☰ Table of contents
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 and the Australian Institute of Health and Welfare.1,2 It is important to note that this definition differs from the World Health Organization (WHO) recommended age range of 10–19 years, and the United Nations definition (for statistical purposes) of 15–24 years.3 The preventive health issues for young people are very broad, and many areas relevant to youth health, in particular smoking, physical activity, obesity, alcohol, sexual health, depression and suicide, are addressed in other chapters. Therefore, this chapter focuses on three topics: social emotional wellbeing (previously psychosocial in the second edition of this guide) assessment, the prevention of unplanned pregnancies, and illicit substance use. A new addition to this National Guide is that young people are considered separately in the lifecycle charts (refer to ‘National Guide lifecycle chart: Young people’).
According to the WHO, ‘Promoting healthy behaviours during adolescence, and taking steps to better protect young people from health risks are critical for the prevention of health problems in adulthood, and for countries’ future health and ability to develop and thrive’.4
Young people’s specific developmental and health needs are distinct from those of children and adults. Their sexual and reproductive health, in particular, tend to be different from those of adults.5 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 abuse, sexual abuse, neglect and homelessness.
Adolescence is a period of risk taking and experimentation, which is necessary in order to develop resilience.
However, this also provides greater potential for adverse health outcomes. According to the US National Academy of Medicine and the National Research Council of the National Academies, young adults have significantly lower rates of healthcare system use compared with other groups, but significantly higher emergency room visit rates compared with those immediately younger and older than them. These lower use rates do not necessarily indicate better health.6
There continue to be individual and systems-based barriers to young people using primary care. For example, young people are concerned about confidentiality and privacy, cost of care and medications, and are often embarrassed to discuss sexual matters or access contraception. Health service providers often do not provide youth-friendly spaces including flexible appointments, and are themselves often uncomfortable about discussing health risks with young people. This therefore explains young people’s reluctance to seek help for health problems and why they seldom receive counselling about risk-taking behaviours when they do.7–11 Clinician training and systems-based approaches such as screening tools and templates incorporated into medical charts (charting tools), however, are associated with increases in rates of screening and counselling of adolescents about risky behaviours.10,12,13
An overview of the health of Aboriginal and Torres Strait Islander young people
In the 2011 Census, 144,387 people in the age group 12–24 years identified as Aboriginal, Torres Strait Islander or both.14 They comprise 3.7% of the total Australian population of young people in that age range, and 27% of the total Aboriginal and Torres Strait Islander population. By contrast, young people comprise 18.1% of the total Australian population.14 Most Aboriginal and Torres Strait Islander young people live in major cities, and inner and outer regional areas; however, they account for 38% of all young people who live in very remote areas in Australia.2
In 2007–08, Aboriginal and Torres Strait Islander young people aged 15–24 years were equally likely as all young people to rate their health as ‘excellent’ (25% and 27% respectively); less likely to rate their health as ‘very good’ (33% and 40% respectively); and more likely to rate their health as fair or poor (10% and 7% respectively). Overall, 90% of young Aboriginal and Torres Strait Islander people aged 15–24 years rated their health as excellent, very good, or good, compared to 93% of young non-Indigenous people.2
The burden of illness in Australian young people is attributable to mental disorders such as anxiety and depression, substance use and injuries.2 In the years 2003–07, the death rate for Aboriginal and Torres Strait Islander young people was 2.5 times greater than for non-Indigenous young people. The injury death rate was three times higher.2 The leading causes of death and illness for all Australian youth continue to be accidents and injuries (unintentional and self-inflicted), accounting for around two-thirds of all youth deaths.2
Health risk factors such as obesity, physical inactivity, smoking, lower educational attainment, and imprisonment are more prevalent among Aboriginal and Torres Strait Islander youth compared to non-Indigenous youth. In 2014–15, 46.6% of Aboriginal and Torres Strait Islander males and 44.4% of females aged 18–24 years were current smokers, compared with 12.8% and 15.1% respectively for non-Indigenous people aged 18–24 years.15 Indigenous youth are more likely than non-Indigenous youth to consume alcohol at risky or high-risk levels in the short term (23% versus 15% respectively). In 2008, the incidence of notifiable sexually transmitted infections for Indigenous young people aged 12–24 years was 10.6 times the incidence for non-Indigenous youth.15 Specifically, chlamydia and gonorrhoea notification rates were 7.1 and an alarming 81.1 times higher respectively.2
Aboriginal and Torres Strait Islander youth continue to be less likely to access primary healthcare services and are more likely to present to tertiary healthcare services than non-Indigenous young people. Specific additional barriers that Indigenous young people face include poor health literacy, culturally unresponsive systems, and a sense of ‘shame’. The concept of ‘shame’ extends beyond embarrassment – it includes a sense of selfdoubt, lack of belonging, inadequacy and disempowerment. The lack of belonging speaks especially to the collectivist rather than individualistic perspective within the Indigenous culture. In addition, some topics such as sex are taboo among some Aboriginal and Torres Strait Islander groups; this by extension becomes a taboo topic between genders, leading to separate women’s and men’s business. Primary care services that either are unaware of or do not accommodate these possibilities create additional barriers to access.16 Therefore, provision of 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 delivering effective preventive interventions.1,8,11,16–18