Introduction
Dear Editor,
We read the article titled “Child Health in the First 100 Years of the Republic of Türkiye: A Story of Hope, Labor, and Success” by Seren with great interest.1 We congratulate the author on their thorough exploration of the advancements in child health during the first century of the Republic. This era has witnessed remarkable progress in healthcare systems, policies, and the overall well-being of children. However, we observed that while the article provides a detailed overview of child health, it does not extensively address the developments in adolescent medicine, a pivotal yet distinct phase of child health. To offer a more holistic perspective, we would like to emphasize the key milestones and achievements in adolescent medicine in Türkiye.
While adolescence is defined within the field of pediatrics, it has long been distinguished from childhood and is defined by the World Health Organization as the period between the ages of 10 and 19.2 Adolescent medicine focuses on addressing the unique physical, psychological, and social health needs of this developmental stage, including growth and development, mental health, chronic illness management, sexual and reproductive health, and the prevention and treatment of risky behaviors such as substance use and unsafe sexual practices. This field bridges the gap between pediatric and adult medicine, providing holistic and developmentally appropriate care tailored to adolescents. Adolescent medicine specialists aim to promote the optimal health and well-being of adolescents and young adults, provide necessary services during the transition from adolescence to adulthood, and increase public awareness of adolescent medicine.
Establishment of Adolescent Medicine Divisions in Türkiye
The first Division of Adolescent Medicine was established in the United States in 1951 by Dr. J. Roswell Gallagher at Boston Children’s Hospital, Harvard University.3 Inspired by this pioneering initiative, Prof. Dr. İhsan Doğramacı sent Prof. Dr. Mithat Çoruh to train at the same clinic. Upon his return, Dr. Çoruh founded Türkiye’s first Division of Adolescent Medicine within the Department of Pediatrics at Hacettepe University Faculty of Medicine in 1963.4 Subsequently, the second division was founded in 1988 at the Institute of Child Health, İstanbul University, followed by the third in 1996 at İstanbul University Cerrahpaşa Faculty of Medicine.5
In 2009, the Council of Higher Education (Yükseköğretim Kurulu) initiated efforts to expand adolescent medicine divisions across Türkiye, beginning with major healthcare institutions in Ankara and İstanbul. Since then, these divisions have proliferated, establishing a greater presence, and clinics offering adolescent medicine services are now accessible in several regions.
Doctoral Education in Adolescent Medicine
Despite its critical importance, adolescent medicine is not yet recognized by the Ministry of Health as an official subspecialty in Türkiye. Historically, pediatricians interested in adolescent health faced limited access to specialized training. To address this gap and accommodate the unique healthcare needs of adolescents, Hacettepe University’s Institute of Child Health launched Türkiye’s first doctoral (PhD) program in Adolescent Medicine in 2004. This program has trained professionals who have since established adolescent medicine clinics nationwide. Subsequently, doctoral programs were established at Istanbul University Faculty of Medicine (2014), Ankara University (2020), and Dicle University (2022). Within the scope of this program, 14 pediatricians have graduated from doctoral education at Hacettepe University Faculty of Medicine to date, and the programs continue to advance the field by cultivating expertise and fostering research.
Adolescent Medicine Associations in Türkiye
Türkiye is home to two active adolescent medicine associations: the first Adolescent Health Association (Adolesan Sağlığı Derneği-ASD), established in Istanbul in 2004, and subsequently the Adolescent Health Association (Ergen Sağlığı Derneği-ESD), established in Ankara in 2007. ESD organized the inaugural National Adolescent Medicine Congress in 2006, which has since been held biennially. ASD began organizing meetings in 2022, further enriching the professional discourse in the field.
Initiatives by the Ministry of Health
Since 2000, the Ministry of Health has launched initiatives to prioritize adolescent health. Forty-one Youth Centers were established within Mother and Child Health and Family Planning (Ana Çocuk Sağlığı ve Planlaması-AÇSAP) Centers, with specialized training provided to multidisciplinary teams. These centers remained inactive after being affiliated with Community Health Centers.
Key milestones include the Adolescent Health Development Workshop in 2013 and the integration of adolescent-specific assessments into the Infant, Child, and Adolescent Monitoring Protocols in 2015, which were updated in 2018.6 In addition, a “Pocket Book for Approaching Adolescent Medicine Problems in Primary Health Care” was disseminated in 2017 to support healthcare providers and is undergoing revision.7
The establishment of Child and Adolescent Substance Addiction Research, Treatment, and Education Centers (Çocuk Ergen Madde Bağımlılığı Araştırma, Tedavi ve Eğitim Merkezi-ÇEMATEM) further underscores the Ministry’s commitment to adolescent health. First launched in 1995 as Volatile Substances Research, Treatment and Education Centers (Uçucu Maddeler Araştırma, Tedavi ve Eğitim Merkezi-UMATEM), these centers now provide specialized care for adolescents across Türkiye.
In 2021, Türkiye opened its first smoking cessation clinic exclusively for individuals under 18 years of age at Ankara Bilkent City Hospital. This initiative expanded to include Hacettepe University and Istanbul Training and Research Hospital in 2023, followed by Ankara University, Başkent University, and other centers in 2024.
Adolescent Health Data
Adolescents (ages 10-19) currently constitute 13 million of Türkiye’s population, while 6.8 million youth fall within the 19-24 age group. While the proportion of youth in the overall population has remained stable, their absolute numbers have increased.8 Mortality trends show a slight decrease in youth mortality rates from the 1980s to 2022, although a significant rise was observed in 2023 (Table I).9-11 External causes of injuries and poisonings, which are the most common cause of death in the 15-24 age group, increased from 2692 (44%) to 9220 (70.7%) from 2022 to 2023. According to the data, the increase in the number and rate of deaths among 15-24 age group in the last year was stated to be caused by the Kahramanmaraş earthquake in 2023.11
| Table I. Youth population and death statistics of Republic of Türkiye8-10 | ||||||
| Year | Total population | Youth population (15-24 age) |
Proportion of youth population in total population (%) | Total death | Youth death (15-24 age) | Proportion of youth deaths in total deaths (%) |
| 1935 | 16 158 018 | 2 433 916 | 15,1 | |||
| 1940 | 17 820 950 | 2 568 914 | 14,4 | |||
| 1945 | 18 790 174 | 3 461 047 | 18,4 | |||
| 1950 | 20 947 188 | 4 350 499 | 20,8 | |||
| 1955 | 24 064 763 | 4 650 353 | 19,3 | |||
| 1960 | 27 754 820 | 4 607 042 | 16,6 | 96 403 | 2 961 | 3,1 |
| 1965 | 31 391 421 | 5 254 191 | 16,7 | 95 427 | 2 878 | 3,0 |
| 1970 | 35 605 176 | 6 545 971 | 18,4 | 104 556 | 3 184 | 3,0 |
| 1975 | 40 347 719 | 7 796 643 | 19,3 | 120 302 | 3 654 | 3,0 |
| 1980 | 44 736 957 | 9 016 986 | 20,2 | 130 062 | 3 860 | 3,0 |
| 1985 | 50 664 458 | 10 191 944 | 20,1 | 141 324 | 3 441 | 2,4 |
| 1990 | 56 473 035 | 11 311 973 | 20,0 | 150 292 | 3 455 | 2,3 |
| 1995 | 169 856 | 4 620 | 2,7 | |||
| 2000 | 64 729 501 | 12 575 362 | 19,4 | 174 315 | 4 072 | 2,3 |
| 2007 | 70 586 256 | 12 397 606 | 17,6 | 212 731 | 3 228 | 1,5 |
| 2008 | 71 517 100 | 12 441 662 | 17,4 | 215 562 | 3 109 | 1,4 |
| 2009 | 72 561 312 | 12 514 737 | 17,2 | 369 440 | 7 052 | 1,9 |
| 2010 | 73 722 988 | 12 545 094 | 17,0 | 366 187 | 6 657 | 1,8 |
| 2011 | 74 724 269 | 12 542 174 | 16,8 | 375 923 | 6 813 | 1,8 |
| 2012 | 75 627 384 | 12 591 641 | 16,6 | 376 000 | 6 608 | 1,8 |
| 2013 | 76 667 864 | 12 691 746 | 16,6 | 372 094 | 6 069 | 1,6 |
| 2014 | 77 695 904 | 12 782 381 | 16,5 | 383 639 | 5 446 | 1,4 |
| 2015 | 78 741 053 | 12 899 667 | 16,4 | 397 037 | 5 076 | 1,3 |
| 2016 | 79 814 871 | 12 989 042 | 16,3 | 420 189 | 5 976 | 1,4 |
| 2017 | 80 810 525 | 12 983 097 | 16,1 | 423 878 | 5 839 | 1,4 |
| 2018 | 82 003 882 | 12 971 396 | 15,8 | 426 785 | 5 905 | 1,4 |
| 2019 | 83 154 997 | 12 955 672 | 15,6 | 436 624 | 5 486 | 1,3 |
| 2020 | 83 614 362 | 12 893 750 | 15,4 | 509 147 | 5 547 | 1,1 |
| 2021 | 84 680 273 | 12 971 289 | 15,3 | 566 624 | 5 877 | 1,0 |
| 2022 | 85 279 553 | 12 949 817 | 15,2 | 505 269 | 6 092 | 1,2 |
| 2023 | 85 372 377 | 12 872 039 | 15,1 | 525 814 | 13 038 | 2,5 |
According to UNICEF’s State of the World’s Children 2024, Türkiye’s adolescent mortality rate was 3% in 2022. According to the Global Health Estimates for 2019 of the World Health Organization the top mortality cause of adolescents aged 15-19 years is interpersonal violence, followed by road injuries and self-harm in both sexes. Additionally, tobacco use among adolescents aged 13-15 years was reported at 17.9%, while alcohol use among adolescents aged 15-19 years was 6% for males and 2% for females in Türkiye. The adolescent birth rate was 1.2% for ages 15-19 years in 2022.12
The Future of Adolescent Medicine in Türkiye
While Türkiye has made significant progress in adolescent health, there remains a need for further advancements, particularly in recognizing adolescent medicine as an official subspecialty. This recognition will enable the training of more dedicated physicians and enhance pediatricians’ ability to address the specific health concerns of adolescents. The continued efforts of adolescent medicine specialists are essential, as the health and well-being of today’s youth lay the foundation for a healthier future society.
We hope this contribution highlights the importance of adolescent medicine in Türkiye’s healthcare journey and inspires further discussions in this field.
Source of funding
The authors declare the study received no funding.
Conflict of interest
The authors declare that there is no conflict of interest.
References
- Seren C. Child health in the first 100 years of Republic of Türkiye: a story of hope, labor and success. Turk J Pediatr 2024; 66: 387-400. https://doi.org/10.24953/turkjpediatr.2024.4523
- World Health Organization (WHO). Adolescent health. 2025. Available at: https://www.who.int/health-topics/adolescent-health (Accessed on Jan 8, 2025).
- American Academy of Pediatrics. Celebrating 90 years of adolescent health. 2023. Available at: https://www.aap.org/en/about-the-aap/gartner-pediatric-history-center/celebrating-90-years-of-adolescent-health (Accessed on Nov 27, 2024).
- Ergen Sağlığı Derneği. Ülkemizde adolesan sağlığının ve Ergen Sağlığı Derneğinin tarihçesi. 2024. Available at: http://www.ergensagligi.org (Accessed on Nov 27, 2024).
- Orbatu D, Haspolat YK. Ergen sağlığı ve hastalıklarına yaklaşım. Ankara: Orient Yayınları; 2024: V-VII.
- T.C. Sağlık Bakanlığı. Bebek, çocuk, ergen izlem protokolleri. Ankara; 2018.
- T.C. Sağlık Bakanlığı. Birinci basamak sağlık çalışanları için ergen sağlığına ve sorunlarına yaklaşım cep kitabı. Ankara; 2017.
- World Health Organization (WHO). Türkiye [Country overview]. 2024. Available at: https://data.who.int/countries/792 (Accessed on Nov 27, 2024).
- Turkish Statistical Institute (TÜİK). İstatistik Göstergeler, Statistical Indicators 1923-2013. Ankara: TÜİK; 2014.
- Turkish Statistical Institute (TÜİK). İstatistiklerle gençlik. 2023. Available at: https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Genclik-2023-53677 (Accessed on Nov 27, 2024).
- Turkish Statistical Institute (TÜİK). Ölüm ve ölüm nedeni istatistikleri. 2023. Available at: https://data.tuik.gov.tr/Bulten/Index?p=Olum-ve-Olum-Nedeni-Istatistikleri-2023-53709 (Accessed on Jan 8, 2025).
- World Health Organization (WHO). Global health estimates. 2024. Available at: https://www.who.int/data/global-health-estimates (Accessed on Nov 27, 2024).
Copyright and license
Copyright © 2025 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
