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  1. 1. WHO defWHO def adolescentsadolescents 10 -19 yrs10 -19 yrs Adolescence ‘adolescere’ Latin = “to grow, to mature” i.e. achieving an identity.
  2. 2. Adolescence Definition:Definition: • “A period between childhood and adulthood.” » Oxford’s Dictionary • “Adolescence is that period of life of an individual when society no longer views him as a child but does not as yet concede him either the roles or the functions inherent in the status of adult”. » Holinshead.
  3. 3. Adolescence is.. …that part in our life where nothing seems to go smoothly yet our best
  4. 4. Adolescence WHO / UN Definitions: – Adolescent : 10 – 19 years – Youth : 15 – 24 years – Young Adults : 10 – 24 years
  5. 5. Some Definitions • Puberty Physical characteristics that occur during adolescence • The Growth Spurt Rapid changes in height and weight during puberty. • Primary Sex Characteristics The changes that mark the beginning of puberty for girls and boys. • Secondary Sex Characteristics Other external changes that make adolescents look like mature men and women
  6. 6. TeenagersTeenagers Comprise 2nd largest population group. (23%)Comprise 2nd largest population group. (23%) • over 1 billion world overover 1 billion world over • World over - 1 out of every 5 personWorld over - 1 out of every 5 person • Developing - 1 out of every 4 personDeveloping - 1 out of every 4 person • 10-19 years age group constitute > 1/510-19 years age group constitute > 1/5thth of India’s population.of India’s population. • By the year 2010 there will be moreBy the year 2010 there will be more adolescents alive in the world than everadolescents alive in the world than ever beforebefore • Healthy and well-adjusted adolescents ofHealthy and well-adjusted adolescents of today will become productive citizenstoday will become productive citizens andand dynamic leaders of tomorrow.dynamic leaders of tomorrow. CSN Vittal
  7. 7. Salient attributes of Adolescence • Physical, psychological, emotional and social development • Rapid but uneven physical growth • Sexual maturity and onset of sexual activity • Desire for exploration and experimentation • Development of adult mental process and self identity • Transition from dependence to relative independence
  8. 8. Factors affecting the adolescent development • Socioeconomic circumstances • The environment in which they live and grow • The quality of relationships with their families • Communities and peer groups • Opportunities for education and employment
  9. 9. Growth Spurt 1. Average spurt is 24 to 36 months 2. Growth spurt is assoc. with bone age (not age in years) 3. Growth spurt: up to 25% of final height 4. Peak height velocity (PHV) a. Two years sooner in females vs. males b. Tanner 2 in females vs. 4 in males c. Tanner 5: Most teens are beyond PHV
  10. 10. 1. Starts: 10 years in females vs 11.5 years in males 2. PHV: 8.0 cm/year in females vs 9 cm in males 3. Age: PHV at 11.5 years in females vs 13.5 in males (Two years sooner in females vs. males) - Tanner 2 in females vs. 4 in males 4. Depends on onset of puberty and effects of nutrition / illness 5. End: epiphyseal/diaphyseal closure (adult bone age) Linear Growth
  11. 11. Tanner’s Stages Sequence of somatic andSequence of somatic and physiologic changes give rise tophysiologic changes give rise to sexual maturitysexual maturity • SMR Stages : 1 to 5 on parameters: 1. Pubic hair 2. Breast development 3. Genital development
  12. 12. SMR Stages - Girls BreastBreast StageStage Pubic HairPubic Hair Prepubertal – Nipple elevation only I Prepubertal, no pubic hair Small, raised breast bud (thelarche) II Sparse growth of hair along labia General enlargement of raising of breast and areola III Pigmentation, coarsening and curling, with an increase in amount Further enlargement with projection of areola and nipple as secondary mound IV Hair resembles adult type, but not spread to medial thighs Adult contour, with areola in same contour as breast, & only nipple projecting V Adult type and quantity, spread to medial thighs
  13. 13. SMR Stages - Boys GenitalGenital StageStage Pubic HairPubic Hair Prepubertal I Prepubertal, no pubic hair Enlargement of testes > 4 ml; reddening and change in texture in skin of scrotum; II Sparse hair at the base of penis Increase first in length & then breadth of penis; growth of testes and scrotum III Darkening, coarsening and curling, increase in amount Further growth of testes and scrotum, darkening of scrotal skin IV Hair resembles adult type, but not spread to medial thighs Adult size and shape genitalia V Adult type and quantity, spread to medial thighs
  14. 14. Sexual Maturity Rating – Tanner
  15. 15. Adolescence StagesStages Early : 9-13 years Mid : 14-15 years Late: 16-19 years
  16. 16. Adolescence Variable Early Middle Late Age 10-13 14-16 17-20 SMR 1-2 3-5 5 Somatic Sec. sex characters Rapid growth High growth peaks, body shape and comp. change, acne, odor, menarche, spermarche Slower growth Sexual Interest exceeds activity Drive surges, experimentation, orientation Consolidation of sexual identity Cognitive & moral Concrete operational, conventional morality Emergence of abstract thought, self centered Idealism, absolutism
  17. 17. The Sequential Changes of Puberty Adolescent Female • Breast bud (thelarche) • Pubic hair development (pubarche) • Height velocity peak • Menarche • Axillary hair • Final pubertal changes, e.g., full breast, pubic hair, and completed height development Biological Changes
  18. 18. Adolescent Male • Early testicular growth • Pubarche • Testicular and penile growth • Nocturnal emissions (spermarche) • Height velocity changes • Marked voice changes • Facial hair growth • Final pubertal changes e.g. full genital, height and muscle development The Sequential Changes of PubertyBiological Changes
  19. 19. ELIZ HEALTH PATH FOR ADOLESCENTS Under Weight < 18.5 Normal 18.5 – 24.9 Over Weight 25 – 29.9 Obesity > 30
  20. 20. • Rapid and uneven growth and development vis a vis peers • Ignorance about sex and sexuality • Endocrinal and other psychological changes • Lack of understanding & suboptimal support at family level • Social frustration • Inadequate school syllabus • Misdirected peer pressure, absence of adequate knowledge • Lack of recreational, creative and working opportunities. • Lack of rehabilitation facilities for handicapped adolescents Factors contributing to healthFactors contributing to health problems of adolescentsproblems of adolescents
  21. 21. Psychosocial Development Teenage Adult With Parents Rebellious Reacceptance Puberty changes Concern Acceptance Friends / peers All important More selective Behaviour Risk taking Put self limits Attitudes Highly moralistic Realistic
  22. 22. Factors affecting Adolescent Health • Social environment: – Attitudes and norms – Relationships with family – Policies of the decision makers – Mass media • Gender: – Discrimination • General health: – Problems of childhood – malnutrition, deprivation, abuse, infections, etc. – Problems of adolescence – risk taking behaviour, tobacco, alcohol, unprotected sex, violence and injury, etc.
  23. 23. Protective Factors of Adolescent Health 1. Caring and meaningful relationships 2. Positive school environment 3. Structure and boundaries of behaviour 4. Having spiritual beliefs 5. Encouragement of self expression 6. Opportunities for participation and contribution
  24. 24. ISSUES BOTHERING BOYS Inadequate facial hair Embarrassment Breast enlargement - Do - Pimples - Do - Self stimulation Physiological Size of penis Does not matter at all ! Interest in sex & nudity Natural Pornography Distorted image Chance for sexual abuse Avoid & resist
  25. 25. ISSUES BOTHERING GIRLS Hirsutism Embarrassment Breast shape, size - Do - Pimples - Do - Urge for self stimulation Not unusual Interest in sex & nudity Natural Sexual exploitation To be recognized early & resisted Menstrual problems …….
  26. 26. “The way a person pictures his or her body”
  27. 27. Body image • Important ingredient of self-concept • Help whether we accept or reject ourselves • Whether we feel confident in social relationships • Whether we have an idealized or realistic idea of attractiveness, strength, skills and sex appeal.
  28. 28. Body Image Perceptual Evaluation of size of one’s bodyEvaluation of size of one’s body 1 Affective or cognitive Evaluation of abilitiesEvaluation of abilities 2
  29. 29. Body image – Self Esteem • Comparing with peers – developing a feeling of inferiority • Interfere with day to day functioning and studies • Problems in relationships with peers and family, jealousy, arguments and other negative expressions Higher levels of body satisfaction are associated with higher levels of self esteem.
  30. 30. “The sum total of one’s thinking, feeling, attitude and behaviour towards sex”
  31. 31. Human Sexuality •  The physical aspect to enjoy beauty is not a sin, but not at the cost of someone’s discomfort. • The mental aspect “giving type” – finding happiness in making the partner happy. • The spiritual aspect “do not hurt someone if possible & do not hurt yourself ever”
  32. 32. Adolescent Sexuality & Sexual Behaviour • Adolescence is a period of heightened feelings, arousal, urges and sexual feelings directed towards self and the others • During adolescence sexual exploration and expression is common • Certain restlessness of character • 47% of women between 20-24 yrs were married before 18 yrs • 12% of women between 15-19 yrs have already become mothers • 43 % of women & 11% of men aged 20-24 yrs had sexual debut • 10% of teenagers suffer from STIs • HIV prevalence is 0.18% among 20-24 yrs olds (NFHS 3 ) In India
  33. 33. Issues in Human Sexuality • Individual’s role as per accepted norms for that particular sex. • Depends on economy, education status of families, career options, etc. • Individual’s role as per accepted norms for that particular sex. • Depends on economy, education status of families, career options, etc. • Recognition of one’s own sex • Recognition of one’s own sex Gender Identity Gender Identity Gender RoleGender Role
  34. 34. Issues in Human Sexuality • Transexualism (Gender Identity Disorders) • Homosexuality • Pornography • Virginity – Based on tradition, self discipline and self dignity • Premarital Sex
  35. 35. Are the horizontal lines parallel? If so why do they appear like that ? OpticalIllusions
  36. 36. Adolescent Sexuality High risk behaviourHigh risk behaviour Smoking, alcohol, sexual engagementSmoking, alcohol, sexual engagement High risk behaviourHigh risk behaviour Smoking, alcohol, sexual engagementSmoking, alcohol, sexual engagement • Troubled • Confused • Feel guilty Boys Girls Vulnerability forVulnerability for STI,HIV,STI,HIV, Pregnancy &Pregnancy & Sexual exploitationSexual exploitation Vulnerability forVulnerability for STI,HIV,STI,HIV, Pregnancy &Pregnancy & Sexual exploitationSexual exploitation Concentration difficulty,Concentration difficulty, distractiondistraction Poor school performance,Poor school performance, Social and familySocial and family maladjustmentsmaladjustments Concentration difficulty,Concentration difficulty, distractiondistraction Poor school performance,Poor school performance, Social and familySocial and family maladjustmentsmaladjustments
  37. 37. Illness – G & D problems – Precocious or delayed puberty – Short stature
  38. 38. Risky behaviours – Accidents – Intended injuries – Violence – Homicide & Suicide
  39. 39. Adolescent Violence, Injuries & Sexual abuse • Physical Injuries • Alcoholism & drug abuse • Delinquent behaviour • Eating and sleep disorders • Reproductive health problems • Post traumatic stress disorders • Depression and anxiety • Suicidal behaviour and self harm
  40. 40. Nutritional problems – Under nutrition – Obesity – Eating disorders – Micronutrient deficiencies • An Adolescent - Male expected to take 2400 Cal / d (As much an adult sedentary male) - Girl may require 2100 Cal / day (A little less than that of her mother)
  41. 41. Issues in Adolescent Nutrition • Under nutrition – 47 % girls and 58 % boys between 15-19 yrs (BMI < 18) • Anemia (Hb < 13g/dL) - > 56% girls & 30 % boys • Early malnutrition affects physical work capacity • Stunting and delayed maturation compound the risk of adolescent pregnancy • 75% relative increase in obesity in adolescents is noted since 1970 • Inadequate food supply, gender based discrimination – strong factors
  42. 42. Reproductive Health Problems – High maternal mortality – High perinatal mortality – High LBW rate – Abortion – Menstrual problems – RTI
  43. 43. Mental Health Problems – Behaviour disorders – Emotional problems – Stress & anxiety – Depression – Scholastic issues – Substance usage – Psychiatric disorders
  44. 44. Mental Health Problems Erik EriksonErik Erikson All of the earlier crystallizations of identityAll of the earlier crystallizations of identity formed during childhood come intoformed during childhood come into question during adolescence with thequestion during adolescence with the overwhelming combination of physicaloverwhelming combination of physical changes, increased sex drive,changes, increased sex drive, expanded mental abilities, andexpanded mental abilities, and increasing and conflicting socialincreasing and conflicting social demands.demands. CrisisCrisis – dose not connote catastrophe or threat but a turning point in the life of an individual CrisisCrisis – dose not connote catastrophe or threat but a turning point in the life of an individual – Identity problems
  45. 45. Drug Abuse - warning signals • Sudden fall in academic performance • Noticeable change in attitudes, interests & behaviour • Isolation from others • Frequently altering moods of depression & elation • Easy fatigability, lack of enthusiasm / marked incapacity for enjoyment
  46. 46. Other Adolescent Health Problems • Infections – Tuberculosis – UTIs • Sleep Disorders – Insomnia – Day time sleep • Skin Problems • Orthopedic problems – Slipped Femoral Capital epiphyseal disk • Chronic Diseases – Head ache – Refractive errors – Goiter – Asthma
  47. 47. 1. Self-Awareness 2. Empathy 3. Critical Thinking 4. Creative Thinking 5. Decision Making 6. Problem solving 7. Effective Communication 8. Interpersonal Relationship 9. Coping With Stress 10. Coping With Emotions CSN Vittal cc oo rree ll iiff ee ss kk ii ll ssll
  48. 48. SAYING ‘NO’ TO PEER PRESSURE If one is assertive one can : – Stand up for one’s own values and needs – Take control of one’s own decisions – Trust and value one’s own feelings – Recognise the attempts of others to control Nobody has a right to touch you unless you want them to, be firm and say ‘NO’ Learn to say ‘NO’ the first time itself, it will be much easier than doing it later. Remember while saying NO don’t hurt the person, rather make the person feel how hurt you yourself are, having to say NO.
  49. 49. Barriers preventing adolescents from seeking available health services • Do not recognise illnesses • Unaware of consequences • Do not want to draw attention to themselves • Do not know where to go • Fear that health workers may - humiliate their patients - ask difficult questions - conduct unpleasant procedures • Uncomfortable with health workers of the opposite sex • Parental consent required • Concerns about confidentiality • Cumbersome bureaucratic procedure • Long waiting time
  50. 50. – To setup ideal Adolescent Friendly health facilities – To make existing ones more youth friendly – Deliver services and supplies outside health settings, e.g. school linked clinics, market place clinics & workplace clinics, etc.
  51. 51. Adolescents InsideAdolescents Inside Handle with CareHandle with Care Thank Q - Vittal