Ch13

Health Promotion StrategiesHealth Promotion Strategies
Through the Life SpanThrough the Life Span
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Health Promotion Strategies Through the Life Span, Eighth Edition
Ruth Beckman Murray, Judith Proctor Zentner, and Richard Yakimo
Chapter 13
The Adolescent: Basic Assessment
and Health Promotion

AdolescenceAdolescence
 Puberty
– 10 to 14 years for females
– 12 to 16 years for males
 Adolescence
– Begins with puberty and extends until the
person is physically and psychologically
mature
– Can be broken into early, middle, and late
adolescence

Adolescence and FamilyAdolescence and Family
 Early adolescence
– Child begins to separate emotionally from
parents
– Rebellion may being
 Middle adolescence
– Often low point in parent-child relationships
– Risk-taking behavior is common

Adolescence and Family cont.Adolescence and Family cont.
 Late adolescence
– May follow late adolescence
– Youth may return home and depend on
parents
 Adultulescence
– Emotional separation is being completed
– More autonomy is granted by the parents
– Adolescent demonstrates more stability

Stressors for ParentsStressors for Parents
 Redefining past child-parent relations and
their values
 Evaluating career choices
 Dealing with competition between parents
and teens
 Feeling anxious to relinquish childrearing
responsibilities
 Dealing with isolated and technologically-
knowledgeable teens

Family ConflictFamily Conflict
 Conflict can be a result of traditional and
new values
– More emphasis on technology
– Question authority
 Effective parents
– Work at being communicative, flexible, and
supportive
– Not threatened by offspring’s sexuality
– Do not overprotect

Foreign-Born Parents and ChildrenForeign-Born Parents and Children
 Language issues
 Parental guidance
 Coping with stresses related to
immigration
 Parental overmonitoring
 Cultural and religious conflicts
 Parental concerns about Americanization

Culture and ConflictCulture and Conflict
 Some cultures may not have adolescent
conflict
– Examples may include Asian-, African-, or
Mexican-American
– Adolescents may still be influenced by
subcultures
 Be sensitive to sociocultural background,
family structure and organization, and
religious beliefs and values

MaltreatmentMaltreatment
 Use careful screening and astute
communication skills
 Establish relationship
 Interview adolescent alone
 Discuss signs of types of abuse
 Discuss with parents importance of
listening, teaching safety, and following
intuitive feelings

IncestIncest
 Family crisis
 Active, directive, and even coercive
approach necessary
 Couple may unite against adolescent
 Crisis support needed for adolescent and
mother
 Group and individual therapy needed
 Effects last into adult life

Family Developmental TasksFamily Developmental Tasks
 Overall goal to allow adolescent
increasing freedom and prepare him or
her for young adulthood
 Provide facilities for individual differences
and needs
 Work out system of financial responsibility
 Establish a sharing of responsibilities
 Reestablish satisfying marriage
relationship

Family Developmental Tasks cont.Family Developmental Tasks cont.
 Strengthen communication with family
members
 Rework relationships with relatives,
friends, and associates
 Broaden horizons of the adolescent and
parents
 Formulate a workable philosophy of life

Reaching TasksReaching Tasks
 Explore how parents can
– Gradually increase teenager’s responsibilities
– Allow privileges formerly denied
– Resist granting instant adult status
– Emphasize reasonable limits and listening
skills
– Explore ways to handle disagreements

Neuroendocrine InfluencesNeuroendocrine Influences
 Hypothalamus-pituitary-gonadal system
becomes active
 Hypothalamus initiates secretion of
neurohumoral releasing factors
 These stimulate the pituitary gland to
release hormones to develop secondary
sex characteristics to develop

GrowthGrowth
 Adolescence is the second major growth
period of accelerated growth
 Growth follows sequence
 Weight is gained before height
 Late adolescent is more physically stable
and can handle body more efficiently

Female CharacteristicsFemale Characteristics
of Sexual Developmentof Sexual Development
 Menarche (marks puberty)
 Breast development
 Pubic and underarm hair growth
 Growth spurt
 Change in vaginal secretions and output
of oil and sweat-producing glands
 Widening of hips

Male CharacteristicsMale Characteristics
of Sexual Developmentof Sexual Development
 Spermatogenesis (marks puberty)
 Growth of testes and scrotal sac
 Pubic, facial, and underarm hair growth
 Growth spurt
 Growth of penis, prostrate gland, and
seminal vesicles
 Deepening voice and complexion changes

Neurological DevelopmentNeurological Development
 Brain reshapes at puberty
 Neuronal communication improves in
efficiency and precision
 Corpus callosum and the parietal and
temporal lobes all continue to mature
 Circuit that links the prefrontal cortex to
the midbrain reward system develops
 Biological rhythms change

Structural DevelopmentStructural Development
 Growth in skeleton, muscle mass, adipose
tissue, and skin
 Skeletal system grows faster than muscles
– Causes disrupted balance and decreased
coordination
May be worse in males
Improves through adolescence

SkinSkin
 Texture becomes courser
 Sebaceous glands become extremely
active and increase in size
 Sweat glands fully develop
 Acne emerges

Cardiovascular andCardiovascular and
Respiratory SystemsRespiratory Systems
 Heart grows slowly at first
 Systolic blood pressure and pulse rate
increase
 Respiratory system also grows slowly
 Red blood cell mass and hemoglobin
concentration increase
 White blood cell count decreases

Gastrointestinal and Urinary SystemsGastrointestinal and Urinary Systems
 Gastrointestinal System
– Matures rapidly
– Stomach capacity increases
– Fluid and electrolyte balance changes
 Urinary System
– Bladder capacity increases
– Renal function has matured

Physical AssessmentPhysical Assessment
 Establish rapport
 Use HEADSS assessment tool
 Be honest about confidentiality
 Keep in mind physical privacy
 Assess for common problems in
adolescent
– Examples: blood pressure, myopia, presence
of urinary infections, presence of scoliosis

Nutritional NeedsNutritional Needs
 Needs increase as metabolic rate
increases
 Requirements peak in the year of
maximum growth
 Increased appetite
 Protein, fiber, calcium, phosphorus, and
iron needs all increase
 Vitamin needs generally decrease
compared to school-age needs

Nutritional NeedsNutritional Needs
Figure 13-1:
Vegetarian
food guide
rainbow

MalnutritionMalnutrition
 Excess imbalance or deficit nutrient
availability
 Underweight may be a symptom of an
undiagnosed disease
– Examples include anorexia nervosa and
bulimia nervosa
– Treatment requires holistic approach

Malnutrition cont.Malnutrition cont.
 Overweight (BMI 25-29%)
 Obesity (30% or above)
 Food and activity habits are primary cause
 Effects
– Heart disease and hypertension
– Cancers
– Diabetes
– Negative body image and self-esteem

Malnutrition cont.Malnutrition cont.
 Interventions
– Educate about diet modification, exercise
programs, behavior modification, medications,
counseling, community resources, and
surgical techniques
– Assess teen and family’s weight, size, food
intake, and activity habits
– Teach about BMI

PlayPlay
 Three types: cooperative, team, and
construction
 Benefits
– Reduced body fat
– Reduced risk of disease
– Increased confidence
– Social acceptance
 Encourage adolescents to participate in
safe exercise 60 minutes a day

Sleep and RestSleep and Rest
 Inadequate oxygen supply may create
need for additional rest
 Rest prevents illness, depression, and
suicidal thoughts
 Early adolescents: 9 hours nightly
 Adolescents: 8 hours nightly
 Teens are least alert and most stressed in
the morning

Health Care PromotionHealth Care Promotion
 Health screening measures
 Immunizations
 Counseling
 High-risk categories
 Assess for common problems
 Teach parents and adolescents
preventative measures

Cognitive DevelopmentCognitive Development
 Period of Formal Operations
– Move to more abstract thinking but may return
to concrete operations during stressful times
– Mind has great ability to acquire and use
knowledge
– Capable of highly imaginative and analytic
thinking
– May go from simple understanding of right
and wrong to an awareness of multiplicity
– Metacognition is important

School ExperienceSchool Experience
 Students should get a chance to use
– Logical, convergent thinking
– Creative problem-solving
 Dropping out of school can have many
negative consequences
 Immigrants have different experience in
U.S. schools depending partly on gender

Emotional DevelopmentEmotional Development
 Characterized by mood swings and
extremes in behavior
 Adolescents may deal by internalizing and
externalizing
 Requires an interweaving and
organization of opposing tendencies into a
sense of unity and continuity
 Counsel parents to be supportive

Self-ConceptSelf-Concept
 Self-esteem drops in females and rises in
males through adolescence
 Factors
– Age of maturation
– Degree of attractiveness, size, and physique
– Name or nickname
– Peer relationships
– Degree of identification with same-sex parent
– Culture and family background

Body ImageBody Image
 Rapid growth changes affect body image
– Time may be spent on grooming, hygiene, or
clothing style
– Males may try to build muscle and be tempted
by steroids
 By late adolescence, self-image is
complete and self-esteem should be high
 Help adolescents develop realistic self-
image

Body ArtBody Art
 May be acquired to
– Express individuality or rebellion
– Mark significant events
– Manifest sign of group membership
 Risks can include
– Physical risks
– Psychosocial risks
 Explore choices with adolescents

Sexual ActivitySexual Activity
 Increasing hormones can cause rapid
arousal of emotions and mood shifts
 Sexual desire differs in males and females
 Both genders are concerned about
development and appearance
 Present sex education information to both
adolescent and adult

Moral and Religious DevelopmentMoral and Religious Development
 Conventional Level
 Conformist Stage: early adolescence
 Conscientious Stage: late adolescence
 Gender differences may exist
 Adolescent must compare religious and
scientific views
– Teen can find consolation in religious views
– House of worship can be place to build
relationships

Roles of Peer GroupRoles of Peer Group
 Promote opportunities for friendships
 Sense of acceptance, stability, and
immediacy
 Role models and relationships to define
personal identity
 Experiences to integrate masculine or
feminine behavior
 Opportunities to learn behavior

Peer GroupsPeer Groups
 Early adolescence
– Help counter the instability felt from rapid
growth
 Mid-adolescence
– Group allegiance is strong
– Pressure to conform and fear of rejection
– Sexual experimentation may begin
 Late adolescence
– Peer group replaced with individual friendship

Parent’s RoleParent’s Role
 Validate with parents that they have
reason to be concerned about
adolescent’s peers
 Encourage parents to guide teen into
wholesome activities and groups
 Help parents understand peer group
relationships

SlangSlang
 Trademark of adolescence
 Considered group dialect
 Provides sense of belonging to group
 Helps to exclude authority figures or
outsiders
 Permits expression of rebellion
 Help parents understand the purpose of
the dialect and how they can get involved

Leisure TimeLeisure Time
 Adolescent spends an increasing amount
of time from home
 Adolescent should have free time and not
be overcommitted to activities
 Socioeconomic and educational level can
impact free time
 Share with parents guidelines for
adolescent parties and state laws about
parent responsibility

DatingDating
 One use of leisure time
 Prepares the adolescent for intimate
bonds with others
 May include cyberdating, group dates, or
couple dates, or individual dates
 Share information about dating violence
 Discuss with adolescents ways to reduce
risk of violence

Sexual HarassmentSexual Harassment
 More recently defined as illegal activity
 Is defined by the victim
 Can cause
– Not wanting to go to school
– Difficulty with attention
– Feeling embarrassed
– Having difficulty with daily activities
– Losing self-confidence
– Anxiety and depression

Safety Measures for ParentsSafety Measures for Parents
 Monitor teen driving and recreational
activities
 Monitor peer relationships during visits in
the home
 Monitor and limit access to lethal weapons
 Install and test smoke alarms
 Stay informed about safety measures and
risks for adolescents

Identity Formation versusIdentity Formation versus
Identity DiffusionIdentity Diffusion
 Identity means that individual believes he
or she is specific and unique and has
emerged as an adult
 Types
– Personal
– Real
– Claimed
 Identity formation a result of family, peers,
culture, experiences

Identity DiffusionIdentity Diffusion
 Failure to achieve a sense of identity
 Individual feels self-conscious and
confused about self and roles in life
 Individual may pursue antisocial behavior
 Likely to occur if individual
– Has close contact to adult with identity issues
– Is in rebellion
– Is engaged in aggressive or violent behavior

Identity-Seeking ProcessIdentity-Seeking Process
 Can be diffused by
– Repeated stress
– Parents who are withdrawn, remote, or
neglectful
– Pop culture or cults
 Identity moratorium is time of making no
decisions but rethinking values and goals
 Assist parents and adolescent with identity
diffusion

Depression and Suicide RiskDepression and Suicide Risk
 Most adolescent have short bouts with
suicidal preoccupations
 Parents should be aware of composite
behaviors that may indicate suicidal
thoughts
 Listen to distressed adolescent
 Assess for depression
 Refer to resources as necessary

AlcoholAlcohol
 Gateway drug that is often portrayed by
media as “cool”
 Peer pressure and parental drinking
contribute to consumption
 Impairs long-term memory, self-control,
and cognitive function
 Help adolescent clarify values and see
detrimental effects

NicotineNicotine
 One of most addictive substances
 Can cause permanent genetic damage to
lungs
 Risk factors include
– Low self-esteem and self-efficacy
– Limited social skills
– Vulnerability to peer pressure and media
– Having parents who smoke
 Explore risks and cessation strategies

Drug AbuseDrug Abuse
 Risks
– Peer pressure
– Need to overcome insecurity, escape, or rebel
– Need to demonstrate autonomy
 System factors that protect adolescent can
be external, internal, contextual, or
interpersonal
 Factors may also include effective coping
style, self-esteem, and cognitive maturity

Sexual ActivitySexual Activity
 Oral sex is on the rise in adolescents
 Risks for STDs
 Teach importance of abstinence and safe
sex
 Interview adolescent alone and with
parents during assessment
 Males may be less likely to recognize risks
and be knowledgeable about
contraceptives

Sexual Activity cont.Sexual Activity cont.
 Unintended pregnancy carries health and
physiological risks for pregnant teen,
family, and offspring
 Follow statutes for reporting STDs and for
teen confidentiality
 Help couples determines values and
feelings about pregnancy and abortion
 Help teenage mother be effective and
make positive choices

Excessive Computer and Internet UseExcessive Computer and Internet Use
 Can be risk behavior to health
 Teens may use to construct identity or
sexuality
 Teens may become object of harassment
or bullying
 Teens may use to obtain drugs or make
unknown contacts

Role of Health Care ProviderRole of Health Care Provider
 Do not assume adolescent knows the
basis for health promotion
 Give specific information
 Counsel parents and teens about risk-
taking behaviors
 Use value-clarification to foster thinking
 Teach parents techniques for building self-
esteem
 Teach Decision-Making Model

Developmental TasksDevelopmental Tasks
 Accept the changing body
 Learn to handle the body and maintain
good health
 Achieve a satisfying and socially-accepted
feminine or masculine role
 Find the self as a member of one or more
peer groups
 Achieve independence from parents and
other adults

EgoEgo
 Develops realization that one’s way of
mastering experience is not only way
 Maintains sense of unity and centrality
 Reasons, judges, and plans
 Mediates among impulses and actions
 Chooses meaningful stimuli
 Maintains reality

Adaptive MechanismsAdaptive Mechanisms
 Frustration can result from stressors
(home life, peers, school)
 Adaptive mechanisms are the same ones
used in other developmental eras but
used differently
 Compensation, sublimation, and
identification improve interaction with
others

Upcoming Tasks for AdolescentUpcoming Tasks for Adolescent
 Move out of parental home to greater
independence
 Plan future and career
 Stabilize self-identify
 Establish close relationship with another
 Tasks for provider
– Help walkaway or runaway
– Help adolescents clarify values and attitudes
related to occupation selection

Developmental Tasks cont.Developmental Tasks cont.
 Select an occupation
 Prepare to settle down in a close
relationship with another
 Develop the intellectual and work skills
and social sensitivities of a competent
citizen
 Achieve socially responsible behavior in
the cultural setting
 Develop a workable philosophy.

Ch13

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