2. ADOLESCENT
• The term adolescence is derived from the Latin word “adolescere”
meaning “to grow up”.
• 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.
• This period of preparation for undertaking greater responsibilities
including responsible healthy parenthood
• Adolescents as people between 10 and 19 years of age.
12/05/2022 Dr N B Reddy
3. • 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
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ADOLESCENCE
4. ADOLESCENT HEALTH
• First, Adolescents constitute an important share of the population.
• Second, the burden of disease for adolescents is a unique one and
needs to be addressed multi- dimensional in nature and require
holistic approach, rather than together with the needs of younger
children..
• Third, adolescence is a period during which important health
behaviors are set and it is critical to ensure that adolescents adopt
healthy behaviors
• A large number of adolescents are malnourished, get married early,
working in vulnerable situations, and are sexually active.
• They are exposed to tobacco or alcohol abuse.
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5. a) Biological changes – onset of puberty
b) Cognitive changes – emergence of more advanced cognitive
abilities
c) Emotional changes – self image, intimacy, relation with
adults and peers group
d) Younger adolescents are heavily influenced by their peers
and as adolescents get older they reduce their dependence on
their parents
e) Social changes – transition into new roles in the society
The following changes are taking place during
adolescent period:
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6. Early adolescence(10 -13yrs):
Spurt of growth and development of secondary sex organs.
Middle adolescence(14-16yrs):
Separate identity from parents,
New relationship to peer groups,
with opposite sex and desire for experimentation.
Late adolescence(17-19yrs):
Distinct identity, well formed opinion and ideas
Early Adolescence
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7. Multifactorial Causation of Health Problems
Underlying factors Immediate Causes
High – Risk
Behavior
Adolescent Health
Problems
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8. Adolescent health problems
Biomedical illness
Congenital malformation/defects
- Precocious/ delayed puberty
- Short stature
- Asthma, congenital & rheumatic heart diseases
- Tuberculosis, malaria
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9. Key Issues in Adolescent Health
Status
• The mortality rate among adolescents is lower than among
other age groups
• Road injury is the leading cause of death among adolescents,
followed by HIV/AIDS, self-harm, and interpersonal violence
• Complications related to pregnancy and birth are a leading
cause of death among adolescent females, ages 15–19
• Adolescent mortality rates are much higher in Africa (260.6
per 100,000 adolescents) than the global average (94.2 per
100,000 adolescents)
•
12/05/2022 Dr N B Reddy
10. Key Issues in Adolescent Health
Status
• The high adolescent mortality rate in Africa is driven by
deaths from HIV/AIDS
• Depression is the leading cause of DALYs lost among
adolescents, followed by road injuries, iron deficiency
anemia, HIV, and suicide
• Injuries are a leading cause of death and DALYs, and in a
majority of countries, at least 50 percent of young adolescent
boys report serious injuries in the preceding year
• In some countries, up to one in three adolescents is obese
• Tobacco use is decreasing among younger adolescents in
most high-income countries and in some low- and middle-
income countries; however, rates of prevalence among
adolescents remain high in many a range of mostly middle-
income countries
12/05/2022 Dr N B Reddy
11. MENTAL DISORDERS
• Conduct and behavioural disorders
• Learning disorders
• Anxiety disorders
• Teen depression
• Juvenile delinquency
- Adjustment problems
- Violence
- Other psychiatric problems
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12. Behavioural Problems
Consequences of Risk-taking behavior
- Unintended injuries : automobile & sports related accidents
- Intended injuries : violence, homicide, suicide
- STDs, HIV/AIDS
• SUBSTANCE ABUSE
- tobacco, alcohol, illicit drug use begins in adolescence.
-150- 300 million smokers
- India – 4.54% 0f 12-17yr
- 13.86% of 18-23yrs
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13. ADOLESCENT PSYCHOLOGY
• Role of family and environment pivotal in Character and
personality building
• Cognitive emotional and attitudinal changes
• Seek Individuality Attention and Independence
• Peer groups more influential
• Peer pressure- addictions antisocial activities
14. PROBLEMS -
ADOLESCENT NUTRITION
Changing lifestyle
Skipping breakfast
Dining outside often
Fast foods
Junk foods
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15. NUTRITION…..
Increased nutritional needs
Calories : boys- 2500-2800 Calories /day
girls- 2200 Calories/day
Protein- 45-60g
Calcium- 1200 mg/day
Iron boys- 12 mg/day
15 mg/day
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16. Nutritional problems
Malnutrition/ under- nutrition
45% girls, 20% boys undernourished
Micronutrient deficiencies
• 75% < 50% of RDA of Vit A
• IDD in 6-12yrs – 30 -50%
Obesity
Eating disorders
Anemia in adolescents
66% girls, 45%boys anemic
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17. Reproductive health problems
- Teenage pregnancy
- Abortion related problems
- Menstrual problems
- Reproductive tract infections
- Acne
• 50% of females under18yrs – married
• 11% (16million) birth – adolescent girls 15- 19yrs
• Adolescent abortion – 1- 4.4million/ year
• 20-30% boys, 10% girls sexually active before
marriage
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18. Reasons for adolescent reluctant to seek help
• FEAR
• UNCOMFORTABLE WITH OPPOSITE HEALTH WORKER
• POOR QUALITY PERCEPTION
• LACK OF PRIVACY
• CONFIDENTIALITY
• CUMBERSOME PROCEDURE
• LONG WAITING TIME
• PARENTAL CONSENT
• OPERATIONAL BARRIER
• LACK OF INFORMATION
• FEELING OF DISCOMFORT
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19. Impact of adolescence:
• Lack of formal or informal education
• Malnutrition and anemia
• Early marriage, teenage pregnancies
• Habits and behaviours picked up during adolescence
period have lifelong impact
• Lot of unmet needs regarding nutrition, reproductive
health and mental health
• They require safe and supportive environment
• Desire for experimentation
• Sexual maturity and onset of sexual activity
• Transition from dependence to relative independence
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20. • Ignorance about sex and sexuality
• Lack of understanding
• Sub optimal support at family level
• Social frustration
• Inadequate school syllabus about adolescent health
• Misdirected peer pressure in absence of adequate knowledge
• Lack of recreational, creative, and working opportunity
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21. • Health education
• Skill based health education
• Life skill education
• Family life Education
• Counselling for emotional stress
• Nutritional counselling
• Early diagnosis & management of medical and
behavioural problem
PREVENTION
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22. Early Adolescence: Ages 10 - 14
Physical Changes
– Puberty, typically ages 8 to 13 in girls, 9 to 14
in boys
– Muscle acquisition and growth spurts
– Menstruation and breast growth (girls)
– Voice deepening and facial hair growth (boys)
Critical Interventions:
1. Sexuality Education
2. Mass Media
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23. Cognitive, Social, and Psychological Changes
– Self-consciousness and low self-esteem
– Feelings of awkwardness or discomfort related to physical changes
– Susceptible to peer pressure
– Improved ability to engage in abstract thinking and introspection
– Tendency to focus on the present rather than the future
Critical Interventions
1. Parent-child Communication
2. Strengthening the protective environment
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Early Adolescence: Ages 10 - 14
24. Older Adolescence: Ages 15 - 19
Physical Changes
• Continued physical growth, especially for boys
Critical Interventions:
1. Sexuality Education and Sexual and Reproductive Health
2. Harm Reduction and risk reduction through prevention of
initiation
3. Mass Media and technology
4. Engaging young people and the community to change social
norms
5. Addressing stigma, discrimination and legal barriers to
access
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25. Young Adults: Ages 20 - 24
Critical Interventions:
1. Biomedical interventions
2. Condom provision and uptake
3. Sexual and reproductive health, family planning and
PMTCT
4. Reaching young people in the workplace
.
12/05/2022 Dr N B Reddy
26. – To boost immunity that is decreasing
– Efforts to decrease disease
– To have specific Protection
– To provide recent vaccines available for
immunization
Why Adolescent Immunization is important?
12/05/2022 Dr N B Reddy
27. Adolescent immunization schedule
TT Booster at 10 and 16 years
Rubella As part of MMR vaccine or (Monovalent) 1 dose to
girls at 12-13 years of age, if not given earlier
MMR 1 dose at 12-13 years of age. (if not given earlier)
Hepatitis B 3 Doses (0, 1 and 6 m) if not given earlier
Typhoid TA, Vi or Oral typhoid vaccine every 3 years
Varicella* 1 dose up to 12-13 years, and 2 doses after 13 years
of age. (if not given earlier)
Hepatitis A* 2 doses (0 and 6 months) if not given earlier
12/05/2022 Dr N B Reddy
28. Children and Adolescents Aged 7 through
18 Years -CDC
Vaccine Minimum Age for
Dose 1
Dose
1 to Dose 2
Dose
2 to Dose 3
Meningococcal
ACWY
NA 8 weeks
DT; DTaP 7 years 4 weeks 4 weeks
Human
papillomavirus
9 years Routine dosing intervals are
recommended
Hepatitis A NA 6 months
Hepatitis B NA 4 weeks 8 weeks
Inactivated
poliovirus
NA 4 weeks 6 months
MMR NA 4 weeks
Varicella NA 3 months age <13 years.
4 weeks if age >13 yrs.
Dengue 9 years 6 months 6 months
Dr N B Reddy
29. Guiding Principals for
Adolescent Health Program
(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
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30. 12/05/2022
Adolescent Health Initiatives
• Two component
- Adolescent friendly health services
- Adolescent friendly counselling services
• Adolescent health clinics
- Clinical services
- Counselling services
Dr N B Reddy
31. 12/05/2022
Adolescent friendly health services
Adolescent friendly policies
- Fulfils the rights of adolescents
- Account for special groups, including vulnerable &
underserved groups
- Attention to gender factor
- Privacy & confidentiality
- Free & affordable
Dr N B Reddy
32. 12/05/2022
Adolescent friendly health care
providers
- Technically competent
- Good interpersonal communication skills
- Non – judgmental & considerate
- Devote adequate time
- Treat all clients with equal care & respect
- Provide information & support
Dr N B Reddy
33. ADOLESCENT COUNSELING
School Avoidance Separation Anxiety
Coping With Chronic Illness
Building Social Competence
Managing Powerful Peer Personalities
Avoiding Drug & Alcohol Use
Transitioning - High School to College
Accepting Imperfection
Building Friendships
34. What is ‘Life Skills’?
Abilities that help promote
mental well being and
competence in young people
as they face the realities of
life.
•WHO
– “The abilities for adaptive and
positive behavior that enables
individuals to deal effectively with
the demands and challenges of
everyday life”
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“life-skills based education
is
-behavior change or
behavior development
approach
-designed to address a
balance of three areas:
knowledge, attitude, and
skills.
35. 12/05/2022
What are the “Life Skills” ?
• Decision Making &
Problem Solving
• Creative & Critical
Thinking
• Negotiation Skills
• Effective Communication
& Interpersonal Relationship
•Self Awareness & Empathy
Coping with stress &
Emotions
Dr N B Reddy
36. 12/05/2022
How ‘Life Skills’ lead to primary
prevention of health problems?
Knowledge
Attitudes
Values
Life Skills
Behavior reinforcement or change
Positive Health Behavior
Prevention of Health Problems
Dr N B Reddy
38. Pre-conception counselling
• A woman who enters pregnancy in a good state of
health with a healthy diet and well controlled medical
disease is more likely to have a healthy pregnancy and a
good outcome than a woman who enters pregnancy with
an unhealthy lifestyle and uncontrolled medical disease.
• Pre-conception or pre-pregnancy counselling involves
seeing women several months prior to conception in
order to discuss and modify lifestyle choices and assess
and improve medical health before pregnancy.
39. Purpose of pre-Conception counselling
• Inform the woman and her partner of general advice, and advice
about lifestyle behaviours including exercise, diet, smoking and
drinking;
• Detect any mental health or medical issues that will impact on
pregnancy and advise if pregnancy should not be contemplated at
present;
• Identify couples who are at risk of having babies with genetic
disorders and refer them for genetic advice before they embark on
pregnancy; and
• Discuss contraception if it is considered that pregnancy is not
advisable at present or if the woman prefers not to get pregnant
yet.
40. General Pre conceptional advice
Supplements
• Folic acid
– Folic acid 0.4 mg daily is recommended to all women
trying to conceive and should be continued until 12 weeks
gestation along with an increase in folate containing foods
• with a previous pregnancy affected by an NTD.
• taking antifolate drugs (e.g. most antiepileptic agents,
sulfasalazine);
• with diabetes;
• with a raised BMI (>35 kg/m2);
• with thalassaemia or sickle cell disease throughout
pregnancy
41. Supplements
• Vitamin D
– Vitamin D 10 mg (400 IU) daily is recommended
– Vitamin D may play a role in early placental development,
and subsequently the development of pre-eclampsia
Women with the following risk factors will need to empirically
take a higher dose of vitamin D (at least 1000 IU daily)
• Skin pigmentation
• Poor sun exposure
• Factors affecting its absorption
• Obesity
• Previous child with rickets or vitamin D deficiency;
• Previous child who had neonatal fractures at delivery
42. General Pre conceptional advice
• Smoking
– Women should be advised to stop smoking prior
to pregnancy
• Alcohol
– Women should be advised to stop Alcohol prior to
pregnancy
• Medication
– Drugs that are harmful to the foetus may have an
effect depending on the time of exposure
