RISK BEHAVIOR IN ADOLESCNECE risks

COMPETENCIES
 Discuss risk-taking behavior as to its definition, theories, Risk Factors:
risk and protective factors, and warning signs - Poor academic achievement closely
 Discuss common risk behaviors in Filipino adolescents associated with substance abuse,
according to risk factors, diagnostic approach, management delinquency, teen pregnancy, school
strategies, and prevention involving the following: dropout and violence
- Sexuality and reproductive health - Occur more frequently as the male adolescent grows
- Road traffic accidents and injuries older
- Violence - For substance abuse:
- Suicide and depression o Male
- Substance abuse o Family support for substance abuse
- Malnutrition and eating disorder o Absence of religious involvement
o Large amount of money for unwise spending
Adolescent is relatively healthy period in life o School underachievement
- Expected tasks to accomplish to adulthood: - Early sexual activity
1. Attain self-identity o History of sexual abuse
2. Achieve independence and self-goals o Family instability
(vocation and career) o Low socioeconomic status
3. Establish a healthy relationship with o Single parent household
peers and the community o Poor knowledge of STIs
o Minimal parental household chores
- WHO: 85% of adolescents live in developing countries
o Sharing of sleeping facilities
- PHILIPPINES: top causes of admissions were:
o STiI are more common among those who
1. Appendicitis
have multiple partners, smoke marijuana,
2. Pregnancy complications, delivery and
and use condoms irregularly
puerperium=, including those with - Juvenile Delinquency
abortive outcome o Associated with breakdown of family
3. Arthropod-borne viral infections like dengue structure, family conflicts
o Domestic violence
Definition and Theories o Drug use and abuse, gang involvement
- Risk behavior applies to any behavior that o Economic deprivation
compromise adolescent development o Family history of behavioral problems
- Risk taking behavior is a set of volitional actions o Lack of protective environment
initiated during the teenage years that have a o Pregnancy
major negative health and social consequences. o Dropping out of school
- Commonality exists among the root o Attempted suicide is associated with family
causes of risky behaviors, health irritability, emotional problems, financial
problems and disability among difficulties, peer pressure, and unemployment
adolescents o Depression has been reported as the major
- Risk taking has been considered by some as psychiatric illness that leads to completed suicide
normative and necessary for the achievement - Protective factors:
of independence and social competence o Strong parent-adolescent relationship
- Certain amount of “eustress” is necessary to o Family praying as group
build self- confidence and provide o School connectedness
reinforcement for taking initiatives o Attendance in a religious institution
- Studies have also demonstrated that risk
behaviors do not occur in isolation. These tend to
cluster together or one risk behavior can lead to Warning Signs in Adolescents:
another - Excessive daydreaming
Reasons for taking Risks: - Refusal to work, on-compliance
- Satisfying their curiosity, impressing friends, - Sleeping in class
responding to peer pressure, establishing - Poor hygiene
autonomy from parents, defying norms and - Strange changes in physical appearance
values of conventional authority, confirming - Non-conformity (deviation from the normal)
their self-identity, and coping with anxiety, - More serious behaviors:
frustration or failure o Repeated violation of law of school rules
- Sensation-seeking has been associated with risk o Running away from home, truancy,
behaviors like use of drugs, driving motor aggressiveness or temper
vehicles, and delinquency. outbursts
- Influence of mass media and community or o Sexual promiscuity, dark drawings, or writings
societal norms may provoke adolescents to take o Alcohol and drug abuse

Common Risk Behaviors:
- Sexuality and reproductive health problems:
o STDs and HIV infections
o Teenage pregnancy
o Homosexuality
- Road traffic accidents and injuries
- Violence
- Suicide and depression
- Substance abuse
o Smoking, alcohol and drugs
- Malnutrition and eating disorders
o Undernutrition
o Overweight and obesity eating disorders
SEXUALITY AND REPROUCTIVE HEALTHPROBLEMS
- Menarche occur at an average of 13years
- Youths in many countries choose to marry at a later
age but first experience sexual intercourse earlier
- Philippines (Data from Young Adult Fertility and
Sexuality Study(YAFS))
o From 1994-2002, premarital sex increased
from 18% to23%
o Average age for male is 17y/o; female is 18y/o
o 20% of aged 15-24 y/o had premarital sex
- YAKS2002:
o 27% wend along even if they did not want it;
o Boys no preference
o Females usually with fiancé/romantic love
o 48% occurred at male partner’s house
or at a friend’s house
st
o Contraception used the 1 time
- Childbearing starts earlier among the poor, in rural
areas, less formal education
SEXUALITY AND REPRODUCTIVE HEALTH PROBLEMS
REASONS FOR EARLY SEXUALACTIVITY
1. Curiosity
2. Partner coercion
3. Peer pressure
4. Desire to be like an adult
5. Older teens: being in love
6. Alcohol and drug use
7. The younger the adolescent, the higher the possibility that
sex is coerced
- Males: in early sexual activity, peers have stronger
influence than parents. The perception that peers engage
in sex and are using birth control methods induces an
adolescent male to greater sexual activity.
- Females: committed relationship, pressure from the
partner, inability to say “no” to perceived
expectations of the boyfriend increase the chances
for sexual activity
- A female adolescent who is achievement-oriented
and values her future will more likely delay sexual
activity.
- Sex education has not been proven to encourage
sexual activity but may even decrease the possibility
of pregnancy.
- The knowledge of contraceptives increases the
likelihood of their use.
STDs AND HIV INFECTIONS
Sexually active youth face additional risks from
unsafe sex practices. A study by Wi (1998) in selected sites in
the Philippines involving females between 15 and 24 years old
noted that the prevalence of chlamydia infections was 7.7%
while gonorrhea was found in 0.7. This study also showed that
6.2% of their partners used condoms.
Almost all had heard of HIV and had the following
misconceptions about it: HIV could be transmitted by
mosquito bites and by sharing a meal with an infected person.
HIV could be prevented by correct condom use, having only
one uninfected partner, and by practicing abstinence.
Contraceptive use among adolescents is relatively
low. In the preceding study,
only12%ofthemalesusedcondomintheirfirst
sexualencounter.IntheNDHSSurvey2008,15.5%ofgirlsaged15-
19 years had high-risk sexual intercourse defined as sex with a
non- marital, non-cohabiting partner, and only 8.7% of their
partners used
condoms.TheYAFS3statedthat50%ofyoungmaleswhopaidforse
x used condoms. Females who paid for sex were more
cautious, with 67% of their partners using condoms.
TEENAGE PREGNANCY
o Most often unintended, outside marriage
o Often curtails the normal development of an adolescent
o Hastens the assumption of adult responsibilities of an
unprepared adolescent
o NDHS 2007: 26% of 15-24y/o began childbearing early
o Flick (1986) half of initial premarital pregnancies occurred
in the 1st 6 months of sexual relationships.
RISK FACTORS:
1. Less educated woman, minimal or elementary schooling
2. Adolescent living in rural area(*2x)
3. Poor economic status
4. Substance abuse
5. Physical and sexual abuse
6. Family dysfunction
7. Low usage of contraception
8. Influence of the media on adolescent sexuality
9. Cognitive and emotional immaturity
10. Psychological problems
a. Anxiety
b. Depression
11. Unhappy childhood
12. Changing social norms
13. Lack of parental supervision
OUTCOMES:
1. More preterm deliveries(SGA)
2. Minimal or no PNCU
3. Poor fetal and maternal outcomes
4. Abortion and its complications
5. Malnourished newborns
6. Early parenthood is associated with:
a. Impaired development
b. Loss/limited opportunities for school and employment
 MANAGEMENT: o Ask about suicide and depression
 Approach to care of a pregnant adolescent is multidisciplinary o Careful PE:
 1st consult, emphasize the importance of regular PNCU  Accurate Tanner staging
 Interview should be non-judgmental and thorough. Include  Check for signs of STDs:
social, economic and psychological issues affecting the  Cutaneous lesions
pregnancy  Discharges
 Abortion out of the question  Inguinal LN
 Discussion on the possibility of adoption or foster care  Genital warts
 Involvement of the partner during PNCU is encouraged  Rectal exam
 Should assist the adolescent in maintaining good relationship  Check sphincteric tone
with the family  Anal lesions
 Parental involvement and communication help adolescents  Fissures herpetic lesions
make responsible decisions.  Signs of trauma-like hematoma, bruises
o Parents can help adolescents understand their growing
needs and body changes o A good history paves the way to doing a careful PE which
o Can guide and support their children’s thoughts and includes:
feelings during the latter’s maturation process  Pubertal staging
 Pregnancy prevention programs can assist adolescents to  Examination of the skin (skin lesions, cutaneous pieces of
recognize peer pressure STD evidence, and signs of trauma-like hematomas
 Increasing self-awareness and self-esteem can also help them and bruises)
develop a sense of control over their lives.  Examination of rectum in males (sphincter tone, anal
 Encouraging adolescents to participate in school activities or lesions, fissures, herpetic lesions, warts, bleeding
employing them in menial, temporary jobs can also help delay evidence)
early sexual activity and pregnancy.  Lymphadenopathy(especially inguinal)
 Males: penile warts, vesicular lesions and discharges
 Females: breast, external genital, cervix, vagina, uterus
HOMOSEXUALITY and ovary
o Males having sex with males should be screened for STIs
SEXUALORIENTATION which include:
o Not necessarily defined by sexual behavior or actual sexual  Hepatitis B
practice
 Gonorrhea
o It is an enduring emotional, romantic, or sexual attraction for
 Syphilis
another person.
 Chlamydia
o Falls within continuum.
 External pathogens
o Sexual behavior does not equate sexual orientation.
o Tests should include smears, not only of the penile and
anal orifices but also of the oropharynx area.
HOMOSEXUALITY o Should be offered screening for HIV, and counseling on
the nature of the disease should be done before and
o Homosexuals are vulnerable to STDs, HIV/AIDS, abuse, after testing
violence and suicide o Those who are susceptible to hepatitis B should be
o Face barriers to sexual healthservices immunized against the disease.
o Emotional and psychosocial issues that may affect the o Human papillomavirus vaccine should also be offered.
young homosexual, especially those who have not yet *Females who have exclusive relationships with females have lesser
fully “come out” include: chances of developing STDs.
 Significant peer rejection *Women who have relationship with the opposite sex should
 Low self-esteem also be educated on birth control methods.
 Family acceptance
MANAGEMENT STRATEGY:
 Feelings of hatred, anger, hostility and isolation
*These problems may lead to: o Treat with confidentiality
o Early detection and prevention of risk behaviors as well
 Runaway behavior
as mediation of psychosocial issues may help the
 Homelessness
confused adolescent
 Depression
 Suicide
 Substance abuse (smoking, drug and alcohol intake
 School or job failure ROAD TRAFFIC ACCIDENTS ANDINJURIES
*A non-heterosexual orientation significantly increases the Philippine National Injury Survey 2008: (10-14 y/o) drowning, RTAs,
odds of suicide attempts. Animal bites

DIAGNOSTIC APPROACH RISK FACTORS:

o During interview, assure confidentiality 1. Emotional and social immaturity
o Careful sexual history and never presume that 2. Alcohol and drug use
adolescents engage only in heterosexual relationships 3. Failure to use safety devices
o Always ask about sexual preference and sexual practices 4. Unsafe working conditions
o Focus on risk taking behaviors 5. Increasing mobility
6. Tendency to take risks
 7. Sense of invulnerability
8. Driving with several passengers onboard
MANAGEMENT STRATEGY
o Office-based injury prevention counseling includes:
 The use of motor vehicle restraints
 Parental supervision
o Parent education pamphlets provided as part of age-specific
anticipatory guidance at clinic visits have been found to be
cost- effective
o The health-provider should also alert parents on any high-risk
situations involving the adolescent.
o Adolescents who have not ventured into risk-taking should:
1. Learn how to protect themselves from accidents before
they happen by using the helmet or the seat belt when
riding a vehicle, motorbike, or skateboard.
2. Learn first-aid techniques and know where to ask for help
3. Maintain a healthy body through proper diet and exercise
o Parents must serve as role models to their children.
 Should take steps to reduce the risk of accidents.
 Should discuss with adolescents these risks and how
accidents can be avoided.
 Should monitor their children.
o Some prevention strategies in the family include:
1. Avoiding drinking and driving
2. Securing guns in home
3. Giving alcohol-free parties
VIOLENCE
 Exposure to violence has been increasing in the teenager’s
environment
 Abanilla at al. (2004): 8% of students carried weapons in school.
o 3x likely for those who bully
o 7x likely for those who engage in physical fights
 Exposure to violence and abuse increased the odds of those
victimized to subsequently engage in violent behavior.
 Likewise, exposure to violence in school, illicit drug use, alcohol
intake, sexual abuse, gang membership, attempted suicide,
male gender, and school year level of the respondents
increased the odds of violent behavior.
 A nationwide survey showed that half of the students were
involved in physical fights at least once during the past 12
months.
 Most injuries were sustained while playing a sports during
sports or following a fall.
 One third of students also admitted being bullied in school,
described as being kicked, hit, push around, shoved, or locked
indoors.
 Violence is said to be a learned behavior or response.
RISK FACTORS:
1. Violence in school
2. Illicit drug use
3. Alcohol intake
4. Sexual/physical abuse
5. Gang membership
6. Attempted suicide
7. Male gender
8. Exposure to television violence: correlated with increased
level of aggression
9. History of antisocial behavior
10. Mental health disorders
a. Mood disorders
b. ADHD
c. Oppositional defiant, conduct, and psychotic
disorders
SCREENING AND PREVENTION
TABLE 22-1. Assessment and screening for violence
Family/environmental
1. History of mental illness, previous domestic
violence, and substance abuse in the
parents/ other family members
2. Family stressors like unemployment, divorce, or
death
3. Inappropriate supervision/care/support systems
4. Presence of corporal punishment,
physical/emotional abuse, and other
disciplinary attitudes and practices of parents
5. History of violence in the home (domestic
violence or child abuses, school (bullying), or
community
6. Exposure to media violence
7. Access to firearms in the home or elsewhere
Personal
1. Involvement in gangs/peers with known history
of violence
2. Experiences of physical assault or sexual
victimization
3. Signs of poor self-esteem or depression
4. Poor school performance and physical,
emotional, or developmental disabilities
*Adapted from the American Academy of Pediatrics
 Health providers must also impart their willingness to help
adolescents and empower them to resist being caught in
uncompromising situations that may lead to harm
 Adolescents must reveal if they are victims of any form of
recurring violence.
 Many may experience physical, psychological and sexual
violence
 Teenagers and minors should avoid places where they are
likely to be assault
SUICIDE ANDDEPRESSION
 Suicide is a major public health problem
 Among the top 20 leading causes of death for alleges
 Suicide is among the top 3 causes of death in the
population aged 15-34 years, making it a leading cause of
death for young adults.
 Suicide rates have increased worldwide
 Philippines: 1960 0.7/100, 000 to 2.1/100, 000 in1993
 The National Poison Management & Control Center of the
University of the Philippines Manila – PGH recorded in
2007 a total of 156 adolescent cases of international or
suicidal poisoning with 70% committed by females
(Table22-2)
TABLE 22-2. Adolescent poisoning cases
Poisoning Case Male Female Total
Intentional 45 111 156
Accidental 14 12 26
  Suicide is the result of an act deliberately initiated and
 performed by a person in the full knowledge or expectation of its fatal outcome.
 Among the troubled youth, it becomes a choice when they lose self-confidence and control of situations, and are unable to cope with pressure
and stress.
 Because teens can be so intense and dramatic, they maychoose a final solution to a temporary problem without much forethought.

RISK FACTORS:
 Mental illness primarily depression along with alcohol use disorders, abuse, violence, loss, cultural and social background, represents major risk
factors (Table22-3).
 Among children and adolescents, the nature of depression usually differs from that found indults.
 Depressed young people tend to exhibit more “acting-out” behavior such as:
o school truancy
o low academic grades
o bad behavior
o violence
o abuse of alcohol or drugs
 They also tend to sleep and eat more. At the same time, refusal to eat and anorexic behavior are frequently found in combination with depression in
young people, more often seen among girls.
 Sever eating disorders are themselves associated with an increased risk for suicide
 Strong correlation between depression and suicide
 Common precipitating factors for suicide:
o Family conflicts
o Breakdown of relationships
o Financial difficulties
o Antisocial behavior
 Suicide thoughts might also be correlated with body physique

TABLE 22-3. Risk factors for teenage suicide

Personal
 Loss of close family members
 Break-up with boyfriend/girlfriend
 Loneliness, feeling of hopelessness
and isolation
 Previous suicidal attempts and suicidal
ideation
 Failure from high expectations set by
oneself and/or family
Family/Environmental
 Easy access to poisonous substances and
lethal devices and equipment (guns in
the house)
 Family violence such as frequent
parental fights and physical and sexual
abuse
 Lack of communication among family
members or friends; inability to
release feelings of anger and
frustrations
 History of mental disorders particularly
clinical depression, generalized anxiety
disorders, and schizophrenia
 Family history of suicide; mental disorders;
child maltreatment
 Local epidemics of suicide, “copycat” from
neighbor, media, Internet
 Barriers to accessing mental health treatment

PROTECTIVE FACTORS:
 Identifying protective factors against adolescent suicide is
important in buffering from suicidal thoughts and behavior.
These include:
 Family and community support(connectedness)
 Easy access to a variety of clinical interventions and support for
help-seeking
 Support from ongoing medical and mental healthcare
relationships
 Effective clinical care for mental, physical, and substance abuse
disorders
 Skills in problem-solving, conflict resolution, and non- violent
ways of handling disputes
 Cultural and religious beliefs that discourage suicide and
support instincts for self-preservation
 Positive, hopeful outlook about future with specific concrete
plans and goals
REASONS FOR TEENAGE SUICIDE
 Teens commit suicide in desperation and confusion
because of the fear of humiliation, rejection, social
isolation, hurt, and loss.
 As a form of escape, some adolescents may be worried
about disappointing friends or family members.
 They may fee unwanted, unloved, victimized, o r being a
burden to others.
 Others may be angry, ashamed, or guilty about something.
WARNING SIGNS FOR SUICIDAL BEHAVIOR
Teens with suicidal ideation may present the following
warning signs:
 Behavioral changes due to a psychiatric disorder like
depression (sadness, weeping spells; decreased interest
in daily activities like hygiene, appearance, and eating;
repetitive, continuous sleep disturbances:; anxiety and
restlessness; confusion and irritability, drug or alcohol
intoxication; and conduct disorder such as running away
or being incarcerated
 Expression/communication of thoughts of suicide,
death, dying or the afterlife (in context of sadness,
boredom, hopelessness or negative feelings)
 Impulsive and aggressive behavior, frequent expressions
of rage and mood swings
 Increasing use of tobacco, alcohol, or drugs
 Immediate intensive medical intervention for teens in
critical condition after suicide attempt.
 Close monitoring and investigate the root cause.
 Once the medical crisis has passed, continued support is
essential (counselors and other professionals).
 Address teens ability to build own coping skills.
 Support group
 Referral to psychiatrists or psychologists
angel·myrem|unpmed2018
 Exposure to another’s suicidal behavior
 Recent sever stressor (difficulties in dealing with sexual
orientation, unplanned pregnancy)
 Significant real or anticipated loss
 Family instability, significant family conflict
 Difficulty in decision-making
 Self-injurious behavior (starving, injuring self)
 Becoming highly religious/atheistic
 Exercising special care in distributing money or property
DIAGNOSTIC APPROACH
Aside from a thorough psychosocial history using
HEADSSS FIRST, there are several tests used to screen for
depressed and suicidal adolescents. The U.S. Teen Screen
National Center for Mental Health Checkup is an evidence-
based mental health and suicide risk screening program. The
screen includes the following tests:
1. PSC-Y Screening Questionnaire Starter Kit, a broad
mental health screening questionnaire
2. PHQ-9 Modified for Teens Screening Questionnaire
Starter Kit, a depression screening questionnaire
3. CRAFFT Screening Questionnaire Starter Kit, a
substance use screening questionnaire
*Other tests include:
1. Children’s Depression Inventory, a reliable and valid
self- rating scale for boys and girls 7-17 years of age
2. Beck Depression Inventory, a series of questions
developed to measure the intensity, severity, and
depth of depression in patients with psychiatric
diagnosis
MANAGEMENT STRATEGY
FIGURE 22-2. Approaches to prevention of suicide (Adapted from WHO)
 Possible psychotherapy, pharmacotherapy, behavioral
therapy and other psychosocial interventions if warranted
 Effective strategies for the prevention of suicide include:
o Restriction of access to means of suicide such as
toxic substances and firearms
o Identification and management of persons
suffering from mental and substance use disorders
o Improved access to health and social services
o Responsible reporting of suicide by media
Mental Health Problems | Dr. A. Agdeppa | 7 | P a g e
  People who talk about suicide often commit suicide. SMOKING, ALCOHOL AND DRUGS
Because they often have opposing feelings about whether
or not they want to die, there is always hope that they can
change their minds if given professional help.
 Studies have shown that talking about suicide has never
harmed anyone or precipitated suicide. Instead, it has
helped save many lives.
 Feeling anxious and or sad from time to time is normal
 Remind them that most problems are temporary and can
be overcome
 There is always hope and strength by believing in oneself
and having faith in one’s own religion.
*Parents should follow these steps in dealing with their teenage
children:
1. Watch and listen actively.
2. Demonstrate respect with actions and words.
3. Ask questions.
4. Get to know their friends.
5. Help build their self-esteem.
6. Encourage decision-making and responsibility.
7. Set clear limits and consequences for their behavior.

SUBSTANCE ABUSE
Substance use among adolescents presents a difficult
challenge to physicians. Use of illicit drugs and substances
considered as “gateway drugs” such as tobacco and alcohol is
common among adolescents.

 Tobacco use is decreasing in developed countries bu

tspreading rapidly among developing countries.
 Tobacco dependence is considered a “pediatric disease” as
most people begin smoking as adolescents and become
dependent on nicotine.
 Alcohol use and heavy drinking are common during
adolescence and young adulthood.
 Alcohol intake at an early age is associated with future
alcohol- related problems like gastrointestinal diseases
including liver cirrhosis and ulcers and neurological
disorders such as encephalopathy, neuropathy, addiction,
and withdrawal.
 Alcohol use by adolescents is more likely to be episodic
(binge) and heavy, which makes its use in this age group
particularly dangerous.
 Rapid binge drinking ,possibly related to abetordare,butsthe
teenager at even higher risks for alcohol intoxication, in
which
severe central nervous system depression and suppression
of the gag reflex and respiratory drive can be fatal

angel·myrem|unpmed2018 Mental Health Problems | Dr. A. Agdeppa | 8 | P a g e

 COMMON MANIFESTATIONS
 Nicotine addiction is classified as nicotine use disorder.
 The criteria for the diagnosis include any three for the
following manifestations observed within year:
1. Tolerance to nicotine with decreased effect and
increasing dose to obtain same effect
2. Withdrawal symptoms after cessation
3. Smoking more than usual
4. Persistent desire to smoke despite efforts to decrease
intake
5. Extensive time spent smoking or purchasing tobacco
6. Postponing work, social, or recreational events in order
to smoke
7. Continuing to smoke despite health hazards.

 DSM-IV-TR defines ALCOHOL ABUSE as a maladaptive pattern

of use that leads to clinically significant impairment of distress,
as manifested by at least one of the following conditions within
a period of 12months:
1. Recurrent alcohol use that results in a failure to fulfill
major role obligations at work, school, or home
2. Recurrent alcohol use in situations where it is physically
hazardous
3. Recurrent alcohol-related legal problems
4. Continued alcohol use despite persistent or recurrent
social or interpersonal problems caused or exacerbated by
the effects of alcohol.
 ALCOHOL DEPENDENCE ,meanwhile ,is defined as maladaptive
pattern of use that leads to clinically significant impairment or
distress, as manifested by at least three of the following factors
within the same 12-monthperiod:
1. Tolerance
2. Withdrawal
3. Alcohol often taken in larger amounts or over a period
longer than was intended
4. Persistent desire or unsuccessful efforts to cut down or
control its use
5. Great deal of time spent on activities necessary to obtain
or use alcohol, or recover from its effects
6. Important social, occupational, or recreational activities
given up or reduced because of use
7. Continued alcohol use despite knowledge of persistent or
recurrent physical or psychological problem that is likely
caused or exacerbated by alcohol use.
DIAGNOSTIC APPROACH
angel·myrem|unpmed2018
 Laboratory investigation through drugtesting
o May be used to determine the cause of dysfunctional
behavior, other changes in mental status, or suspicious
physical findings.
MANAGEMENT STRATEGIES
 Once identified, nicotine dependence calls for prompt
medical intervention.
 Counseling, nicotine-replacement therapies, nicotine patches
 Behavioral interventions, group counseling in conjugation
with pharmacotherapy
 5 stages of TRANSTHEORETICAL MODEL OFCHANGE:
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
 Prevention efforts is also essential:
- Minimum age for purchase
- Limit tobacco promotions
- Increasing price
- Tobacco control among parents
 Education among adolescents: negative consequences on
the physical, health and social aspects.
 The use of alcohol and other substances increases the
likelihood of behaviors with potentially harmful
consequences such as unprotected sexual activity,
dangerous driving, and violence.
 Matters concerning drinking, unprotected sex, early
pregnancy, and date rape should be discussed with the
adolescents.
 Avoidance of drunk driving or even associating with
drunk drivers should be emphasized
 Heavy use of alcohol and other substances can have very
negative consequences during adolescence.
 Injecting substances such as heroin greatly increases the
likelihood of getting HIV-AIDS.
 Adolescents should not be pressured into using
Mental Health Problems | Dr. A. Agdeppa | 9 | P a g e
 substances by their peers or by images seen in the quad-
media.
 They should not hesitate to seek for help from a health
worker when using illicit drugs or other substances.
 Adolescents may be more willing to accept help if they
are shown the progression of their substance abuse
 Discussing reasons and motivations to quit using tobacco,
alcohol, and other drugs may encourage the adolescent
to consider changing such behaviors and to recognize the
importance of seeking treatment.
MALNUTRITION AND EATING DISORDERS
UNDERNUTRITION
The Food and Nutrition Research Institute (FNRI) reported in 2008:
 17% of adolescents were underweight
 More pre-adolescents aged 11-12 years (26%)
compared to those aged 13-19 years were underweight.
 More females (69%) than males (53%) had normal BMI-for-
age.
 More males (22%) than females (12%) were
underweight among adolescents aged 11-19years.
 Trends between 1993 and 2008 showed that the
prevalence of underweight increased among
adolescents aged 11-19 years (16% vs. 17%).
 On the other hand, more adolescents aged 11-12 years
were overweight or obese(5%)comparedwith13-19-
year-olds(4%).
 Male adolescents were slightly more vulnerable to
being overweight or obese than their female
counterparts (4.8% vs. 4.4%)
In the 2008 National Nutrition Survey, Malnutrition such as iron
deficiency, iodine deficiency, and vitamin A deficiency remain
significant nutrition health problems especially among infants and
children, indirectly affecting the population entering the period of
adolescence. Among 13-19-year-old adolescents, the prevalence
rates of micronutrient deficiencies were as follows:
 Iron deficiency anemia: 10% males; 18%females
 Iodine deficiency:30%
 Vitamin A deficiency:5%
Issues among adolescents that were identified in relation to nutrition
were:
1. Stress
2. Heavy burden of studies
3. Lack of education due to poverty
4. Irritability
5. Frustration
Other issues discovered included intentional missing of meals and
media-driven consumption of junk food.
OVERWEIGHT AND OBESITY
The change in the lifestyle and eating habits of our youth
has brought another “epidemic”. Overweight and obesity acquired
during childhood and adolescence may persist into adulthood and
increase the risk for:
 Coronary artery disease
 Diabetes
 Gall-bladder disease
 Osteoarthritis of weight-bearing joints
 Some types of cancer
One major concern regarding the increasing prevalence of obesity is
its association with cardiovascular risk factors which can lead to fatal
angel·myrem|unpmed2018
and non-fatal cardiac events in adulthood. Overweight and obese
individuals are at increased risk for:
1. Type 2 diabetes mellitus(T2DM)
2. Dyslipidemia (most commonly low HDLch olesterol
3. Systolic hypertension
*More than two-thirds of children 10 years and older who are obese
will become obese adults.
 Screen for risk factors in the family
o SGA/LGA
o Obesity
o DM
o Genetic disorders
 Assess for snoring, apnea, polydipsia/phagia, binge eating,
regularity of menses
 Complete dietary history, preference, written 24-hour dietary
recall
 Lifestyle (activities, sports
 PE: weight, height, BMI, proofs of syndromic disorders or
neurogenetic abnormalities
MANAGEMENT STRATEGIES
 Multidisciplinary approach
o Endocrinologists
o Geneticists
o Nutritionists
o Psychiatrists
o Psychologists
o Guidance counselors
 Dietary modifications, increased physical activity and behavioral
therapy
 Requires adolescent complete understanding and cooperation
 At least 60 minutes of moderate physical activity/day
 OD family meals
 Parents as role models
 National education awareness and campaign
EATING DISORDERS
There is an increasing number of young girls who are
so obsessed with fitness and weight. They undergo food
restriction and are easily persuaded to try fad diets that they
suffer significant weight loss. Ill-timed and unsupervised
weight loss may lead to impaired growth and development.
Adolescents who engage in restrictive diets have been found
to have a 7-fold risk for developing disordered eating. This
behavior carries the risk for developing eating disorders later
in life.
Eating disorders are characterized by extreme
preoccupation with weight and body shape. These disorders
appear in adolescence although cases have also been reported
to begin in childhood or adulthood. They have both medical
and psychological consequences and may co-exist with other
disorders like substance abuse, anxiety disorders, and
depression. Eating disorders are treatable unless discovered at
their late stage or phase.
Eating disorders are not reportable in Philippine
health statistics. Foreign studies showed that females develop
these disorders more than males. Bulimia nervosa (BN) is more
common than anorexia nervosa (AN) with the prevalence of
1% and 0.4-0.5%, respectively
RISK FACTORS
1. Perfectionism
2. Low self-esteem
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 3. Impaired body image
4. Excessive dieting
5. Ballet, gymnastics and any visual sports
6. Family history of eating disorder or obesity
7. Affective illness or alcoholism in 1st degree family
8. Multifactorial etiology
9. Social and environmental factors in a biologically
vulnerable person with psychological predisposition
10. Also speculated that a disturbance in the
neurotransmitter serotonin may be a risk factor
o Patients with anorexia nervosa can be treated using family
therapy.
o Cognitive behavioral therapy may reduce relapse risks in
adults
o The use of fluoxetine reduces bulimic symptoms (binge
eating and purging) in the short-term
o Individual or group counseling decreases core behavioral
symptoms and psychological features among patients with
binge eating disorder in both short and long terms.

DIAGNOSTICAPPROACH
Screening for eating disorders can be approached by using the
following guide questions:
1. Do you eat a large amount of food in a short period of
time?
2. DO you ever feel like you cannot stop eating even
after you feel full?
3. When you overeat, do you take laxatives or
diuretics? Smoke cigarettes or take street drugs?
Stimulate vomiting?
*A YES answer to any of these questions may require further
evaluation

MANAGEMENT STRATEGY
o Multidisciplinary approach that addresses the medical,
nutritional and psychological needs
o Once suspected, the following steps should be taken:
1. Give feedback based on history and physical findings
2. Establish weight monitoring plans
3. Discuss any psychiatric risk
4. Provide the patient and family information about the
course, prognosis, and treatment of eatingdisorders

o Indications for hospitalization of Anorexia Nervosa

include:
1. Very rapid weight loss or very low energy intake
2. BMI below second percentile
3. High risk of suicide
4. Sighs of physical compromise like severe dehydration,
wide pulse pressure, slow heartbeat, and low diastolic
blood pressure.

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