Chapter 105 The Epidemiology of Adolescent Health Problems

Circumstances impacting adolescent lives vary across the globe. In countries at war, adolescents may be serving as soldiers. In countries deeply affected by AIDS, youth may be at the demographic epicenter of the epidemic and/or assuming the role as primary provider for younger siblings in the aftermath of parent death. In low income nations, youth may be laboring long hours in rural fields near their homes or in distant cities as urban migrants, while in middle and high income nations, they are more likely to be in school. Health promoting behaviors also vary; among youth ages 11, 13, and 15 yr from 29 countries, 54% of U.S. females and 74% of U.S. males exercise on 2 or more occasions per week. Among the remaining 28 countries, rates of exercise twice a week for males range from 90% in Northern Ireland to 60% in Greenland, and for females, rates range from 66% in Germany and the Czech Republic to a low of 37% in Greenland. Among females in all 29 countries, there is a decline in this proportion with age; this trend is not seen among males.

Health outcomes also vary. About 16 million women aged 15-19 yr old give birth annually, accounting for 10% of births worldwide. The average adolescent birthrate in low-income countries is 5-fold that of high-income countries. Complications from pregnancy and childbirth are the leading cause of death among adolescents in developing countries; death as an outcome of pregnancy is rare in developed countries. Perceptions of feeling healthy also vary greatly by country as shown in Figure 105-1; those who do not feel healthy increases proportionately with age.

Figure 105-1 Proportion of 15 yr old youth from 28 nations who report not feeling healthy.

(From Health Resources and Services Administration, Maternal and Child Health Bureau: U.S. teens in our world. Understanding the health of U.S. youth in comparison to youth in other countries (website). www.mchb.hrsa.gov/mchirc/_pubs/us_teens/main_pages/ch_1.htm. Accessed April 16, 2010.)

Despite these variations by geographic region and level of economic development, there are many similarities in adolescent health issues. In all nations, adolescence is a time of immense biologic, psychologic, and social change (Chapter 104). Many of the psychologic changes have a biologic substrate in the development and eventual maturation of the central nervous system, particularly the frontal lobe areas responsible for executive functioning (Fig. 105-2). In addition to cognitive development, there are both risk and protective factors for adverse adolescent health behaviors that are dependent on the social environment as well as the mental health of an adolescent (Table 105-1).

Figure 105-2 It has been speculated that the impact of puberty on arousal and motivation occurs before the maturation of the frontal lobes is complete. This gap may create a period of heightened vulnerability to problems in the regulation of affect and behavior, which might help to explain the increased potential in adolescence for risk taking, recklessness, and the onset of emotional and behavioral problems.

(From Steinberg L: Cognitive and affective development in adolescence, Trends Cogn Sci 9:69–74, 2005.)

Table 105-1 IDENTIFIED RISK AND PROTECTIVE FACTORS FOR ADOLESCENT HEALTH BEHAVIORS

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