Adolescents: health risks
- Dr.M.A.Aleem
Neurologist
ABC Hospital Trichy
Former Vice principal
KAPV Govt. Medical College
Trichy
Estimated 1.2 million adolescents died in 2015, over 3000 every day, mostly from preventable or treatable causes.
Road traffic injuries were the leading cause of death in 2015.
Other major causes of adolescent deaths include lower respiratory infections, suicide, diarrhoeal diseases, and drowning.
Globally, there are 49 births per 1000 to girls aged 15 to 19 per year.
Half of all mental health disorders in adulthood start by age 14, but most cases are undetected and untreated.
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 include:
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 annual adolescent birth rate (2010–2015) at 46 births per 1000 girls this age – country rates range from 1 to 208 births per 1000 girls. 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 specify a minimum age of marriage at 18 and which are enforced 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.
HIV
More than 2 million adolescents are living with HIV. Although the overall number of HIV-related deaths is down 30% since the peak in 2006 estimates suggest that HIV deaths among adolescents are rising. This increase, which has been predominantly in the WHO African Region, may reflect the fact that although more children with HIV survive into adolescence, they do not all then get the care and support they need to remain in good health and prevent transmission. In sub-Saharan Africa only 10% of young men and 15% of young women aged 15 to 24 are aware of their HIV status.
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, adolescents will need to be central to control efforts.
Young people need to know how to protect themselves 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, by 90% in the African Region between 2000 and 2012. Diarrhoea and lower respiratory tract infections are estimated to be among the top 5 causes of death for 10–19 year olds. These two diseases, together with meningitis, are the top three causes of adolescent death in African low and middle-income countries (LMICs).
Mental health
Depression is the third leading cause of illness and disability among adolescents, and suicide is the third leading cause of death in older adolescents (15–19 years). 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
Violence is a leading cause of death in older adolescent males. Interpersonal violence represents 43% of all adolescent male deaths in LMICs in the WHO Americas Region. Globally, 1 in 10 girls under the age of 20 years report experiencing sexual violence.
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 and ongoing support can help deal with the physical and psychological consequences.
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 a primary cause of injuries (including those due to road traffic accidents), violence (especially by a partner) and premature deaths. It can also lead to health problems in later life and affect 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.
Injuries
Unintentional injuries are the leading cause of death and disability among adolescents. In 2015, over 115 000 adolescents died as a result of road traffic accidents. Young drivers need advice on driving safely, while laws that prohibit driving under the influence of alcohol and drugs need to be strictly enforced. Blood alcohol levels need to be set lower for teenage drivers. Graduated licences for novice drivers with zero-tolerance for drink-driving are recommended.
Drowning is also a major cause of death among adolescents – 57 000 adolescents, two-thirds of them boys, are estimated to have drowned in 2015, and teaching children and adolescents to swim is an essential intervention to prevent these deaths.
Malnutrition 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.
Exercise and nutrition
Iron deficiency anaemia is the leading cause of years lost to death and disability in 2015. 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 and exercise 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 and opportunities to engage in physical activity are important for all but especially children and adolescents. Yet available survey data indicate that fewer than 1 in every 4 adolescents meets the recommended guidelines for physical activity: 60 minutes of moderate to vigorous physical activity daily.
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 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.
More than 1.2 million adolescents die every year, nearly all preventable
More than 3000 adolescents die every day, totalling 1.2 million deaths a year, from largely preventable causes, according to a new report from WHO . In 2015, more than two-thirds of these deaths occurred in low- and middle-income countries in Africa and South-East Asia. Road traffic injuries, lower respiratory infections, and suicide are the biggest causes of death among adolescents.
Most of these deaths can be prevented with good health services, education and social support. But in many cases, adolescents who suffer from mental health disorders, substance use, or poor nutrition cannot obtain critical prevention and care services – either because the services do not exist, or because they do not know about them.
In addition, many behaviours that impact health later in life, such as physical inactivity, poor diet, and risky sexual health behaviours, begin in adolescence.
Adolescents have been entirely absent from national health plans for decades. Relatively small investments focused on adolescents now will not only result in healthy and empowered adults who thrive and contribute positively to their communities, but it will also result in healthier future generations, yielding enourmous returns.
Data in the report, Global accelerated action for the health of adolescents (AA-HA!): Guidance to support country implementation by WHO, reveal stark differences in causes of death when separating the adolescent group by age (younger adolescents aged 10–14 years and older ones aged 15–19 years) and by sex. The report also includes the range of interventions – from seat-belt laws to comprehensive sexuality education – that countries can take to improve their health and well-being and dramatically cut unnecessary deaths.
Road injuries top cause of death of adolescents, disproportionately affecting boys
In 2015, road injuries were the leading cause of adolescent death among 10–19-year-olds, resulting in approximately 115 000 adolescent deaths. Older adolescent boys aged 15–19 years experienced the greatest burden. Most young people killed in road crashes are vulnerable road users such as pedestrians, cyclists and motorcyclists.
However, differences between regions are stark. Looking only at low- and middle-income countries in Africa, communicable diseases such as HIV/AIDS, lower respiratory infections, meningitis, and diarrhoeal diseases are bigger causes of death among adolescents than road injuries.
Lower respiratory infections and pregnancy complications take toll on girls’ health
The picture for girls differs greatly. The leading cause of death for younger adolescent girls aged 10–14 years are lower respiratory infections, such as pneumonia – often a result of indoor air pollution from cooking with dirty fuels. Pregnancy complications, such as haemorrhage, sepsis, obstructed labour, and complications from unsafe abortions, are the top cause of death among 15–19-year-old girls.
Adolescents are at very high risk of self-harm and suicide
Suicide and accidental death from self-harm were the third cause of adolescent mortality in 2015, resulting in an estimated 67 000 deaths. Self-harm largely occurs among older adolescents, and globally it is the second leading cause of death for older adolescent girls. It is the leading or second cause of adolescent death in Europe and South-East Asia.
A vulnerable population in humanitarian and fragile settings
Adolescent health needs intensify in humanitarian and fragile settings. Young people often take on adult responsibilities, including caring for siblings or working, and may be compelled to drop out of school, marry early, or engage in transactional sex to meet their basic survival needs. As a result, they suffer malnutrition, unintentional injuries, pregnancies, diarrhoeal diseases, sexual violence, sexually-transmitted diseases, and mental health issues.
Interventions to improve adolescent health
Improving the way health systems serve adolescents is just one part of improving their health. Parents, families, and communities are extremely important, as they have the greatest potential to positively influence adolescent behaviour and health.
The AA-HA! Guidance recommends interventions across sectors, including comprehensive sexuality education in schools; higher age limits for alcohol consumption; mandating seat-belts and helmets through laws; reducing access to and misuse of firearms; reducing indoor air pollution through cleaner cooking fuels; and increasing access to safe water, sanitation, and hygiene. It also provides detailed explanations of how countries can deliver these interventions with adolescent health programmes.
Top 5 causes of death for all adolescents aged 10–19 years in 2015
1. Road traffic injury115 302
2. Lower respiratory infections72 655
3. Self-harm67 149
4. Diarrhoeal diseases63 575
5. Drowning57 125
Top 5 causes of death for males aged 10–19 years in 2015
1. Road traffic injury88 590
2. Interpersonal violence42 277
3. Drowning40 847
4. Lower respiratory infections36 018
5. Self-harm34 650
Top 5 causes of death for females aged 10–19 years in 2015
1. Lower respiratory infections36 637
2. Self-harm32 499
3. Diarrhoeal diseases32 194
4. Maternal conditions28 886
5. Road traffic injury26 712
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