Adolescence: A period that needs special care

Prof (Dr) Karuna Hazarika

(Principal, Tezpur Medical College, Tezpur. He can be reached at drkaruna97@gmail.com)

Adolescence is a unique stage of human development and is a phase of life between childhood and adulthood from 10 to 19 years of age. During this period, all experience rapid changes in physical, cognitive and psychosocial growth of life. This critical change affects everything – how they feel, think, make their decisions and interact with people around them. The transition of life sometimes carries new risks of life that may result from bodily or behavioural change or may influence the future health of young people. In this period, all experience growth spurts and puberty changes. There is rapid bodily growth for a period and followed by slow growth then another growth spurt. The changes with puberty may happen gradually and bodily changes become obvious at the same time. The World Health Organization (WHO) defines an adolescent as any person between 10 and 19. This age range also falls within the definition of young people which refers to the 10-to-24 age group.

The physical changes occur during the adolescence period due to the effects of hormonal changes. The teenager's body is transformed from child to adult. This particular phase is called puberty, and it usually starts between the age of 9 and 16. The sexual hormone that plays its role in the bodily changes in boys is testosterone and the one that plays its role in the bodily changes in girls is estrogen. Most physical changes observed are increased perspiration, acne problems, development of external sex characteristics, growth of hairs in the pubic region and armpit, changes of voice and broader shoulder in boys and starting of menstruation and broadening of hips in girls etc. In general, the first sign of puberty appears in girls earlier than in boys. These changes continue until the age of 18 to 22.

Adolescence is the period of life where there is not only bodily changes but there will be full of emotional and psychological transformation that is very significant as physical changes. As part of life, they search for their identity and feel the need for their independence. Of course, there is confusion about their need and desire for autonomy in the back of their mind. The growth of friendship is prominent in most teenagers and changes in behaviour are observed the most. It may even lead to conflict between teenagers and parents. Sometimes, they feel carefree, try to seek new experiences and sometimes may get exposed to situations that are dangerous to their health and wellbeing, like smoking cigarettes, drinking alcohol, taking drugs, reckless driving or sexual misbehaviour etc. Apart from bodily changes due to influences of hormones, adolescence may lead to mood swings as well. This needs lots of patience and understanding from parents. This is also a time for the first experience of sexual relations due to the hormonal and physical changes that are experienced by teenagers. The changes make them more aware of their sexuality. This may again lead to behavioural changes as well. So, it is important to create an environment for helpful and effective discussion of sexuality too. But this is not an easy thing. Therefore, it is very important to choose the right strategy and right time for parental discussion without disturbing their mindset and privacy.

There are about 1.2 billion people between the ages of 10 and 19 worldwide as per UNICEF. It is important to know how they develop and grow across us. As determined, some of the factors that have a tremendous impact on the development of adolescents like social media, urbanization, unhealthy food habit, conflict in small issues leading to even armed conflict in developed countries, migration to different countries and urban areas of native countries and climate change etc. Though it is expected that adolescent has a better way of improving health and wellbeing, there are approximately 1.2 million deaths in a year, and unfortunately, they are all from preventable causes. This is a great loss to a nation. Sometimes self-harm is also a leading cause of death amongst youth. This is because of a lack of information, adequate and quality services and even a protective environment that is needed to stay healthy. The main reasons are considered to be some communicable diseases like malaria, cholera, and lack of sanitation and hygiene facilities. Especially in middle-income countries, the risk due to HIV and deaths due to AIDS are high. Other factors like unhealthy diet, unhealthy lifestyle, alcohol and substance abuse, mental ill health and unhealthy environment are also the cause of ill-health of teenagers today. For girls, the onset of puberty is a major factor which results in early marriage and pregnancy in some countries where poverty, and social and gender norms are the factors for restricted life choices of girls. This restricts them from education and social and economic opportunity as well. It is estimated that 23 million adolescent girls become pregnant every year and maternal mortality is on the rise. It is also linked to child marriage.

The UNICEF responded with the partner countries to improve the overall health of adolescents. This is in the direction toward communicable disease, gender-responsive healthcare, supporting HIV and AIDS prevention programmes as per need, looking into menstrual health and hygiene, promoting mental health and wellbeing, good nutrition, responding to non-communicable disease and reducing home violence due to behavioural changes etc. The Government of India has taken steps through NHM, as there are approximately 253 million people of this age group in India. The direction is to get dividends through the proper maintenance of the health of this group by delaying marriage, reducing teenage pregnancy and maternal mortality, reducing STI incidence, reducing HIV prevalence and considering the youth as important resources of the economy. Rashtriya Kishor Swasthya Karyakram (RKSK), launched on 7th February 2014 and School Health & Wellness Programme launched in February 2020 are two especially dedicated programmes for the holistic development of the adolescent. RKSK is targeted to improve nutrition, injuries and violence (including gender-based violence), non-communicable disease, mental health, and substance abuse. The target of the programme is to reach adolescents in their own environments such as family, school and community to provide adequate care through counselling, social and behavioural change communication and strengthening adolescent-friendly health clinics. The School Heath & Wellness programme plays a critical role to improve lifelong healthy behaviours. This is also an important part of the health and wellness component of the Ayushman Bharat Programme and is incorporated in government-aided schools in districts. Two teachers (preferably one male and one female) are designated as 'Health and Wellness Ambassadors', and they will be trained for health promotion and disease prevention on 11 thematic areas with a joyful interactive session for one hour every week.

The adolescent is now considered a source of development of a nation, so proper care must be taken to complete at least secondary education for everyone whatever the economic condition might be, particularly the females. The goal needs to be the development of adolescents' strength and values through education to build the entire generation economically independent and productive to break the cycle of poverty. The development of strength of adolescents is associated with resilience and life satisfaction. Identification of strength along with health assessment can provide a picture of how teenagers are doing in different contexts of life. All youth have the ability to access and act on their strengths. A strength-based evaluation and perspectives development should be considered to develop a way to empower children and adolescents to be experts in their own field of choice and to find solutions to face challenges of life so that they can happily contribute to the development of the nation.