AC Adolescent Health

ADOLESCENT HEALTH
To Introduce The Topic

"Adolescence" - concept first
popularized in the early 20th
century by researcher and
psychologist - G. Stanley Hall
To Introduce The Topic
New attention to adolescent health
Adolescent health has come of age.
Finally - Sense of urgency that action is
needed now to make a real difference
to the health of adolescents.

To Introduce Topic
Reasons for growing attention
Important for today and tomorrow
A better understanding
Recognizing neglected problems
Knowledge about determinants
Some are more vulnerable
A key decade in the life-course
Human rights and health
Adolescence: A Period Needs
Special Attention
Recognizing Adolescence
Physical Changes
Neurodevelopmental changes
Psychological and Social
changes

Recognizing Adolescence

Specific health and developmental
needs and rights.
All societies recognize the difference -
being a child and becoming an adult.
The period between childhood and
adulthood is growing longer and more
distinct.

Adolescent
Adolescence - from Latin word
adolescere - grow, to mature.
Transition - childhood to
adulthood.
No longer children yet not adults.
Rapid physical growth, significant
physical, emotional, psychological
and spiritual changes.

AAggressive, anemic, abortion
DDynamic, developing, depressed
OOverconfident, overindulging, obese
LLoud but lonely and lack information
EEnthusiastic, explorative and experimenting
SSocial, sexual and spiritual
CCourageous, cheerful and concern
EEmotional, eager and emulate
NNervous, never say no to peers
TTemperamental, teenage pregnancy
Defining terms - Period of
Adolescence
Adolescence (WHO): 10-19 yrs
Youth (United Nations):15-24 yrs
Young people (UN) :10-24 yrs

Period of Adolescence
To accommodate the different phases
of development, adolescence is often
divided into
Early Adolescence : 10-13 yrs
Middle adolescence : 14-16 yrs
Late adolescence : 17-19 yrs
Adolescent girls reaches
developmental milestones earlier.
Adolescence: Physical
changes
Most rapid phases of human
development.
Many biological changes take
place.
Most obvious are the physical
changes - endocrine changes.
Internal and external influences

Adolescence: Neurodevelopmental
changes
Important neuronal
developments - linked to
hormonal changes
Developments in regions of
the brain - limbic system,
pre-frontal cortex.

Adolescence: Neurodevelopmental
changes
Biological maturity
precedes psychosocial
maturity.
Adolescent brain has
significant neural
plasticity, - still able to
change.

Adolescence: Psychological
changes
Increasing cognitive and intellectual
capacities.
Develop stronger reasoning skills, logical
and moral thinking, and become more
capable of abstract thinking and making
rational judgments.
Able to take other peoples perspectives
into consideration and often want to do
something about the social issues
Adolescence: Psychological
changes
Developing and consolidating their
sense of self.
Want greater independence and
responsibility.
Want to assert more autonomy over
their decisions, emotions and actions
and to disengage from parental control
Adolescents may be particularly
vulnerable
Adolescence: Social
changes
Adolescents internal & external
environment - affects and are
affected.
Differ among cultures, societies,
social values and norms and the
changing roles, responsibilities,
relationships and expectations of
this period of life.

Adolescence: Social
changes
Changes affect adolescents in their
immediate environment
Family, school and community
and
Reflect in a wider societal
changes - increasing
urbanization, globalization &
access to digital media and social
networks.

Contributors to the health and
development of adolescents
Politicians
Journalists
Bureaucrats
Relatives
Friends
Family friends
Teachers
Sports coaches
Healthcare providers
Religious leaders
Traditional leaders
Parents
Brothers/Sisters
Adolescents
Musicians
Film stars
Sports figures
Adolescent Health
Epidemiology
Significant death and disease during the
adolescent years.
Morbidity and mortality - Damages
many young lives & imposes a burden
on the future.

Top causes - deaths in
adolescents, Global - 2012
Road traffic injuries
HIV/AIDS
Suicide
LRI
Violence
Diarrhoea
Drowning
Meningitis
Epilepsy
Endocrine, blood,
immune disorders

Top causes of illness and
disability
Depression
Road traffic injuries
Anemia
HIV/AIDS
Self-harm

Back and neck pain
Diarrhoea
Anxiety disorders
Asthma
LRI

Disability Adjusted Life Years
(DALYS)
Global burden of disease in
adolescents - Disability adjusted life
years (DALYs) worldwide in the age
group 10-24 years is 230 million
which constitutes 15.5% of total
DALYs.

Regional Highlights
1 of every 3 deaths among
adolescent males in the low and
middle-income countries -
Interpersonal violence.
1 of every 5 deaths among
adolescents in high income
countries - Road traffic
injuries.
Regional Highlights
1 of every 5 deaths among adolescent
males in the low and middle income
countries - War and conflicts.
1 of every 6 deaths among adolescent
females in the South-East Asia Region -
Suicide.
1 of every 6 deaths among adolescents
in the African Region - HIV.

Adolescents Health-related
Behaviours
Affect health - Present and
future.
Lead to the major causes of
mortality and morbidity
among adolescents.
Other behaviours -
contribute to adult
non-communicable diseases.

Behaviours
WHO global consultation -
adolescents said reasons for
adopting unhealthy
behaviours:
Enjoying,
Having formed a habit -
difficult to break, and
Peer pressure.

Behaviours
WHO global consultation -
adolescents said positive role
in their health :
Healthy eating
Adequate physical activity
Prevent health problems -
condom use
Monitoring health-related
behaviours and conditions
Global School-based Student Health
Survey (GSHS)

(ages 1317)
Health Behaviour of School-Age
Children: (HBSC) (ages 11, 13 and 15)
Global Youth Tobacco Survey (GYTS)
(ages 1315)
DHS - Older adolescents (1519)
years
Behaviours
Mental health issues
Violence and injuries
Sexual and
reproductive health
behaviours
Underweight and
nutrition-related
behaviours

Behaviours
Behaviours affecting current
and future health
Obesity and physical activity
Alcohol use
Cannabis use
Tobacco use

Mental Health Issues
Leading risk factors for
death.
Todays important
health problem faced by
adolescents.
Suicides, Mental
health disorders.

Mental Health Issues -
Suicides
Widely among adolescents ages 1218.
High income countries 510%.
Higher in Low and middle income
countries around 15%.
1 in every 3 adolescents reports
attempting suicide - In few countries.
Gender differences - Girls are nearly
twice in attempting suicide as boys.

Suicides
India - highest suicide rates in the
world.
Contributes to more than 10% of
suicides in the world.
Health Ministry - up to 120,000
suicides themselves every year and
almost 40 % -under the age of 30.

Suicides
Young women more likely than young
men - India
The suicide rate in India - increasing
steadily 10.5 (per 100,000 of population)
in 2006.
Alarming rate of suicidal deaths - Kerala,
Karnataka, Tamil Nadu and Andhra
Pradesh and Pondicherry.

Research Findings - Suicide
The study conducted by vellore CMC on
teenagers in Tamil Nadu, in the vellore
region - results;
Average suicide rate for women is as
high as 148 per 100,000, and
58 per 100,000 for men.
Causes of Suicide Research
Findings
Depression,
A previous suicide attempt,
A family history of psychiatric
disorders (especially depression and
suicidal behavior),
Family disruption,
Findings
Chronic or debilitating physical
disorders or psychiatric illness.
Alcohol use and alcoholism
Living out of the home
History of physical or sexual abuse
Psychosocial problems and stresses
Conflicts with parents,
Breakup of a relationship,
Findings
School difficulties or failure,
Legal difficulties,
Social isolation, and
Physical ailments (including
hypochondriacal preoccupation)
Commonly reported or observed in
young people who attempt suicide
Mental Health Issues - Mental
disorders
Many mental disorders usually
start during childhood or
adolescence.
Delayed - Diagnosis and
treatment.
Half of all lifetime mental
disorders appear to start by age 14.

Mental Health Issues - Mental
disorders
Treatment - access is scarce.
WHO has developed the Mental
Health Action Plan for 2013-2020.
It includes recommended actions for
improving the mental health of
adolescents.

Violence and Injuries
Leading causes of mortality and
morbidity among adolescents -
important to monitor measures of
violence and injury.
Physical fighting,
Intimate partner violence,
Bullying,
Serious injuries.

Violence and Injuries - Physical
fighting

Common among
younger adolescents, -
boys than girls.
Lead to severe injuries -
Associated with
substance misuse and
behavior problems.

Violence and Injuries - Intimate
Partner Violence
Common
Physical injuries, traumatic
experiences - result -
neurological and behavioural
changes
Lead to - immediate and later
health problems and
Repeated victimization.

Partner Violence
Prevalence.
30% of women ages 15-19 who are
cohabiting have experienced
violence by their partners -
WHO
Regional prevalence - around 10%
in some high income countries to
43% in South-East Asia.

Partner Violence
High income countries -
adolescents intimate partner
violence - around 10%.
Overall, one-third of women
aged 15-49 have experienced
physical violence and
About 1 in 10 have experienced
sexual violence.

Research Findings - IPV
Associations Between Early Marriage and Young Women's Marital
and Reproductive Health Outcomes: Evidence from India - K.G.
Santhya, Usha R, Rajib A, Shireen J. Jejeebhoy, Faujdar R and Abhishek
S. Data from 8,314 married women aged 2024 living in five Indian
states (rural and urban areas of Andhra Pradesh, Bihar, Jharkhand,
Maharashtra, Rajasthan and Tamil Nadu). RESULTS: Young women
married at age 18 or older were involved in planning their marriage than
women married before age 18. to reject wife beating (1.2), to have used
contraceptives to delay their first pregnancy (1.4) and to have had their
first birth in a health facility (1.4). women who had married early to have
experienced physical violence (0.6) or sexual violence (0.7).
Research Findings - IPV
Speizer IS, Pearson E: Association between
early marriage and intimate partner violence in
India: a focus on youth from Bihar and
Rajasthan.
Demonstrate that women aged 20 to 24
who married before age eighteen, are more
likely to have ever experienced IPV in their
lifetime.
J Interpers Violence 2011, 26(10):1963-1981.
Violence and Injuries -
Bullying
Harassment, Maltreatment,
Discrimination
Another indicator of involvement
in violence.
Linked to a wide range of mental,
psychosocial, cognitive/
educational and health problems

Violence and Injuries -
Bullying
Depression and suicide, poor coping
responses, consumption of alcohol and
other drug use.
Increased bullying among 15-year-old
boys or girls.
53% of Indian children between 8 and
17 years have been bullied online -
Hindustan Times September 19, 2012.

Research Findings - Bullying
Economic Times. India Times 18/01/2012
According to Microsofts Global Youth Online
Behavior Survey of 25 countries, India ranked third
with 53% of respondents (children aged between 8 -
17) saying they have been bullied online, behind
China (70%) and Singapore (58%). In India, the survey
found that more than 5 in 10 children surveyed said
they have experienced what adults might consider
online bullying.

70
79
53
54
50
52
76
63
57
54
37
72
24
42
23
37
Knowledge
about online
bullying
Worried
about online
bullyying
Bullied
online
Bullied
ofline
Bully
someone
online
Bully
someone
offline
Formal
school
policy
Provides
education
India
WW
Online Bullying Metrics:
India Vs. World Wide Average

Violence and Injuries - Serious
injuries
Common, requires medical
attention.
More boys than girls report
injuries.
At least 50% of young adolescent
boys report serious injuries.
Among girls ages 13 - 15, rates
are 30 - 40% in most countries.
Risk behaviors related to violence and injury among school-going
adolescents in Karnataka, Southern India - Swain S, Mohanan P, Sanah
N, Sharma V, Ghosh D International Journal of Adolescent Med & Health, Feb 2014.
Results: Considering all violence risk behaviors, 33.07% of students had at
least and 18% had at least two violence-related risk behaviors. Nearly
21.78% thought of hitting somebody, 16.34% of boys and 9.5% of girls
carried sharp objects to school, 18.81% of boys and 10.39% of girls
damaged or stole other students' property, 18.37% bullied others in the past
month at the school campus, and 11.32% were involved in serious fights.
Out of 381 students, 114 (30.32%) were bullied, 10% had been slapped
intentionally, and 18% of girls felt unsafe to go out of their home because of
threat compared with 15% of boys. In total, 71 (18.93%) students thought of
suicide and 22 of them attempted it.
Sexual and Reproductive
Health Behaviours (SRH)
SRH is a major area of concern -
inadequate awareness and knowledge.
High chances - STIs, Early
marriage/Teenage pregnancy
and Unsafe abortions.
Female genital mutilation and sexual
coercion - harmful traditional practice

SRH - STIs
In India - 49,000 adolescent
males & 46,000 adolescent
females with HIV positive.
The adolescents need to know - to
protect - HIV/STI/RTI.
SRH - STIs
Around 35% adolescent males
and 19% adolescent females -
comprehensive knowledge of HIV
- UNICEF;April 2012.
Only 30% of unmarried women
aged 15 to 24 heard about
RTI/STI.
- (DLHS-3), 2007-08: India.
SRH - STIs
(NFHS-3) - 11% of females and
7% of males aged 15-24 - history
of STI.
Men - Prevalence of two STI
symptoms : abnormal bad
smelling genital discharge and
genital sore (more in men aged
20-24).
SRH Teenage pregnancy,
Early Marriage & Unsafe Sex
In India - oppose
premarital sex - some
studies indicate a
growing trend
towards premarital
sexual activities among
adolescents.
Early Marriage - Neglected
aspect.
Prevalence - In urban is
around 29%, & 56% in rural
counterparts.
Early child bearing,
complications - mother &
child

Recent Indian data - 30% of
girls aged 15-19 are currently
married or in union,
compared to only 5% of boys
of the same age.
The figure is the eighth
highest in the world.
UNICEF, 2011
Press info Bureau GOI:
About 16 million girls
under age 18 give birth
each year.
Another 3.2 million
undergo unsafe abortions.
3.2 million unsafe abortions
- developing countries
among girls aged 15-19
Adolescents - serious
complications are reported
[2008]

Illiteracy
Ignorance
Poverty
Early
Marriage
Teenage
Pregnancy
High
Maternal
and Infant
mortality
VICIOUS
CYCLE
Research findings: 2012
3% of adolescent males and 8%
of adolescent females had sex
before age 15,
1% female and 63% males aged
15-19 had high risk sex with a
non-marital, non-cohabitating
partner. 2012
31% adolescent males and 20% adolescent
females used a condom during their last
high risk sex. [2012]
Knowledge of contraception among
adolescents
More than 90% in NFHS-3; but only a
little more than 10% of adolescent girls
were found using any form of
contraceptive. [2004]
Underweight and Nutrition-
related behaviours
Important health risk.
Contributes to mortality.
Under weight and
Anaemia, Obesity.
Same concerning levels -
underweight and obesity.
Underweight & Anemia
Nutrition related behaviours
Nearly 50 % of
adolescent girls aged 15-
19 in India are
underweight (highest in
the World).
Fruit and vegetable -
improve micronutrient
levels.

Underweight and nutrition-
related behaviours
Top health-compromising
behaviours among
adolescents are (WHO):
Unhealthy diets
Physical inactivity
Alcohol and other
substance use
Poor sleep habits.

and future health - obesity and
physical activity
A growing concern
Adverse consequences
- physical morbidity in
adult hood.
Behaviours Affecting Current
and Future Health - Obesity And
Physical Activity
Contribute to non-communicable
diseases and conditions - cancer,
cardiovascular diseases, chronic
respiratory diseases and diabetes.
Prevalence of overweight among
adolescents varies between 10 and
30%.

Prevalence and determinants of overweight and
obesity among adolescent school children of
south Karnataka, India - M shashidhar, Ganesh K
S,

and Suphala S K
The overall prevalence of overweight among adolescents
was 9.9% and obesity was 4.8%. Prevalence of
overweight - 9.3% among boys and 10.5% among girls;
5.2 and 4.3% were obese, respectively. According to the
BMI, 23.9% (215) were underweight, 60.6% (546) were
normal, 11.4% (103) were overweight, and 4% (36) were
obese. Contd
Risk of overweight was two times higher among the
adolescents of high SES, 21 times higher among those
participating < two hour/week in any type of physical
activity,
7.3 times higher among those who reported watching
television and playing games on the computer for 4
hours/day, and 5.6 times higher among those who ate
chocolates daily in addition to a normal diet.
and future health - Alcohol use
Alcohol use contributes to
risks during adolescence
Injury, violence,
unprotected sex and suicide
attempts.

and future health - Cannabis
use
Initiation of cannabis use
before age 18 lead to
persistent use,
Associated - decline in IQ
scores and increase in the
risk of injuries.
use
Usage - 1% to 2% of countries -
1 in every 3, 15-year-olds.
Cannabis use (4-20%)in India
Epidemiological survey
2008.
use
Specific effects of cannabis on
academic performance.
Majority reported: forgetfulness
(75%), impaired attention
(66%), day-dreaming (77%),
slowing down (75%) and
distractibility (64%).

and future health - Tobacco
use
Smoked and smokeless - increases
the risk of persistent nicotine
addiction in adolescent.
Leading to regular and sustained
tobacco use in adulthood.
use
Largest contributors to non-
communicable diseases.
Early mortality among adults.

use
Smoked tobacco prevalence.
Globally, 1 in every 10 girls and 1 in every
5 boys aged 13-15 years use tobacco -
areas where tobacco use is more
common.
1 of every 3 younger adolescents
currently smokes cigarettes.
use
Highest smoking rates - Europe and
Western pacific regions.
Different methods used for tobacco
smoking.

use
In India, a study conducted in Bangalore
- Prevalence of 6.8% smoking among 13-
15 years aged students (Shashidhar et al.,
2011)
use
Smokeless tobacco
Less commonly used
Boys consistently report more
use than girls.
and future healthtobacco
use
Smokeless tobacco
The highest rates among youth
ages 13-15 years were reported in
the Marshall Islands (16% of boys
and 7% of girls) and India (15%
of boys and 5% of girls).

Prevalence of Tobacco Use Among Adolescents in
India. Jayakumary M, Binoo D, Teena T, Jayadevan S,
Jeesha C H, Mohammed T. 2012.
It was conducted in 10 randomly selected schools in
Kannur district of Kerala, India. A total of 3,000 school
children participated. The study observed an overall
prevalence of 5.5% for users. The prevalence observed
among boys was 12% and none of the girls were
tobacco users. Associations between fathers and
friends tobacco habits were observed.
Factors Affecting Adolescent
Health
Individual characteristics
The immediate environment
Social values and norms
Policies and laws
Social determinants
The physical and biological environment
Towards Adolescent -
Responsive Health Systems
Adolescents - Significant needs.
Different challenges for the healthcare, -
Rapidly evolving physical, intellectual
and emotional development.
Adolescents special needs not met from
approaches

Progress toward universal health
coverage - transition from adolescent-
friendly projects to adolescent-
responsive health systems.
Services - beyond sexual and
reproductive health - address full range
of health and development needs.

Bringing services closer to adolescents
School health services,
e-health and
m-health.
School Health Services
Way to bring health care
closer to adolescents.
Advantages - access, equity
and responsiveness to
adolescents needs.
Little evidence on their
effectiveness.
School Health Services
Individual clinical care,
Group-based health promotion,
prevention,
Infectious disease control,
Screening,
Case management for chronic
conditions and
Referrals for further health
services.

E-health and m-health
Coverage offered by internet and
mobile communication
technologies (e-health and m-
health).
Technologies may complement
efforts to bring services closer to
adolescents.
E-health and m-health
Can achieve high coverage at
low cost.
Provide confidential and
anonymous interactions,
Easy access 24 hours a day and
Possibility for personalized
interaction.
Working With Other
Sectors
Creating safe and supportive families
Creating safe and supportive
communities
Protection in the physical and social
environment
Education and health sectors share
interests
Preparing for and obtaining decent
work

Ten Key Actions for The
Health Sector
Adolescent health is essential
for public health
Strengthen advocacy for
adolescent health
Incorporate a focus on
adolescents into all health
policies, strategies and
programmes
Health Sector
Use the response to adolescent
health as an indicator of equity
Maintain a positive perspective
toward adolescents, and involve
them
Support interventions that go
beyond the individual adolescent
Health Sector
Improve the collection, analysis
and use of data
Focus on universal health coverage
for the second decade
Work with other sectors to
improve the health of adolescents
Define and fund research priorities
Implications for health and
behaviour
Adolescent development drives
the changes in the disease burden
between childhood to adulthood.
Adolescents neurodevelopmental
changes and evolving capacities
affect perception and
communication.
behaviour
Pubertal changes affect the
incidence and clinical
manifestations of a number of
diseases.
Social and emotional changes
during adolescence heighten risks
for behavioural problems.

behaviour
The appearance of certain health
problems in adolescence, reflects
biological changes and the social
context.
Many of the health-related
behaviours arise during
adolescence have implications
for both present and future
health and development.
Implications for policies
and programmes
Adolescents need explicit
attention
Adolescents are not all the same
Some adolescents are particularly
vulnerable
Adolescent development has
implications for adolescent health

and programmes
Adolescent development has
health implications throughout
life
The changes during adolescence
affect how adolescents think and
act
Adolescents need to understand
the processes in adolescence.
and programmes
To contribute positively, adults
need to understand the processes
taking place during adolescence
Public health and human rights
converge around concepts of
adolescent development
Adolescent Health Programs -
GOI
Kishori Shakti Yojana : To improve the
health and nutritional status of girls
Balika Samridhi Yojana: To Delay the
age of marriage
National AIDS Control Programme
Reproductive and Child Health
Programme

References
Progress for Children A report card on adolescents, Number 10, April 2012
Indian J Community Med. Jan 2010; 35(1): 176178. Prevalence and Determinants of
Overweight and Obesity Among Adolescent School Children of South Karnataka, India. M
Shashidhar Kotian, Ganesh Kumar S,

and Suphala S Kotian
Dr.R.DakshinaMurthy and Dr.S.K.Panner Selvam SUICIDE AMONG
ADOLESCENTS : Indian Streams Research Journal (April ; 2012)
Associations Between Early Marriage and Young Women's Marital and
Reproductive Health Outcomes: Evidence from India - K.G. Santhya, Usha R, Rajib A,
Shireen J. Jejeebhoy, Faujdar R and Abhishek S. International Perspectives on Sexual and
Reproductive Health, 2010, 36(3):132139.
Speizer IS, Pearson E: Association between early marriage and intimate partner
violence in India: a focus on youth from Bihar and Rajasthan. J Interpers
Violence 2011, 26(10):1963-1981
Online Bullying among youth 8-17 years old India. Cross tab marketing services & Tele
communications research group for Microsoft corporation. The Hindu, July 9, 2012.
Children in India are Worst Victims of Cyber Bullying, Economic Times. India Times 18/01/2012.
http://www.endcyberbullying.org/children-in-india-are-worst-victims-of-cyber-
bullying/#ixzz3DZM2ev1x
Adolescent Reproductive and Sexual Health in India: The Need to Focus, Bharti Mehta,a,
Amandeep Kaur,b, Vijay Kumar,c, Sumit Chawla,d, Manisha Malik,e, Sneh KhatrifJournal of
Young Medical Researchers, Vol. 1, No. 1, Aug-Jan 2013, e1
Anil Malhotra, Cannabis Use and Performance in Adolescents, J. Indian Assoc. Child Adolesc.
Ment. Health 2006; 2(2): 59-67.
Jayakumary Muttappallymyalil, Binoo Divakaran, Teena Thomas, Jayadevan
Sreedharan, Jeesha C Haran, Mohammed Thanzeel Prevalence of Tobacco Use
Among Adolescents in India. Asian Pacific Journal of Cancer Prevention, Vol 13, 2012.

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ADOLESCENT HEALTH

To Introduce The Topic

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