The case study final wcah - copy2

Adolescent with
special needs
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Page 1

INTRODUCTION

• World-wide, estimates of the number of adolescents and
young adults who live with a disability vary widely.
• Estimating the number of disabled young people is
complex, for two reasons:
a) The first is that frequently, disabled young people are
grouped together with children or adults, blocking
attempts to estimate their numbers as a distinct group.
b)The second is that definitions of disability vary widely.
• In some nations, only individuals with significant disabilities
are identified; in others, even those with mild disabilities are
included.
Page 2

Definition of Adolescent with special needs

Defined as those (children/adolescents) who have
or are at increased risk for a chronic
physical, developmental, behavioral, or emotional
condition. And who require health and related
services of a type or amount beyond that required by
children generally.

Willis JH Adolescent with special needs

Page 3

Aetiology
• The etiology of developmental disabilities and special health care needs
is complex.
• Adolescents may have physical impairments, developmental delays or
chronic medical conditions that are caused by or associated with the
following factors:
 Chromosome anomalies, genetic conditions
 Congenital infections
 Inborn errors of metabolism
 Prematurity Neurologic insults
 Neural tube defects
 Trauma
 Maternal substance abuse
 Environmental toxins
• For some conditions, the etiology is unknown. These conditions may
cause physical, emotional, or behavioral problems that are challenging
for the child and for the family.
Page 4

Prevalence
Title Journal Result
Adolescent with special www.epi.umm.edu/let/pubs/i Approximately 7-18% of
health needs mg/adol_ch18.pdf children and adolescent
(Chapter 18) ages birthto 18 years in the
Willis JH US have a chronic physical,
behavioural, developmental
or emotional condition
causing limitation in
activities, and/or requiring
special care.
Disabitlity Rates among Journal of Adolescent Health In the 10-14 year old group
adolescents: An International rates range from 108
Comparison 1993 /100000 in Myanmar to 6726
Suris J, Blum R per 100000 in Canada.

Amonng 15 to 19 year old
rates range from
142.6/100000 in Myanmar to
5099.5/100000 in Austria.

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The need for screening for
adolescent with special needs

Page 6

Bibliograp Study Study population and Results
hy citation design methods
MENTAL Literature The present preliminary study is based Findings of this comparison with
HEALTH: review on a literature review of international prevalence rates of
SPECIAL epidemiological features of learning learning disorders and related
NEEDS AND disorders and comorbidities using the diseases show a sizable gap
EDUCATION Cochrane library key word search. between real existing needs in
Available statistics for learning Malaysia, and their perception.
Dr. Huberta disorders from the WHO are compared The present undersupply of
Peters with records for the year 2007 from the adequate service for children with
ASEAN Ministry of Education in Malaysia learning difficulties is aggravated by
Journal of the lack of systematic
Psychiatry, developmental screening in early
Vol.11(1): Jan childhood in Malaysia.
– June 2010.

Mental health Cross Total of 373 of new cases from the Children with Attention Deficit
difficulties in sectional month of January to December 2007 Hyperactive Disorder (ADHD) were
children: a study who attended the Psychiatry the highest disorder. Primary
University Adolescent and Child (PAC) Unit, support group difficulties were the
Hospital University Malaya Medical Center most common co-morbid condition
experience (UMMC). noted.
It is essential that extensive
Norhaniza I screening of children and their
MJP-Online families be done to detect family
Early 01 -10-10 difficulties and co- morbid
conditions, which would be
necessary for favorable outcomes to
Free Powerpoint Templates met.
be
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Study title Citation Results
ADOLESCENTS Book review It is estimated that up to 40-50% of children and adolescents
WITH SPECIAL School Public Health with special health care needs have nutrition-related risk
HEALTH NEEDS University of factors or health problems.
Janet Horsley Minnesota. Stang J,
Willis Story M (eds) Physical conditions such as a cleft lip or palate or a disease
Guidelines for process such as cystic fibrosis may limit an individual‘s ability
Adolescent Nutrition to feed, digest, or absorb food.
Services (2005)
http://www.epi.umn.ed Drug nutrient interactions may alter digestion, absorption or the
u/let/pubs/img/adol_ch bioavailability of nutrients in the diet.
18.pdf
Depression may alter an individual‘s appetite and motivation to
follow a
specified diet plan.

Prevalence and Sullivan P.B Lambert Questionnaire by parents of children age 4 to 13. 59%
Severity of feeding B, Rose M, Ford constipated, 22% problems with vomiting, 31% at least 1 chest
and nutritional Adams, Johnson A, infection,.
problems in Griffiths P, 2000,
children with Developmental Med & Feeding problems were prevalent 89% needed help with
Neurological child Neurology, feeding, 56% chocked on food, 20% of parents describe
impairment 42,674-680 feeding was stressful and un-enjoyable, 28% prolonged
‘Oxford feeding feeding, 8% fed through gastrostomy tube.
study‘
Many of these children would benefit from nutritional
assessment and management as their overall care.

Page 8

Nutritional assessment guideline

Stang J, Story M (eds) Guidelines for AdolescentTemplates
Free Powerpoint Nutrition Services (2005)
Page 9

Disability and the Millennium Development
Goals (MDGs)

• Disability is not specifically mentioned in the
MDGs, but disabled people are implicitly included.
• Most development agencies acknowledge that the
goals cannot be achieved without addressing the
needs and rights of disabled people.
• However, the relationship and relevance of disability
to the MDGs is not so well articulated and
acknowledged.

Page 10

Sexual and
Reproductiv
e Health
Page 11

Page 12

Overview of HIV

Young people are particularly vulnerable to HIV infection because of
risky sexual behaviour and substance use, because they lack
access to accurate and personalized HIV information and prevention
services, and for a host of other social and economic reasons.

SOURCE: UNAIDS. 2002. Report on the Global HIV/AIDS Epidemic: July 2002. Geneva

Young people aged 15–24 years accounted for an estimated 42% of
new adult HIV infections worldwide in 2010. Globally, young women
aged 15–24 years accounted for 64 per cent of all HIV infections
among young people.
SOURCE: UNICEF 2011

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HIV - Malaysian scenario..

In Malaysia, 27% of new infections are amongst teens and youth aged between
13 to 29 years old. It is likely that people infected with HIV before the age of
30 were infected in their twenties and sometimes even during their teens.
SOURCE: Ministry of Health : December 2008 statistics

Of the 87 710 cumulative total of HIV cases since 1998, 2 122 (2.4%) were
individuals aged less than 19 years old. 1.4% of all HIV cases were found to
be between the ages of 13-19 years. In 2009, children below 19 years of
age made up 3.1% (95) of 3 080 new reported HIV cases for that year.
.
SOURCE: UNICEF MALAYSIA: UNGASS COUNTRY REPORT 2010

Page 14

Overview of STDs
448 million new cases of curable STIs (syphilis, gonorrhoea, chlamydia
and trichomoniasis) occur annually throughout the world in adults
aged 15-49 years.
SOURCE: WHO 2005

…….estimation of that 19 million new infections occur annually in the
United States, almost one half of which occur in persons 15 to 24
years of age.
This includes an estimated 2.8 million new chlamydia infections
and 1.6 million new genital herpes infections
SOURCE: Centers for Disease Control and Prevention (CDC)

Page 15

Sexual Health – Malaysian scenario

• Today's youth are confronted with numerous issues regarding their sexual
health. This is evident in studies done in Malaysia, such as the National
Population and Family Planning Board Study o Reproductive Health and
Sexuality in 1994 which found that adolescents aged 10 – 19 years old were
already engaged in sexual activities, though the prevalence was less than
1%. Ten years down the road (2004), a similar study found that the
prevalence of sexual intercourse among adolescents had risen to 2.2%; and
0.3% claimed that they had been raped or sodomised.
• SPEECH BY YB DATO‘ SRI
LIOW TIONG LAI MINISTER OF HEALTH MALAYSIA
• AT THE 9th WORLD CONGRESS INTERNATIONAL ASSOCIATION FOR
ADOLESCENT HEALTH

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WHY HIGHER RISK??

• unprotected intercourse
• biologically more susceptible to infection
• engaged in sexual partnerships frequently of
limited duration
• multiple obstacles to use health care
• patterns of behaviour that can undermine sexual
health.

Page 17

Prevalence

Page 18

GLOBAL SCREENING PROGRAMMES
FOR STD

Page 19

MALAYSIA N ADOLESCENT HEALTH SCREENING IN
PRIMARY HEALTH CARE

• SARINGAN STATUS KESIHATAN
(BSSK/R/1/08)
• B. 1) Adakah anda mengalami masalah atau
kesukaran semas membuang air kecil dan/
atau air besar
• Pernahkah anda mendapat luka/ ulcer yang
lambat sembuh di bahagian kemaluan
• Adakah anda pernah mendapat lelehan luar
biasa atau nanah dari bahagian kemaluan
anda
• Pernahkaj anda melakukan hubungan seks
– Jika ya, jawab soalan e
• Adakah anda:
• Menggunakan sebarang kaedah
kontraception untuk elakkan
kehamilan
• Bertukar2 pasangan
• Melakukan hubungan sejenis
Page 20

ADOLESCENT CHILD
CLINIC
KOLKATA, INDIA

World Health Organization
(WHO) came forward in
collaboration with Govt. of
India (GOI) for constituting a
National Task Force for
Adolescents Care. Clinic
based service along with
outreach activities have
been initiated. As a result
the Clinic was born on 28th
June, 2002 at Department of
Pediatrics, Medical
College, Kolkata India with
Dr Sukanta Chatterjee as
founder in-charge. Free Powerpoint Templates
http://www.ahckolkata.org/questionnaire.html Page 21

• With a few exceptions, all adolescents in the United
States can legally consent to the confidential diagnosis
and treatment of STDs. In all 50 states and the District of
Columbia, medical care for STDs can be provided to
adolescents without parental consent or knowledge. In
addition, in the majority of states, adolescents can
consent to HIV counselling and testing.

Source: Sexually Transmitted Diseases Treatment Guidelines, 2006 Centers for Disease
Control and Prevention. MMWR 2006

Page 22

SCHOOL BASED SCREENING
Bringing High-Quality HIV and STD Prevention to Youth in Schools:
CDC's Division of Adolescent and School Health (DASH) – SRH
Screening in US
1. Schools Play a Critical Role in HIV and STD Prevention
2. HIV/STD Prevention Programs Can
Reduce Risk Behaviors and Be
Cost-Effective
3. DASH Promotes Effective HIV
Prevention Through Schools :
• Bridge between public health and
education.
• Nationwide network of leaders
in school-based HIV prevention
. DASH provides funding and
technical assistance

Page 23

Evaluation of School Based
Programme
AUTHO STUDY TYPE& TITLE RESULT
R METHODOLOGY
Asbel et al School-Based Screening cross-sectional data from high prevalence of CT
Sexually for Chlamydia the first year of an annual infections was identified among
Transmitte Trachomatis and program offering education, Philadelphia public high school
d Neisseria Gonorrhoeae screening, and treatment for students. This program
Diseases: Among Philadelphia CT and GC demonstrated the effectiveness
October Public High School of a school-based screening
2006 - Students program to identify and treat
Volume these infections
33

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COMMUNITY BASE SCREENING - SOCIAL
NETWORK US
EXAMPLE: Youth go online to
screen for STDs

A program that offers teenagers and young adults
the chance to order STD home-testing kits using a
computer or mobile phone, is reaching
youth, especially those from low-income
households.— Offering free confidential home-testing
kits on the Internet appears to be the best way to get
teens and young adults to undergo screening for
sexually transmitted infections.
An online program, I Want the Kit, started in
Baltimore in 2004 lets men and women in their teens
or 20s order confidential home-testing kits for the
most common STDs, Chlamydia
trachomatis, Neisseria gonorrhoeae, and
Trichomonas vaginalis.

Page 25

Evaluation of self screening methods
AUTHOR TITLE RESULT
and
DESIGN
Gaydos at el Chlamydia Trichomatis Age specific Positivity for internet age groups was much
Sexually Prevalence in Women Who Usedd an higher than those for family planning age
Transmitted Internete Based Self Screening groups. The positivity for internet participants
Diseases. Program Compare to Women Who ranged from a low of 4.4% in Baltimore in
38(2):74-78, Where Screend In Family Planning 2005 to a high of 15.2% Baltimore in 2007.
February 2011 Clinics Family planning clinic prevalence in
Baltimore and Maryland ranged from a low of
Cross sectional 3.3% in Baltimore in 2006 to a high of 5.5%
study in Baltimore in 2008.

CM Holland et al Self Collected Vaginal Swabs for the Detection Twenty-four percent of sexually active subjects had
of Multiple Sexually Transmitted Infection In one or more infections diagnosed by Only 30% of
Journal of Adolescent Girl subjects with infections had pelvic exams while
Pediatric detained; therefore 70% of girls with infections would
and Adolescent G have been missed in the absence of the self-testing
ynecology, Volum option. The self-collection technique was acceptable
e 15, Issue to 95% of subjects.
5, December STI testing using self-collected vaginal specimens is
2002, Pages 307- highly acceptable to adolescent girls, and can
313 dramatically increase the detection rate for these
Free Powerpoint Templates infections when pelvic exams are not
three treatable
Cross sectional performed. Page 26
study

Screening at high risk areas
author Title Study Design& Method conclusion

Original Research The Impact of Cross Sectional Study Adolescents who tested positive for
Article Community Base From August 2006 to January an STI reduced their number of
Journal Sexually Transmitted 2008 vaginal and oral sex partners and
of Adolescent Health, Infection Screening 636 sexually active African the probability of unprotected sex
Volume 47, Issue Result On Sexual American adolescents (age, 14– Community-based STI screening
1, July 2010, Pages Risk Behaviour of 17) from community-based can help to reduce sexual risk
12-19 African American organizations in two mid-sized behavior in youth who
Adolescents U.S. cities. Participants were test positive for STIs. Alternative
screened for STIs and approaches will be needed to
completed an audio computer- reduce risk behavior in youth who
assisted self-interview. test
Approximately 85% of negative but who are nevertheless
participants completed 3- and 6- at risk for acquiring an STI
month follow-up assessments.

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ENGLAND
• The National Chlamydia Screening
Programme (NCSP) is an NHS sexual
health programme that was set up by
the Department of Health in England
in 2003.
• The NCSP aims to ensure that all
sexually active young people under 25
are aware of chlamydia, its
effects, and have access to free and
confidential testing services.
• Since the launch of the programme
nearly one and a half million
chlamydia tests have been performed
by the NCSP

Page 28

Evaluation of Screening
Programme
AUTHOR TITLE Study population & Result
Method
Lorimer K. et "It has to speak to Men and women aged The gender difference
al people's everyday 16-24 years attending in willingness to
Sexual life...": qualitative study non-medical settings participate in
Transmitted of men and women's were invited to nonmedical screening
Infection willingness to participate in urine- that extending the
2009 participate in a non- based screening and reach
Jun;85(3):20 medical approach to later to participate in a of screening could
1-5 Chlamydia follow-up in-depth certainly assist in
trachomatis interview. bringing more young
screening men into screening but
may not necessarily
destigmatise
screening
for women. As such,
the potential benefits
to men must be
Free Powerpoint Templates considered in the
context of the potential 29
Page

HIV SCREENING PROGRAMS

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AUTHO TITLE STUDY RESULT
R POPULATION&
METHOD
Mollen Description of a health educator A total of 1287 patients were approached for
C. et al novel pediatric provided sexual potential counseling and testing during the first
AIDS emergency health counseling in
3 years of the project. Of these, 643 (50.0%)
Patient department- a 30-minute agreed to meet with the health educator and
Care based HIV session as well aswere counseled. Three hundred eighteen
STD 200 screening optional HIV testing
(49.5%) of these patients agreed to HIV
8 program for and test results to
testing. One hundred eighty-seven (58.8%)
Jun;22(6 adolescents. patients aged 14-24
patients returned for follow-up. Two patients
):505-12 years, and (0.6%) whose previous HIV status was
arranged necessaryunknown tested positive for HIV; both of these
follow-up care forpatients were successfully linked to care. Fifty-
adolescents who six health care providers (17.3% of ED
tested positive for
providers) were surveyed about their opinions
HIV of the program; although 93% were supportive
of the program, several respondents were
concerned about the appropriateness of HIV
testing in the ED setting. This project suggests
that, if appropriate resources are available, a
dedicated HIV counseling and testing program
can be successfully implemented in a busy,
urban, pediatric ED. Providing access to these
services to high-risk adolescents has the
potential to significantly impact their health 31
Page

Author Title Method Conclusion
Beckmen The retrospective chart review of all Coincident with the
K.R et al effectiveness of patients 12-18 years of age seen institution of an
WMJ. 2002;1 a follow-up in the ED between April 1, 1993 appropriate follow-up
01(8):30-4. program at and March 31, 1997 with ICD-9 system, HIV testing in the
improving HIV codes for STD. The follow-up ED increased and follow-
testing in a program started April 1, 1995. up of these patients
pediatric Rates of HIV testing were improved. However,
emergency compared between the two years further steps should be
department. before and after the institution of taken to improve the HIV
the follow-up program to testing in the pediatric ED
determine whether the follow-up
program had an impact on the
rate of HIV testing.
Tanya K.L et Changes in Retrospective medical record The HIV testing rates
al Human review increased significantly
Arch Pediatr Immunodeficienc 13 to 22-year-old sexually following publication of
Adolesc Med. y Virus experienced patients. recommendations for
2010;164(9): Testing Rates routine testing and further
870-87 Among Urban increased following
Adolescents introduction of rapid
After testing. Combining
Introduction of routine and rapid testing
Routine and strategies may increase
Rapid Testing uptake of HIV testing
among adolescents in 32
Page
primary care settings

Barriers to Adolescents‘ Use of Reproductive Health Services in Three
Bolivian Cities
From de Belmonte, L.R., E.Z. Gutierrez, R. Magnani and V. Lipovsek. January 2000. Barriers to
Adolescents‘ Use of Reproductive Health Services in Three Bolivian Cities. Washington, DC: FOCUS
on
Young Adults/Pathfinder International

PHYSICAL ECONOMIC

HEALTH CARE
PHYCOSOCIAL
SYSTEM

Page 33

BARRIERS AND ISSUES

In general, studies reported low levels of awareness and knowledge of
sexually transmitted diseases, with the exception of HIV/AIDS.
Although, as shown by some of the findings on condom use, knowledge
does not always translate into behaviour change, adolescents' sex
education is important for STD prevention, and the school setting plays an
important role. Beyond HIV/AIDS, attention should be paid to infections
such as chlamydia, gonorrhoea and syphilis
FN Samkange- Zeeb et al 2011

Page 34

―The higher prevalence of STDs among adolescents also may reflect
multiple barriers to accessing quality STD prevention services, including
lack of health insurance or ability to pay, lack of transportation, discomfort
with facilities and services designed for adults, and concerns about
confidentiality.
Traditionally, intervention efforts have targeted individual-level factors
associated with STD risk which do not address higher-level factors
(e.g., peer norms and media influences) that may also influence behaviors.‖
DiClemente RJ et al 2007;32

―Interventions for at-risk adolescents and young adults that address
underlying aspects of the social and cultural conditions that affect
sexual risk-taking behaviors are needed, as are strategies designed to
improve the underlying social conditions themselves. “
Sieving RE et al 2011 and Upchurch DM et al 2004

Page 35

Perceived barriers to care included
lack of knowledge of STDs and
available services, cost, shame associated with seeking
services, long clinic waiting times, discrimination, and urethral
specimen collection methods. Perceived features of ideal STD services
included locations close to familiar places, extended hours, and urine-based
screening. Television was perceived as the most effective route of disseminating STD
information.
Further research is warranted to evaluate improving convenience, efficiency, and
privacy of existing services; adding urine-based screening and new services closer to
neighborhoods; and using mass media to disseminate STD information as strategies
to increase STD screening.
E.C Tilson et al

Adolescents who view STDs as stigmatizing have a reduced likelihood of being
screened, but it is unclear whether this relationship reflects their care seeking or
providers' practice of offering STD screening at a routine health visit
(Cunningham SD 2009)

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HOW TO IMPLEMENT THE BEST
INTERVENTION PROGRAM?

Page 37

A Review of STD/HIV Preventive Interventions for
Adolescents:
Sustaining Effects Using an Ecological Approach Ralph J.
DiClemente, L.F. Salazar and R.A. Crosby J. Pediatric.
Psychology 2007

Behavioral intervention programs to reduce adolescent
sexual risk behaviors have shown statistically significant
reductions in the short-term; however, longer-term
follow-up has demonstrated that effects diminish. One
criticism has been the reliance on individual-level
models.

Page 38

Multiple influences underlying adolescent sexual-risk behavior.

DiClemente R J et al. J. Pediatr. Psychol. 2007;32:888-906

© The Author 2007. Published by Oxford University Press on behalf of the Society of Pediatric
Psychology. All rights reserved. For permissions, please e-mail: Page 39
journals.permissions@oxfordjournals.org

ECOLOGICAL APPROACH IN STD/ HIV PREVENTIVE
INTERVENTION
(a) the Microsystem—the roles and characteristics of the developing
individual,
(b) the Mesosystem—the settings with which the developing person
Cultural norms and traditions, large-scale policies and laws, economic
interacts:
conditions, and the political climate
• setting aside specific clinic hours for adolescents may enhance
accessibility to health care
•to target not adolescents per se, but rather their sexual networks
(Rothenberg, 2001).
(c) the Exosystem—settings with which the individual does not
interact but nevertheless have an effect on the persons‘ development
•parents to participate
(d) the Macrosystem—cultural values and larger societal factors that
influence the individual
• Cultural norms and traditions, large-scale policies and laws,
economic conditions, and the political climate.

can either serve to restrain and/or promote individual behaviors
Page 40

Can Malaysia Do It?

Page 41

High Risk
Behavior

Page 42

INTRODUCTION
Key Facts
More than 2.6 Million young people aged 10-24 die every year, mostly from
preventable causes
Tobacco use
Estimated 150 million young people use tobacco
Numbers increasing globally , especially among women
Current practices – laws prohibiting smoking in public places, banning tobacco
advertising and raising prices of tobacco products
Quit smoking campaigns
Alcohol and substance abuse
Starts at a young age – 13-15 years
Increases risky behaviors – causing road traffic accidents, domestic and
interpersonal violence and premature deaths
Current practices – banning alcohol advertisements, regulations of place of
sale, barring access
Page 43

INTRODUCTION
Violence and accidents
Leading causes of death particular young males
Approximately 430 young people aged 10-24 die everyday due to interpersonal
violence
For each death, 20-40 youths require hospital treatment
Current practices – nurturing relationships within family, providing training in life
skills, reducing access to firearms
Road traffic injuries cause an estimated 700 young people to die everyday
Current practices – advertising on safe road driving skills, strict law
enforcement, prohibition of driving under influence

WHO Fact Sheet –August 2011Young people: health risks and solutions

Page 44

PREVALENCE OF HIGH RISK BEHAVIOUR

Page 45

SMOKING
Authors Study type & Title Findings
methodology
Danielle E Ramo, 163 articles Tobacco and Marijuana Most show an
Howard Liu, examined tobacco use among adolescents association of tobacco
Judith J Prochaska and marijuana co- and young adults: a and marijuana as a
(2011) Clinical use (36%) systematic review of their strong relationship.
Psychology Review co-use

Yorulmaz F et. al. In Turkey cross Smoking among 30.46% smoked; boys
(2002) Swiss Med sectional community adolescents: relation to smoked more than
Weekly based study 883 school success, socio girls; average of 5.65
middle and high economic status, cigarettes/day
school students nutrition and self esteem

Karekla M et.al. Cross sectional Smoking prevalence and 6% middle school
(2009) European study tobacco exposure among students and 24% in
Journal of Public adolescents in Cyprus high school students
Health Mostly due to media
exposure of smoking

Page 46

SUBSTANCE ABUSE
methodology
Pedrelli P et.al. Cross sectional Compulsive alcohol use 82 (994) college
(2010) The American study as part of a and other high-risk students reported
Journal on larger study. behaviors among college compulsive use of
Addictions, 20, 14- Recruited during a students illicit drugs.
20. mental health 79.3% marijuana; 4.9%
screening in three cocaine; 1.2%
universities in U.S. methamphetamine;
using Consumptive 1.2% heroin; 30.8%
Habits pain relievers; 26.9%
Questionnaire psychostimulants;
3.8% benzodiazepines

Ulbrich TR (2010) National Survey on Prevalence of Substance 9.5% adolescents
http://www.uspharm Drug Use and Health Abuse in the Adolescent aged 12-17 admitted
acist.com/content/d/f Population using illicit drugs
eatured%20articles/c
/19742/

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VIOLENCE AND ABUSE
methodology
Nayara Serhan Cross sectional Adolescent health risk - Males are more
(2010) Bahrain study screening in primary care involved in physical
Medical Bulletin, Interviewed setting fights than females
32(3) General medical and - 77% adolescents do
physical not use car seat belts
examinations
Miller E et.al. (2010) Cross sectional Intimate partner violence 40% reported
Matern Child Health survey among and health-care seeking experiencing some
J, 14, 910-917 women age 14-20 patterns among female sort of physical and
years users of urban adolescent sexual violence from
clinics their male intimate
partner
36% reported not
seeking care for these
issues
75% of the
respondents felt that
doctors should ask
about their
relationships

Page 48

THE MALAYSIAN SCENARIO
methodology
Lee LK et al. Cross sectional Smoking among Prevalence was 14 %;
(2005)Asia Pacific study among 4500 secondary school 37.8% started at the
Journal of Public students in Negeri students in Negeri age 13-14; Males
Health, 17(2), 130- Sembilan Malaysia Sembilan, Malaysia higher compared to
136 females; seen among
high risk teens;
associated with
alcohol, substance
abuse and sexual
activity
Mahmood Nazar Cross sectional Pattern of Substance and More than 77.3%
Mohamed study in Northern Drug Misuse Among reported never used
Sabitha Marican states of Peninsular Youth in Malaysia any of the substances
Nadiyah Elias among all types of Males showed higher
Yahya Don school going youths use than females
Jurnal Antidadah Using Substance No difference between
Malaysia and Drug Misuse Malays and Non
Index ( max score 54 Malays
never used at all) Associated with
Malaysia scored 29. displine problems,
living arrangements
Free Powerpoint Templates and alcohol use
Page 49

THE MALAYSIANSCENARIO
methodology
Wong Li Ping (2011) Street outreach Socio demographic and Street racing age
BMC Public Health, interviewer- behavioral characteristics ranged from 12-35
11, 446 administered survey of illegal motorcycle years; 50.1% stunt
street racers in Malaysia riding and 35.8%
consumed alcohol
while riding; 78.3%
cigarette smoking;
27.8% alcohol; 18.8%
recreational drug use
Lai Kah Lee et al. Cross sectional Violence among 27.9% physical fights;
(2007) Ann Acad Med survey involving Malaysian adolescents 6.6%had been injured
Singapore, 36, pp. 4500 students in a fight; 5.9% carried
169-74 a weapon; 18.5% had
their money stolen in
the past year; 55% had
been involved in theft.

Page 50

THE MALAYSIANSCENARIO
methodology
Dr. Hj.Azimi Hamzah Cross sectional Situation of Girls and Age 15-17
(2007) Malaysian study from various Young Women in Smoking31.7%
Youth Report data sources Malaysia Alcohol 13.6%
Illegal drugs 7.7%
Age 20-25
Smoking 38.5%
Alcohol 25.1%
Illegal drugs 12.9%
Ikechukwu UU (2009) 242 teenagers from Relationship between Found a positive
Masters thesis UPM secondary schools bullying, victimization, correlation between
in Selangor prosocial behavior and depression and
depression among bullying
teenagers in Selangor
Malaysia

Page 51

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HEALTH SCREENING FOR ADOLESCENTS

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HIGH RISK SCREENING
• Adolescent health screening was done in Minneapolis in
a clinical setting.
• Assessed for biomedical, psychosocial, physical risks,
substance abuse and sexual behavior.
• Interview based questionnaire and medical records and
per AMA guidelines.
• Results – poor results from private settings than family
and govt settings. Primary care physicians were
insufficiently trained in youth issues.

Robert Wm Blum et. al. (1996) Don‘t Ask,They Won‘t Tell: The Quality of Adolescent
Health Screening in Five Practice Settings, American Journal of Public Health, 86,
pp.1767-1772.

Page 54

HIGH RISK SCREENING
190 adolescents, 12-18 years, in the Netherlands
CAGE-aid a standardized screening procedure to assess
the substance abuse problem
Adolescents enrolled into a mental health centre
Results – CAGE was an appropriate instrument to screen
for substance abuse disorder – sensitivity 91% and
specificity 98%
This screening instrument picked up a prevalence of 11-
12% of substance abuse

Couwenbergh C et.al. (2009) Screening for substance abuse among adolescents Validity
of the CAGE-AID in Youth Mental Health Care, Substance Use and Misuse, 44, 823-834.
Page 55

HIGH RISK SCREENING
The most frequently used screening tool in Massachusetts is the CRAFFT
screening tool.
It is used for screening alcohol and other drugs
CRAFFT score of 2 or more is high risk and needs a psychiatric referral and is
on evaluation and follow up program
1) Have you ever ridden in a CAR driven by someone (including yourself) who was
―high‖ or had been using alcohol or drugs?
2) Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
3) Do you ever use alcohol or drugs while you are by yourself, or ALONE?
4) Do you ever FORGET things you did while using alcohol or drugs?
5) Do your family or FRIENDS ever tell you that you should cut down
on your drinking or drug use?
6) Have you ever gotten into TROUBLE while you were using alcohol or drugs?

http://www.mcpap.com/pdf/CRAFFT%20Screening%20Tool.pdf

Page 56

YRBSS
• Youth Risk Behavior Surveillance System (YRBSS)
• The Youth Risk Behavior Surveillance System (YRBSS) monitors six types
of health-risk behaviors that contribute to the leading causes of death and
disability among youth and adults, including—
• Behaviors that contribute to unintentional injuries and violence
• Tobacco use
• Alcohol and other drug use
• Sexual risk behaviors
• Unhealthy dietary behaviors
• Physical inactivity
• YRBSS also measures the prevalence of obesity and asthma among youth
and young adults.
• YRBSS includes a national school-based survey conducted by CDC and
state, territorial, tribal, and local surveys conducted by state, territorial, and
local education and health agencies and tribal governments.

Page 57

HIGH RISK SCREENING IN MALAYSIA
High risk screening is one of the component in Adolescent
Health Screening that is done in all primary health clinics
in Malaysia

Part Adakah anda mengambil perkara berikut?
A)Rokok B)Alcohol C)Dadah D)Lain2
C2

Part Adakah anda menunggang motosikal dan
C3 memandu kereta dengan cara merbahaya?

Part Adakah anda pernah didera sama ada secara
C6 emosi, fizikal, seksual atau dibuli?

Page 58

LAW & POLICIES

Page 59

TOBACCO

• National Tobacco Control Programme
• Reduce uptake of smoking by young people
• Increasing tobacco taxes
• WHO World No Tobacco Day 31 May 2007
• Control of Tobacco Product Regulation 2004
• Code of Practice (Indoor Air Quality)
• 1994, Legal smoking age is 18 in Malaysia
• 1969, warning labels a must on packs
• NO laws for adolescent health screening

Page 60

ALCOHOL AND SUBSTANCE ABUSE
• Islam being the official religion it is bound that alcohol
consumption is ‗haram‘.
• Under the Syariah Law caning and penalty fine is
advocated
• Maximum blood alcohol concentration is 0.8
• Ban on advertising in national radio or television
• Minimum purchase age is 18, no limit on drinking age in
Malaysia
• No laws on prohibition of drinking for non muslims
• Drug Act 1952 –death penalty for traffickers
• No laws specifically for adolescent health screening

Page 61

VIOLENCE
• Child Act 2001
• Juvenile Courts Act 1947 previously
- For criminal proceedings, age below 10 complete
immunity, 10-12 partial immunity and >12 they are
prosecuted.
• No laws for health screening

Page 62

INTERVENTIONS

Page 63

“Old age is like everything else. To make a success of
it, you have got to start young”
-Theodore Roosevelt-

Page 64

SMOKING INTERVENTIONS
Author/s Title Study design Intervention Findings
Roger E. Thomas School based Systematic review Intervention of Result – those in
Rafael Perera programmes for 94 RCTs social influences the intervention
(2008) preventing 3 Good Quality and social group smoked
smoking competences less than the
Classroom control
communication,
community and
family
interventions
Roger E. Thomas Family based Systematic review Showed positive
Diane Lorenzetti program for 22 RCTs effects of family
(2008) smoking 4 Good Quality intervention
prevention

Page 65

SMOKING INTERVENTIONS
Marta Civljak Internet based 20 RCTs and Only 3 involved
Aziz Sheikh intervention quasi randomized adolescents and
Lindsay F Stead trials inconclusive
Josip Car findings
(2010)
Chris Lovato Impact of tobacco 19 Longitudinal Increases the
Allison Watts advertising and studies likelihood of
Lindsay F Stead promotion smoking among
(2011) adolescents
JongSerl Chun Smoking among Meta analysis of Smoking Importance of
Joseph Guydish adolescents in 19 RCTs cessation addressing
Ya-Fen Chan substance abuse campaigns – as smoking
(2007) treatment: a study those who smoke component in
of programs, were 8x more substance abuse
policy and likely to use drugs centres
prevalence and 11x more
likely to consume
alcohol

Page 66

SUBSTANCE ABUSE INTERVENTIONS
Roger E Thomas Mentoring Systematic review Less use of illegal
Diane Lorenzetti adolescents to 4 RCTs out of drugs
Wendy Spragins prevent drug and 2113 abstracts 2 found reduced
(2011) alcohol use rate of alcohol
initiation
1 found reduced
rate of drug usage
Silvia Minozzi Detoxification 2 trials comparing Currently
Laura Amato treatment for buprenorphine Methadone is the
Marina Davoli opiate dependent and clonidine norm but no
(2009) adolescents No TRIAL using systematic review
Methadone

Page 67

SUBSTANCE ABUSE INTERVENTIONS
Silvia Minozzi Psychosocial Systematic review Ongoing stage
Laura Amato treatment for
Simona Vecchi drugs and alcohol
Marina Davoli abusing
(2011) adolescents
Nyanda McBride A systematic Systematic review Classroom based Has an impact on
(2002) Health review of school 69 studies drug education young peoples
Education drug education involving goals, behavior,
Research police officers, decreases use,
effective.

Page 68

Page 69

VIOLENCE AND ABUSE INTERVENTIONS
Susan Family and Systematic review Family and
Woolfenden parenting 8 trials parenting
Katrina J Williams interventions in Involving 749 interventions
Jennifer Peat children and adolescents reduces time
adolescents with spent in
conduct disorder institutions and
and delinquency significant
aged 10 – 17 reduction in being
rearrested

Page 70

CONCLUSION

Page 71

Why invest in adolescent
health and development?
1. Investing in adolescent health and development
yields benefits for the adolescent and for society

Adolescents represent over 20% of the total population in most countries of the Western
Pacific Region. They are a vast current and future resource for their countries.

Adolescence carries the highest risks of morbidity and mortality from certain causes,
including accidents and injuries, early pregnancies and sexually transmitted infections.
This is an important reason to focus health prevention efforts on adolescents.

Healthy and developed adolescents have a better chance of becoming healthy,
responsible, and productive adults, leading to greater skills, fewer work days lost to
illness, longer working lives and increased productivity and progress.

Page 72

2. Investing in adolescent health and
development promotes equity and social
justice
Adolescents' health needs are qualitatively different from those of other age groups.
They face puberty, rapid emotional development, increasing independence, and a
range of new choices. Adolescents are a heterogenous group who live in varying
situations and have different needs.

Gender inequalities can influence the pace and quality of adolescent health and
development. For example, household-level, gender-based discrimination in health
and nutrition can result in anaemia, a prevalent condition among young girls in the
Region. In settings where early marriage is the norm, early and repeated pregnancies
put adolescent girls' health and survival at risk. At the same time, ideals of
"macho"behaviour may expose adolescent boys to greater risk of violence and injury.

Page 73

3. Investing in adolescent health and
development promotes human rights

Adolescents have basic rights to health and
development. These rights are, on their own, an
important reason to invest in adolescents.

Giving attention to the health and development of
adolescents promotes the realization of their rights in
other areas too, including their rights as children,
women and workers.

Page 74

Other reasons why we need to invest in the health and
development of adolescents
 They are a vulnerable group of population

 Helps prevent deaths that occur globally due to road traffic injury, violence,
substance abuse and chronic tobacco use.

 Improve the health and well-being of millions of adolescent

 Promote the adoption of healthy lifestyles

 They is economic benefit is helping adolescents as they in turn are a return on
investment by harnessing a healthy workforce

 Increases the educational and employment opportunities

 Being a signatory to the UN Convention to the Rights of a Child which clearly
states that adolescents have the right to obtain the health information and
services they need to grow and develop to reach their full potential

Page 75

GAPS IN SCREENING
• Political Commitment
• Enforcement of policies and legislations
• Specific target groups actions
• Family and community participation
• Monitoring and evaluation

Page 76

RECOMENDATIONS
The American Medical Association has brought out Guidelines for Adolescents
Preventive Services (GAPS) in 1997.
It is a comprehensive set of recommendations developed to provide a
framework for the organization and content of clinical preventive health
services.
Topics addressed by GAPS :-
 Promoting parent‘s ability to respond to health needs of their adolescents
 Promoting adjustment to puberty and adolescence
 Promoting safety and injury prevention
 Promoting physical fitness
 Promoting healthy dietary habits and preventing eating disorders and
obesity
 Promoting healthy psychosexual adjustment and preventing the negative
health consequences of sexual behaviors
 Preventing hypertension
 Preventing hyperlipidemia
Page 77

KEY HOME MESSAGES
1. As many of the common morbidities and moralities of adolescence are
related to preventable health conditions associated with behavioral,
environmental and social causes, it is important that preventive services for
this age group reflect these issues.
2. It is important to both reinforce positive health behaviors (e.g. exercise and
good nutrition) while discouraging potentially health-risk behaviors (e.g.
unsafe sexual practices, smoking, unsafe driving etc.).
3. As lifetime habits may form during this age group, it is an important time to
implement health promotion and preventive services.
4. Evidence based research on preventive services guidelines is only in its
infancy. This is an important area of research given the limitation on health
resources and the focus on evidence-based medicine.

Page 78

THANK YOU

Page 79

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Page 83

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