CHAPTER 20
Adolescent Health
SHERIDAN PHILLIPS
465ADOLESCENT DEVELOPMENT AND HEALTH 465
Physical Development 465
Psychosocial Development 467
Interaction of Physical and Psychosocial Development 468
Interaction between Developmental Issues and
Health Care 472
Health Promotion 477
SALIENT AREAS OF ADOLESCENT HEALTH 477
Sexual Activity and Health Consequences 477
SPECIAL SERVICES FOR ADOLESCENTS 480
Legal Consultation 480
School-Based Health Services 480
FUTURE DIRECTIONS 481
SUMMARY 482
REFERENCES 482Adolescent health is a broad, multidisciplinary “eld encom-
passing, at a minimum, clinical and developmental psychol-
ogy, education, environmental design, law, nursing, nutrition,
pediatrics, psychiatry, and social work. The sheer amount of
information relevant to promoting adolescent health poses
various challenges. Clinically, good patient care requires
collaborative efforts among different disciplines, with an
overlap of core knowledge that is shared, as well as appreci-
ation for the specialized expertise of each professional.
Similarly, designing training programs necessitates setting
priorities for knowledge and skills for one discipline while
drawing from others as well. Advancing our knowledge of
adolescent development and care, and disseminating such
information, ideally involves familiarity with “ndings and
journals in many “elds.
One chapter cannot do justice to this broad array of areas.
We focus on those unique aspects of adolescence that
have particular salience for teenagers• health and health care.
Many aspects of health are therefore omitted. For example,
while the treatment of psychiatric disorders is clearly impor-
tant in adolescence, these mental health needs are not unique
to this developmental stage. Similarly, some adolescents re-
quire treatment for cancer, heart disease, and a variety of
other physical disorders, but such problems are more preva-
lent at other ages. This chapter reviews aspects of physical
and psychosocial development speci“c to adolescence and
their interaction with health care, including major sources of
morbidity and mortality, salient areas of health care, and spe-
cial services for adolescents.
ADOLESCENT DEVELOPMENT AND HEALTHPhysical DevelopmentThe onset of puberty in males is typically signaled by subtle
testicular changes at about 11.5 years of age, concomitant
with the start of their growth spurt. The average duration of
puberty is three years, but it can range from two to “ve years.
The growth spurt peaks relatively late at about 14 years,
when changes in the genitals and pubic hair are very evident.
(For further information regarding physical development,
see McAnarney, Kreipe, Orr, & Comerci, 1992; Neinstein,
1996a.)
Pubertal development begins earlier in females, with the
start of their growth spurt at about 8.7 years, followed by the
“rst sign of breast development (breast budding) one year
later. Their growth spurt peaks at 11.6 years, well before sig-
ni“cant changes in breast and pubic hair and before menarche
at about 12.3 years. Major changes in body size and compo-
sition therefore occur much earlier in girls than boys, with
girls reaching their growth peak at about the same chronolog-
ical age as boys begin their adolescent growth spurt.
Even among normal adolescents, the timing and duration
of puberty vary tremendously and are thus poorly correlated
with chronological age. This prompted the development of
a rating scale for sexual maturity (Tanner, 1962), based on
pubic hair and breasts for females and pubic hair and genitalia
in males. For both sexes, the scale ranges from Stage 1
(completely prepubertal) to Stage 5 (adult secondary sexual