Adolescent Health-An

Overview

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DR. AJAY GUPTA

MAX HOSPITAL , SHALIMAR BAGH

Introduction:

The term adolescence is derived from the Latin word

adolescere meaning to grow, to mature.

It is a time of physical and emotional change as the body

matures and the mind becomes more questioning and
independent.

Adolescents (10-19 years) constitute about one fourth of

India's population and young people (10-24 years) about
one third of the population

Definitions:
Adolescence:

10 19 years

Early

10 13 years

Adolescence:

Middle
Late

adolescence: 14 16 years

adolescence:

Youth:
Young

17 19 years
15 24 years

people:

10 - 24 years

Adolescent Health-An Overview

No longer Children, Not Yet Adults

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Young people

Adolescence

10-24 Years

10-19 years

Youth
15-24 Years

Adolescent Health-An Overview

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Adolescents: A Very diverse population segment
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Different stages of development

Different circumstances
Different needs and
Diverse problems

Adolescent Health-An Overview

Why Focus on Adolescents?

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70% of mortality in adulthood is linked to

habits picked up during adolescence.
(Risk taking behavior, substance abuse,
eating habits, conflict resolution);
Communication gap exists with parents
and other adults (Lack of family
Connectedness)
Lack of connectedness with parents and
other adults prevents transmission of
health messages and crucial skills,
leading to adoption of risky behaviorsubstance abuse, early sexual debut,
STI/HIV etc.

Why pay attention to the health of adolescents?

To reduce death and disease in adolescents:

An estimated 1.7 million young people aged from 10 to 19 die

each year due to accidents, violence, pregnancy related
problems or illnesses.

To reduce the burden of disease in later life:

Malnutrition in adolescence can lead to lifelong health

problems

Failure to care for the health needs of young pregnant women

damage their own health and that of their babies.

Some of the highest infection rates for sexually transmitted

infections are in adolescents.

Diseases of late middle age, such as lung cancer, bronchitis

and heart disease, are strongly associated with smoking habit.

ADOLESCENT HEALTH PROBLEMS

1.

Obesity & overweight

2.

Adolescent pregnancy

3.

Micronutrient deficiency

4.

Emotional problems

5.

Behavioural problems

6.

Substance abuse & injuries

7.

Sexually transmitted infection

Health problems of adolescents:

General health problems

Adolescent never recognize symptoms, and mostly underestimate their

problems and they do not know where to go for help.

They may leave diseases untreated because they are afraid of the outcome,
worried about the stigma or do not believe that they will be treated well at a
clinic

Malnutrition:

Inadequate diet can delay or impair healthy development. Stunting during

adolescence.

Anemia is also one of the most important problem among adolescents due to
malnutrition

Obesity and eating disorders exist along side malnutrition.

Mental health problems:

Depression is common, especially for young people who have low

self-esteem

Depression can also lead to the ultimate tragedy almost 90,000

young people commit suicide each year across the world

Early & unprotected sex:

Many young people become sexually active without planning the

sexual relationship or thinking about the consequences.

This results into the high number of unwanted pregnancies and

unsafe abortions and the steep rise in HIV infection.

The following changes are taking place

during adolescent period:
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)

Social changes transition into new roles

in the society

DISADVANTAGE

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DOUBLE DISADVANTAGE
CARRY THE BURDEN OF PRE EXISTING DISEASES OF CHILD HOOD
DEVELOPING RAPIDLY AND HAVING EXTREME DEGREE OF PRESSURE
FROM PEERS, PARENTS, SOCIETY AND SELF

LACK KNOWLEDGE AND SKILL TO COPE UP WITH PRESSURE

Adolescent Health-An Overview

Adolescent Health-An Overview

Characteristics

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A Aggressive Anaemic Abortion

D Dynamic,Developing,Depressed

O Overconfident,Overindulging,Obese

L Loud but lonely,& Lack information

E Enthusiastic,Explorative,& Experimenting

S Social,Sexual, & Spiritual

C Courageous,cheerful, &concern

E Emotional,Eager,& Emulating

N - Nervous,Never say no to peers

T Temperamental,Teenage pregnancy

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Ill Health Recipe: Ye Dil Mange

More Lifestyle of Adolescents 14
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Tobacco/
Alcohol
Excess
dietary FAT

Lack of vegetables
& fruits

Sedentary
habits

Sexual behavior/
poor genital hygiene
Adolescent Health-An Overview

Adolescent Health-An Overview

Evidence of Common Roots*

adolescents

A positive relationship with

parents
Conflict in the family
A positive school
environment
Friends who are negative role
models
A positive relationship with
adults in the community
Having spiritual beliefs
Engaging in other risky
behaviours
*Broadening the Horizon Evidence from 52 countries

Early Sex Substance Depression

Use
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Risk & Protective factors for

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PREVALENCE OF ANAEMIA IN ADOLESCENT

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70%
60%
50%
40%

42

30%

36

34

20%
10%
0%

16

BOYS

GIRLS-R
NORMAL

ANAEMIC

GIRLS(U)

Adolescent Health-An Overview

Health problems

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Large number are malnourished, and anaemic

(56% Baroda study, 95% SWACH study), or
stunted (59% boys, 37% girls- NNMB 2000);
Obesity is increasing,8-10% in public schools of
Delhi.
Adolescent pregnancy common (50%of women
in india had a child before reaching the age of
20IP-JAN 2004)
Large number of adolescents are still unimmunized. (TT,RUBELLA );

Adolescent Health-An Overview

HEALTH PROBLEMS

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One out of 10 children in India is sexually
abused at any given point of time (WHO)
Sexual problems;25%of patients attending
Government STI clinics are Younger than 18
Year old (Ramasubban-1995)
Increasing vulnerability to HIV/AIDS,Over 50%of
all new HIV cases in india are among 1024years (UNAIDS-2002)
Substance abuse is quite common

Prevalance of obesity in India

School children in Chennai

> 22% HSE group

15% from MSE groups .
only 4.5% from LSE group

Affluent Adolescent
School children
Delhi

31% overweight;
7.5% obese.2
Pune

24% overweight.3
Chennai

22% overweight.1
1.

Indian Pediatr 2002; 39: 449-452.

2.

Indian Pediatr 2004; 41: 559-575.

3.

Diabetes Res Clin Pract 2002; 57:

185-190.

Urban India
Elite classes
Urban slums

Fattening

Rural India

Poverty and
Undernutrition

Factors responsible
Changes in Life Style
(Urbanisation)
Unhealthy eating patterns
Wrong choices of food,
increased portions
Increased oil consumption
Snacks, colas, rewards

Other factors
High glycemic index of foods

Genetic / Constitutional
predisposition

Sedentary pursuits
Long school hours,
tuitions,
Reduced physical activity
vehicles, reduced play
areas
TV, telephones

Bhave S, Bavdekar A, Otiv M. IAP National Task Force for Childhood ,Prevention of Adult Diseases: Childhood
Obesity. Indian Pediatr 2004; 41:559- 75.
Khadilkar VV, Khadilkar AV. Prevalence of obesity in affluent schoolboys in Pune. Indian Pediatr 2004; 41: 857-858

Indian scenario
Midst

of a rapidly escalating epidemic T2DM

and CHD
Prevalence T2DM increased in urban Indian
adults from < 3% in 1975 to > 12% in the year
2000
By the year 2025 it is predicted that India will
have a rise of 59% of diabetics in the
population... Which is the highest number of
diabetic patients in the world.
Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK, et al. High
prevalence of diabetes and impaired glucose tolerance in India: National urban
diabetes survey. Diabetologia, 2001; 9: 1094-1111.

NY Times Sep 13 2006 NR Kelinfield

Modern ways open Indias door to diabetes

Type 2 DM India -1

10% of newly diagnosed DM are in age group of 10

18 years
Most were asymptomatic: picked up on screening for
obesity or strong family history.
Venkatnarayan KM. Type 2 Diabetes in Children: A problem lurking for India ?
Indian Pediatr (editorial) 2001; 38: 701-704.

Cut off values of BMI for

overweight
Agency

State of overweight

WHO

Tendency for
overweight
> 25 kg/m2

IOTF

> 23 kg/m2

> 25 kg/m2

NCHS

> 30 kg/m2

> 85thcentile
> 95th centile
(90th centile recently) (97th centile recently)

Cutoff Values for BMI For Obesity in Indian

Studies
95th centile
Girls

95th centile
Boys

Author

Range

Year

Vedavati

22-27 kg/m2

1998

Agarwal

23-27 kg/ m2

1988-1994

Cole

24-29 kg/m2

1963-1993

Khadilkar

24-27 kg/m2

2004

Agarwal

22-27 kg/m2

1988-1994

Cole

23-28 kg/m2

1963-1993

Local BMI values are collected on smaller samples and comparison

between them and with international norms are not feasible.

BMI values show

wide variations
between regions,
and the period of
the studies.
Pune study, age
10-13 years, BMI
of boys have
been even higher
than the
international
values.
Delhi Agarwals
chart for the 85th
and 95th centile
show lower BMI
values than the
WHO values

Characteristics of obesity in India

Frank

obesity not as high as in the

West
But body composition & metabolism of
Indians (asians in general) make
them especially prone to adiposity
(fat content in the body) and its
consequences.
South Asians have at least 3 to 5%
higher body fat for the same BMI as
compared to Caucasians.
The fat is typically located centrally
(i.e. waist, trunk) and around
visceral organs - metabolically more

Constituents of the Metabolic Syndrome

(Syndrome X, Insulin Resistance Syndrome)

Central Obesity: waist circumference

> 90 cms for males

and

> 80 cms for females)

As per the new 2005 International Diabetes Federation

definition 3, the criteria for the diagnosis of the metabolic
syndrome are:
central obesity + any two of the following four factors*
Raised serum triglycerides
> 150 mg /dl
Reduced serum HDL cholesterol
< 45 mg / dl
Raised blood pressure (BP systolic
> 130, and diastolic
> 85 mm Hg)
Raised fasting blood sugar level
( > 100 mg/dl)

Indian cohort studiesdelhi

An

increase of BMI of 1 SD from 2 to 12 years

of age,
increased the odds ratio for disease (IGT /
DM) by 1.36. in young adults
It

is now evident that our traditional understanding

of concepts of `catch up growth in childhood, and
healthy weight gain during adolescence may
need redefining.

Bhargava SK, Sachdev HPS, Fall CHD, Osmond C, Lakshmy R, Barker DJP, et al. Relation of serial changes in
childhood body-mass index to impaired glucose tolerance in young adulthood
New Eng J Med 2004; 350: 865-875.

KEY MESSAGES

India

: alarming epidemic of T2 DM, CHD

& other associated with the IRS
(metabolic syndrome X). Ethnically,
Indians have lower muscle mass and
higher body fat (especially central
obesity).
Targeted effectively through school /
college campaigns to focus on healthy
eating, increased physical activity and
reduction in sedentary habits.

PROGRAMMES FOR ADOLESCENTS 30

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KISHORI SHAKTI YOJANA To improve the health and

nutritional status of girls

BALIKA SAMRIDHI YOJANA To Delay the age of marriage

NEHRU YUVA KENDRA ACT AS HEALTH AWARENESS
UNIT-Through active participation
of youth

MAHILA SAMAKHYA PROGRAMME- Equal access to education

facilities for adolescent girl
and young women

Adolescent Health-An Overview

PROGRAMMES FOR ADOLESCENTS

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SCHOOL AIDS EDUCATION, UNIVERSITY TALKS AIDS

TRAINING OF RURAL YOUTH FOR SELF EMPLOYMENT
REPRODUCTIVE AND CHILD HEALTH PROGRAMME

? WHERE ARE THE BOYS

NO COMPREHENSIVE PROGRAMME
ADDRESSING ALL NEEDS OF ADOLESCENT

Adolescent Health-An Overview

To promote healthy
development to meet
needs and build
competencies
Safety,
Belonging,
Self
Esteem,
Caring
relationship

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Programming
To prevent and respond to
health problem from:

Early, unprotected,
unwanted sex

Use of tobacco and misuse

of alcohol and other
substances

Accidents

Psychological
eg communication

Violence

Poor nutrition

Moral
eg personal responsibility

Endemic disease

Physical
eg eating habits

Vocational
eg entrepreneurial skills

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STRATEGIES FOR PROMOTION OF ADOLESCENT HEALTH

A =ADOPTION OF HEALTHY LIFE STYLE

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D=DEVELOP APPROPRIATE I.E.C. STRATEGY

DISCOURAGE EARLY MARRIAGE AND TEENAGE PREGNANCY

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O=ORGANIZE ADOLECENT/ YOUTH FRIENDLY CLINIC

L=LIFE SKILL EDUCATION , LEGAL SUPPORT, LIASIAN WITH PEERS , PARENTS
E=EDUCATE ABOUT SEXUALITY,SAFE SEX,SPIRITUALITY,RESPONSIBLE
PARENTHOOD
S=SAFE, SECURE AND SUPPORTIVE ENVIRONMENT TO BE PROVIDED
C=COUNSELLING / CURRICULM IN SCHOOL INCUSIVE OF FAMILY
LIFE EDUCATION
E=ENABLE &EMPOWER FOR RESPONSIBLE CITIZENSHIP
N=NETWORKING FOR EXPERIENCE SHARING
T=TRAINING FOR INCOME GENERATION,TEEN CLUBS

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

A positive and encouraging attitude has to be

developed among the family members ,parents
and teachers.

School teachers should be trained on adolescent

health.

Community leaders play a vital role on

adolescent health care.

Adolescent Health-An Overview

THE CHALLENGES ARE THERE BUT

POTENTIAL IS FAR GREATER

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Thank You!