Talk To Rotary 4nov2009

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 ongoing 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, Ages 10-24, 1980-2002

160 140

131.7

Males Females

Deaths per 100,000

120 100

85.0

80 60 40

47.2

20

34.1

19 80 19 81 19 82 19 83 19 84 19 85 19 86 19 87 19 88 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02

0

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

Mortality by Race/Ethnicity & Gender, Ages 10-24, 2002 160 140

131.1

Males

125.2

Females

Deaths per 100,000

120 82.2

100 80

77.6

59.1 44.2

43.9

60

26.9

40

34.0

20.1

20 0 American Indian/Alaskan Native, nonHispanic

Black, nonHispanic

Hispanic

Source: CDC, National Center for Injury Prevention and Control, 2005 -

White, nonHispanic

Asian/Pacific Islander, nonHispanic

Leading Causes of Death for Adolescents and Ages 10-19, 2002 Motor Vehicle Accidents Other Unintentional Injuries

20.6% 34.1%

Suicide

3.0% Homicide

7.1% Malignant Neoplasms

11.9%

12.6% 10.7%

Source: CDC, National Center for Injury Prevention and Control, 2005 -

Heart Disease Other

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

AI/AN, non-Hispanic

20.5

10.1 0

39.6 10

20

30

40

Deaths per 100,000 Source: CDC, National Center for Injury Prevention and Control, 2005 -

50

60

Injury Risk Behaviors by Gender, High School Students, 2003 50% Males 40%

Females 29.2%

31.1%

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

1.7

API, non-Hispanic

Females Males

6.4 4.7

AI/AN, non-Hispanic

11.9

2.8

Hispanic

21 6.3

Black, non-Hispanic 0

10

57.1 20

30 Deaths per 100,000

Source: CDC, National Center for Injury Prevention and Control, 2005 -

40

50

60

Homicide Trends, Males, Ages 15-19, 1990-2002 160

AI/AN, non-Hispanic White, non-Hispanic Black, non-Hispanic

140

Hispanic API, non-Hispanic

Deaths per 100,000

120 100 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% 6%

10%

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% 20%

23.6% 17.7%

14.2% 11.8%

11.2% 6.2%

10%

2.1% 3.1%

0% Seriously Considered

Made Suicide Plan

Attempted Suicide

Required Medical 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

Hispanic

2.6

Males Females

9.7 10.1

Black, non-Hispanic

1.6

White, non-Hispanic

14.6

2.9

33.3

AI/AN, non-Hispanic

9.1

0

10

20 Deaths per 100,000

Source: CDC, National Center for Injury Prevention and Control, 2005 -

30

40

Sadness or Hopelessness which Prevented Usual Activities by Gender & Race/Ethnicity, High School Students, 2003 50% Females

42.3% 40%

36.3% 32.3%

30%

Males 34.0% 28.8%

34.5%

Total 28.8%

25.5%

20% 20.5%

20.9%

25.4%

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% 60% 40%

67%

68%

64% 53%

37%

49%

39%

49%

37%

27%

31% 28%

29%

20% 31%

26%

25%

14%

Alcohol

Cigarettes

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

03 20

01 20

99 19

97 19

95 19

93 19

91 19

89 19

87 19

85 19

83 19

81 19

79 19

77 19

19

75

0%

Any Illicit Drug

Past Month Substance Use by Type and Race/Ethnicity, Ages 12-17, 2004 40% Any Alcohol Use Any Cigarette Use Any Illicit Drug Use

26.0%

20%

19.9%

18.5%

18.0%

17.9% 14.4% 11.1%

9.8%

11.1%

10.2% 9.1%

6.0%

9.4% 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

Rate per 1,000

120 100 80 60 40 20

Abortions

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

Pregnancies

00

99

20

19

98

97

19

19

96

95

19

19

94

93

19

92

19

19

91

90

19

19

89

88

19

19

87

86

Births

19

19

85

19

84

19

83

19

82

81

19

19

19

80

0

Sexual Intercourse Experience by Race/Ethnicity, Gender & Grade Level, 2003 100% Males Females

80%

66%

71% 67% 60%

60%

47%

60%

64%

61%

47%

35%

40%

26%

30%

20% 0% White, nonHispanic

Black, nonHispanic 9th Grade

Hispanic

White, nonHispanic

Black, nonHispanic 12th Grade

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

Hispanic

Chlamydia Rates by Race/Ethnicity & Gender, Ages 15-19, 2003 3500

Males Females

3495.2

3000

Rates per 100,000

2500 2000

1794.1

1500 1000

574.6

500 0

127.5 Black, non-Hispanic

American Indian/Alaskan Native

322.5 136.9 Hispanic

Source: STD Surveillance Report, 2004 http://www.cdc.gov/nchstp/dstd/Stats_Trends/Stats_and_Trends.htm

39

193.2

49

139.1

White, non-Hispanic Asian/Pacific Islander

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

Percentage

30% White NH Males

White NH Females

Black NH Males

Black NH Females

Mexican Males

Mexican Females

24.7% 23.6%

20%

18.7% 16.3% 14.6%

14.1% 13.4% 11.6%

10.7% 10%

7.7%

8.8%

12.7%

10.7%

8.9%

6.1% 3.8%

4.6%

0%

1976-80

1988-94

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

1999-2002

19.9%

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% 90% 80%

Males Females

77% 67%

70%

74%

72%

66%

60%

60%

51% 45%

50% 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 Female

90% 80% 70% 60% 50% 40% 30%

24% 20%

21% 20%

30%

27%

26% 20%

22%

23%

20% 10% 0% Total

White

Black

Hispanic

Ate 5+ Servings/Day Source: Youth Risk Behavior Surveillance System, 2005 - http://apps.nccd.cdc.gov/yrbss/

Other

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.