Adolescence is a developmental stage distinct from childhood and adulthood. At what age the label adolescence is appropriate depends on the data source. The Guide to Clinical Preventive Services (U.S. Preventive Services, 1996a) uses ages 11 to 24 years. The most meaningful approach to this stage is to separate adolescence into three periods:
(a) early adolescence, ages 10 to 14;
(b) middle adolescence, ages 15 to 19; and
(c) late adolescence, ages 20 to 24.
During this transitional period adolescents reach physical and sexual maturity, develop more sophisticated reasoning ability, and make important educational and occupational decisions that will shape their adult careers. The actual number of adolescents and their proportion in the U.S. population is in-creasing. This group represented 14% of the population in 1990, 13.9% in 1993, and 14.2% in 2002. Of the adolescent population, those between ages 10 and 14 years represent 53% compared to 47% between ages 15 and 19 years (U.S. Bureau of the Census, 2003).
As a result, the cohort of adolescents will likely continue to increase in size. According to Day (1996) reasons for this increase include the fact that “baby boomers” are having children later in life, non-White populations are experiencing high fertility rates, and a large number of immigrants are in their 20s. Also, the percentage of adolescents within the White population (12.8%) is lower than that within the Hispanic (17.5%) or Black populations (17.1%). In 2001, the adolescent population between the ages of 10and 19 consisted of 63.2% Whites not of Hispanic origin, 14.7% Blacks, 15.6% His-panics, 3.6% Asian/Pacific Islanders, and 1% American Indians, Eskimos, and Aleuts; therefore, it is crucial for nurses to be culturally competent in order to care for adolescents (Health Research Service Administration, 2001; American Medical Association,1999).
Common concerns by adolescents and their parents have been documented (Neinstein, Radzik, &Sherer, 2002). Adolescents’ concerns include parental conflicts,
peer interpersonal concerns, identity, school, social situations, depression, medical problems, psychosomatic issues, safety, and prospects for the future. Parents’ concerns include acting-out behaviors, risk-taking, emotionall ability, drug and alcohol use, academic problems, sexual activity, eating disorders, safety issues, peer influences, psychosomatic problems, and “wasting time.” The authors concluded that any adolescent concern should lead to assessment. When problems involve high-risk violent or self-injurious behavior or a severe or chronic disorder, referral is required.
Other issues can generally be handled by discussion and reassurance with family, health care providers, or other community resources. Most adolescent mortality and morbidity results from behavior and lifestyle and there-fore is preventable. Many behavior patterns developed during adolescence continue into adult hood, and most of the leading health problems of adults are those associated with behaviors initiated early in life (e.g., smoking). In the past 10 years, major advances have been made in understanding the health beliefs of adults and how these beliefs influence health-related behaviors.
As our focus has turned to the early origins of health beliefs and behaviors, adolescence has increasingly become a focus of investigations. Researchers are making some progress in understanding how parental health attitudes and behaviors, social norms, peer pressures, and mass media affect teenagers; health-related beliefs and lifestyles. There is still much to learn regarding cognitive aspects (attitude, beliefs, perceptions), emotional aspects (feelings, concerns, moods, personality), social effects (norms, culture, environment, socioeconomic status), and biobehavioral (neurohormonal, psycho-neuro-immunological) influences on the health practices of adolescents.
Before working with adolescents, nurses must understand how the egocentrism of this period influences behavior. Elkind (1984) described the “imaginary audience” as one consequence of adolescent egocentrism, that is, the assumption that everyone around them is watching them and is concerned about their appearance and behavior. Hence, they are very self-conscious and often go to extreme lengths to avoid what they are convinced will be mortifying experiences. Another consequence of the adolescent egocentrism and self-centeredness is the “personal fable,” which is a set of beliefs in the uniqueness of one’s feelings and one’s immortality. Others often describe this belief as “It won’t happen to me”—the story we tell ourselves, whether having sex without protection, driving fast, smoking, or drinking, that other people may experience the negative consequences but we will not.
Romer (2003) offered an excellent overview of research on risk reduction to promote the health of adolescents. Two important concepts related to adolescent lifestyles are (a) how adolescents organize their lives and pattern their behavior in ways that put them at lower or higher risk for serious health problems; and (b) how these patterns develop, persist, or cease at different times during the life span.
Research topics included decision making, problem solving, peer and parental influence, personality, and specific risks: suicide, alcohol and other substance use, sexual activity, and gambling behaviors.
Most of the health problems of adolescents have their origins in environmental or behavioral factors. Reducing adolescent morbidity and mortality requires strategies that involve multiple approaches delivered through multiple settings, including schools, the mass media, communities, families, and health care settings. In addition, legislation that prevents adolescents’ access to cigarettes, alcohol, and guns can promote health. Regardless of the approach, it is essential that all nurses under-stand how to provide culturally competent health care for adolescents.