Adolescent health concerns: Not all sex, drugs and reckless risk taking.

Often when young people’s health feature in the media, the focus is on ‘problem-behaviour’ issues like alcohol consumption, smoking, teenage pregnancy, or poor diet and lack of physical exercise. Adolescents on the whole are perceived as being physically healthy and mostly at risk from behaviours that they themselves control, and which may be perceived as a normative part of being a young person. Teenagers are stereotypically portrayed as risk takers, and the potentially negative outcomes of their behaviour has led to a strong focus on reducing risk taking as a priority for young people’s health initiatives. In 2010 the UK government published the White Paper ‘Healthy lives, healthy people’¹, which recognises the distinct needs of different age groups and the necessity for approaches that are tailored to best meet individual circumstances. It reinforces the importance of people being ‘in charge’ of their own health, and of access to appropriate information and genuine dialogue with health care professionals. However, the concerns listed specifically in relation to adolescents are very much focused on the stereotypical issues listed above, with little or no mention of other types of health concerns.

There is no denying that involvement in risk behaviours can at times result in significant and detrimental consequences for young people, both in terms of health and more generally for academic achievement and maintenance of positive relationships. However, just focusing on the problem behaviours of adolescence may lead to other concerns being marginalised or ignored altogether. The latest National Report for HBSC England² shows that in 2009/ 10, 7% of boys and 10% of girls aged 11-15 years reported smoking at least sometimes; a sharp decrease since 2002 when 15% of boys and 21% of girls said they smoked at least sometimes. When it comes to drinking alcohol, at age 11, 4% of boys and 2% of girls say they drink alcohol every week; the figures for 15 year olds are 32% of boys and 23% of girls who report weekly alcohol consumption. Again, these figures have reduced dramatically since 2002 – for some age groups they have more than halved. We know from other statistics that teenage conceptions are at their lowest rate since 1969³. Meanwhile, the latest HBSC England report also show that many young people suffer from a range of physical health concerns. Headaches are the most prevalent, with 33% of all young people aged 11-15 years saying that they experience headaches every week. Among 15 year old girls, weekly headaches are reported by almost half (48%). Around a fifth (22%) of 11-15 year olds say they suffer from weekly stomach aches, and 14% from weekly back aches. More than half of young people aged 11-15 years (51% of boys and 62% of girls) suffer at least one physical symptom weekly (HBSC England unpublished data). Furthermore, unlike many of the risk behaviours, reported incidences of physical symptoms like headaches are increasing among young people.

Our findings that headaches are the most commonly reported physical symptom by young people is backed up by other research.⁴ Frequent somatic symptoms have been identified by children themselves to be related to the school environment (pressure of studying, noisy classrooms)⁵, and insecurity or conflict within the family.⁶ Other research has confirmed the association between somatic complaints and school-related stress⁷ and several studies have found the presence of functional symptoms to correlate negatively with young people’s quality of life.^8-10 Complaints like headaches and stomach-aches may have physical causes, which need to be investigated, or may be symptoms of other problems and stress. It is important not to dismiss young people presenting with such complaints as malingering, but to understand that regardless of the origins these symptoms can be indicative of serious problems and, consequently, lead to negative outcomes. Children and young people presenting in health care settings are also far more likely to discuss physical health symptoms than they are to discuss risk behaviours, meaning that such concerns may be more amenable to intervention.

Seeing adolescent health mainly from the perspective of problematic risk taking could result in overlooking the physical health complaints experienced by this age group; this tendency is already evident in both national and international policy. Meanwhile, we suggest that physical health complaints are far more frequently occurring among adolescents than are risk behaviours, that they are on the increase and can have a significantly negative impact on young people’s lives, and therefore deserve greater attention and respect than is currently the case.

Josefine Magnusson

References

1. Department of Health (2010) Healthy lives, healthy people. Department of Health
2. Brooks, F., Magnusson, J., Klemera, E., Spencer, N., and Morgan, A. (2011) HBSC England National Report:Findings from the 2010 HBSC study for England. University of Hertfordshire
3. Office for National Statistics (2013) Conceptions in England and Wales, 2011. Statistical Bulletin, Office for National Statistics
4. Shannon, R.A., Bergren, M.D., and Matthews, A. (2010) Frequent Visitors: Somatization in School-Age Children and Implications forSchool Nurses. The Journal of School Nursing, 26:169-182
5. Hjern, A., Alfven, G., and Östberg, V. (2008) School stressors, psychological complaints and psychosomatic pain. Acta Paediatrica, 97 (1): 112-117
6. Odegaard, G., Lindbladh, E., and Hovelius, B. (2003) Children who suffer from headaches – A narrativeof insecurity in school and family. British Journal of General Practice, 53 (488): 210-213
7. Henriksen, R.E., and Murberg, T.A. (2009) Shyness as a risk factor for somatic complaints amongNorwegian adolescents. School Psychology International, 30 (2): 148-162
8. Langeveld, J.H., Koot, H.M., and Passchier, J. (1997) Headache Intensity and Quality of Life inAdolescents. How are Changes in Headache Intensity in Adolescents Related toChanges in Experienced Quality of Life? Headache: The Journal of Head and Face Pain, 37 (1): 37-42
9. Youssef, N.N., Murphy, T.G., Langseder, A.L. and Rosh, J.R. (2006) Quality of life forchildren with functional abdominal pain: A comparison study of patients’ andparents’ perceptions. Pediatrics, 117 (1): 54-59
10. Hunfeld, A.M., Perquin, C.W., Duivenvoorden, H.J.,  Hazebroek-Kampschreur, A.J.M., Passchier, J., van Suijlekom-Smit, L.W.A., and van der Wouden, J.C. (2001) Chronic pain andits impact on quality of life in adolescents and their families. Journal of Pediatric Psychology, 26 (3): 145-153