Is the teenage health message sinking in?

The chief medical officer used a report last week to highlight deficiencies in services for adolescents. Rachel Liddle reports.

Recent headlines about teenagers have been dominated by knife crime and zero tolerance on drink driving, but the focus may be starting to shift.

People are beginning to realise that something must be done about teen health.

England's chief medical officer (CMO) Sir Liam Donaldson made this the focus of his report last week, saying that binge drinking, smoking, drug use, unsafe sex, poor diet and low levels of physical activity must be tackled.

He admits that a minority of England's 6.5 million adolescents engage in these behaviours, but the numbers involved are still large.

Looking at the positives
One positive is that data from the NHS Information Centre suggest young people today may not be as bad as their predecessors.

A survey of secondary school pupils in England last autumn found that 10 per cent of 11- to 15-year-olds admitted taking drugs in the previous month, down from 12 per cent in 2001.

Similarly, 6 per cent of teens admitted smoking at least once a week, the lowest rate since the surveys began in 1982.

Despite this, concerns remain. The CMO wants a summit to look at both health promotion and healthcare services for teenagers. He also wants NHS organisations to consult with the Youth Parliament and to set up a panel of teenagers to advise marketing executives on which campaign ideas will and, perhaps more importantly, won't work.

Teenagers are the least likely age group to visit their GP, even though many admit to having issues they would like to discuss, says the CMO. Confidentiality seems the biggest concern.

Confidentiality fears
Claire Phillips, director of policy and research for England's children's commissioner, said: 'Young people tell us that they worry about confidentiality, especially things related to contraceptives or substance abuse.'

GPs may have to go some way to reassure this vulnerable age group that consultations are private. They may also have to learn to 'engage' with teenagers and adapt consultation styles to get them talking.

Pilots into alternative primary care services for teenagers are under way, but the traditional GP practice still has an important role, said Ms Phillips.

The Royal College of Nursing has a tool kit that practices can use to see if they are adolescent friendly.

As well as advertising confidentiality policy for under-16s, practices can encourage teenagers to visit their GP or practice nurse about sensitive issues by publicising the availability of emergency contraception or even just adding a few teen magazines in the waiting room.

Meanwhile, all healthcare professionals may soon have to go through formal training in teen health. Coinciding with Sir Liam's report, the RCGP and Royal College for Paediatrics and Child Health (RCPCH) launched an Adolescent Health Project. This translates as extra training for doctors and nurses to understand teenagers' health needs and to improve how they communicate with this group.

E-learning modules and face-to-face learning will be made freely available to NHS staff.

'We want to support the roll-out of this across all doctors and nurses working with teenagers because we believe it will control teenage health,' said a DoH spokesman.

RCGP chairman Professor Steve Field said better services for adolescents 'must be a priority' for all healthcare professionals. 'As the first point of contact in the healthcare system we need the tools to be able to support young people,' he said.

Sexual health is a key area that GPs could help with. Latest results from the Health Protection Agency (HPA) show that half of all new STIs diagnosed in 2007 were among those aged 16-24. This amounts to just under 200,000 young people.

Presenting the results, Professor Peter Borriello, director of the HPA's Centre for Infection, said the casual 'shag' that is becoming the norm for teenagers stands for 'syphilis, herpes, anal warts and gonorrhoea'.

Promoting safe sex
Professor Borriello admitted it is impossible to say if efforts to promote safe sex are working.

The fact that the number of new STIs diagnosed in 2007 was 6 per cent higher than in 2006 suggests they may not be.

Rather than lay the blame at the door of GUM clinics and GPs, Professor Borriello said: 'We're asking young people to be responsible for their own health.'

But Ms Phillips thinks GPs should take the opportunity to talk about teen health issues, including sexual health, when teens come into the practice.

'The fact that there's such an increase in STIs is very worrying and GPs need to play a part in that. It's sometimes very difficult for teenagers to get advice and find somebody to talk through the issues with. A GP actually is a good person to do that but they don't always put themselves forward.'

But as well as warning teens away from the perils of unsafe sex and drug taking, GPs need to be alert to rare symptoms that can often signal rare diseases - such as certain cancers.

A recent poll of teens and young adults by the Teenage Cancer Trust showed nearly half of those with bone and brain tumours or Hodgkin's lymphoma had to visit their GP four to five times before being referred to a specialist.

Professor Tim Eden, an expert in teenage and young adult cancer and medical advisor to the Teenage Cancer Trust, said it was unfair to blame GPs as A&E units also miss teen cancers. But GPs should be vigilant, he said.

Analysis of data from three practices in Scotland, showed that while teenagers attended quite a lot, 'only 3.5 to 4 per cent of their symptoms could be seen as being due to cancer,' said Professor Eden.

The NHS is delivering more preventive care and if GPs can help teenagers lead healthier lifestyles, they might secure the nation's future public health.

Sexual health

50% of new STIs diagnosed in 2007 were among those aged 16-24

Source: Health Protection Agency.

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