Sommer Marni, Daly Garrison, Kabiru Caroline, Lhaki Pema, Okwaro Neville, Chandra-Mouli Venkatraman
Mailman School of Public Health, Columbia University, New York, USA.
Population Council, Nairobi, Kenya.
Int J Adolesc Med Health. 2020 Feb 7;34(3):/j/ijamh.ahead-of-print/ijamh-2019-0171/ijamh-2019-0171.xml. doi: 10.1515/ijamh-2019-0171.
The very young adolescent population (ages 10-14) is currently under-served by health care systems, particularly in low- and middle-income countries. Although there is a substantial and growing effort to reach adolescents with the health services and commodities they need, such efforts often overlook the period of early adolescence given this population's lower vulnerability to risk-taking behaviors. However, early adolescence is a period of significant change, with the onset of puberty introducing physiological, emotional, and social changes in girls' and boys' lives. This period also represents a time of intensifying gendered norms, and the transition of youth from childhood focused health care (e.g. deworming programs, nutrition interventions) to additional mid- and older adolescent related care [e.g. human papilloma virus (HPV) vaccine, and contraceptive provision). Strengthening young adolescents' engagement with health care workers around preventative and promotive health behaviors could have profound impacts on their health and wellbeing, which in turn could have cascading effects across the course of their lives. Critically, young adolescents would gain trust in health care systems, and be more likely to return when significant health issues arise later in adolescence or adulthood. Such an effort requires sensitizing health care workers and building their capacity to respond to young adolescents' unique needs, by defining a package of actions that they are mandated to provide, training them, providing them with desk reference tools, and putting in place systems to provide supportive supervision and collaborative learning on the one hand, and encouraging caregivers to connect their pubescent-aged boys and girls with the health care system, on the other hand. This paper presents an argument for increased focus in particular on building attitudes and capacities of health care workers on engaging with early adolescents, applying Principle 3 of the Society of Adolescent Medicine's position paper entitled "Health Care Reform and Adolescents."
极年轻的青少年群体（10至14岁）目前在医疗保健系统中未得到充分服务，尤其是在低收入和中等收入国家。尽管为使青少年获得他们所需的医疗服务和用品做出了大量且不断增加的努力，但鉴于这一群体从事冒险行为的脆弱性较低，这些努力往往忽视了青春期早期阶段。然而，青春期早期是一个发生重大变化的时期，青春期的开始给女孩和男孩的生活带来了生理、情感和社会方面的变化。这一时期也意味着性别规范的强化，以及青少年从以儿童为重点的医疗保健（如驱虫计划、营养干预）向更多与青少年中期及后期相关的护理（如人乳头瘤病毒（HPV）疫苗接种和避孕措施提供）的过渡。加强青少年与医护人员围绕预防性和促进性健康行为的互动，可能会对他们的健康和幸福产生深远影响，进而可能在他们的一生中产生连锁反应。至关重要的是，青少年会对医疗保健系统产生信任，并且在青春期后期或成年期出现重大健康问题时更有可能回来就诊。这样的努力一方面需要提高医护人员的敏感度并增强他们满足青少年独特需求的能力，方法是确定他们必须提供的一系列行动、对他们进行培训、为他们提供案头参考工具，并建立提供支持性监督和协作学习的系统，另一方面需要鼓励照顾者将他们处于青春期的男孩和女孩与医疗保健系统联系起来。本文提出了一个观点，即尤其应更加关注培养医护人员与青春期早期青少年互动的态度和能力，这应用了青少年医学协会立场文件《医疗保健改革与青少年》中的原则3。
