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University of Malta
Faculty of Health Sciences
Department of Nursing

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NUR 1126 Paediatrics and Maternal Care

Title: Endorsing Health amongst Adolescents with Concerning Trends in Morbidity and Mortality

Name & Surname: Jasmine Borg (32798M)

According to the World Health Organisation (WHO), health is defined as being the complete state of physical, mental and social well being and not merely the absence of disease or infirmity. Health is a phenomenon which is subject to continuous change, activity and progress, and so described as being something dynamic. Nursing is considered to be one of those professions which embraces all aspects of the lives of individuals. This idea could clearly be understood through health promotion and health maintenance in nursing interventions among different age groups. Additionally, the WHO describes health promotion as being ” the process of enabling people to increase control over their health and its determinants, and thereby improve their health”. It incorporates activities which escalate well being as well as enhance wellness or health. Lifestyle change can be facilitated through a combination of efforts to upsurge awareness, change behaviour, and create environments that support good health practices. Epp (1987) says that it is a framework which helps in formulating ways of dealing with day-to-day health issues. Although this idea has brought changes in attitudes and behaviours amongst individuals throughout the years, the shift has been slight and slow (Epp,1987). Studies discuss that health promotion nowadays incorporates a multi factorial exercise which encompasses education, training, research, legislation, policy coordination and community development.

The adolescent phase is a stage which is marked by accelerated physiological changes due to puberty, physcosocial and emotional changes. It is the transition were ones gets to let go the childhood platform and move to that of becoming a responsible adult. At this age teenagers, strive for independence and social circles begin to grow (Sons, 2009). Adolescence is the period which brings about increasing demands not only on the young adult but also on the family as well as the family physician. Peers start to play an essential role in the physiological, and social development of adolescents, thus peer education may be used to address health promotion among this particular age group (Ochieng, 2009). In addition to this, as young people, they start exploring with their sexuality which goes far beyond the platonic stage, and while certain teenagers feel the need to discuss certain topics, many stay back from doing so from authority figures such as family members and teachers (Laverack, 2014). Research has found that despite that health promotion amongst the general practice setting is limited, teenagers still trust their doctors for health related issues. It was best found that physicians use empathic, personal messages to communicate with adolescents about these issues (Ham et al, 2012). Additionally general practice certainly without any doubt plays a role in preventing the onset or continuation of health damaging behaviours that may not be as yet endorsed as part of a lifestyle (Walker & Townsend, 1999).

Health wellness can furthermore be managed through counselling sessions, where information is verbally explained and discussed regarding serious health problems, risky behaviour and poor health habits which may arise among teens. These may include; smoking, conceptions, suicide, accidents, eating disorders and sexually transmitted diseases. Laverack (2014) suggests that such an exercise can be easily established at school by the school nurse. This is likely so since it is considered to be a healthy environment not only for school aged children but evenly so, adolescents. The school nurse plays a vital duty in ensuring that adolescents develop a healthy overall lifestyle. This point is sustained by the Department of Health (2014) which highlights the roles and responsibilities taken up by the school nurse, which incorporates the following :

Assures that children between the age of 5-19 have all the required vaccinations and immunisations as per the government’s protocol
Arranging screening services to monitor both the mental and physical development of the child/teenager 
Providing health education relating health issues to target a healthy lifestyle
As part of the nurses’ job he/she should act as an activist to ensure that health policies are implemented.
Arrange for referrals with additional health care professionals when required. 

Throughout the years it was found that there was an increase on the number of health promotion activists being present around schools, community health services, drug and alcohol commissions and at the place of work (Epp, 1987).

Media is a powerful weapon in the world we live in today which can be used very easily to manipulate people. None the less having said this, it can be used as dynamic tool to pass on an effective message to the public. According to research, mass media campaigns appeared to perform better when embedded in a range of initiatives than when standing alone. Mass media aids health workers to expand their audience which is vital, considering the fact that face-to-face channels of communication often require too many human resources and reach only a small number of people. It is believed to serve an effective way to persuade target audiences to adopt to new behaviours, or to remind them or make them aware of the critical negative consequences of certain behaviours. Printed media such as the use of pamphlets and leaflets can also disseminate vital health information reliably, amongst this particular age group (Walker & Townsend, 1999).

Adolescence is the time hen new health behaviours are laid down- behaviours that track into adulthood and will influence health and morbidity throughout life.According to studies, adolescents were considered to fall under a healthy criteria, however the search for a meaningful personal identity was one of the essential tasks faced by a youth. During this period, the teenager experiences what is known as “identity crisis”. It involves confusion about one’s social position and often a feeling of loss of continuity to one’s personality.  Consequently, this problem has lead teenagers to engage and explore in a considerable spectrum of health risk behaviours that have left adverse affects both on one’s present and future health. 

Sexual Health 
Adolescent sexual behaviours are a significant public health issue due to the risk of sexually transmitted diseases (STDs) and negative social consequences of unforeseen teenage pregnancies. Young people tend to underestimate their probability of getting pregnant. Research explains that adolescents, round the average age of 16 years, start experimenting with multiple partners and engage themselves in unprotected sex without the use condoms (Mellanby, Phelps & Tripp, 1993). This has shown the highest rates of developing gonorrhoea, syphilis and chlamydia infection amongst this social class (Walker & Townsend, 1999). Statistics additionally convey that those who took part in any form of sexual activity before the age of 16 years where twice as likely to have a friend with a sexually transmitted disease (STD). There was a spike in HIV infection by mid 1991 and a quarter of the diagnosed (14,666 people) were below the age of 25 years. A survey conducted by the the Directorate of Health Information and Research (2013) concluded that in the year of 2012, 41 percent of 16-18 year old teenagers engaged in sexual intercourse. 16.8 percent of those who were sexually active were under the influence of alcohol and drugs during sexual encounter, and 6 percent admitted to have one night stands.

The state offers a number of services which can be made of good use. At Mater Dei hospital one finds the Genitourinary (GU) clinic which is free of charge like all other services and guarantees confidentiality and treatment even if the client is a minor. It works with a system of codes and numbers and not names and surnames. Its main purpose is to diagnose and treat sexually transmitted diseases. A number of acts here in Malta, such as the Malta Medical Students Association and the Malta Gay right movement work together with the government to promote safer measures regarding sex and help in increasing awareness on the negative impact and consequences of taking part in such behaviours irresponsibly. Moreover, since cervical cancer ranks as the 16th most frequent cancer among women in Malta and the 6th most frequent cancer among women between 15 and 44 years of age (ICO Information Centre on HPV and Cancer, 2017) the state introduced the Human Papillomavirus Virus (HPV) vaccination programme back in 2012. It continues to explain that, since then, twelve year old girls are immunised for free at the immunisation clinics as well as various health centres around Malta. Counselling services related to young teen pregnancies, contraception and sexually transmitted diseases, screening and pregnancy test services should be stressed and heartened to a greater extent, simultaneously made more easily accessible among these youths.

Alcohol, Drug Abuse and Smoking
Alcohol continues to prevail as being the number one choice among 90 percent of high school seniors (Shore et. al, 1991). Approximately by the age of 16, over 40% of boys and girls report weekly alcohol consumption at an average of 3.4 units per boy, and 1.6 per girl. Research has shown that most people drink at the highest consumption levels in their lives while they are between the ages of 16 and 24 years. Walker & Townsend (1999) expound that as a consequence this has induced a higher risk of dying in alcohol related – traffic accidents among this particular age category. It was reported that 10 minute discussions relating alcohol misuse could decrease the intake by 20% (Oler et al. 1994). This issue not only arises abroad but also among Maltese adolescents. A survey conducted by SEDQA back in 2011 has established that out of the 90% of students who confessed of consuming alcohol, 56% of them drank more than 5 drinks in one sitting and 20% of which have declared of becoming drunk at least once in the past month. Results from this survey also addressed that at least 37% reported being intoxicated in the last 12 months and 20% in the last 30 days (Arpa, 2011).

Tobacco smoking in Malta ranks as the second common behaviour in which students participate in. The same SEDQA survey specified that 23% of the students surveyed, smoked regularly and 20% of them had started smoking before the age of 13. Raj and Kumar (2010) discuss the adverse complications which may arise from smoking such as; stroke, heart disease, COPD, lung cancer together with many more. Early initial use of tobacco widens the probability of developing lung cancer in the future. International sources state that girls have a higher possibility of becoming daily smokers than boys. Moreover, according to a survey held by MORI resulted that children who smoke have a higher tendency of exposing themselves to multiple other risks. There was a strong link with the use of illegal drugs. 50% of the smokers had experimented with drugs ( 8% cannabis, 11% acid, 10% glue sniffing, 10% amphetamines) when compared to the 2% who did not smoke(Walker & Townsend, 1999). Drug prevention programmes have been introduced within schools, communities and residential centres were such issues can be discussed. One may also find the SEDQA helpline number 175 for any further additional information or counselling one may need.

Mental Health and Stress 
Mental health disorders seem to be a quite prevalent among teenagers, and these problems appear to be multiplying both in number and severity. Poor mental health is strongly related to other health issues which concern us, for instance substance abuse, violence and eating disorders such as anorexia and bulimia. Evidence points out that 14% of adolescents were diagnosed to have a mental health problem. Many of these teenagers were found to be suffering from other stressors outside their lives which could have lead to this result. They were also prone to a higher chance of suicidal demeanour and self harm. Sawyer et al. (2001), expressed that only a small percentage identified with a mental health problem seeked some form of help prior to the study. In fact in 2014, suicide was the second leading cause of death among individuals aged between 10-14 years Americans and globally it ranked as the 3rd cause of death in 2015 (WHO, 2017).

Preventing Obesity and Encouraging Healthy Habits 

Obesity and overweight have in the last decade become a global complication. According to the World Health Organisation (2017) obesity is defined as having “excessive fat accumulation that may impair health.” Back in 2016, 41 million children under the age of 5 were overweight or obese. Adding on to this, in the same year, over 340 million children and adolescents aged 5-19 were overweight or obese. Many co-morbid conditions such as; metabolic, cardiovascular, psychological, orthopaedic, neurological, hepatic, pulmonary and renal disorders are seen in association with childhood obesity (Raj and Kumar, 2010). A myriad of elements contribute to teenage obesity, however consuming unhealthy foods containing large amounts of saturated fat and sugar than recommended levels and not participating in any form of physical activity, are two preventable measures that play a major part in the predominance of children and adolescents. In the most recent Health Behaviour in School Aged Children (HBSC) survey (2013–2014), Malta ranked as the country with the highest prevalence of obese children aged between 11 and 15. Tackling the problem of obesity “requires a multidisciplinary, multi-phase approach, which includes dietary management, physical activity enhancement, restriction of sedentary behaviour, pharmacotherapy and bariatric surgery” (Raj and Kumar, 2010). It is advisable that teenagers target for at least 1hr of moderate intensity exercise everyday. Various strategies have been initiated and put into practise especially were children spend most of their time, which is at school. Certain programs include the following : 

Tuck shop at schools should opt for healthy foods 
Increasing physical activity at school by allocating more time to physical education 
Parents should encourage and provide a healthy breakfast and lunch for school
Teachers should monitor eating habits and physical activity levels among students

Even though adolescents might seem to be at the peek of life, they are still seen as minor individuals. Adolescence is a period in our lives through which we experience all sorts of changes which span from those physical to emotional changes. It is a stage which brings with it a number of dilemmas within oneself, which make us more vulnerable to fall into the trap and be tempted to experiment and involve ourselves in unhealthy habits which may turn out to be pernicious later on in our lives. It is important to bear in mind that, regardless of the the fact that they might still be considered as underage individuals, they still hold their own set of rights. 

Despite the low efficacy of most health promotion messages at individual level, health professionals do have a role in health promotion in their clinical interactions with young people. Trying to convince teenagers to comply with medical regimens and appointments may turn out to be quite demanding and confronting for physicians. Having said this, this dispute can be enhanced by providing a warm, positive, flexible environment as much as possible when addressing this particular age group and ensuring confidentiality at all times. The Government may also co-operate by joining forces with other organisations and address teenage health as a main concern. We already have the foundations upon which to build, hence with one main target let us continue aiming to encourage and make sure that positive health is endorsed and maintained amongst the ones which will eventually determine the future!

References 

Arpa, S. (2011). ESPAD – European School Survey Project on Alcohol and Other Drugs. Malta: Sedqa.

B, W., Braveman, S. A., & Mellin, L. Family Medicine. USA: Springer.
CB, S. (1991). Health effects of cigarette smoking. Clinics in Chest Medicine , 12 (4), 643-658.

Directorate for Health Information and Research. (2013, October). Sexual Knowledge,
Attitudes and Behaviours- National Survey for 2012, from
https://health.gov.mt/en/health…/sexual_health_survey_report_2012.pdf)

Epp, J. (1987). A framework for Health Promotion. Achieving Health For All , 1 (4).
ICO Information Centre on HPV and Cancer. (2017). Human Papillomavirus and Related Cancers, Fact Sheet 2017. 

Health Behaviour in School Aged Children. (2012). 2009/2010 International Report- Social
Determinants of Health and Well-Being among young people, from http://www.hbsc.org/publications/international/#osix

J Townsend, H. W. (1991). Adolescent smokers seen in general practice: health, lifestyle, physical measurements, and response to antismoking advice. British Medical Journal , 303 (947).

Laverack, G. (2014). A-Z of Health Promotion. UK.

Mellanby, A., Phelps, F., & Tripp, J. H. (1993). Teenagers, sex, and risk taking. British Medical Journal , 307 (6895), 25.

MJ O., 3rd, M. A., CA, M., E, R., A, H., D, W., et al. (1994). Depression, suicidal ideation, and substance use among adolescents. Are athletes at less risk? Archieves Of Family Medicine , 3 (9), 781-785.

Nicholson, W. (2014). Maximising the School Aged Children Nursing Team Contribution to the Public Health of School. UK: Crown.

Ochieng, B. (2001). Health promotion strategy for adolescents’ sexual behaviour. Journal of Child Health Care , 5 (2), 77-81.

P, H., & C, A. (2012). Adolescent health screening and counselling. Am Fam Physician , 86 (12), 1109-16.

Raj, M., & Kumar, R. K. (2010). Obesity in children & adolescents. The Indian Journal of Medical Research , 132 (5), 598–607.

Sawyer, M., Arney, F., Baghurst, P., Clark, J., Graetz, B., Kosky, R., et al. (2001). The Mental Health of Young People in Australia: Key Findings from the Child and Adolescent Component of the National Survey of Mental Health and Well-Being. Australian & New Zealand Journal of Psychiatry , 35 (6), 806-814.

Sons, J. W. (2009). Adoloscent Health. San Francisco , California: Jossey-Bass.

Walker, Z. A., & Townsend, J. (1999). The Role of General Practice in Promoting Teenage Health. Family Practice , 16 (2), 164–172.

World Health Organisation . (2017, October). Obesity and overweight.

World Health Organisation. (2017). More than 1.2 million adolescents die every year, nearly all preventable. Geneva.

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