Alcohol misuse: tackling the UK epidemic - London

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44 are more difficult to reach than others, so services must be capable of providing advice and help through diverse environments. Often neither children’s nor adults’ services are appropriate for adolescents. There may be difficult transition issues, especially in mental health care provision, where adolescents can fall between CAMHS and adult mental health services. Mental health services in particular should be capable of treating the conditions common among adolescents in an appropriate age environment. Recently there have been calls for every healthcare organisation to have a policy and identified lead professional for the provision of services for young people. 198 Professionals dealing with adolescents may sometimes benefit from specialised training. Improving adolescents’ access to services must involve adolescents’ perceptions of the services provided. Adolescence is often a time when individuals use health services independently for the first time. In this sense, adolescents can be considered ‘new’ users of healthcare services and should be provided with the necessary information, support and encouragement. 198 Adolescents should also perceive services to be user friendly. For example, sexual health services appear to have a more positive effect on adolescents when they are provided by youth-oriented clinics. Resources have been developed to help professionals provide appropriate services for adolescents. 199 Taking into account the views and self-defined needs of adolescents may be one way to improve their use of health services. Article 12 of the United Nations (UN) Convention of the Rights of the Child states that children should have the right to express their views freely in all matters affecting them and that these views should be given weight in accordance with the age and maturity of the child. A key concern for adolescents, which may affect their use of services, is confidentiality. Young people over 16 are considered competent and should be assured of confidentiality in consultations. However, even under this age, adolescents are assumed to be competent for confidentiality purposes if the clinician is confident that they understand the consequences of their decisions. Adolescents presenting for contraception services are generally given complete confidentiality. 198 Health services may need to explain patient confidentiality to adolescents in order to encourage them to use the services provided. Consent, rights and choices in health care for children and young people (2001) contains a full discussion of adolescents’ confidentiality issues. 191 Clinical interventions Although many interventions in adolescent health focus on prevention, clinical treatment is also important. Treatment of adolescent addiction has not traditionally been high on the government’s agenda. However, in the context of smoking, drinking and drug use, helping adolescents to change their behaviour may prove to be as important as prevention. There is evidence that brief interventions, cessation counselling and substitute prescribing may help to modify behaviour. Appropriate and effective clinical interventions are vital for treating mental and sexual health problems. Adolescent obesity may also be tackled in a clinical environment, though success is typically limited. Multifaceted interventions Multifaceted interventions involving, for example, education, the media and community, may be successful in improving adolescent health. Multifaceted approaches have the advantage of recognising the individual, social and environmental influences on behaviour. The most important criteria for multifacted interventions is that the messages delivered are consistent and straightforward. For example, the most effective way to prevent adolescents from smoking may be to use a combination of school-based education, media campaigns, price increases, cessation support and smoking bans in public places. British Medical Association Adolescent health
Multiprofessional interventions Health problems can impact on many other areas of adolescent life. Problems facing dependent drug users are, for example, often far beyond the remit of medical interventions. For this reason, many commentators advocate a multiprofessional approach to intervention. 124,200 This may involve collaboration between doctors, school health service professionals, young offenders teams, social workers and specialist treatment centres. This can be a particularly valuable approach in drug prevention where adolescent use is frequently related to other complex, non-medical social problems. Liaison between health and education services is also valuable to adolescent sexual health. Local multiprofessional forums can inform strategy, monitor performance and develop joint commissioning. 200 Multiprofessional collaboration may help to ensure that adolescent health services are provided seamlessly and that adolescents do not suffer harm during the transition between children’s and adult services. Structural and environmental change Structural and environmental factors are increasingly recognised as playing an important role in adolescent health. Ensuring adequate access to good, affordable food and recreational activity may make more difference to adolescents’ diets and activity than health education. 8 Reducing the availability of cigarettes and alcohol by enforcing age restrictions or increasing their price may help to reduce tobacco and alcohol use. Regulating the advertising and marketing of cigarettes and alcohol may be able to change adolescents’ attitudes to substance use. Since mental health problems are often the result of a combination of biological and societal factors, changes at a local or societal level may help to reduce problems among adolescents. Raising educational attainment and reducing poverty may help to reduce rates of teenage pregnancy and adverse outcomes. British Medical Association Adolescent health 45
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BMA Board of Science Alcohol misuse
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ii BMA Board of Science Editorial b
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iv BMA Board of Science Acknowledge
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vi BMA Board of Science Glossary No
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viii BMA Board of Science Recommend
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x BMA Board of Science Alcohol misu
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BAC (mg/100ml) 58 100 90 80 70 60 5
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Page 112 and 113: vi Contents Introduction...........
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Page 116 and 117: 2 heavier smoking, drinking and mor
Page 118 and 119: 4 Nutrition, exercise and obesity N
Page 120 and 121: 6 The data for 1998 shows a 21 per
Page 122 and 123: 8 Interventions in adolescent nutri
Page 124 and 125: 10 The efficacy of traditional educ
Page 126 and 127: 12 The treatment of individuals wit
Page 128 and 129: 14 Smoking, drinking and drug use A
Page 130 and 131: 16 The use of illicit substances, a
Page 132 and 133: 18 smoking prevalence was highest a
Page 134 and 135: 20 Interventions in adolescent drug
Page 136 and 137: 22 be expensive given the amount co
Page 138 and 139: 24 is potential to use the media, n
Page 140 and 141: 26 Summary Adolescents in the UK ar
Page 142 and 143: 28 Mental health problems in adoles
Page 144 and 145: 30 Risk factors for conduct, depres
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Page 148 and 149: 34 Sexual health Adolescents and se
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Page 152 and 153: 38 Interventions in adolescent sexu
Page 154 and 155: 40 The timing of educational interv
Page 156 and 157: 42 Helping adolescent parents The h
Page 160 and 161: 46 The way forward This report has
Page 162 and 163: 48 Annex 1 BMA policy on adolescent
Page 164 and 165: 50 References 1 Lobstein T J, James
Page 166 and 167: 52 56 Social Exclusion Unit (1998)
Page 168 and 169: 54 115 Charles Gallichan (2003) Pub
Page 170 and 171: 56 173 NHS Centre for Reviews and D
Page 172 and 173: Subject: Young People and Alcohol D
Page 174 and 175: Call for Evidence: Children and You
Page 176 and 177: 5. Do you know of any international
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