Which health problems affect adolescents and what can be done to prevent and respond to them?

Mental health

Many mental health problems emerge in late childhood and early adolescence. Enhancing social skills, problem-solving skills and self confidence can help prevent mental health problems such as conduct disorders, anxiety, depression and eating disorders as well as other risk behaviours including those that relate to sexual behaviour, substance use, and violent behaviour. Health workers need to have the competencies to relate to young people, to detect mental health problems early, and to provide treatments which include counselling, cognitive-behavioural therapy and, where appropriate, psychotropic medication.

Substance use

In addition to laws that limit the availability of illicit substances, tobacco and alcohol, interventions to reduce demand for these substances improve the conditions for healthy development. Increasing their awareness of the dangers of substance use, building their competence to resist peer pressure and to manage stress in a healthy manner is effective in reducing adolescents' motivation for substance use.

Violence

Life skills and social development programmes for children and adolescents are important for reducing violent behaviour. Supporting teachers and parents to build skills in problem solving and non-violent disciplining is also effective in reducing violence. If and when violence does occur, actions to make health systems more responsive, and to build the empathy and competence of health workers, can help ensure that adolescents who experience violence, including sexual violence, get effective and sensitive care and treatment. Ongoing psychological and social support can help adolescents deal with the long term psychological effects of violence, and to reduce the likelihood of their becoming perpetuators of violence in the future.

Unintentional injuries

Approaches for reducing road traffic crashes, and the occurrence of serious injuries if and when crashes occur, are important for safeguarding adolescent health. These include:

• enforcing speed limits;
• combining education with laws to promote seat belt (and helmet) use and to prevent driving under the influence of alcohol or other psychoactive substances;
• providing alternatives to driving by increasing the availability of safe and inexpensive public transport.

Actions to make the environment safer and to educate children and adolescents on how to avoid drowning, burns and falls can help reduce the likelihood of their occurrence. When someone is injured, prompt access to effective trauma care can be life saving.

Nutrition

Chronic malnutrition in earlier years is responsible for widespread stunting and to adverse health and social consequences throughout the life span. This is best prevented in childhood but actions to improve access to food could benefit adolescents as well. Anaemia is one of the key nutritional problems in adolescent girls. Preventing too-early pregnancy and improving the nutritional status of girls before they enter pregnancy could reduce maternal and infant mortality, and contribute to breaking the cycle of intergenerational malnutrition. This will involve improving access to nutritious food, to micronutrient supplementation and in many places to preventing infections as well. Adolescence is a timely period to shape healthy eating and exercise habits which can contribute to physical and psychological benefits during the adolescent period and to reducing the likelihood of nutrition-related chronic diseases in adulthood. Promoting healthy lifestyles is also crucial to halting the rapidly progressing obesity epidemic.

Sexual and reproductive health

Programmes that aim to educate adolescents about sexual and reproductive health need to be combined with programmes aimed at motivating them to apply what they have learnt in their lives. They should also be combined with efforts to make it easier for adolescents to obtain any preventive or curative health services they might need from competent and empathetic health workers. Sexual coercion in adolescence needs to be fought at different levels. Laws requiring severe punishment for this crime should be passed and energetically enforced, and public opinion should be mobilized to become fiercely intolerant of it. Girls and women should be protected from sexual harassment and coercion in educational institutions, work places and in other community settings.

Preventing too early pregnancy may require the enactment and enforcement of laws that specify a minimum age for marriage, as well as actions to mobilize families and communities to give their daughters the additional time they need to grow and develop from girlhood into womanhood before becoming wives and mothers. Alongside this, health services should be ready to provide adolescents who are pregnant with the antenatal care they need, or to obtain a safe abortion where this is permitted by law. Effective care during child bearing is important to ensuring the survival of mothers and their babies, and the prevention of problems such as fistulas.

HIV

Young people’s risk of HIV infection is closely correlated with age of sexual debut. Abstinence from sexual intercourse and delayed initiation of sexual behaviour are among the central aims of HIV prevention efforts for young people. Decreasing the number of sexual partners and increasing access to, and utilization of comprehensive prevention services, including prevention education and provision of condoms, are essential for young people who are sexually active. Programmes should also focus on prevention and early intervention in other health risk behaviours, such as substance use. Young people need HIV testing services that are accessible and appropriate. Young people living with HIV need treatment, care, support and positive prevention services. All HIV services for young people should involve young people living with HIV in their planning and provision.