Adolescent Holistic Health Issues

Adolescence is the transition from childhood to adulthood. It is a stressful developmental period filled with major changes in physical maturity, sexuality, cognitive processes, emotional feelings, and relationships with others. The age of adolescence is generally regarded as 11-19 years of age; however, some individuals function as adolescents well into their 20’s or more! Adolescence is the time for formulating a sense of personal identity, emancipation from the family unit, and for challenging parental authority.

As adolescents gain independence and take more responsibility for their own health, preventative healthcare and education become vital to ensure understanding and compliance. Prevention includes, but is not limited to, knowledge about sexually transmitted diseases, pregnancy prevention, and the effects of drugs, substance abuse and smoking. The Society of Adolescent Medicine identifies seven criteria for providing healthcare to adolescents:

1. Flexibility of healthcare providers to recognize and respond to the individual and diverse needs of adolescents,
2. Confidentiality of medical information requiring adolescent consent (with the encouragement of family/guardian involvement),
3. Visibility of adolescent preventive healthcare guidelines,
4. Quality care,
5. Access to care,
6. Coordination of medical, mental health, social and other services, and
7. Availability of age-appropriate services.

Adolescence is a time of many transitions that do not follow the same time line for everyone. It is important to understand the physical changes that are occurring in both sexes. There are growth spurts with rapid gains in height and weight. Weight gains are due to increased muscle development in males and body fat in females. During a one-year growth spurt, boys average at least 4.1 inches and girls 3.5 inches in height. Typically girls are two years ahead of the boys.

Puberty, which is the beginning of adolescences, is a time when hormonal levels change and secondary sex characteristics blossom. This is the point when reproduction is possible. Secondary sex characteristics include:

• Menarche (first menstrual period for girls) and penis growth for boys,
• Growth of pubic hair,
• Facial hair growth for boys,
• Growth of underarm hair,
• Voice changes for boys,
• Nocturnal emissions occurring in the boys, and
• The beginning of acne with the increased production of oil and sweat gland activity.

A normal child’s brain will grow the most during the first five years of life. It reaches 90 percent of its final size by age one. Recent studies suggest that this process is not completed until late adolescence and that the connections between neurons affecting emotional, physical, and mental abilities are incomplete. This may be the reason some teens cannot control their emotions, and seem to have no common sense. Growth of a child’s body is complete between the ages of 16 and 18, when the growing ends of bones fuse. Reproductive maturity and gametogenesis is usually delayed for one to two years after external changes are exhibited.

These physical changes cause teens to sleep longer. It is not unusual for teens to sleep over nine hours a night. They tend to be sleepy at getting up times. Teens are curious about what they will look like and are confused by the changes. Suddenly, they show a personal interest in appearance and height, weight, penis size, and bra size becomes important.

Girls focus on loosing weight and some develop eating disorders such as anorexia nervosa (starvation) or bulimia (binge eating and vomiting). In contrast, boys, tend to be constantly hungry and companionship at meals and at after-school snacks becomes important.

Adolescence is the time when teens want to fit in with their peers, but may not be physically developing at the same rate as their peers. Some develop early and some later than others. Teens who mature early tend to be placed in leadership positions because adults assume early maturing teens are also cognitively mature. Teens who mature early tend to be more popular with their peers. Younger girls who mature early tend to be pressured into developing dating relationships with older boys because of their new physical endowments, before they are emotionally ready. These girls tend to suffer from anxiety, eating disorders, and depression.

The growth spurts that teens experience causes them to be clumsier and to appear uncoordinated. Self-image is challenged during this phase of development. Now is the time when teens feel awkward and shy about demonstrating affection to the opposite sex, parent or guardian.

Direct questions about sex are asked as sexual values are being established. Teens tend to equate intimacy with sex and engage in the physical act, assuming the emotional attachment will follow. They want to know how to abstain from sex and when it is the right time to have sex. Questions about birth control and sexually transmitted diseases are common during this stage of their growth and development.

Teens have better thinking skills than they did at a younger age. A process called Concrete Operations occurs when the youth is seven to eleven years old. She/he is able to deal with properties of the present world in solving new problems. At this time the youth cannot yet deduce or reason hypothetically. Thus reasoning is inductive because decisions are based on the influence of others. Developing advanced reasoning skills starts at approximately twelve to fifteen years of age. This is called the development of Formal Operations. The adolescent learns to attack problems from the angle of all possible combinations of relations. Free use of hypothetical reasoning occurs. Variables are systematically isolated and manipulated. The youth becomes introspective.

Formal operation is the ability to foresee the consequences of his /her actions and to detect the logical consistency within a statement. Finally, the adolescent is able to think realistically about self, others, and their world, without egocentrism. This means the teen thinks about the whole not just the self. Developing abstract thinking skills by thinking about things that cannot be seen, heard, or touched is also part of this cognitive process.

Teens develop the ability to think using a process called meta-cognition. This process allows individuals to think about how they feel and what they are thinking. This process is the ability to think realistically about self, others, and their world. Logical strategies are created to meet a need. One device is the creation of mnemonic devices to help in memory retainment.

All of these Cognitive Changes cause adolescents to demonstrate the following actions:

Changes in adolescent physical and cognitive development are also accompanied by major changes in adolescent’s relationships with others, including family and friends. The following are five recognized psychosocial issues: establishing an identity; establishing autonomy, independence, and a self-governance; establishing intimacy; establishing self-esteem and comfort with one’s sexuality; and achievement.

Establishing an identity or self-knowledge about one’s characteristics, or personality is vital. This is one of the most important tasks of adolescents. At this stage he/she begins to integrate the opinions of influential others into their own likes and dislikes. Values and beliefs, occupational goals, and relationship expectations emerge. Difficulty in developing a clear concept of self or identity occurs when adolescents are unable to resolve struggles about who they are as physical, independent, sexual persons.

Establishing autonomy, independence, and a self-governance within relationships is a necessary achievement for adolescents to become self-sufficient within society. The adolescent learns to independently work out his/her own problems, and live by his/her own set of principles of right and wrong while becoming less emotionally dependent on parents or guardians.

Establishing intimacy is of primary importance. Now is the time to develop close relationships in which people are open, honest, trusting, and caring. Adolescents report feeling more understood and accepted by their peers and spend less and less time with their parents and other family members. Close friendships tend to develop with adolescents that are more similar in social class, ethnic backgrounds, and interests. It is within these groups that adolescents explore their sexuality, and feelings about it. Girls are more intimate with self-disclosure; whereas boys form relationships with groups of friends who validate each other’s worth with their deeds and actions.

Establishing self-esteem and comfort with one’s sexuality also occurs during this time. Due to the many body changes during adolescence, teens become more concerned about who they are and who they want to be. The key question raised is “how much do I like myself?” Adolescents tend to place more importance on their appearance. As teens move into the late adolescent stages he/she develops a more secure sense of who they are. The teen at this stage is physically mature enough to reproduce and becomes actively conscious of the opposite sex. How teens are educated in attitude and deed will greatly determine whether they develop a healthy sexual identity. This is the time when teens become sexually active. Teen pregnancies and sexually transmitted diseases/AIDS start to appear within this population.

Several predictors of sexual intercourse during the early adolescent years, including early pubertal development, a history of sexual abuse, poverty, lack of attentive and nurturing parents, cultural and family patterns of early sexual experience, lack of school or career goals, substance abuse, and poor school performance or dropping out of school (Klein, 2005). Factors associated with a delay in the initiation of sexual intercourse include living with both parents in a stable family environment, regular attendance at places of worship, and higher family income (Klein). Recently, parental supervision, setting expectations, and parent/child connectedness have been recognized as clearly associated with decreasing risky sexual behavior and other risky behaviors among adolescents (Klein).

Achievement is pushed and valued within our society. Teens now begin to see the relationship between their current abilities, need for more knowledge and experience in order to improve their chances to reach their future goals.

All of these psychosocial changes cause teens to change how they interact with family and friends. Teens spend more time with their friends and less with their family. Acceptable and not acceptable social skills and practices are developed and reinforced through peer pressure. When it comes to decisions about education, values and long-term plans, the teen still tends to conform to parental influences. More questions about sexuality and when it is the right time to experience sex arise. Teens become curious about what their parents did as teenagers and how they handled sex. Some teens begin to keep a journal to help establish their feelings and individual identities. Privacy and having their own space is vital to being independent and to being considered equal in their parents’ eyes. Teens become more argumentative and start to question adults’ values and judgments. They tend to feel they know best! Teens when asked where they are going or who they will be with are elusive and answer in generalities. Teens become involved with many activities in order to determine what they are good at, what’s thought of as cool, and what they enjoy. They are quick to change their interests. Many teens do not want to be seen with their parents even though the parent may now be more of a friend/equal!

Adolescents can be broken down into three stages. These are Early Adolescence, Middle Adolescence, and Late Adolescence.

Puberty is also considered Early Adolescence. Each sex has special characteristics during this period of growth and development. Both sexes vacillate between maturity and babyishness. Moodiness, sloppiness, and disorder become the norm. They rebel against home and rules/curfews. Same sex close friendships develop and questions about erotic feelings or behaviors toward the same sex arise. Some special characteristics of girls include, but are not limited to the following:

• Giggling,
• Crush on older men,
• Talkative, but not communicative,
• Interested in romantic love, and
• Play acting.

Some special characteristics of boys include, but are not limited to the following:

• Boisterous,
• Aggressive,
• Clumsy,
• Secretive,
• Dirty- poor attention to grooming,
• Talks a lot about sex and girls,
• Spends more time out of the house,
• Gains more weight and height than girls,
• Same gender sexual encounters are relatively common, and
• Can express sexuality through masturbation.

Middle Adolescence is the phase of development when there is a limited concept of cause and effect and the teen feels omnipotent. Often times the adolescent is between 12-16 years of age. During this phase, the greatest experimental risk taking happens. This is evidenced by drinking and driving, drinking while pregnant, and having unprotected sex. Sexually transmitted diseases now start to rise among this population. Thus drinking, drugs, smoking, and sexual experimentation are of primary importance to the Middle Adolescence. This is the time when first intercourse, first drink, or first pregnancy occurs. The major pre-occupation of Middle Adolescent is sex.

Testosterone increases are found in both sexes; however, higher levels are found in boys causing greater sexual aggressiveness and more physical drives and gratifications. Girls tend to view sexual gratification as secondary to fulfillment of other needs such as love, affection, reassurance, and self-esteem. They are less likely to abstain from sex in a relationship they sense brings closeness to someone and/or a means to act out against authority. The adolescent transition to male-female and sexual relationships are influenced by sexual interest and by cultural and social norms and expectations.

During Middle Adolescence parental conflicts occur often on a daily basis as the teenager strives for independence and thinks he/she knows all. This behavior is normal and confrontation and resolution are needed. Adolescent males and females tend to have more disagreements with their mothers than with their fathers. Teenagers now seek more advice from their friends than their parents.

Late Adolescence is a time when there are fewer conflicts and disagreements with parents/guardians. The Adolescent now seeks parental respect for opinions and acceptance of maturity. Now the teenager wants to be accepted by society, at college and in the workplace. Late Adolescence brings on questions related to career choices. Adolescents explore different work areas by volunteering or taking on part time jobs to assist them in making decisions related to their future vocations. Once a decision is reached, the adolescent’s self-concept and sense of self-worth help establish a positive identity.

However, indecisions regarding vocational choices are common. Much of this is caused by family influences: mother or dad’s professional aspirations for their children based on what they did or had hopes of doing when they were younger. The adolescent’s interests may conflict with the parent’s choices. If the adolescent is talented in a specific area and/or has varied interests this too makes choosing a vocation extremely difficult and can lead to conflicts with his/her parents. Other factors influencing vocational choices are:

• Motivation,
• Family values,
• Social class,
• Socioeconomic conditioners,
• Need for prestige,
• Vocational independence, and
• Special abilities.

Some special characteristics demonstrated by girls during Late Adolescence include, but are not limited to:

• Having fantasies of romantic love and seeking a mate,
• Their sexual interests are less demanding, and
• There is less of an interest in plans for a career.

Some special characteristics demonstrated by boys during Late Adolescence include, but are not limited to:

• A greater interest in sexual gratification and less interest in finding a mate, and
• More concern about establishing a career.

During Late Adolescence both sexes tend to demonstrate the following:

• Concern about establishment of their own ego identity,
• Concentration on appearance, (bathroom time takes twice as long),
• Mood swings and rebellion,
• Waning intimate relationship with buddy/girlfriend,
• Greater interest in opposite sex for different reasons,
• Physical growth reaches potential,
• Sleep and food requirements are almost at the adult level,
• Companionship at mealtimes is preferred, and
• Need for parental/guardian’s approval and respect.

Non-optimal negative identity, often occur as the adolescent tries to become more independent. These adjustments delay the growth process. Peer groups highly influence the adolescent and he/she ends up conforming to the groups’ expectations. This makes it very difficult for the adolescent who may have to move. Social isolation could result as he/she attempts to fit in, or once accepted the adolescent might over identify with a peer or assume many traits of his/her parents. This can lead to identity crisis. Teens in conflict are confused, often in conflict with everyone, and do crazy things, like dating people a lot older than themselves.
Communication barriers are common during adolescence. The adolescent does not want to appear vulnerable and distrusts adults. Many feel adults do not listen to them and therefore cannot understand their feelings and behaviors. Adolescents now distrust adults and authority figures.

The adolescent years are filled with turmoil for both the adolescent and the family. Adolescent developmental issues can complicate the teenager’s ability to cope with illness, injury, medical treatments, hospitalization, surgery, and the required treatments, because their physical appearance, desire to be independent, and accepted by their peers is of primary importance. Presently about 10% of adolescents under the age of 17 years suffer from a chronic disability or illness.

Common adolescent conditions are:

• Acne
• Asthma
• Breast Conditions
• AIDS
• Sexually Transmitted Diseases
• Diabetes
• Gynecological and Menstrual Conditions
• High Blood Pressure
• Infectious Mononucleosis
• Obesity
• Oral Health
• Slipped Capital Femoral Epiphysis
• Sports injuries
• Teen pregnancy
• Alcohol and Drug Abuse
• Teen Suicide
• Motor Vehicle Accidents
• Bulimia
• Anorexia nervosa

A substantial number of morbidity and social problems resulted from the approximately 870,000 pregnancies that occurred each year among women 15-19 years of age. An estimated three million cases of sexually transmitted diseases (STDs) occurred among those 10-19 years of age (CDC, 2002).

50% of adolescent pregnancies occur within the first six months of initial sexual intercourse despite the increasing use of contraceptive devices and medications (Klein, 2005). The HIV epidemic and the public health education efforts have made an impact and more adolescents use barrier contraceptives. However, in 2003, among high school students who reported they had sexual intercourse only 63% reported having used a condom the last time they had intercourse (Klein). Even with the education provided on HIV prevention once prescription contraceptives are started, the use of condoms decreases. Many adolescents have already been sexually active a year before a prescription contraceptive is used (Klein). Currently there is decreased use of the pill and increased use of an injectable contraceptive.

Using information from 33 states with confidential name-based HIV infection reporting The Center of Disease Control reported that by the end of 2004 that there were 187,093 males and 61,726 females who had acquired AIDS. There were 528 teens with AIDS who were 13-14 years of age and 4,559 individuals 15-24 years of age with AIDS.

Leading causes of mortality and morbidity among adolescents were related to the following categories of health behavior:

These behaviors are frequently interrelated and often are established during youth and extend into adulthood.
Behaviors that contribute to Unintentional Injuries are related to:

• Seat belt use,
• Motorcycle helmet use,
• Bicycle helmet use,
• Riding with a driver who had been drinking alcohol, and
• Driving after drinking alcohol

Behaviors that contribute to Violence:

• Carrying a weapon,
• Physical fighting,
• Dating violence,
• Forced sexual intercourse,
• School-related violence and,
• Depression and suicide ideation and attempts.

Physicians and other healthcare providers who are knowledgeable in adolescent medicine help adolescents and their families/guardians develop workable strategies to deal with developmental issues, conflicts, and complications that could occur between illness, treatment and specific developmental needs. These professionals help to improve communication between all parties to help adolescents deal with peer pressure and the desire to experiment with sex, drugs, poor nutrition, and fads.

Young people can have mental, emotional, and behavioral problems that are real, painful, and costly. These problems, often called disorders, are sources of stress for children and their families, schools, and communities. The number of young people and their families who are affected by mental, emotional, and behavioral disorders is significant. It is estimated that as many as one in five children and adolescents may have a mental health disorder that can be identified and require treatment.

Mental health disorders in children and adolescents are caused by biology, environment, or a combination of the two. Examples of biological factors are genetics, chemical imbalances in the body, and damage to the central nervous system, such as a head injury. Many environmental factors also can affect mental health, including exposure to violence, extreme stress, and the loss of an important person.
Families and communities, working together, can help children and adolescents with mental disorders. A broad range of services is often necessary to meet the needs of these young people and their families. Most adolescents who experience mental health problems can return to their activities of daily living, if they receive appropriate treatment. Physicians and other healthcare providers dealing with mental health issues are available in many communities. There are also professionals available for low to no-income families.

The National Institute of Mental Health (NIMH), part of the National Institutes of Health (NIH), reported the following:

• 8 percent of adolescents suffer from depression,
• One in ten children and adolescents suffer from mental illness severe enough to cause problems in their development and daily life,
• Anxiety disorders are the most common mental health problems that occur in children and adolescents, and
• Eating disorders such as bulimia and anorexia nervosa are also common

Young people, who experience excessive fear, worry, or uneasiness may have an anxiety disorder. According to one study of 9- to 17-year-olds, as many as 13 of every 100 young people have an anxiety disorder. Anxiety disorders include the following.

• Phobias, which are unrealistic and overwhelming fears of objects or situations.
• Generalized anxiety disorders, which cause patterns of excessive, unrealistic worry that cannot be attributed to any recent experience.
• Panic disorders, which cause terrifying panic attacks that include physical symptoms, such as a rapid heartbeat and dizziness.
• Obsessive-compulsive disorders, which cause patterns of repeated thoughts and behaviors, such as counting or hand washing.
• Post-traumatic stress disorders, which cause flashbacks and other symptoms and occurs in children who have experienced a psychologically distressing event, such as abuse, being a victim or witness to violence, or exposure to other types of trauma, such as wars or natural disasters.

Among teachers of required health education, elementary school teachers who provided accident and injury prevention education spent a median of 5 hours per school year teaching the topic, middle/junior high school teachers spent a median of 4 hours, and senior high school teachers spent a median of 5 hours.

During the two years preceding the study (SHPPS, 2001):

• 39.6% of states and 40.0% of districts provided funding for or offered staff development on accident or unintentional injury prevention education to health education teachers.
• 22.9% of elementary school classes, 30.2% of required health education courses in middle/junior high schools, and 34.3% of required health education courses in senior high schools had a teacher who received staff development on accident or unintentional injury prevention education.

Tobacco use, including cigarette smoking, cigar smoking, and smokeless tobacco use, is the single leading preventable cause of death in the United States. Each year smoking causes more than 400,000 premature deaths and 5 million years of potential life lost. The estimated direct and indirect costs associated with smoking in the United States exceed $68 billion annually. Approximately 80% of tobacco use occurs for the first time among young people less than 18 years of age.

In 2001, 29% of high schools students reported current cigarette use and 15% reported current cigar use. In addition, 8% of high school students and 19% of white male high school students reported current smokeless tobacco use.
Each day in the United States, approximately 4,400 youths aged 12-17 try their first cigarette (SAMHSA, 2002). If current patterns of smoking behaviors continue, an estimated 6.4 million of today’s children can be expected to die prematurely from a smoking-related disease. Although the percentage of high school students who smoke has declined in recent years, rates remain high: 29% of high school students report current cigarette usage (smoked cigarettes ≥ 1 of the preceding 30 days) (Grunbaum, et al., 2002).

Non-Hispanic white and Hispanic students (32% and 27%, respectively) are significantly more likely than black students (15%) to report current cigarette use (Grunbaum, et al., 2002). Nationwide, 64% of students have tried cigarette smoking. Male students (66%) are significantly more likely than female students (62%) to have tried cigarette smoking (Grunbaum, et al., 2002). 22% of high school students have smoked a whole cigarette before age 13 (Grunbaum, et al., 2002). 15% of students report having smoked cigars, cigarillos, or little cigars in the past month. 8% of high school students use smokeless tobacco (15% males and 2% females). Adolescents who use smokeless tobacco (snuff, chewing tobacco) are more likely than nonusers to become cigarette smokers.

Cigarette smoking by young people leads to serious health problems, including cough and phlegm production, and increase in the number and severity of respiratory illnesses, decreased physical fitness (both performance and endurance), adverse changes in blood cholesterol levels, and reduced rates of lung growth and function. Cigarette smoking causes heart disease; stroke; chronic lung disease; and cancers of the lung, mouth, pharynx, esophagus, and bladder. Use of smokeless tobacco causes cancers of the mouth, pharynx, and esophagus; gum recession; and an increased risk for heart disease and stroke. Smoking cigars increases the risk of oral, laryngeal, esophageal, and lung cancers.

The younger people begin smoking cigarettes, the more likely they are to become strongly addicted to nicotine. Several studies have found nicotine to be addictive in ways similar to heroin, cocaine, and alcohol. Because the typical tobacco user receives daily and repeated doses of nicotine, addiction is more common among tobacco users than among other drug users. Of all addictive behaviors, cigarette smoking is the one most likely to become established during adolescence. Of high school students who are current smokers, 57% have tried to quit in the past month (Grunbaum, et al., 2002).

All states have laws making it illegal to sell cigarettes to anyone under the age of 18, yet among students who report current cigarette use, 19% purchase their cigarettes in a store or gas station. Approximately two thirds of students (67%) who purchased or attempted to purchase cigarettes in a store or gas station were not asked to show proof of age (Grunbaum, et al., 2002). Cigarette companies spend more than $9.5 billion each year to promote their products, and in 1998 tobacco companies spent nearly $7 billion to advertise and promote cigarettes (FTC, 2000). Children and teenagers constitute the majority of all new smokers, and the industry’s advertising and promotion campaigns often have special appeal to these young people (CDC, 2000). 88% of young smokers (ages 12-17) choose the three most heavily advertised brands: Marlboro, Camel, and Newport (SAMHSA, 2001).

Healthy eating is associated with reduced risk for many diseases. Healthy eating in childhood and adolescence is important for proper growth and development and can prevent health problems such as obesity, dental caries, and iron deficiency anemia. Most young people are not following Dietary Guidelines for Americans recommendations.

Unhealthy diet and physical activity patterns together account for at least 300,000 deaths among adults in the United States each year; only tobacco use contributes to more deaths (HHS, 2001). Diet is a known risk factor for the three leading causes of death heart disease, cancer, and stroke; as well as for obesity, diabetes, high blood pressure, and osteoporosis. In 2000, the cost of obesity in the United States was over $117 billion, of which $61 billion was for direct medical costs and $56 billion was for indirect costs (HHS, 2001).

Type 2 diabetes, formerly known as adult onset diabetes, has become increasingly prevalent among children and adolescents as rates of overweight and obesity rise. A CDC study estimated that one in three American children born in 2000 will develop diabetes in their lifetime (Venkat, Boyle, Thompson, Sorensen, & Williamson, 2003).

Early indicators of atherosclerosis, the most common cause of heart disease, begin during childhood and adolescence. Atherosclerosis is related to blood cholesterol levels, which are associated with dietary habits (Kavey, Daniels, Lauer, Atkins, Hayman, & Taubert, 2003). Osteoporosis, a disease where bones become fragile and can break easily, is associated with inadequate intake of calcium. Children and adolescents who consume adequate amounts of calcium through dairy products and other calcium rich foods will have stronger bones and may have reduced risk of developing osteoporosis later in life.

Research suggests that not having breakfast can affect children’s intellectual performance (Kleinman, Hall, Green, Korzec-Ramirez, Patton, Pagano & Murphy, 2002). The percentage of young people who eat breakfast decreases with age; while 92% of children ages 6–11 eat breakfast, only 75–78% of adolescents ages 12–19 report eating breakfast. A study among inner city children at nutritional risk showed that participants in a school breakfast program increased their nutrient intake and were more likely to improve their academic and psychosocial functioning than their counterparts who did not participate in the program (Kleinman, et al., 2002).

Overweight is defined as a body mass index (BMI) at the 95th percentile or higher. Almost 9 million children and adolescents in the United States aged 6–19 years are overweight (CDC, 2001). The prevalence of overweight among children aged 6–11 has more than doubled in the past 20 years, increasing from 7% in 1980 to 15% in 2000. Overweight among adolescents aged 12–19 has tripled in the same time period, rising from 5% to 15% (CDC, 2001). Overweight children and adolescents are more likely to become overweight or obese adults ;( Micic, 2001) (Ferraro, Thorpe & Wilkinson, 2003) one study showed that children who became overweight by age 8 were more severely obese as adults (Freedman, Kahn, Dietz, Srinivasan, & Berenson, 2001).

While the prevalence of overweight and obesity has increased in all segments of the U.S. population, disparities exist based on race and ethnicity, sex, and socioeconomic status. For example, overweight is particularly common among minority groups and those with a lower family income (HHS, 2001).

Less than 40% of children and adolescents in the United States meet the U.S. dietary guidelines for saturated fat, fruit, and vegetable intake. Of U.S. youth aged 6-19, 67% exceed dietary guidelines recommendations for fat intake, and 72% exceed recommendations for saturated fat intake. Only 21% of high school students eat the recommended five daily servings of fruits and vegetables (when fried potatoes and potato chips are excluded).

Only 39% of children ages 2–17 meet the USDA’s dietary recommendation for fiber (found primarily in dried beans and peas, fruits, vegetables, and whole grains) (Lin, Guthrie & Frazao, 2001). Eighty-five percent of adolescent females do not consume enough calcium. During the last 25 years, consumption of milk, the largest source of calcium, has decreased 36% among adolescent females (Cavadini, Siega-Riz & Popkin, 2000). Additionally, from 1978 to 1998, average daily soft drink consumption almost doubled among adolescent girls, increasing from 6 oz to 11 oz, and almost tripled among adolescent boys, from 7 oz to 19 oz (USDA, 2003).

A large number of high school students use unsafe methods to lose or maintain weight. A nationwide survey found that during the 30 days preceding the survey 13.5% of students went without eating for one or more days; 5.4% had vomited or taken laxatives; and 9.2% had taken diet pills, powders, or liquids without the advice of their physicians (Grunbaum, Kann, Kinchen, Williams, Ross, Lowry & Kolbe, 2001).

Unprotected sexual intercourse and multiple sex partners place young people at risk for HIV infection, other sexually transmitted diseases (STDs), and pregnancy. Each year, approximately three million cases of STDs occur among teenagers and approximately 860,000 teenagers become pregnant. In 2001, 46% of high school students had ever had sexual intercourse, 14% of high school students had four or more sex partners during their lifetime, and 42% of sexually active high school students did not use a condom at last sexual intercourse (The Youth Risk Behavior Surveillance System (YRBSS):
2001).

Among teachers of required health education, elementary school teachers who provided STD prevention education spent a median of 1 hour per school year teaching the topic, middle/junior high school teachers spent a median of 2 hours, and senior high school teachers spent a median of 3 hours (SHPPS, 2001)

During the two years preceding the SHPPS study (2001):

• 92.2% of states and 47.5% of districts provided funding for or offered staff development on STD prevention education to health education teachers.
• 13.6% of elementary school classes, 31.8% of required health education courses in middle/ junior high schools, and 46.5% of required health education courses in senior high schools had a teacher who received staff development on STD prevention education.

31.4% of states and 47.4% of districts require that districts or schools provide one-on-one or small-group discussions on HIV prevention to students when needed (not including classroom instruction). 12.0% of states and 15.4% of districts require districts or schools to provide HIV testing and counseling services to students when needed. 30.4% of districts have arrangements with organizations or professionals not located on school property to provide one-on-one or small-group discussions on HIV prevention to students when needed, and 25.2% have arrangements to provide HIV testing and counseling. 2.0% of middle/junior high and 4.1% of senior high schools make condoms available to students as part of standard health services.

Healthcare professionals have an additional challenge in dealing with adolescent patients because of their developmental stage as well as their propensity for risky behavior. The healthcare professional needs to understand the adolescent’s special circumstances when working with an adolescent client.

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