~~ 4 Both hypertension and diabetes are multifactorial disease complexes, being dependent on a mixture of heredity, diet, obesity, exercise, etc. The primary factors responsible in the Marshalls have not been ascertained. Even the exact incidence of each disease is unknown. An adequate understanding of the epidemiology of these problems and causative factors in this environment will be an important initial step in developing adequate detection and treatment programs. E. Social Problems With traditional folk ways and family relationships undergoing dramatic change over the years, kinship lines and responsibilities have been fragmented for most Marshallese families. The underlying support system for all family members has been disintegrating over time and the youth, as well as the elders, have become disenchanted and alienated. The Marshallese perceive the increasing use of alcohol as one of the most serious problems in the Islands and identify fragmentation of kinship ties it as the contributing factor in further and in other destructive social changes. Arrests for alcoholism (adolescents and adults) have tripled in the past 3 years for adolescents (Wally Wotring, Director of Public Safety) and have already doubled for adults in 1980 (January through September). Drunken behavior has also been involved in the increase of car accidents on Majuro and the alarming upward trend of suicide throughout the Marshall Islands (suicide rates for adolescents are considered by some local respondents to be twice the rate found in the United States). Other distressing social problems affecting coping abilities and the mental health of the local people include dislocation and redistribution of people, increase in crime rates (especially forgery, burglary and assault and battery), increased prostitution, use of drugs, intrafamily violence, divorce, loss boundaries, of understanding and neglect of parenting and communication parenting across skills, generational lack of family planning and enhancement of family life; increase in juvenile delinquency, homosexual relationships, and lack of employment opportunities for all age groups (adolescence through the aged). Additional mental health problems are evident in the form of apathy, alienation, depression, stress syndromes, confusion and ambivalence, motivation drives, self-identity crises, role dysfunction and low role identification crises (adolescents and adults), and fear of the future and the unknown (economics, health and basic survival). 14