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Adolescent Health, COVID-19, and the Call to Action for Adolescent Health and Wellness

Jonathan D. Klein, MD, MPH

Associate Vice Chancellor for Research�Professor and Executive Vice Head, Department of Pediatrics�University of Illinois at Chicago, Illinois, USA�

President, International Association for Adolescent Health

October 2022

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Adolescents and Young Adults

Bio-psycho-social considerations�

Puberty: Child 🡪 Adult�
Cognitive Maturation: Formal operational thought 🡪 Higher-executive function
Social: Dependence 🡪 Adult Interdependence�

Healthy and risky behaviors

Family, school, and friends

Investing in Adolescent Health

Present health
Future adult health
Their children’s health

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WHO Global Action Plan for Prevention and Control of Non-Communicable Diseases, 2013-2020�

Five diseases (2108)

Cardiovascular disease - Mental health
Cancer
Chronic pulmonary disease
Diabetes

Five risk factors (2018)

Tobacco use - Environment
Unhealthy diet
Harmful alcohol use
Physical inactivity

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Global Burden of NCDs� (Enfermades non-transmissible = ENTs)

Result in 41 million deaths annually
> 70% of deaths - in low & middle income countries
Often known as chronic diseases
Long duration and generally slow progression
Cardiovascular, cancer, respiratory diseases, and diabetes account for 82% of all NCD deaths
Leading cause of death and disability worldwide

http://www.who.int/mediacentre/factsheets/fs355/en/

While the annual number of deaths due to infectious disease is projected to decline, the total annual number of NCD deaths is projected to increase to 52 million worldwide by 2030.

NCD rates are increasing faster in low- and middle-income countries, with worse outcomes than in wealthier countries. NCDs also reduce economic progress, increasing poverty and the potential for political instability. Children and adolescents living with NCDS or caring for family members with NCDs have lower educational attainment and poorer access to employment opportunities. To eradicate extreme poverty and maximize the potential of all children — in health, education and employment — the SDGs must recognize the long-term economic burden of the NCD epidemic.

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NCDs are often seen as illnesses of elderly populations.

Young people are at the center of the NCD epidemic. They are uniquely vulnerable, disproportionately affected, but also offer the potential to drive change for current and future generations.

 Addressing NCD risks and treatment in children, adolescents, and youth is an issue of human rights

 Childhood and adolescence represent an “age of opportunity” for prevention and control, early detection, treatment, and care of NCDs

 The international development community cannot promote sustainable development without paying attention to the impact of NCDs on children, adolescents, and youth

It is estimated that over half of the 36 million NCD deaths every year are associated with behaviors that began or were reinforced during adolescence.

Efforts to eliminate exposure to infectious agents during childhood and adolescence will also reduce NCD risk later in life. Examples of this include vaccinating against hepatitis B virus (HBV), a major cause of liver cancer, vaccinating against human papillomavirus (HPV), a main cause of cervical cancer and preventing and treating rheumatic fever, which can lead to rheumatic heart disease (RHD).

It also represents an imperative and an obligation for early detection, treatment and care, as many children and adolescents live with chronic, life threatening and debilitating NCDs. Common NCDs in children include type 1 diabetes, RHD, congenital heart disease, asthma, and cancers including leukemia, lymphoma and solid tumors. Access to affordable, quality treatment and care is a fundamental human right that should be enjoyed by all, including children and adolescents. Too often, young people in LMICs are denied access to affordable, quality essential NCD services and deprived of lifesaving medicines and technologies. As a result, there are harsh inequities in survival rates for childhood-related NCDs between rich and poor countries. For example, there is a 80% survival rate for childhood cancer in some high-income countries, compared to less than 10% in some LMICs.13

But while there may be a political mandate and political will, there remains a significant gap between political rhetoric and progress at the national level on NCDs, early life interventions and operationalizing a life-course approach. The 2013 UN Secretary- General’s Report on NCDs underscores that progress on NCDs since 2011 has been “insufficient and highly uneven”. Although 95% of countries have a national unit, branch or department in their Ministry of Health with responsibility for NCDs,16,17 national NCD plans are neither fully implemented nor adequately resourced in the majority of countries. And despite the life-course approach being a central tenant of the UN Political Declaration and the Global NCD Action Plan, the 2013 Report fails to mention it once when reflecting on progress.

Investing in NCDs makes sense for sustainable development because it saves lives, promotes social cohesion, improves economies, and supports a health planet.

The health of mothers before and during pregnancy, and the nutritional status and growth in fetal and early postnatal life, have profound effects on vulnerability to NCDs later in life

The period of adolescence is also pivotal in reducing NCDs and maximizing health across all stages of life. During this period, decisions that are made, habits that are formed and paths chosen can have life-long repercussions, and impact across generations.

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Child survival and �Non-communicable Diseases (NCDs)

Prevention

Nutrition – Malnutrition and Obesity
Tobacco and Secondhand smoke, Alcohol/drugs
Injury
Mental health - Early brain development, toxic stress
Environment – food, air quality, etc.�

Access to care – treatment and medicines

Diabetes, congenital heart dx, cancer, asthma, other special health care needs -- treatment affects survival

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The SDGs call for:

Equitable opportunities
All countries to prioritize the most vulnerable

An opportunity to scale-up �preventive services for children and youth

Go to scale with effective evidence-based interventions
Expand content to address changing epidemiology
Expand the quality of front-line health worker delivery of care

Expand political will…

and improve preventive care

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The SDGs call for:

Equitable opportunities
All countries to prioritize the most vulnerable

An opportunity to scale-up �preventive services for children and youth

Go to scale with effective evidence-based interventions
Expand content to address changing epidemiology
Expand the quality of front-line health worker delivery of care

Expand political will…

and improve preventive care

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Adolescent and Young Adult Health and COVID-19

COVID-19 pandemic - unique combination

public health crisis
social isolation – school closures
economic recession

Significant disruptions �in access to care

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Access and Care System Disruption

Despite some recovery, substantial disruptions to essential health services persist

~35% of countries report disruptions in adolescent services

Disruptions – worse in lower vs. higher-income countries

Data & surveillance - disrupted by school closures & staff deployment

WHO-2019-nCoV-EHS-continuity-survey-2021

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COVID-19 Pandemic and Mental Health

COVID19 🡪 ~25-28% increases in

Post-Traumatic Stress
Depression
Anxiety Disorders
Grief-related symptoms

The greatest increases were in:

Places highly affected by COVID-19
Women
Younger people

Mediated by individual and family vulnerability and coping /resiliency
Coping strategies associated with reduced distress included keeping a daily routine, physical activity, and positive reappraisal/reframing (Zurich long study)
Prolonged school closure – worse impact

Global Burden of Disease, 2020

WHO, 2022

Harrison et al, submitted, 2022

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MMWR 2021;70:888–894

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Food and Eating

Increased hunger and food insecurity (UN Food Program)

2.3 billion (29%) were moderately or severely food insecure (31.9% women/27.6% men)
Mainly due to country level disruptions in domestic food supply chains, food production, loss of income, retail food price inflation

Eating behaviors – better and worse

Food supply and school program closures
Limited access to fresh produce

Physical activity

Meta-analysis 22 studies 🡪20% decline in exercise (R. Neville, JAMA Peds, July 2022)

Eating disorders

Meta‐analysis - 26 studies - worse (Sidelli L, et al, Eur Eat Disord Rev. 2021)
65% symptomatic deterioration in EDs (95% CI =48 – 81)
52% increased weight in obesity (95% CI = 25 – 78) 🡨significant COVID risk factor
>50% depression and anxiety

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Sexual and Reproductive Rights and Health

Direct and indirect disruptions in family planning �(UNFPA. Impact of the COVID-19 Pandemic on Family Planning and Ending Gender-based Violence, Female Genital Mutilation and Child Marriage)

reduced access
limited supplies
staff deployed to pandemic – especially STI surveillance staff
disruptions in education, normal social development, immunizations (HPV)
mostly decreased STI rates

Disruptions in interventions to reduce child marriage
Significant increases in teen pregnancy (Ethiopia, S. Africa, Kenya)
Changing use of SRH preventive and screening services

US - EHR data showed HPV vaccinations down by 68% (>> other vaccines)
25% of 2019 HPV vaccine coverage was lost - Global coverage was only 15% (WHO/UNICEF, July 2022)

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Drugs, Alcohol, and Tobacco

Drug use can increase risks associated with COVID infection
Social distance, isolation/quarantine can intensify drug abuse
Surveillance systems disrupted
Alcohol, Marijuana use remained stable
Tobacco and e-cigarettes – some increases and some decreases

Significant mis-information campaigns
Perceived risk led to more quitting
Past 30-day vaping - January–June 2021 (CDC, April 2022 - Adolescent Behaviors & Experiences Survey)

25.2% in-school students 9.1% virtual students

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Semana de Congresos

Jornadas Nacionales

2021

Titulo

Subtitulo

Créditos:

https://www.nature.com/articles/s41591-021-01283

True prevalence 12-45% ??

Varies w/virus strain or wave and with immunization

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Call to Action for Adolescent Well-being

adolescents2030.org

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Middle East & North Africa

South Asia

North America

Sub-Saharan Africa

Europe

Caribbean

East/Southeast Asia

International Association for Adolescent Health Goals

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IAAH 2022-2025 Council

Young Professionals Network

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IAAH YPN Officers

1

Community Engagement Committee

Communications Committee

Leadership and Mentorship Committee

Education and Training Committee

@IAAHglobal | #IAAHYPN

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= YPN Officer Locations

1

2

1

CANADA

3

IRELAND

INDIA

NIGERIA

AUSTRALIA

1

TURKEY

1

UNITED KINGDOM

2

INDONESIA

3

1

BURUNDI

PERU

2

1

TRINIDAD

AND TOBAGO

@IAAHglobal | #IAAHYPN

539 Young Professionals in the YPN network

Working in 86 different countries

#

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�Summary�

Significant disruption in health services access and use
Significant impact on mental health, sexual health and development, food and nutrition, and tobacco
Strategies to address prevention and amelioration of risks are moving slowly and competing for resources with other services
Surveillance, other public health programs, and clinical systems to address adolescents’ needs are and will continue to be stressed
Evidence-based advocacy is needed to prioritize young people’s needs

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�Thank you !��

jonklein@uic.edu��@jklein_NCDchild