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ISSUES RELATED TO ADOLESCENT DEVELOPMENT IN INDIA AND THE SOLUTIONS Adolescence is the most crucial and important period of an individual’s life. It is the phase of rapid revolutionary changes in the individual’s physical, mental, moral, spiritual, sex and social outlook. Human personality develops new dimensions. It is the period to learn new things. It is the period of Anxiety and worries. It is the period of ambitions. It is the period of conflicts and complexities. This assignment is to study the problems of adolescent people in India and to give appropriate solutions. Three research articles are taken in to consideration for better understanding and to find the effective solutions. The adolescent people constitute more than 1.2 billion worldwide, and about 21% of Indian population. Rottenness and mortality occurring in this age group is mostly due to preventable causes. In this developmental stage a transition from childhood to adulthood is occurring. So the growing children have lack of knowledge and awareness about physical and psychological changes happening to them. Mental health problems, like mood disorders, anxiety disorders, and thought disorders (such as schizophrenia) as well as psychosocial disorders, may develop or first become apparent during adolescence. Suicide is main cause of death for this age group. Other causes of death include accidents, unintentional injuries, and homicide etc. In our country India, 21% of population is adolescents. Those people are the future of our nation, forming a major demographic and economic force. So it is essential to understand the issues of the younger generation, who are the hopes of the nation. Common Issues of adolescents (all over the world) Traditionally adolescence has been thought of as a period of heightened emotional tension resulting from glandular and other changes. Problems related to romance are very real at this stage. The adolescence is happy when the romance is moving smoothly but becomes despondent when things go wrong. Adolescent worry about the future when he finds that the end of his schooling is in sight. 3 Being treated like a child or being treated unfairly is more likely to make the adolescent angry than anything else. Adolescence and crime: Hollingworth is of the opinion that adolescence is a period of marked criminality. It has been shown by research studies that most criminals begin their careers during adolescence. Common adjustment problems  Lack of interest in school work  Lack of proper study schedule  Insufficient study habits  Childhood illness that continue into adolescence  Consequences of risky and illegal behaviour Identification of Adolescent developmental issues in India The research article “Adolescent health problems in India: A review from 2001 to 2015” Written by Punyatoya Bej addresses the problems faced by Indian adolescents from the past 14 years. In India so many programmes launches to solve all problems faced during adolescent period still adolescents are facing problems. The one-fifth of the total population of India constitutes adolescents. The studies are conducted from 2001 to 2015 from Pub Med, Google scholar and other community medicine and public health related journals. As per the research, the main problems faced by Indian adolescents  sexual health problems and teenage pregnancy According the research report, sexual health problems and teenage pregnancy are the most common problems faced by Indian adolescents. About 16 million women in the age of 15-19 give birth to child in each year in the world. 95% of these births are happening in low and middle income countries. Half of these births are happening in seven developing countries. In that India is also included. High rates of adolescent child bearing found in South and South-West Asia due to marriage at early age. India is third number in the levels of adolescent child bearing.  problems related to menstruation The most common problem faced by adolescent girls are menstrual problems like dysmenorrhoea and premenstrual syndrome. Dysmenorrhoea (painful menstruation)(67.2%) is the commonest problem and 63.1% had one or the other 4 symptoms of pre-menstrual syndrome (PMS). This is the main reasons for absenteeism from school. Daily routine of girls was affected due to prolonged bed rest, missed social activities or commitments; disturbed sleep and decreased appetite. Girls from families of high socio-economic class have significantly lower mean ages of menarche in both urban and rural area. The mean age of menarche was significantly higher in girls involved in vigorous sporting activity in urban area compared to their non-sporting counterparts. In India mensuration is surrounded by so many myths and misconception with a long list of do’s and don’ts for women. Hygiene-related practices of women during menstruation are of considerable importance, as it may increase vulnerability to Reproductive Tract Infections (RTIs) / STDs (Sexually Transmitted Infections). Poor menstrual hygiene is one of the major reasons for the high prevalence of RTIs in the country and contributes significantly to female morbidity. Most of the adolescent girls in villages use rags and old clothes during menstruation, increasing susceptibility to RTI's.  illicit drugs  tobacco and alcohol use Uses of alcohol and tobacco are on increasing trend among adolescent age groups of school and college going students. It is basically due to peer pressure, as a source of stress reliever, easy availability and promoted by elderly or friend circles. Current use of smoked and smokeless tobacco was 9.1% and 17.4% respectively among adolescent. Substance abuse is quite common in India. Studies have found that tobacco, alcohol and even the injectable drugs are commonly used.  Obesity and overweight Obesity is emerging as a public health problem among adolescents in India. India is going towards epidemiological transitions. Cultivations, productivity, economic enhancement all contribute that there is no scarcity of foods. In a study prevalence of obesity and overweight was 16.6%. Body dissatisfaction was highest among overweight youth and girls.  eating problems Adequate nutritional intake is very essential for adolescent for normal development. But during adolescent period more prevalence of unhealthy food habits, skipping meals, remain fast to lose weight. Over half of the children skipped breakfast, ranging 5 from daily to once in two weeks, the main reason being getting up late in the morning .(30) Adolescent usually follow an erratic food eating habits like missing breakfast.  Anaemia The prevalence of anaemia in India among adolescent girls and boys is 55.8% and 56.1% respectively. The prevalence of anaemia among unmarried adolescent south Indian girls in an urban slum setting was 29%. Significant association of anaemia was observed in low socioeconomic status, religious and infrequent or no consumption of meat. Prevalence of micronutrient deficiencies was high in adolescent girls.  behavioural problems Adolescents are rarely perceived to be ill, while in fact they have significant morbidity and mortality related to mental health problems. There is a high prevalence of psychiatric illness among adolescents and the escalation of mental health admissions of adolescent is 14-fold by the age of 15 year. Studies from India consistently document the highest suicide rates in the world, and the majority of completed suicides had been seen within adolescents group. Prevalence of depression among Indian adolescent was 13.3% by using Patient Health Questionnaire – 9 and 3.13% by using K-SADS-PL (Kiddie-Sads-Present and Lifetime). Major depressive disorder was diagnosed in 0.81%, dysthymia in 1.51% and depressive disorder NOS in 0.81%.  Oral health problems. Oral health knowledge is very poor among adolescent though it is an important health issue. In a study by Gupta T et al found that 90% of participants had knowledge about causes of dental caries and the role of tooth brushing in its prevention. Lower proportions of participants were aware of gum disease and the role of fluoride and dental floss. A majority of the children used a toothbrush and toothpaste, 63.3% of the children did not know whether their toothpaste contained fluoride or not, 61.9% of them cleaned their teeth two or more times a day and only 18.2% of the children visited the dentist for routine check-ups. Rural adolescents have increased inadequate oral hygiene and few have not visited a dentist. In the research article “Study for adolescent problem and psychology” written by Trivedi Monica, Trivedi Gittica and Astha Kakkad, adolescents suffer from psychosocial problems at 6 one time or other during their development. Due to rapid industrialization and urbanization majority of young couple are employed and get less time to look after their children. Psychosocial problem and drug abuse are quite prevalent in this age group. The study is aimed to the prevalence of psychosocial, emotional, behavioral problems, sexual orientation, drug abuse in adolescents (less than 18 years) and compare with college students (18-22years) of age. As per the research, the main problem faced by Indian adolescents Domestic violence: According to this research the incidence of Domestic violence was 18% in families of school going children almost equivalent to 15 % in college age group. Anxiety is obviously more in school age group 75% as compared to 46% in college group. The reason being might be the study was done at the time of exams of children and hence increased stress factor. Stress is 50 % in school going children as compared to 41 % in college students. The percentage is almost equal and the slight difference seen might be due to the fact that study was done at the time of exams of school children. Depression rate is almost equal among school and college going children approx. 30%.One third students both of school going and college age group (approx. 30%) were aggressive and violent. In the study it saying that, that the Incidence of aggression and violence was more in children with family history of domestic violence (50%) in school going age group while in college students with history of crime 35% (one third) had history of domestic violence in family. Peer pressure: Behavior of our children is influenced by their co-students hence on assessing the peer pressure factor it was found that 26-29% of school and college age group children submit to peer pressure which is around one third of adolescent’s decisions are influenced by the fact of what their co students think. Hence it’s absolutely right of parents being concerned about their children company. Pre-marital sex age of onset: On questioning about Premarital Sex 43/580 in school & 98/669 in college going children were exposed to premarital sex. This article also discusses the obesity problems and menstruation preoblems discussed in the previous article. 7 The article “Health behaviours & problems among young people in India: Cause for concern & call for action” also discussing the problems of adolescents in India. The research studies found that, nearly 10-30 per cent of young people suffer from health impacting behaviours and conditions that need urgent attention of policy makers and public health professionals. Nutritional disorders (both malnutrition and over-nutrition), tobacco use, harmful alcohol use, other substance use, high risk sexual behaviours, stress, common mental disorders, and injuries (road traffic injuries, suicides, violence of different types) specifically affect this population and have long lasting impact. Multiple behaviours and conditions often coexist in the same individual adding a cumulative risk for their poor health. Many of these being precursors and determinants of non-communicable diseases (NCDs) including mental and neurological disorders and injuries place a heavy burden on Indian society in terms of mortality, morbidity, disability and socio-economic losses. As per the research, the main problem faced by Indian adolescents Under nutrition and micro nutrient deficiency, Obesity and overweight (discussed in the previous article) High-risk sexual behaviour: It is a broad term covering early sexual activity especially before 18 years of age and includes unprotected intercourse without male or female condom use except in a long-term, single-partner (monogamous) relationship, unprotected mouth-to-genital contact except in a long-term monogamous relationship, having multiple sex partners, having a high-risk partner (one who has multiple sex partners or other risk factors), exchange of sex (sex work) for drugs or money, having anal sex or having a partner who does except in a long-term, single-partner (monogamous) relationship and having sex with a partner who injects or has ever injected drugs38. It is a known risk factor that puts individuals at risk for contracting HIV/AIDS and a range of other sexually transmitted diseases like gonorrhoea, herpes, genital warts, Chlamydia, syphilis, trichomoniasis, etc. Common mental disorders: At least 20 per cent of young people are likely to experience some form of mental illness - such as depression, mood disturbances, substance abuse, suicidal behaviours, eating disorders and others These are the problems facing by Indian adolescents. 8 Solutions for Adolescent developmental issues in India In the research article “Study for adolescent problem and psychology”, written by Astha Kakkad, solutions for the problems faced by adolescents are suggested. National policies meeting the requirement of youth : Adolescent need to be involved in decision and actions. To ensure that programmers and policies meet their needs, adolescents must be heard and must contribute to planning, implementation, monitoring and evaluation of services. The role of parent: Positive steps to be taken for de addiction and home environment need to be discussed in parent meetings in schools. Awareness in early stage: In order to Prevent health compromising behaviour (eg.-tobacco, alcohol and drugs, unsafe sex) awareness regarding their harms to be publicized at an early stage in school so that peer pressure doesn’t come into play. Health services for adolescents: Universal health coverage for adolescent. Health services need to move beyond adolescent pregnancy and HIV to address the full rank of adolescent health and development needs. Issues specific health policies. Curriculum for awareness: School curriculum should include chapters on unsafe sex, drug abuse, violence, obesity, adolescent pregnancy, HIV infection. Currently these all are studying the students opted science subject. Make sure other students also getting opportunity to know this in detail. In the research article “Adolescent health problems in India: A review from 2001 to 2015” Written by Punyatoya Bej – the solutions for issues of adolescents are as follows. Adolescents require a strong family and society support. Primary care practitioners are the main health care providers to all families in India. Primary care practitioners should update knowledge on adolescence health problems and involve in health education in the form of role play and health education talk. These will encourage the adolescents to get knowledge and awareness about their health problems and consult to doctors. 9 Health education and counselling to adolescents are necessary in India to improve adolescence health. Health education programme can be held by primary care practitioner doctors in their locality with involving family members and adolescents. The article “Health behaviours & problems among young people in India: Cause for concern & call for action” written by Singh Sunitha and Gopalkrishna Gururaj explaining the solutions for the issues of adolescence in India. Need of monitor, evaluation, and examination of the impacts of the existing policies: The importance of investing in youth has been recognized in India's Constitution. One of the Directive Principles of State Policy, states that “…it is imperative that children are given opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity and that childhood and youth are protected against exploitation and against moral and material abandonment”. Policies and programmes focussing on education [National policy on education (1986 modified in 1992), Sarva Shiksha Abhiyan, Rashtriya Madhyamik Shiksha Abhiyan], welfare [National Policy for the Empowerment of Women (2001); Balika Samridhi Yojana, 1997; National Policy on Child Labour, 1987], employment (Swarnjayanti Gram Swarozgar Yojana) and others (National Policy for Persons with Disabilities) have included young people and highlight health as one of the components. In many of these, the detailed implementation – monitoring and evaluation plan are not elaborated in detail and their impact needs to be examined in detail. National youth policy in India for supporting the youth should evaluate the effectiveness of the policy The exclusive National Youth Policy of 2003 driven by the Ministry of Youth Affairs & Sports has attempted to focus on special requirements of youth, covering 13 to 35 years, further subdivided into 13-19 years and 20-35 years. The adapted strategies include youth empowerment, gender justice, inter-sectoral approach, and an information and research network. The priority target groups under the policy include rural and tribal youth, out-of-school youth, adolescents particularly females, youth with disabilities and adolescents under special circumstances like victims of 10 trafficking; orphans and street children. A number of State-specific policies and programmes also exist that highlight State strategies for meeting the needs of youth. It is also apparent that the impact of these policies on health of youth has not been evaluated for its coverage, comprehensiveness, efficacy and effectiveness. It is essential to evaluate the policy otherwise it will not be evident how much people got the advantages of the policy. Strong need of a public health community There is a strong need for public health community to identify, prepare, integrate and implement activities that help to promote health and healthy lifestyles of young people and establish mechanisms for delivery of population-based interventions along with measuring its impact. There is a need to generate good quality and robust population data that can drive policies and programmes. Strategic investment for the youth Strategic investments in health, nutrition, education, employment and welfare are critical for healthy growth of young people and these programmes need to be monitored and evaluated for their efficacy and effectiveness using public health approaches.