 Adolescent and Faculty Health

Dr Nashwa Radwan
Prof. of Public Health and
Preventive Medicine
 Definition
 Adolescence is the period of life
between puberty and full maturity. It
is characterized by rapid growth and
change in anatomy and physiology
as well as shifting values and
allegiances. It is roughly from 12 to
21 years of age.
 Characteristics of adolescent
personality
Although adolescent are frequently portrayed
as hostile, and rebellious, they actually have
many positive attributes. Adolescents are
intensely idealistic and often have a passion
for fairness and social justice. They are
energetic and enjoy peak physical health.
They tend to be optimistic about the future
and excited about dreams, plans and goals.
 Rationale for being a priority
health program:
 Adolescence is a time of dramatic physical and
psychosocial developmental changes that
challenge the coping skills of adolescents, families,
health professionals, and communities to a greater
degree than any other age.
 This transitional phase between childhood and
adulthood lasts for more than a decade, beginning
around age 10 years and extending through age
21 years or later. In dynamic changes three areas
are of special interest:
 Developmental stages of
adolescence
Development is a dynamic process that continues
throughout the lifespan. Adolescence is
commonly divided into three developmental
stages.
 Early [ 11-14 years]
 Middle [ 15 – 17 years]
 Late [18 –21 years]

- Age ranges are approximate. At each stage,

characteristics changes take place in physical,
psychosocial and cognitive thinking.
 Dynamic changes
physical changes :
 The growth spurt, development of adult body physique,
hormonal changes, sexual development, and the ability
to reproduce come with puberty.
psychosocial changes:
 Essential tasks of adolescence include emancipation from
family, development of peer relationships and sexual
intimacy determination of educational and vocational
goals and establishment of identity and self-
responsibility.
cognitive changes:
 Adolescence progress from concrete operational thinking
(here and now) to abstract operational thinking with a
maturing ability to engage in deductive reasoning,
understand risk and benefits and appreciate future
consequences of current choices.
 Adolescent health
problems
1-Mortality
2-Morbidity:
A-Physical problem.
B-Mental problem.
C-Behavioral problem.
Mortality
 A-Mortality

-Injuries represent the leading cause of

death among adolescents. Most of
adolescent deaths are motor vehicle
related.
-Other traumatic causes of death include
homicide, suicide, and drowning.
-Cancer.
-Drug abuse and alcohol.
B-Morbidity
 1- Physical problems

-One in five adolescents has some form of

chronic illness, deformity, or physical
handicap.
-Chronic illnesses which may responsible for
delayed puberty include severe asthma and
other pulmonary disorder, renal disease,
cardiac disorder and inflammatory bowel
disease.
-Dental problems affect two – thirds of the
adolescent population.
-Skin pathology, which includes acne, affects
more than one third of adolescent
population
 2-Mental problems
Key Issues facing Young People
 Abuse

 Low self esteem.

 Depression.

 Anxiety.
 Abuse
 What is abuse?
 Everyone has the right to be safe. Abuse is when
a person acts in such a way towards someone
that make him or her feel unsafe, hurt. , or
angry.
 Children, adolescents and elderly people do not
have to deal with abuse on their own.So, they
are more liable to abuse.
 There are organizations that can help and
support you.
 Types of abuse

 Sexual abuse.
 Physical abuse.
 Emotional abuse.
 Sexual abuse
 Sexual abuse is when someone touches another or does
things to him that may leave him feeling angry, hurt and
probably confused.
 Abuse can be done by known and trusted people as well as
strangers.
 Abuse can happen when a person is too frightened to say
no, or he has thought that he had to do as he was told.
 If someone is told that what is happening must be kept a
secret and that he is special because of it, then that person
knows what they are doing is wrong.
 It is okay for Children and Young People not to keep
secrets about being abused.
 You are not responsible or to blame for being abused, the
person doing the hurting is in the wrong.
  
 Physical abuse

 It is against the law for a person to

physically attack another person. Yet it
is not against the law for a parent to
physically punish their son/daughter, as
long as it does not result in
bruising/cuts/broken bones/scars.
 Emotional abuse

 Abuse is not just about physical or sexual

abuse but can also include bullying or
making you feel small or bad about yourself.
 Adults have responsibility for their own
anger. They need to control their behavior
whatever the situation.
 How can obtain help?
 If you are being abused, you can obtain help to prevent
the abuse from occurring and support from your local
Social Services .
 If you need help to deal with the emotional impact of
abuse, the Child and Family Consultation service may be
able to help.
 A lot of people feel worried or frightened that getting
help will mean that their family is broken up or that the
person hurting them will end up going to prison. Social
Workers work very hard to try and ensure that children
and their families remain together and they have a duty
to provide families with the help they need to ensure
that children can remain with their families. If someone
in your family is hurting you or abusing you, then, if
necessary, that person will need to leave the family, not
you.
 Depression: What is it?

 Everyone feels low from time to time, it’s

part of being human, reacting to what is
going on around you. Maybe a friend lets us
down or we’re not getting good marks for
our schoolwork. Usually we bounce back
and feel better in a while or decide what we
are going to do about the problem.
Depression is a state where

 We feel low a lot of the time.

 It gets to the point where we want to stay away from
other people.
 We have difficulty with everyday activities like eating
or sleeping.
 Nothing much makes us feel better
 We tend to notice the negative things about life.
 Turn what other people say to us into criticism.
 We expect the worst to happen.
 About 5% of young people in their teens will suffer
depression this badly. At its worst, it may make us
feel that we want to harm ourselves
 What can you do if you are
depressed
 Although it is common for people who feel
depressed to want to hide away from
others, it is important that you talk to other
people about it, a friend or an adult you
trust. This might be one of your parents, or
another relative, or the school nurses if you
are still at school.
If the problem continues, go and see your
GP. GPs often do not have a lot of time for
talking but he or she will know about
services that they can refer you on to,
 Self Esteem
 What problems can there be?
 Unfortunately we are not born with a reservoir full
of self-esteem.
 Our feelings about ourselves, our value and the
world are gained through our experiences.
 Crucially, how we are treated by others often
determines our views of ourselves.
 Indeed persons at any age told that they are
stupid, thick or ugly or who are not valued in other
ways, will come to believe that this is true and that
they are indeed stupid, thick and or ugly.
 So what to do?
 We are all born the same, no one despite any handicap,
Learn to accept it, repeat daily to yourself.
 Talk about what is worrying you to a trusted person.

 Talk about the good experiences in your life.

 Know that the period of feeling so low of mood will pass

 . Eat regularly, sleep regularly

 Take up exercise – swimming, yoga.

 Read self help books – they were written by people who

once felt like you did and look, now they are authors!

 But most importantly don’t give up!

 Anxiety

 What is stress?
 We all experience Stress at one time or
another.
 It is said that moderate levels of stress may
even be beneficial and helps to keep us alert
and provides us with some of the energy we
need to be interested in our environment.
 Indeed, some stress is needed to do things
like crossing the road in safety because we
are more alert to danger and our bodies are
getting ready to take actions
 What kind of problems can cause
you to experience stress

 There are many changes for you with school exams.

 Friends may pressure you.
 Worries about future careers and qualifications.
 Perhaps you are being bullied by people at school, or by other
people outside of school.
 Your mum and dad are arguing a lot or are separating.
 Your mum or dad may be seriously or long-term ill.
 Your parents are out of work and have money problems
 Someone who was important to you has died recently
 3-behavioral problems
Cigarette smoking is reported by more
than 10% of the population- most
adult smokers begin in
adolescence.
 2-Drug abuse
Including the use of depressants,
stimulants, hallucinogens, among
this population
 3-Pregnancy and sexually
transmitted diseases
(STDs)
A-There is a higher incidence of infant mortality.
B-There is a higher incidence of sexually transmitted
diseases.
C-Adolescent mothers usually are unprepared
psychologically, economically and educationally for
parenthood.
D-Adolescent parents are at increased risk for failure to
complete their education and to find employment,
there by limiting their future economic well being.
 4-Eating problems

 Preoccupation with body image and

adult sexual roles had led to increase
in eating problems with potentially
severe metabolic side effects including
death.
 The incidence of obesity also
increases in adolescence, especially
among adolescent girls.
 What people eat differs from one person to the
other. Some people choose to follow a “healthy”
diet; some people prefer “junk food”. Some people
eat more than they need; others eat less than they
need. In most cases, these variations between
people are perfectly normal.
 However some people take it to the extreme, either
by compulsive overeating or by avoiding eating.
This can be very dangerous to one’s health and can
cause some serious damage, both to one’s mind
and to their body.
 Both boys and girls can suffer from eating
problems, but it is mostly girls that are likely to
develop eating problems.
 Anorexia Nervosa
 A lot of people worry about how they look, and some believe
that they are overweight, even though they are not.
 Unfortunately, some people, mostly young girls, take
drastic measures to reduce their weight and bodily fat. They
eat very small quantities of food, usually the kind of food
that does not contain any fat.
 In order to lose weight, people with anorexia nervosa will
exercise too much, make themselves vomit, pretend they
have eaten when they have not or even take laxatives.
 Despite sometimes appearing to be very thin, they do not
believe this to be the case, and may ignore advice.
 Bulimia Nervosa And
Compulsive eating
 People who suffer from bulimia eat more food than they
need or want, which they then try to get rid of by forcing
themselves to vomit or by taking laxatives. It is not
always obvious that someone is suffering from bulimia;
they don’t always look overweight or underweight, but
their bodies can get seriously damaged.

 Some people eat more than they need over a length of

time, which can make them overweight and cause them
health problems. People with compulsive eating
problems often eat too much to comfort themselves or to
distract themselves from something threatening to their
mental or physical health.
Signs of eating problems

 Eating food with low calorific content only.

 Exercising too much

 Sudden loss or gain of weight

 Skipping meals frequently

 Large quantities of food missing from the

kitchen
 What causes eating
problems?
 There is a wide variety of possible reasons for eating
problems. Usually they are the result of an underlying
emotional problem. Sometimes problems at school or at
home, loss of someone we care about, parents’ divorce or
abuse can trigger the start of eating problems.

Society has also played an important role in maintaining

eating problems. The role models that most people have
are thin people, portraying a “perfect” image. Young
people especially are very vulnerable to that influence and
some of them will do anything to look like their role model.
 Adolescent health services
Are the health activities concerned
with the adolescents and aimed to
improvement and maintenance of
their health status.
Components of adolescent health
services

 Health appraisal.
 Immunization.
 Health education.
 Management and prevention of
adolescent health problems
 Health appraisal

-An appraisal of health is an evaluation

or assessment of the present health
status.
-It must be a continuous process from
school entrance examination, the
observation by teachers, to the last
health evaluation in the final year of
high schools
 Objectives
1-Assessment of health status.
2-Case finding.
3-A source for health indices and
statistics.
Methods of health appraisal
 Comprehensive medical
examination.
 Health supervision
 Screening tests.
 Surveys.
 Comprehensive medical
examination
 It is recommended at each of the three
stages of adolescent development:-
 Items of examination includes:-
 Physical examination: to assess physical
development.
 Personal interview: to assess psycho-
social development.
 Laboratory investigations: e.g. urine for
suspicious drug abuse
 Health supervision
Health supervision visits for adolescents differ from
traditional health maintenance visits in the following:-
 1-The provider activity complements health guidance that
adolescents receive from school, family and community.
 2-Preventive intervention target” new morbidities” such
as alcohol, drugs, and sexual risk taking, rather than
emphasize biomedical problems.
 3-The provider screens for" co morbidities” which are
clusters of risk taking behaviors rather than treats
categorical health conditions.
 4-Periodic health supervision visits are recommended to
provide anticipatory guidance and early intervention
rather than episodic visits such as those of immunization
 Screening tests
Screening is the initial examination of
an individual to detect disease not
yet under medical care. Screening
may be concerned with a single
disease or with many diseases
[called multiphase screening ]
 Screening tests among
adolescents includes
 Screening for physical growth and
development.
 Screening for smoking and drug abuse.
 Screening for suicidal attempts.
 Screening for sexually transmitted
diseases.
 Screening for tuberculosis [regularly
during childhood in high risk population].
 Screening for hypertension.
 a) Screening for physical
growth
 If there are no signs of puberty by age 16,
delayed puberty should be evaluated. The most
common causes of delayed puberty include
familial short stature, constitutional growth delay,
and chronic illness. In delayed puberty, the most
important aspects of screening are
 Family history.
 Past growth pattern.
 S M R stage.
 Medical history.
 Bone age radiographs.
 Measurement of 8 A.M. serum testosterone in boys or
serum follicle – stimulating hormone in girls
 b- Screening for drug abuse
and cigarette smoking
 Primary caregivers should routinely screen
adolescents for alcohol and drug abuse .Adolescent
substance abuse occurs along a continuum, ranging
from experimental use (a normal developmental
variation) to regular use (often in a social context).
 Four questions have good ability to predict which
adolescents may be at risk:
 Do you smoke cigarettes?
 Have you ever been suspended from school?
 Do you have a problem with alcohol or drugs?
 Have you ridden in a car driven by some one [including
yourself] who had been using alcohol or drugs?
 Do you have any closet friend or a member of your
family who having a problem with drug abuse?
 CAGE

One of the most useful tools to screen for serious drug

and alcohol problems in the CAGE series of questions:-
 C = Have you ever felt the need to cut down on your
use of alcohol or drug use?
 A = Have you ever gotten annoyed by some one’s
criticism of your alcohol or drug use?
 G= Do you ever feel guilty or bad about your alcohol
or drug use?
 E= Do you ever need an eye- opener, by a drink or
drug in the morning before you go to school?
 Two or more “yes” answers have a high degree of
sensitivity and specify in diagnosing substance abuse
 C) Screening for suicide
Suicide attempts have been usually associated with:
 1-Depression
 3-Overall number of life stressors
 5-Increasing family conflict
 2-Illicit substance abuse
 4-Health risks behaviors e.g. lack of seat belt use, physical
fighting, gun carrying.
 6-Hitory of suicide in a close family member or friend.
 7-History of previous suicide attempt.
Two questions are widely recommended to be highly predictive for
suicide risk:
 Have you felt sad or depressed for more than 3 days.
 Have you thought of killing yourself in the past 3 months.
Recognizing a suicidal adolescent is difficult, but if risk factors are
present, promote intervention is essential
 Adolescent surveys
An adolescent survey is a field study to
define the magnitude of certain
health problem among adolescents.
Collected date is the basis for
planning and evaluation of
prevention and control programs for
adolescents
 -2-Immunization
Recommended immunizations for
adolescents may include:-
 - MR: May given at entry to
secondary or high school.
 -TD: Repeat every 10 years
throughout life
 -BCG: At high risk communities.
3- Health education
 Primary caregivers have a critical role in
ensuring that adolescents are competent and
motivated to make wise choices as they form
life long habits.
 The centers for Disease Control- Division of
Adolescents and School Health selected six
priority health behaviors which are major risk
factors of morbidity and mortality and are
highly prevalent, modifiable, and measurable.
Other areas of great concern for mortality such
as suicide and homicide are difficult to reduce
to a single achievable behavioral goal and
therefore are not addressed in the six priority
behaviors.
 Priority six behaviors
 Use seat belts.
 Do not drink or use drugs and drive.
 Do not have a sex.
 Do not smoke.
 Eat a low – fat diet.
 Get regular aerobic exercise.
 Counseling of
adolescents
 Counseling is most effective if it actively engages
the adolescent in problem solving. Four steps are
involved.
 Define the problems: Ask the adolescent to
describe the situation and any feeling for fears about it.
 Explore the options: Ask the adolescent to
describe some ways to solve the problems , the health
provider simply listens.
 Analyze the consequences: Ask the adolescent
to review the most likely positive and negative
consequences of the best solution considered.
 Develop an action: Ask the adolescent to identify
the specific steps to take after leaving your office.
Include a plan for follow up.
4-Management and prevention
of adolescent health problems:
 Sex – related problems
 Sex education is intended to avoid have a sex and
use of contraceptives and thereby reduce the risk of
unwanted- pregnancy for early marriage.
 Intensive management of adolescent pregnancies
may reduce the risk of low – birth – weight infants
and post neonatal death.
 Routine adolescent care should also include pap
smears and vaginal cultures for sexually active
adolescent girls to screen for STDs and early cervical
changes indicative of cancer.
Smoking and substance abuse
-Educational campaigns meet with limited
success, but intensive – school – based
efforts may limit cigarette smoking
among adolescents.
 Potential methods for prevention of
substance abuse include:
 Enforcement of drinking – age laws.
 Parental monitoring.
 Enhancing moral rules.
 Motivating physical exercise.
 Injuries
 A) Regulatory activities are more effective than educational
campaigns. Such activities include the establishment of:

1-Drinking – age laws.

2-Motorcycles and bicycle helmet laws.
3-Requirements for protective gear in athletic programs.
4-Regulations concerning access to firearms.

 B) Management of injuries is an essential component of an

adolescent health program, which should also include:

 Prompt access to emergency service.

 Careful assessment of psychological status.
 Management of injuries and drug ingestion.
 Referral to mental health services if suicidal intent is
indicated.
 Improvement of adolescent health
services

1-School – based and school linked clinics

Implementation of school – based and school linked
health services is seen as one means to overcome
barriers to health services. It ranges from professional
telephone consultations with school- based personnel
to comprehensive onsite health clinics that provide
primary care , mental and social health services and
other support . Advantages of school – based clinics
include good accessibility and affordability.
2-Increased caregiver training
in adolescent medicine
 Specific training programs in
adolescent medicine are needed in
pediatrics, family ,obstetrics,
gynecology and internal medicine.
 3-Expanded health care
insurance
 Health insurance programs may
expand to improve accessibility for
homeless, emancipated, out of
school, unemployed, and other
disadvantaged adolescents.