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Clinical guidelines

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people Second edition

Overview: The health of young people

Author Dr Annapurna Nori 
Expert reviewer Professor Sherry Saggers

Overview

In this chapter the terms ‘young people’ and ‘adolescents’ refer to people aged 12–24 years. This is consistent with the definitions used by the University of Melbourne Centre for Adolescent Health, the NSW Centre for the Advancement of Adolescent Health and the Australian Institute of Health and Welfare.1,2 It is important to note that this definition differs from the World Health Organization defined age range of 10–19 years.

The preventive health issues for young people are very broad. To narrow the scope for the National Guide, this chapter focuses on three topics: psychosocial assessment, the prevention of unplanned pregnancies, and illicit substance use. Other areas relevant to youth health, in particular smoking, physical activity, obesity, alcohol, sexual health, depression and suicide, are addressed in other chapters.

According to the World Health Organization, ‘Nearly two thirds of premature deaths and one-third of the total disease burden in adults are associated with conditions or behaviours that began in youth, including tobacco use, a lack of physical activity, unprotected sex or exposure to violence. Promoting healthy practices during adolescence, and efforts that better protect this age group from risks will ensure longer, more productive lives for many’.3

Young people’s specific developmental and health needs are distinct from that of children or adults. Their sexual and reproductive health in particular tend to be different from those of adults.4 The underlying aetiology of illness in young people is most often psychosocial.1 Although social and economic factors can influence health in all age groups, the adverse health outcomes for young people are strongly influenced by family breakdown, physical/sexual abuse and neglect and homelessness. Adolescence is a period of risk taking and experimentation, thereby providing greater potential for adverse health outcomes. Despite this, young people underutilise primary care, are reluctant to seek help for health problems and seldom receive counselling about risk taking behaviours when they do.5–7 Clinician training and charting tools are associated with increases in rates of screening and counselling of adolescents about risky behaviours.8

An overview of the health of Aboriginal and Torres Strait Islander young people

In the 2006 census, around 120 378 people identified as Aboriginal, Torres Strait Islander or both in the age group 12–24 years.9 They comprise 3.4% of the total Australian population of young people in that age range and 26.5% of the total Aboriginal and Torres Strait Islander population.9 By contrast, young people comprise 18% of the total Australian population. Most Aboriginal and Torres Strait Islander young people live in major cities and inner and outer regional areas, however, they account for over half of all young people in Australia living in very remote areas.9

Among the general Australian youth population, the leading causes of death and illness are accidents and injuries (unintentional and self inflicted), mental health problems (including depression and suicide) and behavioural problems (including illicit drug use). Half of all deaths in those aged under 19 years are caused by injuries.10 The overall death rate and the injury death rate for Aboriginal and Torres Strait Islander young people are four and five times greater than for non-Indigenous young people respectively.

In 2004–05, young Aboriginal and Torres Strait Islander people aged 15–24 years were less likely to rate their health as excellent or very good, compared to young non-Indigenous people (59% compared to 70% respectively).2 Aboriginal and Torres Strait Islander young people were slightly more likely than non-Indigenous young people to rate their health as fair or poor (9% compared to 7%). They are more likely to experience health risk factors such as obesity, physical inactivity, smoking, lower educational attainment and imprisonment. Fifty percent of Aboriginal and Torres Strait Islander young people aged 18–24 years are smokers, compared to 26% of their non-Indigenous counterparts. In the 18–24 years age group, the prevalence of a long term health condition is 1.5 times greater than for non-Indigenous young people. Hospital separations due to mental and behavioural disorders (including substance and alcohol abuse) are 1.6 times greater than non-Indigenous youth in several Australian states.

Among the general population in 2005, half of sexually transmissible infections (STIs) notifications were for young people aged 12–24 years.2 In the same period 13% of all chlamydia notifications, 64% of all gonococcal notifications and 56% of all syphilis notifications were for Aboriginal and Torres Strait Islander young people. Aboriginal and Torres Strait Islander youth are less likely to access primary healthcare services and are more likely to present to tertiary healthcare services than non-Indigenous young people. Youth friendly primary care services that are sensitive to the administrative, financial, cultural and psychological hurdles experienced by young people is an integral step in providing effective preventive interventions.1,7,11,12

Note: a detailed review of unplanned pregnancy and illicit drug use epidemiology is provided in separate sections.

References

  1. Chown P, Kang M, Sanci L, Newnham V, Bennett DL. Adolescent health: enhancing the skills of general practitioners in caring for young people from culturally diverse backgrounds. GP resource kit, 2nd edn. Sydney: NSW Centre for the Advancement of Adolescent Health and Transcultural Mental Health Centre, 2008.
  2. Australian Institute of Health and Welfare. Young Australians: their health and wellbeing 2007. Cat. no. PHE 87. Canberra: AIHW, 2007.
  3. World Health Organization. 10 facts on adolescent health. Geneva: WHO, 2008. Cited October 2011. Available at www.who.int/ features/factfiles/adolescent _health/en/index.html.
  4. World Health Organization. Promoting and safeguarding the sexual and reproductive health of adolescents, 2006. Cited October 2011. Available at www.who.int/ reproductivehealth/publications/ adolescence/policy_brief_4_rhstrategy/en/index.html.
  5. Ma Jun WY, Stafford Randall S. US adolescents receive suboptimal preventive counseling during ambulatory care. J Adolesc Health 2005;36(5):441e1-e7.
  6. Hwang L, Tebb K, Shafer M, R P. Examination of the treatment and follow-up care for adolescents who test positive for Chlamydia trachomatis infection. Arch Pediatr Adolesc Med 2005;159:1162–6.
  7. Carr-Gregg M, Enderby K, Grover S. Risk-taking behaviour of young women in Australia: screening for health-risk behaviours. Med J Aust 2003;178:601–4.
  8. Buckelew S, Adams S, Irwin C, Gee S, Ozer E. Increasing clinician self-efficacy for screening and counselling adolescents for risky health behaviors: results of an intervention. J Adolesc Health 2008;43(2):198–200.
  9. Australian Bureau of Statistics. Census. Canberra: ABS, 2006. Cited October 2011. Available at www.abs.gov.au/ websitedbs/censushome.nsf/ home/Census.
  10. Australian Institute of Health and Welfare. Making progress: the health, development and wellbeing of Australia’s children and young people. Canberra: AIHW, 2008.
  11. American Medical Association. Guidelines for adolescent preventive services (GAPS) recommendations monograph. Chicago: American Medical Association, 1997. Cited October 2011. Available at www.ama-assn.org/ ama1/pub/upload/mm/ 39/gapsmono.pdf.
  12. Elster AB, Kuznets NJ, American Medical Association Department of Adolescent Health. AMA guidelines for adolescent preventive services (GAPS): recommendations and rationale. Baltimore: Williams & Wilkins, 1994.
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