National Family Health Survey shows a considerable percentage (43%) of pregnant and mothered adolescents in India. Early marriage and low contraceptive usage are the reasons behind this trend. Early and unplanned adolescent pregnancies are highly prone to adverse pregnancy outcomes like eclampsia, low birth weight, early neonatal death and congenital malformation [1].

Many adolescents are sexually active but have inadequate knowledge about STDs and self-protection against them and sexual abuse is more common in the age group. There are a lot of confusions, worries and inhibitions in adolescents regarding STIs. For example, vaginal infections need not be necessarily transmitted by sexual acts. Due to lack of awareness and social stigma, the diseases were often undisclosed, left untreated, or fails to receive the ideal treatment leading to complications like infertility, pelvic inflammatory disease and cancer.

From the studies done in the past, it is evident that adolescents have no proper knowledge regarding STIs and an educational intervention shows significant improvement in the knowledge level of the participants. Media also plays a major role in exposing them to sexually explicit materials which make them perpetrators of sexual violence.

AHFI Recommendation: This can be solved by providing accurate and age-appropriate sex education and abuse prevention skills to defend themselves if they encounter sexual abuse. This should also be complemented with proper parenting skills. With this approach sexual abuse, early sex debut and unsafe sexual practice can be reduced and contraceptives usage can be increased. This will prevent unwanted pregnancy, AIDS/STIs and its complications.

Nutritional requirements are higher among adolescents than in any other period of life. Inadequate diet intake at this age leads to stunted growth and delayed sexual maturation [2]. Lots of junk food products are promoted by celebrities with catchy advertisements leading to the adaptation of unhealthy food habits. Media influences the diet and lifestyle among adolescents and leads to nutritional disorders by making them sedentary and giving false hopes. Habits like dieting and exercising inspired by a media celebrity cannot be taken as a positive impact, often they do it in an incorrect way and consume low-quality protein supplements without proper guidance which may lead to complications like renal failure. Instead of taking a balanced diet they starve and end up with anorexia nervosa.

AHFI Recommendation: These issues need to be reduced by routine screening and providing frequent nutritional education.

Mental health problems are one of the most neglected issues among adolescents. Now the world has started realizing its threat, like mortality and morbidity due to mental disorders in adolescents increased and topped in recent years. In India, suicide among adolescents is higher than any other age group i.e. 40% of suicide deaths in men and 56% of suicide deaths in women occurred in 15–29 years of age [3]. Alcohol use and psychiatric problems (unipolar depressive disorders and anxiety disorders) are the important cause of Years Lost due to Disability [4].

And also, sexual orientation, gender identity/expression and symptoms of body dysmorphic disorder (BDD) begin during adolescence. If an adolescent is obsessed with his/her appearance, they experience severe distress, which might significantly affect their academic performance. This might interfere with an individual’s ability to interact with classmates and teachers, and may even prevent students from attending school at all.

Focus towards these problems in adolescents happens to be less. It is essential to give equal importance to other key areas like mental health services (sound body, sound mind, safe environment and healthy diet) and BCC towards a healthy lifestyle. In the past decade, mental health problems have emerged as an important cause of adolescent morbidity.

AHFI Recommendation: Regular screening for symptoms of poor mental health will be initiated at the “Clinic for Adolescents”, apart from that, parents and teachers will be sensitized in detecting abnormal behaviors to initiate appropriate management at an early stage and prevent them from developing into a disorder.

Sexual abuse is one of the major problems faced by women of any age group but adolescent girls are common victims. Boys are also victimized at times mostly by the elder homosexuals. These problems mostly go unnoticed as the victim suffers in silence because of fear and social stigma. Sexual abuse leads to worse physical and mental health and poor academic performance [5]. Road traffic injuries emerged as a leading cause of death among adolescents. Rash driving, driving without a license, drunken driving and use of mobile phones while driving are factors associated with road traffic injuries in young drivers.

AHFI Recommendation: This can be prevented by strict enforcement of law and by conducting awareness campaigns targeting adolescents insisting on the need for following safety rules. Research done in this age group shows adolescents who rose in authoritative parenting have higher protective and fewer risk behaviors than adolescents from non-authoritative families. Parental monitoring and authoritative parenting are important to shape their children with good character and positive social behavior.

Substance abuse is yet another issue that should be viewed seriously because taking a risk without knowing its consequences is very common in adolescents. Habits like smoking and alcoholism have a lifelong impact and the potential to cause health problems like coronary heart disease and diabetes in adulthood. Even though there is a legal restriction, alcohol and tobacco products are available generously for the under-18 age group.

AHFI Recommendation: Primordial prevention from substance abuse by strict enforcement of the law that can prevent the occurrence of the risk factors in the community. Existing users can be managed with Harm Reduction Therapy coupled with counseling.

Parents have greater responsibility in guiding their children throughout this phase but due to cultural barriers, they neglect to talk about physical and physiological changes with them, in consequence of this, growing children learn about sexuality and secondary sex characteristics from their peer groups or other inappropriate sources which leads to abnormal social behavior. Most of the children’s psychiatric disorders were unidentified because of parents’ ignorance and negligence.

AHFI Recommendation: To avoid such issues, parents should maintain a healthy relationship with their children and try to have an open conversation to understand their problems and should provide the needed support to solve it. Parental monitoring and authoritative parenting are important to shape up their children with good character and positive social behavior at the same time they should be friendly and facilitate them for their achievements [6].

All the services for adolescents should be delivered as a single program. It is also essential to develop a screening tool specific to Indian adolescents. This has been already implemented by National Adolescent and Young Adult Health Information Centre, the University of California, who proposed Guidelines for Clinical Preventive Services for Young Adults [7], innovating such tools based on our requirements can be very useful in diagnosing diseases and to search for and eliminate any risk factors as early as possible.

To address this scenario, AHFI proposes redefining the current approach by expanding the target population i.e., parents and teachers should also be included while defining, planning, implementing and evaluating specific services for adolescents.