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Risky health behaviors, rather than infectious or chronic diseases,
are the leading causes of morbidity among adolescents.1-7 Most
morbidity results from 3 risky behaviors initiated in early to middle
adolescence: substance use, sexual activity, and motor/recreational
vehicle use. These 3 behaviors tend to covary. For example, substance
use plays a major role in motor vehicle crashes. Use of substances
is associated with sexual behavior, often placing adolescents at
risk for acquisition of sexually transmitted infections and unintended
pregnancy.1
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The primary diagnosis for adolescent emergency room visits is injuries.
Trauma-related disorders are also a leading reason for outpatient
provider visits as well as inpatient hospitalization for both males
and females.5 Sexually transmitted infections are
the most common reported infectious diseases in adolescents, and
childbirth and complications related to pregnancy are the leading
cause of inpatient hospitalizations for female adolescents.7,8
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Additional causes of morbidity are related to chronic conditions
or special health care needs.8 Mental health disorders
affect between 10% and 20% of adolescents; anxiety disorders
are the most common diagnosis, followed by depression (see Chapter 72).9,10 Asthma is
a major chronic illness: About 16% of adolescents are reported
to have lifetime asthma, and 10% to 15% reported
to have current asthma.11 Diabetes is another common chronic
illness. In 2004, there were 2.29 cases per 1000 adolescents among
younger adolescents (ages 10–14 years) and 3.35 cases per 1000
older adolescents (ages 15–19 years), indicating that diabetes
increases throughout adolescence.12 The prevalence
of both asthma and diabetes has increased in recent years.
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The number of adolescents who are overweight and obese is of
increasing concern. The percentage of overweight adolescents has more
than tripled over the past 25 years, with 17% of adolescents
ages 12 to 19 considered overweight in 2004. The health consequences for
adolescents can include diabetes, metabolic syndrome, high cholesterol,
and hypertension; and overweight adolescents have a 70% chance
of becoming overweight or obese adults (see Chapter 32).13,14
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Approximately 6% of adolescents have a chronic disease
that interferes with general functioning.6,15-17 The
most common causes of chronic illness include mental health disorders and
diseases of the respiratory and musculoskeletal systems. Younger
male adolescents living in poverty are the group most impaired by chronic
disease. Most adolescents suffer no major problem in their psychosocial
functioning as a result of chronic disease.
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Common medical problems for which adolescents seek medical care
include acne, reproductive health problems resulting from variants
of normal physiological maturation and initiation of sexual activity;
and specific disorders of the skeletal system such as Osgood-Schlatter
disease, idiopathic scoliosis, and common sports injuries; and mental health
disorders.6 Reproductive health problems
are discussed in Chapters 74, 75, 76, 77, and 78, skeletal disorders are
discussed in Chapters 210, 211, 212, 213, 214, ...