© The Atlanta Journal - Constitution Sunday, 10/12/1997
Section: SCIENCE    Letter: G    Page: 8    Words: 2435
SCIENCEWATCH: THE 1918 FLU EPIDEMIC
THE WHOLE WORLD WAS INFECTED'
On the anniversary of this lethally efficient flu, one scientist prepares
to dig up a promising key to a mystery that killed millions
By M.A.J. McKenna/STAFF WRITER
 

Seventy-nine years ago this Friday, the bodies of seven young men were lowered into the stone-hard ground of a snow-covered island so far above the Arctic Circle that polar bears have been seen in the streets of its only
town.

   The seven men were miners, who had come from the Norwegian mainland to dig coal in the icy Svalbard archipelago 720 miles below the North Pole. But instead of taking from the earth, they were added to it: Sick on arrival, they died within days and were buried in the wind-scoured cemetery of the town of Longyearbyen.

   The spare white crosses above the graves are the miners' only monument ---and another kind of monument, too: They are the high-water mark of a wave of death that washed across the globe in the last year of World War I.

   This week, an international team of researchers takes the first steps to end the seven miners' long isolation. Led by Kirsty Duncan, a charismatic young Canadian geographer, they will survey the grave site with ground-penetrating radar.

   If they find what they hope to find ---that the bodies lie frozen in undisturbed permafrost ---they will return in a year to dig them up and sample their tissues. The samples will be analyzed at some of the most sophisticated infectious-disease laboratories around the world.

If conditions are perfect and the team is lucky, the secret the seven miners have kept for eight decades may be revealed: The virus that killed 40 million people in the Spanish influenza epidemic of 1918.

 40 million victims

   There has never been an epidemic like the 1918 flu. The medieval Black Death killed as many people ---possibly 40 million Europeans, one out of every three ---but it took 150 years to do it.

   The Spanish flu was more efficient. From March 1918 to the following February, it sickened and killed families, cities, regiments on the battlefield: 675,000 Americans, 90,000 people in the Philippines, possibly
20 million in India.

   "The whole world was infected," said Dr. Jeffery Taubenberger, a U.S. pathologist advising the Canadian-led team.

   In Atlanta, where 750 died, all public gatherings were banned. The San Francisco City Council required the entire population to wear surgical masks. Apocryphal stories from New York City said people got on subway cars and died before they reached the end of the line.

   The toll was so great that it reduced average U.S. life expectancy by 13 years. It may even have changed history: The Treaty of Versailles that ended World War I but set the stage for World War II might not have been so punitive if peace-loving President Woodrow Wilson had not been disabled by flu during negotiations.

   It was not what we think of now as flu ---the cough and sniffles, fever and muscle aches that send sufferers to bed for up to several weeks and lead, in the unlucky few, to potentially fatal pneumonia. The Spanish flu killed in days; its preferred victims were not the young and old, the usual targets of infectious diseases, but those in their 20s. And it killed horribly, triggering a massive immune reaction that saturated the lungs of its victims with blood and fluid, so they drowned from within. Contemporary accounts describe corpses as slate-blue from lack of oxygen and hemorrhage into the skin.

   "There are stories of dying people whose appearance changed in two hours from white to black," said Dr. Robert Webster, a flu expert and Memphis virologist advising the Canadian team. "There are stories of sick young soldiers being put in tents, and people outside watching (coughed-up) blood hit the tent walls."

"Some aspects of the description sound almost like hemorrhagic fevers, like Ebola and Lassa, that have come out of Africa," said Dr. Charles Smith, a Toronto forensic pathologist on the team.

   The Spanish flu killed more Americans than World War I, World War II, the Korean War and the Vietnam War combined, yet it is now barely remembered. Unlike AIDS, the other great plague of this century, it produced almost no art, no theater, no literature of grief. Only one slender novella, Katherine Anne Porter's "Pale Horse, Pale Rider," memorializes it. Yet it remains an urgent threat. The influenza virus mutates unpredictably every year; every few decades, it changes sharply enough to cause a worldwide pandemic. The last two, in 1957 and 1968, were mild in comparison to 1918 ---but no one can predict when such a deadly flu will come again.

   The 1918 virus could tell us, if it could be analyzed. But there are only a few places on the globe where some trace of the killer may remain. The Longyearbyen cemetery is one of them.

 On the trail of a killer

   The Spanish flu has obsessed Kirsty Duncan for almost five years, a significant chunk of her life. The expedition leader, a Ph.D. who teaches climatology and geography at two Canadian universities, is just 30 years old.

   Fine-boned and dramatic, with hip-length hair and the honed body of a former gymnast who still does 1,000 sit-ups a day, Duncan lives in a Toronto suburb with her husband, a British pediatrician. She works in her parents' house several streets away, a comfortable split-level decorated with evidence of her avid enthusiasms: Gaelic textbooks, photos of her as a Highland sword dancer, and piles of overstuffed loose-leaf folders containing every letter and note she has written about the 1918 flu.

   Her search started with a book: "America's Forgotten Pandemic," by Alfred W. Crosby, a little-known but detailed account of the flu.

   "My interest was originally how climate change might affect disease," she said. "I'd done work on plague and malaria and the connection between global warming and Lyme disease, and I was interested in the seasonality of flu. And then I read this book.

   "I was amazed ---horrified. And I came home and said to my husband, 'I will find out what caused this disease.' "

   That impulse launched her on a quest that earlier had defeated eminent scientists. For four years, she pored over death records from Alaska, Iceland and Siberia, looking for a place where the unembalmed bodies of flu victims might be preserved.

   Climate, political instability and the biology of the disease were against her. The flu virus reproduces and leaves the body within days of infection, and it is genetically fragile and breaks down quickly after death. She needed a site where victims had died quickly and been chilled immediately ---and where records existed to confirm those events.

   Then a mountaineering friend from graduate school in Edinburgh told her several years ago about a hike he had led across a Norwegian glacier. They'd had terrible troubles, he said, with permafrost.

   "I knew there had been flu in Norway," she said, her voice brightening with remembered excitement. "I knew from one of my professors that they had mined coal far north. And I guessed, if they were transferring people from the mainland to undertake mining, they might have brought the disease."

   It was a good guess. After several years' work and many disappointments ---no church or government records from the era, no medical histories because the only hospital had been bombed in World War II ---she found coal company logs detailing the miners' deaths and burial in the company town of Longyearbyen.

   Two more years of permission-seeking followed: from the Norse Polar Institute, the local government, the Norwegian government, the surviving relatives of the seven dead men. In May 1996, Duncan finally set out to meet the town.

   She expected hostility but found extraordinary warmth, from the female govern or of the territory, the schoolteacher who had translated the diaries, the minister who had championed her work to the local community. On the last day of her visit, at the minister's urging, she set out to visit the gravesite.

   "In my heart of hearts, I believe a cemetery is a sacred place, and what we propose to do is very hard for me," she said, her voice roughening to a whisper. "It is quite a distance from the church ---it's on a hillside, you can see it from anywhere in town ---and it was one of the longest, hardest walks of my life.

   "It was white with snow, and the crosses were white. The ones I wanted were all the way at the back against the fence. I looked at them. I thought about how these young men were just starting out in life. And I asked their forgiveness for what I was about to do."

 A team of medical detectives

   Duncan has recruited a remarkable scientific team, volunteers attracted by the force of her personality, the challenge of a grueling expedition and the chance to solve one of the great medical mysteries of this century.

   Included in the 11 are a geologist, a medical archaeologist, several pathologists and experts in virology and infectious disease from Canada, England and the United States. One of the leaders is Smith, a forensic pathologist who is officially an expert on suspicious deaths in children ---and unofficially an enthusiastic student of difficult exhumations.

   This expedition, he acknowledged, is about as difficult as an exhumation can be. Sitting in his office in Toronto's Hospital for Sick Children, a crowded space containing a photo of a prized Hereford cow from his family farm and the cranial bones of an infant he exhumed in India as part of an Ontario murder case, he detailed a few of the problems.

   "We are not absolutely sure yet that the crosses are where the graves are because the crosses were replaced for a royal visit in 1985," he said. "We don't know if the bodies were put into seven separate graves or one pit. We can't even be sure if they are in coffins. We don't know if they are frozen to the ground."

   The team is moderately sure the bodies have been well-chilled since shortly after death. According to records, the corpses were placed in unheated storage at a time of year when the temperature was about 20 degrees, then buried deep enough to be below the line at which the ground remains frozen year-round.

   But until they radar the site this month during their preliminary expedition ---in fact, until they begin to dig next year ---they won't know for sure.

   "The first rule of exhumation," Smith said, "is that you never know what you're going to find until you look."

   If the bodies seem accessible, the team will have to tackle the technical challenges of autopsying them in difficult conditions: short daylight hours, low Arctic temperatures and punishing wind.

   The Norwegian government has ruled that the bodies may not leave the cemetery. The excavators may not be able to get the bodies out of the graves. And they will have to surround their site and themselves with elaborate safety precautions.

   Though they believe the probability is slight, there is a chance the flu still might be infectious, and no one wants to be responsible for reviving the worst virus the world has ever known.

   "If I can't be convinced that we can do this safely, I'm not going back," Smith said cheerfully. "But the chance of coming up with live virus is probably remote."

 Many attempts, no successes

   The Canadian exhibition is the most dramatic attempt to recapture the virus of 1918, but not the first or only one.

   It has been an elusive quarry. Contemporaneous accounts make it clear that although Americans knew flu was communicable ---they held open-air church services and stayed away from public places ---they had no idea how to combat it. Health authorities advised them to take laxatives and quinine salts and keep their windows open.

   It wasn't until 1933 that a team of British bacteriologists, using a farm full of ferrets, identified the infectious agent as a virus. But the flu had mutated away from its deadly 1918 form; they could see only its shadow, by analyzing antibodies left in the blood of survivors. To this day, scientists have never seen the complete 1918 virus.

   In 1951, a team from the University of Iowa exhumed and analyzed bodies from an Alaskan town where 80 of the 150 residents had died. But the bodies had not stayed frozen; no virus remained in the tissues. In the 1980s, Webster, a Memphis virologist and flu expert, unsuccessfully tried to isolate the virus from preserved autopsy specimens.

   Ten years later, genetic research techniques are so improved that a second lab attempt has succeeded.   Taubenberger, the American pathologist recruited by Duncan as an adviser, leads a team that has isolated 15 percent of the virus.  It is a significant scientific achievement ---but it has not plumbed the  medical mystery of what made the 1918 virus so lethal.

   "It could be one genetic change that we haven't found yet," said Ann Reid, Taubenberger's chief collaborator. "It could be a combination of many genes, and possibly the relationship of the host to the virus. The biology
is very, very complicated."

   If the Canadian or American teams solve that puzzle, they still may have only contributed to history. Some flu scientists doubt the knowledge will be much use in the future. CDC's flu branch, for instance, initially was part of the Canadian expedition but has withdrawn. But if the exhumations go well the agency may be forced to step back in;  it houses not only the world's premier disease detectives, but one of only two labs in North America capable of handling an infectious organism as deadly as the recovered virus might be.

   At the moment, though, they remain cool to the project. "In terms of preparing for the next pandemic, we already know what we have to do," said Dr. Keiji Fukuda, chief of epidemiology at the CDC's flu branch.

   "For all practical purposes, it doesn't matter whether we're doing that in response to the 1918 virus or something completely different," Fukuda said.

   So many uncertainties remain that members of the Canadian exhibition have disciplined themselves not to look too far ahead. Despite her passion for the search, Duncan in particular is sturdily pragmatic ---perhaps because, with the goal so close, hope feels like too great a risk.

   "People ask me, am I excited, am I ready to go," she said not long before the team departed. She had been up very late the night before. She pulled her long hair off her neck with a weary gesture and ran a finger along the edge of a milk crate stuffed with her notes.

   "It has been such a long process; there have been so many hurdles, I don't allow myself to get excited anymore. But I imagine myself back in that cemetery. I promised them I would find out what killed them, and I will."
 
Memo: This is the lead story in a five-story package.


 


© The Atlanta Journal - Constitution
Tuesday, 07/23/1996
Section: LOCAL OLYMPICS    Letter: S    Page: 28    Words: 1203
ATLANTA GAMES DAY 5
CITY CLOSE UP: OLYMPIC STRESS
The crankiness is cranking up, and mental-health experts worry that the
heat and crowding are producing too much anger, anxiety and aggression.
By M.A.J. McKenna, Andy Miller, Susan Gast, Paul Lomartire/STAFF WRITERS

  It's not the last copter out of Saigon.

   It's not the last lifeboat off the listing deck of the Titanic.

   It's the 7:15 p.m. Doraville train out of Five Points station. But the way the crowd is shoving and surging, it would be hard to tell.

   Caught in a thicket of strap-hanging arms, 72-year-old Jack Eagan of Bloomingdale, N.J. - veteran of the Tokyo, New York and Moscow subways, and six consecutive Summer Olympic Games - smiled and took a deep breath.

   "I guess," he said, edging between pairs of knees, "people down here aren't used to this kind of thing."

   Believe it. The crowding, the expense, the traveling, the heat: They're all taking a toll on local residents and Olympic visitors, and shoving, swearing and stress are the visible result.

   If pushing were a sport, someone would have a gold by now.

   Not every participant is having a bad experience; many have praised Atlanta's manners and mood. But mental-health specialists - some caught in the crush with the rest of us, some watching from afar - are surprised and concerned by this week's Olympic mob.

   "The authorities have to do something about crowd control," said psychologist Arthur Bachrach, former director of environmental stress programs at the Naval Medical Research Institute. "Otherwise, I think you could have a real bomb there."

   There's a couple of things going on at once, the experts warn: It's hot, and heat - and exhaustion and dehydration - affect judgment and behavior.

 Shoving becomes a new sport

   It's crowded, and that can produce feelings of panic and being trapped. Put those together, and the result is anxiety, anger and aggression.

   "Try to remember that we're animals, and that some of the same things that apply to animals apply to us," said Dr. Barbara Rothbaum, an assistant professor of psychiatry at Emory University. "If you put animals in these conditions, they will respond defensively."

   Which is just what's happening, all over town:

   - Long waits for buses at the Birmingham soccer venue fired tempers among crowds who drove several hours before cooling their heels in park- and-ride lots. "I got shoved up against the bus" by an impatient crowd rushing one vehicle after the game, said Amy Scott of Decatur. "I was really scared."

   - A group of young men collided with a young woman and baby on a late-night weekend train. Robert Grand of Shreveport, La., who watched the resulting scuffle, said, "One of the guys took a plastic bottle and popped
the woman on the head."

   - Barbara Brinker, 71, and grandson Matt Fowley, 11, of New York wandered for 2 1/2 hours after a volleyball match before finding a shuttle bus. "I'm exhausted, and I'm hot," said the sweat-soaked grandmother. "We thought the buses would stop, but they said they were for athletes."

   - On the ill-fated Downtown Employees Shuttle Service, whose operation has been a source of constant complaints, a passenger enraged by a three-hour wait let loose at a newly arrived driver. "Call in!" she shrieked as she charged up the stairs of the bus. "Call in now!"

   Those are not scenes that Southerners would be proud of. That's part of the problem. Beneath the aggravation lies some discomfort. Visiting strangers might behave like this, but we're not supposed to.

   And normally, we don't.

   Of course, the Olympics are not normal.

 Nothing is predictable anymore

   "We're used to predictability," said Atlanta psychologist Richard Offutt. Added George Williams, a second psychologist: "People who can afford $600 for Opening Ceremony tickets are used to a more genteel lifestyle than being pushed into a train. We expect comfort. When we're denied that, we get frustrated and angry."

   Expectations play a huge role in the push-and-shove dramas being played out downtown, Rothbaum said: "If you know it is going to be very crowded and know it will take an hour to get on the train, it won't be comfortable, but you can handle it. If you're caught off guard, it can lead to aggression, where you push people out of the way to create some space."

   Disastrous crowding has unique psychological effects that have been recorded in medical studies. It alters your sense of time, so that 10 minutes on the platform feels like an hour. It fosters mild paranoia - victims of a weather disaster, crowded into a shelter or soup kitchen, will inspect each other's plates to make sure no one gets an unfair share.

   Worst of all, said Bachrach, who conducted Navy training for extreme heat and cold, it vastly increases susceptibility to irritation.

   "The 14th cough behind you in the movie theatre is no louder than the first, but it sounds like it is, because your tension is aroused," he said. "The stimulus intensity builds with time. What would normally not be irritating becomes exceptionally irritating; the minor mannerisms of people begin to offend."

   Compounding the problem: For Atlantans, life is already vastly disarranged.

   Many area businesses have closed down, cut back or changed hours. Some employers have moved people to satellite locations or set up telecommuting arrangements. Prices have gone up. The disruption makes it much easier to fall in with the prevailing bad mood.

   Bad directions play a part as well. Bill and Lois Queen of Titusville, Fla., were sent to three different entrances before getting into the Omni Saturday - and got two sets of directions for getting to MARTA afterward.

 Getting directions is tough

   "Nobody seems to know where anything is," said New Yorker Danny Tobias outside the water polo venue. "We asked 20 different people, and got 20 different answers."

   And then there are bad rules. Scott Mitchell of Minneapolis bought a beer Sunday for a middle-aged Spaniard at the wrestling venue. The European visitor couldn't buy it himself - at least, not without a picture ID.

   "I guess I took the risk of buying beer for a minor," Mitchell said. "He was at least 55 years old."

   Given all that, it's not hard to understand Chris and Angie Stenander of Gainesville, who waited for MARTA Sunday for a long time before a train arrived. Though full, they decided to go for it.

   ''We felt we had to squish on," Angie said. "So we squished on."

   But even that can be done with finesse, as five Japanese ticketholders demonstrated Saturday morning to a capacity crowd at the Arts Center station. Facing doors that opened onto an already packed train, the group
executed an about-face and back-in that fitted them with barely a wriggle into the fascinated crowd.

   Maybe that scene holds the key. Despite the crush, the crowd let the tourists in - and despite the provocations, other visitors have said, Atlanta is still more friendly and polite than the rough and tumble of Eastern cities. Some graded Atlanta an A-plus for effort.

   Beneath the panic and crankiness, Southern sensitivity may still be lurking. As witness the ugly Downtown Shuttle scene mentioned earlier.

   Once the enraged female commuter climbed off the downtown shuttle - to buttonhole and berate a supervisor in the parking lot - another passenger walked forward to give the abused driver a hug.

   "It's OK," he told her. "You're doing OK."


 © The Atlanta Journal - Constitution
Friday, 05/03/1996
Section: SPORTS OLYMPICS    Letter: G    Page: 4    Words: 1071
OLYMPIC WEEKLY - 77 DAYS
CHEATING THE GAMES: DRUG TESTING
A clash of high ideals, harsh reality
As testing equipment has improved, so have efforts to flout the rules
By M.A.J. McKenna, Andy Miller/STAFF WRITERS

Mineral water, low-fat protein, complex carbohydrates: Olympic athletes are expected to go on a training diet as the Games approach.

   But for some athletes, this training menu has a second page. It reads, in part: anabolic steroids, peptide hormones, insulin, amino acids and herbs.

   Despite efforts by officials and angry opposition by clean colleagues, some athletes will compete at the Games with the help of performance-enhancing substances.

   Officials would rather not dwell on that ugly certainty. The Olympic movement exalts the Games as a high ideal, pure competition unsullied by calculation or commerce. The hard reality is less poetic. Driven by dreams of national glory or desire for a fortune in endorsements, athletes use every legal means to achieve excellence. And some use illegal means as well.

   In truth, drug use is the shadow contest of the Games, as trained for and as fiercely fought as the athletic competitions. Doping presents Olympic officials with an unenviable challenge: The better detection gets, the more cheaters they catch, and the cleaner the Games become. Yet every positive test, every suspension and every legal challenge further sullies the image of the Games.

   Testers in Atlanta will be armed with the latest drug-testing equipment and methodology, and the official position holds that doping is under control. But some athletes and sports experts say drug use is as pervasive, and the array of available substances as wide, as ever - and that the ability to detect drug use lags behind.

   Only the unlucky, they say, will get caught.

   "Doping is clearly a widespread problem," said Dr. Robert Burton, a sports psychiatrist at Northwestern University Medical School. "Athletes are always looking for, sometimes obsessively searching for, any minute competitive advantage. And as the level of competition increases, so does the pressure."

   And so athletes take dope: to increase their strength and speed, for events such as weightlifting and sprints; to improve their endurance for long-distance running and cycling; to steady their hands for shooting or archery.

   Drug use - proved and disputed - has been a constant theme in the run-up to the Atlanta Olympics:

   - In 1994, 11 Chinese athletes, most of them swimmers, tested positive for performance-enhancing drugs.

   - In 1995, about 75 international weightlifters were snagged with positive tests, 11 of them at the World Championships in China.

   - Swimmer Jessica Foschi was banned after a positive steroid test and then cleared. She later failed to make the U.S. team.

   - British runner Diane Modahl had her suspension lifted this spring after a positive steroid test was found marred by lab errors.

   - The IOC upheld its 1972 decision to strip U.S. swimmer Rick DeMont of his gold medal after he tested positive for a disallowed asthma drug.

   - Australian swimmer Samantha Riley was issued a "strong warning" after she took a banned drug as a headache medicine.

   Despite recurrent findings of drug use by athletes, no one can precisely define the scope of the problem. "To pinpoint actual numbers is almost impossible," said Dr. Gary Wadler of Cornell University Medical College, author of "Drugs and the Athlete." "We tend to hear only about the significant cases, where there are high-profile athletes or serious issues of due process."

   Drugs have always been an unseemly Olympic subplot. Peter Ueberroth, who ran the Los Angeles Games in 1984, believes the Soviet bloc's boycott that year stemmed partly from fear of wholesale doping disqualifications. New, sophisticated machinery, he said, "was a factor in some teams not attending."

   And in 1988, Ben Johnson tested positive for anabolic steroids after a world-record sprint at the Seoul Games.

   "I (took steroids) to beat the best people in the world . . . because that is the only way I could have won," Johnson told the Journal-Constitution in 1993.

   Johnson estimated the Seoul bust cost him $30 million in endorsement fees. "What goes on in track and field ain't going to change," he added. "Everybody is trying to make a buck. Doing things the bad way."

   Beyond the headlines generated by Johnson and others, some Games have left a trail of rumors and reports about positive tests either missing or not announced. That won't happen in Atlanta, says Dr. John Cantwell, ACOG's chief medical officer. The '96 Games will launch two new approaches on doping.

   First, an array of super-sensitive equipment will let testers reach further back in an athlete's training cycle to ferret out steroid use.

   The devices will represent the strongest anti-doping effort at an Olympic Games, says Cantwell. "If I were an athlete and abusing drugs, and took them a month before the Games, I'd be worried I'd get caught," Cantwell says.

   Also new: an independent court of arbitration to resolve drug-testing disputes. To participate in the Games, athletes will be required to sign a form agreeing in advance to submit drug-testing and other disqualification grievances to arbitration rather than the U.S. courts. No signature, no Olympics, according to U.S. Olympic Committee vice president Michael Lenard.

   Atlanta's drug-testing effort, at a cost of about $2.5 million, will analyze samples from about 1,800 of the more than 10,000 competing Olympians. Each individual medal winner will be tested, along with two from each medal winning team. Others will be selected at random.

   The International Olympic Committee Medical Commission will supervise the program. The SmithKline Beecham Lab, with help from other IOC labs, will run the samples.

   Cantwell offers a guess of possibly 12 positives in Atlanta, rivaling the total at any Games.

   Some argue that a random testing program done on all athletes without notice - and out of season - is the most effective strategy to stamp out drugs.

   Some call for more consistency and coordination among the various sports federations, which have different anti-drug policies.

   Dr. Robert Voy, who resigned as USOC medical officer in 1989 after criticizing anti-doping efforts, says his opinions "have pretty well been vindicated."

   Many of the challenges that faced early Olympic drug-testing efforts remain today, Voy says. "Drug use still occurs," he says, "there are athletes still testing positive . . . and out-of-competition testing hasn't really increased."




 
© The Atlanta Journal - Constitution
Sunday, 01/14/1996
Section: LOCAL NEWS    Letter: A    Page: 8    Words: 1016
TEENS & PREGNANCY
First of a five-day series
By M.A.J. McKenna/STAFF WRITER
 

Melissa Moore checks her 8-month-old toddler into day care each morning before boarding the bus for Decatur's Towers High School. She is 14.

   Crystal Lee Jackson of Calhoun married her longtime boyfriend when they discovered she was pregnant. She was 16.

   Renita Huff of Atlanta lost her first child six months into her pregnancy. She was 17.

   Moore, Jackson and Huff have a lot of company: They are three of the more than 25,000 teen girls who become pregnant in Georgia each year, earning the state the highest teen pregnancy rate in the nation.

   It's an ugly ranking, and not a new one: Georgia has led the nation in teen pregnancies since at least 1990, according to federal statistics. Among those who work with teenagers, the lack of improvement generates impatience and deep distress: An entire generation, they charge, is losing its future before our eyes.

   "Teen pregnancy is the canary in the mine," said Mary Willoughby, a senior planner at the Savannah Youth Futures Authority. "It is a real indicator of how organized and healthy our communities are, and of what kind of opportunities our kids are seeing for themselves."

 Problem affects many groups

   Georgia's ranking as teen-pregnancy capital comes from the Atlanta-based Centers for Disease Control and Prevention, which each September releases teen pregnancy and birth rates for every state. Because CDC collects data from each state and reprocesses it, its numbers always lag by several years; the ranking released last September used data from 1992. More recent numbers from the state, which has counted teen pregnancies through 1994, show rates just as high.

   Georgia owes some of its status to a statistical quirk. Its numbers are more complete; unlike some other states, it reports to the CDC every live birth, miscarriage and abortion.

   But Georgia also possesses many characteristics that contribute to teen pregnancy. It has a high rate of poverty, one of the greatest risk factors. It has a large black population, a contributor because the rate of teen pregnancy among blacks is about twice that of whites.

   It has 159 counties, making social services harder to deliver. And because it's in the Bible Belt, religion exerts significant influence on discussion of sex and the availability of birth control to teens.

   Teen pregnancy in Georgia crosses every line of class, race and region.

   It happened to Erin Woofter, an 18-year-old who lives with her mother and is engaged to the father of her year-old son. It happened to Mario Tucker, an 18-year-old high school student who shares care of his 9- month-old daughter but fears it will prevent him from attending college. And it happened to Tanisha Burroughs, a 16-year-old who is raising her 5- month-old son with both families' help.

   It also happens to younger girls who see no future for themselves, to older men who feel no guilt, and to parents who possess no concept of responsibility.

   "I have a 15-year-old in my practice, dating a man substantially older, who came in for a child health exam concerned because she is not getting  pregnant," said Charlotte Writer, a nurse practitioner with the Cobb County Health Futures Alliance. "Her mother felt that she had been in and out of trouble her whole life and was now focused. This (relationship) was fine with her."

 An economic burden

   Teen mothers and the 500,000 children they bear each year start their lives together at an overwhelming disadvantage. Economic trends and political hostility make it unlikely they will beat the odds stacked against
them. They are likely to spend their lives in a social and educational underclass, at enormous cost to society - and to the next generation learning that this is an appropriate way to live.

   For that reason, few social goals are as easily agreed upon as reducing teen pregnancy. The concept unites right and left, black and white, religious and extremely secular. Yet few battles are as bitter as the search for solutions.

   To many conservatives, allowing teenagers free access to birth control is appalling; those who disagree consider it irresponsible not to provide that option. Conservative politicians propose economic disincentives such as cutting welfare payments; liberals charge the strategy sacrifices lives to  make a political point.

   Abortion further inflames the debate. State law calls for one parent or a judge to consent before an abortion is performed on a minor. Thanks to a potent combination of factors - fear of telling parents, lack of information on abortion in sex education and ignorance about their own bodies - many girls who seek abortions arrive too late. One sign: One in three teen pregnancies ends in abortion nationwide, but only one in four in Georgia.

   And almost no one knows how to reach the invisible half of the epidemic: the teenage boys and adult men who are sexual partners of the girls.

 Conflicting messages on sex

   The fight rages against the backdrop of a society that sends woefully mixed messages about sex. Popular culture is saturated with sex and sexual norms have changed rapidly, yet the subject still makes most Americans blush and squirm.

   Conflicting messages are not lost on teenagers. "Sex sells everything," said Tracy Holbrook, a Mableton 17-year-old. "It is everywhere you look."

   "Kids are caught between two bumper stickers: Just Say No and Just Do It," says Emory School of Medicine professor Marion Howard, M.D., creator of a successful pregnancy-prevention program. She adds: "Without adults' willingness to take stock, it is somewhat unrealistic to expect young people to modify their behaviors."

   Dealing effectively with teen pregnancy, experts say, requires abandoning the comforting myths that cluster around it, and facing honestly the social conditions - poverty, fractured families, cultural influence, sexual abuse - that foster its growth.

   "Teen pregnancy is a symptom," said Dr. Mary Langley of Morehouse School of Medicine. "We are focusing on the symptom and not on the problem, and that's why our programs don't work."
 
 
Memo: This is the main story of the first package of a five-day series and a year-long project, "Teens & Pregnancy," in which Journal-Constitution writers focus on the problem of teen pregnancy.