WH&Y authors: Doctor Jennifer Marino
We can’t begin to understand the state of adolescent health and wellbeing in Australia without good data, and yet the data we have now is patchy at best. What we need is a new commitment to the ongoing collection of cross-sectional data for adolescent health and wellbeing across the country.
WHAT WE KNOW
Surveys of health and well-being do not generally evaluate adolescence as its own age group.
- Surveys tend to lump younger adolescents in with children, and older adolescents in with adults, or they are restricted to those aged 16 or 18 and over.
- School-based surveys necessarily omit school leavers, and underrepresent those more likely to be absent from school, such as those who are chronically ill, economically disadvantaged, or not in secure housing.
- Household-based surveys are problematic for a number of reasons. They don't allow for confidential reporting. They tend not to capture data from minority populations. And they generally exclude young people who are not securely housed.
- Some indicators that are especially relevant to adolescent health, such as family functioning, sleep and body image, are poorly or infrequently reported.
- There are no national indicators to measure the impacts on individuals as they transition into, through, and out of adolescence.
- In particular, the collection of data concerning adolescent sexual and reproductive health, and violence in dating relationships among young people, is impeded by community sensitivities. In this area, the youngest adolescents are the most vulnerable group and the one least likely to be represented in national data sources.
Australia has several superb longitudinal cohorts, but The Longitudinal Study of Australian Children (LSAC) is the only nationally representative sample. Moreover, the adolescents involved in the LSAC are ‘ageing out’, with the ‘B cohort’ turning 16 and 17 in 2021, and ‘K cohort’ turning 20 to 21.
WHY IT MATTERS
We need new data to keep in touch with Australian adolescents. Data linkage is a useful tool, but it is no substitute for purpose-collected data.
Several successful models exist for the collection of ongoing cross-sectional data for adolescent health and wellbeing. Every four years, the World Health Organisation’s Health Behaviours of School-Aged Children (HBSC) surveys school students aged 11, 13 and 15 from schools schools in 50 countries across Europe and North America. In the US, the Youth Risk Behavior Surveillance System (YRBSS) conducts annual surveys through schools nationally, and through state, territorial and local education and health agencies, and tribal governments, at a local level.
- Around a quarter (23.7% in males, 28.7% in females) of the disease burden in young people aged 15 to 24 is caused by mental health and substance use disorders, with additional burden from self-inflicted injury (12.8% in males, 6.0% in females)1.
- One in seven adolescents aged between 12 and 17 (14.2%) have experienced a mental disorder in the last twelve months. One in ten (10.9%) reported ever having self-harmed, and about three-quarters of these (73.5%) had done so in the past year. Self-harm is twice as common in girls as in boys.
- About one in thirteen adolescents (7.5%) had seriously considered attempting suicide in the past year, and about one in 40 (2.4%) had made an attempt. Suicidal behaviours are more common in girls than boys.2 However, the rate of completed suicide in males aged 15 to 24 is over three times higher than that in females, and suicide is the leading cause of death in this age group for both genders3.
- About 1 in 50 live births in Australia is to a mother aged 15 to 19. Although adolescent birth in Australia is at historic lows, rates remain high among vulnerable groups, including young people living in rural or remote settings, economically disadvantaged young people, and Aboriginal and Torres Strait Islander youth. Little is known about access to abortion and contraception in this age group4,5.
- Rates of notification of chlamydia, the most common sexually transmitted infection (STI) in Australia, have declined over the past five years among young people aged 15 to 19, but this age group continues to predominate, with rates second only to those aged 20 to 24. Chlamydia notification is three times higher among Aboriginal and Torres Strait Islander people. Most chlamydia infections in people under 30 remain undiagnosed and untreated. Gonorrhoea notification rates have been rising among those 15 to 19 and are highest among those living in remote areas and among Aboriginal and Torres Strait Islander people.6
- Intentional self-harm, road crash, and accidental poisoning are the leading causes of death among Australians aged 15 to 243. In this age group, self-inflicted injury is the leading cause of disease burden in males, and in the top five causes for females1.
- Over three million Australians aged 15 to 24 have a long-term health condition7 and about 7% have a disability8.
1. Australian Institute of Health and Welfare (2019) Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian Burden of Disease series no. 19. Cat. no. BOD 22. Canberra: AIHW.
2. Lawrence D, Johnson S, Hafekost J, Boterhoven De Haan K, Sawyer M, Ainley J, Zubrick SR (2015) The Mental Health of Children and Adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Department of Health,
4. Australian Institute of Health and Welfare 2020. Australia's children. Cat. no. CWS 69. Canberra: AIHW. Viewed 25 August 2020, https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/teenage-mothers
About The Authors
Dr Jennifer Marino is a Senior Research Fellow in the Department of Obstetrics and Gynaecology at th...