Teen Health Care Called a Smart Investment

14470624_978183495644643_5868853190292882850_nOver the last several weeks I have noticed the push for HPV vaccination in our Male and female young patients. These vaccinations are important if we are pushing for a health care system, which is sustainable, that which supports preventive health care. HPV is short for Human Papillomavirus, a common virus. In the United States each year, there are about 17,500 women and 9,300 men affected by HPV-related cancers that’s a new case every 20 minutes.. Many of these cancers could be prevented with vaccination. In both women and men, HPV can cause anal cancer and mouth/throat (oropharyngeal) cancer. It can also cause cancers of the cervix, vulva and vagina in women; and cancer of the penis in men.

For women, screening is available to detect most cases of cervical cancer with a Pap smear. Unfortunately, there is no routine screening for other HPV-related cancers for women or men, and these cancers can cause pain, suffering, or even death. That is why a vaccine that prevents most of these types of cancers is so important.

HPV is a virus passed from one person to another during skin-to-skin sexual contact, including vaginal, oral, and anal sex. HPV is most common in people
in their late teens and early 20s.Almost all sexually active people will get HPV at some time in their lives, though most will never even know it.

Most of the time, the body naturally fights off HPV, before HPV causes any health problems. But in some cases, the body does not fight off HPV, and HPV can cause health problems, like cancer and genital warts. Genital warts are not a life-threatening disease, but they can cause emotional stress, and their treatment can be very uncomfortable. About 1 in 100 sexually active adults in the United States have genital warts at any given time.

All preteens need HPV vaccination and it is recommended for preteen girls and boys at age 11 or 12 years so they can be protected from HPV infections that cause cancer. Teens and young adults who didn’t start or finish the HPV vaccine series also need HPV vaccination. Young women can get HPV vaccine until they are 27 years old and young men can get HPV vaccine until they are 22 years old. Young men who have sex with other men or who have weakened immune systems can also get HPV vaccine until they are 27.

HPV vaccination is a series of shots given over several months. The best way to remember to get your child all of the shots they need is to make an appointment for the remaining shots before you leave the doctor’s office or clinic.

HPV vaccination has been studied very carefully and continues to be monitored by CDC and the Food and Drug Administration (FDA). No serious safety concerns have been linked to HPV vaccination. These studies continue to show that HPV vaccines are safe.

The most common side effects reported after HPV vaccination are mild. They include pain and redness in the area of the arm where the shot
was given, fever, dizziness, and nausea. Some preteens and teens may faint after getting a shot or any other medical procedure. Sitting or lying down for about 15 minutes after getting shots can help prevent injuries that could happen if your child were to fall while fainting. HPV vaccines offer the best protection to girls and boys who receive all three-vaccine doses and have time to develop an immune response before they begin sexual activity with another person. This is not to say that your preteen is ready to have sex. In fact, it’s just the opposite—it’s important to get your child protected before you or your child has to think about this issue. The immune response to this vaccine is better in preteens, and this could mean better protection for your child.

This brings up another topic, the health care of our teens and preventative care. This group of patients is so important if we are truly going to improve our health care system with sustainability and in order to prevent more severe disease.

Healthypeople.gov reviewed the topic of adolescent health. Adolescents (ages 10 to 19) and young adults (ages 20 to 24) make up 21 percent of the population of the United States. The behavioral patterns established during these developmental periods help determine young people’s current health status and their risk for developing chronic diseases in adulthood.

Although adolescence and young adulthood are generally healthy times of life, several important public health and social problems either peak or start during these years. Examples include:

  • Homicide
  • Suicide
  • Motor vehicle crashes, including those caused by drinking and driving
  • Substance use and abuse
  • Smoking
  • Sexually transmitted infections, including human immunodeficiency  virus (HIV)
  • Teen and unplanned pregnancies
  • Homelessness

Because they are in developmental transition, adolescents and young adults are particularly sensitive to environmental—that is, contextual or surrounding—influences. Environmental factors, including family, peer group, school, neighborhood, policies, and societal cues, can either support or challenge young people’s health and well-being. Addressing the positive development of young people facilitates their adoption of healthy behaviors and helps to ensure a healthy and productive future adult population.

Adolescence is a critical transitional period that includes the biological changes of puberty and the need to negotiate key developmental tasks, such as increasing independence and normative experimentation.,

There are many examples of effective policies and programs that address adolescent health issues. They include:

  • State graduated driver licensing programs
  • Teen pregnancy prevention programs
  • Violence prevention programs
  • Delinquency prevention programs
  • Mental health and substance abuse interventions
  • HIV prevention interventions

Teen birth rates in the United States have declined to the lowest rates seen in seven decades; yet still rank highest among developed countries. Contributing to this decline are increases in the proportion of teens who have never had sex, combined with increases in contraceptive use among sexually active teens.  As a health care provider, you play a critical role in further reducing teen pregnancy rates through the care you provide to your adolescent patients.

  • Teens need regular health care services to receive comprehensive sexual and reproductive health counseling about the importance of delaying the initiation of sexual activity and about their contraceptive options. They need counseling on which method would be best for them, and on how to use that method correctly and consistently. Parents and guardians also need guidance and information to help them talk with their teens about sex, pregnancy, and contraception.

The financial burdens of preventable health problems in adolescence are large and include the long-term costs of chronic diseases that are a result of behaviors begun during adolescence. For example, the annual adult health-related financial burden of cigarette smoking, which usually starts by age 18, is $193 billion.

There are significant disparities in outcomes among racial and ethnic groups. In general, adolescents and young adults who are African American, American Indian, or Hispanic, especially those who are living in poverty, experience worse outcomes in a variety of areas (examples include obesity, teen pregnancy, tooth decay, and educational achievement) compared to adolescents and young adults who are white.

The leading causes of illness and death among adolescents and young adults are largely preventable. Health outcomes for adolescents and young adults are grounded in their social environments and are frequently mediated by their behaviors. Behaviors of young people are influenced at the individual, peer, family, school, community, and societal levels.

As illustrated by the following examples of research findings, health outcomes are linked to multiple environmental factors.

Family

  • Adolescents who perceive that they have good communication and are bonded with an adult are less likely to engage in risky behaviors.
  • Parents who provide supervision and are involved with their adolescents’ activities are promoting a safe environment in which to explore opportunities.
  • The children of families living in poverty are more likely to have health conditions and poorer health status, as well as less access to and utilization of health care.

School

  • Academic success and achievement are strong predictors of overall adult health outcomes. Proficient academic skills are associated with lower rates of risky behaviors and higher rates of healthy behaviors.
  • High school graduation leads to lower rates of health problems and risk for incarceration, as well as enhanced financial stability during adulthood.
  • The school social environment affects students’ attendance, academic achievement, and behavior. A safe and healthy school environment promotes student engagement and protects against risky behaviors and dropping out.

Adolescents growing up in distressed neighborhoods characterized by concentrated poverty are at risk for a variety of negative outcomes, including poor physical and mental health, delinquency, and risky sexual behavior.

Adolescents who are exposed to media portrayals of violence, sexual content, smoking, and drinking are at risk for adopting these behaviors.

Two important issues influence how adolescent health will be approached in the coming decade. First, the adolescent population is becoming more ethnically diverse, with rapid increases in the numbers of Hispanic and Asian American youth. The growing ethnic diversity will require cultural responsiveness to health care needs and sharpened attention to disparate health and academic outcomes, which are correlated with poverty, especially among adolescents from minority racial and ethnic groups.

The second emerging issue is the increased focus on the use of positive youth development interventions for preventing adolescent health risk behaviors. Youth development interventions can be briefly defined as the intentional process of providing all youth with the support, relationships, experiences, resources, and opportunities needed to become successful and competent adults. There is growing empirical evidence that well-designed youth development interventions can lead to positive outcomes. Ongoing, rigorous evaluation will determine what works, why it works, and how successful interventions can be applied.

Molly Walker wrote that adolescents face considerable health challenges on a global scale, most notably from injuries, common infectious diseases, mental health conditions, and sexual and reproductive health problems, according to a new report released by a global health commission.

Though global efforts have succeeded in slowing the mortality rates of young children less than 5 years of age, the same cannot be said for the adolescent population, where the decline in deaths has been slower. Examining causes of preventable death worldwide, younger adolescents (ages 10-14) were more likely to die of HIV/AIDS, road traffic accidents, and drowning, while older teens and young adults (ages 15-19 and ages 20-24) were more likely to die of traffic accidents, self-harm, and violence, reported George C. Patton, PhD, of the University of Melbourne, in Australia and colleagues, in The Lancet commissions.

Diseases such as diarrheal and infectious diseases, lower respiratory infections, and malaria comprised about a fifth (21%) of deaths among younger adolescents. Not surprisingly, the leading risk factors for death among this group include unsafe water, unsafe sanitation, and lack of hand washing.

While the leading cause of ill health among younger adolescents was iron deficiency (18.8% males and 15.6% females), the fastest growing cause of ill health in 23 years was unsafe sex (up to 2nd place in 2013 from 13th place in 1990).

Linda Arnold, MD, of the American Academy of Pediatrics (AAP) section on international child health, said that a key to combatting preventable disease was education — both in terms of schooling and in terms of reproductive health education, especially among young girls.

“We need to speak out in support of access to free, high quality secondary education, the single best investment for improving health and well-being,” said Arnold in an email to MedPage Today. “Clinicians can support adolescents by identifying and addressing their health needs at a local level, reducing barriers to access, and ensuring that services are available to all, regardless of gender, ethnicity or [socioeconomic status].”

The authors themselves noted the importance of education in a statement, saying “every year of education beyond age 12 is associated with fewer births for adolescent girls and fewer adolescent deaths for boys and girls.”

“Our data show a clear need for renewed efforts to improve health and reduce the burden of disease in young people. Continued inaction will have serious ramifications for the health of this generation and the next,” said co-author Ali Mokdad, PhD, of the Institute for Health Metrics and Evaluation (IHME) in Seattle, in a statement. “Most of these health problems are preventable and treatable and tackling them will also bring huge social and economic benefits.”

To combat this problem, the authors suggest a multi-tiered approach that not only includes investing in secondary education for adolescents, but in laws that “empower and protect” adolescents, such as making 18 years of age the minimum legal age for marriage.

They also suggest more investment in mental health resources, especially since depression is the number one cause of ill health among adolescents, affecting 10% of the global adolescent population.

“In a rapidly changing world, we must work across sectors to transform health systems at all levels, ensuring universal access to services targeted to meet the complex physical, mental and reproductive health needs of all adolescents,” said Arnold. “Doing so represents an investment with substantial immediate and long-term returns at individual, societal and global levels.”

The recommendations of the commission are similar to those from the World Health Organization’s (WHO) Global Strategy for Women’s, Children’s and Adolescents’ Health, which was launched in September 2015. Noteworthy are the twenty-three new commitments, corresponding to over $2 billion in pledges for women’s, children’s and adolescents’ health and well-being were announced on the margins of the UN General Assembly on Thursday. This includes a pledge by Save the Children for global health and nutrition work in both development and humanitarian settings.

A new Global Investment Framework for Women’s and Children’s Health demonstrates how investment in women’s and children’s health will secure high health, social, and economic returns. Researchers have evaluated health systems strengthening and six investment packages for: maternal and newborn health, child health, immunization, family planning, HIV/AIDS, and malaria. Nutrition is a cross-cutting theme. They then used simulation modeling to estimate the health and socioeconomic returns of these investments. Increasing health expenditure by just $5 per person per year up to 2035 in 74 high-burden countries could yield up to nine times that value in economic and social benefits. These returns include greater gross domestic product (GDP) growth through improved productivity, and prevention of the needless deaths of 147 million children, 32 million stillbirths, and 5 million women by 2035. These gains could be achieved by an additional investment of $30 billion per year, equivalent to a 2% increase above current spending. What a great return on a small investment and imagine what we could do just within our own country. Are we able to take the initiative and invest in our youth? I will discuss women’s health and the investment in their health care and preventative medicine in a future post.

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