Annexes

Annex A: The stages of adolescence (PAHO classification)

Annex I.A: Mobile-cellular telephone subscriptions per 100 inhabitants in countries of the Americas, 2000-2016

Subregion/Country	Year
Subregion/Country	2000	2005	2010	2015	2016
North America
Canada	28.43	52.76	75.68	82.98	84.06
Mexico	13.55	42.56	77.52	85.99	88.23
United States	38.47	68.32	91.31	117.59	127.16
Caribbean
Anguilla	19.54	103.36	186.63	177.91	NA^a
Antigua and Barbuda	28.33	104.16	192.68	191.68	194.08
Aruba	16.51	103.38	129.73	135.72	NA
Bahamas	10.59	69.21	118.83	80.29	91.82
Barbados	10.65	75.37	124.85	116.46	115.00
Belize	7.05	35.30	62.93	60.97	63.87
Bermuda	20.69	82.20	135.79	57.95	NA
British Virgin Islands	NA	NA	174.57	198.59	NA
Cayman Islands	25.67	166.47	181.17	155.49	157.68
Cuba	0.06	1.20	8.89	29.65	35.49
Dominica	1.72	73.71	148.34	106.29	107.43
Dominican Republic	8.14	38.78	88.78	82.59	80.83
Grenada	4.23	45.51	116.50	112.25	111.12
Guadeloupe	39.76	NA	NA	NA	NA
Guyana	5.35	36.98	71.29	67.19	66.43
Haiti	0.64	5.40	40.42	68.84	60.54
Jamaica	14.21	73.88	116.07	111.51	115.57
Martinique	42.06	NA	NA	NA	NA
Montserrat	9.87	NA	84.80	96.60	NA
Puerto Rico	34.71	53.00	79.09	87.09	87.75
St. Kitts and Nevis	2.63	103.79	152.81	131.84	136.87
Saint Lucia	1.59	63.88	111.73	101.52	94.82
Saint Vincent and the Grenadines	2.19	64.94	120.56	103.65	102.98
Suriname	8.80	46.60	99.28	136.83	145.94
Trinidad and Tobago	12.77	71.25	142.63	157.67	160.61
U.S. Virgin Islands	32.25	74.51	NA	NA	NA
Central America
Costa Rica	5.39	25.49	66.99	150.66	159.23
El Salvador	12.48	39.72	123.84	145.26	140.75
Guatemala	7.65	35.57	125.98	111.48	115.34
Honduras	2.49	18.58	124.72	95.54	91.22
Nicaragua	1.77	20.52	68.05	116.11	122.14
Panama	13.43	51.95	180.70	174.19	172.30
South America
Argentina	17.58	57.33	141.38	146.70	150.67
Bolivia (Plurinational State of)	6.86	25.88	70.69	92.18	90.75
Brazil	13.29	46.31	100.88	126.59	118.92
Chile	22.01	64.69	115.75	129.47	127.12
Colombia	5.66	50.60	95.76	115.74	117.09
Ecuador	3.85	45.34	98.53	79.77	84.30
Paraguay	15.34	31.96	91.66	105.39	104.77
Peru	4.90	20.14	99.50	109.87	117.06
Uruguay	12.37	34.73	131.59	150.60	148.71
Venezuela (Bolivarian Republic of)	22.32	46.76	96.00	92.97	86.99

Source: (49).
^a NA = not available.

Annex I.B: Number of Facebook users and Facebook penetration (percentage) in the Region of the Americas, by country, as of June 2016

Subregion/Country	Number of Facebook users	Facebook penetration (%)
North America
Canada	22,000,000	60.1
Mexico	69,000,000	53.0
United States of America	201,000,000	61.6
Caribbean
Antigua and Barbuda	50	53.4
Aruba	78	74.6
The Bahamas	210	52.9
Barbados	160	56.0
Belize	160	42.7
Bermuda	39	63.6
Dominican Republic	4,500,000	41.8
Grenada	56	51.9
Guyana	280	36.2
Haiti	1,300,000	11.8
Jamaica	1,100,000	39.1
Montserrat	2,9	56.0
Puerto Rico	2,100,000	57.1
Saint Kitts and Nevis	35	61.6
Saint Lucia	88	46.9
Saint Vincent and the Grenadines	59	53.7
Suriname	260	47.1
Trinidad and Tobago	700	51.1
U.S. Virgin Islands	25	70.5
Central America
Costa Rica	2,900,000	59.0
El Salvador	3,100,000	50.3
Guatemala	5,300,000	31.2
Honduras	2,700,000	32.5
Nicaragua	1,900,000	30.6
Panama	1,700,000	42.6
South America
Argentina	29,000,000	65.5
Bolivia (Plurinational State of)	4,600,000	41.6
Brazil	111,000,000	52.5
Chile	12,000,000	65.5
Colombia	26,000,000	53.0
Ecuador	9,700,000	58.3
Paraguay	2,900,000	42.6
Peru	18,000,000	56.0
Uruguay	2,400,000	69.4
Venezuela (Bolivarian Republic of)	13,000,000	40.7

Source: (48).

Annex II.A: Regional health goals and targets for adolescent and youth health for 2010-2018, under the Regional Strategy and the Plan of Action

Goals and targets
Reduce adolescent and youth mortality
1.1	Reduce the mortality rate of adolescents and youth ages 10-24
Reduce unintentional injuries
2.1	Reduce the mortality rate caused by transport accidents among men 15-24 years of age
Reduce violence
3.1	Reduce the suicide rate among those 10-24 years old
3.2	Reduce the homicide rate among men aged 15-24 years
Reduce substance use and promote mental health
4.1	Reduce the percentage of adolescents between the ages of 13 and 15 who have consumed one or more alcoholic beverages during the last 30 days
4.2	Reduce past-month use of illicit substances among those 13-15 years old
4.3	Reduce tobacco use among adolescents and youth 15-24 years of age
Ensure sexual and reproductive health
5.1	Reduce the percentage of births by mothers 15-19 years old
5.2	Increase the percentage of condom use during last high-risk sex among those 15-24 years old
5.3	Increase contraceptive prevalence among adolescents and youth ages 15-24 years
5.4	Reduce the prevalence of HIV-infected women aged 15-24 years
5.5	Reduce the estimated number of adolescents and youth 15-24 years of age living with HIV
5.6	Reduce the specific fertility rate of adolescents aged 15-19 years old (annual number of live births per 1,000 females 15-19)
Promote nutrition and physical activity
6.1	Reduce the proportion of obese or overweight adolescents 13-15 years of age
6.2	Increase the proportion of adolescents 13–15 years of age who engage in regular physical activity
6.3	Decrease the prevalence of anemia in adolescent women (10-19 years old)
Combat chronic diseases
7.1	Reduce the rate of decayed/missing/filled teeth (DMFT) for 12-year-old adolescents
7.2	Increase coverage of tetanus and diphtheria vaccine among those 10-19 years old
Promote protective factors
8.1	Increase parental knowledge of adolescent activities (GSHS)

Source: (4).

Annex II.B: Leading causes of death in adolescents (aged 10-19 years) in the Americas, 2010-2014

Annex II.B1: Leading causes of death in adolescents (aged 10-19 years) in the Americas in 2010 (43 countries reporting), with number of deaths and age-adjusted rates per 100,000, by sex

Rank	Cause of death	Males		Females		Total
Rank	Cause of death	Number	Adjusted rate	Number	Adjusted rate	Number	Adjusted rate
1	Assault (homicide)	17,501	22.25	2,104	2.8	19,605	12.72
2	Road traffic injuries	9,833	12.51	3,734	4.96	13,567	8.82
3	Intentional self-harm (suicide)	3,928	5.02	1,645	2.20	5,573	3.63
4	Event of undetermined intent	3,196	4.18	623	0.86	3,819	2.56
5	Accidental drowning and submersion	2,519	3.26	474	0.65	2,993	1.98
6	Malignant neoplasm of lymphoid, hematopoietic and related tissue	1,744	2.24	1,174	1.57	2,918	1.91
7	Congenital malformations, deformations and chromosomal abnormalities	920	1.18	736	0.99	1,656	1.08
8	Influenza and Pneumonia	931	1.19	651	0.87	1,582	1.03
9	Accidental poisoning	751	1.00	361	0.50	1,112	0.75
10	Diseases of the urinary system	560	0.72	510	0.68	1,07	0.70
11	Cerebrovascular diseases	530	0.69	402	0.54	932	0.62
12	Malignant neoplasm of brain	456	0.59	359	0.48	815	0.55
13	Pregnancy, childbirth and the puerperium	0.00	0.00	784	1.05	784	0.52
14	Septicemia	407	0.54	346	0.47	753	0.51
15	Accidental threats to breathing	456	0.60	231	0.31	687	0.46
16	Others	14,708		9,533		24,241
	Total	58,44	74.33	23,667	31.46	82,107	53.34

Source: (39).

Annex II.B2: Leading causes of death in adolescents (aged 10-19 years) in the Americas in 2011 (39 countries reporting), with number of deaths and age-adjusted rates per 100,000, by sex

Rank	Cause of death	Males		Females		Total
Rank	Cause of death	Number	Adjusted rate	Number	Adjusted rate	Number	Adjusted rate
1	Assault (homicide)	17,464	22.21	2,119	2.82	19,583	12.73
2	Road traffic injuries	10,042	12.80	3,509	4.67	13,551	8.81
3	Intentional self-harm (suicide)	4,23	5.39	1,91	2.54	6,14	4.00
4	Event of undetermined intent	3,199	4.32	587	0.83	3,786	2.62
5	Malignant neoplasm of lymphoid, hematopoietic and related tissue	1,775	2.27	1,28	1.72	3,055	2.00
6	Accidental drowning and submersion	2,336	3.04	448	0.61	2,784	1.84
7	Congenital malformations, deformations and chromosomal abnormalities	984	1.27	763	1.03	1,747	1.15
8	Influenza and Pneumonia	880	1.13	706	0.94	1,586	1.05
9	Accidental poisoning	778	1.05	373	0.52	1,151	0.79
10	Diseases of the urinary system	556	0.71	454	0.6	1,01	0.66
11	Cerebrovascular diseases	499	0.64	382	0.51	881	0.58
12	Pregnancy, childbirth and the puerperium	0	0.00	830	1.14	830	0.56
13	Malignant neoplasm of brain	453	0.59	320	0.44	773	0.51
14	Septicemia	385	0.52	289	0.40	674	0.45
15	Epilepsy and status epilepticus	396	0.52	257	0.34	653	0.43
16	Others	14,468		9,13		23,598
	Total	58,445	74.46	23,357	31.11	81,802	53.24

Source: (39).

Annex II.B3: Leading causes of death in adolescents (aged 10-19 years) in the Americas in 2012 (39 countries reporting), with number of deaths and age-adjusted rates per 100,000, by sex

Rank	Cause of death	Males		Females		Total
Rank	Cause of death	Number	Adjusted rate	Number	Adjusted rate	Number	Adjusted rate
1	Assault (homicide)	18,212	23.83	2,043	2.80	20,255	13.53
2	Road traffic injuries	10,194	13.35	3,504	4.79	13,698	9.16
3	Intentional self-harm (suicide)	4,207	5.51	1,757	2.40	5,964	3.99
4	Event of undetermined intent	3,183	4.38	603	0.87	3,786	2.66
5	Malignant neoplasm of lymphoid, hematopoietic and related tissue	1,744	2.31	1,123	1.55	2,867	1.94
6	Accidental drowning and submersion	2,395	3.19	404	0.56	2,799	1.91
7	Congenital malformations, deformations and chromosomal abnormalities	961	1.27	758	1.04	1,719	1.16
8	Influenza and Pneumonia	863	1.14	670	0.92	1,533	1.04
9	Accidental poisoning	707	0.98	312	0.44	1,019	0.72
10	Diseases of the urinary system	506	0.68	462	0.64	968	0.66
11	Cerebrovascular diseases	540	0.72	406	0.57	946	0.65
12	Malignant neoplasm of brain	509	0.68	390	0.54	899	0.61
13	Pregnancy, childbirth and the puerperium	0	0.00	778	1.09	778	0.54
14	Septicemia	406	0.55	288	0.40	694	0.48
15	Accidental threats to breathing	489	0.67	203	0.29	692	0.48
16	Others	14,278		8,803		23,081
	Total	59,194	77.55	22,504	30.8	81,698	54.66

Source: (39).

Annex II.B4: Leading causes of death in adolescents (aged 10-19 years) in the Americas in 2013 (37 countries reporting), with number of deaths and age-adjusted rates per 100,000, by sex

Rank	Cause of death	Males		Females		Total
Rank	Cause of death	Number	Adjusted rate	Number	Adjusted rate	Number	Adjusted rate
1	Assault (homicide)	17,497	23.26	1,872	2.60	19,369	13.15
2	Road traffic injuries	9,334	12.42	3,158	4.39	12,492	8.49
3	Intentional self-harm (suicide)	3,937	5.25	1,746	2.43	5,683	3.87
4	Event of undetermined intent	3,025	4.24	534	0.78	3,559	2.55
5	Malignant neoplasm of lymphoid, hematopoietic and related tissue	1,634	2.19	1,131	1.58	2,765	1.89
6	Accidental drowning and submersion	2,22	3.01	393	0.56	2,613	1.81
7	Congenital malformations, deformations and chromosomal abnormalities	851	1.15	761	1.07	1,612	1.11
8	Influenza and Pneumonia	914	1.23	671	0.94	1,585	1.09
9	Accidental poisoning	685	0.94	354	0.52	1,039	0.73
10	Diseases of the urinary system	447	0.6	459	0.64	906	0.63
11	Cerebrovascular diseases	491	0.66	404	0.57	895	0.62
12	Malignant neoplasm of brain	485	0.65	377	0.53	862	0.59
13	Pregnancy, childbirth and the puerperium	0	0.00	748	1.09	748	0.53
14	Accidental threats to breathing	457	0.64	217	0.31	674	0.48
15	Septicemia	388	0.53	269	0.39	657	0.46
16	Others	13,76		8,561		2,2321
	Total	56,125	74.7	21,655	30.12	77,78	52.87

Source: (39).

Annex II.B5: Leading causes of death in adolescents (aged 10-19 years) in the Americas in 2014 (26 countries reporting), with number of deaths and age-adjusted rates per 100,000, by sex

Rank	Cause of death	Males		Females		Total
Rank	Cause of death	Number	Adjusted rate	Number	Adjusted rate	Number	Adjusted rate
1	Assault (homicide)	14,016	21.35	1,548	2.47	15,564	12.1
2	Road traffic injuries	8,205	12.51	2,629	4.19	10,834	8.43
3	Intentional self-harm (suicide)	3,675	5.61	1,622	2.59	5,297	4.13
4	Malignant neoplasm of lymphoid, hematopoietic and related tissue	1,425	2.19	923	1.48	2,348	1.83
5	Accidental drowning and submersion	1,956	2.99	295	0.47	2,251	1.76
6	Event of undetermined intent	1,405	2.28	336	0.58	1,741	1.44
7	Congenital malformations, deformations and chromosomal abnormalities	772	1.18	663	1.07	1,435	1.13
8	Influenza and Pneumonia	713	1.11	561	0.91	1,274	1.01
9	Accidental poisoning	711	1.12	325	0.54	1,036	0.84
10	Malignant neoplasm of brain	437	0.68	301	0.48	738	0.59
11	Cerebrovascular diseases	418	0.64	314	0.51	732	0.58
12	Diseases of the urinary system	372	0.57	359	0.58	731	0.57
13	Accidental threats to breathing	394	0.62	207	0.35	601	0.49
14	Septicemia	314	0.49	263	0.43	577	0.46
15	Pregnancy, childbirth and the puerperium	0	0.00	577	0.93	577	0.45
16	Others	11,731		7,209		18,94
	Total	46,544	71.02	18,132	28.91	64,676	50.40

Source: (39).

Annex II.C: Leading causes of death in youth (aged 15-24 years) in the Americas, 2010-2014

Annex II.C1: Leading causes of death in youth (aged 15-24 years) in the Americas in 2010 (43 countries reporting), with number of deaths and age-adjusted rates per 100,000, by sex

Rank	Cause of death	Males		Females		Total
Rank	Cause of death	Number	Adjusted rate	Number	Adjusted rate	Number	Adjusted rate
1	Assault (homicide)	41,241	53.17	3,765	5.04	45,006	29.53
2	Road traffic injuries	21,869	28.18	5,885	7.87	2,7754	18.21
3	Intentional self-harm (suicide)	9,031	11.69	2,559	3.44	11,59	7.63
4	Event of undetermined intent	6,745	8.93	942	1.29	7,687	5.18
5	Accidental poisoning	2,804	3.71	1,042	1.43	3,846	2.59
6	Accidental drowning and submersion	3,262	4.27	321	0.43	3,583	2.39
7	Malignant neoplasm of lymphoid, hematopoietic and related tissue	1,944	2.52	1,261	1.69	3,205	2.11
8	Influenza and Pneumonia	1,373	1.78	903	1.21	2,276	1.50
9	Pregnancy, childbirth and the puerperium	0	0.00	1,851	2.49	1,851	1.23
10	Human immunodeficiency virus (HIV) disease	1,161	1.54	619	0.85	1,78	1.20
11	Diseases of the urinary system	926	1.20	779	1.05	1,705	1.13
12	Congenital malformations, deformations and chromosomal abnormalities	956	1.24	669	0.90	1,625	1.08
13	Cerebrovascular diseases	829	1.08	669	0.90	1,498	1.00
14	Ischemic heart diseases	746	0.97	302	0.41	1,048	0.69
15	Epilepsy and status epilepticus	576	0.74	369	0.50	945	0.62
16	All others	24,498		13,095		37,953
	Total	117,961	151.97	35,031	46.82	152,992	100.33

Source: (39).

Annex II.C2: Leading causes of death in youth (aged 15-24 years) in the Americas in 2011 (39 countries reporting), with number of deaths and age-adjusted rates per 100,000, by sex

Rank	Cause of death	Males		Females		Total
Rank	Cause of death	Number	Adjusted rate	Number	Adjusted rate	Number	Adjusted rate
1	Assault (homicide)	40,385	52.06	3,657	4.90	44,042	28.90
2	Road traffic injuries	22,103	28.48	5,654	7.57	27,757	18.22
3	Intentional self-harm (suicide)	9,543	12.31	2,781	3.73	12,324	8.10
4	Event of undetermined intent	6,938	9.45	897	1.27	7,835	5.44
5	Accidental poisoning	3,105	4.08	1,102	1.51	4,207	2.82
6	Accidental drowning and submersion	3,116	4.05	341	0.47	3,457	2.29
7	Malignant neoplasm of lymphoid, hematopoietic and related tissue	1,971	2.55	1,317	1.77	3,288	2.16
8	Influenza and Pneumonia	1,184	1.55	836	1.14	2,02	1.35
9	Pregnancy, childbirth and the puerperium	0	0.00	1,92	2.6	1,92	1.28
10	Human immunodeficiency virus (HIV) disease	1,127	1.46	600	0.82	1,727	1.14
11	Diseases of the urinary system	936	1.21	718	0.96	1,654	1.09
12	Congenital malformations, deformations and chromosomal abnormalities	998	1.29	663	0.89	1,661	1.09
13	Cerebrovascular diseases	778	1.01	641	0.86	1,419	0.94
14	Ischemic heart diseases	829	1.08	291	0.4	1,12	0.74
15	Accidental falls	811	1.07	113	0.16	924	0.62
16	Others	23,652		12,889		36,668
	Total	117,603	151.52	34,42	46.06	152,023	99.75

Source: (39).

Annex II.C3: Leading causes of death in youth (aged 15-24 years) in the Americas in 2012 (39 countries reporting), with number of deaths and age-adjusted rates per 100,000, by sex

Rank	Cause of death	Males		Females		Total
Rank	Cause of death	Number	Adjusted rate	Number	Adjusted rate	Number	Adjusted rate
1	Assault (homicide)	41,619	55.14	3,685	5.07	45,304	30.57
2	Road traffic injuries	22,855	30.25	5,569	7.66	28,424	19.17
3	Intentional self-harm (suicide)	9,204	12.19	2,691	3.71	11,895	8.03
4	Event of undetermined intent	7,051	9.80	923	1.33	7,974	5.64
5	Accidental poisoning	2,925	3.97	993	1.39	3,918	2.70
6	Accidental drowning and submersion	3,082	4.14	316	0.45	3,398	2.34
7	Malignant neoplasm of lymphoid, hematopoietic and related tissue	1,908	2.54	1,252	1.73	3,16	2.14
8	Influenza and Pneumonia	1,183	1.57	845	1.17	2,028	1.37
9	Pregnancy, childbirth and the puerperium	0	0.00	1,894	2.63	1,894	1.30
10	Human immunodeficiency virus (HIV) disease	1,144	1.51	577	0.80	1,721	1.16
11	Diseases of the urinary system	929	1.24	766	1.06	1,695	1.15
12	Congenital malformations, deformations and chromosomal abnormalities	912	1.21	675	0.93	1,587	1.07
13	Cerebrovascular diseases	836	1.11	627	0.87	1,463	0.99
14	Ischemic heart diseases	830	1.12	313	0.43	1,143	0.78
15	Nonintentional firearm discharge	825	1.15	92	0.13	917	0.66
16	Others	23,514		12,678		36,192	25.29
	Total	118,817	157.24	33,896	46.61	152,713	102.96

Source: (39).

Annex II.C4: Leading causes of death in youth (aged 15-24 years) in the Americas in 2013 (37 countries reporting), with number of deaths and age-adjusted rates per 100,000, by sex

Rank	Cause of death	Males		Females		Total
Rank	Cause of death	Number	Adjusted rate	Number	Adjusted rate	Number	Adjusted rate
1	Assault (homicide)	39,579	52.98	3,497	4.87	43,076	29.39
2	Road traffic injuries	21,382	28.57	5,09	7.08	26,472	18.03
3	Intentional self-harm (suicide)	8,778	11.75	2,537	3.54	11,315	7.72
4	Event of undetermined intent	6,687	9.36	801	1.16	7,488	5.34
5	Accidental poisoning	3,007	4.12	1,111	1.59	4,118	2.87
6	Malignant neoplasm of lymphoid, hematopoietic and related tissue	1,885	2.53	1,153	1.61	3,038	2.07
7	Accidental drowning and submersion	2,738	3.72	262	0.37	3	2.08
8	Influenza and Pneumonia	1,273	1.71	855	1.19	2,128	1.46
9	Pregnancy, childbirth and the puerperium	0	0.00	1,802	2.53	1,802	1.24
10	Human immunodeficiency virus (HIV) disease	1,187	1.59	520	0.73	1,707	1.16
11	Diseases of the urinary system	895	1.21	695	0.98	1,59	1.10
12	Congenital malformations, deformations and chromosomal abnormalities	910	1.22	688	0.97	1,598	1.10
13	Cerebrovascular diseases	767	1.02	608	0.85	1,375	0.94
14	Ischemic heart diseases	882	1.20	338	0.48	1,22	0.85
15	Septicemia	524	0.72	382	0.54	906	0.63
16	Others	23,285		12,098		35,383
	Total	113,779	152.09	32,437	45.11	146,216	99.62

Source: (39).

Annex II.C5: Leading causes of death in youth (aged 15-24 years) in the Americas in 2014 (26 countries reporting), with number of deaths and age-adjusted rates per 100,000, by sex

Rank	Cause of death	Males		Females		Total
Rank	Cause of death	Number	Adjusted rate	Number	Adjusted rate	Number	Adjusted rate
1	Assault (homicide)	31,259	47.59	2,742	4.35	34,001	26.42
2	Road traffic injuries	18,199	27.66	4,533	7.19	22,732	17.64
3	Intentional self-harm (suicide)	8,471	12.87	2,37	3.77	10,841	8.42
4	Accidental poisoning	3,131	4.8	1,139	1.83	4,27	3.34
5	Event of undetermined intent	2,903	4.61	563	0.94	3,466	2.81
6	Malignant neoplasm of lymphoid, hematopoietic and related tissue	1,691	2.59	1,02	1.63	2,711	2.12
7	Accidental drowning and submersion	2,45	3.75	209	0.34	2,659	2.07
8	Influenza and Pneumonia	1,098	1.68	710	1.13	1,808	1.41
9	Congenital malformations, deformations and chromosomal abnormalities	789	1.21	656	1.05	1,445	1.12
10	Diseases of the urinary system	793	1.23	606	0.98	1,399	1.11
11	Pregnancy, childbirth and the puerperium	0	0.00	1,404	2.24	1,404	1.09
12	Human immunodeficiency virus (HIV) disease	955	1.44	405	0.64	1,36	1.05
13	Ischemic heart diseases	873	1.34	301	0.49	1,174	0.92
14	Cerebrovascular diseases	670	1.02	485	0.77	1,155	0.90
15	Accidental threats to breathing	630	1.00	227	0.37	857	0.70
16	Others	20,165		10,379		30,544
	Total	94,077	143.01	27,749	44.03	121,826	94.54

Source: (39).

Annex II.D: Annex II.D: Evidence-based adolescent health interventions

Annex II.D1: Evidence-based interventions recommended by WHO and PAHO for preventing adolescent suicide, road traffic injuries, and youth violence

Interventions to prevent adolescent suicide
Ecological level	Intervention	Further explanation
Structural and environmental	Adoption of national mental health policies	Related to suicide, these should focus on strengthening effective leadership and governance; providing comprehensive, integrated, and responsive services in community-based settings; implementing strategies for prevention; and strengthening information systems, evidence, and research.
	Policies to reduce harmful use of alcohol	Policy options outlined in the 2010 WHO Global Strategy to Reduce the Harmful Use of Alcohol also support suicide prevention, including policies related to drinking-driving countermeasures, reducing the affordability of alcohol, reducing the exposure to all forms of alcohol marketing, reducing the access to purchasing and drinking alcohol.
	Surveillance of suicide and suicide attempts	Sustainable and long-term surveillance of suicide cases and of hospital presentations due to suicide attempts and self-harm provide critical information for prevention, intervention, and treatment.
	Improved access to health care	Adequate, prompt, accessible treatment for mental and substance-use disorders can reduce this risk of suicidal behavior. Implementing health-literacy policies and practices throughout health systems and institutions is also key.
	Restriction of access to means	Restriction includes legislation to limit access to pesticides, firearms, and medications commonly used in suicide, and safer storage and disposal of each, as well as environmental interventions to prevent suicide by jumping.
	Responsible media reporting	Media guidelines should stress: avoidance of detailed descriptions of suicidal acts, sensationalism, or glamorization and oversimplification; use of responsible language; minimizing the prominence of suicide reports; and educating the public about suicide and available treatments.
	Electronic media strategies for service delivery	Online suicide prevention strategies include self-help programs and professionals engaging in chats or therapy with suicidal individuals. Text messaging is an alternative, particularly when the Internet is not accessible.
	Raising awareness about mental health, substance-use disorders, and suicide	Awareness-raising campaigns aim to reduce stigma and promote help-seeking and access to care. Different types of exposure (e.g., television, print media, the Internet, social media, and posters) can reinforce key messages. At the local level, awareness raising can target specific vulnerable populations.
Community and interpersonal	Interventions for vulnerable groups with a higher risk of suicide	These interventions should be tailored and targeted toward groups that are most at risk of suicide in particular settings. For example, interventions targeting lesbian, gay, bisexual, transgender, and intersex (LGBTI) adolescents should focus on addressing risk factors such as mental disorders, substance abuse, stigma, prejudice, and individual and institutional discrimination.
	Gatekeeper training	For people in a position to identify whether someone may be contemplating suicide (e.g., clinicians or teachers), gatekeeper training develops knowledge, attitudes, and skills for identifying adolescents at risk, determining the level of risk, and referring at-risk adolescents for treatment.
	Crisis helplines	Crisis helplines are public call centers that people can turn to when other social support or professional care is unavailable or not preferred. Helplines can be in place for the wider population or may target certain vulnerable groups, e.g., with peer assistance.
Individual	Assessment and management of suicidal behaviors	The 2016 WHO mhGAP intervention guide recommends comprehensively assessing everyone presenting with thoughts, plans, or acts of self-harm. The guide advises asking any person over 10 years of age who is experiencing a priority mental, neurological, or substance use disorder—or chronic pain or acute emotional distress—about his or her thoughts, plans, or acts related to self-harm and suicide.
	Assessment and management of mental and substance-use disorders	This involves training primary-health-care workers to recognize depression and other mental and substance-use disorders and to perform detailed evaluations of suicide risk. Training should take place repeatedly over years and should involve the majority of health workers in a country.
	Follow-up and community support	Repeated follow-up by health workers for patients discharged after suicide attempts, as well as community support, are low-cost, effective interventions that are easy to implement. Follow-up can include postcards, telephone calls, or brief in-person visits.
Interventions to prevent and mitigate road traffic injuries among adolescents
Ecological level	Intervention	Further explanation
Structural	Drinking age laws	Raising the legal drinking age to 21 years reduces drinking, driving after drinking, and alcohol-related crashes and injuries among youth.
	Blood alcohol concentration laws	Set a lower permitted blood alcohol concentration limit (0.02 g/dl) for young drivers than recommended for older drivers (≤0.05 g/dl). Enforce blood alcohol concentration limits, e.g., with random breath testing of all drivers at a certain point, or only those who appear to be alcohol impaired. Establish penalties and stiff sanctions for driving under the influence of alcohol.
	Seat-belt laws	Promote seat-belt laws for all vehicle occupants, including in back seats. When laws requiring seat-belt use are enforced, rates of use increase and fatality rates decrease. Although most countries now have such laws, half or more of all vehicles in low-income countries lack properly functioning seat belts.
	Helmet laws	Create mandatory helmet laws for two- and three-wheeled vehicles (including tricycles and others), and enforce them. Establish a required safety standard for helmets that are effective in reducing head injuries.
	Mobile phone laws	There is still little information on the effectiveness of these relatively new driving interventions. However, 142 countries prohibit the use of hand-held phones; 34 prohibit hands-free phones; and 42 prohibit text messaging.
	Speed limits	Roads with high pedestrian, child, or cyclist activity should allow speeds no higher than 30 km/h. Limits should be enforced in such a way that drivers believe there is a high chance of being caught if they speed. According to the best practices, maximum urban speed limits should be set at less than or equal to 50 Km/h. Where countries have changed their speed limits, but have taken little action to enforce them, there have been very limited benefits.
	Restriction of young or inexperienced drivers	A graduated licensing system phases in younger driver privileges over time, such as first having an extended learner period involving training and low-risk, supervised driving, then a license with temporary restrictions, and finally a full license.
	Restriction of availability of alcohol	Reducing hours, days, or locations where alcohol can be sold, as well as reducing demand through appropriate taxation and pricing mechanisms, are cost-effective ways to reduce drink-driving among young people. Ban the sale of alcohol at gas stations and along major highways, as these are risky to any driver, including young drivers.
	Legal disincentives to drive unsafely	Make unsafe behavior less attractive, e.g., give penalty points or take away licenses if people drive while impaired.
Environmental	Road design/redesign/traffic calming and safety measures	Examples include infrastructural engineering measures (e.g., speed humps, mini-roundabouts, road narrowing treatments, chicanes, rumble strips, designated pedestrian crossings); visual changes (e.g., road lighting or surface treatment); redistribution of traffic (e.g., one-way streets); promotion of safe public transport, separating pedestrians from other traffic through sidewalks, raised crossings, overpasses, underpasses, refuge islands, and raised medians; improving roadway lighting, including around pedestrian crossings; removing obstacles that block the line of sight between pedestrians and vehicles.
Organizational	Prehospital care	Standardize formal emergency medical services, including equipping vehicles with supplies and devices for children as well as adults. Where no prehospital trauma care system exists: teach interested community members basic first aid techniques; build on existing, informal systems of prehospital care and transport; and initiate emergency services on busy roads and high-frequency crash sites.
	Hospital care	Improve the organization and planning of trauma care services in an affordable and sustainable way in order to raise the quality and outcome of care.
	Rehabilitation	Improve services in health care facilities and community-based rehabilitation to minimize the extent of disability after injury, and help adolescents with persistent disability to achieve their highest potential.
Community	Alcohol campaigns	Make drinking and driving less publicly acceptable; alert people to the risk of detection and arrest, and the consequences; and raise public support for enforcement.
	Speed management	Mass media campaigns linked to other approaches to speed management raise awareness about the dangers of speeding, and gain greater public support for new legislation, stricter enforcement, and stronger penalties.
	Seat-belt campaigns	Public campaigns about seat-belt laws can target adolescents, to increase awareness and change risk-taking social norms.
	Helmet campaigns	Educate adolescents about the benefits of wearing helmets on two-wheeled vehicles, by using peer pressure to change youth norms regarding helmet acceptability and to reinforce helmet-wearing laws.
	Community-based projects	Community projects can employ parents and peers to encourage adolescents to wear seat belts.
Individual	Helmet distribution	Programs that provide helmets at reduced or no cost enable adolescents with little disposable income to use them. Distribution can be taken to scale through the school system.
	Motorized two-wheeler interventions	Promote use of daytime running lights; reflective or fluorescent clothing; light-colored clothing and helmets; and reflectors on the back of vehicles.
	Cyclist interventions	Promote front, rear, and wheel reflectors; bicycle lamps; reflective jackets or vests; and helmets.
	Pedestrian interventions	Promote white or light-colored clothing for visibility; reflective strips on clothing or articles such as backpacks; walking in good lighting; and walking facing oncoming traffic; enacting and enforcing laws on public intoxication; urging pedestrians to abide by road signs and signals, and the rules of the road, to promote a culture of safety.
Interventions to prevent youth violence
Ecological level	Intervention	Further explanation
Structural	Reduce access to and misuse of firearms	Programs may require new legislation, additional police to supervise implementation, public awareness campaigns, and more elaborate monitoring systems.
	Reduce access to and the harmful use of alcohol	Regulate or ban the marketing of alcohol to adolescents, including advertising, promotions and sponsorships of sports and cultural events; restrict alcohol availability (in public places, schools, sports facilities, large events; reduce days, hours and density of outlets; enforce laws to restrict sales to intoxicated youth with penalties/sanctions to bar owners; reduce demand through taxation and pricing; raise awareness and support for policies; and implement interventions for controlling the harmful use of alcohol.
	Financial incentives to attend school	Money is granted on a per-student or per-family basis, and is tied to 80% or higher school attendance. Grants may cover direct costs (e.g., school fees and supplies) and opportunity costs (e.g., when families lose income from child labor).
Environmental	Spatial modifications and urban upgrading	For areas with high levels of violence, situational crime prevention includes a security assessment, a stakeholder analysis, and a planning process involving communities, local governments, and housing, transport, and other sectors.
	Poverty deconcentration	These strategies offer vouchers or other incentives for residents of economically impoverished public housing complexes to move to less impoverished neighborhoods.
	Hotspot policing	Police resources are deployed in areas where crime is prevalent. Mapping technology and geographic analysis help identify hotspots based on combined crime statistics, hospital emergency records, vandalism and shoplifting data, and other sources.
Organizational	Demand- and supply-side interventions for drug control	Drug control may focus on reducing drug demand, drug supply, or both. Most interventions require substantial technical capacity within health services and the police force.
Organizational	School-based bullying prevention	Teachers are trained to recognize and explain bullying to students, what to do when it occurs, effective relationship skills, and skills for bystanders. Specialists work with students involved in bullying. School policies and procedures also may be established, and parents may be trained.
Community	Gang and street violence prevention interventions	This may focus on reducing gang enrollment, helping members leave gangs, and/or suppressing gang activities. Community leaders are engaged to convey a strong message that gang violence is unacceptable. Police involvement, vocational training, and personal development activities may also be included.
Community	Community- and problem-oriented policing	The systematic use of police-community partnerships and problem-solving techniques identifies and targets underlying problems, to alleviate violence. One necessary precondition is a policing system that is legitimate, accountable, nonrepressive, noncorrupt, and professional. Another precondition is good relations among the police, local government, and the public.
Interpersonal	Parenting programs	Goals are to promote parental understanding of adolescent development and to strengthen the parents’ ability to assist their children and adolescents in regulating their behavior through non-violent means.
	Home visits	Home visiting programs monitor and support families while there is a high risk of maltreatment (e.g., families living in highly deprived settings).
	Peer mediation	Peer mediators may be nominated by a class and receive 20-25 hours of training on how to mitigate peer conflicts and seek help if needed. Other students may also be trained in conflict resolution skills.
	Dating violence prevention	School-based or after-school participatory activities address the characteristics of caring and abusive relationships; how to develop a support structure of friends; communication skills; and where and how to seek help in case of sexual assault.
Individual	Life-skills development and social and emotional learning	These age-specific programs help adolescents to understand and mange anger and other emotions, show empathy for others, and establish relationships. They involve 20-150 classroom sessions over several years.
	After-school and other structured leisure time activities	Structured leisure time activities can include cognitive and academic skills development; arts, crafts, cooking, sports, music, dance, and theater; activities related to health and nutrition; and community and parental engagement.
	Academic enrichment	Adolescents are targeted through mass media, after-school lessons, or private tutoring to help them keep up with school requirements and prevent them from dropping out of school.
	Vocational training	Vocational training for at-risk youth can have a meaningful impact on violence prevention if integrated with economic development and job creation. It is important to ensure the capacity of training institutions, available technical equipment, existing cooperation with businesses, and sustainable financing models.
	Mentoring	Volunteer mentors receive training on adolescent development, relationship building, problem solving, communicating, and specific concerns (e.g., alcohol and drug use). A mentor shares knowledge, skills, and perspective to promote an at-risk adolescent’s positive development.
	Therapeutic approaches	Qualified mental health specialists or social workers work with individual adolescents on social skills and behavioral training, anger- and self-control techniques, and cognitive elements (e.g., moral reasoning and perspective-taking to appreciate the negative impacts of violence on victims). Families and social networks of at-risk adolescents may also be targeted.

Source: (6).

Annex II.D2: Evidence-based interventions recommended by the World Health Organization for reducing adolescent tobacco use and exposure

Ecological level	Intervention	Further explanation
Structural and environmental	Reduce the affordability of tobacco	Reduce the affordability of tobacco products by increasing tobacco excise taxes.
	Ban tobacco advertising	Enforce comprehensive bans on tobacco advertising, promotion, and sponsorship, including with cross-border advertising, the Internet, and social media. Also actively promote the entertainment media, cinema, and drama as smoke-free.
	Smoke-free environments	Create bylaws ensuring completely smoke-free environments in all schools, recreational areas, indoor workplaces, public places, and public transport.
Organizational and community	Campaign to raise awareness of the dangers of tobacco	Conduct regular and effective mass-media campaigns to raise awareness of the dangers of tobacco.
Organizational and community	Tobacco prevention within school programs	Integrate tobacco prevention within school policies, skills-based health education, and health services. See Tobacco Use Prevention: An Important Entry Point for the Development of Health-Promoting Schools for age-appropriate knowledge, attitude, and skills-building targets. In no circumstances should these programs be implemented in collaboration with or funded by the tobacco industry.
Individual and interpersonal	Guidance on stopping tobacco use	Clinicians should encourage all nonsmokers to not start smoking; strongly advise all smokers to stop smoking, and support them in their efforts; and advise individuals who use other forms of tobacco to quit. For more specific guidance, see Toolkit for Delivering the 5A’s and 5R’s Brief Tobacco Interventions in Primary Care.

Source: (6).

Anne II.D3: Evidence-based interventions recommended by the World Health Organization to promote adolescent physical activity and healthy diets

Interventions to promote adolescent physical activity
Ecological level	Intervention	Further explanation
Structural and environmental	Urban planning policies	Governments should partner with communities, the private sector, and NGOs to develop safe spaces for physical activity and facilities for sports, recreation, and leisure. Active transport policies should ensure that walking, cycling, and other nonmotorized transport are accessible and safe for all.
Structural and environmental	School and public facilities	Adequate facilities should be available on school premises, youth workplaces and in public spaces for physical activity during recreational time for adolescents (including those with disabilities), with the provision of gender-friendly spaces where appropriate.
Organizational and community	Public awareness programs on physical activity	Provide guidance to children and adolescents, their parents, caregivers, teachers, and health professionals on healthy body size, physical activity, sleep behaviors, and appropriate use of screen-based entertainment.
	Physical education curricula in schools	A good physical education curriculum develops abilities and conditioning; provides activity for specific needs to all children; encourages continued sports and physical activity later in life; and provides recreation and relaxation.
	Regular, structured sports activities	Regular, structured sports activities among adolescents strengthen the links among physical activity, sports, and health, and also reduces sedentary behaviors.
Individual and interpersonal	Guidance on physical activity for younger adolescents	Clinical guidance for adolescents aged 10-17 years recommends: at least 60 minutes of moderate-intensity to vigorous-intensity physical activity daily amounts of physical activity greater than 60 minutes, for additional health benefits most of the daily physical activity should be aerobic; vigorous-intensity activities should be incorporated, including those that strengthen muscle and bone, at least three times per week
Individual and interpersonal	Guidance on physical activity for older adolescents	Clinical guidance for adolescents aged 18-19 years recommends: at least 150 minutes of moderate-intensity aerobic physical activity throughout the week, or at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week (or an equivalent combination of moderate- and vigorous-intensity activity) aerobic activity should be performed in bouts of at least 10 minutes duration for additional health benefits, increase moderate-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity muscle-strengthening activities should be done that involve major muscle groups on two or more days a week
Interventions to promote adolescents having healthy diets
Ecological level	Intervention	Further explanation
Structural and environmental	Nutrient profiles	Develop and use nutrient profiles to identify unhealthy foods and beverages.
	Nutrient labeling system	Implement a standardized global nutrient labeling system; control the use of misleading health and nutrition claims; and implement mandatory front-of-pack labeling.
	Reduce affordability of unhealthy foods and beverages	Tax and increase the pricing of energy-dense, nutrient-poor foods and sugar-sweetened beverages.
	Reduce the impact of marketing of unhealthy foods and beverages	Reduce the impact of marketing of foods and beverages high in sugar, salt, and fat. Establish cooperation between Member States related to cross-border marketing. Implement the WHO set of recommendations on the marketing of foods and nonalcoholic beverages to children.
Organizational and community	Nutrition literacy campaigns	Ensure that appropriate and context-specific nutrition information and guidelines are developed and disseminated to all in a simple, understandable, accessible manner.
	Healthy food environments in schools and other public institutions	Require settings frequented by adolescents (e.g., schools, child care settings, children’s sports facilities and events, and youth workplaces) to create healthy food environments.
	Improved access to healthy food	Improve the availability and affordability of healthy foods in public institutions and settings, particularly in disadvantaged communities.
	Campaigns to raise awareness of adolescent obesity	Campaigns should target policymakers, medical staff, and adults, adolescents, and children in general, promoting capacity-building related to adolescent obesity and its risk factors.
Individual and interpersonal	Guidance on a healthy diet	Clinical dietary guidance for older adolescents (18-19 years) includes: restrict salt to less than 5 g (one teaspoon) per day, reduce it when cooking, and limit processed and fast foods restrict free sugars to less than 10% of total energy intake; a further reduction to below 5% or roughly 25 g (six teaspoons) per day would provide additional health benefits have five servings (400-500 g) of fruits and vegetables per day (one serving is equivalent to one orange, apple, mango, or banana, or three tablespoons of cooked vegetables) limit fatty meat, dairy fat, cooking oil (less than two tablespoons per day); replace palm and coconut oil with olive, soy, corn, rapeseed, or safflower oil; replace other meat with chicken (without skin)
Individual and interpersonal	Weight management interventions for obese adolescents	Develop and support family-based, multicomponent, lifestyle weight management services for adolescents who are overweight (including nutrition, physical activity, and psychosocial support). These should be delivered by multiprofessional teams as part of universal health coverage.

Source: (6).

Annex II.E: Suicidal behavior among students ages 13-15 years in countries of English-speaking Caribbean,^a Southern Cone,^b Andean area,^c and Central America,^d

English-speaking Caribbean
Indicator	Total	Males	Females
General
Percentage of students who ever seriously considered suicide during the 12 months before the survey	20.7 (19.5-21.9)	17.0 (13.9-20.5)	23.9 (21.3-26.6
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	19.9 (18.8-21.1)	15.7 (14.2-17.4)	23.7 (21.9-25.5)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	18.0 (15.1-21.4)	16.6 (13.2-20.7)	19.4 (15.6-23.9)
Students who are current drinkers^e
Percentage of students who ever seriously considered suicide during the 12 months before the survey	26.4 (24.6-28.3)	21.7 (16.7-27.8)	31.6 (26.2-37.6)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	25.0 (23.4-26.7)	18.3 (15.1-22.1)	32.1 (29.2-35.2)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	23.8 (19.3-28.9)	21.7 (14.5-31.3)	26.1 (21.7-31.1)
Students with poor social support^f
Percentage of students who ever seriously considered suicide during the 12 months before the survey	57.5 (48.9-65.6)	62.0 (51.6-71.4)	53.9 (42.7-64.7)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	43.4 (37.7-49.2)	37.4 (19.2-59.9)	48.2 (36.7-59.9)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	47.6 (29.1-66.8)	48.9 (23.7-74.6)	47.5 (32.7-62.7)
Students with strong parental relationships^g
Percentage of students who ever seriously considered suicide during the 12 months before the survey	10.2 (7.6-13.6)	6.4 (4.2-9.5)	13.2 (9.1-18.7)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	10.9 (8.7-13.6)	7.9 (4.4-13.8)	13.1 (10.6-16.1)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	11.5 (8.6-15.2)	NA^h	15.0 (9.9-21.9)
Southern Cone
Indicator	Total	Males	Females
General
Percentage of students who ever seriously considered suicide during the 12 months before the survey	16.5 (14.9-18.3)	10.7 (9.1-12.6)	21.7 (20.0-23.6)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	15.7 (14.2-17.3)	11.3 (9.8-13.0)	19.5 (17.7-21.4)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	15.7 (14.4-17.1)	12.5 (10.4-15.0)	18.3 (16.7-20.1)
Students who are current drinkers
Percentage of students who ever seriously considered suicide during the 12 months before the survey	22.6 (20.4-24.8)	14.0 (11.5-17.0)	30.1 (27.6-37.6)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	21.7 (19.7-23.8)	15.0 (12.3-18.2)	27.3 (25.0-29.8)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	20.6 (19.1-22.3)	15.2 (11.9-19.2)	25.2 (23.0-27.6)
Students with poor social support
Percentage of students who ever seriously considered suicide during the 12 months before the survey	64.4 (50.8-76.1)	60.7 (44.0-75.2)	66.1 (51.5-78.2)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	52.2 (39.1-65.1)	39.4 (26.2-54.2)	60.0 (44.5-73.7)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	45.2 (35.9-54.9)	30.9 (24.3-38.4)	54.3 (38.0-69.7)
Students with strong parental relationships
Percentage of students who ever seriously considered suicide during the 12 months before the survey	9.1 (8.0-10.3)	6.8 (4.8-9.7)	10.9 (9.3-12.7)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	8.9 (7.4-10.7)	6.3 (4.7-8.6)	11.1 (8.7-14.1)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	9.5 (7.9-11.3)	7.8 (6.0-10.0)	10.9 (8.4-14.1)
Andean area
Indicator	Total	Males	Females
General
Percentage of students who ever seriously considered suicide during the 12 months before the survey	18.9 (17.1-20.7)	11.4 (9.8-13.1)	26.4 (24.2-28.6)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	15.4 (13.9-17.1)	9.3 (7.7-11.3)	21.5 (19.6-23.5)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	17.9 (16.4-19.4)	13.0 (11.3-15.0)	22.7 (20.7-24.7)
Students who are current drinkers
Percentage of students who ever seriously considered suicide during the 12 months before the survey	33.2 (28.7-38.1)	20.1 (16.0-24.9)	47.7 (42.3-53.1)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	27.1 (23.2-31.3)	16.5 (12.7-21.2)	38.6 (33.7-43.7)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	30.6 (26.5-35.0)	20.7 (16.3-25.9)	41.6 (36.5-46.9)
Students with poor social support
Percentage of students who ever seriously considered suicide during the 12 months before the survey	50.1 (42.4-57.8)	38.7 (26.2-52.8)	56.5 (45.0-67.3)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	41.2 (33.5-49.3)	29.2 (18.9-42.3)	47.9 (36.4-59.6)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	44.5 (37.0-52.2)	41.9 (28.6-56.4)	45.9 (36.7-55.5)
Students with strong parental relationships
Percentage of students who ever seriously considered suicide during the 12 months before the survey	13.1 (10.6-16.1)	9.8 (6.8-14.0)	15.7 (11.9-20.3)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	9.0 (7.0-11.3)	6.1 (4.1-9.1)	11.2 (8.3-14.8)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	11.3 (8.7-14.4)	NA	12.7 (9.4-17.1)
Central America
Indicator	Total	Males	Females
General
Percentage of students who ever seriously considered suicide during the 12 months before the survey	14.8 (13.7-16.0)	10.7 (9.3-12.2)	18.9 (17.1-20.9)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	13.0 (11.9-14.2)	9.0 (7.6-10.7)	16.9 (15.2-18.6)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	13.2 (12.0-14.5)	9.1 (7.8-10.7)	17.1 (15.3-19.0)
Students who are current drinkers
Percentage of students who ever seriously considered suicide during the 12 months before the survey	30.5 (26.7-34.5)	20.3 (16.2-25.0)	40.4 (35.1-46.0)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	26.9 (23.6-30.6)	17.3 (13.7-21.8)	36.1 (31.4-41.0)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	26.5 (23.0-30.2)	16.1 (12.6-20.4)	36.3 (30.9-42.1)
Students with poor social support
Percentage of students who ever seriously considered suicide during the 12 months before the survey	49.3 (38.6-60.0)	NA	48.3 (34.6-62.2)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	41.8 (32.4-51.8)	NA	43.4 (31.2-56.5)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	45.4 (35.5-55.6)	43.4 (26.6-62.0)	46.4 (33.3-60.1)
Students with strong parental relationships
Percentage of students who ever seriously considered suicide during the 12 months before the survey	5.8 (4.5-7.4)	5.4 (4.0-7.3)	6.3 (4.2-9.3)
Percentage of students who ever made a plan about how they would attempt suicide during the 12 months before the survey	5.7 (4.5-7.3)	4.9 (3.4-7.0)	6.6 (4.8-9.1)
Percentage of students who actually attempted suicide one or more times during the 12 months before the survey	6.4 (5.0-8.0)	5.7 (4.0-8.2)	7.1 (5.1-9.8)

Source: (79).

^a Caribbean countries included in the analysis: Antigua and Barbuda, The Bahamas, Barbados, Cayman Islands, Dominica, Grenada, Guyana, Jamaica, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago.

^b Southern Cone countries included in the analysis: Argentina, Chile, Uruguay.

^c Andean area countries included in the analysis: Bolivia, Colombia (subnational, capital city only), Ecuador (subnational, capital city only), Peru.

^d Central American countries included in the analysis: Belize, Costa Rica, El Salvador, Guatemala, Honduras.

^e Current drinker is defined as having at least one drink containing alcohol on one or more of the past 30 days.

^f The peer social support construct is composed of four questions related to the respondents’ perceptions of their relationships with their peers: 1) how often the respondent feels lonely, 2) the number of close friends they report, 3) how often other students are kind and helpful, and 4) how often they report being bullied.

^g The parental relationship construct is composed of three questions related to respondents’ perceptions of the behavior and attitudes of their parents/guardians, in terms of whether the parents/guardians: 1) checks if homework is complete, 2) understands problems and worries, and 3) really knows what the respondent did in his or her free time.

^h NA = not available.

Annex II.F: Number of adolescents aged 10-19 years living with HIV in Latin America and the Caribbean (LAC) in 2015

Country	Estimated number	Percentage of total
Brazil	28,000	38%
Haiti	8,400	11%
Mexico	6,600	9%
Colombia	5,600	8%
Venezuela (Bolivian Republic of)	3,800	5%
Argentina	3,300	4%
Dominican Republic	3,100	4%
Guatemala	2,800	4%
Peru	2,400	3%
Honduras	1,400	2%
Jamaica	1,200	2%
Ecuador	1,100	1%
Bolivia (Plurinational State of)	1,000	1%
Chile	< 1,000	1%
El Salvador	< 1,000	1%
Guyana	< 1,000	1%
Panama	< 1,000	1%
Paraguay	< 1,000	1%
Nicaragua	< 1,000	1%
The Bahamas	< 500	< 1%
Costa Rica	< 500	< 1%
Trinidad & Tobago	< 500	< 1%
Uruguay	< 500	< 1%
Belize	< 200	< 1%
Cuba	< 200	< 1%
Suriname	< 200	< 1%

Source: (108).

Annex III.A. Adolescent and youth health policies, strategies, and plans of countries of Latin America and the Caribbean, as of July 2017

Country	Document title	Period covered or year of publication	Link
Anguilla	National School Health Action Plan and Policy	2016
Antigua and Barbuda	Antigua and Barbuda Child and Adolescent Health Strategy	2016
Argentina	Ley 26.061 de Protección Integral de Derechos de Niños, Niñas y Adolescentes	2005	https://www.educ.ar/recursos/118943/ley-nacional-26061-de-proteccion-integral-de-los-derechos-de-ninos-ninas-y-adolescentes
	Ley Nacional Nº 25.673, de creación del Programa Nacional de Salud Sexual y Procreación Responsable	2003	http://www.msal.gob.ar/saludsexual/ley.php
	Ley N° 26.150 de Educación Sexual Integral	2006	http://www.me.gov.ar/doc_pdf/ley26150.pdf
	Ley N° 26.485 de Protección Integral para Prevenir, Sancionar y Erradicar la Violencia contra las Mujeres en los Ámbitos en que Desarrollen sus Relaciones Interpersonales	2009	https://www.oas.org/dil/esp/Ley_de_Proteccion_Integral_de_Mujeres_Argentina.pdf
	Ley 26.529 Derechos del Paciente en su Relación con los Profesionales e Instituciones de la Salud	2009	http://servicios.infoleg.gob.ar/infolegInternet/anexos/160000-164999/160432/norma.htm
	Ley 27.130 Ley Nacional de Prevención del Suicidio.	2015	http://servicios.infoleg.gob.ar/infolegInternet/anexos/245000-249999/245618/norma.htm
Belize	Children’s Agenda 2017-2030	2017-2030	http://humandevelopment.gov.bz/wordpress/wp-content/uploads/2017/06/Childrens-Agenda-2017-2030.pdf
Belize	National Youth Development Policy of Belize	2012	http://www.youthpolicy.org/national/Belize_2013_National_Youth_Development_Policy.pdf
Bolivia	Plan estratégico nacional para la salud integral de la adolescencia y juventud boliviana	2015 – 2020
	Plan plurinacional de prevención de Embarazos en adolescentes y jóvenes	2015-2020	http://opendata.gerlop.net/docs/PLAN%20PLURINACIONAL%20PREVENCION%20EMBARAZO%20ADOLESCENTE%20(3).pdf
	Protocolo de Prevención, Atención y Sanción a toda forma de vulneración a La Integridad Sexual de Niñas, Niños y Adolescentes	2017	http://bolivia.unfpa.org/sites/default/files/LIBRO%20JUSTICIA%20FINAL%20COMPLETO.pdf
Brazil	Diretrizes Nacionais para a Atenção Integral à Saúde de Adolescentes e Jovens na Promoção, Proteção e Recuperação da Saúde	2010	http://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_nacionais_atencao_saude_adolescentes_jovens_promocao_saude.pdf
Brazil	Orientações básicas de atenção integral à saúde de adolescentes nas escolas e unidades básicas de saúde	2013	http://bvsms.saude.gov.br/bvs/publicacoes/orientacao_basica_saude_adolescente.pdf
	Política Nacional de Atenção Integral à Saúde de Adolescentes em Conflito com a Lei: normas e reflexões	2012	http://www.saude.sp.gov.br/resources/ses/perfil/profissional-da-saude/grupo-tecnico-de-acoes-estrategicas-gtae/saude-das-populacoes-privadas-de-liberdade/saude-dos-adolescentes-em-conflito-com-a-lei/legislacao/pnaisari_17_01_2012_versao_preliminar.pdf
	Atenção Psicossocial a Crianças e Adolescentes no SUS Tecendo Redes para Garantir Direitos	2014	http://bvsms.saude.gov.br/bvs/publicacoes/atencao_psicossocial_criancas_adolescentes_sus.pdf
British Virgin Islands	Policy and plan of action on adolescent health	2014/2015
British Virgin Islands	Family Health Strategy	2012
Chile	Programa Salud Integral Adolescentes y Jóvenes	2012-2020	http://www.minsal.cl/programa-salud-integral-adolescentes-y-jovenes/
	Control del Joven Sano	2011-2020	http://www.bibliotecaminsal.cl/control-joven-sano/
	Política Nacional de Salud de Adolescentes y Jóvenes	2008-2015	http://web.minsal.cl/wp-content/uploads/2015/09/Pol%C3%ADtica-Nacional-de-Salud-de-Adolescentes-y-J%C3%B3venes-2008-2015-Chile.pdf
	Estrategia Nacional Sobre Drogas	2009 - 2018	http://www.senda.gob.cl/media/2015/08/Estrategia-Nacional-2009-2018.pdf
	Política Nacional De Niñez Y Adolescencia – Sistema Integral De Garantías De Derechos De La Niñez Y Adolescencia	2015 - 2025	http://www.consejoinfancia.gob.cl/wp-content/uploads/2016/03/POLITICA-2015-2025_versionweb.pdf
Colombia	Estrategia de atención integral a la primera infancia (política de primera infancia de cero a siempre)	2013	http://www.deceroasiempre.gov.co/QuienesSomos/Documents/Fundamientos-politicos-tecnicos-gestion-de-cero-a-siempre.pdf
Colombia	Plan decenal de Salud Pública 2012-2021	2012-2021	http://www.saludcapital.gov.co/DPYS/Documents/Plan%20Decenal%20de%20Salud%20P%C3%BAblica.pdf
Costa Rica	Plan estratégico nacional de salud de las personas adolescentes	2010-2018	https://www.ministeriodesalud.go.cr/index.php/biblioteca-de-archivos/sobre-el-ministerio/politcas-y-planes-en-salud/planes-en-salud/1040-plan-estrategico-nacional-de-salud-de-las-personas-adolescentes-2010-2018/file
	Norma nacional para la atención integral de la salud de las personas adolescentes: componente de salud sexual y salud reproductiva	2015	http://www.pgrweb.go.cr/scij/Busqueda/Normativa/Normas/nrm_texto_completo.aspx?param1=NRTC&nValor1=1&nValor2=79909&nValor3=101259&strTipM=TC
	Agenda nacional de la niñez y la adolescencia compromisos 2015-2021	2015-2021	https://www.unicef.org/costarica/agenda_naciona_na_2015(1).pdf
	Plan de Acción Consejo Interinstitucional de Atención Madre Adolescente	2012-2016
Cuba	Programa nacional de salud para la atención integral en la adolescencia	2012-2017	http://www.codajic.org/sites/www.codajic.org/files/Programa%20nacional%20de%20salud%20para%20la%20atenci%C3%B3n%20integral%20en%20la%20adolescencia%20%28Cuba%29.pdf
Dominica	Adolescent and Youth Health Policy and Plan of Action	2017- 2027	Not yet available
Dominican Republic	Plan estratégico nacional para la salud integral de adolescentes	2010-2015	http://www.codajic.org/sites/www.codajic.org/files/Plan%20Estrat%C3%A9gico%20Nacional%20para%20la%20Salud%20Integral%20de%20Adolescentes%202010-2015%20%20Republica%20Dominicana.pdf
	Plan nacional de prevención de embarazos en adolescentes	2011-2016	https://www.unicef.org/republicadominicana/prevencion_embarazo_adolescente2011.pdf
	Estrategia para el fortalecimiento de la respuesta del Sistema Nacional de Salud a la violencia, con énfasis en la violencia de género y contra niños, niñas, adolescentes, mujeres y personas adultas mayores.	2016-2020	http://countryoffice.unfpa.org/dominicanrepublic/drive/ESTRATEGIADEABORDAJEVIOLENCIAYSALUD2016AL2010.MSP.OEGD..pdf
El Salvador	Plan estratégico intersectorial para la atención integral en salud de las personas adolescentes y jóvenes 2016-2019	2016-2019	http://asp.salud.gob.sv/regulacion/pdf/planes/plan_intersectorial_adolescentes_2016_2019_v2.pdf
	Política Nacional de Protección Integral de la Niñez y de la Adolescencia	2013-2023	http://asp.salud.gob.sv/regulacion/pdf/politicas/politica_nacional_pnpna.pdf
	Política de Salud Sexual y Reproductiva	2012	http://asp.salud.gob.sv/regulacion/pdf/politicas/Politica_de_Salud_Sexual_y_Reproductiva.pdf
	Plan para la Implementación de la Política de Salud Sexual y Reproductiva	2013	http://asp.salud.gob.sv/regulacion/pdf/planes/plan_implementacion_politica_salud_sexual_29112013.pdf
	Ley General de Juventud	2013	http://www.injuve.gob.sv/wp-content/uploads/2016/03/Ley-General-de-Juventud.pdf
Ecuador	Estrategia Nacional Intersectorial de Primera Infancia	2013-2017	http://www.desarrollosocial.gob.ec/wp-content/uploads/downloads/2015/04/Proyecto_puesta.pdf
Ecuador	Plan nacional de prevención del embarazo en adolescentes en ecuador		http://www.codajic.org/sites/www.codajic.org/files/Plan%20Nacional%20de%20Prevenci%C3%B3n%20del%20Embarazo%20en%20Adolescente%20Ecuador.pdf
Grenada	National Adolescent Health Policy and Strategic Plan for Grenada	2013
Grenada	National Sexual and Reproductive Health Policy and Plan	2013
Guatemala	Política de bienestar y salud para la adolescencia y juventud	2015-2024	http://www.osarguatemala.org/osartemporal/Archivos/PDF/201612/351_3.pdf
	Política nacional de juventud	2012-2020	http://conjuve.gob.gt/descargas/pnj.pdf
	Política Pública de Protección Integral y Plan de Acción Nacional para la Niñez y Adolescencia de Guatemala	2004-2015	http://www.segeplan.gob.gt/downloads/clearinghouse/politicas_publicas/Grupos%20Vulnerables/Pol%C3%ADtica%20Ni%C3%B1ez%20y%20Adolescencia.pdf
	Plan de Nacional de Prevención del Embarazo en Adolescentes (PLANEA)	2013-2017	http://conjuve.gob.gt/descargas/PLANEA.pdf
	Plan Nacional de Desarrollo K’atun nuestra Guatemala 2032	2014-2032	http://www.undp.org/content/dam/guatemala/docs/publications/undp_gt_PND_Katun2032.pdf
Guyana	Strategic policy on Reproductive health
Haiti	Plan Stratégique National Santé Jeunes et Adolescents	2014-2017	https://mspp.gouv.ht/site/downloads/PSNSJA%20merged.pdf
	Protocoles de Prise en charge Santé Jeunes et Adolescents	2017
	Plan Strategique National Multisectoriel 2012 – 2015 Revise Avec Extension À 2018	2015 - 2018	https://www.mspp.gouv.ht/site/downloads/PSNM%202018.pdf
Honduras	Estrategia Nacional para la Prevención del Embarazo en Adolescentes de Honduras	2012	http://www.paho.org/hon/index.php?option=com_docman&view=download&category_slug=salud-materna-nino-y-adolescente&alias=332-estrategia-nacional-para-la-prevencion-del-embarazo-en-adolescentes-en-honduras&Itemid=211
	Política Nacional de Juventud	2007 - 2021	http://www.youthpolicy.org/national/Honduras_2007_National_Youth_Policy.pdf
	Plan de Igualdad y Equidad de Género de Honduras	2010-2022	http://extwprlegs1.fao.org/docs/pdf/hon157565.pdf
	Política de Protección Social	2012	http://www.rnp.hn/wp-content/uploads/2013/03/Politica-de-Proteccion-Social.pdf
Jamaica	National Strategic Plan Pre-adolescent and adolescent health and development	2011-2015
Jamaica	Standards and related criteria for adolescent health. A guide for assuring quality health services for adolescents	2014
Mexico	Programa de Acción Específico: Salud de la Infancia y la Adolescencia	2013-2018	http://www.censia.salud.gob.mx/contenidos/descargas/transparencia/especiales/PAE_Salud_para_la_Infancia_y_la_Adolescencia.pdf
	Programa de Acción Específico de Salud Sexual y Reproductiva para Adolescentes	2013-2018	http://cnegsr.salud.gob.mx/contenidos/descargas/SSRA/SaludSexualyReproductivaparaAdolescentes_2013_2018.pdf
	Plan Nacional de prevención de embarazo en adolescentes		https://www.gob.mx/cms/uploads/attachment/file/55979/ENAPEA_0215.pdf
	Programa Nacional de Juventud	2014-2018	http://www.imjuventud.gob.mx/imgs/uploads/PROJUVENTUD2014new.pdf
	Programa nacional de prevención de adicciones	2013-2018	http://www.conadic.salud.gob.mx/pdfs/programas/PAE_2015.pdf
Nicaragua	Estrategia Nacional de Salud Sexual y Reproductiva	2008	http://www.iadb.org/WMSfiles/products/SM2015/Documents/website/MINSA_Nicaragua-Estrategia_nacional_salud_sexual_reproductiva.pdf
Panama	Normas Técnicas y Administrativas del Programa Nacional de Salud Integral de los y las Adolescentes	2006	http://www.minsa.gob.pa/sites/default/files/programas/norma_adolescentes_final_19_oct_2006_negro_azul.pdf
Paraguay	Plan Nacional de Salud Adolescente	2016-2021	http://www.mspbs.gov.py/plan-nacional-de-salud-adolescente-2016-2021/
	Norma Técnica de atención integral para adolescentes en los Servicios de Salud	2017-2020
	Plan estratégico Nacional de Prevención de Embarazo Adolescente no Intencional	Being prepared, as of July 2017
	Plan Nacional de Salud Sexual y Reproductiva	2014-2018	http://www.cepep.org.py/archivos/PNSSR2014.pdf
Peru	Plan de Salud Escolar 2013-2016	2013-2016	http://sellomunicipal.midis.gob.pe/wp-content/uploads/2016/10/5_ds010_2013_SA_plan_de_salud_escolar_2013-2016.pdf
	Plan multisectorial para la prevención del embarazo en adolescentes	2013-2021	http://www.unfpa.org.pe/Legislacion/PDF/20131106-MINSA-Plan-Prevencion-Embarazo-Adolescente.pdf
	Plan Nacional de Acción por la Infancia y Adolescencia	2012-2021	https://www.unicef.org/peru/spanish/PNAIA-2012-2021.pdf
	Plan Nacional de Prevención y Tratamiento de adolescentes en conflicto con la Ley penal	2013-2018	https://www.minjus.gob.pe/wp-content/uploads/2015/08/plan-nacional-prevencion.pdf
	Plan Estratégico Nacional de Juventudes	2012-2021	http://www.youthpolicy.org/national/Peru_National_Youth_Strategy_2012_2021.pdf
	Plan Nacional de Igualdad de Género 2012 - 2017	2012 - 2017	http://www.mimp.gob.pe/files/planes/planig_2012_2017.pdf
Saint Kitts and Nevis	Youth Policy	2017
Saint Lucia	National Child and Adolescent Health Policy and Multi-Sectoral Workplan	2015
Saint Vincent and the Grenadines	National Adolescent Health and Development Policy	2017
	Adolescent Manual	2017
	Adolescent Action Plan	2017
Suriname	Integraal beleidsplan voor kinderen en adolescenten: Het Actie programma	2012-2016	http://monitoring.caricom.org/regional-framework-of-action-for-children--2/report/download/focal_point_documents/Beleidsplan_President_2013_final.pdf
Suriname	National Sexual and Reproductive Health and Rights Policy of Suriname	2013-2017
Trinidad and Tobago	Adolescent Health Policy	2017-2018	Draft Document. Research is currently being conducted and concept paper is being drafted.
	Sexual and Reproductive Health Policy	2017	On-going. Currently being finalized
	National Strategic Plan for the Prevention and Control of Non Communicable Diseases	2017-2021	http://health.gov.tt/downloads/DownloadItem.aspx?id=385
	Policy On Universal Health Coverage	2017-2018	On-going. Research is currently being conducted and concept paper is being drafted.
Uruguay	Estrategia Nacional para la Infancia y la Adolescencia	2010-2030	http://www.inau.gub.uy/biblioteca/eniabases.pdf

Source: Reported to PAHO by national health authorities, as of 30 July 2017.

Annex III.B: Countries of Latin America and the Caribbean with a budget allocation for adolescent health activities, as reported to the World Health Organization in 2010-2016

Country	Budget allocation	Date of reporting
Argentina	Yes	July 2016
Belize	No	January 2010
Bermuda	Yes	February 2014
Bolivia (Plurinational State of)	No	June 2016
Brazil	Yes	August 2016
Chile	Yes	January 2014
Colombia	Yes	June 2016
Costa Rica	Yes	June 2016
Cuba	Yes	June 2016
Dominican Republic	Yes	June 2016
Ecuador	Yes	January 2014
El Salvador	No	June 2016
Guatemala	Yes	June 2016
Guyana	Yes	July 2016
Haiti	No	July 2016
Honduras	Yes	February 2012
Jamaica	Yes	January 2014
Mexico	Yes	February 2012
Nicaragua	No	February 2010
Panama	No	January 2014
Paraguay	No	June 2016
Peru	Yes	July 2016
Saint Vincent and the Grenadines	Yes	November 2016
Suriname	No	July 2016
Trinidad and Tobago	Yes	June 2016
Uruguay	No	September 2016

Source: WHO Global Maternal, Newborn, Child and Adolescent Health Policy Indicator Surveys, 2009-2016 (136).

Annex III.C: Issues for which adolescents are a specific target group in the national policies, strategies, and plans of countries of Latin America and the Caribbean, as reported to the World Health Organization, 2009-2016

Country	Issue								Date of reporting
Country	Sexual and reproductive health and family planning	Interventions to prevent HIV/AIDS	Nutritional intervention	Alcohol use prevention	Tobacco control activities	Mental health	Injury prevention	Violence	Date of reporting
Argentina	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	July 2016
Belize	Yes	Yes	No	No	No	Yes	No	No	January 2010
Bermuda	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	February 2014
Bolivia (Plurinational State of)	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	June 2016
Brazil	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	August 2016
Chile	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	January 2014
Colombia	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	June 2016
Costa Rica	Yes	Yes	No	Yes	Yes	Yes	No	No	June 2016
Cuba	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	June 2016
Dominican Republic	Yes	Yes	Yes	No	No	Yes	No	Yes	June 2016
Ecuador	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	January 2014
El Salvador	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	June 2016
Guatemala	Yes	Yes	Yes	Yes	Yes	Yes	No data	Yes	June 2016
Guyana	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	July 2016
Haiti	Yes	Yes	No	No	No	No	No	No	July 2016
Honduras	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	February 2012
Jamaica	Yes	Yes	No data	No data	Yes	No data	No data	No data	January 2014
Mexico	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	February 2012
Nicaragua	Yes	Yes	Yes	No	No	Yes	Yes	Yes	February 2010
Panama	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	January 2014
Paraguay	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	June 2016
Peru	Yes	Yes	No	Yes	Yes	Yes	No	Yes	July 2016
Saint Vincent and the Grenadines	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	November 2016
Suriname	Yes	Yes	No	Yes	Yes	No	No	No	July 2016
Trinidad and Tobago	Yes	Yes	No data	Yes	Yes	Yes	Yes	Yes	June 2016
Uruguay	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	September 2016

Yes Yes
No No
No data No data

Source: WHO Global Maternal, Newborn, Child and Adolescent Health Policy Indicator Surveys, 2009-2016 (136).

Annex III.D: Legal and regulatory access for adolescents to selected health services, as reported to the World Health Organization, 2009-2016

Country	Health services				Data reporting
Country	Contraceptive services except sterilization	Emergency contraception	HIV testing and counseling	Harm reduction interventions for injectable drug users	Data reporting
Argentina	Yes	Yes	Yes	No	July 2016
Belize	No	No data	No	No data	January 2010
Bermuda	Yes	Yes	Yes	Yes	February 2014
Bolivia (Plurinational State of)	No	No	No	No	June 2016
Brazil	Yes	Yes	Yes	Yes	August 2016
Chile	Yes	Yes	Yes	No data	January 2014
Colombia	Yes	Yes	Yes	Yes	June 2016
Costa Rica	Yes	No	Yes	No	June 2016
Cuba	Yes	Yes	Yes	No data	June 2016
Dominican Republic	Yes	Yes	Yes	Yes	June 2016
Ecuador	Yes	Yes	Yes	Yes	January 2014
El Salvador	Yes	Yes	Yes	Yes	June 2016
Guatemala	Yes	Yes	Yes	No	June 2016
Guyana	No	No data	Yes	No data	July 2016
Haiti	Yes	No	No	No	July 2016
Honduras	Yes	No	Yes	No data	February 2012
Jamaica	Yes	Yes	No	No	January 2014
Mexico	Yes	Yes	No	No	February 2012
Nicaragua	No	No data	No	No	February 2010
Panama	Yes	Yes	Yes	Yes	January 2014
Paraguay	Yes	No	No	No data	June 2016
Peru	No	No	No	No	July 2016
Saint Vincent and the Grenadines	Yes	No data	No	No	November 2016
Suriname	Yes	No data	No	No	July 2016
Trinidad and Tobago	No	No	No	No	June 2016
Uruguay	Yes	Yes	Yes	No	September 2016

Yes Yes
No No
No data No data

Source: WHO Global Maternal, Newborn, Child and Adolescent Health Policy Indicator Surveys, 2009-2016 (136).

Annex III.E: Existence of a defined package and standards of health services for young people, and systems for regular adolescent-specific training for health providers, as reported to the World Health Organization, 2009-2016

Country	Clearly defined comprehensive package of health services for adolescents	National standards for delivery of health services specifically for young people (ages 10-24)	System in place for regular adolescent-specific training for health providers in first-level facilities	Date of reporting
Argentina	Yes	Yes	Yes	July 2016
Belize	No	No	No data	January 2010
Bermuda	Yes	Yes	No data	February 2014
Bolivia (Plurinational State of)	Yes	Yes	Yes	June 2016
Brazil	Yes	Yes	Yes	August 2016
Chile	Yes	Yes	No data	January 2014
Colombia	Yes	Yes	Yes	June 2016
Costa Rica	Yes	Yes	Yes	June 2016
Cuba	Yes	Yes	Yes	June 2016
Dominican Republic	Yes	Yes	No	June 2016
Ecuador	Yes	Yes	No data	January 2014
El Salvador	Yes	Yes	Yes	June 2016
Guatemala	Yes	Yes	Yes	June 2016
Guyana	No	No	Yes	July 2016
Haiti	No	No	No	July 2016
Honduras	Yes	Yes	No data	February 2012
Jamaica	Yes	Yes	No data	January 2014
Mexico	Yes	Yes	No data	February 2012
Nicaragua	No	No	No data	February 2010
Panama	Yes	Yes	No	January 2014
Paraguay	Yes	Yes	No	June 2016
Peru	Yes	Yes	No	July 2016
Saint Vincent and the Grenadines	No	No	No	November 2016
Suriname	No	Yes	No	July 2016
Trinidad and Tobago	No	No	No	June 2016
Uruguay	No	No	Yes	September 2016

Source: WHO Global Maternal, Newborn, Child and Adolescent Health Policy Indicator Surveys, 2009-2016 (136).

Annex IV.A: The Sustainable Development Goals (SDGs)

Annex IV.B: Sustainable Development Goal 3 and targets

Goal 3: Ensure healthy lives and promote well-being for all at all ages

Goal 3 targets:

By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births
By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being
Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol
By 2020, halve the number of global deaths and injuries from road traffic accidents
By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes
Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all
By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination
Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate
Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all
Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States
Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks

Source: (1)