Adolescent health

ADOLESCENT HEALTH
YANGLEM PUSPARANI DEVI
COLLEGE OF NURSING, RIMS

In this session we will cover the following from the many topics
concerning adolescent and its health….
Who are adolescent?
Developmental Characteristics of adolescence
General Problems during adolescence
Why Adolescent and it’s Health is Important?
Why Invest in Adolescent Health?
Adolescent Health Issues and recommended Solution (WHO)
Profile of Adolescents in India
Adolescent Health programs and its Ministries in India
Challenges in Existing Adolescent Health Programs

WHO ARE ADOLESCENT?
The World Health Organization (WHO) defines an
adolescent as any person between ages 10 and 19.This
age range falls within WHO’s definition of young
people, which refers to individuals between ages 10
and 24 years.
It is a transitional stage of physical, physiological and
psychological development from puberty to legal
adulthood.They have specific needs which vary with
gender, life circumstances and socio economic
conditions.There are approximately 1.2 billion adolescent
in the world of which 253 million in India. This constitutes
about 20% of world’s adolescent population. In India
adolescent account nearly 21% of the nations population.

DEVELOPMENTAL CHARACTERISTICS OF ADOLESCENCE
Stage
with Age
Early Adolescence (ages 11-13
years)
Middle Adolescence (ages
14-15 years)
Late Adolescence (ages 16-
18 years)
Physical
Growth
Puberty: Rapid growth, Secondary
sexual characteristics appear
Secondary sexual
characteristics, 95% of adult
height reached
Physical maturity and reproductive
growth levelling off and ending
Intellectual /
Cognition
Cause and effect relationships
underdeveloped;
Stronger “ Self” than “Social
awareness”
Cause and effect relationships
are better understood; Highly
self-absorbed
Future oriented; able to
understand, plan and pursue long
term goals; Philosophical and
idealistic
Autonomy
Challenge the authority; Wide mood
wings; Begins to reject childhood
likings; Argumentative and disobedient
Conflict with family predominates
Emancipation: Vocational/
technical/college and/ or work;
adult lifestyle
Body Image
Preoccupied and critical of change
appearance; Anxiety (secondary
sexual characteristics); Comparison
with peers
Less concern of physical
changes; interest in personal
attractiveness; Excessive
physical activity alternating with
lethargy
Usually comfortable with body
image

DEVELOPMENTAL CHARACTERISTICS OF ADOLESCENCE
Stage
with Age
Early Adolescence (ages 11-13
years)
Middle Adolescence (ages
14-15 years)
Late Adolescence (ages 16-
18 years)
Peer
Group
Intense friendship with same sex;
Contact with opposite sex in
groups
Strong peer allegiances- fad
behaviours; Sexual drives
emerge begin to explore
ability to date and attract a
partner
Decisions /Values less
influenced by peers; Relates to
individuals more than to peer
group; Partner selection based
on individual preference
Identity
Developm
ent
"Am I normal?“; Day dreaming;
Vocational goals change
frequently; Begin to develop own
value system; Emerging sexual
feelings and sexual exploration;
Imaginary audience; Desire for
privacy; Magnify own problems:
"no one understands"
Experimentation - Sex, drugs,
friends, jobs, risk-taking
behaviour
Pursue realistic vocational
goals or career employment;
Relates to family as adult;
Begin to distinguish their
imaginations from real;
Establishment of sexual
identity, sexual activity is more
common

DEVELOPMENT CHARACTERISTICS OF ADOLESCENCE

GENERAL PROBLEMS DURING ADOLESCENCE
Physical Changes Sexual Development
Changes
Emotional and
Psychological Changes
• Normal growth - anxiety
and tension
• Increase in height and
weight-malnutrition and
anaemia
• Breast development –
stooping of shoulders,
abnormal posture and back
pain
• Skin becomes oily –acne
• Body image –requirement
for protein, energy,
prevalence of malnutrition
• Desire to have sex -unsafe
sex, unwanted pregnancy,
RTI/STI, HIV/AIDS
• Ejaculation-fear, guilt, myths
and emotional problem
• Masturbation –myths,
confusion, inadequate
knowledge
• Menstruation–menstrual
disorder, unhygienic
practices leads to RTI/STI
• Development of self-
identity-confusion
• Curiosity –risk taking
behaviour , eating
behaviour and life style
disorders such as smoking,
alcohol and drugs
• Relationships –peer
pressure , parental
relationships and sexual
relationships

WHY ADOLESCENTS AND ITS HEALTH IS IMPORTANT?
The global community is responding to this call for action. In September 2015, the
United Nations Secretary-General launched the Global Strategy for Women’s,
Children’s and Adolescents’ Health (2016–2030) in support of the 2030 Agenda for
Sustainable Development.The Global Strategy envisions a world in which every
woman, child and adolescent realizes their rights to physical and mental health and
well-being, has social and economic opportunities, and is able to participate fully in
shaping prosperous and sustainable societies.
This new strategy identifies adolescents as central to achieving the Sustainable
Development Goals (SDGs) of the 2030 Agenda, including those related to poverty,
hunger, education, gender equality, water and sanitation, economic growth, human
settlement, climate change and peaceful and inclusive societies.
By empowering today's youth, we will lay the groundwork for a more
sustainable future for generations to come.
UN Secretary-General Ban Ki-moon

WHY ADOLESCENTS AND ITS HEALTH IS IMPORTANT?
Rights of adolescents:
The rights of children (people under 18 years of age) to survive, grow and develop
are enshrined in international legal documents.
• In 2013, the Committee on the Rights of the Child (CRC), which oversees the
child rights convention, published guidelines on the right of children and
adolescents to the enjoyment of the highest attainable standard of health, and
• General Comment on realizing the rights of children during adolescence was
published in 2016.
It highlights the states’ obligations to recognise the special health and
development needs and rights of adolescents and young people.
• The Convention on the Elimination of Discrimination AgainstWomen
(CEDAW) also sets out the rights of women and girls to health and adequate
health care.

WHY INVEST IN ADOLESCENT HEALTH –THE BENEFIT
A critical, overarching reason to invest in the health of
adolescents is that adolescents, like all people, have
fundamental rights to life, development, the highest
achievable standards of health and access to health services.
These are supported by global human rights instruments, to
which almost all countries are signatories.
They are the future of any nation, forming a major
demographic and economic force.
An age of opportunity: (As adolescent Flourish, so do
their communities, and all of us have a collective
responsibility in ensuring that, adolescent does in fact
become an age of opportunity).

1. Investment brings a triple dividend:
Promoting and protecting adolescent health
will lead to great public health, economic and
demographic benefits (It will bring a triple
dividend of health benefits).
1.1. For adolescents now – promotion of
positive behaviours (e.g. good sleep habits
and constructive forms of risk-taking, such as
sport or drama) and prevention, early
detection and treatment of problems (e.g.
substance use disorders, mental disorders,
injuries and sexually transmitted infections)
can immediately benefit adolescents.

1.2. For adolescents’ future lives – support for establishing healthy behaviours in
adolescence (e.g. diet, physical activity and, if sexually active, condom use) and reduction of
harmful exposures, conditions and behaviours (e.g. air pollution, obesity and alcohol and
tobacco use) will help set a pattern of healthy lifestyles and reduce morbidity, disability and
premature mortality later in adulthood.
1.3. For the next generation – promotion of emotional well-being and healthy practices
in adolescence (e.g. managing and resolving conflicts, appropriate vaccinations and good
nutrition) and prevention of risk factors and burdens (e.g. lead or mercury exposure,
interpersonal violence, female genital mutilation, substance use, early pregnancy and
pregnancies in close succession) can help protect the health of future offspring.

2. Investment reinforces gains made from early childhood:
2.1. maintains and reinforces successful health interventions that children benefited from in
early childhood, and
2.2. rectifies earlier health deficits.
2.3. gains made through substantial investment in maternal and child health programmes over
recent decades are at risk of being lost if there is insufficient investment in adolescent health
programming today.
3. Investment brings wider societal gains
3.1. improved adolescent health brings economic and larger societal benefits through greater
productivity, reduced health costs and enhanced social capital.
3.2. likely to result in declines in mortality and fertility rates, which can contribute to
accelerated economic growth. In low- and middle-income countries (LMICs)

3.3. Essential to achieve the 17 SDGs and their 169 targets, each of which relates to
adolescent development, health or well-being directly or indirectly.
3.4. Finally, investing in adolescent health is vitally important because:
- it is a unique phase of human development and
- of the particular disease and injury burdens that are borne by adolescent populations.
4. A call for accelerated action for the health of adolescents
Recognizing the critical importance of adolescent development – and investing sufficiently to
fully promote and protect adolescent health and well-being – is key to sustainable
development.

ADOLESCENT HEALTH PROBLEM AND CONTRIBUTING FACTORS
Key facts on Adolescent Health Risk by WHO
(13 Dec 2018)
 More than 1.1 million adolescents aged 10-
19 years died in 2016, over 3000 every day,
mostly from preventable or treatable causes.
 Road traffic injuries were the leading cause
of death among adolescents in 2016. Other
major causes of adolescent deaths include
suicide, interpersonal violence, HIV/AIDS
and diarrhoeal diseases.
 Half of all mental health disorders in
adulthood start by age 14, but most cases
are undetected and untreated.
 Globally, there are 44 births per 1000 to girls
aged 15 to 19 per year.

ADOLESCENT HEALTH ISSUES AND SOLUTION (WHO)
Health Issues Recommended Solutions
1. Injuries:
• Over 135 000 adolescents died as a result of
road traffic accidents in 2016. (“vulnerable road
users”, including pedestrians, cyclists or users of
motorized two-wheelers).
• Drowning among top 10 causes of death among
adolescents – nearly 50 000 adolescents, are
estimated to have drowned in 2016.
• Comprehensive Road safety laws and
strengthened enforcement. Advice on driving
safely. Graduated licenses for novice drivers and
zero-tolerance for drink-driving and under the
influence of drugs.
• Teaching children and adolescents to swim is an
essential intervention to prevent these deaths.
2. Mental health:
• Depression is one of the leading causes of
illness and disability among adolescents, and
suicide is the second leading cause of death in
adolescents.
• Violence, poverty, humiliation and feeling
devalued can increase the risk of developing
mental health problems.
• Building life skills in children and adolescents;
providing psychosocial support in schools and
other community settings for good mental
health.
• Strengthen ties between adolescents and their
families. Problems should be detected and
managed by competent and caring health
workers.

3. Violence:
• Interpersonal violence is the third leading cause
of death in adolescents, globally (varies
substantially by world region).
• Globally, nearly one in three adolescent girls aged
15 – 19 years (84 million) has been a victim of
emotional, physical and/or sexual violence by
their husband or partner.
• Promoting relationships between parents and
children, training in life skills, and reducing access
to alcohol and firearms can help to prevent
injuries and deaths due to violence.
• Effective and empathetic care for adolescent
survivors of violence including ongoing support
can help with the physical and psychological
consequences.
4. HIV/AIDS: An estimated 2.1 million adolescents
with HIV in 2016.
Many of the HIV-positive adolescents are unaware
of their status, and many of those who are aware of
their status do not receive effective, long-term
antiretroviral treatment.
Other infectious diseases:
Diarrhoea and lower respiratory tract infections
are estimated to be among the top 10 causes of
death for 10–19 year olds.
• One of the specific targets of Sustainable
Development Goal (SDG 3) is that by 2030
there should be an end to the epidemics of AIDS,
tuberculosis, malaria and neglected tropical
diseases, hepatitis, water-borne diseases and
other communicable diseases.
• Knowing to protect from HIV infection and
having means to do so. (safe sex, clean needles
and syringes). Better access to HIV testing and
counselling, treatment services for those who

5. Early pregnancy and childbirth: Some 11% of
all births worldwide are to girls aged 15–19 years
and this is the leading cause of death for
adolescent girls due to complications from
pregnancy and childbirth.
The UN Population Division puts the global
adolescent birth rate in 2018 at 44 births per 1000
girls this age.
• Better access to contraceptive information and
services
• Enforcing the law that specify a minimum age of
marriage at 18 can help.
• Girls who do become pregnant need access to
quality antenatal care.
• Where permitted by law, adolescents who opt to
terminate their pregnancies should have access
to safe abortion.
6. Alcohol and drugs: Drinking among
adolescents is a major concern
• reduces self-control and increases risky
behaviours
• an underlying cause of injuries, violence and
premature deaths.
• It also lead to health problems in later life and
affects life expectancy.
• Setting minimum age for buying and consuming
alcohol and regulating how alcoholic drinks are
targeted at the younger market are among the
strategies for reducing harmful drinking.
• Drug control may focus on reducing drug
demand, drug supply, or both, and successful
programmes usually include structural,
community, and individual-level intervention

7. Nutrition and micronutrient deficiencies:
• Iron deficiency anaemia was the second leading
cause of years lost by adolescents to death and
disability in 2016.
• Many boys and girls in developing countries
enter adolescence undernourished, making them
more vulnerable to disease and early death.
• At the other end of the spectrum, the number of
adolescents who are overweight or obese is
increasing in low-, middle- and high-income
countries. Globally, in 2016, over one in six
adolescents aged 10–19 years was overweight.
Prevalence varied across regions.
• Iron and folic acid supplements
• Regular deworming to prevent micronutrient
(including iron) deficiencies.
• Developing healthy eating habits in adolescence
• Reducing the foods high in saturated fats, trans-
fatty acids, free sugars, or salt and
• providing access to healthy foods are important

8.Tobacco use:
• The vast majority of people using tobacco
today began doing so when they were
adolescents.
• Globally, at least 1 in 10 adolescents aged 13 to
15 years uses tobacco.
• Prohibiting the sale of tobacco products to
minors (under 18 years) and
• increasing the price of tobacco products
through higher taxes, banning tobacco
advertising and ensuring smoke-free
environments are crucial.
9. Physical Activity:
• Prevalence of inactivity is high across all WHO
regions, and higher in female adolescents as
compared to male adolescents.
• Globally, only 1 in 5 adolescents are estimated
to meet the WHO guidelines of at least 60
minutes of moderate-to-vigorous-intensity
physical activity daily such as games, sports,
cycling, walking etc.
• To increase activity levels, countries, societies
and communities need to create safe and
enabling environments and opportunities for
physical activity for all adolescents.
• Physical activity provides fundamental health
benefits for adolescents, including improved
cardiorespiratory and muscular fitness, bone
health, maintenance of a healthy body weight,
and psychosocial benefits.

PROFILE OF ADOLESCENTS HEALTH IN INDIA
1. Mental Health
In India suicide among adolescents is higher than any other
age groups that is 40% of suicide deaths in men and 56% of
suicide deaths in women occurred in 15–29 y of age.
The prevalence rate of child and adolescent psychiatric
disorders in the community has been found to be 6.46% and
in schools, it was 23.33%
2. Child and Adolescent Labour:
53% dropout during class 1 - 10, Nearly one out of three
adolescents in 15-19 years is working - 20.6 % as main
workers and 11.7 % as marginal workers. Employers like to
engage children and adolescents because of cheap labour.
3. Nutritional Health: Findings from (NFHS 3) indicate
that as many as 56% of females and 30% of males in the 15 -
19 age group are anaemic.
2.4% females and 2% males suffer from obesity.

4. Substance Abuse:
• In the age group 15–19, about 11% of adolescent
boys and 1% of adolescent girls had consumed
alcohol.
• About 29% boys and 4% girls use some kind of
tobacco.The average age of tobacco and alcohol use
initiation was earliest at 12.3 y and 3.6 y.
• About 11% of cannabis users were introduced to it
before the age of 15. Initiating cannabis at this age is
strongly associated with the development of
Schizophrenia spectrum disorders in adulthood
• More than 33% of the diseases and almost 60% of
premature deaths among adults can be
associated with behaviours that began during
adolescence e.g.Tobacco, alcohol, poor eating habits,
sexual abuse and risky sex (WHO 2002).

5. Reproductive and sexual health:
• At national level 27% of 15-19 year old girls are
already married. Maternal mortality rate due to
teenage pregnancy is 9%.
• Quite high knowledge about contraceptives amongst
adolescents but high gaps between knowledge and
usage.
• Extreme poverty, low status of women, lax border
checks and the collision of law enforcement officials
has lead to increase in Trafficking and Prostitution.
• As per (NFHS 3) awareness of STls’ and HIV/AIDS
was limited in 15-24 yrs age group. Just 19% of young
men and 15% of young women reported awareness of
STI.

6.Accidental and IntentionalViolence:
• About 77.5% of adolescents are at risky
behaviours, ignores traffic rules leading to
road-traffic accidents and deaths.
• Sexual abuse is one of major problems
faced by adolescent girls and boys equally.
These problems mostly go unnoticed as
the victim suffers in silence because of fear
and social stigma.This indirectly affects the
physical health, mental health and the
academic performance
• Crimes and against girls includes : eve
teasing to abduction, rape, prostitution and
violence to sexual harassment.

ADOLESCENT HEALTH PROGRAMS AND ITS MINISTRIES IN INDIA
Ministry of health and family welfare
Adolescent reproductive and sexual
health (ARSH)
Preventive, promotive, curative and counselling services for
reproductive and sexual problems.
School health programme Nutritional interventions, promoting health lifestyle, counselling
and immunization
Women & Child Development
Kishori shakti yojana Services improving health, nutritional and educational status of
girls
Balika samridhi yojana Services to raise the age of marriage and to improve enrollment
and retention of girls at school
Rajiv Gandhi Scheme for
Empowerment of Adolescent Girls
Iron and Folic Acid supplementation, nutrition & health education,
ARSH, life skill education and vocational training for girls aged 16
and above under National Skill Development Program
Integrated program for street children Shelter, nutrition, education, health care and recreation facilities
to street children. Child Help Line Service (1098)

ADOLESCENT HEALTH PROGRAMS AND ITS MINISTRIES IN INDIA
Human Resource Development
Sarva Shiksha Abhiyan Free and compulsory education to 6-14 years age group
Mahila samakhya programme Provides equal educational opportunities for women
Adolescent education program Creates awareness and positive attitude to develop skills to
enable them to respond to real life situations
Youth Affairs & Sports
Nehru yuva Kendra sangathan Empowerment of rural youth
The national service scheme Personality development of students through community
service
National Program forYouth and
Adolescent Development
Leadership qualities and personality development of youth
Others
Narcotic Drugs & Psychotropic Substances
Act, 1985- AH Strategy
Prohibition on sale to minors
National AIDS Control Programme Phase Appropriate referral of HIV/AIDS and RTI/STI cases

CHALLENGES IN EXISTING ADOLESCENT HEALTH SERVICES
• Services of the programs have not reached the target group adequately because resources like
materials, money and man power are limited.
• There is no direct access, space for privacy and ideal timing (restrictions in days and time) for the target
population.
• Service providers are not given proper training.
• extra burden for the health care provider, as no separate man power has been allotted separately for
adolescent health services.
• Little knowledge of the adolescent about the need of health services. Scared of revealing personal issues
and getting examined by opposite sex health worker. So themselves act as major obstacle.
• Though Adolescent Friendly Health Services (AFHS) are to address all the health needs, however
delivery of services mainly targets reproductive and sexual health. Even with this great focus there is in
fact an increasing trend in first pregnancy in adolescent and the birth-rate in the age group 15 to 19 y is
still 31.5 per thousand adolescent girls, which is high for the efforts and inputs given by the health
system

• Duplicacy of the scheme under different Ministries. In 2014 Ministry of Health & Family Welfare
(MoHFW), launched a comprehensive programme (Rashtriya Kishor Swasthya Karyakram), but similar
services provided by MoHFW and other ministries are not going to be terminated.
-To avoid such confusions and to be cost effective, all the services for adolescents should come under a single
programme.
- It is also essential to develop a screening tool specific for Indian adolescents.This has been already
implemented in United States by National Adolescent andYoung Adult Health Information Centre, University of
California. Innovating such tools based on our requirements can be very useful in diagnosing diseases and to
search for and eliminate any risk factors as early as possible.
• Having critically analysed the problems and the services for the adolescents two questions that arise
are: Are we going in the right direction? Is it enough to deal with the target population alone?
To address this current scenario, we should consider redefining our approach; the target population should
include elders like parents and teachers also in defining, planning, implementing and evaluating specific
programmes for adolescents.
CHALLENGES IN EXISTING ADOLESCENT HEALTH SERVICES

COMPREHENSIVE ADOLESCENT HEALTH PACKAGES AND
SUCCESSFUL ADOLESCENT HEALTH PROGRAMS

ADOLESCENT HEALTH PROTECTION ANDYOU

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