Which of the following are girls in middle adolescence more likely to report than boys?

Overview

Survival chances for adolescents and young adults vary greatly across the world. In 2020, the probability of dying among those aged 10–24 years was highest in sub-Saharan Africa, Oceania (excluding Australia and New Zealand), northern Africa and southern Asia (1). The average global probability of a 10-year-old dying before age 24 was 6 times higher in sub-Saharan Africa than in North America and Europe.

Main health issues

Injuries

Unintentional injuries are the leading cause of death and disability among adolescents. In 2019, nearly 100 000 adolescents (10–19 years) died as a result of road traffic accidents (2). Many of those who died were vulnerable road users, including pedestrians, cyclists or users of motorized two-wheelers. In many countries, road safety laws need to be made more comprehensive, and enforcement of such laws needs to be strengthened. Furthermore, young drivers need advice on driving safely, while laws that prohibit driving under the influence of alcohol and drugs need to be strictly enforced among all age groups. Blood alcohol levels should be set lower for young drivers than for adults. Graduated licences for novice drivers with zero-tolerance for drink-driving are recommended.

Drowning is also among the top causes of death among adolescents; more than 40 000 adolescents, over three quarters of them boys, are estimated to have drowned in 2019. Teaching children and adolescents to swim is an essential intervention to prevent these deaths.

Violence

Interpersonal violence is among the leading causes of death in adolescents and young people globally. Its prominence varies substantially by world region. It causes nearly a third of all adolescent male deaths in low- and middle-income countries in the WHO Region of the Americas. According to the global school-based student health survey 42% of adolescent boys and 37% of adolescent girls were exposed to bullying. Sexual violence also affects a significant proportion of youth: 1 in 8 young people report sexual abuse.

Violence during adolescence also increases the risks of injury, HIV and other sexually transmitted infections, mental health problems, poor school performance and dropout, early pregnancy, reproductive health problems, and communicable and noncommunicable diseases.

Effective prevention and response strategies include promoting parenting and early childhood development; addressing school-based bullying prevention, programmes that develop life and social skills, and community approaches to reduce access to alcohol and firearms. Effective and empathetic care for adolescent survivors of violence, including ongoing support, can help with the physical and psychological consequences.

Mental health

Depression is one of the leading causes of illness and disability among adolescents, and suicide is the second leading cause of death in people aged 15–19 years (2). Mental health conditions account for 16% of the global burden of disease and injury in people aged 10–19 years. Half of all mental health disorders in adulthood start by age 14, but most cases are undetected and untreated.

Many factors have an impact on the well-being and mental health of adolescents. Violence, poverty, stigma, exclusion, and living in humanitarian and fragile settings can increase the risk of developing mental health problems. The consequences of not addressing adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.

Building socioemotional skills in children and adolescents and providing them with psychosocial support in schools and other community settings can help promote good mental health. Programmes to help strengthen the ties between adolescents and their families and improve quality of home environments are also important. If problems arise, they should be detected and timely managed by competent and caring health workers.

Adolescent mental health fact sheet

Alcohol and drug use

Drinking alcohol among adolescents is a major concern in many countries. It can reduce self-control and increase risky behaviours, such as unsafe sex or dangerous driving. It is an underlying cause of injuries (including those due to road traffic accidents), violence and premature deaths. It can also lead to health problems in later life and affects life expectancy. Worldwide, more than a quarter of all people aged 15–19 years are current drinkers, amounting to 155 million adolescents. Prevalence of heavy episodic drinking among adolescents aged 15­–19 years was 13.6% in 2016, with males most at risk.

Cannabis is the most widely used psychoactive drug among young people with about 4.7% of people aged 15–16 years using it at least once in 2018. Alcohol and drug use in children and adolescents is associated with neurocognitive alterations which can lead to behavioural, emotional, social and academic problems in later life.

Prevention of alcohol and drug use are important areas of public health actions and may include population-based strategies and interventions, activities in school, community, family and on the individual level. Setting a minimum age for buying and consuming alcohol and eliminate marketing and advertising to minors are among the key strategies for reducing drinking among adolescents.

Tobacco use

The vast majority of people using tobacco today began doing so when they were adolescents. Prohibiting the sale of tobacco products to minors (under 18 years) and increasing the price of tobacco products through higher taxes, banning tobacco advertising and ensuring smoke-free environments are crucial. Globally, at least 1 in 10 adolescents aged 13–15 years uses tobacco, although there are areas where this figure is much higher.

HIV/AIDS

An estimated 1.7 million adolescents (age 10–19 years) were living with HIV in 2019 with around 90% in the WHO African Region (3). While there have been substantial declines in new infections amongst adolescents from a peak in 1994, adolescents still account for about 10% of new adult HIV infections, with three-quarters amongst adolescent girls (4). Additionally, while new infections may have fallen in many of the most severely affected countries, recent testing coverage remains low suggesting that many adolescents and young people living with HIV may not know their status (5).

Adolescents living with HIV have worse access to antiretroviral treatment, adherence to treatment, retention in care and viral suppression. A key factor contributing to these is limited provision of adolescent-friendly services including psychosocial interventions and support.

Adolescents and young people need to know how to protect themselves from HIV infection and must also have the means to do so. This includes being able to obtain access HIV prevention interventions including voluntary medical male circumcision, condoms and pre-exposure prophylaxis, better access to HIV testing and counselling, and stronger links to HIV treatment services for those who test HIV positive.

Other infectious diseases

Thanks to improved childhood vaccination, adolescent deaths and disability from measles have fallen markedly. For example, adolescent mortality from measles fell by 90% in the African Region between 2000 and 2012.

Diarrhoea and lower respiratory tract infections (pneumonia) are estimated to be among the top 10 causes of death for adolescents 10–14 years. These two diseases, along with meningitis, are all among the top 5 causes of adolescent death in African low- and middle-income countries.

Infectious diseases like with human papilloma virus that normally occurs after onset of sexual activity can lead to both short-term disease (genital warts) during adolescence but more importantly also leads to cervical and other cancers several decades later. Early adolescence (9–14 years) is the optimal time for vaccination against HPV infection and it is estimated that if 90% of girls globally get the HPV vaccine more than 40 million lives could be saved over the next century. However, it is estimated that in 2019 only 15% of girls globally received the vaccine.

Human papillomavirus (HPV) and cervical cancer fact sheet

Early pregnancy and childbirth

Approximately 12 million girls aged 15–19 years and at least 777 000 girls under 15 years give birth each year in developing regions. Complications from pregnancy and childbirth are among the leading causes of death for girls aged 15–19 years globally.

The UN Population Division puts the global adolescent birth rate in 2020 at 41 births per 1000 girls this age, and country rates range from 1 to over 200 births per 1000 girls (6). This indicates a marked decrease since 1990. This decrease is reflected in a similar decline in maternal mortality rates among girls aged 15–19 years.

One of the specific targets of the health Sustainable Development Goal (SDG 3) is that by 2030, the world should ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.

Adolescents need and have a right to comprehensive sexuality education, a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. Better access to contraceptive information and services can reduce the number of girls becoming pregnant and giving birth at too young an age. Laws that are enforced that specify a minimum age of marriage at 18 can help.

Girls who do become pregnant need access to quality antenatal care. Where permitted by law, adolescents who opt to terminate their pregnancies should have access to safe abortion.

Adolescent pregnancy fact sheet

Nutrition and micronutrient deficiencies

Iron deficiency anaemia was the second leading cause of years lost by adolescents to death and disability in 2019. Iron and folic acid supplements are a solution that also helps to promote health before adolescents become parents. Regular deworming in areas where intestinal helminths such as hookworm are common is recommended to prevent micronutrient (including iron) deficiencies.

Developing healthy eating habits in adolescence are foundations for good health in adulthood. Reducing the marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt and providing access to healthy foods are important for all, but especially for children and adolescents.

Undernutrition and obesity

Many boys and girls in developing countries enter adolescence undernourished, making them more vulnerable to disease and early death. At the other end of the spectrum, the number of adolescents who are overweight or obese is increasing in low-, middle- and high-income countries.

Globally, in 2016, over 1 in 6 adolescents aged 10–19 years was overweight. Prevalence varied across WHO regions, from lower than 10% in the WHO South-East Asia Region to over 30% in the WHO Region of the Americas.

Physical activity

Physical activity provides fundamental health benefits for adolescents, including improved cardiorespiratory and muscular fitness, bone health, maintenance of a healthy body weight, and psychosocial benefits. WHO recommends for adolescents to accumulate at least 60 minutes of moderate to vigorous intensity physical activity on average per day across the week, which may include play, games, sports, but also activity for transportation (such as cycling and walking), or physical education.

Globally, only 1 in 5 adolescents are estimated to meet these guidelines. Prevalence of inactivity is high across all WHO regions, and higher in female adolescents as compared to male adolescents.

To increase activity levels, countries, societies and communities need to create safe and enabling environments and opportunities for physical activity for all adolescents.

Rights of adolescents

The rights of children (people under 18 years of age) to survive, grow and develop are enshrined in international legal documents. In 2013, the Committee on the Rights of the Child (CRC), which oversees the child rights convention, published guidelines on the right of children and adolescents to the enjoyment of the highest attainable standard of health, and a General Comment on realizing the rights of children during adolescence was published in 2016. It highlights states’ obligations to recognize the special health and development needs and rights of adolescents and young people.

The Convention on the Elimination of Discrimination Against Women (CEDAW) also sets out the rights of women and girls to health and adequate health care.

WHO response

In May 2017, WHO published a major report: Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to support country implementation. The AA-HA! Guidance has drawn on inputs received during extensive consultations with Member States, United Nations agencies, adolescents and young people, civil society and other partners. It aims to assist governments in deciding what they plan to do and how they plan to do it as they respond to the health needs of adolescents in their countries. This reference document targets national-level policymakers and programme managers to assist them in planning, implementing, monitoring and evaluation of adolescent health programmes. Teams from over 68 countries have been trained in applying the AA-HA! guidance for national priority-setting, programming, monitoring and evaluation, and many countries are in the process of using the AA-HA! approach to update national strategies and policies.

To improve adolescent health measurement globally, WHO, in collaboration with UNAIDS, UNESCO, UNFAP, UNICEF, UN Women, the World Bank Group, and the World Food Programme (WFP), has established the Global Action for Measurement of Adolescent health (GAMA) Advisory Group. GAMA provides technical guidance to WHO and UN partner agencies to define a core set of adolescent health indicators, for the purpose of harmonizing efforts around adolescent health measurement and reporting.  

Overall, WHO carries out a range of functions to improve the health of young people, including

• production of evidence-based guidelines to support health services and other sectors;
• making recommendations to governments on adolescent health and adolescent-responsive health systems including the provision of high quality, age-appropriate health services for adolescents;
• documenting progress in adolescent health and development;
• raising awareness of health issues for young people among the general public and other interested stakeholders; and
• advocating with governments and working with youth-led and youth serving organizations to support establish national level structures and processes to institutionalize adolescent participation in dialogues about relevant areas of public policy, financing and programme implementation.

References

(1) United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME). Levels and Trends in Child Mortality: Report 2021. https://childmortality.org/wp-content/uploads/2021/12/UNICEF-2021-Child-Mortality-Report.pdf

(2) Liu L, Villavicencio F, Yeung D et al. National, regional, and global causes of mortality in 5-19-year-olds from 2000 to 2019: a systematic analysis. Lancet Glob Health 2022;10:e337-47.

(3) UNAIDS, https://aidsinfo.unaids.org/

(4) UNICEF, 2020. https://data.unicef.org/topic/hivaids/adolescents-young-people/#:~:text=HIV%20in%20adolescents,of%20new%20adult%20HIV%20infections.

(5) Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach – 2nd ed: World Health Organization; 2016.

(6) United Nations Department of Economic and Social Affairs, Population Division. World population prospects: fertility data 2020-2025. 2020. https://population.un.org/wpp/Download/Standard/Fertility/.