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OBJECTIVES

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  • Recognize the relationship between adolescent development and vulnerability to poor health outcomes.

  • Identify characteristics of uniquely vulnerable adolescent subpopulations.

  • Describe variations in adolescent morbidity and mortality in vulnerable subpopulations.

  • Review behavioral risk factors that contribute to adolescent vulnerability.

  • Describe interventions to decrease risks.

  • Identify individual, family, and community protective factors supporting adolescent health and well-being.

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INTRODUCTION

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Rosa is a 15-year-old girl who comes into the community health clinic with her mother. She has vague abdominal complaints but denies nausea, vomiting, or diarrhea. Her mother shares that they have not come in for regular health care because of concerns about cost and not having legal residency in the United States. They came to the United States from Mexico when Rosa was 7 and live in a small apartment in the inner city with Rosa’s aunt and her family. Rosa’s father lives in Mexico.

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Adolescence is the transition from being a dependent child to an independent adult. Extending from the onset of puberty until the completion of brain development (roughly between the ages of 10 and 26), it is a time of great vulnerability and opportunity. The health-related behaviors and conditions of most noncommunicable diseases—tobacco and alcohol use, diet and exercise habits, and increased weight—often begin in adolescence. In addition, sexually transmitted diseases; human immunodeficiency virus (HIV); and other health issues, for example, those related to early maternity or to exposure to violence, also have serious impacts on the health and development of adolescents, their future adult selves, and future generations. With over 1 billion adolescents worldwide, the importance of this stage of life cannot be overstated. Homelessness, recent immigration, minority status, or Lesbian, Gay, Bisexual or Transgender (LGBT) identification further increase the vulnerabilities of this already vulnerable developmental life stage. This chapter focuses on how health-care providers can identify potential problems, support the maturation process and the development of a positive self-image, and address behaviors that may put youth at risk for poor health outcomes.

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ADOLESCENT DEVELOPMENTAL TASKS

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In the last two decades, neurobiological research, aided by magnetic resonance imaging, has demonstrated the profound brain growth that occurs during adolescence.1 The cells of the brain respond to hormonal changes (estrogen, progesterone, testosterone), and are likely influenced by environmental factors such as nutrition, education, infection, and parenting. The limbic structures of the brain, associated with socioemotional development, are among the first to experience changes accompanying the onset of puberty, although full maturation does not occur until later in adolescence.1 The neural connections of the prefrontal cortex, responsible for cognitive development and impulse control, develop more slowly.1 It is this “asynchronous” development of the brain that may lead to emotional liability, risk taking, and behavioral control issues.

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The overall task for the adolescent is to become an autonomous functioning “other” adult, individuated from his or her family. Adolescent psychosocial development generally is ...

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