Young people seem to draw the short straw when it comes to health services, so why are they being neglected and allowed to fall by the wayside? 

 

 

Young people between 10 and 19 years of age have experienced the least improvement in health status of any age group in the British population over the last 50 years.

So says the Chief Medical Officer’s report on child health (‘Prevention pays – our children deserve better’), which was published in October 2013. Such a situation seems crazy when good health services for teenagers are essential to guarantee a healthy future for the adult population.

Nicola Gray, independent pharmacist researcher in Manchester and trustee of the Association for Young People’s Health (AYPH) charity, says that we need as many healthy young people as possible to support the economy and our ageing population.

“We need to invest further resources into improving teenagers’ health and wellbeing. Public health needs to think about what harms people at different stages of life. Adolescence is normally a time of experimentation. Many behaviours that start at this age, such as smoking, weight issues and healthy eating, go on to have a huge impact in later life. Teenagers need clear messages so that they can weigh up the risks and benefits.”

While there are several pharmacy-based sexual health schemes for teenagers and young people, there are few services that focus on wider teenage issues. Pharmacies are well placed to offer relevant services but the main barrier is getting teenagers through the door.

Ash Soni, RPS English Pharmacy Board vice-chair and community pharmacist, says that pharmacies should make sure posters and leaflets are relevant to this age group. “Use images that young people recognise and identify with to draw them in,” he says. “Once you have done that, you break down the first barrier. Then you need to make the pharmacy a ‘young people friendly’ environment, with some younger members of staff, for example. Look at whether you stock relevant products for teenagers, such as hair gel, sanitary products and acne treatments. If they recognise the brands, this will draw them in.”

Lifestyle choices

Being in good physical health enables young people to deal with the challenges of growing up and eases their transition to adulthood. As teenagers get older and become more independent, they begin to make their own choices about their diet and lifestyle.

According to the AYPH’s Key Data on Adolescence 2013, relatively small proportions of young people meet recommended levels of physical activity. Surveys suggest that in Scotland, in 2010, only19 per cent of boys and 11 per cent of girls aged 11 to 15 years met the recommended targets. The proportions for England were 28 per cent of boys and 15 per cent of girls.

AYPH data also shows that the consumption of five portions of fruit and vegetables a day is low for 11-18-year-olds who, on average, only eat three portions. There is particular concern about the nutrition of young women, nearly half of whom are estimated to be deficient in their iron, selenium and magnesium intake.

Obesity in children and teenagers is a growing problem in the UK. According to the AYPH report, 31 per cent of boys and 37 per cent of girls in the 11-18 age group are overweight or obese. However, eating disorders, such as anorexia, can also start in the middle-teenage years.

A recent study at UCL and the London School of Hygiene and Tropical Medicine shows that 12 per cent of 13-year-old girls and 5 per cent of 13-year-old boys are terrified about putting on weight. One in three girls and one in five boys at this age were distressed by their body shape.

Risky behaviour

Adolescence often marks the beginning of risk-taking behaviour and is a time when lifelong health behaviours are set in place. Smoking cigarettes, drinking alcohol and the use of illicit drugs by young people have long been seen as key policy concerns. The Health and Social Care Information Centre (HSCIC) report on smoking, alcohol and drug use among 11-15-year-old pupils in England revealed that in 2012 around:

• 120,000 were regular smokers
• 320,000 had drunk alcohol in the past week
• 200,000 had taken drugs in the last month
• 370,000 had taken drugs in the last year.

There are many things that pharmacies can do to tailor existing services to teenagers. Smoking, for example, is often tied in with the peer group and/or family members, but research at University College London (UCL) in September 2013 found that campaigns to get young people to stop smoking could be more successful if they focused on the positive benefits, such as having more money and better skin, rather than emphasising negative outcomes like increased disease risk. 

The study reveals that young people have greater difficulty in learning from bad news and using it to interpret their risk of future events. This might explain why they often don’t respond to warnings.

“We think we’re invincible when we’re young and any parent will tell you that warnings often go unheeded,” says Dr Tali Sharot, the senior author on the paper and a Wellcome Trust research fellow. “Our findings show that if you want to get young people to better learn about the risks associated with their choices, you might want to focus on the benefits that a positive change would bring rather than hounding them with horror stories.”

Health advice

The Health Behaviour in School Aged Children study in 2010 found that one in seven young people in England aged 11 to 15 years reported having been diagnosed with a long-term illness, disability or medical condition. According to the Chief Medical Officer’s report of October 2013, the long-term self-management behaviours for diabetes, asthma, epilepsy and other chronic conditions are largely initiated in adolescence and remain with teenagers throughout life. It is therefore essential that teenagers are given sufficient information about their condition and its management.

In 2012, the Anaphylaxis Campaign commissioned a survey of over 500 young people aged 15 to 25 years. Over one-third said they didn’t always carry their life-saving adrenaline and 72 per cent were not currently receiving any kind of expert medical care or advice.

“There are significant links between young people with long-term conditions and mental health issues,” says Nicola Gray. “Medicines adherence is much lower in young people than in adults or children. Pharmacists are ideally placed to ask how teenagers are coping with their asthma or diabetes, for example. A lot of the enhanced services for teenagers in pharmacy focus on sexual health, but MURs with young people can provide the ideal opportunity to offer broader lifestyle advice.”

In October 2013, the Teenage Cancer Trust (TCT) stressed that cancer in young people can be hard to diagnose because the symptoms (e.g. pain, swelling or extreme tiredness) are so similar to other less harmful problems such as infections, sports injuries and exam stress. It is important therefore to be vigilant if young people’s symptoms show no improvement. A report by the TCT says that over a third of young people with cancer are diagnosed through admission to A&E departments, with over a quarter already having been to see their GP about their symptoms.

Common teenage health issues

Pharmacies can encourage teenagers through their doors by stocking relevant products and offering appropriate advice. Some brands, such as skincare products or deodorants, are aimed specifically at the teenage market. Many common health issues in adolescence (e.g. acne or body odour) tend to get trivialised, yet teenagers are particularly sensitive to negative remarks and anything that affects their body image. Even mild acne can have an impact on self-confidence so should be managed as soon as it appears.

Acne

Acne is linked to the increase in testosterone that occurs during puberty. The skin’s sebaceous glands produce excessive amounts of oily sebum, which combines with dead skin cells to clog up hair follicles, leading to the formation of comedones (blackheads and whiteheads). In people prone to acne, a build-up of P. acnes on the skin’s surface leads to the formation of pustules (pus-filled spots).

Management options depend on the severity of the symptoms. It usually takes several months to see any improvement, so customers should be warned not to expect overnight results. Mild cases may be kept under control with products containing ingredients such as benzoyl peroxide. If OTC products don’t work or the acne is extensive or severe, teenagers will need to speak to their GP, who may initially prescribe topical or oral antibiotics. Those affected by acne should use skincare products, make-up and cosmetics specifically formulated for spot-prone skin.

Body odour

Body odour is caused by bacteria that break down sweat, usually in the armpits, genital area and feet. Changing clothes, underwear, socks and shoes regularly may help to reduce any odour, while girls may find that regularly shaving their armpits also helps.

Basic hygiene is also essential – for example, having a bath or shower at least once a day (and especially after exercise). Antiperspirants (usually containing ammonium chloride) reduce the amount of sweat produced, whereas deodorants simply mask the smell of sweat.

Dandruff

Dandruff causes dry white or grey flakes on the scalp and hair that can lead to embarrassment, especially if the flakes are visible on dark clothing. The cause of dandruff remains uncertain, but the condition may be associated with the overgrowth of the malassezia fungus on the scalp.

OTC antidandruff shampoos, usually containing antifungal ingredients, may be used to manage mild to moderate symptoms but it’s a matter of trial and error to find the right one. Most products need to be used regularly, even if the dandruff disappears.

Customers should see their GP if OTC products are ineffective, as they may need a prescription- strength antifungal shampoo or a course of steroid lotion. Dandruff can be mistaken for scalp psoriasis, which tends to cause silvery-white scales and intense itching. According to the Psoriasis Association, around a third of people develop psoriasis before 18 years of age.

Shaving rashes

Shaving is an important part of growing up but can also be quite daunting. Choosing the right shaver can reduce the risk of common hazards, such as cuts or irritation. Men’s electric shavers are quick and convenient for boys, but don’t shave as closely as disposables and can irritate the skin. Although disposable razors can also cause redness and blotches, the use of a shaving gel/cream should stop the skin from getting too dry and reduce razor burn.

Girls who wish to shave their legs or underarms should ideally use women’s razors and shaving products. The bikini line is a much more sensitive area, and therefore more prone to irritation, so girls may wish to use waxing or depilatory creams instead.

Period pains

Period pain can occur on the first few days of a period and sometimes for a week beforehand. The amount of pain varies from one person to another and from one period to the next. Sometimes the pain can spread to the lower back and thighs and may be accompanied by nausea, headaches, tiredness and dizziness. In teenage girls, there isn’t usually any underlying cause, but severe or excessive pain should be discussed with a doctor, especially if it is associated with heavy bleeding.

To relieve the pain, teenagers can take suitable analgesics (e.g. ibuprofen or naproxen). Exercise, massage, heat products, a warm bath or shower, or TENS machines might also offer relief.

Sexual health services

Teenage births in England fell by 8 per cent in a year according to data from the Health and Social Care Information Centre in December 2013. But it’s not all good news. According to the Health Protection Agency, the highest rates of sexually transmitted infections are among those aged 15 to 24 years.

The FPA’s clinical and information lead, Lynn Hearton, says that pharmacies should focus on signposting teenagers to relevant services. “It is important not to work in isolation,” she says. “See who else in the local area is working with young people. This means knowing what the pharmacy’s limitations are and which other services are better suited to help. For example, ‘I can’t give emergency contraception to this 14-year-old girl because of protocol, but I can let her know exactly which clinic she can go to’.”

Teenage pregnancy rates fell in Northern Ireland, including Belfast, between 2001 and 2010. However, they have consistently been 1.3 times higher in Belfast than in Northern Ireland generally. In September 2013, the ‘Be Safe Belfast’ pilot pharmacy project was launched to enable community pharmacies in Belfast to provide sexual health advice to teenage girls between 16 and 19 years of age.

“We are providing teenagers with information on the different long-term contraceptive options available, and then signposting them to their GP or family planning clinic if necessary,” says Joanne Corrigan, a community pharmacist in Belfast city centre. “We discuss the practice of safe sex and the dangers of STIs. We also offer free condoms and a pregnancy test if required, and identify if EHC is a suitable option for the patient.”

The ‘C-card’ scheme entitles teenagers and young people around the UK to free condoms from a variety of sources including pharmacies. Pharmacist Chris Nicholls, who owns Hadlow Pharmacy in Tonbridge, Kent, says that most of the teenagers they see as part of the scheme are from the nearby college.

“Teenagers hear about us mainly through word of mouth but also through student services and the sexual health nurse,” he says. “We are part of the local Teenage Pregnancy Partnership and have a C-card sign on the door. We offer EHC, chlamydia testing and treatment, and supply free condoms. We don’t offer other services specifically to teenagers, but do sometimes get the opportunity to chat about typical teenage issues, such as acne.”

In 2011, Davey’s Chemists, an independent pharmacy chain in Merseyside, received the DH’s ‘You’re Welcome’ accreditation, as part of an initiative to make services friendly to young people. It became involved through Teenage Health in Knowsley (THinK), a joint venture between NHS Knowsley and Knowsley Council.

“The scheme encouraged greater health awareness in young people,” says managing director John Davey. “It’s important to tailor services so teenagers and young people feel welcome, comfortable and confident about using local healthcare services, including pharmacies. The success of any scheme aimed at young people depends on how you talk to them. Children and teens are a lot more aware than we give them credit for, so they need to be given the full background information and options open to them.

The success of any scheme aimed at young people depends on how you talk to them