Peter S Azzopardi

Improving adolescent reproductive health in Asia and the Pacific: do we have the data? A review of DHS and MICS surveys in nine countries.

Data on adolescent reproductive health (ARH) are required to inform evidence-based policies and programs. The reports of national-level household surveys such as the Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) are important sources of such data in developing countries. The aim of this study was to map data on ARH from DHS and MICS reports from selected countries in the Asia and Pacific regions. The DHS and MICS reports for Bangladesh, Cambodia, Indonesia, Papua New Guinea, Philippines, Solomon Islands, Timor-Leste, Vanuatu, and Vietnam were reviewed. Data on 128 indicators, including ARH outcomes, outcomes for babies of adolescent mothers, and adolescents’ access to health information and services, were mapped. Available data are limited because of the omission of cohorts such as young adolescents (10-14 years old) and, in many surveys, unmarried women; the omission of important indicators; and failure to report data disaggregated by age. DHS and MICS reports have limited capacity to inform policy and programs to improve ARH. A review of DHS and MICS sampling strategies and reporting templates, and a consideration of alternative data collection strategies, are warranted.

Global Measures of Health Risks and Disease Burden in Adolescents

Adolescents are commonly viewed as healthy in comparison with other age groups (Sawyer and others 2012). Adolescence is an age at which many positive attributes of health peak, and these positive attributes predict health in later life. Physical fitness peaks about age 20 years; it remains high until the early 30s, when it declines steadily to old age (Rockwood, Song, and Mitnitski 2011). Those with the highest fitness levels in their 20s are more likely to stay physically healthy throughout life, using less health service as they age (Rockwood, Song, and Mitnitski 2011). Adolescent cardiorespiratory fitness, muscular strength, and body composition are also predictive of lower all-cause mortality and cardiovascular disease in later life (Ruiz and others 2009). Adolescence is similarly central in skeletal health. Bone mineral density, a primary determinant of later-life osteoporosis and its complications, peaks in the late teens to early 20s (Baxter-Jones and others 2011). In the two years of peak skeletal growth, adolescents accumulate more than 25 percent of adult bone mass; patterns of physical activity and adolescent nutrition are important modifiable influences (JuliánAlmárcegui and others 2015; Whiting and others 2004). Increasingly, adolescence is recognized as a time of changing trajectories and health across the life course (Patton and Viner 2007; Sawyer and others 2012). This is evident in mortality shifts showing a rise in deaths that are largely preventable: deaths from intentional and nonintentional injuries; deaths due to human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), tuberculosis, and other infectious diseases; and deaths due to maternal causes (Patton and others 2009). Patterns of nonfatal disease burden also shift across these years. The prevalence of mental disorders rises sharply across adolescence (Gore and others 2011). Many risk processes leading to chronic noncommunicable diseases (NCDs) in later life, including tobacco use, alcohol and illicit substance use, unsafe sex, obesity, and lack of physical activity, typically emerge in these years (Gore and others 2011). Definitions of age groupings and age-specific terminology used in this volume can be found in chapter 1 (Bundy and others 2017).

Health and Disease in Adolescence

Rising adolescent health problems, such as road traffic injuries (RTIs), mental disorders, and substance use disorders, are an increasing cause for concern in countries that have otherwise reduced maternal mortality and boosted child survival (Patton and others 2009). Moreover, with aging populations and a convergence to a disease burden dominated by noncommunicable diseases (NCDs) in later life, adolescent health risks, such as tobacco use, physical inactivity, obesity, substance use, and poor diet, assume greater significance (Jamison and others 2013). Adolescence is defined as ages 10–19 years. Definitions of age groupings and age-specific terminology used in this volume can be found in chapter 1 (Bundy and others 2017). Better adolescent health requires matching interventions to health profiles, focusing on the important social determinants of health during the adolescent years, considering adolescent development and neurodevelopment, and addressing gender and equity. The Sustainable Development Goals will put a greater focus on adolescents as recipients of interventions and as decision makers and implementation partners in healthrelated issues. Although the Millennium Development Goals increased the focus on sexual and reproductive health among adolescents and young adults ages 15–24 years, other areas of health risks and problems received far less attention, and health gains have been weaker among adolescents than among other age groups. When reading this chapter, it is important to remember that nearly all of the data and evidence come from studies of programs in high-income countries (HICs). We cannot say with any certainty the extent to which the results presented here apply to lowand middle-income countries (LMICs). This lack of research is a particular challenge in planning and selecting interventions for this age group and helps to emphasize the need for much more research into the health of adolescents in LMICs.

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Adolescence is the phase of life stretching between childhood and adulthood, and its definition has long posed a conundrum. Adolescence encompasses elements of biological growth and major social role transitions, both of which have changed in the past century. Earlier puberty has accelerated the onset of adolescence in nearly all populations, while understanding of continued growth has lifted its endpoint age well into the 20s. In parallel, delayed timing of role transitions, including completion of education, marriage, and parenthood, continue to shift popular perceptions of when adulthood begins. Arguably, the transition period from childhood to adulthood now occupies a greater portion of the life course than ever before at a time when unprecedented social forces, including marketing and digital media, are affecting health and wellbeing across these years. An expanded and more inclusive definition of adolescence is essential for developmentally appropriate framing of laws, social policies, and service systems. Rather than age 10-19 years, a definition of 10-24 years corresponds more closely to adolescent growth and popular understandings of this life phase and would facilitate extended investments across a broader range of settings.

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Adolescence is the phase of life stretching between childhood and adulthood, and its definition has long posed a conundrum. Adolescence encompasses elements of biological growth and major social role transitions, both of which have changed in the past century. Earlier puberty has accelerated the onset of adolescence in nearly all populations, while understanding of continued growth has lifted its endpoint age well into the 20s. In parallel, delayed timing of role transitions, including completion of education, marriage, and parenthood, continue to shift popular perceptions of when adulthood begins. Arguably, the transition period from childhood to adulthood now occupies a greater portion of the life course than ever before at a time when unprecedented social forces, including marketing and digital media, are affecting health and wellbeing across these years. An expanded and more inclusive definition of adolescence is essential for developmentally appropriate framing of laws, social policies, and service systems. Rather than age 10-19 years, a definition of 10-24 years corresponds more closely to adolescent growth and popular understandings of this life phase and would facilitate extended investments across a broader range of settings.

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Adolescence is the phase of life stretching between childhood and adulthood, and its definition has long posed a conundrum. Adolescence encompasses elements of biological growth and major social role transitions, both of which have changed in the past century. Earlier puberty has accelerated the onset of adolescence in nearly all populations, while understanding of continued growth has lifted its endpoint age well into the 20s. In parallel, delayed timing of role transitions, including completion of education, marriage, and parenthood, continue to shift popular perceptions of when adulthood begins. Arguably, the transition period from childhood to adulthood now occupies a greater portion of the life course than ever before at a time when unprecedented social forces, including marketing and digital media, are affecting health and wellbeing across these years. An expanded and more inclusive definition of adolescence is essential for developmentally appropriate framing of laws, social policies, and service systems. Rather than age 10-19 years, a definition of 10-24 years corresponds more closely to adolescent growth and popular understandings of this life phase and would facilitate extended investments across a broader range of settings.

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Adolescence is the phase of life stretching between childhood and adulthood, and its definition has long posed a conundrum. Adolescence encompasses elements of biological growth and major social role transitions, both of which have changed in the past century. Earlier puberty has accelerated the onset of adolescence in nearly all populations, while understanding of continued growth has lifted its endpoint age well into the 20s. In parallel, delayed timing of role transitions, including completion of education, marriage, and parenthood, continue to shift popular perceptions of when adulthood begins. Arguably, the transition period from childhood to adulthood now occupies a greater portion of the life course than ever before at a time when unprecedented social forces, including marketing and digital media, are affecting health and wellbeing across these years. An expanded and more inclusive definition of adolescence is essential for developmentally appropriate framing of laws, social policies, and service systems. Rather than age 10-19 years, a definition of 10-24 years corresponds more closely to adolescent growth and popular understandings of this life phase and would facilitate extended investments across a broader range of settings.

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Adolescence is the phase of life stretching between childhood and adulthood, and its definition has long posed a conundrum. Adolescence encompasses elements of biological growth and major social role transitions, both of which have changed in the past century. Earlier puberty has accelerated the onset of adolescence in nearly all populations, while understanding of continued growth has lifted its endpoint age well into the 20s. In parallel, delayed timing of role transitions, including completion of education, marriage, and parenthood, continue to shift popular perceptions of when adulthood begins. Arguably, the transition period from childhood to adulthood now occupies a greater portion of the life course than ever before at a time when unprecedented social forces, including marketing and digital media, are affecting health and wellbeing across these years. An expanded and more inclusive definition of adolescence is essential for developmentally appropriate framing of laws, social policies, and service systems. Rather than age 10-19 years, a definition of 10-24 years corresponds more closely to adolescent growth and popular understandings of this life phase and would facilitate extended investments across a broader range of settings.

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Adolescence is the phase of life stretching between childhood and adulthood, and its definition has long posed a conundrum. Adolescence encompasses elements of biological growth and major social role transitions, both of which have changed in the past century. Earlier puberty has accelerated the onset of adolescence in nearly all populations, while understanding of continued growth has lifted its endpoint age well into the 20s. In parallel, delayed timing of role transitions, including completion of education, marriage, and parenthood, continue to shift popular perceptions of when adulthood begins. Arguably, the transition period from childhood to adulthood now occupies a greater portion of the life course than ever before at a time when unprecedented social forces, including marketing and digital media, are affecting health and wellbeing across these years. An expanded and more inclusive definition of adolescence is essential for developmentally appropriate framing of laws, social policies, and service systems. Rather than age 10-19 years, a definition of 10-24 years corresponds more closely to adolescent growth and popular understandings of this life phase and would facilitate extended investments across a broader range of settings.

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Adolescence is the phase of life stretching between childhood and adulthood, and its definition has long posed a conundrum. Adolescence encompasses elements of biological growth and major social role transitions, both of which have changed in the past century. Earlier puberty has accelerated the onset of adolescence in nearly all populations, while understanding of continued growth has lifted its endpoint age well into the 20s. In parallel, delayed timing of role transitions, including completion of education, marriage, and parenthood, continue to shift popular perceptions of when adulthood begins. Arguably, the transition period from childhood to adulthood now occupies a greater portion of the life course than ever before at a time when unprecedented social forces, including marketing and digital media, are affecting health and wellbeing across these years. An expanded and more inclusive definition of adolescence is essential for developmentally appropriate framing of laws, social policies, and service systems. Rather than age 10-19 years, a definition of 10-24 years corresponds more closely to adolescent growth and popular understandings of this life phase and would facilitate extended investments across a broader range of settings.