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      Progress in adolescent health and wellbeing: tracking 12 headline indicators for 195 countries and territories, 1990–2016

      , PhD a , b , c , d , f , * , , MBiostat a , , MSc a , f , , MPH a , b , g , , Prof, PhD h , , MD h , i , , Prof, PhD h , , BSc h , , Prof, PhD h , , Prof, PhD c , j , , MA k , , Prof, PhD a , e , , MBChB k , l , , BA&Sc k , , PhD e , , PhD m , n , , Prof, MD o , , Prof, MD a , d , f , , Prof, PhD p , q , , Prof, PhD r , s , k , , MBBS t , , Prof, PhD t , , Prof, MD a , d , f

      Lancet (London, England)

      Elsevier

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          Summary

          Background

          Rapid demographic, epidemiological, and nutritional transitons have brought a pressing need to track progress in adolescent health. Here, we present country-level estimates of 12 headline indicators from the Lancet Commission on adolescent health and wellbeing, from 1990 to 2016.

          Methods

          Indicators included those of health outcomes (disability-adjusted life-years [DALYs] due to communicable, maternal, and nutritional diseases; injuries; and non-communicable diseases); health risks (tobacco smoking, binge drinking, overweight, and anaemia); and social determinants of health (adolescent fertility; completion of secondary education; not in education, employment, or training [NEET]; child marriage; and demand for contraception satisfied with modern methods). We drew data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016, International Labour Organisation, household surveys, and the Barro-Lee education dataset.

          Findings

          From 1990 to 2016, remarkable shifts in adolescent health occurred. A decrease in disease burden in many countries has been offset by population growth in countries with the poorest adolescent health profiles. Compared with 1990, an additional 250 million adolescents were living in multi-burden countries in 2016, where they face a heavy and complex burden of disease. The rapidity of nutritional transition is evident from the 324·1 million (18%) of 1·8 billion adolescents globally who were overweight or obese in 2016, an increase of 176·9 million compared with 1990, and the 430·7 million (24%) who had anaemia in 2016, an increase of 74·2 million compared with 1990. Child marriage remains common, with an estimated 66 million women aged 20–24 years married before age 18 years. Although gender-parity in secondary school completion exists globally, prevalence of NEET remains high for young women in multi-burden countries, suggesting few opportunities to enter the workforce in these settings.

          Interpretation

          Although disease burden has fallen in many settings, demographic shifts have heightened global inequalities. Global disease burden has changed little since 1990 and the prevalence of many adolescent health risks have increased. Health, education, and legal systems have not kept pace with shifting adolescent needs and demographic changes. Gender inequity remains a powerful driver of poor adolescent health in many countries.

          Funding

          Australian National Health and Medical Research Council, and the Bill & Melinda Gates Foundation.

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          Most cited references 8

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          The age of adolescence

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            Health of the world's adolescents: a synthesis of internationally comparable data.

            Adolescence and young adulthood offer opportunities for health gains both through prevention and early clinical intervention. Yet development of health information systems to support this work has been weak and so far lagged behind those for early childhood and adulthood. With falls in the number of deaths in earlier childhood in many countries and a shifting emphasis to non-communicable disease risks, injuries, and mental health, there are good reasons to assess the present sources of health information for young people. We derive indicators from the conceptual framework for the Series on adolescent health and assess the available data to describe them. We selected indicators for their public health importance and their coverage of major health outcomes in young people, health risk behaviours and states, risk and protective factors, social role transitions relevant to health, and health service inputs. We then specify definitions that maximise international comparability. Even with this optimisation of data usage, only seven of the 25 indicators, covered at least 50% of the world's adolescents. The worst adolescent health profiles are in sub-Saharan Africa, with persisting high mortality from maternal and infectious causes. Risks for non-communicable diseases are spreading rapidly, with the highest rates of tobacco use and overweight, and lowest rates of physical activity, predominantly in adolescents living in low-income and middle-income countries. Even for present global health agendas, such as HIV infection and maternal mortality, data sources are incomplete for adolescents. We propose a series of steps that include better coordination and use of data collected across countries, greater harmonisation of school-based surveys, further development of strategies for socially marginalised youth, targeted research into the validity and use of these health indicators, advocating for adolescent-health information within new global health initiatives, and a recommendation that every country produce a regular report on the health of its adolescents. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Adolescence and the next generation

              Adolescent growth and social development shape the early development of offspring from preconception through to the post-partum period through distinct processes in males and females. At a time of great change in the forces shaping adolescence, including the timing of parenthood, investments in today’s adolescents, the largest cohort in human history, will yield great dividends for future generations.
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                Author and article information

                Contributors
                Journal
                Lancet
                Lancet
                Lancet (London, England)
                Elsevier
                0140-6736
                1474-547X
                16 March 2019
                16 March 2019
                : 393
                : 10176
                : 1101-1118
                Affiliations
                [a ]Murdoch Children's Research Institute, Melbourne, VIC, Australia
                [b ]Maternal and Child Health Program, Burnet Institute, Melbourne, VIC, Australia
                [c ]Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
                [d ]Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
                [e ]Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
                [f ]Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia
                [g ]Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
                [h ]Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
                [i ]Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
                [j ]Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA, Australia
                [k ]Youth Commissioner, Lancet Standing Commission on Adolescent Health and Wellbeing, Lusaka, Zambia
                [l ]Copper Rose, Lusaka, Zambia
                [m ]United Nations Children's Fund, New York, NY, USA
                [n ]Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
                [o ]Mailman School of Public Health, Columbia University, New York, NY, USA
                [p ]Department of Population and Family Health at the Mailman School, Columbia University, New York, NY, USA
                [q ]Centre for Fertility and Health, Norwegian Institute of Public Health, Nydalen, Oslo, Norway
                [r ]Centre of Excellence in Women, Child and Adolescent Health, Aga Khan University, Nairobi, Kenya
                [s ]Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
                [t ]UCL Institute of Child Health, University College London, London, UK
                Author notes
                [* ]Correspondence to: Dr Peter S Azzopardi, Maternal and Child Health Program, Burnet Institute, Melbourne 3004, VIC, Australia peter.azzopardi@ 123456burnet.edu.au
                Article
                S0140-6736(18)32427-9
                10.1016/S0140-6736(18)32427-9
                6429986
                30876706
                © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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                Medicine

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