Adolescent Development and Health

1. Adolescent Development and Health National Adolescent Health Information Center and The Public Policy Analysis & Education Center for Middle Childhood, Adolescent & Young Adult Health Department of Pediatrics & Institute for Health Policy Studies University of California, San Francisco

2. In This Presentation • Development • Tasks and Stages of Adolescence • Health • Mortality • Morbidity • Chronic Conditions

3. Adolescent Development

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Adolescent Health

13. 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 • Sexually transmitted infections • Motor vehicle injuries • Alcohol & other drug problems • Other unintentional injuries • Mental health problems

14. Determinants of Health

15. 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/

16. Trends in Overall Mortality by Gender, Ages 10-24, 1980-2002 Source: CDC Wonder, Compressed Mortality Database, 2004 - http://wonder.cdc.gov

17. Mortality by Race/Ethnicity & Gender, Ages 10-24, 2002 Source: CDC, National Center for Injury Prevention and Control, 2005 - http://www.cdc.gov/ncipc/wisqars/

18. Leading Causes of Death for Adolescents and Ages 10-19, 2002 Source: CDC, National Center for Injury Prevention and Control, 2005 - http://www.cdc.gov/ncipc/wisqars/

19. 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

20. Unintentional Injury Mortality by Race/Ethnicity, Ages 10-24, 2002 Source: CDC, National Center for Injury Prevention and Control, 2005 - http://www.cdc.gov/ncipc/wisqars/

21. Injury Risk Behaviors by Gender, High School Students, 2003 Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/

22. 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 - http://www.cdc.gov/ncipc/wisqars/

23. Homicide Mortality by Gender & Race/Ethnicity, Ages 10-24, 2002 Source: CDC, National Center for Injury Prevention and Control, 2005 - http://www.cdc.gov/ncipc/wisqars/

24. Homicide Trends, Males, Ages 15-19, 1990-2002 Source: CDC, National Center for Injury Prevention and Control, 2005 - http://www.cdc.gov/ncipc/wisqars/

25. Violence-Related Behavior by Gender, High School Students, 2003 Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/

26. 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 - http://www.cdc.gov/ncipc/wisqars/

27. Non-Lethal Suicidal Behavior by Gender, High School Students, 2003 Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/

28. Suicide Mortality by Race/Ethnicity & Gender, Ages 10-24, 2002 Source: CDC, National Center for Injury Prevention and Control, 2005 - http://www.cdc.gov/ncipc/wisqars/

29. Sadness or Hopelessness which Prevented Usual Activities by Gender & Race/Ethnicity, High School Students, 2003 Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/

30. Learning Disabilities & ADHD by Gender, Ages 12-17, 2001 Source: Bloom et al., 2003; NHIS; Parent report - http://www.cdc.gov/nchs/nhis.htm

31. 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/

32. 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.

33. Trends in Past Thirty-Day Substance Use, 12th Graders, 1975-2003 Source: Monitoring the Future, 2004 - http://www.monitoringthefuture.org/

34. Past Month Substance Use by Type and Race/Ethnicity, Ages 12-17, 2004 Source: National Survey on Drug Use & Health, 2005 - http://www.drugabusestatistics.samhsa.gov/nsduh.htm

35. 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.

36. 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.

37. Pregnancy, Birth & Abortion Rates Among Females Ages 15-19, 1980-2000 Source: Henshaw, 2004 -http://www.guttmacher.org/pubs/teen_stats.html

38. Sexual Intercourse Experience by Race/Ethnicity, Gender & Grade Level, 2003 9th Grade 12th Grade Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/

39. Chlamydia Rates by Race/Ethnicity & Gender, Ages 15-19, 2003 Source: STD Surveillance Report, 2004 - http://www.cdc.gov/nchstp/dstd/Stats_Trends/Stats_and_Trends.htm

40. 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.

41. Overweight Prevalence by Gender and Race/Ethnicity, Ages 12-19, 1976-2002 Source: Health, United States, 2005 - http://www.cdc.gov/nchs/hus.htm

42. 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/

43. Vigorous Physical Activity Among High School Students by Grade Level & Gender, 2003 Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/

44. 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/

45. Percentage of High School Students Who Ate 5+ Servings of Fruits & Vegetables by Gender and Race/Ethnicity, 2003 Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/

46. 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.

47. National Adolescent Health Information Center and Public Policy Analysis & Education Center for Middle Childhood, Adolescent & Young Adult Health ON THE WEB: http://nahic.ucsf.edu/ http://policy.ucsf.edu/ BY EMAIL: nahic@ucsf.edu policycenter@ucsf.edu BY PHONE: (415) 502-4856