Alcohol Use and Teens: The Role of Adults

What are you telling your teens (with words or actions) about alcohol use? There was a very thought-provoking article in Time Magazine last week about alcohol use and teens. In spite of the fact that it focused on the negative and forgot to point out that nearly half of teens do not drink alcohol and 80% do not binge drink, it presented some very interesting facts including:

• more than half of underage teens drank alcohol;
• 40% of the underage drinkers got their alcohol from an adult; and
• 20% of underage drinkers have participated in binge drinking (5+ in a sitting).

The article also forgot to point out that alcohol is involved in most sexual assault and rape cases, which I think should always be mentioned. However, as disturbing as those facts are, the thing that bothered me the most was the critical and enabling role of adults. The article suggested that teens who binge drink are likely to come from families where an adult binge drinks, and much of the alcohol consumed was provided by adults.

I think this topic brings up several important assumptions and suggests a couple of key decisions for parents to make. First, the assumptions - do you as a parent think that it is inevitable that teens drink? Do you assume that if you do not provide teens with alcohol that they will get it somewhere else? Do you believe that teens who are prohibited from drinking are more likely to binge drink when they get to college, or turn 21? Do you believe your child would not drink and drive or get in a car with someone else who had been drinking? Do you think your child understand the vulnerability for sexual assault associated with alcohol use? Do you believe that your own relationship with alcohol use is healthy?

Now the decisions - will you allow your teen to drink at special occasions or dinner? Will you allow other teens to drink in your home at special occasions or dinner? Will you allow your teen to drink more than a small amount during the meal? Will you provide alcohol to teens during a party in your home? If alcohol is served at a party, should the parent be a) present, and b) liable for anything that happens? Will you drink more than one in front of your children? Will you drink and drive?

These are sticky questions and translate in real problems for adults who may not be responsible drinkers and for the few teens with a propensity for alcoholism and risk taking. I realize that your answers may be different if you grew up with an alcoholic parent, your child is a risk taker, or you live in a very alcohol-oriented community, but I think it is important to think about these issues and talk through them with your children.

As always, teens are more likely to abide by rules that they participate in making, seem fair, and have clear consequences if broken. Good luck!

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Labels: Alcohol, Healthline, Parenting, Teen Health

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Vacation and Financial Education

While I am in vacation planning mode I realized that an important consideration in every family about what the vacation will include is the total cost of a vacation.

Whether you stay with family or friends, drive, fly, leave the country, go to an amusement park, have a picnic, take a helicopter ride, or hike a mountain, may well have to do with your family budget, which you may or may not be used to sharing with your children.

Planning a vacation is a great way to introduce budgeting to your teens and help them understand how expensive traveling can be. It is fair and reasonable that the parent(s) pick the total cost of the vacation, which usually decides the number of days you can travel. Once the total is decided on, then make a list of the other expenses including travel (e.g., car rental, airfare, gas, parking at the airport or a super shuttle to/from the airport), accommodations (e.g., hotels or a thank you gift for family or a friend), food, activities, souvenirs, and unexpected costs.

If you are comfortable, let the kids go wild, picking everything they want, identify the costs and then total it up. If it is over your budget, then start helping them prioritize what is important. Is the convertible worth the extra $200 a week? Is a 4-star hotel as important as being able to spend the day at an amusement park? Would everyone be happy taking a cooler and making sandwiches every day versus going out for lunch. Are there places to stay that include a breakfast for everyone? Other important things might be to give everyone a souvenir budget for the whole trip - that they decide how to spend, but once it is spent, there is no more.

Picking restaurants, activities, distance from home, mode of travel, etc. all may be easier and quicker if done by a parent, but teens will get some great planning skills and financial education by participating in the process. Good luck planning!

Phot credit: Jacob.Enos

Labels: Financial Education, Healthline, Teen Development, Travel

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Planning Vacations With Teens

It is summertime again and the vacation is coming! I am sorry to say but long gone are the years when the parents decided what the vacation would be, when it would be, and which activities would happen. Sorry, now you have teenagers.

If, as a parent, you are consciously trying to give more autonomy and responsibility to your teens, and teach them the things that we know as grownups, then it is time to include them in the planning. Just because you have gone someplace every year, seen certain relatives, or always done a certain activity, does not mean that, now that your kids are teens, it would be their first pick.

Respect and love in family vacation planning mean that everyone gets to do what they love, or at least some of what they love. Chances are good that in your family, like mine, you have very different personalities. One person wants to do an all day zip line safari, one wants to edit a chapter of a book she is writing, one wants to kayak, and one wants to see a museum.

You may be lucky and have malleable teens who will do what they are told, and never complain, but that does not mean they are happy or learning how to make a memorable vacation happen. More likely, if you have not included the teen in the planning, you have a teen who seems reluctant during the planning, not very excited about the trip, says "do I really have to come?" or worse ye, is sullen and withdrawn during the entire vacation.

Any reluctance or ambivalence is a clue that your teen does not feel included in the planning, and is likely not going to have the best time in the world. Fear not! It is never too late to include them. Haul out the map, or the go to the Chamber of Commerce in the city where you will be visiting via the Internet, and tell the kids it is time they helped plan the vacation. Depending on your plan, the teens in the family can be given a day to plan, or an activity to pick, or a place to stop along the drive. Letting them pick some of what they do will add to their excitement and make them more tolerant of doing the things other people in the family want to do.

A few other hints: 1) have media-free time during the day - whether it is an hour or until after dinner, people can only interact if they are not focused on a screen or the music blaring in their ears; 2) food should be included in the planning and be a high point of every day - let them help plan, shop, prepare, serve, and clean-up; and 3) parents - unplug - no work, checking messages, answering email, etc... family is the most important now!

Have a great vacation!

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Labels: Healthline, Parenting, Teen Development, Travel

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Thank You - Grand Rounds 4.40

Thank you Roy, ClinkShrink & Dinah at Shrink Rap for hosting Grand Rounds 4.40 this week and including my book review about "Bodily Harm."

This week was a tribute to shrinks who "do" technology - way fun - and very interesting! I have not finished reading all the submissions however - it may take all day!

You three are so creative - thanks!

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Labels: Grand Rounds, Healthline, Self-Injury

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Tattooing & Body Piercing

I know, every parent's nightmare - "Mom, I want to get (a tattoo) or (my belly button pierced)." Take a deep breath and say, "OK, let's talk about it, there are lots of things to consider."

It may not make you feel better, but decorating bodies is not new. In fact, archaeologists have found carved figures from Stone Age people showing some sort of tattooing and figures back to 6000 B.C. include tattoos by most indigenous people. Piercing has also been common, but harder to document because the piercings will seal if the piercing object is removed.

Before you start the conversation, you might want to think about your own biases. Prior to the 1970s, tattoos were seen as "low life" and associated with gangs and criminals, but that changed when the baby boomers started experimenting with body art. Tattoos and piercing are pretty mainstream these days and many of the professional-looking people that you deal with every day are likely tattooed, yours truly included.

When you are ready to start the conversation, I suggest you thank your teen for talking with you about this decision and not doing something impulsive. Then, ask your teen why they want to get a tattoo, what design were they considering, and where they plan to put it. Things to consider are visibility - can they cover it up easily with clothing? Future - will it matter to a career, and permanency - they are hard to remove and the process will leave a scar.

Then there are the risks associated with tattooing and piercing. There is blood involved, so disease risk is important. State laws control body art studios and will require disposable needles and sterilization equipment to kill germs on jewelry. Reusing needles can spread hepatitis and HIV. There is also a risk that you will be allergic to the ink or that you will develop scars at the tattoo site. The iron oxide in some inks can also injure tissue during MRIs.

Specific to piercings, infection is a concern, especially for piercings around the mouth, which is full of bacteria, and specific to navels - clothes are going to rub it and healing takes a long time. It will not work to take jewelry out for school or work - the jewelry has to stay in for months during the healing, and the teen is going to have to soak the piercing with warm salt water several times a day for weeks, and whenever the piercing gets infected.

Another concern is health history. It is important to ask your doctor about any risks specific to you - some heart problems and conditions rule out any body art. If you and your teen decide that the tattoo or piercing may happen, it is really important to use a professional studio. Pick one and go visit it, ask to see the autoclave they use for sterilizing things, and make sure they do not use piercing guns (which cannot be sterilized) and that the needles are not re-used. In addition, check out the jewelry and make sure it is made from surgical grade stainless steel, 14-karat gold, or titanium. At a good studio there will be licenses hung on walls and the artists will be happy to explain the procedures.

So, now you have discussed the risks and done your homework. Lucky foryou, if you live in CA a person has to be 18 to get a tattoo, so no worries, they have to wait. If your teen is still interested, there are henna tattoos that last for weeks, so maybe that is an alternative, and might be a great way to see how people react, or to try different designs.

However, teens can get a piercing done, but it will require parental permission. That decision is up to you and your teen. There is magnetic jewelry that looks like a piercing that could be used first to see how it feels to have something on your nose or ear. Good luck!

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Labels: Body Art, Healthline, Teen Health

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Book Review: Bodily Harm (The Breakthrough Healing Program for Self-Injurers)

Self-injury is a behavior people rely on to relieve or distract themselves from difficult feelings, or to communicate emotions that they seem unable to speak. Several teens have asked me via comments on Teen Health 411 for help with self-injury and up until now, all I could do was refer them to counselors, and 1-800-DONT CUT at Self Abusive Finally Ends (SAFE). Now I am pleased to say that I can encourage them to purchase the book "Bodily Harm," as well.

Karen Conterio and Wendy Lader are founders of the first short-term self-injury treatment program (SAFE) in the country and together with Jennifer Kingson Bloom, they have written a book that provides help for self-injurers, as well as support for the people who love them or treat them.

Most importantly, this book addresses the hopeless and desperate feelings of the self-injurer, who with the principles of this book can choose a more meaningful and productive life, and realize that they are not alone. Not that treatment is easy - there is no easy way to break a highly comforting pattern of behavior, but this book tells a self-injurer how to start the treatment process and provides the support and many of the "tools" s/he will need. There is even a 90-item questionnaire included in the book to help a self-injurer pay attention to issues to consider when deciding to seek help.

I cannot say that I really understand self-injury, but after reading this book, my heart goes out to every person suffering alone with this secret. There is no "typical" self-injurer, but many are successful (on the outside), female, middle-class, white, and intelligent, with low self-esteem and trouble forming intimate relationships. There is no "cause" of self-injury, although many of the people who choose self-injury perceived their childhoods and parenting as traumatic, and many were physically, emotionally and sexually abused.


There is a great chapter for families included in the book with questions and answers about how to discuss your concerns and how best to support the self-injurer. There is a useful section on warning signs of self-injury, which include scars on the arms or legs, a pattern of curious abrasions, wearing long sleeves, social withdrawal, sensitivity to rejection, difficulty handling anger, and behaviors that frequently accompany self-injury including compulsive behavior, eating disorders, alcohol and drug abuse, and kleptomania.

Another chapter was written to help therapists who treat self-injurers and there are appendices with tools like samples of no harm contracts and an impulse control log in the back of the book. The book points out that the wish to self-injure is a thought, not a feeling and that self-injury is a behavior that has been distracting the person from difficult feelings, and a behavior that can be changed. The impulse log is a tool to help the self-injurer see that the desire to self-injure is a signal that s/he is experiencing a feeling - anger, sadness, loneliness - that can be addressed without self-injury.

If you are suffering, please do not delay seeking treatment. The earlier the better and remember, you are not alone! You can have a life that is stable and comfortable!

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Labels: Healthline, Self-Injury, Teen Health

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Which Teens Work - If They Can Find a Job

As summer arrives, the job market for teens seems to be suffering with the rest of the economy. In fact, teens seem to be competing with unemployed adults for work, and the poorest teens find it hardest to get work. Our local paper had a chart from the Department of Labor: Center for Labor Market Studies which showed clearly that white teens (ages 16-19) from families with incomes over $75,000 a year were the most likely to be employed last summer.

In fact, about half of those teens worked compared to less than 30% of Black and Hispanic teens from families with incomes under $60,000 a year. I could not figure this out until a friend pointed out that it is the wealthier teens who have the family and school connections that help them get summer jobs - with colleagues of parents, in parents' offices, at pools where they swim, stables where they ride, stores where they shop, and as counselors where they have attended camps.

Of course, the teens who really need the jobs cannot find them and the teens who do not need to work, but are doing it to build character, college resumes, or savings accounts, can - what was I thinking?

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Labels: Employment, Healthline, Teen Development

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Hands Free Law Starts 7/1/08 in CA

Finally! About two years after it became a new law, driving and talking on the cell phone will be illegal in California for teens starting July 1, 2008 - without or without a hands free device. Teens may not talk on a cell phone and drive at the same time!

But parents, beware, the law applies to you, too. People over 18 can talk with a hands free device while driving, although never a good idea. If you are pulled over while driving and holding a cell phone at your ear, you will get a "DWT" or driving while talking citation, which will cost about $20 the first time, plus some fees - which could get you to $100 before you are through clearing it. Repeat offenders will be charged more each time they are cited.

It is hoped that this new legislation will help reduce the number of traffic deaths - which is about 4,000 a year in CA. The grace period ends July 1, 2008 and the CHP has said it will start issuing citations on the first day.

Photo credit: Mike "Dakinewavamon" Kline

Labels: Driving, Healthline, Teen Health

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Thank You: Grand Rounds 4.39

Thank you David Khorram at Mariana's Eye for hosting Grand Rounds 4.39 this week and including a post from Teen health 411 encouraging people to try a soda free summer.

This week was very interesting and fun to read. It is amazing how much blogging goes on in a week, and your headlines were great!

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Labels: Grand Rounds, Healthline, Nutrition

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Book Review: Girl's Guide to Becoming a Teen

As a parent of two girls, I know that they can use all the information they can get to help navigate the changes they experience during the gain of "40 pounds and 10 inches" associated with puberty!

In 2006 the American Medical Association published a wonderful book to help parent and teens, called "The Girl's Guide to Becoming a Teen." Even though there are some great books about puberty out there for girls, this one is pretty comprehensive, so I thought I would review this one for the awesome readers of Teen Health 411.

I am very glad I read this book, and suggest every family with young girls put a copy on their bookshelf (hence the link above takes you to Amazon.com).

This is a straightforward book about the physical and emotional changes that girls will experience somewhere after age 8 as their bodies change from children to adults. I was not happy that the first few chapters focus on eating, exercise and weight, because I think choosing that focus just feeds right into our culture's obsession with "external beauty," but talking about this with our daughters can mitigate the impact.

The authors are comforting and matter-of-fact about breasts, smells and vaginal discharge, eating, fitness, height, weight, skin, hair and hair removal, teeth, feelings, and relationships. I think a nice addition to the book would have been a hygiene chart, so here is a link to one: hygiene chart for preteens. There is some talk about sexuality, sexually transmitted infections, and contraception, but not in great detail, and very appropriate for preteens.

This book does a good job of addressing the social aspects of being a preteen - making friends, being a friend, bullying, sexual harassment and even sexual assault and abuse all have short sections with important ideas for preteens to think about.

Again, books about puberty are a conversation starter for parents - no book includes all the information preteens need about puberty, relationships, and sexuality - but this book is a great start. Leave it out and your daughter will find it, or encourage her to read it! You want her to understand that you are approachable about health questions and want to be the one who answers her questions.

Be brave - get the book and start reading! It would be a good one for boys, too - to help take the mystery out of periods, breasts, and girls! Good luck!

Photo credit: Christiaan Briggs

Labels: Book Review, Healthline, Parenting, Preteens

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Book Review: Boy's Guide to Becoming a Teen

In 2006 the American Medical Association published a wonderful book called "The Boy's Guide to Becoming a Teen." There are not many good books about puberty for boys out there, so I thought I would review this one for the fabulous readers of Teen Health 411.

I am very glad I read this book, and suggest every family with young boys put a copy on their bookshelf (hence the link above takes you to Amazon.com).

This is a straightforward book about the physical and emotional changes that boys will experience somewhere between 8 and 16 as their bodies change from children to adults. The book is completely sensitive to the range of changes boys experience, with some becoming hairy in the 4th grade and others never being able to grow a beard.

The authors are comforting and matter-of-fact about eating, fitness, height, weight, skin, hair, teeth, feelings, relationships, and most importantly to the target audience, penis 101 - scrotum, testicles, penises, yes, they tend to be crooked, erections, wet dreams and even masturbation are presented simply and without judgment. There is some talk about sexuality and contraception, but not in great detail, and very appropriate for preteens.

What sets this book apart from other books about puberty may be the extent to which it addresses the "feeling" side of boys - self esteem, relationships with peers and parents, strategies for coping with being shy, angry, and even stressed out. Making friends, being a friend, experimentation with substances and cigarettes, bullying, sexual harassment and even sexual assault and abuse all have short sections with important ideas for boys to think about.

I feel the same way about most books about puberty - they are really a conversation starter for parents - not all the information any preteen or teen needs about puberty, relationships, and sexuality - but this book is a great start. If you can tell your son you would like him to read it, and then make an appointment to talk about it - it will help him understand that you are approachable about health questions and want to be the one who answers his questions.

Be brave - get the book and start reading! It would be a good one for girls, too - so they have a little more compassion for the preteen boys in their lives! Good luck!

Photo credit: Christiaan Briggs

Labels: Healthline, Parenting, Preteens

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Youth Trends Results - Entertainment

So what are teens and preteens up to these days with regard to their media consumption?
Are we making headway with all of the public health messages sayings "reduce screen time," get active, and get involved?" Sadly, I have to say we do not seem to be making much progress.

Youth Trends produces a report twice a year called The Tween and Teen Lifestyle Report which is only available to subscribers, but I pulled a few interesting tidbits from the Winter 2008 report off the GenDigital Blog.

Movies

• During a typical month teens see an average of 1.8 movies (in a theater) while tween see an average of 1.3
• Teens prefer action/adventure movies and tweens prefer comedies followed by animated movies
• The most popular movie/actor for girls is Johnny Depp and Pirates of the Caribbean
• The most popular actor for boys was Adam Sadler, followed by Will SMith and Will Ferrell

Internet

• Nine out of ten youth have Internet access at home or school
• Teens spend 12.5 hours a week online while tween s spend only 6.4 hours
• The most popular sites are social networking sites, particularly Facebook
• AddictingGames.com is becoming the top casual gaming site among all youth
  

TV

• TV consumption has actually increased (groan)
• Teens watch an average of 11.9 hours a week and tweens watch an average of 12.2 hours a week
• Boys watch more TV - for teens an average of 13.2 hours a week and for tweens an average of 14.5 hours a week
• Favorite shows for boys - The Office, Family Guy, The Simpsons and South Park
• Favorite shows for girls - The Hills, Grey's Anatomy, House, and Dancing with the Stars

Photo credit: Henrique Vicente

Labels: Healthline, Media, Preteens, Teen Health

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Sugar and a Soda Free Summer

The SF Bay Area is gearing up to have a "Soda Free Summer!" Six counties are being encouraged by the public health department and many community-based organizations to learn about the health risks associated with soda consumption and help families avoid soda.

Soda, along with sweetened teas and sports drinks are seen as a key cause of the nation's obesity trends, particularly in youth. Studies have shown that the extra calories from soda and other sweetened drinks leads to weight gain because they do not satisfy people's hunger, therefore they are just extra calories.

The Center for Weight and Health at U.C. Berkeley reports that sugared beverage consumption has increased 500% in the last 50 years, at the same time that obesity and diabetes rates have skyrocketed.

Rethink Your Drink! One medium triple thick chocolate shake from McDonalds has 21 teaspoons of sugar in it. One 20 oz. bottle of coke has over 16 teaspoons of sugar in it. Sunny Delight (16 oz) has 15 teaspoons of sugar in it. And lest you think water is good for you, Vitamin Water (20 oz) has 8 teaspoons of sugar in it (the same amount of sugar as a Snickers Bar).

You can calculate how many teaspoons of sugar are in your food or drink using this:
Fact: 4 grams (g) of sugar = 1 teaspoon of sugar
Math: Amount of sugar on label times (x) servings per container = total grams of sugar
Answer: Total grams of sugar divided by 4 = teaspoons of sugar in your food

Alternatives to soda include water with some fresh mint leaves or a slice of orange, lemon or lime and smoothies with non-fat yogurt and fresh fruit, low-fat or non-fat milk.

For educators, you can get sugar savvy curriculum materials in English and Spanish at the Bay Area Nutrition & Physical Activity Collaborative (banpac), and the soda free summer site has family materials in English, Spanish, Vietnamese and Chinese.

Have fun being healthier this summer!

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Labels: Healthline, Nutrition, Parenting

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Teens and Alcohol - What is Normal?

People, people, people, most teens do not drink! I am frustrated by the media's continued insistence that they do. Just last week there was another article in my local paper saying things like: "alcohol is the drug of choice for young people" and "... underage drinking ... has reached epidemic proportions."

Some of the things the article said that did not bug me were "parents are young people's role models. The way they drink, where, when, and what provisions they put into place to stay safe and not drive are critical."

It is true that some teens drink, and those teens are likely to have a drinking problem when they get older, but the majority of teens do not drink regularly and when they do, they are not meaning to "get drunk." Every time we "lie" to teens we undermine our credibility and make it harder for teens to hear our concern for their well-being.

If a teen is drinking, it is a problem and worthy of intervention with doctors, counselors, the school, and community. However, if we portray drinking as the norm, we encourage it- which I know cannot be what people truly want to be doing.

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Labels: Alcohol, Healthline, Teen Health

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Thank You - Grand Rounds 4.37

Thank you Happy Hospitalist for hosting Grand Rounds 4.37 this week and including a post from Teen Health 411 about self-injury.

This week was really funny and a great read - much more fun than what I should have been doing this morning!

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Labels: Grand Rounds, Healthline, Self-Injury

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