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Adolescent Health
http://www.inclen.org/research/ah.html
Adolescence
is a period of exploration and experimentation, but young people
often lack the knowledge, experience and maturity to avoid the
grave risks that confront them. In both developed and developing
countries adolescents can face overwhelming problems, among them
early pregnancy, high school drop-out rates, substance abuse and
violence, making them more vulnerable to life-threatening
disease and conditions.
Adolescents comprise 20% of
the total world population, 85% of whom live in developing
countries. Low education and high unemployment often compound
the problems of developing world adolescents. Furthermore, the
adolescent population in developing countries is burgeoning,
with the number of urban youth growing a projected 600% between
1970 and 2025 (WHO Fact
Sheet #186, 12/97).
For the most part, young people’s problems have been ignored,
with little understanding of the potential impact of a
generation at risk on the future. If today’s young people are to
realize their adult potential, new solutions must be found.
These solutions will be based on understanding the complexities
of adolescent cultures, how they experience risk and what
factors contribute to their vulnerabilities.
Frequently, sexuality
presents the first challenge to healthy adolescent growth. Often
unplanned, and sometimes pressured, adolescent sexual relations
occur before young people have adequate knowledge of
contraception, sexually-transmitted diseases (STDs) or health
services available to them. In developing countries, girls under
18 have a maternal mortality rate that is two to five times
higher than women 18 to 25. Between 1 and 4.4 million adolescent
abortions occur each year, most of which are unsafe, performed
by unskilled practitioners illegally. One out of 20 adolescents
contracts a curable STD, excluding viral infections -- at least
111 million cases in persons under 25 each year. STDs often go
undetected or untreated among young women, who, embarrassed or
stigmatized by the presence of a STD, are reluctant to seek
help. Yet STD agents, such as Chlamydia and human papilloma
virus, can have dire consequences at later times, such as
infertility or cervical cancer. STDs may also facilitate the
transmission of HIV.
Although the overall world
population living with HIV/AIDS appears to be declining,
evidence shows that new HIV infections among adolescents are
rising. Worldwide, more than half of all new HIV infections
occurs in the 15 to 24 age group. In South Africa, the rate of
pregnant teens (15 to 19) with HIV doubled between 1994 and
1996. Although young people may know how AIDS is transmitted and
prevented, many believe their risk of infection is minimal. In
one study in Malawi, 90% of teenage boys reported having at
least one sex partner in the previous year but very few used
condoms. Girls appear to have a significantly higher incidence
of HIV infection than boys. Statistics from Uganda show girls
having six times more HIV infection than boys, even though the
rate for teenage girls has dropped 50% since 1990.
Tobacco use is another
serious health problem for adolescents. Swayed by images of
adult smokers or through advertising, young people perceive
smoking to be sophisticated or fun. One third to one half of
young people who experiment with cigarettes become regular
smokers, half of them within one year. Teens who smoke daily for
a number of years develop a habit and addiction level as
difficult to reverse as for adult smokers. Although many try
repeatedly, very few adolescents actually stop smoking. Studies
show that young people who do not use tobacco before the age of
20 are unlikely to start smoking as adults. Studies around the
world show that the majority of adult smokers begin tobacco use
in their teenage years, sometimes earlier, and that smoking is
addictive and dangerous to their health. Therefore, preventing
tobacco use in the first place among teens avoids many lifelong
and life-threatening health problems.
The INCLEN Role
As a multi-disciplinary
network of scientists in 56 medical schools around the world
(mostly in the developing world), INCLEN is particularly
positioned to consider social issues of clinical importance, to
compare such matters across cultural boundaries and to link
descriptive studies to interventions. Many INCLEN researchers
around the world are involved in projects that address the
health problems of adolescents and the unique methodologies
necessary to influence adolescents to minimize their risk
behaviors.
- In
Lucknow, India, INCLEN investigator Dr. Shally Awasthi
has studied sexual behavior patterns of adolescent boys in
urban slums, finding 10% of boys between 15 and 21 were
sexually active, many of whom engaged in sex with commercial
sex workers or men. In addition, 5-9% tested positive in
urine dipstick tests for leukocyte esterase activity,
possibly indicating the presence of urethritis, which can be
sexually transmitted. Having poor risk perception and little
knowledge of sexually transmitted diseases, the boys rarely
used condoms. Dr. Awasthi and her team developed an
instrument for reproductive health counseling in the hopes
of educating sexually active adolescent boys about sexually
transmitted diseases and reducing their risk behavior.
- In
Bangkok, Thailand, Dr. Chitr Sitthi-amorn leads a
multidisciplinary team of practitioners from medical,
educational, public health, policy planning and governmental
institutions in developing an adolescent health program.
After examining the existing youth services, reasons for
nonuse of those services, and unmet adolescent needs, the
team will design and institute a pilot adolescent program,
integrating hospital-based adolescent health services with
community-based youth programs. In monitoring progress, the
program will involve youth in identifying indicators of
success as well as the ongoing monitoring and evaluation
processes.
- In
Santiago, Chile, Drs. Jorge Tolosa. Rodrigo Villegas,
Cristina Di Silvestere and David Streiner examine risk
factors and the decision-making processes of pregnant
adolescents receiving late-term prenatal care regarding
future use or rejection of modern contraceptives. The
fertility among young Chilean women 15 to 19 years old has
steadily increased (while the total fertility rate declined
between 1960 and 1980), especially for unmarried women.
Babies from unwanted pregnancies have higher infant
mortality and greater risks to development for those who
survive. Although adolescent birth control is offered by the
government at no cost, it is underused. This project will
study the variables affecting family planning use by young
people to design a program that will speak to the cultural,
psychosocial needs of this high-risk group.
- In the
Philippines and Thailand, Drs. Jorge Tolosa, Mario
Festin and Manop Kanato lead a pilot project to analyze
youth sexual behaviors, their perceptions of risk for
sexually transmitted diseases and their misconceptions and
knowledge of effective preventive measures. Thai government
data from 1992 states that 47% of STD patients are under 15
years of age. In 1997 half of all Thai HIV cases were from
the same age group. This project is studying youth behaviors
and knowledge about sexual health issues, designing a
school-based intervention program, and testing the
effectiveness of intervention methods such as flyers, talks,
bulletin boards, posters, role-play, peer discussion, videos
and peer counselors.
- In
Kenya, Thailand and Uganda, Drs. Dennis G. Willms, Manop
Kanato and Nelson K. Sewankambo are implementing a test
model of adolescent sexual and reproductive health
interventions based on evidence gathered at the three sites.
Adolescents at an experimental site will participate in
designing, implementing and evaluating intervention programs
in order to develop a generic intervention model compelling
to young people from a range of cultures. The objective is
to enable adolescents to safely navigate themselves through
risk situations, making healthier choices.
Other projects
include:
-
“Tobacco Smoking Among High School Students in Ismailia,
Egypt.” A team of researchers at Suez Canal University led
by Dr. Fatma Hassan surveyed a cross-section of students at
27 high schools. They found that a significant number of
male students persisted in smoking although they knew the
harmful effects of smoking. Smoking habits of teachers,
peers and fathers contributed to development of their
tobacco use.
-
“Menarche and Sexuality in Female School Adolescents in
Yaounde, Cameroon.” Dr. Francisca Monebenimp and colleagues
interviewed 768 schoolgirls ages 9 to 15, finding 13% had
already had sexual intercourse. Although 77% knew condoms
could protect against STDs and AIDS, 94-95.3% had no idea
how STDs and AIDS are transmitted. The girls cited the media
as the major source of their information on sexuality.
- “The
Need for Post-Abortion Counseling for Adolescents – an
Interim Analysis.” In Chennai, India, Dr. R. Sathianathan
and colleagues questioned and tested adolescents
post-abortion to assess effectiveness of post-abortion
counseling. Preliminary findings showed significant
psychological distress and likely future risk behavior – 43%
had suicidal tendencies and 75% had no knowledge of
contraception or STDs.
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