Rapid reductions in child mortality globally have resulted in the largest population of adolescents in human history – a ‘youth bulge’ of 1.8 billion. In countries like Papua New Guinea and Myanmar, 10-24-year-olds now account for almost a third of the population.

This story appeared in the Spring edition of IMPACT. Read the entire edition here online.

Burnet’s Co-Heads of the Global Adolescent Health Group, Dr Elissa Kennedy and Dr Peter Azzopardi, and Women’s and Children’s Health Specialist Ms Liz Comrie- Thomson contributed to a landmark report, ‘Our future: a Lancet Commission on adolescent health and wellbeing’, in 2016.

A key message of the commission was to recognise adolescence as a key developmental stage within the life-course, where investments in adolescent health bring a triple dividend of benefits – now, into future adult life, and for the next generation of children.

“What the Lancet report did for the first time was try to describe the specific health needs of adolescents globally and how these can be addressed. This is important as adolescents don’t automatically benefit from interventions targeting children or adults,” Dr Azzopardi said.

“Adolescence is a time when many health risk behaviours particularly around substance use and poor diet emerge, which have important implications for future health.

“It’s also an important time when young people start making decisions around having a family. In many low- and middle-income countries adolescent fertility rates remain very high, so there’s a real opportunity to ensure the health of the next generation as well.”

Non-communicable diseases (including poor mental health and substance use disorders) are health issues common to adolescents globally. Injuries caused by road traffic accidents and violence are also common causes of poor health. More than half of adolescents grow up in countries which are additionally burdened by high rates of HIV, under-nutrition and infectious disease, as well as high rates of adolescent pregnancy and unmet need for contraception.

Understanding and responding to the needs of adolescents in Australia and globally

Good quality data is essential to addressing adolescent health but is often difficult to collect, as adolescents don’t typically respond to traditional surveys. Burnet is leading the way with novel methods and sampling for improved adolescent health data.

Through the Sex Drugs and Rock’n’Roll Survey, Deputy Program Director, Behaviours and Health Risks, Dr Megan Lim and her team have measured the sexual health risk amongst young people at music festivals and on social media annually for the past 13 years. This study has helped identify emerging issues (such as sexting, pornography and risky alcohol use) and led to interventions addressing these risks.

Linked to this, the Mobile Intervention for Drinking in Young People (MIDY) study tested the feasibility and acceptability of a mobile phone-based intervention to deliver tailored text messages to address risky drinking in young people. SMS questionnaires tracked participants’ consumption, spending, location and mood, and encouraged participants to relate their plans, priorities, and any adverse events.

In response to the success of the MIDY study, researchers at Victoria University in Melbourne have begun a two-year pilot study targeting students at four residential colleges at Melbourne University with SMS texts before, during and after they engage in drinking sessions.

Image: Burnet is working to engage Indonesian young people in prevention strategies.

Burnet is also leading the way to improve methods of data collection relating to adolescent health globally. Dr Azzopardi and Dr Kennedy recently collaborated on a policy brief for humanitarian agency UNICEF, highlighting what specific data needs to be gathered for adolescent health globally and how data collection could be improved.

They have also collaborated in global efforts to identify the unique health issues affecting adolescents, including work creating global profiles of adolescent health, and regional profiles with a focus on the Asia-Pacific region.

“Adolescence is a time of rapid transitions in social role and culture, and a life-stage when young people are particularly at risk of becoming marginalised,” Dr Azzopardi said.

“Deputy Program Director, Disease Elimination, Mr Chad Hughes and his team have led a number of projects to better understand the needs of young people living with HIV in the Asia-Pacific region and how to better address their needs.

“This team is also looking at how to avert harms associated with substance use amongst young people in Myanmar.”

Through his work at the Wardliparringa Aboriginal Research Unit within the South Australian Health & Medical Research Institute, Dr Azzopardi has also been leading a project to better understand the health needs of Aboriginal and Torres Strait Islander adolescents in Australia.

Addressing health risks for future adult health

Non-communicable diseases (NCDs) such as diabetes, cardiovascular disease and poor mental health are emerging as the leading causes of poor health in Australia and globally.

Many of the health risks related to these diseases, such as poor-quality diet, physical inactivity and substance use, typically arise during adolescence, providing opportunities for effective prevention strategies.

In collaboration with researchers through the Australia-Indonesia Centre, Adolescent Health Officer Ms Lisa Willenberg and Dr Azzopardi are undertaking a series of studies to better understand NCD risk amongst adolescents in Indonesia.

These studies aim to measure the prevalence of key risks (including substance use and unhealthy body weight) and how young people perceive these risks. The study is also engaging young people to inform a public health approach to prevention.

Providing the best start for the next generation

In many parts of the world adolescent pregnancy remains high, and these pregnancies are associated with poorer health outcomes for both mothers and their babies, according to Dr Kennedy.

“Adolescent pregnancy also entrenches socioeconomic poverty and disadvantage,” Dr Kennedy said.

“Providing young people with the knowledge and skills to negotiate safe relationships, and ensuring access to sexual and reproductive health services, is important to ensuring the health of adolescents and that of the next generation.”

In Myanmar, Burnet’s Country Program Manager Ms Lia Burns and Dr Kennedy are leading a five-year project to improve the sexual and reproductive health of young people.

This development project aims to improve delivery of reproductive health education in schools; engage with parents and community leaders to address barriers to improving health for young people; and work with health staff to improve delivery of interventions for young people’s health.

Adolescents are also an important focus in Burnet’s flagship project, Healthy Mothers, Healthy Babies (HMHB) based in East New Britain province in Papua New Guinea (PNG).

“Almost one in six girls and young women in PNG are pregnant or have given birth by the age of 18, and young mothers account for around 30 per cent of maternal deaths,” Dr Kennedy said.

“Our upcoming HMHB Young People’s Study in PNG will seek to better understand the factors that contribute to early pregnancy in order to develop novel interventions.”

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