ADOLESCENCE : ADOLESCENCE DR. A.N.MURALIDHAR. MOTC KANHANGAD ADOLESCENT HEALTH : ADOLESCENT HEALTH The term adolescence is derived from the Latin word “adolescere” meaning to grow, to mature.
It is considered as a period of transition from childhood to adulthood.
They are no longer children yet not adults. It is characterized by rapid physical growth, significant physical ,emotional, psychological and spiritual changes.
Adolescents constitute 22.8% of population of India as on 1st march 2000.
They are not only in large numbers but are the citizens and workers of tomorrow.
The problems of adolescents are multi- dimensional in nature and require holistic approach.
A large number of adolescents in India are out of school, malnourished, get married early, working in vulnerable situations, and are sexually active.
They are exposed to tobacco or alcohol abuse. Need for Adolescent Care : Need for Adolescent Care "A world fit for children is one in which ... all children, including adolescents, have ample opportunity to develop their individual capacities in a safe and supportive environment". Slide 4: STAGES Who is Adolescent? : Who is Adolescent? No longer a child but not yet an adult
Adolescents- 10-19 years
Youth - 15 – 24 Years
Young People – 10 – 24 Years What is Adolescence?World Health Organization : What is Adolescence?World Health Organization A phase which involves -
Progression from appearance of secondary sexual characteristics (puberty) to sexual and reproductive maturity
Development of adult mental process and identity
Transition from total social-economic dependence to relative independence Slide 10: Adolescence : 10 – 19 years
Early Adolescence : 10 – 13 years
Middle adolescence : 14 – 16 years
Late adolescence : 17 – 19 years
Youth : 15 – 24 years
Young people :10 - 24 years Global Demographic and Socio-economic information on Adolescents : Global Demographic and Socio-economic information on Adolescents Population
1.1 billion are Adolescents.
1 in every 5 human on this planet is Adolescent.
85% of them live in Developing Countries. Global Demographic and Socio-economic information on Adolescents : Global Demographic and Socio-economic information on Adolescents Education
Formal education is very important
School Provide environment for -
building literacy and
Offer a setting for health screening and services.
In least developed countries 13% girls and 22% boys enroll for secondary education. Global Demographic and Socio-economic information on Adolescents : Global Demographic and Socio-economic information on Adolescents Employment
Many do not complete secondary education.
Seek work in informal sector.
73 million work in conditions that are detrimental to their health.
Many millions live and work on street – are at greater risk for substance use and sexual abuse. Global Demographic and Socio-economic information on Adolescents : Global Demographic and Socio-economic information on Adolescents Poverty
Relative and absolute poverty continues to grow.
Pressure to earn a living at an earlier age –
Exposes them to exploitation by unscrupulous adults Challenges in adolescent development and health in INDIA: : Challenges in adolescent development and health in INDIA: 45% of adolescent girls under nourished
20% of adolescent boys under nourished
Early marriage 26% < 15yrs – girls, 54% < 18yrs
20 – 30% adolescent boys sexually active
10% adolescent girls sexually active
59% adolescents know about condoms
49% adolescents know about contraceptives
4.5% drug abuse
50% of all HIV positive new infections are in the age group of 10 – 25yrs
Adolescent abortion 1 – 4.4millions Slide 16: INDIAN ACADEMY OF PAEDIATRICS
1999 = Family Education for adolescents
2000 = Teenage care clinic in the hospitals
2001 – 2003 = Teenage care wards for girls and boys in the hospitals
31st July Every year = Teenage day
25 – 31st July Every year = Teenage week Slide 17: The following changes are taking place during adolescent period:
Biological changes – onset of puberty
Cognitive changes – emergence of more advanced cognitive abilities
Emotional changes – self image, intimacy, relation with adults and peers group
Social changes – transition into new roles in the society Slide 18: Impact of adolescence:
1) Lack of formal or informal education
2) School dropout and childhood labour
3) Malnutrition and anemia
4) Early marriage, teenage pregnancies
5) Habits and behaviours picked up during adolescence period have lifelong impact
6) Lot of unmet needs regarding nutrition , reproductive health and mental health
7) They require safe and supportive environment
8) Desire for experimentation
9) Sexual maturity and onset of sexual activity
10) Transition from dependence to relative independence Slide 19: Ignorance about sex and sexuality
Lack of understanding
Sub optimal support at family level
Inadequate school syllabus about adolescent health
Misdirected peer pressure in absence of adequate knowledge
Lack of recreational, creative, and working opportunity Slide 20: ADOLSCENT PROBLEMS Why Adolescents are Important? : Why Adolescents are Important? They are a demographic force.
They are an economic force.
They are the future health.
They have a right to participate What are Adolescent Health Problems? : What are Adolescent Health Problems? Young Adolescents
General Health Problems
Mental Health Problems
Early and Unprotected Sex
Accidents and violence
Depression and Suicide
Eating Disorders. What are Adolescent Health Problems? : What are Adolescent Health Problems? Young Adolescents
Can not bear the responsibility of their own health
Lack knowledge about the physical changes happening in body
Such concerns – low self esteem and depression
Need reassurance and Support What are Adolescent Health Problems? : What are Adolescent Health Problems? Malnutrition
Shortage of food – priority for babies – inadequate adolescent diet – delayed/impaired development.
Girls – fed last and fed least – pubertal delay – small pelvis.
Baby mothers – less equipped to withstand complications (physically immature body)
MMR higher in anemic adolescent mothers
Undernourished Adolescent Mother – LBW Babies What are Adolescent Health Problems? : What are Adolescent Health Problems? General Health Problems
Same illnesses but
Less likely to recognize symptoms
More likely to underestimate their importance
Least likely section to go for early treatment
afraid about outcome,
worried about stigma, and
do not have confidence on treatment.
Parents actively take care of health of young children
Parents feel adolescents responsible for their heath needs – as they become more independent
Conditions like Asthma and Epilepsy become uncontrolled – as considered responsible for self medication. What are Adolescent Health Problems? : What are Adolescent Health Problems? They must learn
- recognizing the early symptoms of common diseases
- when, where and how to seek a check up & treatment What are Adolescent Health Problems? : What are Adolescent Health Problems? Menstrual Problems
Without proper knowledge – fail to understand normal and to recognize menstrual problems
School Health Checkups usually fail to identify these What are Adolescent Health Problems? : What are Adolescent Health Problems? Mental Health Problems
May first become apparent in Adolescence
No frame of reference available with them
Thus fail to
Seek medical treatment What are Adolescent Health Problems? : What are Adolescent Health Problems? Early and Unprotected Sex
Sexual activity is more common than available official data – evidenced by increased no. of-
Steep Rise in HIV
Early and unprotected sexual experience is not planned, and with no knowledge of consequences What are Adolescent Health Problems? : What are Adolescent Health Problems? Predisposing Factors for Early and Unprotected Sex
Adolescents live in Increasingly sexualized societies
Impact of Media – Electronic and Print
Rapid Growth of cities and breakdown of traditional family structure – Erode protective cultural layer
Conflict and forced migration – put them at risk
Pressured in to desperate situations – forced into sex for survival sp. during economic hardships etc.
Trend – earlier sexual maturation while late marriage What are Adolescent Health Problems? : What are Adolescent Health Problems? Early and Unprotected Sex – Results In
STI 1 in 20 young people every year
7000 young people every day are infected with HIV
Early and Unprotected Sex – Remedy
Abstaining from Sex
Delaying the onset of first sexual experience
Increasing the level of protection through condoms What are Adolescent Health Problems? : What are Adolescent Health Problems? Addictive Behavior (Risk Taking)
Do not assess the long term consequences
Alcohol and drugs – further reduce caution and judgment
May appear to be a way out for one who sees no positive solution – but actually is a way to more serious problems
Expensive and illegal habits – draws them to crime What are Adolescent Health Problems? : What are Adolescent Health Problems? Accident and Violence
Deaths and Injuries are more common in them
Unintentional Injuries is the leading cause of Death in many countries
Vulnerable both as victims and perpetrators
Violence with in home is usually not treated seriously. What are Adolescent Health Problems? : What are Adolescent Health Problems? Sexual Abuse
For millions – sex is linked with – cruelty, violence and abuse – family members or adults with privileged access.
Women are conditioned to be submissive to men – thus early marriage, birth spacing, unprotected sex or unfaithful partner.
Much sexual abuse takes place in home and is never reported
Homeless –street adolescents are more vulnerable
Young women may trade sex
Increase in world trade sexual exploitation of young people – “sex Tourism”
UNICEF estimates – 1 million adolescents are recruited in commercial sex trade What are Adolescent Health Problems? : What are Adolescent Health Problems? Depression and suicide
Common with Low self esteem
They feel they have no future and are useless
Reduces the quality of life
Likely to take risk with own health
Depression can lead to suicide
90,000 young people commit suicide every year. What are Adolescent Health Problems? : What are Adolescent Health Problems? Eating Disorder
Obesity and eating disorders exist along with malnutrition
From early age adolescents are under pressure to be ultra thin – impact of media
Bulimia and anorexia can permanently damage physical and mental health.
Obesity – if failed to deal in time may lead to serious health problems. ADOLESCENT HEALTH PROBLEMS : ADOLESCENT HEALTH PROBLEMS Anorexia nervosa
Obesity & overweight
Substance abuse & injuries
Sexually transmitted infection
Thinking and studying problems
Identity problems Slide 38: Reasons for adolescent reluctant to seek help
UNCOMFORTABLE WITH OPPOSITE HEALTH WORKER
POOR QUALITY PERCEPTION
LACK OF PRIVACY
LONG WAITING TIME
LACK OF INFORMATION
FEELING OF DISCOMFORT PREVENTION : PREVENTION HEALTH EDUCATION
SKILL BASED HEALTH EDUCATION
LIFE SKILL EDUCATION
FAMILY LIFE DUCATION
COUNSELLING FOR EMOTIONAL STRESS
EARLY DIAGNOSIS & MANAGEMENT OF MEDICAL AND BEHAVIOURAL PROBLEM Estimates of Disease Burden : Estimates of Disease Burden DALY – (Disability Adjusted Life Year)
Time based measure to quantify burden.
Includes – Years of Premature Deaths & Years lived with disability.
1 DALY is 1 lost year of Health Few Figures !!! : Few Figures !!! Young People represents 15% of total Burden
90% of DALYs lost in Developing Countries
Main contributory factors
Sexual and Reproductive Health Problems (STIs, HIV)
Endemic and Chronic Diseases
Drug use and Substance Abuse
Accidents and Injuries
Maternal Conditions Risk Factors for Global Burden : Risk Factors for Global Burden Why pay attention to Adolescent Health? : Why pay attention to Adolescent Health? To reduce death and disease in adolescents
To reduce the burden of disease in later life
To invest in health — today and tomorrow
To deliver on human rights
To protect human capital Why Invest in Adolescent Health? : Why Invest in Adolescent Health? Health Benefits
Current & Future Health
Return On Investments
Alleviate Future Health Cost
As a Human Right Guiding Principals for Adolescent Health Programming(UNFPA, UNICEF & WHO) : Guiding Principals for Adolescent Health Programming(UNFPA, UNICEF & WHO) Adolescence is a time for opportunity and risk
Not all adolescents are equally vulnerable
Adolescent Development underlies prevention of Health Problems
Problems have common roots and are interrelated
Social environment influences adolescent behavior
Gender considerations are fundamental Summary : Summary Adolescents represent a positive force in society, now and for the future.
They face dangers more complex than previous generations faced, and often with less support.
The development needs of adolescents are a matter for the whole of civil society.
Health services play a specific role in preventing health problems and responding to them.
Many changes are needed in order for health services to become adolescent friendly. Slide 47: Conclusion:
This adolescent period is hazardous for adolescent health due to absence of proper guidance and counselling.
Family has a crucial role in shaping the adolescents behaviour
They have to ensure a safe, secure, and supportive environment for the adolescents.
Family members in the community to be informed and educated about this problem.
A positive and encouraging attitude has to be developed among the family members and parents.
School teachers should be trained on adolescent health.
Community leaders play a vital role on adolescent health care. Nutrition: Why should you care ? : Nutrition: Why should you care ? Happiness is nothing more than good health and a bad memory.
Prevention of diseases Healthy Diet: Why is it important in this age ? : Healthy Diet: Why is it important in this age ? You gain 25% of adult height, 50% of adult weight and 40% of adult bone mass during adolescence. Deposition of muscles in boys (50%)
Deposition of fat in girls
Preparation for future healthy mother and father Healthy Diet: How does it prevent diseases ? : Healthy Diet: How does it prevent diseases ? Obesity/under-nutrition
Type-2 Diabetes Mellitus
Vitamins and Mineral
Cancer Healthy Diet: Deciding the right amount : Healthy Diet: Deciding the right amount Actual need varies with physical activity
Physically active people have higher energy needs
If you have low physical activity then you can become obese even with low intake.
Energy intake should balance energy expenditure. Healthy Diet: Food intake : Healthy Diet: Food intake Carbohydrates
e.g. Rice, Chapati Protein-based e.g. Milk, Egg, Dal and Meat. Salads,
Fruits Increase fiber
Decrease oily foods
‘No’ to soft drinks CARBOHYDRATES : CARBOHYDRATES Major and immediate source of energy.
Complex carbohydrates recommended
High-sugar foods not preferred.
Grains, cereals, fresh fruits, vegetables FATS : FATS Source of essential fatty acids.
Unsaturated fat recommended. e.g. Corn, cottonseed, Til oil, soybean, and sunflower oils contain about 50% polyunsaturated fat.
Saturated fats increase cholesterol levels. PROTEINS : PROTEINS Daily requirements
Boys = 0.29-0.32 g/cm height
Girls = 0.27-0.29 g/cm height
0.8 – 1.2 g/kg bodyweight
High intensity athletes = 1.2-1.8 g/kg
Pulses, lentils, soya, dairy products and animal food products. Looks can be deceiving : Looks can be deceiving Iron
Calcium Increased need during adolescence
Needs met by a well-balanced diet
Vitamin B 12
Sources – Fruits, fresh milk, sprouted beans etc. Iron : Iron Anemia is most common nutritional deficiency in adolescents.
Increased red cell mass during adolescence.
Boys = 12 mg/d & Girls = 18 mg/d
Green leafy vegetables, jaggery, wet dates, whole-grain, dried beans, peas & dried fruits, nuts & fortified wheat products, eggs, red meat etc. Zinc : Zinc Second most abundant trace mineral in the body. (next to iron)
Necessary for normal growth.
Clinically apparent deficiency rare.
Daily need = 15 mg
Green leafy vegetables, wheat germ, whole grains meat, cheese, eggs, poultry, liver. Calcium : Calcium Most bone mass acquired during adolescence.
Typical intake of calcium = about 800 mg/ d
Daily need = 1300 mg
Consumption of soft drinks & caffeine contribute substantially to low calcium intake in adolescents.
Bone mass deficiency may is irreversible.
Milk and its products, yogurts, cheese, paneer, banana. What is ‘Normal’ eating ? : What is ‘Normal’ eating ? Eating is regulated by hunger and satiety i.e. feeling full
Eating should be at regular intervals
Choose healthy snacks and food,
If you eat healthy and exercise regularly you can occasionally enjoy high fat and high calorie junk foods. Good eating habits : Good eating habits Maintain hygienic habits
Eat slowly, chew properly
Avoid TV viewing or reading while you eat
Small frequent meals
Never skip meals, specially breakfast
Don’t overeat Do healthy snacks exist ? : Do healthy snacks exist ? Yes, and in plenty.
Snacks like fresh fruits, sprouted beans and nuts are nutritious and healthy.
Avoid energy dense snacks like burgers.
“Empty calories” – High sugar drinks
Aerated drinks interfere with bone density and can damage teeth Why is Fast Food unhealthy ? : Why is Fast Food unhealthy ? High in calorie, fat, sodium and low in fiber which can cause
Obesity, Hypertension, Heart diseases, Diabetes, Cancer etc.
Choose low-calorie and low-fat meals, snacks and desserts
Have low fat or skim milk drinks. The Middle Path: Making Junk food healthy : The Middle Path: Making Junk food healthy Replace the Cheese with Paneer or low-fat cheese
Add plenty of vegetables
Replace frying with grilling or baking
Replace white bread, maida noodles or maida pizza base with whole-grain wheat
Have low-fat or skimmed milk based products Breakfast: The most important meal : Breakfast: The most important meal Brain Food
Improves performance in studies
Improves physical activities
Does not contribute to overweight
Keeps you healthy Skipping breakfast associated with obesity
High sugar breakfast causes a high sugar level which dips fast making you more hungry and you eat more sugary food PHYSICAL ACTIVITY: Why is it important ? : PHYSICAL ACTIVITY: Why is it important ? PHYSICAL ACTIVITY: Types of physical activity : PHYSICAL ACTIVITY: Types of physical activity Daily Chores: walking, climbing stairs, cycling, household activities, etc.
Exercise: planned & structured subset of leisure time physical activity undertaken for improving or maintaining physical fitness.
30-60 minutes every day
Sports: involves competition. It may become an occupation. PHYSICAL ACTIVITY: Importance : PHYSICAL ACTIVITY: Importance This includes :
Cardio-respiratory i.e. Heart & Lung fitness
Endurance & flexibility Television and Obesity : Television and Obesity Excessive TV watching is associated with weight gain specially when associated with increased snacking with junk food and aerated drinks
Combine TV watching with physical activity like stationary bicycling, or spot jogging PHYSICAL ACTIVITY: Keeping in shape : PHYSICAL ACTIVITY: Keeping in shape It is recommended to have 30-60 min. moderate physical activity on weekdays, four days a week
It is not necessary to exercise continuously
Can be divided into 10 -15 minutes of activities several times through the day Nutrition & Exercise: Myths : Nutrition & Exercise: Myths Girls don’t need muscle stretching exercises
You can become obese if you leave exercise
Expensive food and vitamins are needed for good health and machines for exercise
Health drinks Key points : Key points Proper Nutrition & Regular Physical Activity are very important for
Prevention of illness
Future health Slide 76: END HYGIENE : HYGIENE From Head To Toe Knock Knock : Knock Knock Who’s There? Jean.Jean Who? Hi Jean!What’s That Smell? Hygiene : Hygiene From the Greek
“healthy, sound” What is Personal Hygiene? : What is Personal Hygiene? Regular Routine of Personal Care
Washing and Grooming
Your Feet Hair : Hair Brushing your hair cleans and stimulates hair and scalp.
Brush from roots to tips to spread natural oils along the whole length of hair.
Shampoo regularly Hair : Hair How do I choose a shampoo?
Is my hair Oily, or is my hair Dry?
Do I need conditioner?
What will stop the DANDRUFF??? Dandruff : Dandruff What is it?
Dry itchy scalp
White flakes on head and shoulders What causes it?
Skin cells that grow and die off too fast
Fat eating fungus on scalp that grow out of control and feeds off the oil on the hair follicles ACNE : ACNE Acne is created when oil from the oil glands mix with the dead cells and plug up the hair follicles in the skin it creates a “whitehead.”
A “blackhead” is when the air touches the plug, the plug turns black Acne : Acne Acne : Acne What makes acne worse?
Oil-based makeup, suntan oil, hair jells and spray.
For girls, menstruation
Squeezing or picking at blemishes
Hard scrubbing of the skin Who gets acne?
Boys and girls during their teen years. Boys may get it worse because they have more skin oil.
If your parents had bad acne, chances are you may get it bad too. Acne Myths : Acne Myths 1: Does chocolate cause zits?
2: Does Extra washing help clear zits?
A: No, the extra scrubbing
irritates skin and could make
3: Does acne leave scars?
A: Yes, you can reduce the
scarring by NOT PICKING
and avoid excessive scrubbing. Ears : Ears Wash ears daily with a wash cloth don’t forget behind the ears
Do not use Qtips in ears it will smash the ear wax deep into the ear canal
Did you know…..??
Ear wax is usually removed when you chew food or gum Dental Hygiene : Dental Hygiene What causes cavities?
Sugar and Plaque together creates bacteria that causes tooth decay.
Tooth Decay can be transmitted through the mouth from someone who may have tooth decay bacteria. How to avoid tooth decay.
Daily dental hygiene routine that consist of brushing for 2-4 minutes and flossing.
See a dentist every 6 months Halitosis : Halitosis Bad Breath…
Caused by the activity of certain types of oral bacteria
Food stuck in teeth
Stomach problems Body Odor : Body Odor What causes body odor?
Perspiration and bacteria mixed together
Apocrine glands under the arms and in the groin secrete odors
Poor diets or some foods such as onions and garlic Treatments…
The use antiperspirants decreases perspiration and cover odor with a manly smell
Daily baths or showers using soap and scrubbing the entire body with a washcloth
Change clothing daily
Maintain a healthy diet Body Odor : Body Odor So many choices…
What would be best for me…??? Fingernails and Toenails : Fingernails and Toenails File fingernails in one direction
Cut toenails straight across – never cut into corners
Protect against ingrown toenails by avoiding tight shoes, very high heels Athletes Foot : Athletes Foot Tinea Corpois –
Fungal Infection – Athletes Foot
Keep feet and skin clean and dry
Change socks daily
Avoid walking barefoot in public areas
Throw away worn-out shoes and never borrow other people’s shoes Make Hygiene part of your daily routine : Make Hygiene part of your daily routine Slide 96: END Slide 97: THANK YOU