Adolescent Harmful Health Behaviours
Adolescence is naturally a time of increasing independence for young people away from parental supervision. It is normal for young people to experiment with more adult activities and to show some rebellious behaviours. With the right level of support and supervision young people learn about independence in a safe way. There are often difficulties for families in communicating about some of these issues and this period of emotional and physical development is often hard for young people and parents.
Smoking, drug and alcohol abuse
Teenage smoking is increasing, especially among girls. Smoking often becomes a dependency which has lifelong health consequences.
An increasing proportion of teenagers experiment with drug use. Solvent abuse is also common. Young people need age-appropriate support to manage substance abuse.
Harmful drinking behaviours often begin in adolescence. There is a risk of injury through accident, assault and coma. This can be viewed as experimentation behaviour but sometimes represents a self-harming behaviour with more serious background social problems.
Road traffic accidents are the leading cause of death in this age group. Alcohol and failure to wear seat belts or crash helmets increase the risks.
Drug overdose is a common cause of admission to hospital in adolescence. This is often a response to a stressful situation linked to family or peer relationship problems and reflects vulnerability and difficulty getting effective support. There is not usually a serious suicidal intent but the overdose may inadvertently result in serious poisoning. Self-harming can also manifest as deliberate soft-tissue cutting or burning behaviours. Young people who self-harm should be seen acutely by mental health professionals to assess level of risk and to arrange ongoing support.
Sexual Health Issues
Amenorrhoea is often physiological as periods may be very irregular or scanty for months after the onset of menarche. Stress associated with moving schools or exams can disrupt periods, and those undergoing intense athletic training may develop amenorrhoea. Eating disorders and chronic illness can cause amenorrhoea. Pregnancy should also be considered as a cause.
Menorrhagia (heavy periods) and dysmenorrhoea (painful menstrual cramps) are common in the first few years after menarche. Treatment includes prostaglandin synthetase inhibitors (e.g. mefanamic acid) to reduce bleeding or the combined oral contraceptive pill to regulate the cycle.
Polycystic ovary syndrome can present in adolescence with the combination of amenorrhoea, obesity, hirsutism and acne. There are later fertility problems.
Many adolescents have higher risk-taking sexual behaviours. Provision of easily accessible school-based sexual health services can help by giving confidential health information and improves uptake of contraception and testing for sexually transmitted diseases (STDs). Young people are at higher risk of sexual assault from peers and older adults with greater risk following drug or alcohol use.
Some 40% of sexually active teenage girls become pregnant within 2 years. The UK has the highest teenage pregnancy rate in Europe. There are increased perinatal risks for the mother and for the baby. Early support to young mothers and their children is important in improving their long-term outcomes.
One third of teenage pregnancies are managed by termination of pregnancy. There may be reluctance to seek help, sense of guilt and fears about confidentiality so there is a clear need for sensitive support.
Less than 50% use contraception at the time of first having sex. Information and ready access to contraception are important to reduce the rate of teenage pregnancy. Condoms prevent the spread of STDs. The oral contraceptive pill is a reliable method if taken correctly. An alternative is depot (parenteral) hormonal contraception. Intrauterine devices are not usually offered to nulliparous women and carry a risk of pelvic infection. The ‘morning-after pill’ hormonal contraception can be taken up to 72 hours after unprotected sex but often causes sickness and is less reliable with increasing delay in use.
Sexually Transmitted Diseases
STDs such as chlamydia, gonorrhoea and herpes are prevalent in the community and increasingly seen in adolescents. Screening for chlamydia by urine polymerase chain reaction (PCR) test is offered at school sexual health clinics.
Eating disorders are characterized by a fear of being overweight and a distorted body image, so that even extremely wasted individuals feel they are overweight. There may be preoccupation with food and bizarre eating behaviours.
Eating disorders are commoner in girls than boys, and often start as dieting behaviour. The age of onset is becoming younger.Background factors include peer group focus on thin body shape and family history of eating disorders.
This involves extreme dieting to control weight. There may also be excessive physical activity. In anorexia the body mass index (BMI) reduces below 17.5, with dangerous physical changes below BMI 15. Features include emaciation, amenorrhoea, hair loss and lanugo hair. Bradycardia, hypothermia, hypotension and biochemical derangement develop with extreme malnutrition. The mortality rate for anorexia can be up to 10%. In severe situations admission to hospital may be needed for managed refeeding up to the desired weight; nasogastric feeding may be required. Behavioural modification techniques are used to help to reach a healthy weight. The overall prognosis is good with a multidisciplinary team approach.
This is characterized by bouts of binge eating, followed by purging with laxatives or by inducing vomiting. Oesophagitis, parotid swelling and enamel erosion of the teeth are all signs of chronic vomiting.
- Adolescence is a time of rapid physical, psychological and social change.
- Adolescents learn independence but are at risk of harmful risk-taking behaviour.
- Eating disorders are common and need expert management.
- Health workers need to find novel ways of engaging with adolescents, especially vulnerable groups.