Adolescent Health: We have a long way to go

Debra Jackson
Professor and Research Coordinator, School of Nursing and Midwifery, University of Western Sydney, Sydney NSW

Philip Darbyshire
School of Nursing, University of Western Sydney; Principal, Philip Darbyshire Consulting, Sydney NSW

PP: 342 - 344

Article Text

In bringing this special issue of Contemporary Nurse to a conclusion, we would like to reflect on some of the health issues that impact on adolescents and young people. Though the majority of adolescents and young people experience very good mental and physical health (AIHW 2003) in comparison to other age groups, adolescence can be a period of high risk taking and habit forming behaviour, both of which can have long-term ramifications on health and wellbeing. During adolescence, health behaviours and patterns are set, and thus many health problems that will cause problems in later life are established (NSW Health 1999). Significant numbers of adolescents and young people are affected by difficulties including mental health issues, alcohol abuse, suicidal ideation or behaviour, behavioural problems, unintended pregnancy, substance misuse, eating disorders and obesity, infectious diseases, decreasing physical activity, disability and injury resulting from motor vehicle accidents, and increased risks of skin cancers arising from lack of sun protection. These difficulties can affect all aspects of life and can place young people at risk of considerable life adversity with ramifications for years to come (Jackson & Mannix 2003).

Many of the problems and difficulties that beset adolescents are preventable. Drug abuse is one of the major threats to the health and wellbeing of our young people. Adolescence is the time of life in which experimentation with drugs and alcohol can occur, and harmful patterns of drug use can become entrenched (Jackson & Mannix 2003; Usher, Jackson & O'Brien 2005). There are numerous illegal drugs available to young people, and currently methamphetamine (known as meth, crank, ice, 'p' among other street names) is causing concern, with numerous violent crimes attributed to its use (see for example, Goldner 2006). Recently, Police Commissioner of New South Wales Ken Moroney was widely reported as saying he believes ice is more of a problem than heroin, and the greatest scourge he has seen in a career spanning 41 years (Kearney 2006).

Methamphetamine is highly addictive and its use carries health risks including neurological, cardiovascular, respiratory problems, and mental health difficulties (http://www.nida.nih.gov/Infofacts/methamphetamine.html). These difficulties can include paranoia, and aggression, as well as psychotic behaviour such as auditory hallucinations, mood disturbances, paranoia and delusions that can result in homicidal or suicidal thoughts, and violence outbursts or episodes of self harm (http://www.whitehousedrugpolicy.gov/drugfact/methamphetamine/index.html).

Alcohol abuse is also a major challenge to the health and wellbeing of adolescents, and consequences of youth alcohol use may include unwanted and unsafe sex, violence, crime, road and traffic accidents, self-harm and death (Lynskey 2001).

Issues around sexuality and sexual activity also pose a threat to the health and wellbeing of adolescents and young people. Young people particularly women, are disproportionably affected by sexually transmitted infections (STIs) (National Prevention Information Network (NPIN) 2006). Rapid social change has meant that young people are engaging in sex at earlier ages, (Berman & Hein 1999) and are more likely to engage in risk behaviours, including unprotected sexual activity and having multiple sexual partners (National Center for HIV STD and TB Prevention 2001). Furthermore, young people may consider themselves invulnerable to STI, or may lack the skills and knowledge required to initiate and sustain safer sexual practices (WHO 2004).

Despite extensive and very costly public health campaigns, that target mental health issues, tobacco smoking, sun protection, drug and alcohol issues, safer sex, accidental injury, drink driving, and speeding, many thousands of adolescents and young people are still affected by preventable health problems. Research findings suggest that there is little help available for parents concerned about the health and wellbeing of their adolescent (Jackson & Mannix 2003; Jackson, Usher & O'Brien 2006). Many parents of young people with quite serious drug and alcohol problems, and other problems such as self harm, report making numerous unsuccessful attempts to secure professional help for the young person in the very early stages of the abuse trajectory (Jackson, Usher & O'Brien unpublished data). While parents could see some subtle but alarming changes that were the catalyst for their seeking help, they reported that health professionals did not recognise the problems for what they were, until problems were entrenched and serious implications of drug use, such as involvement of the criminal justice system, had already occurred.

Clearly nursing, medicine and other helping professions have a long way to go in meeting the needs of adolescents, and their families. If we accept the adage that 'if you always do what you have always done, then you will always get what you have always got', then it seems that 'health promotion' may have a serious credibility problem on its hands. If years of effort on the part of the 'pamphlet princesses' and millions of dollars worth of advertising and promotion have had limited effect on adolescent health and wellbeing, then perhaps it is time that alternative approaches were considered. We suggest there is a need to go back to basics - to look again at the 'health promoting messages' we are sending and how they are being sent, to look again at the 'taken-for-granted' aspects of adolescent life, and the assumptions that we adults make about this, so that we can recognize and respond to changes before they become so entrenched that they are very difficult to deal with. As clinicians, practitioners, academics and scholars, our brief is to produce the knowledge and information, develop and test the interventions, and extend our skills to better meet the needs of this challenging and vulnerable group. At the very least, such an approach should include an attempt to listen and attend far more carefully and systematically to young people themselves before we presume to deliver yet another 'message' about how 'they' should live.

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