E-Portfolio3: Literature Review

Yassah Ballayan
Dr. Dawnne Wise
HLTH 634-201520
February 1, 2015

Introduction
Adolescent health is a diverse category that covers the physical, emotional, spiritual and
intellectual development during the transition from childhood to adulthood.1 According to the
World Health Organization (WHO), adolescence is the period between the ages of 10 and 19
years old.2 During this important stage of growth and development young people are at risk of
serious health and safety issues.3Many adolescents are involved in car accidents, suicide
attempts, substance use, unplanned pregnancies and preventable illnesses.2,3 The risky behaviors
that some adolescents engage in lead to serious diseases during adulthood such as, tobacco use,
poor nutrition and exercise and unprotected sex.2 There is no single component that impacts
adolescent health, in fact, it is multifaceted. The health of young people is shaped by parents,
families, schools, faith communities, cultures, neighborhoods, health care systems, social norms,
government policies and laws.1,3 Therefore, efforts to improve adolescent health cannot come
from one source alone. It is a comprehensive strategic approach that will be most effective.3
The primary objective of this program plan is to develop a resource center that will serve
the community of Richmond, Virginia. Although, there are organizations that have been
developed to address aspects of adolescent health, the resource center will bring together those
groups and provide information and training to further enhance the progress of improving
adolescent health. The goal of the resource center is to increase access of quality health services
to meet the needs of the priority population. Another goal is the integration of community efforts,
health care delivery systems and state systems.4 Research is another component of the program.
The research team will stay abreast with the best approaches to adolescent health and work to
improve the response to related health issues that arise in the city.
The purpose of this review is to analyze current literature about the target population. The
literature review is also a very critical part of conducting a needs assessment.5It helps the
program planner focus and prioritize more important issues of the population. By identifying the

issues that adolescents encounter, the intervention is able to form a reference point to center the
goals of the program.5 A literature review also builds credibility to the program rationale.5 The
first part of the review analyzes articles that discuss the issues young people face, determinants
of health for this population and health care services that are important to adolescent health. The
second part provides conclusions and recommendations. It also explains differences in research
findings and suggests areas in need of further research. The final section of the review provides a
brief rationale for the program intervention based on the literature review.
For the purpose of reviewing current findings, only research published after the year 2008
were evaluated. The references that were used are those that support the need for intervention in
the target population. The articles that were excluded were research specific to adolescent health
in rural as well as international communities. While assessing health in other places is valuable
data, the most relevant research focuses on urban adolescent health similar to the location of the
planned intervention. Only peer-reviewed articles with full text were used to make a full analysis
of credible sources and results.
Body of Evidence
The first four articles that are examined discuss risky behaviors that adolescents engage
in and the need for intervention. According to Park, smoking in young people starts out of
curiosity and becomes a gateway to other substance abuse and then leads to major health issues
like lung cancer.6 The author also states that 90 percent of people smoke for the first time while
under the age of 18, around age 12 or 13 years old.6 From conducting surveys the researchers
found that peer relations and the surrounding environment to be important factors that increase
the risk of smoking in adolescents.6 Those factors included, family history, companionship,
personal characteristics and psychosocial problems.6

The next journal article by Robinson suggests that young people are more likely to have
poor sexual health.7 They have higher risks of poor levels of contraception, particularly condom
use; and a bias against accessing health care.7 More than 50 percent of pregnancy among
teenage girls are unplanned. The article also found that chlamydia trachomatis and gonorrhea are
the highest reported sexually transmitted infections in young people.7 The author suggests that
an immature genital tract immune system, is a reason for high prevalence of STIs among the
youth.7 Other findings of this article state that cognitive development, socioeconomic and
cultures influence sexual behavior.7
Rose and Bond hypothesized that adolescents that have higher chances of substance
abuse are those that experience stressful social and developmental chanllenges.8 Identity
formation is also suggested by the authors as a contribution to poor choices related to substance
abuse.8 during this stage of life adolescents are trying to figure out their identity status, therefore
they are more likely to explore and engage in different acts.7 The results of the study were in line
with the hypothesis, suggesting that identity diffusion was positively associated with substance
abuse. Also, significant amounts of stress was associated with substance abuse but more
positively related to the inability to cope with stressors.8 Another research study by Demir et al.,
concluded similar results that found the state of identity confusion is linked with depression in
young people.9
When assessing adolescent health it is also important to review the determinants or risk
factors that contribute to the decisions that young people make. The next set of articles is
reviewed to investigate and provide support to the programs idea that improving adolescent
health is multidimensional. Both articles by Viner and Hargreaves et al., focused on the
determining factors that shape adolescent health.10,11 Results from the article by Viner found that
self-esteem, confidence and personal responsibility for health were associated with good

general health and with health promoting behaviors such as healthy eating and physical
activity.10 Both article also found that social factors related to health outcomes include home,
peers, school and neighbourhood.10 A third article emphasize the role of parents are a major
factor in adolescent health.12 The author states that parenting skills yields positive effects on the
behaviors of adolescents for whom parents and caregivers are responsible.12
Another aspect of adolescent health is making sure that access to quality healthcare
services and intervention is available. However, some research suggests that although access to
medical care is available, some adolescents still participant in risky behavior. Hamm and Allen
suggest that primary care physicians are a vital component in improving adolescent health. The
authors states that because the priority population has frequent health visits, physicians are well
positioned to deliver important health advice.13 The authors claim is supported by research
finding that indicate time alone with physician improves sharing of personal concerns.
In one study McDougall discusses the importance of meeting the mental health needs of
adolescents.14 According to the author, timely intervention services is essential.14 During
adolescence many mental health problems go unrecognized and can lead to serious problem in
adulthood.14 The researchers hypothesize that improved mental health knowledge in nurses can
provide early intervention to reduce negative outcomes.14 In regards to reproductive health, Ralph
and Brindis argue that the current system of health services and settings is often poorly
equipped to meet the diverse acute and preventive health needs of adolescents.15 Although most
adolescents have health insurance, services are not always accessible, acceptable, appropriate or
effective for all adolescents.15
Summary and Conclusions
The current literature on adolescent health supports the needs of further intervention to
significantly improve the health status of the priority population. The transitional stage from

childhood to adulthood is a very critical period that often involves partaking in risky behaviors.
Adolescents are at higher risk of making poor decisions like smoking and substance abuse.
Research suggest that there are many factors that influence the decision making process in the
youth. Factors include family history, religion, culture, school, peers and society. Healthcare
providers also play a major role in adolescent health. Multiple articles agree that by furthering
knowledge to physicians and nurses provides great opportunity for early and confidential
intervention to adolescent health. Another way to improve health of the younger population is to
provide medical care that is accessible and effective.
Although the literature review provided great information to support the programs
intervention, some of the studies presented limitation and gaps where further research is needed.
The most common limitation in the studies was the small sample size. A larger sample size may
have yielded more accurate results especially in the article by Community Preventive Services
Task Force. Another limitation is in the cross-sectional study by Hargreaves, the study only used
two questionnaires items to assess self-esteem whereas other similar research used longer scales.
In the article by Ham, the researchers suggested that physician-adolescent conversation is
effective intervention for adolescent health, however there is lack of supportive research.
The literature review was supportive of the primary goals and objective of the proposed
health program to address adolescent health. The program will address the needs of the priority
population through a collaborative effort. The state, local organizations, school system,
community members and families will be included in the intervention. As stressed in a few of the
articles, there is a need to trained healthcare professionals as well as others adults that interact
with adolescents. The training will provide additional education on recognizing signs and

symptoms of mental health and also effective communication. Another aspect of the program
will be focused on research to provide further evidence on approaching adolescent health.

References
1

Missouri Health Department. Guiding Principles for Promoting Adolescent Health.

Missouri Health Department website.
http://health.mo.gov/living/families/adolescenthealth/pdf/GuidingPrinciplesforPromoting
AdolescentHealth.pdf. Accessed January 21, 2015

World Health Organization. Adolescent Health. World Health Organization.

http://www.who.int/topics/adolescent_health/en/. Accessed January 16, 2015
3 Center for Disease Control and Prevention. Adolescent and School Health. CDC.
http://www.cdc.gov/healthyyouth/adolescenthealth/. Accessed January 16, 2015
4 http://www.peds.umn.edu/dogpah/programs-centers/health-resource-center/
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