Routine HIV Testing

The Centers for Disease Control and Prevention recently recommended regular, routine testing for the AIDS virus for all Americans ages 13 to 64, which would make HIV testing as common as a cholesterol test.

These historic guidelines (endorsed by the American Medical Association) are aimed at stopping the spread of the disease and helping the 250,000 Americans who do not know they have HIV get the medical care they need. Nearly 50% of the HIV infections diagnosed every day are people who are already experiencing HIV-related illnesses and will have been transmitting the disease to other people. If people with HIV are diagnosed early, they will have access to life-extending therapy and can learn how to not transmit the virus to their sexual and needle-sharing partners.

Until recently, the Centers for Disease Control and Prevention recommended annual HIV counseling, testing, and referral (CTR) for people at high risk for HIV, including injection drug users (and their sexual partners), people who exchange sex for money or drugs, and men who have sex with men (MSM). The new recommendations however, are to test all pregnant women and to increase HIV testing of everyone seen in a health-care setting unless the patient declines, without requiring a special consent or counseling.

Since the 1980s, the demographics of the HIV epidemic in the United States has changed; more and more of the people getting infected with HIV are under 20 years of age, female, and members of racial or ethnic populations who reside outside of metropolitan areas, and heterosexual men and women who are frequently unaware that they are at risk for HIV.

The new recommendations include routine testing of everyone between the ages of 13 and 64 as part of their regular health care, and everyone treated for TB or sexually transmitted diseases. This is a historic change and one that places a huge HIV education burden on the health care system and parents everywhere. People all need to understand how HIV is transmitted and who is at risk.

For the healthcare system, telling people that a test will be performed, recording the result in their medical record, and notifying people of results will require thought, systems, and privacy protection. For parents, we need to talk with our children about HIV and sexually transmitted infections before their physical examinations and be able to help 13 year olds understand we are asking them to be vaccinated for HPV and tested for HIV.

Some fine points of the recommendation include 1) patients can decline the test, and 2) no person should be tested without their knowledge. What seems to be missing is a requirement that all Americans be educated about HIV transmission risk and understand that a negative HIV test is only valid until they have any unprotected sexual contact with someone or share HIV-infected body fluids in some other way.

The entire report can be found at the Centers for Disease Prevention and Control



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ADHD Cases Linked to Lead and Smoking

A recent study reported in Environmental Health Perspectives suggests that about one-third of attention deficit cases among U.S. children may be linked with tobacco smoke before birth or to lead exposure afterward. Building on previous research linking attention problems, including ADHD, with childhood lead exposure and smoking during pregnancy, and offers one of the first estimates for how much those environmental factors might contribute.

The study's estimate is in line with a National Academy of Sciences report in 2000 that said about 3% of all developmental and neurological disorders in U.S. children are caused by toxic chemicals and other environmental factors and 25 percent are due to a combination of environmental factors and genetics.

ADHD is a brain disorder affecting between 4% and 12% of school-age children -- or as many as 3.8 million youngsters. Affected children often have trouble sitting still and paying attention and act impulsively at home and at school.

The researchers analyzed data on nearly 4,000 U.S. children ages 4 to 15 who were part of a 1999-2002 government health survey. Included were 135 children treated for ADHD. They asked whether mothers had smoked during pregnancy but used blood tests to determine lead exposure, said co-author Dr. Bruce Lanphear, a researcher at Cincinnati Children's Hospital Medical Center. Children whose mothers smoked during pregnancy were 2 1/2 times more likely to have ADHD than children who weren't prenatally exposed to tobacco.

Resources:
Environmental Health Perspectives
Centers for Disease Control and Prevention
We're Talking, Too: Preteen Health



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Online Food Advertising to Kids Another Venue to Market Junk Food

A report released in July by the Kaiser Family Foundation found that 85% of the top food brands that target children through television advertising also have Web sites that market to children. These corporate-sponsored sites are primarily marketing foods and beverages high in fat, calroies, and sugar, also known as junk food.

The study, "It's Child's Play: Advergaming and the Online Marketing of Food to Children," examined the marketing methods used on 77 children's food and beverage Web sites, finding that sites are disguising their efforts to reach children as games or competitions. Advergaming - online games featuring products - was included in 73% of the Web sites. Viral marketing, a technique where consumers market to one another via the Internet, was found on 64% of the sites. The sites encouraged children to send invitations, greeting cards and birthday wishes through emails that display product names and characters.

These techniques are dangerous in light of the country's growing childhood obesity problem. They are not only promotoing the consumption of junk food, but inactivity while sitting at the computer.

For some teens, junk food is an American way of life, and also an addiction. Junk food contributes little or no nutrient value to the diet, but instead provides excess calories and fat. Some examples of junk food are candy, breakfast pastries, high fat chips and dip, and high fat foods from fast food restaurants.

When consumed in small amounts, junk food can be worked into a healthy lifestyle. The key is not to eat junk food more than once a week or replace healthy foods with junk food, but to get enough exercise to burn off the extra calories these foods contribute.

To kick the junk food habit an entire family has to focus on eating healthy foods. Pay attention to the choices available in the house and during the day and avoid situations that may encourage a "junk attack," like sitting in front of the television all evening. When you do eat well, notice that you feel less tired, are less irritated, and may even sleep better.

Do not be extreme, for more information, contact your healthcare provider or a registered dietitian in your area to help you change your eating habits.


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Labels: Obesity

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Health Consequences of Soda Consumption

One of the likely culprits in unintentional weight gain may be soda consumption according to a recent study. A 12-ounce soda has 150 calories and about 10 teaspoons of sugar, mostly as high-fructose corn syrup and drinking only one soda a day can lead to a weight gain of 15 pounds in one year, in addition to higher cholesterol.

While providing little nutrition, soda has increased the risk of diabetes, fractures and cavities according to a review article in the American Journal of Clinical Nutrition. The authors from the Harvard School of Public Health recommend removing soda and other vending machines from schools, reducing soda consumption, and limiting the marketing of soft drinks. Alternatives parents can offer are water and low-fat milk.

Teens can make healthier decisions about how they eat as well. For more information, visit We're Talking Teen Health at the Palo Alto Medical Foundation or Healthline.


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Labels: Obesity

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Organized Activity Participation or Over-Scheduling - Which is Better for Youth?

Researchers have suggested that kids who are involved in organized activities outside of school - extracurricular activities including art, music, and sports, after-school programs, and youth organizations - do better academically, socially, emotionally, and physically compared to "latchkey" children left alone after school. This fact, along with the fact that those activities also provide adult supervision for youth with working parents, is encouraging policy makers to expand opportunities for all youth to participate in after-school activities.

The opposite concern exists in other researchers concerned about the "over-scheduling" of youth motivated by parents wanting to give a competitive edge to their children by involving them in sports, music, community service, and pushing them to the point of stressing them out and compromising their psychosocial development.

To evaluate these two different perspectives, in the 4th issue of the 2006 Social Policy Report, Mahoney, Harris, and Eccles review evidence that help us understand intrinsic motivation and extrinsic pressure from parents to participate in activities. American youth average about 5 hours a week participating in organized activities, including about 40% do not participate in any organized activities and about 6% who spend 20 or more hours a week participating.

The consensus is that those youth who participate in activities outside school do better academically, complete high school and college more often, are psychologically healthier, have better interactions with parents, and are less likely to smoke or use drugs. The level of involvement however can be a negative influence on development if driven by parents, stressful to the child, or precludes family time (e.g., meals together or time to talk).

The entire report can be found at: http://www.srcd.org/press/mahoney.pdf



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The Epidemic of Childhood Obesity

Over the past 30 years, the rate of obesity has doubled for children and adolescents and 31% of adolescents aged 12 to 19 are now considered overweight (Institute of Medicine, 2005). A recent Social Policy Report, by Krishnamoorthy, Hart, and Jelalian review the research on childhood obesity and make policy recommendations.

The authors describe the sociocultural variables that are thought to contribute to the significant increases in obesity, the serious medical and psychosocial risks associated with pediatric obesity, and interventions have been designed to decrease body mass index (BMI).

Overweight adolescents are at increased risk for a number of medical comorbidities, including hypertension, non-insulin dependent diabetes, insulin resistance, obstructive sleep apnea, and asthma. In addition to medical problems, overweight adolescents are at increased for social and emotional problems. Heavy youth tend to have lower self-esteem, negative body image, and higher levels of depression than normal weight youth, in addition to being teased more by peers.

Some of the contributing factors include easy and quick availability of tasty yet highly caloric foods at relatively low cost and in large quantities, the pervasive marketing of such foods especially to children, and the tendency toward a sedentary life style. Favorite leisure activities such as TV and videogames contribute to children's inactivity. Children need to eat healthier foods, eat less, and be more active.

The bottom line from these authors is that change is required at multiple levels, and they offer suggestions for how parents, schools, communities, and governments can each do their part to tackle this epidemic.

The entire report can be found at: http://www.srcd.org/documents/publications/SPR/spr20-2.pdf



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Labels: Obesity

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HIV among U.S. Adolescents

Researchers in the Journal of Adolescent Health called for intensified HIV prevention efforts within minority communities and among men who have sex with men in addition to more effort to encourage testing for at-risk youth. The investigators analyzed HIV/AIDS cases (between 1999 and 2003) among people ages 13-24 from 32 states and the US Virgin Islands.

At the end of 2003 there had been 7,074 adolescents and young adults diagnosed, and 63% were between the ages of 20 and 24. AIDS rates were highest among blacks (63 per 100,000) and youth in the South (22 per 100,000) and Northeast (18 per 100,000). Between 1999 and 2003 there was an increase in HIV cases among males, in particular, males who have sex with men.

Sources
Rangel, A., Gavin, L., Reed, C., Fowler, M., & Lee, L. (2006). Epidemiology of HIV and AIDS among adolescents and young adults in the United States. Journal of Adolescent Health, vol. 39(2) pages 159-163.



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Labels: Sexuality Education

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Alcohol and Teens

There are many reasons to encourage your children to avoid alcohol during their adolescence, but a new study is very sobering. It seems, like sex, the longer you delay the onset of drinking alcohol, the less risk a person will experience over a lifetime. A recent study by Dr. Hingson at the National Institute on Alcohol Abuse And Alcoholism (NIAAA) reported that becoming an alcoholic during adolescence contributes to more severe levels of alcoholism, multiple dependencies, and less chance that the alcoholic will seek help.

Interviews with 4,778 people who had been alcoholics at some time in their lives suggested that 15% become dependent before the age of 18 and 47% were dependent by age 21. For parents this means talk to your children and if they start drinking – get help! For clinicians, it suggests that screening young teens for drinking is imperative.

Sources
Ralph W. Hingson, Timothy Heeren, and Michael R. Winter. (2006) Age of Alcohol-Dependence Onset: Associations With Severity of Dependence and Seeking Treatment. Pediatrics, 118: e755-e763.



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Leading Causes of Injuries Among Children and Adolescents

The Association of State and Territorial Health Officials has produced a fact sheet about injuries and their prevention. That fact sheet states that 2/3 of all deaths among youth ages 5-19 were injury-related in 2003, making injuries the leading cause of death for that age group. Of all of the 15-20 year old drivers killed in crashes, 25% had been drinking alcohol. Youth violence is also high - 750,000 youths ages 10 -24 were admitted to emergency rooms for violence-related injuries in 2004. In addition, suicide is the third leading cause of death among individuals ages 15 – 24, with males four times more likely to die by suicide than females.

Resources
We're Talking Teen Health



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Drivers Education and Teen Fatalities

More adolescents die in car crashes than from any other cause and drivers education has not changed much in 50 years according to the National Transportation Safety Board. Most states require driver education before teens can get a license but the standards for that education vary tremendously and may not include any practice time behind the wheel.

Meanwhile, there are about 6,000 teens killed in car crashes each year and although teen drivers make up only 6% of the licensed drivers in the United States, they are involved in 14% of the fatal crashes. What has changed is that all states now have some form of graduated driver’s licensing that limits nighttime driving and bans teen passengers until teens rack up some driving experience. These restrictions seem to be saving lives, but parents must help enforce them.

Resources
National Transportation Safety Board
Driving Skills for Life
We're Talking Teen Health



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At-risk, Privileged, and Pressured

What can be wrong across middle- to upper-middle-class communities where families with two working parents want the best for their kids in a super competitive world? Why are kids who look good, are getting good grades, play sports or musical instruments, and do community service showing up in the offices of counselors at record numbers? Even without bad divorces, substance abuse, depression, school failure, or delinquent behavior, these kids are in serious trouble.

A new book by Madeline Levine called “The price of privilege: How parental pressure and material advantage are creating a generation of disconnected and unhappy kids” describes kids who are overscheduled, lack enthusiasm, feel pressured, misunderstood, anxious, angry, and empty. In spite of these teens being articulate and intelligent, they do not seem to know themselves very well. They may be impulsive, or boring – they may be personable, but not very creative. They share several things in common though – they are very dependent on approval from others, are held to high academic standards, are given materials rewards, get little pleasure from things, and may not share much family responsibility at home.

It would be a mistake to trivialize this problem, say the parents are “too involved” and dismiss these kids as being “spoiled” – it is much more serious than that. These kids are feeling things they perceive as failures – low grades, low SAT scores, failure to make a varsity team, or a lack of friends at a profound level. Those feelings are contributing to the self-destructive behaviors associated with these unhappy and fragile privileged youth.

These are not marginalized youth – these kids have parents, coaches, teachers and counselors pouring attention and resources into them – they appear to have everything, except a sense of themselves. What may be missing is autonomy or independence – the “self” that develops by being exposed to and learning to handle complex interpersonal challenges and situations.

To become adults, teens must learn to identify their talents, skills, and interests while learning to make their own decisions and balance their lives. Parents want kids who are creative, happy, become self-starters, who can delay gratification, tolerate frustration and show self -control.

The ideal relationship with parents is one that allows for differences of opinions and is built on respect for each individual. Letting a teen make a decision must include the teen living with the consequences of that decision – mom or dad cannot clean up the outcome – dealing with that outcome helps kids make the next decision.

It is hard for parents to watch bad decisions, but we have to do it – we have to not be critical or intrusive. Instead, we need to be emotionally available to them, we can offer our opinion, but we cannot tell them what to do – to do so robs them of that “sense of self.” We also have to avoid creating children who do things to please us and never learn what is important to them.

As parents, we may need to start talking about our concerns and struggle with issues like the lines between connectedness and overinvolvement; love and intrusiveness; encouragement and obssessiveness. We may need to examine how we are modeling personal relationships, friendships, responsibility to others, and self-care. We need to be conscious, face the issues, and work it out – withdrawing never helps and good parenting is always inconvenient to the parent.

Teens need tremendous support and encouragement to become people who love who they “are” which is ultimately much more important than what they “do.”

Sources
Levine, M. (2006) The Price of privilege: How parental pressure and material advantage are creating a generation of disconnected and unhappy kids. HarperCollins Publishers, New York.



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Abstinence-only versus Comprehensive Sexuality Education: The Impact on Sexual Risk Behavior among U.S. High School Students 1991 – 2003

According to a recent research brief from Child Trends the U.S. has some of the highest rates of teenage pregnancy and childbearing in the industrialized world, with 82% of those pregnancies being unintended. Teens in the U.S. also have higher rates of sexually transmitted infections (STIs) than do teens in other industrialized countries.

According to Advocates for Youth every year about 800,000 adolescent females become pregnant, 20,000 young people are newly infected with HIV, and nearly four million new sexually transmitted infections occur among youth aged 15 to 19.

After widespread implementation of comprehensive sexuality education (between 1991 and 1997) there was a significant decline in sexual behaviors among teens that place them at risk for pregnancy and HIV infection. Associated with comprehensive sexuality education was 1) an 11% drop in the number of teens reporting sexual activity; 2) a 14% decrease in the number of teens with 4+ lifetime sexual partners; and 3) a 23% increase in condom use during last sexual intercourse.

The declines in the number of sexually active youth and those with 4+ lifetime sexual partners ended however with the first five-year cycle of the Title V abstinence-only-until-marriage initiative. Since the implementation of the abstinence only programs the proportion of teens reporting they have had sex, and the number with 4+ partners has remained the same. Condom use however continues to increase, albeit at a slower pace.

Labels: Sexuality Education

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Plan B (Emergency Contraception or the Morning After Pill) for Teens

On August 24, 2006 the U.S. Food and Drug Administration (FDA) announced the approval of Plan B (also known as emergency contraception or the morning after pill), as an over-the-counter (OTC) option for women aged 18 and older. Plan B has been available to all women with a prescription, but now women 18 and older can get it without a prescription.

Plan B contains an ingredient used in prescription birth control pills but at a higher dose and with a different dosing regimen. It prevents pregnancy when taken within 72 hours of unprotected sexual intercourse. Research has shown that Plan B is effective and safe with teens. In addition, an increase in awareness and availability of emergency contraception to teens does not change reported rates of sexual activity or increase the frequency of unprotected intercourse among adolescents.

The Society for Adolescent Medicine and the American Academy of Pediatrics believe that requiring adolescents age 17 and younger to obtain a prescription is not good policy: it increases the risk of unintended pregnancies and childbearing among adolescents and does not protect their health.

For more information on Plan B visit:
FDA
not-too-late

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Confidential Reproductive Health Care and Teens

One reason that adolescents forgo medical care is that they may be concerned about confidentiality. Their parent(s) may have always gone to the doctor with them and they are concerned that he or she will tell the parent about any behavior they report to the doctor. This is why at about age 12 (in California) some doctors will tell youth that anything said to them is confidential and start asking the parent to step out of the room for a minute during a physical or ask the child if they would rather meet with the doctor alone.

As health care professionals, we want the adolescents to trust us and disclose any risk behavior so that referrals or appropriate care can be provided. To encourage this, there are confidentiality laws in most states, although I dare say most parents and even some doctors are not clear what they mean.

I will summarize the laws (for minors) related to reproductive health care in California. A minor of any age may consent for care for pregnancy, contraception, abortion, emergency medical services, or sexual assault and rape services. The health care provider may not inform the parent if a minor seeks care for pregnancy, contraception, or abortion. The health care provider must contact the parent for emergency medical services and sexual assault (unless the parent is responsible for the assault, or the minor is over 12 and treated for rape).

A minor over the age of 12 can request testing or treatment for sexually transmitted disease, including HIV, as well as rape, and the health care provider may not tell the parent without the minor’s (signed) consent. That means that parents cannot see the medical records relating to reproductive services of teens.

Reporting the sexual activity of minors to children’s protective service or police
If a minor is being coerced or exploited into sexual activity, it is reportable. In addition, if a minor is having consensual sexual intercourse with an older partner, it is reportable if the child is 11 – 13 and the partner is 14 or older; and if the teen is 14 – 15 and the partner is 21 years or older.

A note to doctors: Even though the laws are in place to encourage teens to seek and receive care, the “system” may provide leaks and physicians must protect teens by understanding how billing and Explanation of Benefits, satisfaction surveys, appointment reminders and lab results are handled. If there is a chance that a parent will find out the teen was seen for a confidential reproductive service, it would be better to refer them to a local Planned Parenthood, or work with your institution to eliminate the barriers to providing care.

A note to parents: I know that the fact that your teen can receive health care for pregnancy, contraception, abortion, testing or treatment for sexually transmitted disease, including HIV, as well as rape without your knowledge or consent may surprise, and maybe outrage you, but please take a deep breath and think about this: if your child is involved in sexual behavior, and you do not know, wouldn’t it better for the doctor to know, provide information and protection to avoid unwanted pregnancy and sexually transmitted infection? The way to avoid this situation is to be an approachable parent. Start early and talk to your kids about everything - sex, alcohol, smoking, drugs, rape, and every other difficult subject –include your values and expectations - you will be glad you did, and it will increase the chances that you will know when your teens become sexually active.

Sources
National Center for Youth Law
Understanding Confidentiality and Minor Consent in California: An Adolescent Provider Toolkit, Adolescent Health Working Group

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Teens Don’t Understand Correct and Consistent Condom Use

The Journal of Adolescent Health published a study in September 2006 suggesting that teens often skip using condoms. It did not seem to matter whether they were having sex with serious (meaning committed) or casual partners, suggesting that teens are overestimating the safety of using condoms “most of the time” with casual partners, and underestimate the risk of unprotected sex with a serious partner.

Teens in this study only reported using condoms about half of the time, suggesting they do not understand that preventing STDs with safer sex techniques means not sharing body fluids during sexual activity and that they are at serious risk for sexually transmitted infection, including HIV. Teens need to be taught that condoms must be used correctly and consistently (meaning every time) for all types of intercourse – oral, anal, and vaginal.

While we are at it, let’s teach them that:
• Delaying their first sexual experience increases the likelihood that they will use a contraceptive method consistently throughout the relationship and avoid unintended pregnancy);
• Hormonal methods of birth control (if used properly) are associated with lower pregnancy rates than are other contraceptive methods; and
• Hormonal methods should be used with condoms (AKA dual use) to also prevent sexually transmitted infections.

Labels: Sexuality Education

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Helping Teens Become Responsible for Health Care

Not only are teens likely to miss preventive medical care, there was also a recent report about young adults suggesting they do not get the health care they need, in part because they tend to healthy, but in part because they never really learned how to be responsible for their health care, access medical care, and include it in their daily life planning.

One way to avoid this is for parents of teens to encourage their teens to become responsible for their health care and build their own relationship with their health care provider. Tell your child starting at age 11 that they can receive confidential care from their doctor and that you want them to feel comfortable asking questions or seeing the doctor without you. When your child is ready for the responsibility, tell them when it is time for their annual physical and that you would like them to make their own appointment this year. Give them the number and let them make the appointment. Once they can drive, they can even take themselves to the appointment.

Tell the doctor that you want to encourage your teen to see them for any concerns they might not want their parents involved in, and leave written consent for your child to receive care. You may still have to come in to sign for immunizations, so encourage the teen to ask if their parent must be present for the visit.

Even with younger teens, you can let them know that as their body and feelings change, there may be questions they have that they would be more comfortable talking to a doctor about, so encourage them to call the doctor, and explore safe, medically accurate Web sites about teen health. You can even bookmark some for them. My favorites are obviously We’re Talking Teen Health and We’re Talking, Too: Preteen Health.

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Adolescent Immunizations

Most parents understand how important vaccines are during early childhood, but many do not know how important adolescent immunizations are in preventing infectious diseases. Teens can be an important bridge for diseases between the elderly and very young. Unfortunately, because teens are so healthy, many are not being seen for preventive care by their physicians and many physicians may forget to check their immunization records.

All adolescents should have their immunizations reviewed when they are 11 or 12 (or as soon as possible). Adolescents who have not received vaccinations for hepatitis A, hepatitis B (HBV), measles, mumps, rubella (MMR), and varicella (approximately 40%) should receive them. In addition, we know that the pertusis (whooping cough) vaccine is less effective after 5 – 10 years, so many teens should receive another dose of the tetanus, diphtheria, and acellular pertusis (Tdap) vaccine.

There are several new vaccines that every adolescent should receive, including one for meningitis (MCV4) and (for females) HPV (Gardasil). Meningococcal disease strikes most often in very young children and teens. It appears with flu-like symptoms but advances rapidly and can end in death or leave the victim with hearing loss and cognitive defects. Human papillomavirus (HPV) infection is a sexually transmitted disease that can results in genital warts, cancers of the reproductive tract, and anal cancer.

Finally, I think adolescents should get a flu shot each year. Adolescents are more than three times more likely to get the flu than adults and more than half of the flu cases each year are in people under 19 years of age.

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Teens and Stress

Like adults, teens can become stressed out without knowing it is happening. One minute all is well, but then he or she gets behind in homework or starts one too many after school activity, or projects are due all at once, or a team goes to nationals, or a family faces a crisis that distracts the teen, or an important person in their life experiences a crisis, a friend or romantic partner dumps them … there is no end to what can go wrong.

Teens though, unlike adults, may not have ever experienced the new level of stress and may not be aware of how much it is affecting their behavior. Parents can help identify the signs of the stress and help teens find ways to remove some of the stress or at least cope with it.

Tips for preventing stress in teens
• Be a role model. Try to remain calm when dealing with stressful situations. When stressed, demonstrate coping strategies – get enough rest, eat well, and seek support. If you know a particularly stressful event is coming, talk with your teen about how to prepare and avoid getting “stressed out.”
• Focus on the process instead of the outcome. How hard a child tries is more important than the grade they receive.
• Help teens monitor activities and “over scheduling.” Talk with your teen about their motivations, balancing extracurricular activities, sports, and schoolwork with time for friends, family, and relaxation.

Tips for addressing stress in teens
• Help teens identify “stress.” Recognize heart beating fast, butterflies, tightness in chest, obsessive thoughts about being ready for things, inability to enjoy restful activities, etc…
• Teach teens ways to relax and cope with stress – taking a bath, exercising, yoga or deep breathing and meditation, listening to or making music, etc…
• Remind teens that they are control of some things in their lives, encourage them to make decisions and prioritize activities they can.
• Encourage teens to talk about what is causing the stress and identify healthy ways of dealing with it.
• Identify perceived “unhealthy” ways of coping with stress including using alcohol or drugs, ignoring a problem, watching too much TV or playing too many video games, or getting irritable and cranky.




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Labels: Mental Health

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Bullying and Teens

Like everything else in our culture, bullying has gotten “extreme.” What used to be considered almost a normal part of growing up has become the focus of many discussions between parents as well as elementary and middle school “character building” classes. More than 60% of students report being bullied in national health surveys and about 20% report bullying people. Although bullying tends to peak in 6th grade, high school students can also experience it.

Bullying can be verbal, physical, mental, and Internet-based. It happens between boys and girls of all ages and in every context of their lives. Bullying can include any of a number of behaviors:
• Hitting
• Teasing or taunting
• Name-calling
• Telling jokes
• Giggling or whispering
• Rumor-spreading
• Sending fake emails
• Sharing pictures on the Internet
• Stealing
• Rejection
• Exclusion

The consequences of bullying are very serious. Both teens who are being bullied and doing the bullying experience stress, cannot learn well, may have emotional or physical symptoms that limit school attendance, and will not do as well socially. Many teens who are bullied also experience violent thoughts of retaliation and may resort to violence to cope with the problem.

Ways to combat some of the consequences of teen bullying include becoming involved in activities that have purpose, build self-esteem, develop skills, and include other teens that share characteristics or interests. Every teen needs to feel good about who they are – it will give them strength to combat the bullying or decide they do not want to be a bully.

What should you do if you child is bullied?
• Do not criticize or blame your child – acknowledge that everyone is a target at some point in their lives – whether it is for size, smarts, ethnicity, sexual orientation, social status, where they live, or who their friends are
• Be empathetic and ask what they have already tried to do and how each attempt worked
• Do not encourage fighting back
• Encourage your child to stay with people and avoid the bully
• Encourage your child to ask for help from a teacher, principal, or counselor
• If nothing the teen does works, then you should call the school and discuss the situation with the administration. Encourage the administration to make the entire school a ”bully-free zone” and encourage adults witnessing any form of bullying to stop it.

Resources
Healtlhline for more information on bullying

We're Talking, Too: Preteen Health Bullying Modules for teachers of 4th and 5th grade

We're Talking Teen Health Information and resources for teens.



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Orthorexia Nervosa - The Newest Eating Disorder

Orthorexia is a term coined by Dr. Steven Bratman. “Ortho” simply means straight or correct, while “orexia” refers to appetite. Orthorexia nervosa refers to a nervous obsession with eating proper foods. While anorexia nervosa is an obsession with the quantity, orthorexia is an obsession with the quality of the food consumed.

While it is normal for people to change what they eat to improve their health, treat an illness, or lose weight, orthorectics may take the concern too far. While it is normal for people switching diets to be concerned with what types of food they are eating, this concern should quickly decrease, as the diet becomes normal. Orthorexia, in contrast, is when a person is consumed with what types of food they are allowed to eat and feel badly about their selves if they fail to stick with their regimen.

People suffering with this obsession about what they eat may find themselves:
• Spending more than three hours a day thinking about healthy food.
• Planning tomorrow’s menu today.
• Feeling virtuous about what they eat, but not enjoying it much.
• Continually limiting the number of foods they eat.
• Experience a reduced quality of life or social isolation (because their diet makes it difficult for them to eat anywhere but at home).
• Feeling critical of others who do not eat as well they do.
• Skipping foods they once enjoyed to eat the “right’ foods.
• Feeling guilt or self-loathing when they stray from their diet.
• Feeling in “total” control when they eat the correct diet.

Often orthorectics will “punish” themselves by doing a penance of some sort, if this “fall from grace” does occur. While orthorexia nervosa isn’t yet a formal medical condition, many professionals do feel that it does explain an important health phenomenon. If you or someone you know suffers from something that sounds or feels like this description of orthorexia nervosa, you should go visit either a nutritionist or doctor.

References
1) Bratman, Steve. "Health Food Junkie--Orthorexia Nervosa, the New Eating Disorder." 1997.
2) Billings, Tom. "Clarifying Orthorexia: Obsession with Dietary Purity as an Eating Disorder." 1997
3) Davis, Jeanie. "Orthorexia: Good Diets Gone Bad." November, 2000.
4) Fugh-Berman, Adriane. "Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating--A Book Review." May 2001.




Photo credit: Meg and Rahul

Labels: Eating Disorders

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Teen Body Image

In today’s culture I am really alarmed by how much focus there is for teens (and even preteens) on body image, shape, skin, hair, and “sex appeal.” It seems like everywhere I look I am struck by the excessive preoccupation with comparing our own body to the media image of the so-called perfect body. I am not only talking about girls - more and more young males are experiencing the same pressure to “be perfect.”

It does not help that the clothing industry seems to believe that young children should look “sexy” and that it is difficult to shop for children’s clothing that is not too provocative. It also does not help when young males go the Web in search of information about male health and are immediately confronted with images suggesting that male health is all about muscles, the size of their penis, and their ability to attract women.

The final sign for me that we have lost all perspective on body image is the fact that when people greet each other the first thing out of their mouth tends to be some judgment about the other person’s clothes, hair, body size, tan, or health – most of which is none of their business.

The majority of this preoccupation with body image is around weight, and acknowledging the issues our country is facing with obesity, there is an immediate need to help teens develop a healthy attitude about their bodies. Here are some resources to help.

Resources
My favorite body image site is Dr. Burgard’s Body Positive Site, which has some nice activities and lots of helpful information.

A Body Positive Approach
The Body Positive Approach is very simple – instead of focusing on weight, you focus on the decisions you make day-to-day about how to parent yourself and meet your needs. The idea is to work with your body, make it a partner (not the enemy), and find joy in it.

The steps that Dr. Burger proposes include:
• Changing your motivation from weight loss to quality of life.
• Replacing “will power” with “inner parenting”
• Making only those changes you can live with forever
• Facing the limitations on our capacity to control weight
• Freeing energy and time for more important projects in life
• Addressing the body blame underlying many different difficulties by
• Creating a body disparagement free zone – which is really hard!
• Healing the relationship with your body so you are motivated to take good care of yourself.
• Building skills that are useful for life and lifetimes
• Learning to defend yourself in a stigmatizing world
• Creating multiple ways to soothe, stimulate, nourish, and rest your body
• Getting “back on the horse” when life bumps you off
• Studying exercise as a foreign language
• Naming and cultivating the “hunger to move.”
• Building an athletic identity
• Discovering preferences for activities
• Body Positive Inspired Eating
• Allowing your body to be your partner in eating – (hunger and satisfaction)
• “Dieting detox” – undoing the damage of dieting to your trust in your body and its signals.
• View of food as sensual nourishment – your right to more than just food.
• Research about behavior change
• Understanding progress and relapse – the harm reduction model
• Letting go and grieving the pursuit of body/self transformation
• Letting go of the belief that our worth is reflected by our body
• Building a supportive community
• Create friendships that reflect the real you
• Becoming an activist to “Clean up the culture.”

Another great site is About-Face which is about making changes:
• Stop talking about your weight (especially in front of young girls).
• Make a list of women you admire.
• Question the motives of the fashion industry.
• Stop weighing yourself.
• Concentrate on things you do well.
• Get physical for fun.
• Value your dollars.
• Voice your opinion.
• Be a role model.
• Break the barriers.




Photo credit: jsgphoto

Labels: Body Image

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Eating Disorders and Teens

Eating disorders are real and serious illnesses experienced by approximately 3% of teens, both males and females. The two most common are anorexia and bulimia. Anorexia usually begins around the start of puberty and involves extreme weight loss (at least 15% of body weight) and usually includes a distorted perception of their body as “fat.” Bulimia (or binging and purging) involves eating and then vomiting or using laxatives to get rid of the food. Both disorders are very complicated, have serious medical consequences, and require expert treatment for recovery.

Warning Signs –(from Alyson Yisrael) reasons to talk to a teen:
• Skipping meals
• Avoiding situations where food may be present
• Not being social/isolating self
• Excessive exercise
• Very low or no fat diet
• Eliminating certain foods or food groups
• Always calculating fat grams and calories eaten
• Taking laxatives, diuretics or diet pills
• Using supplements and protein powders
• Vomiting/frequent bathroom visits after eating
• Rapid changes in weight or behavior
• Unhealthy – pale, wan, drawn
• Weighing self often
• Amenorrhea (periods stop)
• Cold/dizzy

Emergencies
• Fainting
• Collapsing
• Unable to walk
• Throwing up several times a day
• Suicidal

For more information, visit:
Healthline

Palo Alto Medical Foundation
“We’re Talking Teen Health"

National Association of Anorexia Nervosa and Associated Disorders
Hotline, Counseling and Referrals
847-831-3438

Overeaters Anonymous
Find a local group.

Weight Watchers
Find a local group.

National Eating Disorders Association
Information on eating disorders and referrals for treatment.

Labels: Eating Disorders

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Parenting Preteens

Parenting some preteens can really be a surprise. Some preteens (and teens) slide easily from childhood to adolescence with not even a flap – given their personality, family, or just luck, it is an easy transition. For others, it may feel like quite a challenge for the preteen and the parent. One day you wake up to find that your sweet, considerate, enthusiastic child who loves to spend time with you has been replaced with an irritable, demanding replica. Luckily for all parents (and preteens), the periods of pre-teen syndrome (PTS we call it in my family) are short lived and only come and go – at first.

Do not pretend that the PTS replica will not be back! I suggest every family experiences PTS develop a plan and maybe set up an appointment with a family counselor. This is where it is obvious I am a developmental psychologist. The plan should include information, support and skills.

First, you might need to find information. A great web site for information about preteen health is “We’re Talking, Too: Preteen Health” by the Palo Alto Medical Foundation. This site is a good one to bookmark for your preteen and suggest they use it when they have questions about their health. It has resources for parents and teachers, too.

Your plan should also include support and guidance from a therapist and/or other parents – hopefully other parents who want to stay involved and are seeking constructive ways to stay connected to their preteen during this rocky period. The Lucile Packard Foundation for Children’s Health and the Preteen Alliance have a web site just for parents of preteens who want to discuss some of the thorny issues affecting preteens these days.

Finally, the plan needs some behavioral skills. My favorite skill or maybe coping mechanism is “do not engage.” When your preteen or teen starts in about how rotten things are, do not take it personally or let the fact that you just spent an hour making his or her favorite dinner color your reaction. If he or she is whining about having to walk the dog or take out the trash, do not let yesterday’s conversations about sharing the responsibility of pet ownership or the increased allowance for chores color your reaction. Be calm, empathetic, and then, when the PTS replica is gone, you can talk about responsibility and allowance – not during the whiny, cranky phase – it will not end well.

Other very concrete skills are 1) use humor; make a joke, stick your tongue out, 2) talk about this being a PTS day and put a dot on the calendar to mark the “cycle;” 3) scream for someone to bring the chocolate; and 4) make everyone a cup of tea and pretend you have lost your voice. Good luck!




Photo credit: Malingering

Labels: Parenting