PEDIATRICS 2

Adolescent Risk-Taking Behavior by Dra. Maria Teresa A. Reyes June 20, 2017

OUTLINE Teenage Pregnancy

I. Risk Behavior  Unintended
II. Common Risk Behaviors  Outside of marriage
A. Sexuality and Reproductive Health Problems  10% of all birth
i. STD and HIV  By 18 years old, 10% of women are already mothers
ii. Teenage Pregnancy  Risk factors:
iii. Homosexuality
B. Road Traffic Accidents and Injuries
o Less educated women
C. Violence o Substance abuse
D. Suicide and Depression o Physical sexual abuse
E. Substance Abuse o Family dysfunction
i. Tobacco  Outcomes:
ii. Alcohol o Less educated women
F. Malnutrition and Eating Disorders
o No prenatal check-up
i. Overweight and obesity
ii. Metabolic Syndrome o Prematurity or SGA babies
iii. Eating Disorders o Abortion
o Limited opportunity for school and employment
ADOLESCENT RISK BEHAVIORS  Management:
o Education
 Adolescence is a relatively healthy period in the life of a person o Contraception promotion
 Expected tasks prior to adulthood are: o Pregnancy prevention program
o Attain self-identity
o Achieve independence and self-goals Homosexuality
o Establish healthy relationship in peers and community  Self-identification of sexual orientation become clear
o Lack of information
 Sexual orientation
 Risk behaviors o Emotional
o Compromises adolescent development o Romantic
o Volitional action o Sexual attraction
o Daring teenage years  “Coming out” or “disclosure”
o Negative health and social consequences o Difficult or prolonged
 Risk factors o Period of confusion
o Poor academic achievement o Emerging social issue
 Substance abuse o Vulnerable to STDs, HIV/AIDS, abuse violence, suicide
 Delinquency  Diagnostic approach:
 Teen pregnancy o Interview of confidentiality
 School drop out o Careful sexual history
 Violence o Careful physical exam
o Substance abuse  Skin lesion
 Being make  Rectum exam in males
 Family support for substance abuse  Breast and genital parts for women
 Absence of religious involvement o Proper health guidance
 Lots of money for unwise spending  Counselling
 School underachievement
o Early sexual activities
 Sexual abuse Road Traffic Accidents and Injuries
 Family instability  Leading cause of mortality 8:10
 Low socio-economic status  Drowning, RTAs and animal bite – leading cause of injuries
 Single parent household  Risk factors:
 Poor knowledge of STD o Driving under the influence of alcohol/drugs
o Juvenile delinquency o Increasing mobility
 Breakdown of family structure o Peer pressure
 Violence in the home o Emotional mood swing
 Drug use and abuse o Increased use of motorcycles and skateboards
 Gang involvement  Management:
 Socio-economic factor o Parental supervision and monitoring
o Regulate unlicensed driving
COMMON RISK BEHAVIORS o Avoid eating, using cell phones
o Use seatbelts and helmets
Sexuality and Reproductive Health Problems o Observe road safety
 Premarital sex rose for 18% to 23% by 2002
 Contraception Violence
 Fertility rate – 2.7 children (urban areas), 3.8 children (rural areas) Assessment and screening for violence:
 Reasons for early sexual activity:
o Curiosity Family / Environmental
o Coercion from partner 1. History of mental illness, previous domestic violence, and substance
o Peer pressure abuse in the parents / other family members
o Desire to be like an adult 2. Family stressors like unemployment, divorce or death
3. Inappropriate supervision / care /support systems
STD and HIV Infection 4. Presence of corporal punishment, physical / emotional abuse and
 Chlamydia – 7.7% other disciplinary attitudes and practices of the parents
 Gonorrhoea – 0.7%, contraceptive use like condom is relatively low 5. History of violence in the home (domestic violence or child abuse),
 HIV school (bullying) or community
o Infects 7000 young people daily or 2.6M yearly worldwide 6. Exposure to media violence
o 50% incidence occurrence under 15 years to 24 years 7. Access to firearms in the home or elsewhere
o With STD, the risk of having HIV is 3.5x greater

Trans Group: Alas, Ante, Barcena, Carpio, Chandumal, Codeniera, Collantes, Dajalos, Dasillo
Edited By: Page 1 of 3
TOPIC: ADOLESCENT RISK-TAKING BEHAVIOR

Personal Cognitive Behaviors Therapy Process

1. Involvement in gangs / peers with known history of violence What is the problem? Information
2. Experiences of physical assault or sexual victimization What are the causes? Risk factors
3. Signs of poor self-esteem or depression What can be done? Preventive steps
4. Poor school performance and physical, emotional or developmental How can these be implemented? Strategies
disabilities Implementation Actions
Has it worked? Evaluation
Health provides:
Substance Abuse
 Teach anger management
 Victims of bullying Tobacco
 Parents discouraged keeping guns in the house  Considered a “pediatric disease”
 Video games are avoided involving shooting / violence  Every stick of cigarette smoked cuts at least 5 minutes of person’s life
 50% becomes addicted
Suicide and Depression  Toxic effects:
o Repeated coughs and colds
There are 1M deaths annually due to suicide and depression o Increased asthmatic attacks
Table 1. Adolescent Poisoning Cases o Easy fatigability
Poisoning case Male Female Total o Heart disease
Intentional 45 111 156
Accidental 14 12 26
o Cancer
o Osteoporosis
Risk factors for teenage suicide:  Second hand smoke: affects most pediatric population
 Personal  Third hand smoke: residues from second hand smoke that linger on
o Loss of close family members surfaces and react with ambient nitrous acid to form carcinogens
o Break-up with boyfriend / girlfriend called tobacco-specific nitrosamines
o Loneliness, feeling of hopelessness and isolation
o Substance abuse in the form of alcohol as a form of self- Alcohol
medication for overwhelming depression  Heavy drinking is associated with:
o Previous attempts and suicidal ideation o Liver cirrhosis
o Failure from high expectations set by oneself and / or family o Gastric ulcer
 Family / Environmental o Encephalopathy
o Easy access to poisonous substances and lethal devices o Neuropathy
and equipment (guns in the house) o Affiction
o Family violence such as frequent parental fights and o Withdrawal
physical and sexual abuse
o Lack of communication among family members or friends Binge drinking
Children 9-13 years Consumes 3 or more
(inability to release feelings of anger and frustrations)
Girls 14-17 years Consumers 3 or more
o History of mental disorders particularly clinical depression,
Boys 14-15 years Consumers 4 drinks or more
generalized anxiety disorders and schizophrenia 16-17 years Consumes 5 drinks or more
o Family history of suicide, mental disorders and child
maltreatment  Consequences of alcoholism
o Local epidemics of suicide, “copycat” from a neighbour, o Fewer strategies to learn new information
media, internet o Reduced memory skills
o Barriers to accessing mental health treatment o Reduced hippocampal volumes
o Subtle white matter abnormalities
Psychological  Diagnostic tests:
 History using HEADSS first o AUDIT – alcohol use disorder identification test
 Immediate intensive medical intervention o POSIT – problem oriented screening instrument for
o Cognitive behavior therapy teenager
o Antidepressant for 6 months o CRAFT
 A behavioural health screening tool for use with
Pathways to Suicide children under the age of 21 and is
recommended by the American Academy of
Pediatrics Committee on Substance Abuse for
use with adolescents
 It consists of a series of 6 questions developed to
screen adolescents for high risk alcohol and
other drug use disorders simultaneously
 C – have you ever ridden in a CAR drive by
someone (including yourself) who was “high” or
had been using alcohol or drugs?
 R – do you ever use alcohol or drugs to RELAX,
feel better about yourself or to fit in?
 A – do you ever use alcohol / drugs while you are
by yourself, ALONE?
 F – do your FAMILY or FRIENDS ever tell you
that you should cut down on your drinking or drug
use?
 T – have you gotten into TROUBLE while you
were using alcohol or drugs?

I’ve been on the low. I’ve been taking my time. I feel like I’m out of my mind. It feels like my life aint mine.
Who can relate? Page 2 of 3
TOPIC: ADOLESCENT RISK-TAKING BEHAVIOR

Malnutrition and Eating Disorders

Overweight / Obesity
 Increase risk for coronary artery disease
 DM
 Gallbladder disease
 Osteoarthritis
 Cancer
 60% of children 10 years and older who are obese will become obese
adults

Metabolic Syndrome
 CV risk with obesity +2 or more of the following:
o High BP
o Low LDL cholesterol
o Elevated triglycerides
 Management:
o Dietary modification
o Increased physical activity – 60 minutes exercise / physical
activity
 Risk factors:
o Perfectionism
o Low self-esteem
o Excessive dieting
 Outcomes:
o Anxiety
o Obsessive compulsive
o Substance Abuse
o Depression
o Onset at adolescence – low MR
o Onset before puberty – poor outcome
o Vomiting, bulimia, purgative abuse, obsessive compulsive
features – unfavorable outcomes
o Behavioral therapy

Eating Disorders
 Extreme preoccupation with weight and body shape

I’ve been on the low. I’ve been taking my time. I feel like I’m out of my mind. It feels like my life aint mine.
Who can relate? Page 3 of 3