemployed Girls Operates school leavers institutes, skills training, Women's Center Teenage Mothers Implemented through 7 main centers and I I outreach centers island wide. Helps girls continue their education and/or referral for services and skills training Rural Family Support Teenage mothers and Provides academic and skills training, counseling and Organization young men support in 3 rural parishes Mel Nathan Institute Youth 16 and over Operates community college with skills training programs Youth Opportunities In-school youth Mentoring program Unlimited (YOU) Kingston Restoration Inner City youth Remedial education, arts and craft, computer studies, Company-Necessary between i0 and 16 counseling and environment awareness and support to Education Training (NET) students not attending school for financial reasons. Kingston Restoration Students in the South Seeks to develop leadership qualities through organized Company-Youth side of Kingston activities for high school students of the South Side of Education Support Kingston System (YESS) St. Patrick's Foundation Skills training, community gym and health clinic, com- munity development workshops, remedial classes, CXC and GCE classes and job placement Operation Friendship Youth 16-23 Employment generation, education and training programs and primary health care, social work, day care services Addiction Alert Youth at-risk (including Drug education and life skills programs offered in school drug users) One year rehabilitation and training for at-risk youth to become youth leaders, trainers and peer educators Friends Hotline Youth Toll free telephone line that provides counseling and referral Ashe Youth Provides training in the performing arts and remedial education to inner city youth. Fathers Incorporated Young men Offers training workshops, conferences, counseling and micro enterprise development to help men develop pos- itive image of fathering and to become better fathers VOUCH Adolescents Health education and social services on behalf of children Source: Blank (2000) 1 14 WORLD BANK COUNTRY STUDY A. . ** * A AmmIB Responsible Ministry/ Number Total Program Program Agency Descripl:ion Served Budget (J$M) HEART Academies HEART/NTA Skills training to out of 9,900 643.8 sciool youth Vocational Training HEART/NTA Skills training to out of 5,700 3 13.7 Centers school youth School Leavers HEART/NTA On-the-job training 5,100 67.4 Training Opportunities/ Apprenticeship Vocational Training HEART/NTA Training for technical 1,900 82.6 Development Institutions vocational instructors Community-Based HEART/NTA Community based training 8,500 395.3 Training Skills 2000 HEART/NTA, Community based training/ 2,200 7.2 MOLSS, SDC entrepreneurial development (1998/99) (1998/99) National Youth Service MOLGYCD Work experience/ 1,600 98.4 resocialization LEAP HEART/NTA, Remedial education, training 230 27.0 SDC and shelter for street children Lift-Up Jamaica UDC Short term employment 3,700 1,300 Special Training and SDC Training and community 390 Empowerment Program enterprise development Micro Enterprise MIDA Microenterprise credit 8,000 70.3 Development Agency (1998/99) Jamaica Association of MOEC Literacy, numeracy training 11,600 Adult Literacy JAMAL) MICO Care Center MOEC Assessment and remediatiol 2,000 24.0 for special learning needs MICO Youth MOEC Counseling for youth with Unavailable Not available Counseling Research behavioral/emotional Development Ctr. problems VOUCH Health, education, Unavailable 0.3 social services Sporting Programs MOLSS Sporting programs in 215,200 Not available schools and cornrunities Cultural Programs MOEC/JCDC Visual and perforrning arts 35,000-40,000 18.71 programs _ Family Services MOH Counseling, care and 4,500 370.71 protection services Abilities Foundation MOLSS Skills training for dlisabled 27 trainees 4.7 Police Youth Clubs MONSJ Sport, education and camps 22,160 4 H Clubs MOA EdLucation and training 64,300 40.7 Source: Blank (2000) Number Training Stipend/ Beneficiaries/ Program Age Range of Centers Duration Skills Provided [Fees] year Expenditure Youth Training and 15-25 over 20 school- 6 months numeracy, literacy, life None 10,000 TT$30m/year Employment Partnership based and 5 full- skills, 70 skills courses approx. Programme (YTEPP) time centers in 14 occupational TT$1,200/ areas, preparation for student/cycle micro-enterprise Service Volunteer for numeracy, literacy, life [TT$5/month] approx. All (SERVOL) skills and attitudinal (1999 data) TT$4m/year / Junior Life 10 - development, skills 448 / Adolescent 16-19 20 14 weeks courses, technical 1,699 Development training in computers / Skill-training 12 6 months and electronics 1,672 / Hi-Tech 3 3 months 384 Youth Development 14-21 5 (I in Tobago; 2 years (residential) preparation for exams, $TT45/month; 1,325 TT$17m/year > and Apprenticeship I for girls)* several months primary school leaving housing (250 girls; approx. O Centers (trade centers) certificate, trades train- and meals 750 boys, TT$ I 5,000/ z ing (agriculture, con- residential youth/year O< struction, domestic and program) 0 C: commercial sector), 325 (trade job placement centers) m m Source: World Bank (2000) I- 0 z 116 WORLD BANK COUNTRY STUDY Expenditures Annual J$IUS$ Program Ministry Benefits to Youth Beneficiaries ('000,000) School Feeding Ministry Of Educa- School lunch for students ii 302,000 J$395.2/US$ 10.8 Program tion And Culture seected secondary schools School Fee Ministry Of Educa- Fee Assistance to students in 38,500 J$145.3/US$4.0 Assistance tion And Culture selected secondary schools (1997/98) Grants to SLB Grant to low income Unavailable J$62.5/US$1.7 Tertiary Students students enrolled in public universities Student Welfare Ministry Of Educa- Exam Fee Assistance to sec- Unavailable J$2.0/US$0.1 Programs tion And Culture ondary and tertiary students Food Stamps Ministry of Labor Youth receive income sup- 263,000 J$395.2/US$10.8 and Social Security port to extent that they are pregnant, have children under six or are indigent or incapacitated. Outdoor Poor Ministry of Local Youth receive income sup- 13,700 J$1 00.0/US$2.5 Relief Government, Youth pOI-t to extent that they live and Community in poor families, h,ave young Development children, and are indigent or incapacitated. Economic and Ministry of Labor Youth receive benefits to 23,200 J$ 121 .0/US$3.3 Social Assistance and Social Security degree that they are inca- pacitated or have suffered natural or man-man disaster Source: Blank, 2000 CARIBBEAN YOUTH DEVELOPMENT 117 Responsible Government Eligibility Criteria for Beneficiaries/ Annual' Program Body Benefits year Expenditure Self Help and Ministry of Social L, unemployed and no 6,800 households/ TT$3.5m Rehabilitative and Community source of income month (estimated Efforts (SHARE)2 Development r not in receipt of other 30,000 persons, public assistance including 20,000 children) (end- 1997) Unemployment Ministry of Local able-bodied unemployed 60,000 TT$130 Relief Program Government between 17-65 (Obs.: some (URP) r no household income youths may constraints benefit directly) Public Assistance Ministry of Social female-headed household 48,620 1T$56m (PA) and Community c partners have deserted/ (end- 1997) Development died or are incarcerated/ (28,449 children) incapacitated F certified disabled School Feeding Ministry of needy school children, one-third of TT$80m Program Education informal targeting criteria primary school population, app. 63,000 children Civilian Formerly, the selection system prefers 5,891 (1997) TT$25m (1997) Conservation Ministry of older candidates with 24,656 Corps (CCC) National Security, low scores on several (1993-97) Defense Force indices: education, level Currently, YTEPP of employability, occupa- tional status of house- hold, and involvement in community activities age 18-25 Source: World Bank (2000) 'Public expenditure; 2NGOs cooperate in program execution . ! . 'i lt .. .. IMAM Health/ Economic/ Urban Family Life Youth Social Community Poverty/ Active In HIVIAIDS Education Education Health Empowerment Policy Development Violence (Countries) UNICEF > Peer train- > Using class Promotion of > Promotion > Promotion of > Youth and English and ing in part- room as the pri- "youth-friendly" of Youth partici- "youth-friendly" community Dutch speaking nership with mary medium reproductive, pation policies empowerment Caribbean* Red Cross' for transmission physical, and > Capacity build- (Coordinated > Youth of messages emotional ing of National from Barbados Information > Empowering health services Youth Councils Office); Jamaica; and support youth with Trinidad and (St Vincent and Cuba; DR; centers' knowledge and Tobago) the Grenadines, Haiti; Guyana, > Public life skills Dominica) Suriname information (CARICOM > Promotion and advo- countries) of na-ional cac,"i youth policies (Dominica, St. Kitts and Nevis) > Jamaica: Youth Information Centers at the heart of the Adolescent development and Participation program > Support CARI- COM youth pro- grammes EU > Technical > Drug > Social Invest- > Social Invest- Jamaica, St. Kitts, and vocational programs ment Funds ment Funds St Vincent, training > Health infra- (Mainstreaming Barbados, > Education structure approach) Dominica, sector reform St Lucia, > Education Antigua. Re- infrastructure gional Program. > Institutional strengthening of Community Colleges DFID > Education >Drug eradica- >Urban British Over- reform (access tion poverty and *seas Territories, and quality of violence Caribbean post-primary project / regional Pro- education) Inner cities gram, Jamaica. (mainstreaming renewal pro- Cuba, DR, of youth issues) ject (jamaica) Guyana PAHO HIV/AIDS Health/family >Tobacco use Bahamas&,, CPC program education program Barbados', Cuba, >Mental health DR, Guyana, promotion Surinam, Haiti, >Adolescent Trinidad and Health Surveys Tobago, Jamaicae in nine (9) countries (continued) Healthl Economid Urban Family Life Youth Social Community Poverty/ Active In HIVIAIDS Education Education Health Empowerment Policy Development Violence (Countries) CIDA > Expanded > Gender > Sub-regional > CFLI small > CFLI small >Small grants All OECS coun- support in Equality Pro- education sec- grants program grants program program tries including the Caribb- gram Respon- tor reform for (Canada Fund for > OECS Micro Anguilla and ean (ESAC) sive Grant primary and local initiatives) and Small BVI; CPEC Pro- Assistance to Funding (gender secondary > Judicial and Enterprise ject also covers CARFC soda!ization in schools; learn- legal reforms in De-vedupment Guyana, Jamaica, HIV/AIDS schools, non- ing resources; the OECS Project Belize and Suri- Program violent parent- learning out- > Caribbean name. ing skills for comes for Regional Human single/ young IT, math and Resource Devei- parents science; train- opment Program ing systems for Economic for school Competitiveness managers; cur- (CPEC) (skills riculum devel- training and re- opment tooling in major sectors) Common- > strengthening > Economic English Com- wealth youth ministries enfranchise- monwealth Youth > youth partici- ment program countries Programme pation > Youth credit > Human initiative Resource Devel- > Human opment Resource Development UNFPA Strengthening Improve access 21 English and Adolescent for youths Dutch speaking Sexual Health through: countries* programs > Reproductive Cuba health Program Dominican > Family Republic Planning Haiti UNDP Reform of class- > Entrepre- Attention to S Barbados (plus room culture neurship; youth in com- 10 Organization > information munity develop- of Eastern technology ment Caribbean > Social Policy States)**; Cuba; Development DR; Jamaica; Guyana; T and T; Suriname; Netherlands Antilles. USAID Adolescent > 'Uplifting Remedial read- Caribbean reproductive Adolescents' ing and math Regional pro- health, youth- program for drop-outs gram (emphasis friendly clini- includes and students on OECS**) cal services; community- doing poorly Dominican work through based life skills Republic, Haiti, peer mes- program Guyana,Jamaica sages, mass > Parenting media, edu- program cation etc *Anguilla, Antigua and Barbuda, Aruba, the Bahamas, Barbados, Bermuda, British Virgin Islands, Cayman Islands, Dominica, Grenada, Guyana, Jamaica, Montserrat, Netherlands Antilles, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Suriname, Trinidad and Tobago, Turks and Caicos. **Antigua and Barbuda, Anguilla, Barbados, British Virgin Islands, Dominica, Grenada, Montserrat, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines. 'Dominica, BVI, Grenada, St. Lucia, Barbados, Montserrat. i"Barbados, St Lucia, St. Vincent and the Grenadines, Dominica, Trinidad and Tobago. 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An Integrated Approach for Social Inclusion." Report 20088-TR. World Bank, Washington, D.C. 2001a. Dominican Republic PovertyAssessment. Washington, D.C: World Bank. 2001b. "A Review of Gender Issues in the Dominican Republic, Haiti and Jamaica." Report 21866-LAC. World Bank, Washington, D.C. . 2002. Optimizing the Allocation of Resources among HIVPrevention Interventions in Honduras. Washington, D.C.: World Bank. Wyatt, G. E., E. Le Franc, M. B. Tucker, B. Bain, B. Mitchell-Kernan, and D. Simeon. 1993. "Sexual Decision Making among Jamaicans: Final Report." Submitted to Family Health International. Caribbean Youth Development: Issues and Policy Directions is part of the World Bank Country Study seriles. These reports are published with the approval of the subject government to communicate the results of the Bank's work on the economic and related conditions of member countries to governments and to the development community. Young people are the basis for the future health and wellbeing of their communities. Recognizing the critical role of young people to the security of sustainable development, this report brings attention to both the important conritributions youth have made to Caribbean society and the critical challenges they face in assuming socially responsible and productive roles. This study uses an ecological framework to consider negative behaviors and outcomes observed among Caribbean youth, and also to identify ways to Einhance positive influences. Casting aside the often narrow view taken of "youth" as a marginal issue, this report advocates the prioritization of youth development across all sectors, and identifies key prin- ciples and actions for moving forward. World Bank Country Studies are available iinclividually or by subscription, both in print and on-line. 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