it is a unique stage of human development and an important time for laying the foundations of good health. Adolescence is the developmental transition to adulthood that includes rapid changes in the brain and body, often at different rates and is a time for healthy exploration of identity and learning independence. it can also be stressful or challenging for teens because of these rapid changes.

1. ADARSH COLLEGE OF NURSING
ADOLESCENT HEALTH.
SHAH MUZAMIL HABIB.
(B.Sc. 4TH YEAR).

2.  TABLE OF CONTENT
 INTRODUCTION.
 CONCEPTUALASPECTS.
 GROWTH AND DEVELOPMENTALASPECTS.
 FACTS AND MYTHS.
 HEALTH PROBLEMS DURING ADOLESCENCE.
 PROMOTION OF ADOLESCENT HEALTH.
 ADOLESCENT HEALTH PROGRAMMES.
 HEALTH PROMOTION INTERVENTION.
 ROLE OF COMMUNITY HEALTH NURSE IN ADOLESCENT HEALTH.
 SUMMARY.
 RECAPTULISATION.

3.  INTRODUCTION
 It is a stage of transition from childhood to adulthood and is marked by
the termination of childhood at one end and the beginning of adulthood
at other end.
 The adolescent is neither down the stairs nor up the stairs. It is in
between and there is no specific status which may be a source of problem
if proper handling is not done and proper care is not given. In
adolescence, both boys and girls undergo several physiological changes
which include body growth, hormonal changes and sudden development
of primary and secondary sex characteristics.

4.  CONCEPTUAL ASPECTS
 In general the adolescent is referred as an individual who is
in teenage years and is in between childhood and adulthood.
The beginning of the adolescence is marked by profound
physical and physiological changes including rapid body
growth, bone ossification, hormonal changes, maturation of
primary sex characteristics and development of secondary
sex characteristics. These changes continue until full maturity
is attained in all aspects. This beginning period is known as
puberty.

5.  GROWTH AND DEVELOPMENTAL ASPECTS
 As the child moves from childhood to adolescence, he/she
undergoes various physical, physiological, psychological and
emotional changes which are typical of adolescence. Some
of the changes are visible and some are invisible changes
that happen within the body. This happens to all girls and
boys, but in varying degrees. This is natural and normal.

6.  TYPES
PHYSICAL DEVELOPMENT.
PHYSIOLOGICAL DEVELOPMENT.
SEXUAL DEVELOPMENT.
PSYCHOLOGICAL DEVELOPMENT.

7.  PHYSICAL DEVELOPMENT
 The physical changes which occur in early adolescence
include rapid increase in height, weight, muscles size,
head and face size and it is known a adolescent growth
spurt. The timing of the adolescent growth spurt varies
in boys and girls and also within each sex. For girls the
spurt in growth occurs about 2 years earlier to boys. In
boys, it is between 13-15 YEARS AND IN GIRLS
BETWEEN 11-14 YEARS.

8.  PHYSIOLOGICAL DEVELOPMENT
 Many endocrine glands contribute in rapid
growth of adolescents. These glands also
undergo growth spurt. The most gland and
the sex important glands are the pituitary
glands i.e. gonads.

9.  SEXUAL DEVELOPMENT
 As it is understood the main impact of production of gonadal hormones is the development of
primary and secondary sexual characteristics in girls and boys at the time of puberty.
 At about the age of 13 years, the first menstrual cycle i.e. menarche occurs. After menarche, most of
the girls do not have regular periods for some months and they are sterile. The secondary sex
characteristics include growth of pubic hair and hair under arms, budding of breasts, change of voice,
widening of hips, thighs becoming funnel-shaped and broadening of shoulder.
 In boys too, the male reproductive system matures and gains in size and weight. The male sex organs
enlarge out of proportion to general body growth i.e. the penis, prostate gland, the testes and
scrotum are all considerably enlarged at puberty. The secondary sex characteristics include slight
temporary development of breast around nipples, growth of pubic hair and hair under arms,
deepening of voice, widening of chest and shoulder, arms becoming more muscular, considerable
hardening of body muscles, heavy growth of hair on face and body.

10.  PSYCHOLOGICAL DEVELOPMENT
 As the adolescent boys and girls grow in age, they mature mentally and emotionally. Mentally they
grow not only in their knowledge and understanding but also in intellectual power. Intellectually
they develop ability to generalize and deal with abstractions. Even during early adolescence period
they develop capacity to apply principles of logic, to think critically in terms of hypothesis,
assumptions etc.
 Emotionally, the adolescent boys and girls not only mature in physical intimacy with the opposite
sex but also in emotional intimacy, love and affection etc. There are prompt sexual thoughts, day
dreaming, heightened awareness of sexual attraction. All this happens because of hormones which
are released in body. Nocturnal emissions or wet dreams which refers to release of semen by boys
during sleep, is quite common in adolescence. Both boys and girls may experience sexual
excitement either by looking at or by coming closer to some one they are attached to. They may
not realize these as sexual emotions. Sexual fantasies are common and are to be considered normal
as long as these are not leading to perversion. In general, boys and girls become more interested in
each other during puberty.

11.  FACTS AND MYTHS
FACTS MYTHS
1. Once a girl starts her period, she can become
pregnant because her ovaries are mature to
release egg.
1. It is unhealthy for a girl to take bath and swim
during her period (she can do any activity. But
she needs to maintain hygiene of sex organs).
2. Before a girl has had her menarche she can
become pregnant (because ovaries release an
egg before the onset of period).
2. A girl can not become pregnant if she has sex
only once or a few times.
3. Abstinence is the only method of birth control. 3. Once a girl or a boy had gonorrhoea and have
been cured can never get it again.
4. Girls and boys can have sexually transmitted
diseases without having any symptoms (yes,
especially Gonorrhea).
4. The size of penis is equivalent to muscularity or
virility.

12.  HEALTH PROBLEMS DURING ADOLESCENCE
 Globally adolescents account for one fifth of the population i.e. more than one
billion. Four out of adolescents live in developing countries.
 PROBLEMS: -
 NUTRITIONAL PROBLEMS.
 SELF-ESTEEM RELATED PROBLEMS.
 DEPRESSION.
 TENDENCY TOWARDS VOILENCE AND ACCIDENTS.
 DRUG, ALCHOL AND TOBACCO ABUSE.
 ANOREXIA NERVOSA.
 SEXUALLY RELATED PROBLEMS.

13.  NUTRITIONAL PROBLEMS
 Nutritional problems include problems of under nutrition, over nutrition, anaemia
and nutritional neglect. The problem of malnutrition is linked with poverty, socio-
cultural practices and lack of education and ignorance. Anaemia is widely
prevalent in YOUNG ADOLESCENT GIRLS.
 SOME GIRLS WITH AN OBSESSION TO BECOME THIN STOP EATING OR EAT LESS
AS A RESULT OF WHICH THEY SUFFER FROM MANY DISORDERS.

14.  SELF-ESTEEM RELATED PROBLEMS
 Self-esteem is closely identified with self respect and identity.
It implies proper regard for one self as human being and an
accurate sense of one's personal place within the large
society of family, friends, associates and others.

15.  DEPRESSION
 Studies done by Albert and Beck, 1975, Toolen in 1962, have
revealed the occurrence of depression in adolescents. The
occurrence of depression is related to adolescents'
relationship with their parents, loosening of ties with their
parents, family responsibilities, becoming independent,
deviation in growth and development etc.

16.  TENDENCY TOWARDS VOILENCE AND ACCIDENTS
 Adolescents, especially boys are very energetic at this age
and are prone to road accidents because of fast and
negligent driving. They are adventurous and are at particular
risk of violent deaths due to greater risk taking and
aggressive behaviour. Homicides, suicides and accidents
account for significant portion of all deaths in adolescents
these days. Suicides and suicide attempts are associated with
depression.

17.  DRUG, ALCHOL AND TOBACCO ABUSE
 These problems are associated with life style and socio-economic conditions of people. These
are becoming more prevalent in adolescents-both boys and girls mainly because of their risk
taking behaviour. More over the emotional control of family, the moral control of school and the
social control of community is declining.
 PROBLEMS: -
 HIV/AIDS.
 ACCIDENTS.
 SUICIDES.
 MALSEXUAL PRACTICES LIKE STD AND HIV/AIDS
 CANCER.
 HEART DISEASES.

18.  ANOREXIA NERVOSA
 Anorexia nervosa occurs exclusively during adolescence or
early adulthood. It is a rare psychological disturbance which
occurs more in girls than in boys.
 Adolescents with anorexia nervosa refuse to eat. They lose
weight. They do not believe that they are thin. Rather they
like to lose more weight and therefore not only refuse food
but also do exercise. The girls develop amenorrhea. It can be
fatal if not treated.

19.  SEXUALITY RELATED PROBLEMS
 Adolescent is the time when boys and girls are maturing sexually. They get attracted towards
opposite sex i.e. boys are attracted towards girls and girls towards boys. This is but natural to get
feelings for each other. It is alright if there is no sexual exploitation.
 But because of various prevailing conditions such as urbanization, move towards nuclear family
system, growth of slums, easy availability of pornographic materials, exposure to seductive and
exciting pro- grammes of electronic media, loss of socio-cultural values and liberal attitude of
adolescent towards sex, often there is premarital sexual indulgence among boys and girls
resulting in illegitimate pregnancies and associated social problems.
 Also there is sexual exploitation of adolescents by relatives, strangers, even within the home.
There is also increasing sexual harassment, molestation, exploitation at place of work of
adolescent girls and young women.

20.  CONTINUED
 Often adolescent girls and young women are subjected to violence of
many forms which include rape, molestation, forced prostitution and
trafficking, eve teasing, sexual abuse and harassment etc. The National
Crime Records Bureau had revealed the following information about
violence against women: -
 One act of eve teasing every 51 minutes.
 One rape every 54 minutes.
 One kidnapping and abduction every 43 minutes.
 One act of cruelty every 33 minutes.
 One criminal offence against women every 7 minutes.

21. PROMOTION OF ADOLESCENT HEALTH
INTERNATIONAL EFFORTS
 Action for adolescent health began 20 years ago a of adolescent reproductive health. This was made
possible by the sustained support and in the area co-operation of United National Family Planning
Association (UNFPA).
 Over the years it is learnt that the best way to promote adolescent reproductive health is to promote
adolescent health as a whole.
 WHO reflected this in the establishment of the Adolescent Health Programme in 1990. This
programme was renamed to Adolescent Health and Development Programme around 1996 to
promote not only adolescent health but also promote physical psychological and social
development of adolescent of both sexes which underlie their health behaviour and relationships.
 WHO has collaborated closely with other agencies like UNFPA and UNICEF and NGOs and has
developed special methods for adolescent health appropriate for use in all cultures.

22.  NATIONAL EFFORTS
 As for India is concerned, there is no specific adolescent health and development
programme. Their health care needs are served through school health services,
reproductive and child health services and general health services.
 As far Adolescents Sexual and Reproductive Health is concerned it refers to
physical and emotional well being of adolescents and include their ability to
remain free from unwanted pregnancy, unsafe abortions, sexually transmitted
diseases including HIV/AIDS and all forms of sexual violence and coercion keeping
in mind the needs and problems which are faced by adolescents as a result of
their growth and development and of transition from childhood to adulthood.

23.  PREVENTION OF ADOLESCENT HEALTH
PROBLEMS
 Primary prevention: Policies, information and
education.
 Secondary prevention: Identification and reduction of
risk.
 Tertiary prevention: Treatment and rehabilitation.

24.  ADOLESCENT HEALTH PROGRAMS
 Kishori Shakti Yojana: To improve the health and
nutritional status of women.
 Balika Samriddhi Yojana: To delay the age of marriage.
 Adolescent friendly Health Services.
 National AIDS control programme.
 ADOLESCENT REPRODUCTIVE AND SEXUAL HEALTH
PROGRAMME (ARSH).

25.  Kishori Shakti Yojana
 Redesign of the already existing Adolescent girls skim
being implemented as a Component under centrally
Sponsored ICDS scheme.
 Aims at empowerment of adolescent girls So as to enable
them to take charge of their lives.
 Adolescent girls who are unmarried and belongs to
families Below the poverty line and school drops out are
selected and attach to the Local Anganwari centres for
Learning and training activities.

26.  Kishori Shakti Yojana
Scheme-1 ( girl to girl
approach)
 Age group 11 to 15 years.
 Belonging to families whose
income level is below 6400/- per
annum.
Scheme -2 ( Balika
Mandal)
 Age group 11 to 18 years
irrespective of income levels of
the family.
 Younger girls 11 to 15 years
And belonging two poor family.

27.  CONTINUED
 IFA supplementation along with deworming.
 Education for school dropouts and functional
literacy among illiterate adolescent girls.
 Non formal education to adolescent girls.
Emphasize on Life Education aspects including
physical developmental and sex education is
given.

28.  Balika Samriddhi Yojana, 1997
Objectives :
 To change negative family and attitude towards the girl
child at birth and towards her mother.
 To improve enrolment and retention of girl child in
schools.
 To increase the age of girls of marriage.
 To assist the girls to undertake income generation
activities.

29.  CONTINUED
Benefits: A post birth grant amount of Rs. 500/-.
Class Amount of annual scholarship
1-3 Rs. 300/- per annum for each class
4 Rs. 500/- per annum.
5 Rs. 600/- per annum.
6-7 Rs. 700/- per annum for each class.
8 Rs. 800/-per annum.
9-10 Rs. 1000/- per annum for each class.
Procedure for obtaining benefits:
 ICDS infrastructure in rural areas and health department in urban areas.
 The application forms are available with the Anganwadi workers in the villages.

30.  NATIONAL AIDS CONTROL
PROGRAM

31.  ADOLESCENT FRIENDLY HEALTH SERVICES

32.  ADOLESCENT REPRODUCTIVE AND
SEXUAL HEALTH PROGRAM
 Adolescent Reproductive and Sexual Health programme (ARSH) focusses
on reorganizing the existing public health system in order to meet service
needs of adolescents. Steps are being taken to ensure improved service
delivery for adolescents during routine Sub-Centre clinics and also to
ensure service availability on fixed days and timings at the Primary Health
Centre, Community Health Centre and District Hospital levels. Core
package of services includes promotive, preventive, curative and
counselling services being made available for all adolescents - married
and unmarried, girls and boys through adolescent friendly health clinics.

33.  CONTINUED
 ARSH programme envisages creating an enabling
environment for adolescents to seek health care services
through a spectrum of programmatic approaches:-
♠ Facility based health services-Adolescent Friendly Health Clinics.
♠ Counselling-Dedicated ARSH and ICTC counselling.
♠ Community based interventions-Outreach activities.
♠ Capacity building for service providers.

34.  CONTINUED
 Adolescent Friendly Health Clinics (AFHC):
 Through Adolescent Friendly Health Clinics, routine check-up at
primary, secondary and tertiary levels of care is provided on fixed
day clinics. At present 6,302 AFHCS are functional across the
country providing services, information and commodities to more
than 2.5 million adolescents for varied health related needs such as
contraceptives provision, management of menstrual problems,
RTI/STI management, antenatal care and anaemia.

35.  CONTINUED
 Facility based counselling services:
 Counselling services for adolescents on important issues such as nutrition,
puberty, RTI/STI prevention and contraception, delaying marriage and
childbearing, and concerns related to contraception, abortion services, pre-
marital concerns, substance misuse, sexual abuse and mental health problems
are being provided through recruitment and training of dedicated counsellors.
At present 881 dedicated ARSH counsellors are providing comprehensive
counselling services to adolescents across the country. In 23 States/UTs, 1439
ICTC counsellors have been enrolled to provide sexual and reproductive health
counselling to adolescents.

36.  CONTINUED
 Outreach activities:
 Outreach activities are being conducted in schools, colleges,
teen clubs, vocational training centers, during Village Health
Nutrition Day (VHND), health melas and in collaboration with
self help groups to provide adequate and appropriate
information to adolescents in spaces where they normally
congregate.

37.  SERVICES IN ADOLESCENT CLINIC
1. Clinical services:
 General examination
 Nutrition advice
 Detect and anaemia
 Easy and confidential access to MTP
 Antenatal care and advise regarding childbirth
 HIV detection and counselling
 Deaddiction
2. Counselling services
o ADOLESCENT HEALTH COUNSELLING.

38.  ADOLESCENT HEALTH COUNSELLING
 Adolescent counselling : Adolescent counselling
is a process between an adolescent and a
counsellor in a trusting relationship to help that
child or adolescent explore and make sense of a
traumatic experience that has happened to them
(e.g. death of a parent, abusive situations).

39.  AIMS OF ADOLESCENT COUNSELLING
 Adolescent counselling is aimed at helping young people
make sense of their feelings, thoughts and behaviours.
 It focuses on supporting the behavioural, emotional and social
growth of adolescents.
 It is to assist children and adolescents recover their self-
esteem and confidence.
 It helps them understand that the trauma was not their fault
and to address any fear or anger they are feeling.

40.  TYPES OF COUNSELLING
 Individual Counselling.
 Family Counselling.
 Group Counselling.

41.  NEED OF ADOLESCENT COUNSELLING
 Adolescence is the stage when we make the transition from
child to adult, this usually occurs between 10 and 19. This is
a time which a great deal of both physical and mental
changes take place, the physical changes often referred to
as puberty. These changes may predispose adolescents to be
sensitive, to experience mood swings and to have swings in
confidence levels. For this reason, adolescent counselling
should ensure that they take into account this period of
vulnerability when engaging in therapy with an adolescent.

42.  HEALTH PROMOTION INTERVENTION.
 Safe and supportive environment.
 Personal hygiene and adaptation of healthy lifestyle.
 Good nutrition and food hygiene.
 Sex education.
 Health Education and Communication.
 Counselling services.

43.  ROLE OF COMMUNITY HEALTH NURSE
 The community health nurse is an important member of the team concerned
with health of adolescents and young adults. The purpose of nursing care is
to help adolescents and young adults to attain normal growth and
development and sexual and emotional maturity, develop harmonious
relationship with parents, peers and achieve sociological status of full adult-
hood and take family and community responsibility
 The community health nurse performs all her roles such as care giver,
planner, educator, guide, counsellor, adviser, motivator, change agents,
advocate, manager etc. in giving health and nursing services to adolescents
to attain optimum health, growth and developments.

44.  CONTINUED
 The major responsibilities which should be carried by community health nurse are as under:
 Does health assessment using variety of tools and techniques to assess physical, mental/emotional
and social health.
 Monitors growth and development, vital signs, immunization and nutrition status. Identifies deviations
and abnormalities, health and nursing needs.
 Plans and implements comprehensive health and nursing care.
 Evaluates care given.
 Does education and counseling of adolescents, their parents and teachers in general and about any
deviation or abnormality in particular.
 Seeks adolescents' participation by organizing them into youth clubs and health groups in meeting
their health needs and dealing with their problems. She can make use of their energies in various
community activities.