Why Adolescents?

Adolescence, or the second decade of life, is a period in which an individual undergoes major physical and psychological changes. Alongside this, there are enormous changes in social interactions and relationships. It is a phase of an individual’s life rather than a fixed time period; a phase in which an individual is no longer a child but is not yet an adult. Adolescence is a journey.

Adolescent development drives the changes in the disease burden between childhood to adulthood—for example, the increase with age in sexual and reproductive health problems, mental illness and injuries.

The vast majority of adolescents (85%) live in developing countries where, in many areas, they make up a third, or more, of the population. Adolescents face a variety of experiences depending on diverse political, economic, social and cultural realities within their communities. Although, for many, adolescence is a period of learning and building confidence in a nurturing environment, for others it is a period of heightened risk and complex challenges. As adolescents are reaching puberty earlier and marrying later, they face a longer period of sexual maturity before marriage and thus are more susceptible to a wider variety of reproductive health problems.

Sexual activity during adolescence (within or outside marriage) places adolescents at risk of sexual and reproductive health problems, which include early pregnancy (intended or otherwise), unsafe abortion, sexually transmitted infections including HIV, and sexual coercion and violence. For many sexually active adolescents, reproductive health services, such as provision of contraception and treatment for sexually transmitted infections, are either not available or are provided in a way that makes adolescents feel unwelcome and embarrassed. As a result, adolescents are more likely to rely on resources available outside the formal health-service provision system, such as home remedies, traditional methods of contraception, clandestine abortion or medicines from shops or traditional health practitioners.

WHO’s constitution defines health as: “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.”

WHO currently uses two programmatic “entry points” to strengthen the health sector response to adolescent health and development:

HIV prevention, care and support of those with HIV; and
The prevention of early pregnancy, and pregnancy-related mortality and morbidity.

Particularly in low-and-middle income countries, many adolescents and young people are living with HIV, and many experience sexual and reproductive health (SRH) problems. Further, these priorities are the focus of many international development goals (notably the Millennium Development Goals). In addition, most countries have national programmes, strategies and budgets in place to address these priorities.

Adolescent Health Research – Focus on Sub-Saharan Africa (SSA)

Adolescent health is under-measured, seldom prioritised and leaves this population underserved. Adolescents live and interact within social networks and are affected by society, policies, and epidemic settings. Effective interventions require a biopsychosocial approach with consideration for the socio-economic context and this warrants a focus on adolescent health that recognizes the growing population, is grounded in context, and cognisant of specific health drivers and implementation challenges. African adolescent health researchers who live in, work with, and understand the context of the region and their own countries are urgently needed.

There are many research priorities specific to the SSA context, which include:

The investigation of innovative integration of adolescent health services into primary health care.
The establishment of a collaborative network to guide research priorities and expedite evidence-based implementation.
Consideration of the need to conduct adolescent research within a protective ethical-legal framework that ensures adolescent research involvement is ethical, respectful, and beneficial to this population.
The promotion of participatory action research that promotes the authentic and meaningful inclusion of adolescents in research as authorities of their own health and health experiences.
A focus on implementation science to support rapid scale up and persistent use of novel interventions, in varied settings.
A dual focus on both diseased and disease-free adolescents with twin goals of disease control and enhanced preventive and promotive health, acknowledging that the starting point for AH programming is adolescent-friendly and accessible counselling and screening.

Adolescent HIV and sexual health focus

Adolescent girls and young women (AGYW) are particularly burdened by the African HIV epidemic (Call et al., 20021). In South Africa, young women are 4-6-fold more likely to be HIV infected than their male counterparts and in 2014 South African girls alone contributed 10% to global new HIV infections among 15-19-year-old girls. Drivers of HIV risk among young African women include early age of sexual debut, multiple and often older sexual partners, inconsistent/ poor condom use, coercion and violence, trans-generational sex, transactional sex, and sex with strangers. This correlates with the high prevalence of HIV and other STI’s, as well as the high incidence of teenage pregnancy (94 000 SA school girls fell pregnant in 2011).

AGYW need health care interventions that are accessible, layered, and integrated and which are inclusive of the full range of evidence-based biomedical and behavioural tools and approaches that the world now has to offer them. Finding innovative new strategies to implement these interventions, understanding what individual and social support is still required, and standing tall on these gains to find new, more acceptable and more effective solutions to suit the ever-evolving modern day adolescent (and increasingly virtual world) is critically needed.

Adolescents and brain development

Adolescents differ from adults in the way they behave, solve problems, and make decisions. There is a biological explanation for this difference. Studies have shown that brains continue to mature and develop throughout childhood and adolescence and well into early adulthood.

Scientists have identified a specific region of the brain called the amygdala that is responsible for immediate reactions including fear and aggressive behaviour. This region develops early. However, the frontal cortex, the area of the brain that controls reasoning and helps us think before we act, develops later. This part of the brain is still changing and maturing well into adulthood. Other changes in the brain during adolescence include a rapid increase in the connections between the brain cells and making the brain pathways more effective. Nerve cells develop myelin, an insulating layer that helps cells communicate. All these changes are essential for the development of coordinated thought, action, and behaviour.

Changing brains mean that adolescents act differently from adults

Pictures of the brain in action show that adolescents’ brains work differently than adults when they make decisions or solve problems. Their actions are guided more by the emotional and reactive amygdala and less by the thoughtful, logical frontal cortex. Research has also shown that exposure to drugs and alcohol during the teen years can change or delay these developments. Based on the stage of their brain development, adolescents are:

More likely to	Less likely to
Act on impulse Misread or misinterpret social cues and emotions Get into accidents of all kinds Get involved in fights Engage in dangerous or risky behaviour	Think before they act Pause to consider the consequences of their actions Change their dangerous or inappropriate behaviours

Leading health risks in the different age groups

Many of the problems that impact adolescent health are preventable because they stem from behavioural choices, and not physical roots.

10 – 14 year-old group

This group has the lowest risk of death with the adolescent profile.
Leading health risks are related to water, hygiene and sanitation.
Half of all mental health disorders (50%) in adulthood start around 14 years of
age.
Early onset of substance use is associated with higher risks of developing
dependence and other problems during adult life.

15 – 19 year-old group

Leading health risks are behaviour-related, such as alcohol use and unsafe sex.
Globally 43/1000 births to girls in this age group per year.

20 – 24 year-old group

Mental health of this group has a profound impact on their physical health,
academic achievement, and well-being.
Seventy-five percent (75%) of all mental health disorders in adulthood have
emerged by 24 years of age.
Suicide is a leading cause of death.
Trauma associated with common adverse childhood experiences contributes to
mental and behavioural health issues.

BY YOLISWA NTSEPE (MA, PhD)
ADOLESCENT PROGRAMMES MANAGER

UPDATED NOV 22, 2023

TABLE OF CONTENTS:

REFERENCES & ADDITIONAL RESOURCES: