**5. Conclusion**

198 Complementary Pediatrics

• *Eating, Body Image and Exercise:* Adolescents can be especially prone to hazardous eating behavior and unhealthy nutrition choices. Though a regular diet consists of 3 meals per day, meals and snacks tend not to be as structured as in Western countries. There is a wide variety of eating behaviors depending on lifestyle and the demand of one's everyday life. Skipping breakfast, having breakfast as the only meal of the day, having 4 meals including a late night meal, or snacking throughout the day may be normal for some. In addition, some individuals have religious and spiritual reasons to have only one meal per day. Eating disorders have been reported, but are uncommon in Thailand possibly due to a low prevalence or under detection (Limsuwan, 1983). On the other hand, the prevalence of obesity has increased from 6% in 1995 to 22% in 2008 (RCOP, 2009), and dieting is common among Thai adolescents (Aekplakorn & Mo-suwan 2010; Page & Suwanteerangkul, 2007). The media and peers play a major role in the formation of an ideal body image (Thianthai, 2006). Currently, K-pop (Korean pop) and J-pop (Japanese pop) are two popular trends (Winn, 2010). These trends portray adolescent girls, with small physique, white glowing skin, and big eyes. This has resulted in use of cosmetic contact lens to make the cornea look larger and/or change eye color, and complications found are associated with poor hygiene and below standard production of the contact lenses. Fake orthodontic braces worn to look young and wealthy has been associated with heavy metal intoxication. Skin whiteners, popular among adolescent

• *Activities:* Many adolescents in the school system in large cities use their spare time, up to 18 hours/week, to attend extracurricular academic school in order to achieve and get high scores on the national examination for university entrance. Others may participate in motorcycle gangs that race on public streets and highways in the night. These gangs may engage in other high risk behaviors such as alcohol use, other substance use, and unprotected sexual intercourse. Sixty nine percent of Thai children and adolescents use computers and have internet access. Of this group, 21% use it to play games including online games (RCOP, 2009). In areas where the internet is easily accessible, some internet cafés that are close to schools even provide clothes for students in school

• *Drugs:* Common drugs used are tobacco, alcohol, and amphetamine (NSO, Thailand, 2007; RCOP, 2009). Wood alcohol (methanol) can be found especially in areas near the northern, northeastern, and eastern borders of the country; teens should have information about this in order to avoid complications such as blindness. Other cosmetic medications that are used are macro-micro nutrient protein supplements for white glowing skin or for muscularity. There is usage of glutathione injection in order to have the glowing clear and

• *Suicide and mood:* Five to eight percent of Thai adolescents have been found to have depressive symptoms, and 1.1% have tried to commit suicide (RCOP, 2009). Due to culture, Thai adolescents may not be as verbal and may feel pressured to keep their feelings inside. Some may find it hard to verbalize their mood and emotions, especially negative ones; on the contrary, when asked in an appropriate manner, suicidal ideation

fair looking skin. Herbal coffee is commonly used for dieting.

changes in grades, and the school environment.

girls and women, can pose toxic risks.

uniforms to change into.

can be discussed more openly.

adolescents may have lower opportunities for employment (NSO, Thailand, 2008). When interviewing about education, in addition to the open ended non-judgmental approach, it is very reasonable to ask specifically about attending school, grades/

> Adolescence is a dynamic stage of life, with so many changes occurring. Adolescents are a significant part of any country's population and much focus and attention on their needs is required, as they impact a country's health, social, economic, and political status. With the rapid global changes and advancement in technology, adolescents are often 'caught between tradition and progress' (United Nations, n.d.). However, among adolescents globally, there are more similarities than there are differences, and as healthcare providers, we can increase the number of adolescents that achieve health and success by optimizing their care, identifying their challenges, and finding resolutions, in addition to recognizing and promoting their positive attributes and intrinsic resilience.

Adolescent Psychosocial Developmentand Evaluation: Global Perspectives 201

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**11** 

*USA* 

**Comparisons of Bully and Unwanted Sexual** 

A dramatic increase in Internet use among young people in the past decade (Lenhart, 2009) has contributed to a heightened appreciation for the Internet's potential positive (Lenhart, 2009; Rideout, 2001; Ybarra & Suman, 2008) and negative impacts (Guan & Subrahmanyam, 2009; Juvonen & Gross, 2008; Katzer, Fetchenhauer, & Belschak, 2009; Li, 2006; Mitchell, Finkelhor, & Wolak, 2001, 2007; Raskauskas & Stoltz, 2007; Slonje & Smith, 2008; Smith et al., 2008; Wolak, Mitchell, & Finkelhor, 2006; Ybarra, Diener-West, & Leaf, 2007a; Ybarra, Leaf, & Diener-West, 2004) on the health and development of youth. Internet harassment and bullying victimization have received particular research attention, and are consistently found to be associated with psychosocial problems including depressive symptoms, poor caregiver-child relationships, social and behavior problems, and substance use (Guan & Subrahmanyam, 2009; Juvonen & Gross, 2008; Katzer et al., 2009; Li, 2006; Raskauskas & Stoltz, 2007; Slonje & Smith, 2008; Smith et al., 2008; Wolak et al., 2006; Ybarra et al., 2007a). Unwanted online sexual solicitation, defined as being asked to talk about sex, provide personal sexual information, or do something sexual when the youth does not want to when using the Internet, is another area of adolescent health concern. Online sexual solicitation has been associated with psychosocial challenges including depressive symptomatology

Certainly, the Internet is but one environment in which youth must navigate. Victimization has been noted particularly at school, where youth spend a great deal of their time. Studies consistently report that victims of school bullying are significantly more likely to experience negative health and social consequences than non-bullied youth, including health problems, emotional and school adjustment problems, and poorer peer relationships (Due et al., 2005; Hawker & Boulton, 2000; Nansel et al., 2004; Sourander, Helstela, Helenius, & Piha, 2000). Unwanted sexual experiences in the schools is similarly associated with psychosocial

Many studies have reported relative rates of bullying online and offline (Juvonen & Gross, 2008; Katzer et al., 2009; Li, 2006; Raskauskas & Stoltz, 2007; Slonje & Smith, 2008; Smith et al., 2008; Wang, Iannotti, & Nansel, 2009); most report bullying more commonly occurring in

**1. Introduction** 

(Mitchell et al., 2001, 2007; Ybarra et al., 2004).

problems, including alcohol use (Fineran & Bolen, 2006).

**Experiences Online and Offline Among** 

**a National Sample of Youth** 

*Internet Solutions for Kids, Inc, University of Illinois,* 

Michele L. Ybarra, Kimberly J. Mitchell

and Dorothy L. Espelage


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