oa South African Family Practice - Health risk behaviours of high school learners and their perceptions of preventive services offered by general practitioners : original research
Background: Adolescence spans nearly a decade in which young people may initiate health risk behaviours such as unsafe sexual practices and the use of alcohol, tobacco and other drugs (ATOD use). Most adolescent mortality and morbidity, attributable to such health risk behaviours, are preventable. Managing the consequences of health risk behaviours is costly and does not reduce the number of young people making these unhealthy lifestyle choices. The emphasis needs to shift towards the provision of adolescent primary and secondary preventive services. Overseas efforts involve national health risk behaviour screening, the application of national guidelines for primary health care workers in all contexts and continuing evaluation so that appropriate region-specific policies can be instituted. In spite of the completion of the second South African National Health Risk Behaviour Survey and the implementation and evaluation of the National Adolescent-Friendly Clinic Initiative (NAFCI) in government clinics, South Africa still lacks national guidelines for the primary health care worker to administer adolescent preventive services. Furthermore, the NAFCI initiative does not involve the general practitioner (GP) in the private sector. The aim of the research is to provide a profile of adolescent health risk behaviours and describe their GPs' provision of preventive services to address these health risk behaviours.
Methods: This cross-sectional descriptive study was conducted among senior high school learners (grades 10, 11 and 12) from 18 randomly selected secondary public, coeducational schools with an ordinary curriculum in the Johannesburg educational districts, during the first three school terms of 2002. A self-administered research questionnaire was used to ascertain learners' self-reported involvement in health risk behaviours and their interaction with their GP in dealing with these health risk behaviours.
Results: The research questionnaires were completed by 1 139 learners.
- Learners reported a high prevalence of health risk behaviours: 65% for alcohol use, 57% for sexual activity, 39% for tobacco use and 15% for drug use.
- The predominant pattern of substance use was the experimental pattern of having tried these substances: 40% for cigarette use, 53% for alcohol use, 54% for injected drug use and 57% for other drug use. The majority of sexually active adolescents were practising unsafe sex: 55% with multiple partners, 52% without condoms and 28% without family planning.
- Learners reported a high prevalence of coexisting health risk behaviours: 44% for alcohol use and sexual activity, 36% for tobacco and alcohol use and 26% for tobacco use and sexual activity.
- Risk perception was lower for sexual activity (25% felt in danger and 5% felt affected) than for substance use (an average of 82% felt in danger and 40% felt affected).
Of the 1 139 learners, only 271 learners (24%) had a GP in private practice.
- The adolescent-GP interaction was favourable for preventive service delivery: 70% of learners had medical aid cover, 41% had been seeing their GP for more than five years, 92% had a 'family' doctor, 80% had visited their GP in the past six months and 60% had consulted their GP on their own at least once.
- Primary preventive service delivery to those not involved in health risk behaviours was poor: 28% for sexual activity, 24% for drug use, 23% for alcohol use and 19% for tobacco use.
- Uncovering of health risk behaviours occurred to varying degrees: 40% for sexual activity, 18% for alcohol use, 18% for tobacco use and 11% for drug use.
- Secondary preventive service delivery to those involved in health risk behaviours was better: averages of 89% for sexual activity, 84% for drug use, 54% for tobacco use and 38% for alcohol use. Statistically significant learner and GP demographics highlighted the complex dynamics involved in this interaction.
Conclusions: The study showed that adolescents from economically disadvantaged backgrounds have a high prevalence of health risk behaviours but utilise the GP resource to a limited degree. Despite the interaction between adolescent and GP being conducive to the receipt of primary and secondary preventive services, this is not optimal.
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