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WORK WITH YOUTH: PROTECTION OF REPRODUCTIVE HEALTH_
TEENAGERS IN TODAY RUSSIA: HEALTH AND MEDICO-SOCIAL CHARACTERISTICS
A. M. Kulikov ([email protected])
Medical Academy of Postgraduate Studies, St Petersburg, Russia.
■ Consequences of risk-taking behaviors and changes in reproductive behavior become a very important problem for the reproductive potential of young people. The combination of risky behaviors (such as smoking, alcohol drinking) and early sexual activity is often observed. Improvement of the reproductive health of young people could be achieved by treating teenagers as a special risk-taking group with specific medico-social needs and establishing special medico-social services for teenagers
Introduction
Social significance of teenagers consists in the fact that they form the future labor, defense, reproductive and intellectual potential of society. In Russia, however, the number of children from 0 to 17 years of age decreased from 32.8 in 2001 to 28.3 million in 2006 [1].
Sadly, the mortality of teenagers in Russia is the highest in the world. Considering the structure of mortality among children, teenagers (10 - 19 years) make up 72.4 %. Two thirds of the causes of mortality in teenagers are external (e.g., trauma, poisoning, suicide and murder). In Russia, negative tendencies regarding the health of teenagers have been observed [2]. Based on the data from the Research Center of Children Health at the Russian Academy of Medical Sciences, no more then 3 - 10 %o of children and teenagers are considered healthy. Today, three main tendencies are noted: a drastic deterioration of health in this age group, an increased interest of youth in matters of health and a decrease in the availability of medical services for teenagers.
All of this should be considered as a precursor of a demographic crisis and a threat to the national security of Russia. That is why birth rate increase, protection and strengthening of the health of children in all age groups is a major priority of the Russian state. Today, it is very important to understand the reasons for the present condition and to develop ways to significantly improve the present situation.
Material and methods
A review and analysis of data about the health conditions of teenagers in Russia in general and St. Petersburg in particular was done using state statistical reports, materials from Pediatric Congresses in
Russia and leading clinic-prophylactic institutions in Russia that provide medical help for teenagers.
Results
The most significant deterioration in the health of children has been observed in the age group 7 to 17 years, which coincides with the periods of school education and the beginning of college education [3]. In the past 5 years the morbidity of children before 14 years of age increased by 19.2 % and in 15 - 17 years by 20.2 %.
The psychological health of the youth remains a serious problem in Russia. There are around 238,000 teenagers officially registered in psychoneurological clinics [4]. The prevalence rate for depression among young people approaches 19 % [5] and the level of suicide among teenagers in Russia is one of the highest in the world.
There is evidence indicating that the physical condition of children in Russia is deteriorating [1]. During the past 10 years, the number of boys and girls with normal body weight has decreased by 16.9 0% and 13.9 o%, respectively. The number children smaller than normal size has increased 1.5 %% among boys and 1.0 o% among girls.
The condition of the reproductive health of children and teenagers has a direct influence on demo-graphical processes. Only in the past 5 years has the rate of gynecological and andrological diseases among children at all ages increased 1.5 times. More then 50 % of children in the teens have diseases that can come to limit the realization of the reproductive function.
About 20 o% of girls have gynecological diseases and 75 - 80 %% have somatic diseases, limiting fertility [2]. With age, the prevalence of gynecological disorders increase more then 2.5 times, from 116.2 per 1000 examined at 14 years of age to 297.0 per 1000 examined at 17 years of age [6]. In St. Petersburg the menstrual cycle (61.4 - 84.5 %%) and disturbances in sexual development (7.3 %%) are among the most common gynecological diseases during the pubertal period. According to the data of Ministry of Health in Russia, prevalence of menstrual cycle disorders in 15 - 17 year olds between 1992 and 2002 increased from 1,027 to 3,468 per 100,000 inhabitants [7].
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The situation is not any better regarding the reproductive health of male teenagers. The prevalence of andrological diseases in school boys is 12.6 %. For the school boys, 2.2 %o require surgical treatment. The most prevalent andrological diseases among teenagers (per 100 tested) are sinehii (63.0), vericocele (51.7), phimosis (29.2), enuresis (6.8) and hydrocele (2.7) [8].
The early sexual activity of teenagers and the consequences of these activities became one of the most important social problems in Russia. About one half of all school children 16 - 17 years of age have engaged in sexual activity. This behavior was considered inappropriate by only 5 - 12 0% of the boys. Young people are often not physically or psychologically prepared for sexual activity: nor do they possess enough knowledge about sexually transmitted infections (STIs) or about abortion or the potential negative outcomes of early sexual activity.
A collapse in ideals of family life seems to have taken place. Today, 10.5 %% of female students of trade schools and 6.5 %% of school girls do not want to have children. In 1990, the number of such women was less than 1 0%. Young people prefer "civil marriage" or to lead a bachelor's existence to lawful wedlock [9].
The number of abortions between the ages 15 and 19 years in Russia is about 70 per 1000 teenagers, a rate which is one of the highest in the world. Despite a decrease in the absolute number of abortions among girls less than 14 years of age and between 15 and 19 years (in the past 5 years the figures have been 16.5 and 17.3 %%, respectively), every tenth abortion in the country is done in these two age groups. Annually, about 1,500 thousand children are born from mothers who are 15 years of age, 9,000 16 years of age and 30,000 17 years of age [10]. Maternal mortality among teenagers is 5 - 8 times higher than in the general population [11].
Young people 15 - 24 years of age are at a great risk of acquiring STIs. According to the Ministry of Health, more then 52,000 patients under the age of 17 years were registered in 2003 as having STIs. The prevalence of some STIs increased several times. For instance, the frequency of chlamydial infection among children under 14 years of age increased 6.7 times; in teenagers (15 - 17 years), chlamydial infection increased 7.4 times and urogenital herpes infection 4.7 times [3].
In 2004, the following first time established diagnoses of STIs were reported by the Ministry of Health and Social Development in Russia for females 15 - 19 years of age: gonorrhea 23.6 %%, syphilis (all forms) 16.6 0%, trichomoniasis 118.2 %% and chlamy-diosis 13.1 0%.
Half of all new cases of infection by human immunodeficiency virus (HIV) are young people. Of all HIV-infected individuals, 21 %% are teenagers. In the past years, HIV epidemic was concentrated among the drug addicts. Today, almost 25 %% of infected teenagers have acquired HIV via sexual contacts.
In addition to biological and social reasons, another reason for the high prevalence of STIs and HIV among young people is the absence of programs on sexual education.
Consumption of alcohol begins already at 12 - 13 years of age. In the age group 11- 24 years more than 70 % of the children consume alcohol and girls consume nearly the same amount of alcohol as boys. The prevalence of alcoholism among teenagers in 2003 was 39.5 persons per 100,000 teenagers, which is an increase of 65 % when compared with statistics 4 years earlier, i.e. 1999.
In Central Russia from 18 %% to 23 % of young persons from 15 - 17 years of age have used drugs. Every third young male has as at least tried psychoactive substances under their own accord, whereas every fourth has tried after being encouraged by friends and every fifth has tried based on the urge to experience something new.
Presently, 19.2 %% of children at the age of 10 - 11 years smoke, 46.7 %% at the age of 13 - 14 years and 63.6 %% — at the age of 16 - 17 years [3].
The greatest life values for teenagers with risk-taking behavior, such as smoking, use of alcohol and drugs and early sexual debut, were freedom and independence (for 76.9 %%). At the same time those who do not belong to the risk-taking category, most valued a microclimate in family (68.8 %%). Of young men with risk-taking behavior 89.7 %% and 78.1 %% of those who do not belong to that category admitted that they are responsible for their own health themselves [12]. Teenagers of both groups clearly equally understood ways of preserving health (e.g., living a healthy way of life, having a balanced diet and performing physical activity regularly, dispensary supervision and preventive medical check-ups). At the same time, 21.8% of young risk-not taking men believed that their good health was largely dependent on their parents. This seemed to reflect a smaller degree of socialization and a greater degree of infantilism. It is remarkable that nearly twice as many young men risk-free behavior feel that they have problems with health as compared with young men who are risk-takers (34.4 vs. 17.9 %%).
Teenagers have shown different perceptions than other age groups regarding the value they place on health. All young men had an identical opinion concerning the importance of health for establishing a family, full-value life. Differences among teenagers were seen in only two aspects.
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For young men with risk-taking behavior, health was necessary in order to be strong or beautiful and to be able to reap the pleasures of life. Teenagers without risk-taking behavior had a more pragmatic approach to life: study well (40.6 %), devotion to a spiritual life and work hard in order to be successful in life.
Young men without risk-taking behavior more often consider unacceptable an early sex life, smoking, consumption of alcoholic drinks and the use of drugs. At the same time, the same number of teenagers in both groups believes that if risky behavior does not create problems then such behavior is not a problem.
Even in the group with socially approved behavior, about one third of these people did not see anything bad in early sexual activity. Apparently, teenagers adhering to a healthy way of life are apparently just as motivated in engaging in risky behavior as those who do not adhere to a healthy lifestyle. Avoiding "bad habits" in young men is not always proof of their belief in the dangers that are caused by "bad habits". It often reflects certain taboos and legal and social interdictions on the behavior imposed by parents and the stereotypes existing in our society. It is noteworthy that except for aversion of smoking, alcohol, drugs and risky sex behavior, other moral principles of young men without bad habits in many aspects coincide with the morals of other teenagers.
Thus, risk-taking behavior is a characteristic feature of most young people and is therefore it is much more common for teenagers. In fact, risk-taking behavior is considered by many to be a normal part of adolescence. To eradicate risky behavior completely is more or less impossible. However, for its prevention, it is necessary to allocate special target groups on the basis of their medico-social portraits. Thus, ways of prevention should be differentiated in accordance with those characteristics.
Discussion
The present data confirm that a number of priority directions in health protection of teenagers from the point of view of experts (i.e. WHO) are needed. Such directions include the protection of the sexual and reproductive health of teenagers, HIV infection and youth, public health services designed especially for teenagers, teaching young people about a healthy way of life and prevention of risky behavior of teenagers.
Risk-taking behavior is complex. Therefore, one cannot deal with individually taken risk factors. Rather a complex approach is needed in which an effort is made to influence the formation of the teenager as a person with a responsible attitude to health as a
whole and to eliminate social factors promoting risk-taking behavior.
The Union of pediatricians in Russia has developed the program "Protection of the reproductive health of children and teenagers". Realization of the program, including the introduction of new organizational and medical technologies of preservation, restoration and strengthening of reproductive health, professional training of various experts, will allow not only an increase in the birth rate but also the reproductive potential of the nation as a whole. In opinion of the developers of the program, it is necessary to include such a program into the national priority project "Health".
In the opinion of the Ministry of Health and Social Development in Russia, the important role in the protection of reproductive health should belong to a children's polyclinic and, in particular, to local pediatric services.
Even though persons from 10 till 19 years of age are considered teenagers in most parts of the world (in Russia till 18 years), as a teenager is defined person with certain biological and social features: (a) sexual development from the appearance of secondary sexual signs to completed sexual maturity, (b) psychological children's behavioral patterns are replaced by behavior more characteristic of adults and (c) transition from full social and economic dependence on adults to relative social independence.
The basic problem of modern teenagers is the break between end of puberty and social maturing [2]. This problem is aggravated by the persistent trend of Russian beaurocrats to consider the teenager as a child and thus neglecting their special medico-social needs. As a result, young mature people wishing to be recognized as adults increasingly become childish instead. This creates a high risk of undesirable behaviors, especially those related to reproduction. Thus, teenagers find themselves in a dilemma in the sense that they are no longer children, but not yet adult either. Therefore, this age group requires a special approach to the organization and maintenance of the availability of medico-social help [13].
Conclusions
During the past decade, the extremely negative tendencies regarding the health status of teenagers have been noted. The consequences of risky behavior of youngs are becoming increasingly obvious.
Change is possible by recognizing that teenagers belong to a special age group with specific medico-social needs (e.g., reproductive health). The creation of a net-
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work of youth medico-social services is urgently needed. Preventive programs will be effective only when consideration is give to young people's medico-social needs.
References
1. Resolution. XI pediatrician congress of Russia "Actual problems of pediatrics" — http://www.pediatr-russia.ru/pediatr/ kongressll/resol.html [in Russian]
2. Levina L. I. Adolescent medicine: the guideline. 2nd edition / Levina L. I., Kulikova A. M. — St.Petersburg: Peter, 2006. — P. 544. [in Russian]
3. Ilin A. G. Children's state of health in the present conditions: problems and ways of negotiation the emergency situation / Ilin A. G. — Terra Medica. 2005. — N 4 — P. 3 - 5. [in Russian]
4. MironovN.E. Mental health of children's and adolescents in Russia / Mironov N.E. — Information letter. Moscow, 1999. [in Russian]
5. IovchukN. M. The prevalence and clinical presentations of depression in school and teenager populations / Iovchuk N. M., Batygina G. Z. // Journal of Neurology and Psychology. — 1998.— N 9. — P. 33 -36. [in Russian]
6. Krotin P. N. Reproductive behavior and contraceptive selection of teenagers and young people / Krotin P. N.,
Kozhukhovskaya T. U. // Russian Youth Journal. —2004. — N 12. — P. 341 -346. [in Russian]
7. The report on children's state of health in Russian Federation. — Moscow. 2003. [in Russian]
8. Mirskiy V. E. Children's and Adolescent andrology / Mir-skiy V. E., Mihaylichenko V. V., Zayezjalkin V. V. — Saint-Petersburg: Peter, 2003. [in Russian]
9. Dolbik-Vorobey T. A. Student's youth about problems of marriage and fertility / Dolbik-Vorobey T. A. // Sociological investigation. — 2003. — N 11. — P. 78 - 83.
10. ChicherinL. Reproductive health protection of girls on out-patient reception hours / Chicherin L., Zubkova N., Glybina T. — Physician. — 1999. — N 9. — P. 21 - 22.
11. Balaklaenko N. G. Current state of reproductive health protection of adolescent / Balaklaenko N. G., Gavrilova L. V. // Public health. — 2000. — N 7. — P. 26 - 33.
12. KulikovA. M. Social characterization of young people with different grade of risky behaviour / Kulikov A. M., Boyeva V. I. // Region: Politics, Economics, Sociology. — 2003. — N 1- 2. — P.139 - 140.
13. Krotin P. N. The clinics, which are friendly to the teenagers / Krotin P. N., Kulikov A. M., Kozhukhovskaya T. U. // The guideline for physicians and health authorities. — UNICEF, 2006.
EVALUATION OF KNOWLEDGE LEVEL ABOUT THE WAYS OF TRANSMITTING, MEANS OF PROTECTION AND PREVENTION OF STI/HIV AMONG YOUTH CENTERS ATTENDEES IN ST. PETERSBURG
A. Benkovich 1, E. Sokolovskiy 2([email protected]), I. Mahinenko 2, A. Savicheva 3, E. Shipitsyna 3, M. Domeika 4
1 Dermatovenereology Dispenser of Leningrad Region, St.-Petersburg, Russia;
2 Department of Dermatology and Venereal diseases, St.-Petersburg Pavlov State Medical University, St.-Petersburg, Russia;
3 D.O. Ott Research Institute of Obstetrics and Gynecology, St.-Petersburg, Russia;
4 Department of Medical Science, Uppsala University, Uppsala, Sweden
■ Presented data shows level of knowledge about the ways of transmitting, means of protection and prevention of STIs/HIV among youth center attendees in St.-Petersburg. Research was done by carrying out of questionnaire of 456 patients, in the age group between 15 and 25 years. This was the follow of the study conducted in 2003 during which knowledge of 300 patients has been accessed.
■ Keywords: STI, knowledge, youth consultation
Introduction
According to the WHO, the sexually transmitted infections (STIs), are the one of the most often causes of morbidity in the world causing acute diseases, infertility, stable invalidity and mortality, have serious medical and psychological consequences for millions of men, women and children [8,10]. It is well documented that
patients having STIs have five to ten times higher risk of acquiring HIV. According to WHO data, morbidity caused by STIs in the East Europe is at the level of epidemic that indicates wide spread of unsafe sexual behavior [9]. In St. Petersburg the morbidity due to STIs in 2005 reached 1643.39 per 100.000 inhabitants [3, 4]. Increase of STIs among teenagers and children [1] is noticed. Knowledge of factors affecting transmission of STIs, creates the necessary prerequisites for the elaboration of an adequate system of medico-social prevention of these diseases [2, 7, 11, 12].
The purpose of the presented study was to evaluate the knowledge about the transmission, means of protection and prevention of STIs (including HIV) among attendees of youth clinics, and also comparison of the received data, with data of the previous study done in 2003.
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