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Proceedings of the Second International
Conference
on Adolescent Health and Welfare
‘Youth
- Conserving Our Resource
for the Future’
October 1998 Contents
Plenary 1: Adolescent Sexuality –Chaired by Chris Wilkinson and Pierre-Paul Tellier
Plenary P2 Health and Physical Challenge
-Chaired Gerben Sinnema and Simon Clarke
Plenary P3 - Teenage Pregnancy - Chaired by Pamela McNeil and Christine Ferron
Plenary P4 - Disability,Education & Employment – Chair Anne McCarthy,
Richard Brown
Keynote Lecture
chaired by Diana Birch
Protecting Youth from Harm-Lessons
Learned from Adolescent Health-Robert Blum
Youth in a Multicultural Society -
Pamela McNeil
Plenary
P5 - Mental Health -
Chaired by Eric Taylor and Daniel Hardoff
Plenary P6 - Social and Behavioural Issues – Chair Joan-Carles Suris and
David Baum
Plenary Session P7 - Youth and the Family - Chair Gail Slap and
Neville Butler
Plenary Session P8 - Abuse
and Self Harm -
Chaired by Robert Blum and Ann Sutton
Keynote Lecture
Chair Diana Birch-
Runaway and Homeless Youth-Richard Brown
Panel: Dick MacKenzie, Pam McNeil,
Irene Adams, Andrei Smirnov
Closing Address
- Diana Birch
Opening
Diana Birch. - Youth Support
Welcome all of you to the second International
meeting that we have had here at the Royal College.
I know a lot of you were here at our tenth anniversary meeting two years ago and
it’s really great to see a lot of faces back again especially the people who
have come from far afield. I am not
going to speak very long at the opening because I’d like to pass over to Gail
fairly quickly so she’ll have a little extra time and then we can also take some
questions, but I wanted to tell you just a little bit about Youth Support and
what we are doing and tell you a little bit about the conference and some of the
changes in the programme as well.
It’s really exciting at the beginning of a meeting.
It’s the first time we’ve tried a two-day conference and made it truly
international - we have people here from America, from the West Coast, from the
East Coast, from Canada, from Japan, from Chile, South America, all over. And
it’s really, really great to think, that back in ’86 Youth Support started as a
tiny little committee of people who broke away from the Health Service because
we thought that the statutory services particularly the Health Service didn’t
really cater for the needs of young
people - we just had paediatricians
and adult specialists and we didn’t have anybody in adolescent medicine.
Everyone thought that I was completely mad because I just wanted to see young
people and awkward people, pregnant school girls and I was doing this stupid
thing of running Youth Support but it’s just wonderful to see how it’s grown and
see all your faces here. We’ve had marvellous support from our American
colleagues, particularly. I am really pleased to see a lot of SAM (Society for
Adolescent Medicine) members here.
Youth Support was born just before I went to one of the meetings which was held
in Australia and I am very pleased to see some of our Australian colleagues here
who’ve come so far.
Youth Support has developed a lot over the years.
As I said we started up as a small committee, gradually we managed to do a lot
of work on teen pregnancy, on an outreach basis in schools and so on as we
didn’t have a centre, and we started doing a lot of work especially in Jamaica,
and you’ll hear a lot about Jamaica later on in the conference.
And the work that I did with the teen mothers came to a beautiful climax in ’96
when I did the fifteen year follow up of my patients with a fantastic reunion of
all the young parents. We opened the Youth Support House at the end of 1989
which was very exciting so then we had a residential unit and we could do
counselling and a whole load of different things ... ...
Adolescent Reproductive Health - Lessons Learned
and New Directions Gail Slap
It is truly thrilling to be here, there are so
many familiar faces and friends and so many other people that I really look
forward to meet. I think one of the most thrilling things for me is actually
walking in this building. The Royal College of Physicians has always had this
mystique, this is the seat of medicine and over the years that I’ve gone to
various meetings at the American College of Physicians which is the professional
organisation that represents internees in the United States I’ve always looked
at this huge gorgeous mallet that the Royal College of Physicians presented to
the American College of Physicians and I thought, the ACP, the American College,
uses a kind of an ever-green tree as its symbol, I think there is a subtle
statement there, a big difference between the sort of symbolic appearance
between the Royal College compared to the American College, they both do
wonderful work, but this really has a kind of history and special feeling around
the world, so I feel honoured that we are meeting here today. I must say the
other thing I’ve learned about London this time is I thought Bangkok and Mexico City were the places with bad traffic now I
understand why your meetings don’t start until 9.30 10 o’clock in the morning. I
wasn’t prepared. OK
What I want to do today is talk about adolescent
reproductive health and I’d like to do it in a variety of ways. We’ll talk some
about clinical service, but really what I’d like to do is consider with you
where we’ve gone in terms of our research efforts in adolescent reproductive
health and where I think we need to be heading as we move into the next century.
Well, first I think it’s fair to a ask a question why adolescent. Firstly,
and I think you all know this, 20% of the world population is 10 to 19
years old, there are 1.5 billion teenagers between the ages of 10 and 24, 50% of
the world’s population is under 25 and this is climbing, 86% of youth now live
in developing countries and further more if we look at youth around the world
living in urban environments, a
youth is three times as likely to live in a city in a developing country as in a
city in a developed country. These youths face the highest risk, they face the
least support. And even more than that group is the 70% of the world’s urban
migrants who are youths.
So why adolescent reproductive health. Well,
whether you’re married or you are unmarried, people are most likely to begin
their sexual experiences during the adolescent years. 50% of African women and
30% of Latin America women are married in adolescence, and yet if we look at
what’s happening to the average age of marriage around the world it’s actually
increasing. So the time between puberty onset and growth considering even
somewhat later the beginning of menstruation, menarche, and the time of marriage
we are seeing an increased length of time. What that means is that we’re likely
to see increased sexual behaviour during unmarried years. Now in North America
we know that over 75% of teenagers are sexually active. If we look at births we
know that about 20% in the United States and over half of African first births
are to adolescent mothers and around the world the number is 10%. Whether you
think that’s right or wrong and I think I’ve heard people argue both ways one
thing’s for sure, and that is morbidity and mortality faced by mothers and by
their infants is greater during the adolescent years. Maternal mortality for
adolescents is twice that of adults, the risk of low birth weight is about 1 and
a half fold, the risk of death during the first year of life infancy is about
twofold, the risk of neuro developmental delay is about threefold. And finally 1
in twenty teenagers around the world is affected by a sexually transmitted
disease.
But adolescent reproductive health means more
than the risks, it means more than the pregnancies, it means more than the
sexually transmitted disease. It also means looking at individuals - take some
examples - three girls, all aged 12, best friends, birthdays within one
month of each other, and helping them cope with the differences in their
pubertal development, but also trying to understand what controls these
difference in development. If you consider the first 12-year old, she is 10-0-4,
she is 50th percentile for height and weight, note that she is not smiling. Why
is she not smiling? She is wearing braces. Look at this teenager on the left.
She is also 12 years old. What was the first thing she did when I asked to take
her picture. She kicked off her shoes. Why did she kick off her shoes? She is
worried about being too tall . She is barely 10-0-2. And this 12 year old,
10-0-2 notice what she is doing,
when I asked to take the picture. She is standing on her toes because she is
fearful of being too short. So they all have their own difficulties and
differences to deal with and yet they are all entirely normal.
Now let’s look at this 14 year old. This too is
adolescent reproductive health. She has delayed puberty, markedly delayed
puberty. She is in the hospital constantly for her sickle-cell disease. And
let’s look at this 16 year old father who’s hospitalised after a gun-shot wound
out on the street. This young man has 2 children. We cope not just with the
violence of the inner city, not just with the medical complications of his
gun-shot wound, but we cope with the difficulties that this young family faces.
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