A COMPREHENSIVE SCORING SYSTEM FOR ASSESSING

ISSN- 0301-1216

Indian J. Prev. Soc. Med. Vol. 42 No.3, 2011 A COMPREHENSIVE SCORING SYSTEM FOR ASSESSING PSYCHOSOCIAL RISK STATUS OF ADOLESCENTS GIRLS THROUGH ‘HEEADSSS’ APPROACH MK Gupta, CP Mishra ABSTRACT Background: Giving due consideration to the home, education and employment, eating habits, activities, drugs abuse, sexuality, suicide and depression and safety, WHO suggested ‘HEEADSSS’ approach for looking in to the head of the adolescents. However for wider application of the approach for assessing psychosocial behaviour of adolescents for research and policy planning there is a need and scope for evolving comprehensive scoring system to assess psychosocial status of this vulnerable group. Objectives: To evolve a comprehensive scoring system for assessing psychosocial risk status of adolescent girls through WHO’s ‘HEEADSSS’ approach. Methodology: The study protocol was already approved from the ethical committee. A community based cross-sectional study was carried out on adolescent girls from Chiraigaon Community Development Block of Varanasi District. All the villages in the block were divided into 3 strata according to their distance from the Block Headquarter. One village was selected from each stratum by simple random sampling from which total enumeration of adolescent girls (10-19 years) was done by house-to-house survey. Four hundred girls from the enumerated list were selected as per probability proportion to size (PPS). The study subjects were interviewed using a pretested structured proforma. The obtained data was analysed using Microsoft Excel, 2007 and SPSS (16). A comprehensive system four assessing psycho-social status was evolved on the basis of PEER opinion (n=10). Results: Environment pertaining to home, education and employment accounted for 27% of the total psychosocial risk score (100). The contribution of sexuality, suicide and safety to the overall score was 42%. Parameters related to weight status (eating and activity) were assigned score of 16. The overall psychosocial risk score was categorized as normal (0-10), mild risk (10.120), moderate risk (20.1-30), severe risk (30.1-40) and very severe risk (>40) by the experts. As much as 40.0%, 43.6% and 11.75% study subjects had mild, moderate and severe risk for psychosocial abnormality, respectively. Conclusion: Comprehensive scoring system evolved on the basis of PEER opinion is the pioneering work and have been first time attempted globally and gives due consideration to wider applicability in epidemiological research and clinical settings particularly in adolescent guidance clinic. Key words: Adolescents, HEEADSSS, psychosocial status

INTRODUCTION 1

There are an estimated 1.2 billion adolescents (10-19 years) worldwide. While adolescents share many common characteristics, it is important to appreciate that they are not all the same, and these differences (for example age, sex, marital status and parental support) need to be taken into consideration when developing and implementing interventions. _______________________________ 1. Resident, 2.Professor & Head, Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi Indexed in : Index Medicus (IMSEAR), INSDOC, NCI Current Content, Database of Alcohol & Drug Abuse, National Database in TB & Allied Diseases, IndMED, Entered in WHO CD ROM for South East Asia.

MK Gupta et al

Comprehensive scoring for psychosocial risk status of adolescents girls

Adolescent girls (AGs) would behave differently in different environment and circumstances. Their understanding of situation, status in family and thereby in society and also responses to given situation would differ across broad environment and circumstances. A higher income group family is likely to provide more conducive, educative and free environment to adolescent girls than a relatively lower income group family. The impact of urbanization on the life of people is undeniably great. The younger people are more likely to be affected by the sparkle of urbanization, as it provides a lot of opportunities in terms of education, jobs etc. Competition is yet another factor which prompts behaviours of young mind. Urbanization provides more competitive environment, which in general lacks in the rural areas. Therefore, in all probabilities, the problems and perceptions of AGs would also differ across urban-rural sectors. Adolescent girls in India face several social restrictions, sex discrimination, nutritional deprivation and some other adverse situations unlike those in developed countries. With expansion of telecommunication and media across cultural boundaries, the problems of western societies are also being added up while very little or slow improvement is observed in 2

previously existing ones. The health of adolescents, as well as their development is particularly dependent on their behaviour, which is heavily influenced by the environment in which they live. Psychosocial behaviour of adolescents is a complex interaction of psychological growth, social environment, education and exposure to the outer world. Various parameters viz. home environment, Education and employment status, Eating habits, Activities, Drug abuse behaviour, Sexual relationships, Tendency of suicide and depression and safety issues together forms a environment on which the development of a girl’s psychosocial status depends. During childhood and adolescence most of the social influences upon individual can be categorized as being associated either with home or with school environments. In the early years the family is the most potent source of influence. It is well known fact that most of those who become successful in life have come from homes where parental attitudes towards them were favourable and where a wholesome relationship existed between parents and children.

3

Child and adolescent labour is a part of India’s historical tradition. Assistance provided by children on farm or family based occupations was accepted as a normal process of growing up and learning adult roles. Numerous studies concluded that there are discrepancies between adolescence perception of body weight and actual body weight.

4

These might have

significant influence on their dietary behaviour and dietary pattern. In recent years drug and substance abuse amongst adolescents has emerged as a major problem having far reaching socio-medical and economic consequences. As a consequence of industrialization and urban drift, stresses and strains of modern life have rendered adolescents vulnerable to substance abuse more than ever before.

5

It is generally believed that because premarital sex is a taboo in India and because the family exerts control over young people, the youth abstain from premarital sex. The sexuality related experiences of girls and boys are largely shaped by the constructions of gender caste, class and community norms. Decline in the traditional control over youth by family and schools, increase in age at marriage, changes in social values and exposure to media and aspirations are some of the features of the modern society which have heightened the permissiveness in sexual experimentation and lad to incidence of HIV/AIDS. Despite a conservative environment that disapproves of interactions among adolescent males and females, there are opportunities for social mixing, and young people have devised ways of developing romantic partnerships with the opposite sex. All adolescents may not be so fortunate, to get the ideal societal support for the smooth transition from adolescence to healthy adulthood. Some develop maladaptive patterns in emotional and behavioural spheres .This augers ill for the individual’s future resulting in depression, delinquency and suicides among other problems.

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Wanting to act more independent and to spend more time out in the world, the young person must contend with the temptation of new freedoms, the desire to act more grown up, the push of impulse, the pressure of peers, and increased exposure to the unexpected. While parents cannot actually control the adolescent's choices, they can inform those choices, and they should. After all, part of the parent's job is to fill in the blank map of future experience with cautionary information to combat youthful ignorance for safety's sake.

7

Giving due consideration to the points mentioned above, WHO suggested HEEADSSS approach

8

for looking in to

the head of the adolescents. However for wider application of approach for assessing psychosocial behaviour of adolescents for research and policy planning there is a need and scope for evolving comprehensive scoring system to assess psychosocial status of this vulnerable group.

OBJECTIVES: To evolve a comprehensive scoring system for assessing psychosocial risk status of adolescent girls through WHO’s ‘HEEADSSS’ approach.

METHODOLOGY: Period of study: A period of two years (August 2009 to July 2011) was fixed to conduct the study. Initial 6 months (August 2009 to January 2010) were devoted for extensive literature search and designing and pretesting of interview schedule. Data collection was carried out twice a week for a period of one year (February 2010 to January 2011). In the remaining six months (January 2011 to July 2011) data entry and analysis was carried out. Study design: This study adopted a community based cross sectional study design. Sample size: After extensive literature search it was found that there were not much community based studies conducted to assess the psychosocial status of adolescents, especially for girls. As per literature search no prior information could be obtained for psychosocial status of adolescent girls based on all components considered in HEEADSSS approach of WHO. By considering this fact a pilot study on 30 adolescent girls was conducted in Chiraigaon Community Development Block, which demonstrated a prevalence of 50% psychosocial abnormality in rural adolescent girls. Based on this value, the sample size for this study was calculated using the formula:

n

z 2 pq L2

Where, z= 1.96, n= Sample size, p= Assumed prevalence (50 % in this study), q= 100-p, L= permissible level of error in the estimated prevalence, taken as 10% (10% of 50 = 5)

The required sample size was calculated to be:

n


1.96 x1.96 x50 x50 (5) 2

243

384 .16


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Thus the total sample size was round up and fixed to 400 Sampling methodology: Following 3 steps were involved in the selection of study subjects: Stage 1:

In the first stage, out of eight Community Development Blocks of Varanasi District, one Community Development Block (i.e. Chiraigaon) was selected by simple random sampling method.

Stage 2:

In the second stage, all villages of Chiraigaon were divided into 3 strata according to distance (viz. 10km) from Block headquarter. Then by adopting simple random sampling method one village was selected from each stratum.

Stage 3:

In the third stage, total enumeration of adolescent girls was done in the selected village to prepare a sampling frame. The required study subjects were selected by probability proportion to size (PPS) sampling technique. In order to get required study subjects (400), systemic (every third) random sampling was done. This study was

approved by the ethical committee of Banaras Hindu University and prior consent was taken by the participants before interview. Tools and technique of the study: General information pertaining to age, literacy status and occupation of subject, their parents, caste, religion, marital status, family income, total members in the family, number of siblings etc. were obtained by interview method and recorded on a predesigned and pre tested (in non study village on a sample of 30 adolescent girls) schedule. WHO HEEADSSS questionnaire was modified by taking consideration of rural background to make it simple, favourable and appropriate. It includes eight components viz. Home, Education and Employment, Eating, Activities, Drugs, Sexuality, Suicide and Depression and Safety. The psychosocial status of study subjects was detected by interviewing them with the help of predesigned and pre structured schedule. A comprehensive system four assessing psycho-social status was evolved on the basis of PEER opinion (N=10). Ten experts belonging to disciplines of community medicine, medical sociology, paediatrics and psychiatry were asked to score HEEADSSS tool taking overall score at 100 point scale. Their average values were rounded for over all scoring. In case of discordance review opinion of experts was considered in finalizing the ultimate score. th

Analysis of data: Data thus generated were analysed with the help of Microsoft excel 2007 and SPSS version 16 software. Necessary tables were generated for inferential decisions.

RESULTS AND DISCUSSION The present study has been an attempt to look into head of adolescents by adopting a globally accepted ‘HEEADSSS’ approach of WHO. There are three distinct stages in the maturation process of any programme viz. conceptual stage, operational stage and practice stage. As far as HEEADSSS approach is considered, it is still in conceptual stage. Extensive literature search through print and electronic media have not cited a single scientific pursuit where an attempt has been made to develop a comprehensive scoring system on the basis of parameters and sub parameters considered in HEEADSSS approach, without which influence of specific variables on psychosocial status cannot be pinpointed in a precise manner. The comprehensive scoring system evolved on PEER opinion may have some inherent limitations, but its scope is unlimited. Expert opinion in hazy areas is a valid epidemiological approach to develop vision about unexplored areas. Weight for parameters considered in the components were based on PEER opinions giving due considerations to practicality and wider applicability.


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Environment pertaining to home, education and employment accounted for 27% of the total psychosocial risk score (100). The contribution of sexuality, suicide and safety to the overall score was 42%. Parameters related to weight status (eating and activity) were assigned score of 16. Table-1: Allocated risk scores to ‘Home’ component of HEEADSSS for psychosocial status.

Beside good relations with all family members, closeness of someone to heart is essential to express or share some very personal moments of life. Family bondage and phenomenon of migration influence

Home

the psyche of adolescent girls and for development of their individual Have own room

ideologies separate identities are also required in terms of possession of certain goods including their own room, although it may leads to

Relationships at home

due to easy access to mass media or other media of communication. Considering this fact in mind higher score was allocated to the girls who did not have their own room, have subjectively bad relations with family members and felt no one closest to them. The role of a cohesive orderly

0.5

No

0.75

To whom closest at

Father

0.75

home

Sister

0.5

Other

0.75

None

1

9

Anyone new at home (living > 6 months)

home for a long time (>6 months) were felt as inertias in adapting the new

Someone left recently (within 6 months)

environment easily, so considered to affect the psychosocial behaviour specially adolescent girls. Study subjects who ever had run away from

Moved recently (within last 1 year)

home, who felt any physical violence at home and who did not feel home as a safe place were put in a high risk zone as these kinds of behaviours may lead to other factors (e.g. rape, injury, physical and sexual abuse) to

Ever had to live away from home (> 6 months)

dominate and affect the psychosocial status of girls. Feeling of not being safe even at the safest place for a growing girl (home) is definitely a

Ever run away

situation of chronic stress and can suppress her psychosocial growth. The role of interdependent family oriented outlook and cultured meanings

Any physical violence on girl at home

assigned to number of activities carried out in the home have tremendous . Considering these

Feel safe at home

parameters score assigned to ‘home’ was 13 (Table 1).

1.5 0

amply highlighted by Lau & Kwok (2000). Moving in or out of someone from family, recent shifting of family to a new place and living away from

Bad

0

Mother

family environment in positive development among adolescents has been

influence on people’s psychosocial outlooks

Yes

Good

inculcation of behaviour that might not be acceptable as per family values

10, 11

Total score = 13

Yes

0.5

No

0

Yes

0.5

No

0

Yes

0.25

No

0

Yes

1.5

No

0

Yes

2.5

No

0

Yes

2

No

0

Yes

0

No

2.5

Girls who never went to school or had to leave school due to some compulsion or unavoidable circumstances, who any favourite subject or

h

least interest

, who could not perform

well academically during previous year or performance has decreased recently and to whom ever had to repeat a class were considered at risk of abnormal psychosocial development because these kind of situations give a feeling of

behind . For

some better students this kind of feeling may be a precursor of depression, and can also disturb her psychological stability and 12

behaviour towards her colleagues. Williamson (2006)

has also emphasized the importance of environment during childhood

in the development of greater confidence and perception of academic self efficiency during college days. Higher risk score was allocated to the girls who had changed school in past 2 years, who were not exposed to coeducational environment, who did not feel school a safe place, who have bad relations with people at school, who did not have friends in the school, who ever had been suspended, who felt herself not connected with the school and considered dropping out herself from the school


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because these kind of situations may create an environment in which not only academic performance deteriorates but also personality development affects. Co educational environment is gradually becoming the necessity of time especially for girls to make them stand on the same platform as boys, because coeducation may provide them a chance of feeling equity or betterment, though chances of developing risky sexual behaviour cannot be underestimated. The experience of home and schools are reflected in the

Table-2: Allocated risk scores to ‘Education and Employment’ component of HEEADSSS for psychosocial status Education and Employment

attitude and control of behaviour in the later part of life. problems

and

13

Social

performance

school are closely linked.

14

at Any

girl who did not have any future academic or employment goal and who had to devote their lot of time

in

some

Going to school

economically

Favourite subjects at school Least favourite subject Grades last year

productive work other than study were considered to have a hazy own future because work profile in

Any recent changes in grades

terms of hours pushes them at risk of psychosocial abnormality. Choice

of

future

goals

also

depends on socioeconomic status of the family

15

Ever had to repeat a class

. According to a

Changed schools in the past 2 years Co-education

study on an average 12.52 hours per day has been spent by adolescent girls on household chores and other non earning activities whereas a meager 2.44

School is a safe place How well get along with the people at school Have friends at school

hours on average has been found to be spent on earning activities. 16

Girls who did not feel any adult

Ever been suspended Feel connected to school

in school to whom she could talk to about something important or personal may be due to the unsafe school environment or

Ever considered dropping out Future education/employment plans/goals

may represent a hesitating nature of girl; this kind of behaviour was considered

risky.

Working (other than student)

Considering

these parameters score assigned to ‘Education and Employment’

Any adults at school to whom could talk to about something important

was 14 (Table 2).


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Total score =14 Yes No (left due to family pressure) No (left due to own reason) Never Yes No Yes No I II III DNK Yes (decreased) No or increased DNK Yes No Yes No Yes No Yes No V. Good Good Bad Yes No Yes No Yes No Yes No Yes No Yes >6hr Yes >4-6hr Yes >2-4hr Yes 4times Yes 1-3times No Yes No No < 0.5 hr >1 hr Yes No Good if Increased Good if Decreased Good if Maintained

1.5 0.5 0 0 0.25 0.5 0 1 1 0 0.25 1 0.5

(Table 3). Participation in any sports or any socio-cultural activities

Table- 4: Allocated risk scores to ‘Activities’ component of HEEADSSS for psychosocial status.

and having any hobby were considered good for psychosocial development. Assigned score for activity component was 8 (Table 4). TV watching and access to mass media was considered essential for development

Activities

Total score 

8

Do you participate in any sports or other activities Do you have any hobbies

Yes No No Yes No < 2 hr >2-4 hr >4-6 hr > 6 hr Yes No No activity Any activity Just gossip Domestic work Any productive work

0 3 1.5 0 0.5 0 0.5 1 2 0 0.5 0.5 0 0 0.5 0.5

of psychosocial status in a constructive direction as it may be a source of connection with outer world and can give a multidirectional thoughts but being addictive and

How much TV do you watch in a day

devoting a lot of tiem (>4 hours a day) for it can also be a risky situation. Tremendous influence of TV watching and access to mass media on the psychosocial well being of the adolescents has been amply highlighted by several studies, study

26

16, 25

contrary to the findings of another

.


Do you know about computer or Internet What do you and your friends do for fun What do you and your family do for fun

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Knowledge of computer and internet was considered a fine approach in psychosocial development in the context of recent technology advancement. Feeling of isolation and not able to be an active participant in any fun activity in friend circle was reckoned as perilous behaviour. Spending some time with family members just for gossip was thought to be vital for stress relieving phenomenon. Addictive behaviour of self, any friend and family member for any kind of drugs or substance was considered risky in psychosocial development of adolescent girl. It has been rightly mentioned by Brown et al

27

, that smoking is starting point in 28

any drug addiction process. High level of ever used tobacco has been reported by Jindal et al . Some workers have studied the form rich tobacco products were used in different settings and caste groups.

29, 30

Table- 5: Allocated risk scores to ‘Drugs’ component of HEEADSSS for psychosocial status. However, this component was not analysed in

Drugs

the study. Girls who gave any previous history of drug or alcohol problem in the family were thought to be at risk as these kinds of situations have everlasting effect in the developing brain. In many societies express social norms contempt pre-marital sex.

31

However due

to poor achievements in many spheres of life and drug addiction one may indulge in sexual behaviour.

32

Considering these sub-components score assigned to

Total score=15 Friends

Family

Self

Tobacco

2

2

2

Alcohol

1

1

2

Other drugs

1

1

2

Nothing

0

0

0

Any history of alcohol or drug problems in your family

Yes No

1 0

‘Drugs’ was 15 (Table 5) Enhance a relationship up to physical without being aware about ‘safer sex’ and ‘Sexually Transmitted Diseases’ (STDs) was considered as risky behaviour when even inter gender romantic relationships before marriage is itself unacceptable in Indian societies specially in rural areas. In other situation if someone is forced to do something sexual has definitely a pessimistic effect on psychosocial development. Girls who had developed physical relations and always worried to be pregnant and not using any method of contraception or using some wrong method due to lack of awareness were

considered

adolescent

at

friendly

high

risk.

Although

reproductive

health

services are integral component of RCH II, but

Table-6: Allocated risk scores to ‘Sexuality’ component of HEEADSSS for psychosocial status. Sexuality Ever been in a romantic relationship Ever been sexual relationships Know about "safer sex"

it has not been operationalized in the public health sector. Beside few centres in the country, separate adolescent clinics are not in

Ever been forced to do something sexual that she didn't want to do

vogue. The debate for including sex education

Ever been pregnant or worried that she may be pregnant

in schools is still continuing. The argument

What are using for birth control

placed by Abraham (2005)

33

in this regard is

need of hour. Findings of several studies also support

her

view.

34-40

Considering

Satisfied with method for birth control

these

parameters score assigned to ‘Sexuality’ was

Know about STDs

12 (Table 6)


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Total score=12 Yes No Yes No Yes No Yes No Yes No Nothing Any wrong method Any scientific method Yes No Yes No

0.5 0 2 0 0 1.5 2 0 1.5 0 2 2 0 0 1 0 1.5


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Feeling of sad or down more than usual and getting bored all the time even in a group of friends or family may be a foregoing phenomenon for depression if associated with trouble in getting to sleep. Trouble in getting to sleep can leave scope for recollecting some noxious events which again lead to insomnia.

So this vicious cycle can also be fore step for

development of depression and day time sleepiness, which leads to loss of interests in works which were previously enjoyable. Table-7: This kind of situation may compel her for thinking of hurting or killing herself, at times or always and if situations agglomerate these thoughts may be converted in to some life threatening activities. By

Allocated risk scores to ‘Suicide and depression’ component of HEEADSSS for psychosocial status.

Suicide and Depression Feel sad or down more than usual

Total score=16 Yes 3 No 0 Yes 2 No 0 Yes 1 No 0 Yes 2 No 0 Yes 3 No 0 Yes 2.5 No 0 Yes 2.5 No 0

"Bored" all the time

taking this fact in mind these kind of behaviours were given higher scores. Suicide and depression are

Trouble getting to sleep

cumulative effects of physical and mental abuse. Initially it starts with behavioural and emotional problems. Abused children are at higher risk of depressive disorders.

30, 41

ideation in female.

Ever tried to kill herself

These processes may be

responsible for higher lifetime prevalence of suicidal 42

Lost interest in things that used to really enjoy

Ever had to hurt herself

Assigned score for ‘Suicide and Thought a lot about hurting herself or someone else

Depression’ component was 16 (Table 7)

Girls who were found in threatened situations of any kind of violence (physical, sexual etc.) were allocated a higher score. Serious physical injuries were put in the direction of risky psychosocial behaviour because they indicate a safety issue for girls especially if these injuries were due to beaten by someone in family,

Table-8: Allocated risk scores to ‘Safety (Savagery)’ component of HEEADSSS for psychosocial status. Safety (Savagery) Ever been seriously injured Any violence in home

school or workplace. Safety of adolescent girls is generally relatives.

endangered

16, 30

by

family

members

and

Violence at home has a direct repercussion

on child safety.

43, 44

Physical fight in school and

neighbourhood and continuation of these fights were considered dicey. Considering these parameters score assigned to ‘Safety (Savagery)’ was 14 (Table 8)

Does the violence ever get physical Ever been physically or sexually abused Gotten into physical fights in school or neighbourhood Still getting into fights

Total score = 14 Yes (Beaten by someone) Yes (Accidental) No Yes No Yes No Yes No Yes No Yes No

3 1 0 2 0 3 0 3 0 1.5 0 1.5 0

The overall psychosocial risk score was categorized as normal (0-10), mild risk (>10-20), moderate risk (>20-30), severe risk (>30-40) and very severe risk (>40) by the experts. As much as 40.0%, 43.6% and 11.75% study subjects were categorized as mild, moderate and severe risk for psychosocial abnormality, respectively. The Contribution of mean scores of different components of HEEADSSS to their maximum allocated score is given in table 9.


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The proportion contribution to the overall risk score is given in figure 1. The differing figures in these presentations are due to differences in the denominator used for competitions. Table- 9: Contribution of mean scores of different components of HEEADSSS to their maximum allocated score Maximum allocated score

Mean + SD

% contribution

Home

13

2.22 + 1.34

17.1

Education and Employment

14

4.03 + 3.41

28.8

Eating

8

2.62 + 0.96

32.7

Activities

8

2.35 + 1.60

29.4

Drugs

15

2.47 + 1.23

16.5

Sexuality

12

3.73 + 1.40

31.1

Suicide and Depression

16

1.10 + 1.77

6.9

Safety

14

3.27 + 2.60

23.4

Total HEEADSSS

100

21.76 + 7.32

21.8

Parameters

.

CONCLUSION AND RECOMMENDATION Comprehensive scoring system evolved on the basis of PEER opinion is the pioneering work and have been first time Figure 1: Proportion contribution of different components of HEEADSSS

attempted globally and gives due consideration to wider applicability in epidemiological research and clinical settings particularly in adolescent guidance clinic. Majority of the adolescent girls were at psychosocial risk, and nearly one out of ten were at severe risk.

Sexuality 22%

Suicide and Depression 6%

Safety 18%

Although HEEADSSS approach is getting its root in adolescent clinic, it will be worthwhile to adopt the comprehensive scoring system evolved here to measure the effect of service rendered to them. Findings of the study calls for IEC efforts that should be initiated in schools for enhancing coping capabilities of

Drugs 14%

Home 12% Activities 13%

Eating 15%

Education and Employment 18.52 0%

adolescents in home, school and place of employment. The present scoring system can be incorporated as a tool to assess efficacy and effectiveness of intervention programmes directed towards risk reduction in adolescent girls.

REFERENCES 1.

Press Release - Investing In Adolescents Can Break Cycles Of Poverty And Inequity [Internet] 2011. UNICEF India. http://www.unicef.org/india/media_6785.htm

2.

Friedman H.L. Changing Patterns of Adolescent Sexual Behavior : Consequences for Health and Development. J. Adoles, Health 1992; 13:345-350.


250


MK Gupta et al


3.

Kaur and Jagpreet. Gender differences in perceptions of home environment among Indian adolescents. Journal of Social and Psychological Sciences 2009; 2(2): Accession Number: 219656806

4.

Cheung P, Ip P, Lam S, Bibby H. A study on body weight perception and weight control behaviours among adolescents in Hong Kong. Hong Kong Medical Journal. 2007; 13: 16-21.

5.

Drug Abuse, RESEARCH REFERENCE AND TRAINING DIVISION. Vol.No. XLIV 12 June 2000 R.No. 4. [Internet]. http://www.rrtd.nic.in/DrugCover.htm

6.

Robert E R, Attkinson C, Rosenblatt A. Prevalence of psychopathology among children and adolescents. Am J Psychiatry 1998; 155(6): 715- 724.

7.

Carl E Pickhardt. Safety warnings for your adolescent. [Internet] 2010. http://www.psychologytoday.com/blog/survivingyour-childs-adolescence/201004/safety-warnings-your-adolescent

8.

Goldring J, Rosen D. Getting into adolescent heads: an essential update. Contemp Pediatr 2004;21:64

9.

Lau, Sing, Kwok, Lai-Kuen. Relationship of family environment to adolescents' depression and self-concept. Social Behaviour and Personality: An International Journal. 2000; 28 (1): 41-50.

10.

Miller J G. Bringing culture to basic psychological theory–Beyond individualism and collectivism. Psychological Bulletin. 2002; 128(1): 97–109.

11.

Phinney J S, Kim-Jo T, Osrio S, Vilnjalmsdotter P. Autonomy and Relatedness in Adolescent-Parent Disagreements: Ethnic and Developmental Factors. Journal of Adolescent Research. 2005; 20(1): 8–39.

12.

Williamson, Daniel G. The relationship between perceived early childhood family influence, attachment, and academic self-efficacy: An exploratory analysis. Dissertation Abstracts International, 2006, 66(7): 2495-A.

13.

Lai, Ka Wai, McBride-Chang, Catherine. Suicidal ideation, parenting style, and family climate among Hong Kong adolescents. International Journal of Psychology. 2001; 36(2): 81-87.

14.

Paul D, Priscilla S, Siwach S, Gopalakrishanan S, Pant S, Gupta T. Assessments of Psychosocial Morbidities among Adolescents Going to Schools of South-West Delhi. NIPCCD. A Report, 2006.

15.

Verma S, Saraswathi T.S. Adolescence in India: An annotated bibliography. Rawat Publications Jaipur and New Delhi. 2002.

16.

Sinha A K. Socio-economic conditions of adolescent girls: A Case Study of Backward District of Poverty Dominated States. Final Report Submitted to PLANNING COMMISSION: Government of India, New Delhi. 2007.

17.

Al-Sendi A, Shetty P, Musaiger A. Body weight perception among Bahraini adolescents. Child: Care, Health & Development. 2004; 30: 369-376.

18.

Cheung P, Ip P, Lam S, Bibby H. A study on body weight perception and weight control behaviours among adolescents in Hong Kong. Hong Kong Medical Journal. 2007; 13: 16-21.

19.

Rierdan J, Koff E. Weight, weight-related aspects of body image, and depression in early adolescent girls. Adolescence. 1997; 32: 615-625.

20.

Daniels J. Weight and weight concerns: Are they associated with reported depressive symptoms in adolescents? Journal of Pediatric Health Care. 2005; 19: 33-41.

21.

Siegel J M. Body image change and adolescent depressive symptoms. J Adolesc Res. 2002; 17(1):27-41.

22.

Eisenberg M E, Neumark-Sztainer D, Story M. Associations of Weight-Based Teasing and Emotional Well-being Among Adolescents. Arch Pediatr Adolesc Med. 2003; 157: 733–38.

23.

Dave D, Rashad I. Overweight Status, Self-Perception and Suicidal Behaviors among Adolescents. Public Policies and Child Well-Being Conference, May 15-16, 2006

24.

Kim O, Kim K. Body weight, self-esteem, and depression in Korean females. Adolescence. 2001; 36(142): 315-322.

25.

Pratinidhi A K, Gokhale R M, Karad S R. Evaluation of Sex Education and AIDS Prevention Project in Secondary Schools of Pune City. Indian Journal of Community Medicine. 2001; 26(3): 155-161.

26.

Das D K, Biswas R. Gender Inequality among Adolescents in Participation of Activities for Self-Development in Rural West Bengal. Indian Journal of Community Medicine. 2006; 31 (1): 44-45.

27.

Brown B B, Larson R, Saraswathi T S (Eds. 2002). The world’s youth: Adolescence in eight regions of the globe. New York: Cambridge University Press pp 344-362.


251


MK Gupta et al


28.

Jindal SK, Aggarwal AN, Gupta D, Kashyap S, Chaudhary D. Prevalence of tobacco use among school going youth in North Indian States. Indian J Chest Dis Allied Sci. 2005; 47:161–6.

29.

Mini G K, Moli G K. Tobacco Use among Adolescents in India: Results from National Family Health Survey-2, 1998-99. India Journal of Population Education. 2006: 59-64.

30.

Khurana S, Sharma N, Jena S, Saha R, Ingle G K. Mental Health Status of Runway Adolescents. Indian Journal of Pediatrics. 2004; 71(5): 405-409.

31.

Brown A D, Jejeebhoy S J, Shah I, Yount K M. Sexual relations among young people in developing countries: evidence from WHO case studies, Occasional Paper, Geneva: World Health Organization (WHO), Department of Reproductive Health and Research, 2001.

32.

Blum RW, Mmari KN. Risk and protective factors affecting adolescent reproductive health in developing countries, Geneva: WHO, Department of Child and Adolescent Health and Development, 2005.

33.

Abraham L. AIDS Awareness Campaigns, Sex Education Programmes and Pornography: The Shaping of Sexuality Awareness among College Students. The Indian Journal of Social Work. 2005; 66(4):472-511.

34.

Tiwari V K, Kumar A. The Need of Sex Education among Youths: Present Perspectives and Future Prospects. Demography India 2002; 31 (1): 129-159.

35.

Haldar A, Ram R, Chatterjee T, Misra R, Joardar GK. Study of Need of Awareness Generation Regarding Component of Reproductive and Child Health Programme. Indian Journal of Community Medicine. 2004; 29 (2): 96-98.

36.

Patel P, Capor I, Joshi U, Barge S, Uttekar V. Knowledge, Awareness, Belief and Practice on Sexuality and Reproductive Health of Adolescent in Slums of Ahmedabad. CHETNA and Society for Operations Research and Training, Small Research Grants Report No.10, December 2000.

37.

Basir G, Ahmad M, Kasur R, Bashir S. Knowledge, Attitude and Belief on HIV/ AIDS among the Female Senior Secondary Students in Srinagar District of Kashmir. Health and Population – Perspectives and Issues 2003; 26 (3): 101 – 109.

38.

Indo Asian News Service (IANS). Risky sexual behaviour among Jharkhand youths: `Youth in India, Situation and Needs`. 2009-07-29. http://www.sify.com/ news/risky-sexual-behaviour-among-jharkhand-youths-study-news-featuresjh3j4hgifbe.html

39.

Kushwah SS, Mittal A. Perceptions and practice with regard to reproductive health among out-of-school adolescents. Indian J Community Med. 2007; 32:141-3

40.

Mittal K, Goel MK. Knowledge regarding reproductive health among urban adolescent girls of Haryana. Indian J Community Med 2010;35:529-30.

41.

Pathak R, Sharma R C, Parvan U C, Gupta B P, Ojha R K, Goel N K. Behavioural and emotional problems in school going adolescents. Australasian Medical Journal. 2011; 4(1): 15-21

42.

Sidhartha T, Jena S. Suicide Behaviours in Adolescents. Indian Journal of Paediatrics, 2006; 79 (9): 783-788.

43.

Mitra K, Deb S. Stories of Street Children: Findings from a Field Study. Social Change. 2004; 34: 77-85.

44.

Varma S. India: 43 per cent of underage married girls suffer marital violence. 3/9/2011. The Times of India.

----


252
