《儿童少年卫生学 child and adolescent health》拓展阅读：儿童青少年体格生长和体能发育_A life course perspective of maintaining independence in older age.pdf_大学文库

3 LIST OF CONTENTS Page 1. THE LIFECOURSE PERSPECTIVE OF AGEING ........................ 3 2. FETAL DEVELOPMENT........................................................... 4 2.1 Fetal programming....................................................... 4 2.2 Congenital disorders ...................................................... 5 Bibliography .................................................................. 6 3. INFLUENCES IN INFANCY AND CHILDHOOD ..................... 6 3.1 Breastfeeding ................................................................. 6 3.2 Malnutrition in early life ................................................ 7 3.3 Childhood obesity ......................................................... 7 3.4 Childhood infections ..................................................... 7 3.5 Working children........................................................... 8 Bibliography .................................................................. 8 4. ADOLESCENT AND ADULT LIFE STYLE ................................. 9 4.1 Tobacco use .................................................................. 9 4.2 Alcohol ......................................................................... 9 4.3 Illicit drug use ................................................................ 9 4.4 Physical activity ........................................................... 10 4.5 Dietary habits .............................................................. 10 4.6 Body composition........................................................ 11 Bibliography ................................................................ 11 5. INFLUENCES OF SOCIAL ENVIRONMENT .......................... 12 5.1 Economic factors ......................................................... 12 5.2 Education .................................................................... 12 5.3 Cultural and societal factors......................................... 13 Bibliography ................................................................ 14 6. DISEASE DURING THE LIFE COURSE .................................. 15 6.1 Non-communicable diseases ....................................... 15 6.2 Communicable diseases .............................................. 16 Bibliography ................................................................ 17 7. HEALTHY AGEING IN THE FUTURE .................................... 17 Page

THE LIFECOURSE PERSPECTIVE OF AGEING threshold'shown in Figure 1 is not rigidly defined. In a supportive environment an individual who has experienced substantial loss in Ageing can be defined as the process of progressive change in the given functional capacity may continue to live independently while biological, psychological and social structure of individuals. For statistical another, with the same degree of functional loss in a less supportive environment will experience loss of independence. There are also im- example those aged 60 years and above, depending on cultural and portant gender differences in the way we age, with women having a personal perceptions. However, ageing is a life-long process, which begins before we are born and continues throughout life Figure 1: A life-course perspective for maintenance of the highest possible level of functional capacity The functional capacity of our biological systems (eg. muscular strength, cardiovascular performance, respiratory capacity etc. )increases during Functio nal capacity the first years of life, reaches its peak in early adulthood and naturally eclines thereafter This is captured in Figure 1, which has been developed as the conceptual framework of the WHO Programme on Ageing and Health. The slope of decline, however, is largely determined by external factors throughout the life course. The natural decline in cardiac or respiratory function, for example, can be accelerated by smoking, leaving the individual with lower functional capacity than would normally be xpected for his/her age. Similarly, poor nutrition in childhood may predispose through weaker bone structure to the development of osteoporosis in adulthood, thus increasing the slope of decline. The difference in decline in functional capacity between two individuals is often only evident later in life when a sharper descent may result in disabilit bi lity thresh妇 Health and activity in older age are therefore a summary of the living circumstances and actions of an individual during the whole life span Early life interventions to ensure the highest possible functional capacity his conceptual approach presents new opportunities, as people are able to influence how they age by adopting healthier life styles and by adapting to age-associated changes. However, some life course factors, which influence health and ageing, may not be modifiable by the individual For those in older age above the disability threshold, revisiting previous Socio-economic factors, including economic disadvantages and environmental threats, may affect the ageing process by predisposing to disease in later life. In this respect it is important to note that the'disability For those age below the disability threshold, interventions are interventions ing the quality of life

4 1. THE LIFECOURSE PERSPECTIVE OF AGEING Ageing can be defined as the process of progressive change in the biological, psychological and social structure of individuals. For statistical purposes, the aged are commonly placed into specific age groups, for example those aged 60 years and above, depending on cultural and personal perceptions. However, ageing is a life-long process, which begins before we are born and continues throughout life. The functional capacity of our biological systems (eg. muscular strength, cardiovascular performance, respiratory capacity etc.) increases during the first years of life, reaches its peak in early adulthood and naturally declines thereafter. This is captured in Figure 1, which has been developed as the conceptual framework of the WHO Programme on Ageing and Health. The slope of decline, however, is largely determined by external factors throughout the life course. The natural decline in cardiac or respiratory function, for example, can be accelerated by smoking, leaving the individual with lower functional capacity than would normally be expected for his/her age. Similarly, poor nutrition in childhood may predispose through weaker bone structure to the development of osteoporosis in adulthood, thus increasing the slope of decline. The difference in decline in functional capacity between two individuals is often only evident later in life when a sharper descent may result in disability. Health and activity in older age are therefore a summary of the living circumstances and actions of an individual during the whole life span. This conceptual approach presents new opportunities, as people are able to influence how they age by adopting healthier life styles and by adapting to age-associated changes. However, some life course factors, which influence health and ageing, may not be modifiable by the individual. Socio-economic factors, including economic disadvantages and environmental threats, may affect the ageing process by predisposing to disease in later life. In this respect it is important to note that the disability threshold shown in Figure 1 is not rigidly defined. In a supportive environment an individual who has experienced substantial loss in any given functional capacity may continue to live independently while another, with the same degree of functional loss in a less supportive environment will experience loss of independence. There are also important gender differences in the way we age, with women having a Early life interventions to ensure the highest possible functional capacity Adult life interventions aimed at slowing down the decline For those in older age above the disability threshold, revisiting previous interventions For those in older age below the disability threshold, interventions are aimed at improv interventions ing the quality of life 5DQJHRI IXQFWLRQ )XQFWLRQDOFDSDFLW\ $JH /LIHFXUYHRIKLJKHVW IXQFWLRQDOFDSDFLW\ /LIHFXUYHRIUHGXFHG IXQFWLRQDOFDSDFLW\ 'LVDELOLW\WKUHVKROG FKDQJHVLQH[WHUQDOHQYLURQPHQWFDQORZHUGLVDELOLW\WKUHVKROG Figure 1: A life-course perspective for maintenance of the highest possible level of functional capacity

nore likely to develop coronary heart disease in adulthood. These ob- mechanisms, which may determine fetal nutrition and growth, and ovations can even be made in individuals who do have maintained normal body weight later in life. Similar findings were reported for the insulin resistance syndrome, a condition which leads to ept of programming does not dismiss the influences and impor- non-insulin dependent diabetes(Figure 2. 2). More recently, impaired tance of risk factors operating later in life, such as smoking, excessive early growth has been linked with accelerated ageing. a decline in alcohol consumption, inadequate exercise, and obesity, all of which muscular strength(as indicated, for example, by reduced grip strength of contribute to the development of chronic diseases. Instead it proposes the hand) is a marker of ageing, and was found to be more pronounced that these environmental factors amplify the disadvantages that may have among men and w who had low weight at birth. A specific occurred in fetal life. This has important implications for countries where nutritional deficiency is maternal iodine deficiency, which leads to fetal growth retardation is common and rates of smoking, obesity and a hypothyroidism(and subsequently cretinism)in the newborn, if it remaIns sedentary life style are increasing ving fetal development by Figure 2. 2: Prevalence of insulin resistance syndrome in British men aged 64 years according to birthweight targeting health promotion activities at improvement of health and nutrition of girls, young women, and mothers during pregnancy and lactation, especially social groups where fetal growth retar promoting the adoption and maintenance of a healthy life style (chapter 4), with special emphasis on people undernourished while the womb =5.56.5-7.5 2.2 Congenital disorders rthmwe ight (pound s Permanent physical or mental defects in the newborn can be caused by (Source: Barker DIP. Mothers, Babies and Health in Later Life. Churchill Livingston, 1998) genetic disorders, by exposure to toxins, or through infections during pregnancy. Examples of genetic diseases are pheny ketonuria(a metabolic disorder that, if left untreated, can lead to mental retardation), or familial Moreover, the effects of our own fetal development may be carried into hypercholesterolaemia (high cholesterol levels predisposing to the following generation. It has been shown that the two main cardiovascular disease in adult life determinants of a baby's weight are the mother's weight before she conceives and her own birthweight. It may therefore take several Exposure to toxins, such as smoking, drug misuse and excessive alcohol generations before nutrition in the womb can be optimised. Further in- consumption during pregnancy may cause growth impairment and mental tensive research is needed to establish the cellular and molecular retardation in the newborn. Common infections, which may cause long

6 more likely to develop coronary heart disease in adulthood. These observations can even be made in individuals who do not smoke and who have maintained normal body weight later in life. Similar findings were reported for the insulin resistance syndrome, a condition which leads to non-insulin dependent diabetes (Figure 2.2). More recently, impaired early growth has been linked with accelerated ageing. A decline in muscular strength (as indicated, for example, by reduced grip strength of the hand) is a marker of ageing, and was found to be more pronounced among men and women who had low weight at birth. A specific nutritional deficiency is maternal iodine deficiency, which leads to hypothyroidism (and subsequently cretinism) in the newborn, if it remains untreated. mechanisms, which may determine fetal nutrition and growth, and therefore guide interventions. The concept of programming does not dismiss the influences and importance of risk factors operating later in life, such as smoking, excessive alcohol consumption, inadequate exercise, and obesity, all of which contribute to the development of chronic diseases. Instead it proposes that these environmental factors amplify the disadvantages that may have occurred in fetal life. This has important implications for countries where fetal growth retardation is common and rates of smoking, obesity and a sedentary life style are increasing. Improving fetal development by l targeting health promotion activities at improvement of health and nutrition of girls, young women, and mothers during pregnancy and lactation, especially in countries and/or social groups where fetal growth retardation prevails l promoting the adoption and maintenance of a healthy life style (chapter 4), with special emphasis on people undernourished while in the womb 2.2 Congenital disorders Permanent physical or mental defects in the newborn can be caused by genetic disorders, by exposure to toxins, or through infections during pregnancy. Examples of genetic diseases are phenylketonuria (a metabolic disorder that, if left untreated, can lead to mental retardation), or familial hypercholesterolaemia (high cholesterol levels predisposing to cardiovascular disease in adult life). Exposure to toxins, such as smoking, drug misuse and excessive alcohol consumption during pregnancy may cause growth impairment and mental retardation in the newborn. Common infections, which may cause long- (Source: Barker DJP. Mothers, Babies and Health in Later Life. Churchill Livingston, 1998) Figure 2.2: Prevalence of insulin resistance syndrome in British men aged 64 years according to birthweight ! %LUWKZHLJKWSRXQGV 2GGVUDWLRIRULQVXOLQUHVLVWDQFHV\QGURPHDGMXVWHGIRU%0, Moreover, the effects of our own fetal development may be carried into the following generation. It has been shown that the two main determinants of a babys weight are the mothers weight before she conceives and her own birthweight. It may therefore take several generations before nutrition in the womb can be optimised. Further intensive research is needed to establish the cellular and molecular

term injury, include the rubella and cytomegaly virus, and especially 3. INFLUENCES IN INFANCY AND CHILDHOOD malaria infection during pregnancy, which is probably the biggest cause of low birth weight worldwid 3.1 Breast-feeding Reducing disease in the newborn through Protein-energy malnutrition in childhood is common in developing countries and in poorer communities of industrialised countries availability of adequate screening programmes, both pre- and post- Breastfeeding is an effective, low-cost intervention to reduce mainutri- natal, for all pregnant women and their families tion in infancy and childhood. Breastmilk provides ideal nourishment, and protects against infections and allergies, promotes mother/child there s long-term follow-up for those with congenital disease and bonding, and may reduce the development of malabsorpti n synario- e providing information about the risks of toxic substances and the But there is also evidence, that exclusive breast-feeding beyond the age mode of transmission of infectious diseases, which may be hazardous of 6 months may not supply adequate energy to babies, and solid foods to the unborn child. Smoking prevention and cessation programmes should be added to the baby s diet. Infants should be fed exclusively on should be particularly targeted at women breast milk from birth to 4 to 6 months of age; that is, they should be given no other liquids or solids other than breast milk, not even water, promotion of universal immunisation against rubella for girls and for during this period. Continuing to breastfeed up to two years of age or usceptible women beyond, in addition to giving adequate complementary foods, helps to maintain adequate nutritional status and prevents diarrhoea Bibliography 1. Barker DJP Mothers, Babies and Health in Later Life. Churchill Despite this knowledge breast-feeding is not sufficiently encouraged at Livingston, Edinburgh, London, New York 1998 present WHO figures indicate that only 35%of all infants worldwide are exclusively breast fed between birth and 4 months of age 2. Frankel S, Elwood P, Sweetnam P, Yarnell ], Davey Smith G Birthweight, body mass index in middle-age, and incident coronary Increasing rates of breast feeding by heart disease. Lancet 1996: 348: 1 encouraging breast feeding among mothers throughe world 3. The World Health Report 1997. World Health Organization by training health workers who take care of women and infants, on Geneva, 1997 breastfeeding counselling and lactation management sing the media to promote community support for breastfeeding Breastmilk Substitutes and enforcing compliance where adopte

7 term injury, include the rubella and cytomegaly virus, and especially malaria infection during pregnancy, which is probably the biggest cause of low birth weight worldwide. Reducing disease in the newborn through l availability of adequate screening programmes, both pre- and postnatal, for all pregnant women and their families l ensuring long-term follow-up for those with congenital disease and their families l providing information about the risks of toxic substances and the mode of transmission of infectious diseases, which may be hazardous to the unborn child. Smoking prevention and cessation programmes should be particularly targeted at women l promotion of universal immunisation against rubella for girls and for susceptible women Bibliography 1. Barker DJP. Mothers, Babies and Health in Later Life. Churchill Livingston, Edinburgh, London, New York 1998. 2. Frankel S, Elwood P, Sweetnam P, Yarnell J, Davey Smith G. Birthweight, body mass index in middle-age, and incident coronary heart disease. Lancet 1996; 348: 1478-80. 3. The World Health Report 1997. World Health Organization, Geneva, 1997. 3. INFLUENCES IN INFANCY AND CHILDHOOD 3.1 Breast-feeding Protein-energy malnutrition in childhood is common in developing countries and in poorer communities of industrialised countries. Breastfeeding is an effective, low-cost intervention to reduce malnutrition in infancy and childhood. Breastmilk provides ideal nourishment, and protects against infections and allergies, promotes mother/child bonding, and may reduce the development of malabsorption syndromes. But there is also evidence, that exclusive breast-feeding beyond the age of 6 months may not supply adequate energy to babies, and solid foods should be added to the babys diet. Infants should be fed exclusively on breast milk from birth to 4 to 6 months of age; that is, they should be given no other liquids or solids other than breast milk, not even water, during this period. Continuing to breastfeed up to two years of age or beyond, in addition to giving adequate complementary foods, helps to maintain adequate nutritional status and prevents diarrhoea. Despite this knowledge breast-feeding is not sufficiently encouraged at present. WHO figures indicate that only 35% of all infants worldwide are exclusively breast fed between birth and 4 months of age. Increasing rates of breast feeding by l encouraging breast feeding among mothers throughout the world, by training health workers who take care of women and infants, on breastfeeding counselling and lactation management l Using the media to promote community support for breastfeeding l promoting legislation compatible with the Code of Marketing of Breastmilk Substitutes and enforcing compliance where adopted

3.2 Malnutrition in early life and industrialised countries suggest that about 22 million children under ge or 5 years are According to WHO estimates, approximately one third of the world's children suffer from protein-energy malnutrition Overweight in childhood has been linked to such factors as physical activity caused by long periods of TV watching. Over one third of itamin and other nutritional deficiencies may lead to adult diseases overweight children carry obesity into adulthood, thus increasing their like blindness, anaemia, bone disease, and brain damage. lodine risk of developing cardiovascular disease and diabetes deficiency in childhood may lead to learning difficulties, which can be improved by iodine supplementation. Low weight gain in childhood, Reducing childhood obesity through articularly during the first year of life, has been found to be associated with increased risk of cardiovascular disease and diabetes in adulthood e interventions aimed both at obese children and their parents(i.e It is also linked to changes relating to the ageing process, including provision of information about nutritional value of food stuffs and cataract, lower hearing acuity, and reduced muscle strength ccurate labelling of products Malnutrition in childhood increases the risk of acquiring infectious introduction of health promotion activities, which encourage physical diseases, particularly respiratory and diarrhoeal infections, which activity at home and in schools contribute to chronic disease in adult life(chapter 6) education of clinicians to identify overweight children and advise on Improving childhood nutrition through weight reduction measures integrated social policies to improve nutrition in childhood, as food 3.4 Childhood infections security and nutrition are linked to the economic development of countries and individuals Infections in early childhood are common and often preventable. It is providing nutritional information through educational by social estimated that at least 2 million children die each year from infections workers, midwives, health visitors, school environments, and the for which vaccines are available. In those who survive infectious diseases may lead to chronic disorders in later life which can result in premature media death. This is due to both the persistence of the pathogen in the body e early recognition of malnutrition, particularly in underserved rural and the structural and functional impact of infection on the human body Numerous studies have shown that respiratory infections in childhood may determine susceptibility to chronic bronchitis in adult life; children fortification of foods and/or water with micronutrients with poor lung growth before birth are particularly affected. These harmft effects are later magnified by adverse adult life style factors, such 3.3 Childhood obesity smoking and indoor pollution. While undernutrition and malnutrition persist, childhood obesity is Diarrhoeal disease, while often preventable, is common in children increasingly emerging as a global problem. Recent data from developing particularly in developing co H early 20% 8

8 3.2 Malnutrition in early life According to WHO estimates, approximately one third of the worlds children suffer from protein-energy malnutrition. Vitamin and other nutritional deficiencies may lead to adult diseases like blindness, anaemia, bone disease, and brain damage. Iodine deficiency in childhood may lead to learning difficulties, which can be improved by iodine supplementation. Low weight gain in childhood, particularly during the first year of life, has been found to be associated with increased risk of cardiovascular disease and diabetes in adulthood. It is also linked to changes relating to the ageing process, including cataract, lower hearing acuity, and reduced muscle strength. Malnutrition in childhood increases the risk of acquiring infectious diseases, particularly respiratory and diarrhoeal infections, which contribute to chronic disease in adult life (chapter 6). Improving childhood nutrition through l integrated social policies to improve nutrition in childhood, as food security and nutrition are linked to the economic development of countries and individuals l providing nutritional information through educational by social workers, midwives, health visitors, school environments, and the media l early recognition of malnutrition, particularly in underserved rural and poor urban areas l fortification of foods and/or water with micronutrients 3.3 Childhood obesity While undernutrition and malnutrition persist, childhood obesity is increasingly emerging as a global problem. Recent data from developing and industrialised countries suggest that about 22 million children under the age of 5 years are overweight. Overweight in childhood has been linked to such factors as physical inactivity caused by long periods of TV watching. Over one third of overweight children carry obesity into adulthood, thus increasing their risk of developing cardiovascular disease and diabetes. Reducing childhood obesity through l interventions aimed both at obese children and their parents (i.e., provision of information about nutritional value of food stuffs and accurate labelling of products) l introduction of health promotion activities, which encourage physical activity at home and in schools l education of clinicians to identify overweight children and advise on weight reduction measures 3.4 Childhood infections Infections in early childhood are common and often preventable. It is estimated that at least 2 million children die each year from infections for which vaccines are available. In those who survive, infectious diseases may lead to chronic disorders in later life, which can result in premature death. This is due to both the persistence of the pathogen in the body and the structural and functional impact of infection on the human body. Numerous studies have shown that respiratory infections in childhood may determine susceptibility to chronic bronchitis in adult life; children with poor lung growth before birth are particularly affected. These harmful effects are later magnified by adverse adult life style factors, such as smoking and indoor pollution. Diarrhoeal disease, while often preventable, is common in children, particularly in developing countries. WHO estimates that nearly 20% of

all deaths in children under the age of 5 years in the developing world occupational accidents are high. The effects of those exposures and are due to diarrhoeal disease. One million deaths due to measles another long working hours without rest frequently lead to chronic disease and common but preventable childhood infection, were recorded in 1995 Other infectious diseases, such as river blindness, malaria and tuberculosis, may cause life -long and often debilitating functional improving employment opportunities for adults Combating infection by legislation against and regulation of child labour(introduction of la bels marking products not manufactured by children has been publicising the availability and promoting the up-take of immunisa providing access to free schooling, and facilitating enrolment for all combating"vaccine fatigue(which has increased in industrialised creating safer work environments countries) through educational efforts, using health visitors or the reducing domestic overcrowding, and improving housing and on, to reduce transmission of infections 1. Kuh D, Ben-Shlomo Y(eds). A Life Course Approach to Chronic Disease Epidemiology. Oxford University Press, Oxford, 1997 promoting safe water supply, frequent hand washing and good food 2. Barker DJP ers, Babies and Health in Later Life. Churchill hygiene to prevent transmission of diarrhoeal disease providing early diagnosis of and access to therapy for infections, for 3. ForastieriV. Children at Work: Health and safety risks. Internatio- example through government policies, which offer free treatment for nal Labour Organization, Child Labour Collection, 1997. the most debilitating diseases (eg. free leprosy treatment in India) promoting breastfeeding 3.5 Working children The International Labour Organisation es es that the number of working children below the age of 15 is 120 million worldwide The issue is complex as in many cases the child 's income is essential to the familys survival. The work is often carried out in hazardous indus- tries, where exposure to toxic substances and pollution and the risks of 9

9 all deaths in children under the age of 5 years in the developing world are due to diarrhoeal disease. One million deaths due to measles, another common but preventable childhood infection, were recorded in 1995. Other infectious diseases, such as river blindness, malaria and tuberculosis, may cause life-long and often debilitating functional disabilities. Combating infection by l publicising the availability and promoting the up-take of immunisation programmes l combating vaccine fatigue (which has increased in industrialised countries) through educational efforts, using health visitors or the media l reducing domestic overcrowding, and improving housing and sanitation, to reduce transmission of infections l promoting safe water supply, frequent hand washing and good food hygiene to prevent transmission of diarrhoeal disease l providing early diagnosis of and access to therapy for infections, for example through government policies, which offer free treatment for the most debilitating diseases (eg. free leprosy treatment in India) l promoting breastfeeding 3.5 Working children The International Labour Organisation estimates that the number of working children below the age of 15 is 120 million worldwide. The issue is complex as in many cases the childs income is essential to the familys survival. The work is often carried out in hazardous industries, where exposure to toxic substances and pollution and the risks of occupational accidents are high. The effects of those exposures and long working hours without rest frequently lead to chronic disease and disability. Promoting a safer childhood by l improving employment opportunities for adults l legislation against and regulation of child labour (introduction of labels marking products not manufactured by children has been suggested) l providing access to free schooling, and facilitating enrolment for all children l creating safer work environments Bibliography 1. Kuh D, Ben-Shlomo Y (eds). A Life Course Approach to Chronic Disease Epidemiology. Oxford University Press, Oxford, 1997. 2. Barker DJP. Mothers, Babies and Health in Later Life. Churchill Livingston, Edinburgh, London, New York 1998. 3. Forastieri V. Children at Work: Health and safety risks. International Labour Organization, Child Labour Collection, 1997

4. ADOLESCENT AND ADULT LIFE STYLE 4.2 Alcohol The numerous so-called life style risk factors, which are listed below, While small amounts of alcohol protect against heart disease in later life, have been associated with disease, disability and premature death in there is no evidence that encouraging drinking is beneficial for the adult life. They are largely determined by harmful behavioural pattern individual or society as a whole. Chronic alcoh ol misuse is associated which are often acquired during adolescence. Harmful life styles are with impaired liver function and cirrhosis, cardiac disease and disorders inter-related: those who smoke tend to drink more; those who drink are of the central nervous system, including alcohol dessa more likely to use illicit drugs, drop out of school earlier, and engage in more violent behaviour. Parental health behaviour is an important before their fifteenth birthday. The overall impact of alcohol on mortality predictor of the life style that children will adopt is high with approximately 774, 000 deaths annually, many of which occur 4.1 Tobacco use in young adulthood, such as those caused by traffic accidents, injuries, violence and homicides. Alcohol misuse may be the result or cause of a WHO estimates that tobacco causes approximately 4 million deaths each range of social problems including job losses, marital breakdown, and year worldwide, all of which are preventable By 2030 this figure is crime. projected to rise to 10 million deaths a year, of which 70% will occur in developing countries. Studies have shown that the majority of smokers Reducing alcohol problems by began the habit before the age of 19 years. Smoking is the cause of up to providing information about the consequences of alcohol consumption 45%of cancer deaths, and contributes to circulatory diseases, including n health, family and society through educational programmes coronary heart disease and stroke, often at younger age beginning at younger ages Smoking is a major contributor to the development of chronic airflow implementing legislation to ban the sale to and/or consumption of struction, which in turn may greatly reduce quality of life in later years alcohol by teenagers, and limiting availability through taxation and Among those already affected by respiratory disorders, smoking tends to pne ce control worsen lung function controlling advertising of alcoholic beverages, and banning those Preventing tobacco use and treating dependence by addressed at young people providing information about the effects of smoking at school providing access to effective, early treatment for alcohol problems, (incorporating teaching modules into national school curricula) liaising with NGO's and organizations that promote healthy life styles legislation to ban tobacco advertising and the sale of tobacco to 4.3 licit drug use increasing tobacco excise taxes Throughout the world the periods most associated with illicit drug use are adolescence and young adulthood. There is evidence from numerous making smoking-cessation programmes more readily available countries that up to 45% of 16-year-olds have tried illicit drugs at least taking the differential needs of adolescents and adults into account once, and up to 29% were current users Most of these young people are (eg peer pressure) cannabis users, but the use of psychoactive substances, including encouraging health insurers to offer lower premiums for non-smokers, amph ecstasy and solvents is increasing among certain groups and to cover costs for smoking cessation programmes in their policies Health risks, which are associated with amphetamine

10 4. ADOLESCENT AND ADULT LIFE STYLE The numerous so-called life style risk factors, which are listed below, have been associated with disease, disability and premature death in adult life. They are largely determined by harmful behavioural patterns, which are often acquired during adolescence. Harmful life styles are inter-related: those who smoke tend to drink more; those who drink are more likely to use illicit drugs, drop out of school earlier, and engage in more violent behaviour. Parental health behaviour is an important predictor of the life style that children will adopt. 4.1 Tobacco use WHO estimates that tobacco causes approximately 4 million deaths each year worldwide, all of which are preventable. By 2030 this figure is projected to rise to 10 million deaths a year, of which 70% will occur in developing countries. Studies have shown that the majority of smokers began the habit before the age of 19 years. Smoking is the cause of up to 45% of cancer deaths, and contributes to circulatory diseases, including coronary heart disease and stroke, often at younger age. Smoking is a major contributor to the development of chronic airflow obstruction, which in turn may greatly reduce quality of life in later years. Among those already affected by respiratory disorders, smoking tends to worsen lung function. Preventing tobacco use and treating dependence by l providing information about the effects of smoking at school (incorporating teaching modules into national school curricula) l legislation to ban tobacco advertising and the sale of tobacco to children l increasing tobacco excise taxes l making smoking-cessation programmes more readily available l taking the differential needs of adolescents and adults into account (eg. peer pressure) l encouraging health insurers to offer lower premiums for non-smokers, and to cover costs for smoking cessation programmes in their policies 4.2 Alcohol While small amounts of alcohol protect against heart disease in later life, there is no evidence that encouraging drinking is beneficial for the individual or society as a whole. Chronic alcohol misuse is associated with impaired liver function and cirrhosis, cardiac disease and disorders of the central nervous system, including alcohol dependence. It is estimated that over 50% of those who report excessive drinking started before their fifteenth birthday. The overall impact of alcohol on mortality is high with approximately 774,000 deaths annually, many of which occur in young adulthood, such as those caused by traffic accidents, injuries, violence and homicides. Alcohol misuse may be the result or cause of a range of social problems including job losses, marital breakdown, and crime. Reducing alcohol problems by l providing information about the consequences of alcohol consumption on health, family and society through educational programmes beginning at younger ages l implementing legislation to ban the sale to and/or consumption of alcohol by teenagers, and limiting availability through taxation and price control l controlling advertising of alcoholic beverages, and banning those addressed at young people l providing access to effective, early treatment for alcohol problems, liaising with NGOs and organizations that promote healthy life styles 4.3 Illicit drug use Throughout the world the periods most associated with illicit drug use are adolescence and young adulthood. There is evidence from numerous countries that up to 45% of 16-year-olds have tried illicit drugs at least once, and up to 29% were current users. Most of these young people are cannabis users, but the use of psychoactive substances, including amphetamines, ecstasy and solvents is increasing among certain groups of young people. Health risks, which are associated with amphetamine