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All you should know about adolescent health risks and solutions

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Around 1.2 billion people, or 1 in 6 of the world’s population, are adolescents aged 10 to 19.

Most are healthy, but there is still substantial premature death, illness, and injury among adolescents. Illnesses can hinder their ability to grow and develop to their full potential. Alcohol or tobacco use, lack of physical activity, unprotected sex and/or exposure to violence can jeopardize not only their current health, but also their health as adults, and even the health of their future children.

Promoting healthy behaviours during adolescence, and taking steps to better protect young people from health risks are critical for the prevention of health problems in adulthood, and for countries’ future health and ability to develop and thrive.

Main health issues

Injuries

Unintentional injuries are the leading cause of death and disability among adolescents. In 2016, over 135 000 adolescents died as a result of road traffic accidents. Many of those who died were “vulnerable road users”, including pedestrians, cyclists or users of motorized two-wheelers. In many countries, road safety laws need to be made more comprehensive, and enforcement of such laws needs to be strengthened. Furthermore, young drivers need advice on driving safely, while laws that prohibit driving under the influence of alcohol and drugs need to be strictly enforced among all age groups. Blood alcohol levels should be set lower for young drivers than for adults. Graduated licenses for novice drivers with zero-tolerance for drink-driving are recommended.

Drowning is also among the top 10 causes of death among adolescents – nearly 50 000 adolescents, over two thirds of them boys, are estimated to have drowned in 2016. Teaching children and adolescents to swim is an essential intervention to prevent these deaths.

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 and providing them with psychosocial support in schools and other community settings can help promote good mental health. Programmes to help strengthen the ties between adolescents and their families are also important. If problems arise, they should be detected and managed by competent and caring health workers.

 

Violence

Interpersonal violence is the third leading cause of death in adolescents, globally, though its prominence varies substantially by world region. It causes nearly a third of all adolescent male deaths in low- and middle-income countries of the WHO Region of the Americas. Globally, nearly one in three adolescent girls aged 15 – 19 years (84 million) has been a victim of emotional, physical and/or sexual violence perpetrated by their husband or partner.

Promoting nurturing relationships between parents and children early in life, providing 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.

HIV/AIDS

An estimated 2.1 million adolescents were living with HIV in 2016; the great majority in the WHO African Region. Although the overall number of HIV-related deaths has been decreasing since the peak in 2006, estimates suggest that this is not yet the case among adolescents. This reflects the fact that most of today’s adolescents were born before prevention of mother-to-child transmission of HIV by antiretroviral therapy became widespread. However, a substantial proportion of 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.

One of the specific targets of the health 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. Given the high prevalence of HIV in many countries, to achieve this target, adolescents will need to be central to control efforts.

Young people need to know how to protect themselves from HIV infection and must have the means to do so. This includes being able to obtain condoms to prevent sexual transmission of the virus and clean needles and syringes for those who inject drugs. Better access to HIV testing and counselling, and stronger subsequent links to HIV treatment services for those who test HIV positive, are also needed.

Other infectious diseases

Thanks to improved childhood vaccination, adolescent deaths and disability from measles have fallen markedly – for example, adolescent mortality from measles fell by 90% in the African Region between 2000 and 2012.

Diarrhoea and lower respiratory tract infections are estimated to be among the top 10 causes of death for 10–19 year olds. These two diseases, along with meningitis, are all among the top five causes of adolescent death in African low- and middle-income countries.

Early pregnancy and childbirth

The leading cause of death for 15-19 year-old girls globally is complications from pregnancy and childbirth.

Some 11% of all births worldwide are to girls aged 15–19 years, and the vast majority of these births are in low- and middle-income countries. The UN Population Division puts the global adolescent birth rate in 2018 at 44 births per 1000 girls this age – country rates range from 1 to over 200 births per 1000 girls (1). This indicates a marked decrease since 1990. This decrease is reflected in a similar decline in maternal mortality rates among 15–19 year olds.

One of the specific targets of the health Sustainable Development Goal (SDG 3) is that by 2030, the world should ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes. To support this, a proposed indicator for the Global strategy for women’s, children’s and adolescents’ health is the adolescent birth rate.

Better access to contraceptive information and services can reduce the number of girls becoming pregnant and giving birth at too young an age. Laws that are enforced 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.

Alcohol and drugs

Harmful drinking among adolescents is a major concern in many countries. It reduces self-control and increases risky behaviours, such as unsafe sex or dangerous driving. It is an underlying cause of injuries (including those due to road traffic accidents), violence and premature deaths. It can also lead to health problems in later life and affects life expectancy. Setting a 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 use among 15–19 year olds is also an important global concern. Drug control may focus on reducing drug demand, drug supply, or both, and successful programmes usually include structural, community, and individual-level interventions.

Nutrition and micronutrient deficiencies

Iron deficiency anaemia was the second leading cause of years lost by adolescents to death and disability in 2016. Iron and folic acid supplements are a solution that also helps to promote health before adolescents become parents. Regular deworming in areas where intestinal helminths such as hookworm are common is recommended to prevent micronutrient (including iron) deficiencies.

Developing healthy eating habits in adolescence are foundations for good health in adulthood. Reducing the marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt and providing access to healthy foods are important for all, but especially for children and adolescents.

Undernutrition and obesity

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 WHO regions, from lower than 10% in the WHO South-East Asia region to over 30% in the WHO Region of the Americas .

Physical activity

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. WHO recommends for adolescents to accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily, which may include play, games, sports, but also activity for transportation (such as cycling and walking), or physical education.

Globally, only 1 in 5 adolescents are estimated to meet these guidelines. Prevalence of inactivity is high across all WHO regions, and higher in female adolescents as compared to male adolescents.

To increase activity levels, countries, societies and communities need to create safe and enabling environments and opportunities for physical activity for all adolescents.

Tobacco use

The vast majority of people using tobacco today began doing so when they were adolescents. 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. Globally, at least 1 in 10 adolescents aged 13 to 15 years uses tobacco, although there are areas where this figure is much higher. Cigarette smoking seems to be decreasing among younger adolescents in some high-income countries.

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 a General Comment on realizing the rights of children during adolescence was published in 2016. It highlights states’ obligations to recognise the special health and development needs and rights of adolescents and young people.

The Convention on the Elimination of Discrimination Against Women (CEDAW) also sets out the rights of women and girls to health and adequate health care.

WHO response

In May 2017, WHO published a major report: Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to support country implementation. The AA-HA! Guidance has drawn on inputs received during extensive consultations with Member States, United Nations agencies, adolescents and young people, civil society and other partners. It aims to assist governments in deciding what they plan to do and how they plan to do it as they respond to the health needs of adolescents in their countries. This reference document targets national-level policy-makers and programme managers to assist them in planning, implementing, monitoring and evaluation of adolescent health programmes. Teams from 68 countries have been trained in applying the AA-HA! guidance for national priority-setting, programming, monitoring and evaluation, and 18 countries are in the process of using the AA-HA! approach to update national strategies and policies.

Overall, WHO carries out a range of functions to improve the health of young people, including:

  • production of evidence-based guidelines to support health services and other sectors;
  • making recommendations to governments on adolescent health and the provision of high quality, age-appropriate health services for adolescents;
  • documenting progress in adolescent health and development; and
  • raising awareness of health issues for young people among the general public and other interested stakeholders.

References

(1) Sustainable Development Goals Indicators, Global Database
https://unstats.un.org/sdgs/indicators/database/?indicator=3.7.2

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