The World Health Organization's (WHO) Adolescent Health and Development Programme has identified four major causes of death, disability, and ill health among the world's adolescents: sexual and reproductive behavior, tobacco use, suicides, and road traffic accidents (3-5). The leading causes of mortality in 15- to 29-year-olds in the North America and Western Europe include motor vehicle accidents (and other unintentional injuries), suicide, homicide, cancer, and infection (including HIV/AIDS). Approximately one-third of youth have a chronic illness or disability, including 6% with a condition that causes daily limitations and 5% classified as having severe chronic illness or disability (Table 1) (6-9). About 70% have one condition, though about one in five have two diagnoses, and one in 10 have three or more conditions. Current estimates are that 13% to 18% of children in America have a special health care need (9). Over 90% of children with severe illness in America, England, and other developed countries now live past age 20 (10,11).
The impact that chronic illness has on the lives of our children and adolescents is considerable (12). All youth must go through the normal developmental processes of adolescence to become self-functioning adults. All adolescents, whether or not they have a chronic illness (as rheumato-logical disorders), are at a risk for difficulties in adolescence, such as complications of sexuality, substance abuse, mental health disorders, and various other medical disorders. Table 2 lists key adolescent health topics that are considered in this chapter.
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