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Ilorin Journal of Education
1
ADOLESCENT PROBLEMS: THE IMPLICATIONS FOR THE NIGERIAN
PUBLIC HEALTH WORKERS
Maria Michael Ikorok (PhD)
Department of Physical and Health Education,
University of Uyo, Akwa Ibom State
Salimota Omowumi Lawal
c/o Institute of Education,
University of Ilorin, Ilorin
Idongesit Akpabio
Department of Nursing Science,
University of Calabar, Cross River State
Abstract
The paper examined the peculiarities of the adolescents due to the rapid changes
inherent at this developmental stage that are of concern to the public health personnel
in Nigeria. It highlighted the fact that the changes pose serious problems, which require
the intervention of public health. Of particular concern are changes like breaking of
voice by the males, acne, menstruation, and laziness from hormonal influence,
voracious eating and some antisocial behaviour? These changes posited that some of
the problems emanate from ignorance on the part of both adolescents and their parents
on management, and societal expectations of the adolescents, such as; achieving new
and more mature relationships with age mates of both sexes; achieving masculine or
feminine social roles; accepting ones physique and using the body effectively; achieving
emotional independence from adults; preparing for marriage, family life; and economic
career; achieving a set of values and an ethical system as a guide to behaviour -
developing an ideology; and desiring and achieving socially responsible behaviour.
Management of the problems require/ interaction of the public health personnel with the
adolescents, parents, the school system, as well as the community and groups to
enable adolescents develop good self-concept and look forward to achievements
Introduction
The challenges of adolescents and the responsibilities of the public health personnel
are onerous in nature for obvious reasons. In Nigeria, for instance, health care for this
age group tends not to be receiving priority attention, such that many adolescents grope
in the dark about matters concerning their health and survival. They even transfer this
gross ignorance into adulthood. Yet, literature attests that 43 per cent of the Nigerian
population comprise people of this age group (Bamgbose, 2002). Thus, humanity
continues to churn out a teaming population of ignorant parents into the society. It is
therefore, logical, timely, and appropriate that Nigerian School Health Association
considers it fit to discuss the lots of adolescents in our community. This paper shall
examine adolescence as a concept, and. as a period of storm and stress. It shall also
provide sensitization on the responsibilities of adult members of the society to make
adolescents grow up into a fulfilled adulthood through the instrumentality of the public
health nurse.
Adolescent Problems: The Implications For The Nigerian…
2
Concept and Onset of Adolescence
The term “adolescence” is a sociological construct, like other developmental phases
in human growth and development, but unlike others, it breeds a lot of ambiguity.
However, some experts view the term as a construct applied by adult members of the
society to describe the person who is in the transition to acquire biological features
peculiar to the adult population group. The term is derived from the Latin word meaning
to grow up' or 'to grow into maturity'. It is the period of life between childhood and
adulthood and corresponds roughly to the teenage years (thirteen to eighteen years). In
essence, the meaning of adolescence, and the ages at which it begins and ends, differ
from culture to culture, like most sociological phenomena (Kimmel & Weiner, 1985)
In some situations, the term is used interchangeably with youth even though they
are significantly different. Adolescence like youth is a unique period of joy, vigour,
opportunities as well as challenges as the individual begins to appreciate more vividly
phenomena in his or her environment in a more personal manner (Ikorok, 2004).
Managing these challenges may require the attention of public health workers like the
health educators, clinical psychologists, medical doctors and particularly public health
nurses; because by training and certification they have the competences in both public
health nursing, counselling and social works.
Scientists of human development separate the life span into stages such as infancy,
childhood, adolescence, young adulthood middle adulthood, and senior adulthood.
Often, the biological boundaries of adulthood are simply fixed by convention at the
onset of the acceleration of physical growth that occurs during the second decade of life
(Kimmel & Weiner, 1985), and the precise chronological age at which adolescence
starts and ends are not clearly defined. Faced with the difficulty in defining the term with
certainty, Eke (2004) observed that, if the beginning of adolescence can be defined, the
definition of its end is not really tidy. The difficulty arises from the gross variability in the
commencement of biological features of adulthood; namely; menstruation in girls and
perhaps breaking of the voice in boys. The ages 11 - 19 years or 13-22 years are set by
some experts as the yardstick, but reliance on this limit gives a narrow perspective of
adolescence, because girls have been found to menstruate as early as the eighth year
of life (Grinder, 1978).
This not withstanding, it is still logical to associate the period with the beginning of
puberty when rapid changes as secondary biological characteristics occur. Similarly,
social age (the age an individual can legally marry or engage in any legal contract)
marks the upper limit of the adolescence age. Therefore, when one is primarily involved
in adult roles, or is legally engaged as an adult, and is perceived by oneself and by
others as an adult, the person is regarded as no longer an adolescent in terms of social
age. In this situation, roles rather than age define adolescence to the extent that some
children may actually become exploited if this is applied in strict terms. Therefore the
definition of the term should consider many biological, social, and psychological issues
in society; otherwise, the person may be tending to or actually exploiting or abusing the
child
In some cultures, adolescence is marked by qualification for certain initiation rites,
and people publicly celebrate the transition into adulthood. Before the event, the person
was regarded as a child and after the initiation, this concept automatically changes and
the person is given an adult status. The ambiguity of the onset of adolescence and the
surging changes at this age affect the child in diverse ways to the extent of constituting
stress for the individual. Hence the description of adolescence stage as “a period of
Ilorin Journal of Education
3
storm and stress”
Adolescence as a Period of Storm, Stress and Change
Adolescence is a peculiar period in ones life span. Experts describe it as a period of
storm and stress. In all, the concept of adolescence is the notion of transition, a period
of change, growth and disequilibrium that serves as a kind of bridge between one
relatively stable point in life and another relatively stable point, but different points. The
changes inherent at this period serve to create a number of problems for the adolescent
and the society as a whole; the effect comes as storm and often overwhelming and
stressful. Handling these problems by the adult members of the society and the
adolescents as well requires skill, and a paradoxical level of flexibility and firmness.
Management of adolescence should aim at providing a meaningful experience for the
person. Thus, public health workers such as the health educators and public health
nurses, in their course of work in society have to exploit the comprehensive nature of
their training to help the adolescents lead qualitative and productive life years in order
that one does not always view this stage as a problem but a stage of transition which
actually involves normal physiological as well as psycho-social experiences.
Consideration of the transition of the period of adolescence involves the examination
of change in human development. For example, biological changes such as puberty
would affect all individuals who experience it. It is, however important to observe that
the interaction of these changes is not the simple addition of one change to another, but
a complex life experience. Four dimensions of these changes have been identified,
namely; inner-biological, psychological, cultural-sociological, and outer-physical
changes. Each of these, according to Kimmel and Weiner (1988), brings instability,
creates problems, raises questions, or brings transition in the life cycle. It must be
appreciated that change experienced at this period brings problem if not properly
managed.
Because the fourfold transition is obviously complex and changes in all dimensions
do not always synchronize, there is usually some degree of confrontation,
reorganization and conflict between the dimensions. Expectations for the recipients of
the change also follow: eight of such expectations viewed as tasks, are considered here
following the model of one of the pioneers of the study of life span, Robert Havighurst in
1951. The following are the inherent tasks of adolescents identified with the acronym,
the 4As2PsAD-model (Havighurst, 1988).
A: Achieving new and more mature relationships with age mates of both sexes;
A: Achieving masculine or feminine social roles;
A: Accepting ones physique and using the body effectively;
A: Achieving emotional independence of parents and other adults;
P: Preparing for marriage and family life;
P: Preparing for an economic career;
A: Achieving a set of values and an ethical system as a guide to behaviour -
developing an ideology; and
D: Desiring and achieving socially responsible behaviour
Young people ordinarily accomplish the developmental tasks of adolescence in a
sequence of stages. The first stage is the early adolescence, and it coincides roughly
with the junior secondary school years marked by rapid physical and intellectual growth,
confusion and a feeling of insecurity, as the person takes up adult sexual
characteristics. The second stage, the middle adolescence, coincides roughly with
Adolescent Problems: The Implications For The Nigerian…
4
senior secondary school age. Primarily, the person seeks self-reliance and
psychological independence from parents; becomes comfortably involved in expanding
peer relationships; achieves the capacity for intimate friendship; and learns to handle
heterosexual relationships (Havighurst, 1988). The third stage is the late adolescence,
which usually begins as the child enters into higher institution or is already there or is
learning a trade. At this point it is expected that the young person may have formed a
reasonably clear and consistent sense of personal identity and is committed to some
fairly definite social roles, value system, and life goals. All these experiences pose
significant threats to the individual or the society depending on their concept of
adolescence to the extent of generating concerns for public health personnel.
The Public Health Concerns of Adolescence
A comprehensive array of adolescents' problems requiring intervention of public
health personnel such as public health nurses and health educators is beyond the
scope of this paper. The few that is discussed here serve as guide to facilitate normal
transition and prevent the adolescents from being fixated at any stage of development,
and to enable them cope with peculiar changes at this time. However, it is important to
observe that management of adolescence should recognise the need to protect the
rights of these ones as their universal moral entitlement irrespective of social status.
The evident high level of ignorance among a large proportion of most individuals
about authentic problems of adolescents in society justifies that proper attention be paid
this population group in order to be able to identify vividly the peculiar problems, if any,
of this population group. Hence both parents and adolescents must receive accurate
information and education about this period for the well being of the adolescents and
society. It has to be acknowledged that the physical changes in the life of adolescents
are multi-dimensional. Some are obvious and can be easily observed; others are
structural and functional. However, the underlying purpose of the changes is to prepare
the body for reproduction and propagation of specie, and this may result in any of the
following:
Profuse Perspiration and Body Odour
Adolescents sweat very profusely especially around the folds of the body. Without
proper personal hygiene, the person develops a repulsive or repugnant body odour, and
so should be guided on this. In their excessive physical activities, some may become
sloty and do not wash their clothes and the combined effects of dirt and sweat definitely
results in bad odour. Therefore, health education and guidance are given on personal
hygiene to help adolescents develop the habit of clean and regular baths and use of
clean and proper clothing.
Voracious Eating
Adolescents have a high need for nourishment, sometimes they eat rather selfishly
that they may eat even the share of another person. Many become over-weight while
others, particularly girls obsessively trim their weight to be pencil slim and simplify.
Many adolescents become obese, develop a very clumsy appearance because of
indiscipline about maters of feeding (Fawole, 2002).
Skin Blemishes
Nature provides nurture and lubrication for the body more abundantly at this time.
Ilorin Journal of Education
5
Sometime the sebaceous glands malfunction and acne occurs. This usually is a cause
of anxiety for most adolescents, and they try even unproven therapies to their own
disappointment, because the problem resolves with age despite use of cosmetics. It is
sad, however, that cosmetic dealers spread false hope of instant cure of acne when
they know that this problem is hormonal and physiological, for that matter. Due to their
misleading information and their promise of total restoration of looks, so many
adolescents apply steroids rather too early in life on continuous bases as creams; and a
sensitive health authority should view this very seriously.
Awkward and Clumsy Posture
During the period of adolescence, the limps grow so fast that the adolescents look
like all legs and arms; it takes a while for co-ordination to develop. The person becomes
clumsy, prone to accidents, gets out of shape and appears really awkward in posture.
Bone deformities, like knocked knees, are common and they may develop negative self-
concept. The girls develop bad posture in an attempt to conceal the developing breast,
in this way they develop poor self-worth and may lack self-confidence and sometimes
wish that they rather had the physique of another person they probably admire.
Increased sexual activity
It is obvious that as sexual maturity arrives, sex urges naturally increase. The
adolescents require help to realize that they are experiencing normal feelings and
urges. For this reason, however, the educational curricular in Nigeria include sexuality
education as an integral learning experience for the youths. Regrettably, the current
trends in sexuality education tend to be amorous due to misplaced emphasis on safe
sex. Propagators of safe sex tend to devote so much attention to the distribution of
condom than teach the adolescents the implications of premarital sexual activities. This
increased sex urge if not properly managed is crisis itself. Some adolescents probably
also, due to peer pressure, get entrapped in premarital sex, recreational sex, aggressive
sex, teenage pregnancy, abortion, child abandonment, elopement, and other antisocial
behaviour. What follows this can best be imagined.
Ethnocentrism and self-consciousness
At this period the individual becomes so pre-occupied with self to the extent of
overindulgence. Adolescents consider themselves the centre of all attention and often
believe that everyone notices every detail of their appearance and would want to correct
parts of their bodies to become the 'real self. Thus, they preoccupy themselves on their
looks. Sometimes they withdraw from others, and keep only to self. Some erroneously
think that they alone matter and every other thing should stopped at their command. It
is necessary to watch them, otherwise they may conceive crimes or take pleasure in
drugs or join gangsters, or unnecessary risks as they fantasize.
In the view of Grinder (1978), this stage of self-consciousness and fragmented
existence is usually accompanied with a feeling of isolation and loneliness. The
behaviour of adolescents at this time; encompasses inconsistency, unpredictability and
fantasy. Consequently they automatically fight their impulses, accept them and become
more idealistic and may even attempt very risky behaviour.
Tiredness and laziness
Tremendous hormonal activity and energy expended during growth leads to
Adolescent Problems: The Implications For The Nigerian…
6
tiredness and laziness, especially when optimal nutrition and health are not maintained.
Like the hormone relaxing in pregnancy, the surging effects of growth hormones at this
age tends to dull some activities in the individual. Adults may become impatient with
them and therefore they equally require guidance. This being another period of
increased growth and development, the body tries to match energy requirements for
growth and hyper-activity peculiar to this age.
Anti-social behaviour
Delinquency, the forerunner of adult crime, is common at this point. Such acts
include: dropout from school and the likelihood of unemployment in later life, truancy,
cultism, sexual assaults, examination malpractice, stealing and armed robbery,
prostitution, rioting and wanton destruction of property - violence. Other indices of
delinquency that are found in adolescence are: murder, aggression, fighting, wounding,
lying, insubordination, forgery, fraud, and other anti-social and non-conforming
behaviours.
Many behavioural patterns begin in childhood, others in adolescence and adult life.
In these years of experimentation, young people are susceptible to developing
deleterious behaviour, such as drug abuse. For most people, experimentation with drug
assumes its peak in adolescence and this accounts for most motor vehicle accidents
and violence in this cohort. Similarly, one million teenagers consume tobacco each
year, with 75% of this modelling after their smoking parents (McKenzie & Finger, 1997).
Public Health Management of Adolescent Problems
Attempts have been made in this paper to explore the trends in adolescents'
development and associated problems or manifestations. It has been shown that public
health encompass a huge and rapidly expanding body of knowledge related to health
policies and a range of other equally vast and important theoretical perspectives. This
analysis, therefore, will be incomplete if it fails to proffer possibilities for curbing the
pitfalls of this age group through public health management. As in most socio-psycho-
physical problem, and all adjustment difficulties, Ikorok (2002) attests that cure in its
absolute terms is rather ambitious. Management options depend mainly on the specific
nature and source of fat problem as well as its potential and actual impact on health and
welfare of those involved. Since the various indices of adolescence problems are
developmental in origin, it is not considered really logical to treat the indices
independently. Cowley (2003) with his orientation, public health workers serve to co-
ordinate the activities of the various groups implicated in the care of this vulnerable
group. Firstly, they must realize their continuous responsibility for providing health
education to individuals and families in the community and secondly, reach out to the
various groups in the view to improving the quality of life in the society, in the following
ways.
1. Interactions with the youths themselves.
Primary Health Care (PHC) advocacy is that health care should be delivered
wherever people live and work. The public health personnel, and others concerned with
the care of adolescents, therefore, should reach out to the youths, at home, in school, in
church, in mosque, at play, and as groups in clubs and the larger society. Intensive
health education at this age should include value-based sexuality education with special
topics on the developmental process and expectations for age. Topics of interest should
Ilorin Journal of Education
7
also include; personal hygiene, menstruation, masturbation, rest, sleep, and exercises,
nutrition, the need for good self-concept and value-judgement, career, and morals. Drug
use and effects on health are also discussed as well as the dangers of unplanned
pregnancies, abortion, sexually transmitted infections and HIV/AIDS. There may be
need to organize seminars periodically for this population group wherever they could be
accessed.
Additionally, the public health worker must help in identifying and managing health
status problems in this group with understanding. He or she also acts as a liaison
between the parents and their adolescent siblings, in the light of the prevailing
circumstance and local culture. Helping the adolescents to understand the physical and
social aspects of their growth process, to enable them live with their own physical
endowments should also attract paramount attention.
In doing this, the health worker has to apply the principle of the polarized concept
and priorities in public health to be able to assure a culmination of the efforts expended
by all others in the field. Cowley (2003) tabulated the principles as follows:
Target Expectations
Individual/population
Encompasses not only the service responsibilities,
but also points to the dilemmas inherent in choosing
between personal right and collective responsibilities
within society as a whole
Public/Private
Access and use of public services such as health and
nursing care is related to both personal perceptions
and wider social view about what they should be for,
and what remains properly private
Determinants/treatment
Services may be designed to directly target the
determinants of health (root causes) or to treat
established problems by offering clinical treatments to
affected individuals
Social/biomedical model
Views are changing and contested about whether a
social or biomedical view of health is considered
paramount in promoting the public health (p. 13)
2. Interaction of the public health worker with parents of adolescents.
On matters of growth and development, most parents are as ignorant as the youths
despite their own previous experience. Otherwise, why would parents still hoard
information on puberty from their wards? Why would society still observe the puritanical
stance on sexuality education despite trends in society? This is a clear call for the
intervention of the health educator, public health nurse, and others concerned with the
care of this age group. Parents and guardians need guidance to recognize and
appreciate the challenges of adolescence to both the child and themselves. Parents
should be guided to befriend their adolescent siblings and to facilitate good
communication at home; they should also be conscientized to assume their proper
place as teachers in the family and to seek authentic information from professionals
whenever indicated. Everyone cannot teach health or possess authentic information
about health. Parents must exercise wisdom in their choice of the source of health
information in view of quackery and counterfeiting in the field of health care in the
Nigerian society.
Parents need to appreciate that every child is unique. They should avoid unhealthy
comparisons of their wards, since this suggests favouritism, thereby evoking in the child
the tendency for deviant attitudes from either side. Parents should observe a co-
Adolescent Problems: The Implications For The Nigerian…
8
ordinated childrearing practice to engender discipline. Discipline should be done with
"one voice', in a coordinated manner bearing in mind the peculiarities of the local
culture. As earlier discussed, adolescents learn through modelling - they observe their
models, imitate and re-enact the behaviour of the model in a similar situation. Therefore,
parents must show their wards good examples. They should reassess, and where
necessary, redefine their childrearing practices in the interest of the child. They should
give them love and affection and correctively punish them as necessary with love and
respect and within the context of the local culture. The position of "absolute right of the
child'' in the United States of America is not faultless and should be noted. This means
that, in this society with a strictly different social background, parents should not
embrace "the spare the rod" philosophy of America on their wards hook line and sinker
(Cowley, 2003)
3. Interaction with communities and groups.
The scope of public health is embracive. Apart from meeting the needs of parents
and individually, the health worker utilizes community and group potentials in
managing adolescents' problems. At this level, community social control network could
be used to check delinquent behaviour in adolescents. The community should include
adolescents in community development plans and should occupy them meaningfully to
give a sense of responsibility. The community should provide enabling environment for
youths' participation in community development. Community leaders can also help to
identify and discipline as appropriate, or hand over to law enforcement agents, any
unscrupulous adolescent who defies control.
The public health educator can work with other agencies in the community to make
life meaningful for youths. Their involvement in social activities should be monitored to
ensure that they are occupied with licit and legitimate activities.
4. Interaction with schools.
In the school system, the public health educator serves as the child's advocate and
counsellor. Be close to the students, keep correct health records of the child, and
periodically provide health education and health appraisals in schools, as appropriate
for age. A safe school environment de-emphasises violence. The public health educator
should liase with school administration to ensure a conducive physical, social, and
emotional environment in school because this will help the child both within and outside
the school. Other agencies in the community should join forces with the health worker to
ensure a meaningful growth experience for the adolescents in their total environment
recognizing that today's future depends significantly on them.
Conclusion
Like the period of adolescence itself, any discussion concerning adolescents is an
adventure. For such a reason, this paper cannot attempt to exhaustively treat such a
matter. However, it is important to remark that management of any developmental
process is contextual, even though the basic principles may synchronize with already
existing evidence in the field. Therefore, the public health personnel; nurse and others
need to exploit the rich background of their training to make life worthwhile for all
population groups in society. He or she should utilize all the potentials in the
environment of work to enable everyone realize that the passage from infancy to
childhood and from adolescence to adulthood is natural and should be managed with a
Ilorin Journal of Education
9
sense of commitment.
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