ADOLESCENT HEALTH - A VALUED NATIONAL ASSET.
Prof. Ajibola. O. Falaye
Department of Guidance and Counselling
University of Ibadan.
Being a Keynote paper presented at the 15th Annual Workshop of the Public Health Nursing Department, University College Hospital, Ibadan.
1st May- 5th May 2012
The adolescen and youth population of any nation remains an inestimable asset for national development and sustainability. The health of this population becomes an issue of great concern mainly because of peculiarities and uniqueness of this age stage of development. The intricacies of adolescent health could make the adolescent an “endangered specie” if adequate attention is not given to adolescent health in the nation. Thus, the theme for the 15th Annual Workshop of the Public Health Nursing Department, University College Hospital is highly appropriate, germane and relevant at a time when Nigerian youths are the required asset for human power development and capacity.
What is adolescent health?
Is adolescent health getting worse? Do adolescents need to take risks to grow and develop? What is a healthy lifestyle for a young person?
Adolescents – young people between the ages of 10 and 19 years – are often thought of as a healthy group. Nevertheless, many adolescents do die prematurely due to accidents, suicide, violence, pregnancy related complications and other illnesses that are either preventable or treatable. Many more suffer chronic ill-health and disability. In addition, many serious diseases in adulthood have their roots in adolescence. For example, tobacco use, sexually transmitted infections including HIV, poor eating and exercise habits, lead to illness or premature death later in life.
Adolescents as defined by the World Health Organisation (WHO) refer to people between the ages of 10 and 19 years, while youths refer to persons between the age range of 15 and 24 years, and the term young people is used to cover both groups (10-24 years). Young people form a significant population group in terms of demographic parameter as they constitute about a fifth of the human population globally and are rapidly increasing in terms of absolute number. Young people are also a unique population in terms of characteristics and needs and they face unique challenges as a result of their level of development and the societal situation.
One of the most important commitments a country can make for future economic, social and political progress and stability is to address the health and development needs of its young people. In Nigeria, there has been a growing recognition of the challenge of young people’s health issues and need to address this challenge. As evidence from various local and national surveys have shown, young people in Nigeria face the challenges of early sexual initiation, early marriage, and unsafe sexual practices, among others, with the consequences of increasing rate of unwanted pregnancies, unsafe abortions, and sexually transmitted infections (STIs), including HIV and AIDS.
Young people form a significant population group in terms of demographic parameter and are a unique population in terms of characteristics as a result of their developmental processes. They face unique challenges, some of which may compromise their health and development potentials if not well addressed. Since young people represent the future of the country, one of the most important commitments a country can make for future economic, social and political progress is to address their health and development needs.
During the transition from childhood to adulthood, adolescents establish patterns of behavior and make lifestyle choices that affect both their current and future health. Serious health and safety issues such as motor vehicle crashes, violence, substance use, and risky sexual behaviors can adversely affect adolescent and young adults.
Some adolescents also struggle to adopt behaviors that could decrease their risk of developing chronic diseases in adulthood, such as eating nutritiously, engaging in physical activity, and choosing not to use tobacco.
Environmental factors such as family, peer group, school, and community characteristics also contribute to adolescents' health and risk behaviors.
National Policy on Adolescents
The concern about the health and development of adolescent has been expressed in various Regional and International instruments, including the 1985 International Year of the Youth (UN General Assembly), the 1990 UN convention on the Rights of the Child, The OAU African charter on the Rights and Welfare of the Child and more recently, the UN Special Session on Children. The WHO regional committee for Africa also concluded in 1995 that the health situation of adolescents is not satisfactory and subsequently adopted the Adolescent Health Strategy for African Region and endorsed the resolution urging member states to accord adolescent health and development priority in their national and social economic development agenda.
In Nigeria, there has been a growing recognition of the need to respond effectively to the health and developmental challenges of young people. In this respect, the Federal Government, through the Federal Ministry of Health (FMOH) developed a National Adolescent Health Policy in 1995. A National Adolescent Reproductive Health Strategic Framework was developed in 1999, reproductive health having been identified as a key issue in adolescents. As a follow up, a heightened interest in adolescent health issues and strong collaboration between development partners led to the organisation of National Adolescent Reproductive Health Conference in 1999. One of the outputs of the conference was a National Adolescent Reproductive Health Strategic Framework, which complements the policy and aimed at translating the policy into actionable plans.
Aspects of adolescent health
Although adolescents are generally considered physically healthy, they are vulnerable to several unique health problems, such as early childbearing and unwanted pregnancies with its health consequences. Other include higher maternal and child mortality, unsafe abortion; sexually transmitted infections including HIV/AIDS; and sexual exploitation and abuse. Fifteen million young women between the ages of 15-19 give birth each year accounting for over 17% of all annual births in the least developed countries and as high as 40% of all maternal mortalities in some countries in the Region. Also between 1 and 1.4 million adolescents women have abortions in developing countries each year. Lack of accurate information and limited access to adolescent-friendly health services are major contributory factors to the poor reproductive health status of young people in Nigeria which is reflected in the fact that only 57% of young people in 2005 knew all the transmission routes for HIV. Other common problems of adolescents include malnutrition, injuries and disability as a result of risk-taking activities, parasitic and waterborne disease and other harmful substances.
- Mental Health
Mental health itself is not the absence of frank mental illness but is a state of well being in which the individual realizes his/her own abilities, can cope with the normal stress of life can work productively and fruitfully and is able to make contributions to his/her community. It entails the optimal development and use of mental abilities (such as cognitive, affective and relational); the achievement of individual and collective goals consistent with justice; and the attainment and preservation of conditions of fundamental human rights. A disruption which affects the interrelation of the individual, the group and the environment in the above context could manifest as mental health problem.
Young people are generally assumed to have good health, which includes a good mental health which is important to their healthy development. However, mental health problems and disorders are becoming increasingly common among young people. These include mental retardation, hyperkinetic disorders, autism e.t.c.
Mental health problems in young people among others include antisocial disorders, anxiety disorders, depression, psychosis, eating disorders, substance abuse e.t.c and are often characterised by patterns of behaviour, feeling or thinking which interfere significantly with the individuals’ ability to work, to fulfil adequately his/her expected role, to get along with other people or to enjoy life resulting in risky behaviour such as engaging in unprotected sex and dangerous driving, disruptive behaviour, physical inactivity, poor academic performance including school drop out and even suicide.
Although mental health is the 9th component of Primary Health Care, the implementation is fraught with problems hence nothing is being done about the mental health problems of young people. Reasons for this include dearth of mental health professionals in ensuring its practicalization. Presently mental health services for young people are being run with adult mental health services. Thus young people who need admission are admitted into psychiatric wards alongside adult cases. The existing facilities for the treatment of mental disorders have developed in rather isolated and uncoordinated fashion throughout the country. The service structures are generally over centralized and overspecialized and are located in urban areas
The strategies towards prevention and management of mental health problem in young people include:-
• Mental health education through media (formal and informal, rallies in markets, schools etc.
• Integration of mental health into primary health care, including capacity building and early referral system.
• Early management including detection treatment, counselling and rehabilitation of established cases.
In conclusion, mental health of young people needs to be approached in a holistic manner with multisectoral collaboration from all parties and stakeholders. Protection of mental health of young people is an invaluable investment into our future and will promote attaining a state of sustainable development.
- Social well-being
Many of the factors that underline unhealthy developments in young people stem from the social environment. These factors include poverty and unemployment, gender and ethnic discrimination and the impact of social change on family and communities. A good understanding of how such forces shape the lives of young people is fundamental to programming for their health and development.; particularly in the production of stable and mentally health human power capital.
As parents usually remain close to young people and can exercise some degree of authority over their actions, they are vital to any configuration of social factors shaping their health and development. From time to time, peers and the community may be more or less influential, but parents and family are constant elements in most young people’s lives despite fluctuations in their relative importance. Caring relationships with families and friends play a vital role in fostering healthy development. Studies have shown that young people who feel close to their parents consistently show more positive psychological development, behavioral
competence and psychological well-being.
Experiences have shown that a safe and supportive environment is part of what motivates young people to make healthy choices. “Safe” in this context refers to absence of trauma, excessive stress, violence (or fear of violence) or abuse. “Supportive” means an environment
that provides a positive, close relationship with family, other adults (including teachers and religious leaders) and peers. Such relationships can nurture and guide young people, set limit when needed, and challenge certain assumptions and beliefs. Supportive and caring relationships with adults and friends, and positive school experiences are particularly significant aspects of a supportive environment for young people. Such relationships provide specific support in making individual behavior choices, such as when to become sexually active, how to handle anger, what and what not to eat, when and if to use substances.
Nowadays however, the stability of the family in Nigeria, as in many parts of the world, has been seriously threatened, particularly with economic and work situations that tend to keep members of families apart or parents a long time away from interaction with their children. In the long run, these young people resort to activities that result in grave consequences while searching for happiness. Increases in divorce rate and numbers of single parent families have resulted in large number of young people leaving their families. Even when young people remain in their families, the radical changes in social conditions make many parents feel ill-equipped to help prepare their children for the experience of adulthood which they themselves never had.
Studies in Nigeria have shown that there is a general tendency of parents’ and other adults to be secretive about sensitive developmental issues such as sexual and reproductive health (SRH) issues (Uwakwe, Ajufo, Nwangwu and Falaye 2000). As the 2005 National HIV/AIDS and Reproductive Health Survey showed, only 39% of adults have discussed sexual issues with their male children/wards over 12 years of age and 51% had discussed such with their female children/wards in the one year preceding the survey. Poor level of parent-child communication has also been widely reported, which generational gaps tend to make worse. While the traditional perspective, which regards SRH and related issues as things to be discussed only in the secret, parents’ sense of inadequacy and low self-efficacy in providing information to their young ones about healthy development also plays a major contributory role. Thus, it is not surprising, that young people usually turn to alternative sources of information (especially friends who are themselves lacking in appropriate and correct information). Consequently, the information to which young people have access is such that encourage them to act in conformity to the peer group subculture. Because they want to be accepted, young people usually behave in ways that meets the approval of their peer group, irrespective of the consequences.
Serious delinquent and criminal acts begin as disobedience and stubbornness. Results from studies confirm that family circumstances (e.g. parental handling, instability in homes) are some of the most frequently cited causes of deviance. Similarly, parental control and regulation was also cited as the most relevant control mechanism for young people in our society. The implication of this is that parents must be urged to provide more effective control and more supportive family environment.
In other words the government should be ‘family-centered’ in its approach to several social and economic issues. This can be done in several ways including mass enlightenment, provision of proper Counselling division and effective social welfare services and qualitative improvement in the status of the family. Overall, the social environment must foster personal development, encourage young people to adopt healthy behavior, and enable them to gradually take on adult responsibilities through participation in decisions that affect their lives and making contributions to their
families and communities.
- Participation in community development and socio-economic potentials
Young people's behaviors are influenced at the individual, peer, family, school, community, and societal levels. Because many sectors of society contribute to adolescent health, safety, and well-being, a collaborative effort that engages multiple partners is necessary. Such joint efforts can also help to promote a more comprehensive approach to addressing adolescent health—one that views each adolescent as a whole person, recognizing and drawing upon his or her assets and not just focusing on risks.
To have the most positive impact on adolescent health, government agencies, community organizations, schools, and other community members must work together in a comprehensive approach. Providing safe and nurturing environments for our nation’s youth can help ensure that adolescents will be healthy and productive members of society.
Parents and guardians can pass on sound traditional values to young people and provide them with correct sources of information and advice on matters relating to their health and development. They can improve communication with their children and ensure that young people do not engage in harmful practices and behaviour. This can be achieved by being good role models, setting an example in abstaining from harmful substances like drugs and alcohol,
demonstrating respect for each other and refraining from violence and abuse of any form.
- Rationale for National policy on adolescents
Most National health programmes provide for children and the aged, recognising their susceptibility to certain diseases due to biological factors. Because adolescents are less vulnerable to these diseases of childhood and of the elderly, hitherto, little emphasis had been placed in this counts on the health needs of this age group.
Although the 'National Health Policy and Strategy to Achieve Health for All Nigerians' of 1988 provides an open-ended framework for all persons living inNigeria to have access to health care services, a specific policy on adolescent health is necessary on the following premises: In adolescence, the effects of debilitating childhood illnesses and nutritional deficiencies manifest in psychological and other problems-Adolescents are more prone to injury than any other group as they are more physically mobile and less mentally inhibited in this mobility.
Adolescence is the period when individuals develop their capabilities by trying out new behaviours, skills, opportunities, hobbies and relationships, each of which has health implications. In Nigeria, as in other societies, young people are more involved in community work, sports, combat operations, etc., and are therefore more prone to physical injury. Because adolescents constitute about 30% of the population, Adolescent Health is a crucial delivery strategy in such contexts as AIDS, STD and drug abuse control programmes which presentlargely unfamiliar challenges.
When unfavourable economic conditions impose serious hardships on adolescents, they aretempted to engage in risky and anti-social behaviours and practices such as violent crimes, unsafe sexual activities and drug abuse, which pose serious health challenges.
- Importance of adolescents and youth in National development
Youth are one of the greatest assets that any nation can have. Not only are they legitimately regarded as the future leaders, they are potentially and actually the greatest investment for a country's development. They serve as a good measure of the extent to which a country can reproduce as well as sustain itself. The extent of their vitality, responsible conduct, and roles in society is positively correlated with the development of their country.
Nigeria population is predominately young. Therefore, the present Administration, having given due consideration to the signiﬁcance of the youth in socio-economic and political development, has found it most desirable, necessary and urgent to initiate this National Youth Development Policy so that there will be a purposeful, focused, well articulated and well directed effort aimed at tapping the energy and resourcefulness of the youth and harnessing them for the vitality, growth, and development of the country well into the 24th Century. This resolve andcommitment to the development of the youth has been reinforced by resolution of various international organizations which draw attention to the need. to concretely address the problems of the youth and empower them, (eg. The Commonwealth Plan to Action for Youth Empowerment approved in May, 1998).
There is no doubt that almost all Nigerians want change, and the mood for change is evident from small villages to big cities where poverty, disease, lack of social infrastructure and most significantly lack of hope is everyday reality for millions of Nigerians. 21st century Nigeria seems to be a shadow of its glorious past where recruiters from governmental establishments transverse university campuses in search of prospective employees, even before they graduated. Today, the story is different as our youth, even those who have reached the highest academic echelon, are hopeless, helpless, jobless and at times homeless.
The incandescence and pride of being a Nigerian youth many years ago is somehow obliterated by the perpetuation of evils by our very own elders, some of whom have extolled themselves as elder statesmen. Young men and women across Nigeria have been bequeathed with a sense of social, political and economic insecurity by these same people, and many of us have been indoctrinated into a mirage of hope in an attempt to fight, sometimes violently, the selfish cause of the political elites at the polling booths and beyond. Our unquestionable allegiance to these same elders that have destroyed our land in itself raises concern that change in the political landscape of Nigeria is far from remote.
The youth have enormous responsibility in chatting a new cause for Nigeria. Our youth could help build sustainable democracy and democratic institutions. The Nigerian youth could foster the election of individuals with democratic legitimacy and shy away from short-term gains and long-term losses involved in supporting individuals with questionable character.
In fact, the economic role of the youth is so important that it is enumerated as Target 16 of Millennium Goal 8 (Develop a Global Partnership for Development)
ADOLESCENT AND YOUTH HEALTH ISSUES
- Sexual and Reproductive health risk
Studies on the sexual and reproductive behavior patterns of young people in Nigeria have shown that early onset of sexual activity and early marriages are highly prevalent as evidenced by the median age at first marriage of 16.6 years (ranging from 14.6 in the Northwest to 21.3 years in the Southwest according to the 2003 NDHS); the consequences of which include unwanted pregnancies, unsafe abortions and sexually transmitted infections including HIV/AIDS.
The 2005 national HIV sero-prevalence survey conducted at sentinel ante-natal care clinics reported a rate of 3.6% and 4.7% for young people aged 15-19 years and 20-24 years respectively. These have long term consequences such as infertility and increased rates of maternal mortality and morbidity.
Other issues impinging on the health and development include sexual exploitation, domestic violence, and issues of social practices harmful to women including female genital mutilation and early marriage. Lack of accurate information and limited access to adolescent-friendly health services are major contributory factors to the poor reproductive health status of young people in Nigeria which is reflected in the fact that only 57% of young people in 2005 knew all the transmission routes for HIV.
Major forms of sexual and reproductive rights violation affecting young people include denial of access to relevant information and services, female genital cutting/mutilation, sexual assault and early marriage. With 31% of females aged 15-19 years already married in 2003, married adolescents constitute a sizeable portion of young people in Nigeria. Married adolescents are likely to have less exposure to SRH information and more intense, sometimes riskier, sexual exposures with the attendant sexual and reproductive health challenges. They also often face social isolation and restricted developmental opportunities. Other groups of young people that may have special sexual and reproductive health challenges include people having sex with the same sex, the physically and/or mentally challenged, orphans and vulnerable children (OVC), young people in conflict situations, street children and almajiris.
Lack of accurate information as reflected in the fact that only 57% of young people in 2005 knew all the transmission routes for HIV have been identified as a major contributory factor to their poor reproductive health status. Population and family life education, including sexuality education, is not taught in most schools despite the fact that relevant curricula have been designed and approved for use in Nigerian secondary schools. Various stakeholders tend to withhold reproductive health and sexuality information from young people mainly as a result of negative traditional and socio-cultural beliefs.
Young people also have a limited access to relevant reproductive health services. Where health services are available, the non-friendly nature of these facilities to young people limits their utilization (Falaye and Adesemowo 1998). The response of the healthcare system to the needs of young people has been
tepid and ineffective. Any initiative in response to the reproductive health needs of young people must give due consideration to the following:
- Awareness creation on the RH issues and needs of young people
- Involvement of young people and gatekeepers/stakeholders in planning, implementation, monitoring and evaluation of activities
- Establishment of acceptable channels of communication between young people and adults
• Establishment of functional youth-friendly services
• Research to update knowledge and information on adolescent RH issues and services.
> Nigerian adolescent and HIV/AIDS
The present generation of young people is the largest in the country’s history. Coincidentally, the highest rate of HIV infection is constantly recorded among this group. Young people are one of the most vulnerable groups to the disease.As Nigerian adolescents begin to engage in sexual relations at a much earlier age than in the past, cases of HIV/AIDS infection are being reported among pre-teenage youths in schools.
The occurrence of new infections is highest among young people aged 15-24 years, accounting for 40 per cent of new infections in 2006. Having multiple sex partners continues to be recognised as a persistent problem driving the epidemic in the country, especially among adolescent and young people.
A recent HIV/AIDS school-based survey shows a low risk perception among school pupils towards contracting the HIV virus, a high tendency to discriminate and stigmatise HIV positive persons and some level of misconception about the mode of transmission of the HIV virus. For instance 26% of respondents thought that mosquitoes could transmit the virus.
In response to this situation, the Government has developed the Education Sector Strategic Plan on HIV/AIDS and has included HIV-AIDS in the public school health curriculum.
In many parts of the country, traditional values promoting female submissiveness make adolescent girls more vulnerable because it is difficult for them to refuse sexual relationships. In addition, early marriage for girls remains a common practice in some communities, particularly in the Northern part of Nigeria. In 2005, the median age at marriage for women in Nigeria was 17 with some regional variation. Marriage of girls as young as 12 or 10 years is still common in some areas.
This is particularly worrisome given the implications on the child bride. Consequences of child marriage include obstetric fistula, infections, HIV, infertility, limited social support and high infant and maternal morbidity and mortality.
- Substance use and Drug abuse
Drug and substance abuse poses a significant hazard to the health and development of young people and cuts across age and social class. The quest for new experiences and the rebellious nature of the young predisposes them to drug abuse. The average age of drug users/abusers as declined in recent years, and multiple drug use has become more common. Indeed, age at first use of drug has been found to be as early as eleven years (NDLEA 1999). Teenagers in particular are predisposed to drugs by peer pressure, youthful curiosity and the urge to experiment. The ability of drugs to stimulate euphoria, boldness and high levels of energy also make them attractive to young people.
Some of the reasons identified in research reports for the use/abuse of substances by young people in Nigeria include the following: predisposition to experimentation, rebellion and desire for independence; peer pressure; defects in personality such as low self-esteem; notion of ‘machismo’ characterized by independent risk-taking behavior; engagement of older siblings in drug taking; employment outside the home such as teenagers who drop out-of- school to take up menial jobs in market places and motor parks; frustrations caused by tension between improved levels of education and shrinking employment opportunities; parental deprivation as a result of separation, divorce, death of a spouse or persistent discord between spouses in the home; advertisement such as those associating smoking with success, glamour, popularity, youthful vigor and good health; rapid urbanizations (social change) with the breakdown of the family’s effective cultural and social controls; and exposure to high risk jobs (such as tobacco company) and environments that encourage drug use (such as bars). The abuse of drugs is also higher among marginalized, vulnerable groups of young people, such as street children, commercial sex workers, commercial drivers, okada riders and students
Alcohol and tobacco constitute a major threat to the health of young people. They are referred to as “gate way drugs” as most young people who abuse drugs and other dangerous substances started with alcohol and cigarettes. The illicit drug most commonly abused by young people in Nigeria is cannabis. It is illegally cultivated in different parts of Nigeria and is relatively cheap. These factors make cannabis readily available. As one study showed, almost a tenth (8.2%) of young people between the ages of 10-19 years have used cannabis at some time in their lives1. There is also a high incidence of non-medical or self-medicated use of benzodiazepines and psychotropic substances, which are easy to obtain as a result of the ineffective enforcement of laws on their sale and distribution.
Report of the rapid situation assessment of drug abuse in Nigeria, Lagos prescription drugs such as amphetamines and barbiturates, common in adult world, also appear to be increasing among young people. Although the use of highly addictive hard drugs such as cocaine and heroine appear to be low in Nigeria, it is a matter of concern that many young people use multiple drugs. The practice of sniffing volatile organic solvents, such as petrol and glue and abuse of some unconventional substances not yet under international control e.g. pawpaw leaves, zakami, haukatayaro and so on have also been documented from various parts of Nigeria.
Drug taking has a close inter-relationship with crime. This is most evident with respect to the consumption of hard drugs such as cocaine and heroine, which, because of their cost and highly addictive nature, drive their users to robbery or prostitution as a means of maintaining their habit. The ready availability and use of drugs in tertiary educational institutions has been linked to the upsurge of violent cult activities. It is believed that armed robbers, vigilante militants, as well as cult members use drugs as a means of stimulating boldness.
The adverse consequences of drug abuse on young people include dependence, overdose accidents, physical and psychological damage and, sometimes, premature death. Persistent drug use may impair development. It may promote extremely dangerous behavior and is associated with suicidal attempts and fatal or debilitating accidents, often resulting from altered perception and psychomotor reactions. The hazards of drug use have been dramatically accentuated by the spread of HIV infection among users of injectable drugs who share contaminated needles and syringes.
Habitual drug users tend to be alienated from their families, not attending school and living away from home: they often have family problems and a circle of friends among whom drug use is widespread. Often their parents are themselves dependent on substances such as alcohol or tranquillizers. The drug user is likely to fail in many ways – at school, in relationships and at work. As most drug taking is illegal, users and suppliers are directly or indirectly caught up in network of crime and perhaps violence, owing to the vast sum of money that can be derived from the illicit drug trade. Because of this, many young people have turned to crime and prostitution to finance their habit.
- Nutrition and eating habits
To be healthy, young people must have the right kinds and amounts of food. Health and nutrition are closely linked: disease contributes to malnutrition, and malnutrition makes an individual more susceptible to disease. During adolescence, average weight doubles and height may increase by more than 15%. The demands of physical growth can only be met by a balanced intake of nutrients, and a lack or excess of any nutrient may lead to health problems later.
Many young people are becoming economically active, due to poverty and family circumstances, and may be required to perform heavy manual or domestic labour, which may further compound their problem of inadequate diet. Young people may not have adequate nutrition as a result of poverty or due to specific food habits, which have to do with preference for snacking and food fad. Available evidence also indicate that even where intake of calories and protein is sufficient, shortages of other nutrients such as iron, calcium and some vitamins may be relatively common because of peculiar feeding habits.
Obesity among young people, resulting from excessive consumption of certain foods and lack of physical exercises, are also increasing in incidence. Young people are often attracted by processed and refined foods. Such foods are often high in fats and sugars, and excessive consumption of these foods results in malnutrition. The establishment of a preference for food containing these substances may lead to early bio-physiological changes and ultimately pathological changes and disease.
Adolescent females may sometime face more challenges than their male counterparts due to biological and social circumstances. As a result of gender discrimination, for example, young females may receive less food in general compared to their male siblings, or less of certain foods such as meat. Teenage pregnancy, when such occurs, further compounds the precarious nutritional state of many young girls, and they are particularly at high risk of anaemia.
- Educational and mental development among Nigerian adolescents
Formal education is of great importance for the development of all young people. It is in school that literacy, numeracy and thinking skills are fostered and exercised and knowledge is acquired. School also often introduce young people to sports and provides the conditions for healthy, supervised exercise. Schools and teachers may be able to provide some stability to young people who have been uprooted from their culture or whose families are unstable. They are a major source of education and guidance about specific health issues and sometimes provide health screening and services.
The policies and resources of the country will often determine whether schooling for young people is obligatory, available or accessible. Even where education is available, many young people cannot attend school for economic reasons, because of too early marriage, or being resident in hard to reach areas such as riverine or mountainous areas and others who do not attend because of psychosocial difficulties.
Under the National Policy on Education, adopted in 1981 and revised in 1995 and 1998, Nigeria has a 6-3-3-4 education system comprised of six years of primary education, three years of junior secondary education, three years of senior secondary education and four year of higher education. Under the current Universal Basic Education scheme being operated in the country, the first nine years of schooling up to the end of junior secondary, now constitute
the basic education segment. The educational system in the country also includes adult and non-formal education programmes, as well as teacher training and special education, notably for children with disabilities.
- General risk taking behaviour (driving risks, etc)
While inexperience is considered the primary reason why young drivers are over-represented in road crashes, intentional and unintentional risk taking also plays a role.
Driving risks found to be more common among young drivers include: excessive speeding, speeding for the thrill or simply driving too fast for the conditions; driving too close to the vehicle they are following; using a mobile phone while driving (including text messaging); violating traffic rules; and driving at night.
In addition, carrying multiple passengers, especially peer-aged passengers, presents a greater risk for young drivers compared to adult experienced drivers. Likewise, driving after drinking alcohol, even at low blood alcohol levels (e.g., 0.02%), is more risky than for adults, with young drivers’ crash risk at least five times that of adult drivers at the same alcohol level.
Risky driving in young, inexperienced drivers significantly increases their risk of having a crash. Recent Australian studies have shown that self-reported risky driving behaviours are associated with significant increased risk of crashing in the first years of driving on a Provisional licence. In a study of over 20,000 young drivers in New South Wales, self-reported risky driving behaviours were associated with a 50% increase in the risk of crashing.
Further, this recent study found that risky driving behaviours occurred even among young drivers who perceived the behaviours as risky; that is, knowing a behaviour was risky did not stop some young drivers from engaging in that behaviour. This may be why education programs that just focus on increasing knowledge of driving risks and improving attitudes have not been found to reduce actual risky driving behaviour or crashes. The study findings provide support for strong graduated licensing schemes restricting the newest drivers from the riskiest driving conditions and strong enforcement of these laws by police to ensure high levels of compliance.
Risky behaviours associated with increased risk of crashing include:
Driving at night: The highest risk of death for young drivers (aged 25 years or less) involved in a road crash occurs during the night-time hours; especially nearing midnight and into the early morning hours, and during these times on weekends.
Alcohol: Compared to more experienced drivers (those who have been driving for 5 years or more) first year Provisional drivers are 3 times more likely to be injured in a crash if they have been drinking. The risk is greater for young drivers: drivers in their 20s have at least 5 times the risk of crashing compared to drivers in their 30s for all alcohol levels.
The use of mobile phones when driving presents a high risk of motor accidents among youths. The risk of crashing when using a mobile phone increases four-fold, while the risk of driver death is between 4-9 times higher than when not using a phone. Young drivers are also more likely to be severely injured in a crash when distracted by a mobile telephone.
Multiple peer passengers have shown in studies as a factor for increased risk of death in a crash for probationary drivers who carry more than one passenger; the odds of crashing increases by 50% when carrying one passenger, and more than double
Restiveness and militancy among Nigerian youths
Youth restiveness is a despicable act being perpetrated by a significant proportion of the youth in various communities that can no longer be ignored. As the name implies, it is a combination of any action or conduct that constitutes unwholesome socially unacceptable and unworthwhile activities engaged in by the youths in any community. It is a phenomenon which in practice has led to a near breakdown of law and order, low productivity due to disruption of production activities, increasing crime rate, intra-ethnic hostilities, and harassment of prospective developers and other criminal tendencies. The communities in the
oil producing areas in Nigeria still lack basic social infrastructures culminating largely into high level of poverty, mass unemployment, environmental degradation and other social vices.
The result today is that we have a near dicey situation in our hands as far as youth are concerned. We now have a predominantly idle young population. There is now a national crisis on the youth front. Youth are now perceived largely as a problem popularly described as youth restiveness. There are categories in the consideration of youth question:
- The national dimension is reflected in formal bodies such as OPC, Arewa Youth, MASSOB, Egbesu Boys of Africa etc. these are publicly acknowledged bearers of structured political and economic agendas of geo-ethnic divisions.
- There is also a rise in organized youth delinquencies in Nigerian cities today, popularly known as “area boys” resident mostly in Lagos. They have a neo-gang structure and specific city turfs where they operate and defend against rival groups.
- There are a number of smaller youth associations in the states, local governments and towns across the country today. This type is without any explicit political agenda, but focuses more on their welfare concerns.
- There is mergence of cult gangs on campuses which has facilitated the assimilation and subsumption of students in the inclusive category of Nigeria youth. It is the violent restiveness of the youth, which announces their presence in the public mind. Campus cults share in this attribute.
- There is an increase in the number of youth who flee the country through illegitimate means in order to make a living in other countries. Global networks facilitate this physical flight of both male and female youth, as well as child labour smuggling.
The causes of youth restiveness are many, ranging from individual to societal factors. These include:
- Marginalization: The notion appears to have gained ground that the youth resort to
restiveness because of their perceived marginalization by the selfish elders in the
scheme of things in the communities. In order to get their share of benefits accruing
to the society they resort to taking on their elders headlong, culminating in the
restiveness rampant in most of our communities today.
- Unemployment: The youth constitute a large army of the unemployed. There is therefore a tendency for them to look at their plight as the making of a cruel society that does not seem to care for them. It is also believed that the activities of some of the oil prospecting companies predispose our youth to restiveness. This is because these oil companies come, destroy the environment, disrupt production and economic activities, dislodge social structures without commensurate compensation and or programme of sustainable rehabilitation. The result is that while the oil companies make h uge profits, nothing appears to change in the lives of the communities. Instead, they leave behind, low productivity, intra-ethnic hostilities, unemployment, poverty, prostitution and environmental degradation.
- Exuberance: Very often, the youth are described as full of youthful exuberance. This raw energy has of late been channeled into unwholesome and socially unacceptable venture that threaten the very fabrics of the community. Also the issue of availability and accessibility of drugs in street corners which predispose the youth to abnormal behaviours when they come under their influence adds to youth restiveness.
- It is also believed that some disgruntled leaders, elders and politicians in our society resort to recruiting youth for settling scores or using them against perceived enemies. With this trend, the activities of these youth have degenerated to outright criminality. Once these youth get mobilized for these nefarious activities they become uncontrollable and the society suffers
- Terrorism and the Nigerian adolescents and youths
The rate of crime and violence among Nigerian adolescents is very high, complicated and most of all tragic than it is commonly realized or acknowledged. For adolescents in Nigeria, violence, crime and lawlessness has become a natural occurrence in the quest for power, money, social acceptance and unappeasable greed. It has been observed that several research work previously done on gang violence and gangsterism either within Nigeria, Africa or international level focused on the definition of gangs, characteristics, criminal results of gangs and gangs’ involvement.
In Nigeria, young people have been-found to be involved in violence and criminal acts. This is peculiar to out-of-school youths and undergraduates of tertiary institutions in an attempt to ensure a means of survival. Some of these criminal acts include urban gangsters and other vices such as terrorism and antisocial behaviours.
Family influence and gangsterism behaviour
The importance of the family as a primary socialization agent as emphasized throughout this section of the study is worthy of note. The family is the key element to ensure a disciplined, well-balanced and strong individual who is able to respect other individuals, interact on a social level with the inner strength to avoid external negative influences. Ortese (I998), Found out that single parent family stands the risk of delinquent children. To him, children from such families constitute majority to the society’s problem of armed robbery, prostitution, drug abuse etc. Olarenwaju (I999) averred that youths at highest risk of antisocial activities that has a prolong effect on the youths are those ones from single parents or raised in home which one or both parents have a history of alcoholism, drug use, smoking etc. Moreover, the youth may have grown up in a violent atmosphere with parents who fight or batter one another. As they become more old and independent, these youth may adopt the way of life of their parents, he concluded.
Peer influence and gangsterism behaviour
Peer pressure occurs across every country, culture and religion. It can enhance or destroy an individual’s life depending on who the friends are. The nature of a youth’s interactions with his/her peers may be an indicator for later involvement in delinquency. When focusing on the negative peer association per se, delinquent friends not only have a concomitant influence on delinquent behaviour but also impact on the future involvement in serious delinquency and gang membership (Howell, 2003).
Empirical evidence suggests, that adolescents who show allegiance towards their delinquent friends, belong to gangs and have unruly companions, most likely to commit crime and partake in violence. With regard to gang membership, Howell (2003) assert that a strong risk factor is the affiliation with peers who are involved in delinquency. Gottfredson (2001) pointed that associations with delinquent peers increase the chains of delinquent behaviour and that delinquency actually isolates the delinquent youth deeper into delinquent groups.
Media influence and gangsterism behaviour
One of the agents of socialization in the modern day society is mass media and one aspect of the mass media is television. Television has the appeal of audio and visual lasting effects. These long lasting effects have great impact on the behaviour of adolescent. In addition, to the powerful effects of television is the introduction of video machine which is used at both home and public places. The uncontrolled used of various programmes, films and show cases have been found to have influence on adolescent gangsterism. It has been found that despite legislations on the airing of programmes and films cinema houses and private homes have failed to control the types of films that are sold and beamed to the public.
Adolescents form a significant population group in terms of demographic parameter and are a unique population in terms of characteristics as a result of their developmental processes. They face unique challenges, some of which may compromise their health and development potentials if not well addressed. Since young people represent the future of the country, one of the most important commitments a country can make for future economic, social and political progress is to address their health and development needs.
In order to ensure optimal adolescent healthy living for national development, there should participation of the young people themselves; their families; ministries of health, youth affairs, education, labour and employment, finance and planning, communication, information and national orientation; community development; youth technical and vocational training; legislation; non-governmental organizations; the private institutions including corporate bodies and financial institutions; the mass media; professional bodies; researchers and the academia; the United Nations and international agencies.
Government should undertake health advocacy and sensitization programmes to promote young people’s participation in national development agenda and for the elimination of customs and practices that discriminate and/ or impact negatively on their rights as well as health and development; educate and empower their peers for healthy living and health-supporting practices. The government should also set standard, develop guidelines and make available tools for training and other human resources development activities nationwide.
Government should develop, widely disseminate and periodically review national standards, minimum health packages, tools, instruments and materials in support of adolescent/youth-friendly health services in Nigeria, including clinical, counselling and health communication services. They should encourage, promote and facilitate the establishment of adolescent/youth-friendly health services in federal health institutions and the orientation of all services to be adolescent/youth-friendly.
Role of families and communities
Parents and guardians can pass on sound traditional values to young people and provide them with correct sources of information and advice on matters relating to their health and development. They can improve communication with their children and ensure that young people do not engage in harmful practices and behaviour. This can be achieved by being good role models, setting an example in abstaining from harmful substances like drugs and alcohol,
demonstrating respect for each other and refraining from violence and abuse of any form.
Role of the Ministry of Youth Development
The ministry responsible for youth development has a central role to play in the promotion of young people’s health and development and should:
- Establish and manage youth centres with relevant adolescent/youth-friendly services such as counselling to meet the needs of in- and out-of-school young people.
- Organize capacity building activities to increase the potentials of young people for gainful career/employment life and for engendering meaningful participation in national development activities.
- Collect, collate, analyze and disseminate data on adolescent and youth development programmes and activities in a gender-disaggregated manner
Role of the Ministry of Education
The Ministry of Education should:
- Intensify efforts to achieve Universal Basic Education (UBE) and eliminate illiteracy.
- Expand the integration and teaching of family life and HIV/AIDS education (FLHE) into relevant subject curricula at all levels and various institutions.
- Scale-up the training of teachers in FLHE.
- Integrate FLHE into mass literacy, adult and non-formal educational programmes to cater for the out-of-school young people.
- Support FLHE research programmes.
- Ensure the provision of curricula and co-curricular FLHE activities in schools.
- Ensure the effective functioning of school health services and programmes in all parts of the country.
- Ensure the availability of functional teaching aids and optimal learning environment to enhance student learning.
- Monitor the standard of teaching activities and the performance of students in relation to FLHE at all levels.
- Collect, analyze, interpret and disseminate gender-disaggregated education service statistics as well as document and disseminate FLHE best practices and programme experiences.
Role of the Ministry of Labour and Productivity
- Promote practices that will enhance the knowledge and skills of young people to prepare them for gainful employment.
- Promote practices that will ensure equitable access to employment opportunities and reduce under-employment and unemployment among young people (both male and females).
- Discourage workplace practices that could be detrimental to the health and development of young people.
- Ensure mainstreaming of the needs of young people in vulnerable situations and special circumstances, including those with physical and mental challenges and young people living with HIV and AIDS, into the sectoral activities.
- Ensure the regular collection, analysis and dissemination of gender-disaggregated adolescent- and youth-specific employment statistics.
The role of other stakeholders
In this age of information and cultural globalization, the mass media has a big role to play in the area of young people’s health and development. It is therefore imperative to ensure that they:
- Produce programmes and disseminate accurate, culturally-appropriate and gender-sensitive information on young people’s health and development.
- Collaborate with other development partners and sectors in undertaking educational campaigns on young people’s health and development.
- Assist relevant agencies in dissemination of young people’s health and development data and other relevant information.
- Actively involve young people in creating programmes for themselves.
- Encourage less violence and abuse on entertainment programmes.
- Discourage advertisement of harmful substances and behaviours
Civil Society Organizations
These organizations should complement government efforts to
- Mobilize, organize and build the capacity of the informal sector to support young people’s health and development.
- Expand the delivery of adolescent/youth-friendly health and related development services to the community, especially to hard-to-reach areas.
- Undertake operational research activities and adopt innovative methods to improve the delivery of friendly health and development services to young people, including vulnerable ones and those in difficult/special circumstances.
- Collect and submit service statistics to relevant government agencies on regular basis.
The Role of Research institutions/Academia
The relevant institutions should:
- Undertake basic, operational and applied research activities to generate new ideas, monitor and improve programme development and management activities.
- Provide current and up to date data that will effectively inform programme actions.
- Ensure wide dissemination of research findings in suitable forms to policy makers and programme implementers.
- Develop and implement programmes that will effectively support the health and development of the population of young people, including health promotion activities, and counselling services.
- Establish youth-friendly health services in their institutions.
- Develop and activate mechanisms to regularly monitor the health and development of young people within their institutions.
The Role of Faith-based institutions
Religious institutions should:
- Provide moral instructions and spiritual guidance that will promote positive development and health of young people.
- Provide opportunities for constructive activities
- Cooperate with other sectors to enhance the health and development of young people.
- Sensitize their members and communities on health and development issues of young people.
- Promote reproductive health services and other development activities for young people consistent with their religious beliefs.
- Organize and promote programmes that will enhance the health and development of young people.
The Role of Organized Private Sector
The organised private sector should actively participate in programme development and implementation of activities relevant to the health and development of young people, and complement the efforts of the Government and other sectors of the society.
Organised private sector should also endeavour to make their work environment and policies friendly to young people, including the vulnerable ones and those in special circumstances.
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