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ADOLESCENCE BOON OR

BANE
Dr.K.P.Ganta gameshwaran M.D
Associate prof of psychiatry
Thoothukudi Medical College
Children: Our Hope and Future

“In every child who is born,


under no matter what
circumstances, and of no
matter what parents, the
potentiality of the human
race is born again.”
James Agee, American writer, 20th century
Brain Functions
Brain Research and Mylenation
Mylenation: fatty covering of neurons that
increases speed of information traveling
through nervous system

Finding: children who watch excessive


amounts of TV have less mylenation, thus
not able to process information as quickly as
children who have sensory rich experiences
Brain Research and Middle
Childhood
6 – puberty: most
brain growth is in
temporal and parietal
lobes

Implication: critical
time for development
of language (literacy)
and spatial skills
Brain Research and
Adolescence
Adolescent brains have
more activity in amygdale

This is primary area for


processing emotions

Implication: academic
learning occurs in on-
going context of
emotional processing
Brain Based Gender
Differences
1. Portions of the corpus callosum (band of tissue
through which the brain’s two hemispheres
communicate) larger in females
2. Part of hypothalamus responsible for sexual
behavior larger in males
3. Area of parietal lobe involved in spatial tasks
larger in males
4. Areas involved in emotional expression show
more metabolic activity in females
Adolescent Development
Adolescence:
• Period of change from child adult
– Psychological growth
– Cognitive changes
– Social /cultural transformation

Puberty:
• Biologic process
• Transition child  adult
– Secondary sexual characteristics
– Adult size and appearance
– Reproductive capabilities
Tasks of Adolescence
• Body matures to sexual adult
• Cognitively-brain develops abstract thinking skills
• Morally, the teen identifies meaningful moral /social
standards, values and belief systems
• Identity formed– gender, sexual, cultural
• Teen defines an adult role with responsibilities

Source: A. Rae Simpson, PhD, Parenting of Adolescents Center, Harvard School of Public Health
Stages of Adolescent Development
• Early Adolescence
Females: 9 - 13 yo
Males: 11 – 15 yo
• Middle Adolescence
Females: 13 – 16 yo
Males: 14 – 17 yo
• Late Adolescence
Females: 16 – 21 yo
Males: 17 –21 yo
Early Adolescence
• Adjusting to body/pubertal changes “Am I normal?”
• Concern with body image and privacy
• Begin separation from family, increased parent-child conflict
• Self preoccupation and fantasy
• Moody!
• Same-sex friends and group activities
• Concentration of relationships with peers
• Concrete thinking but beginning to explore new ability to
abstract - focused on the present
Middle Adolescence

• Extremely concerned with looks- “Am I attractive?”


• Increased independence from family-(vacation dilemmas)
• Increased importance of peer group (Everyone’s doing it)
• Experimentation with relationships & sexual behaviors
• Movement towards forming sexual orientation / identity
• Increased abstract thinking ability
• Development of ideals & selection of role models
• The altruistic idealist
Late Adolescence
• Autonomy nearly secured-not mean totally
• Body image & gender role definition nearly secured
• Thinking beyond themselvesworld view
• Attainment of abstract thinking & useful insight
• Greater emotional stability
• Greater intimacy skills
• Sexual orientation nearly secured
• Ability to express ideas in words
• Concern for future
• Transition to adult roles-school, work
Protective Factors in Adolescence
• Parental/family connectedness
• Connectedness to a significant adult
• School engagement & success
• Not working, or working < 20 hours/wk
• Being “in-sync” with peers re: physical dev
• Perceived importance of religion and prayer
• Participation in organized activities
Background
Why should we invest in adolescent health?
Annually, an estimated $700 billion is spent on preventable
adolescent health problems.
This estimate considers only the direct and long term medical
and social costs associated with 6 common health problems:

− Adolescent pregnancy − Alcohol & other drug problems


− Sexually transmitted infections − Other unintentional injuries
− Motor vehicle injuries − Mental health problems
Determinants of Health
ACCESS TO CARE
10%
GENES
20%
ENVIRONMENT
20%

BEHAVIOR
50%
Mortality
After peaking in the early 1990s, mortality
rates have decreased to (or are near) record
lows for all adolescents.
Over the last century, the leading causes of
death for adolescents changed from natural
causes to injury and violence.
Injury and violence account for 71% of deaths
among adolescents and young adults.

Sources: CDC Wonder, Compressed Mortality Database, 2004 - http://wonder.cdc.gov;


CDC, National Center for Injury Prevention and Control, 2005 - http://www.cdc.gov/ncipc/wisqars/
Trends in Overall Mortality by Gender,

160 Ages 10-24, 1980-2002


Males
140
131.7 Females
120
Deaths per 100,000

100
85.0
80

60

40
47.2

20 34.1

0
80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

00

01

02
19

19

19

19

19

19

19

19

19

19

19

19

19

19

19

19

19

19

19

19

20

20

20
Source: CDC Wonder, Compressed Mortality Database, 2004 - http://wonder.cdc.gov
Mortality by Race/Ethnicity & Gender,
Ages 10-24, 2002
160
131.1 Males
140 125.2
Females
120
Deaths per 100,000

100 82.2 77.6


80 59.1

60 43.9 44.2
26.9 34.0
40 20.1

20

0
American Black, non- Hispanic White, non- Asian/Pacific
Indian/Alaskan Hispanic Hispanic Islander, non-
Native, non- Hispanic
Hispanic

Source: CDC, National Center for Injury Prevention and Control, 2005 -
Leading Causes of Death for Adolescents
and Ages 10-19, 2002

Motor Vehicle
Accidents
Other Unintentional
20.6% Injuries
34.1% Suicide
3.0%
Homicide
7.1%
Malignant Neoplasms

11.9% Heart Disease


12.6%
10.7% Other

Source: CDC, National Center for Injury Prevention and Control, 2005 -
Injury
Unintentional injury mortality has fallen over the past two
decades due to a decrease in fatal motor vehicle
accidents, the leading cause of death for adolescents.
82% of high school students and 70% of 18-24 year-olds
in 2003 reported that they always use seatbelts.
33% of fatal crashes among 21-24 year-olds in 2002
involved alcohol.
28% of 18-25 year-olds in 2003 reported that they drove
under the influence of alcohol or illicit drugs.

Sources: CDC/NCIPC, 2005; YRBSS, 2004; BRFSS, 2004; NHTSA, 2003; NSDUH, 2004
Unintentional Injury Mortality by
Race/Ethnicity, Ages 10-24, 2002

API, non-Hispanic 3.7 10


Other Unintentional Injuries
Motor Vehicle Accidents
Black, non-Hispanic 6.4 16

Hispanic 5.6 18

White, non-Hispanic 7.6 20.5

AI/AN, non-Hispanic 10.1 39.6

0 10 20 30 40 50 60

Deaths per 100,000


Source: CDC, National Center for Injury Prevention and Control, 2005 -
Injury Risk Behaviors by Gender, High School
Students, 2003
50%
Males
40% Females
31.1%
29.2%
30%
21.5%

20% 15.0% 14.6%


8.9%
10%

0%
Drove After Drinking Rarely/Never Wore Seat Rode w/Driver Who Had
Belts Been Drinking
Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/
Violence

Homicide is the second largest cause of death for


adolescents.
In 2002, males ages 15-19 had a homicide rate 5 times
the rate for same-age females (15 vs. 3/100,000).
In 2002, males ages 20-24 had a homicide rate 6 times
the rate for same-age females (27.5 vs. 5/100,000).
Black, non-Hispanic males ages 15-24 had the highest
homicide rate (86/100,000) in 2002.
Homicide rates have decreased in the past decade
among ages 10-24.
Source: CDC, National Center for Injury Prevention and Control, 2005 -
Homicide Mortality by Gender &
Race/Ethnicity, Ages 10-24, 2002
2
White, non-Hispanic
3.9 Females
Males
1.7
API, non-Hispanic
6.4

4.7
AI/AN, non-Hispanic
11.9

2.8
Hispanic
21

6.3
Black, non-Hispanic
57.1

0 10 20 30 40 50 60
Deaths per 100,000

Source: CDC, National Center for Injury Prevention and Control, 2005 -
Homicide Trends, Males,
Ages 15-19, 1990-2002
160
AI/AN, non-Hispanic
White, non-Hispanic
140
Black, non-Hispanic
Hispanic
120 API, non-Hispanic
Deaths per 100,000

100

80

60

40

20

0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Source: CDC, National Center for Injury Prevention and Control, 2005 -
Violence-Related Behavior by
Gender, High School Students, 2003
50%
43%
Males
40% Females
29%
30% 24%

20%

10%
10% 6%
1%
0%
In a Physical Fight Carried a Weapon Carried a Gun

Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/


Suicide
In 2002, males ages 15-19 had a suicide rate 5 times
the rate for same-age females (12 vs. 2/100,000).
In 2002, males ages 20-24 had a suicide rate 6 times
the rate for same-age females (21 vs. 3.5/100,000).
American Indian/Alaskan Native, non-Hispanic males
ages 15-24 had the highest suicide rate (36) in 2002.
Suicide rates have decreased in the past decade
among ages 10-24, from 9/100,000 in 1981 to 7/100,000
in 2002.

Source: CDC, National Center for Injury Prevention and Control, 2005 -
Non-Lethal Suicidal Behavior by Gender,
High School Students, 2003
50%
Males
40% Females

30% 23.6%

17.7%
20% 14.2%
11.8% 11.2%
10% 6.2%
2.1% 3.1%

0%
Seriously Made Suicide Attempted Required Medical
Considered Plan Suicide Attention

Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/


Suicide Mortality by Race/Ethnicity &
Gender, Ages 10-24, 2002
8.9
A/PI, non-Hispanic 3.6
Males
9.7 Females
Hispanic 2.6

10.1
Black, non-Hispanic 1.6

14.6
White, non-Hispanic 2.9

33.3
AI/AN, non-Hispanic 9.1

0 10 20 30 40

Deaths per 100,000

Source: CDC, National Center for Injury Prevention and Control, 2005 -
Sadness or Hopelessness which Prevented Usual
Activities by Gender & Race/Ethnicity,
High School Students, 2003
50%
42.3% Females
Males
40% 36.3%
34.0% 34.5% Total
32.3%
28.8% 28.8%
30% 25.5%

20%
20.9% 25.4%
20.5% 21.6%

10%

0%
White Black Hispanic Total

Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/


Learning Disabilities & ADHD by
Gender, Ages 12-17, 2001
20%
Males
Females
15%
12.8% 12.1%

10%
7.1%

4.3%
5%

0%
Learning disabilities Attention Deficit Hyperactivity
Disorder

Source: Bloom et al., 2003; NHIS; Parent report - http://www.cdc.gov/nchs/nhis.htm


Mental Health
Among 12-17 year-olds in 2003, past year:
– 21% received mental health treatment or counseling.
Among 18-25 year-olds in 2003, past year:
– 14% have a serious mental illness; higher among
females, non-Hispanic Whites & non-college bound;
– 35% of those with serious mental illness received
mental health treatment or counseling.
There are few national data on adolescent mental
health status.

Sources: NSDUH, 2004; Child Trends, 2003 - http://www.childtrends.org/


Substance Use
Use of tobacco, alcohol and illicit drugs has
decreased from the peaks of the late 1970s and
early 1980s.
American Indian/Alaskan Native and White
adolescents report the highest levels of use.
Rates of heavy substance use are a continuing
concern.
Trends in Past Thirty-Day Substance
Use, 12th Graders, 1975-2003
100%

80%
72%
67%
68% 64%
60%
53%
37% 39% 49% 37% 49%
40%
31% 27%
29% 28%
20% 31% 26% 25%
14%

0%
75

77

79

81

83

85

87

89

91

93

95

97

99

01

03
19

19

19

19

19

19
19

19

19

19

19

19

19

20

20
Alcohol Cigarettes Any Illicit Drug

Source: Monitoring the Future, 2004 - http://www.monitoringthefuture.org/


Past Month Substance Use by Type
and Race/Ethnicity, Ages 12-17,
2004
40%

Any Alcohol Use


Any Cigarette Use
26.0% Any Illicit Drug Use

19.9% 18.5% 18.0%


20%
17.9%

14.4%

11.1% 11.1%
9.8% 10.2% 9.4%
9.1%
6.0% 5.4%6.0%

0%
White NH AI/AN NH Black NH Hispanic Asian NH

Source: National Survey on Drug Use & Health, 2005 - http://www.drugabusestatistics.samhsa.gov/nsduh.htm


Reproductive Health
Overall, reproductive health trends over
the past decade are positive:
– Young people are delaying sexual activity;
– Among sexually active high school students,
there has been an increase in condom use;
– The rates of adolescent pregnancies, births
and abortion have declined;
– The prevalence of most sexually transmitted
infections has decreased.
Reproductive Health
However, certain trends warrant continued
concern:
– The wide prevalence of Chlamydia, as well as
increase in rates over the past five years;
– The relatively modest decline in the pregnancy
rate among Hispanic adolescents;
– The continuing high rate of STIs among young
Black females.
Pregnancy, Birth & Abortion Rates Among
Females Ages 15-19, 1980-2000
140

120

100
Rate per 1,000

80

60

40

20

0
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94

96
97
98
99
00
95
19
19
19
19
19
19
19
19

19
19
19

19
19

19
19
19
20
19

19

19
19
Births Abortions Pregnancies

Source: Henshaw, 2004 -http://www.guttmacher.org/pubs/teen_stats.html


Sexual Intercourse Experience by
Race/Ethnicity, Gender & Grade Level, 2003
100%
Males
Females
80% 66% 71% 67%
64%
60% 60% 61%
60%
47% 47%
35%
40%
26% 30%

20%

0%
White, non- Black, non- Hispanic White, non- Black, non- Hispanic
Hispanic Hispanic Hispanic Hispanic

9th Grade 12th Grade

Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/


Chlamydia Rates by Race/Ethnicity &
Gender, Ages 15-19, 2003
3500
3495.2 Males
Females
3000

2500
Rates per 100,000

2000 1794.1

1500

1000
574.6 322.5
500 193.2
127.5 136.9 39 49 139.1

0
Black, non-Hispanic American Hispanic White, non-Hispanic Asian/Pacific Islander
Indian/Alaskan Native

Source: STD Surveillance Report, 2004 -


http://www.cdc.gov/nchstp/dstd/Stats_Trends/Stats_and_Trends.htm
Overweight
The prevalence of being overweight has
increased among adolescents in the past
three decades .
Increases are found in all regions of the
country, urban/rural, both sexes, all ethnic
groups, rich and poor.
Obesity has been linked with numerous
health problems including heart disease,
hypertension, stroke, diabetes and cancer.
Overweight Prevalence by Gender and
Race/Ethnicity, Ages 12-19, 1976-2002
30%

White NH Males White NH Females

Black NH Males Black NH Females


24.7%
23.6%
Mexican Males Mexican Females

19.9%
20% 18.7%
Percentage

16.3%

14.1% 14.6%
13.4% 12.7%
11.6%
10.7% 10.7%
10% 8.8% 8.9%
7.7%
6.1%
4.6%
3.8%

0%
1976-80 1988-94 1999-2002

Source: Health, United States, 2005 - http://www.cdc.gov/nchs/hus.htm


Physical Activity
Nearly half of American youth are not
vigorously active on a regular basis.
Physical activity declines with age
from childhood into adulthood.

Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/


Vigorous Physical Activity Among High School
Students by Grade Level & Gender, 2003

100%
Males
90% Females
77%
80% 74% 72%
67% 66%
70%
60%
60%
51%
50% 45%
40%
30%
20%
10%
0%
9th Grade 10th Grade 11th Grade 12th Grade

Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/


Nutrition
The majority of high school students report
eating diets low in fat.
Only one fifth of students report eating the
recommended five or more servings of
fruits and vegetables per day.

Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/


Percentage of High School Students Who Ate 5+
Servings of Fruits & Vegetables by Gender and
Race/Ethnicity, 2003
100%
Male
90%
Female
80%
70%
60%
50%
40% 27% 30%
24% 26%
30% 20% 21% 20% 22% 23%
20%
20%
10%
0%
Total White Black Hispanic Other
Ate 5+ Servings/Day
Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/
Conclusion
Adolescence is an important developmental
stage.
Significant improvements in adolescent mortality
and morbidity has occurred over the past two
decades, yet adolescent health risk taking
behaviors requires ongoing investments in such
areas as tobacco, substance use, mental health,
and reproductive health.