Beauty At Any Cost

YWCA USA has produced a new report called "Beauty at Any Cost" and is teaming up with filmmaker Darryl Roberts to distribute his documentary film called "America the Beautiful" to raise awareness about the costs of our culture's obsession with beauty.

This new report portrays our obsession with beauty as a lifelong burden taking a terrible toll on young girls and women in this country. The report shows an alarming increase in toxic cosmetic use, cosmetic surgery, as well as more perceived appearance-based job discrimination, and decreases in self-esteem and healthy interpersonal relationships.

The report and discussion guide can be accessed at the YWCA web site.

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Labels: Beauty, Healthline

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Thank You - Grand Rounds 4.50

Thanks to Laurie Edwards at A Chronic Dose for hosting Grand Rounds 4.50 this week and including the post about the Importance of Education from Teen Health 411.

This week was really interesting. I read by favorites first but then had to read some new ones! Great theme!

Photo Credit: Ed Bierman

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The Importance Of Education

When you think about it, after unconditional love and attention, there may be nothing more powerful a parent can give a child than education. Education brings with it adult mentors who care about kids, knowledge about health, the world, character-building experiences, a responsibility to participate in government, and a sense of unity with the world. Truly exceptional education impacts the whole person, body, mind and soul, instills in a child a love of learning that will guide an entire life, and inspires creativity as well as passion!

On a more practical note, research shows us that a perceived connection to school is a powerful predictor of resilience for all children, providing a safety net of sorts, no matter what family or community they are growing up in. Teens who are connected to school are also less likely to be participating in high risk activities, like drinking, smoking, and early sexual activity.

Giving a child an education not only keeps them busy, it opens up their world and helps them understand the interconnectivity of systems - the earth, human bodies, families, neighborhoods, communities, countries, and the universe. I truly believe that it is hard for a well-educated person to fail in life - because there are always new ways to approach problems.

Providing an education can be as simple as finding a great school that brings out the best in your child, but being involved with that education is also important. Making time to spend time at school volunteering and connecting with your children around educational activities, like reading, shows your child that education and s/he are your priorities.

Other things you can do to support that education include:

• Playing board games;
• Sharing good books;
• Doing community service projects together;
• Traveling;
• Encouraging arts and music;
• Reducing TV and screen time;
• Helping with homework
  

Thinking back on my own life growing up in a pretty dysfunctional family, I have always believed I "made it" because although I could not change my family, I could be successful in school and found adults who believed I was smart and worthwhile, which kept me doing well in school. I remember several moments quite clearly: 1) in 7th grade Mr. Rayburn, a social sciences teacher told me I should go to college because I was really smart (this is in a rural community in the early 70's when few people went to college); 2) sitting in new student orientation at SJSU, a professor suggested those of us who believed in interdisciplinary education and social change should consider a program called New College; and 3) sitting in my first graduate class at Stanford wondering how I would ever fit in with my classmates, and deciding that reading all the "classics" (they had read in their ivy league educations) might help.

Education cannot be taken away - it becomes a part of the person learning something and transforms that person as it happens, bringing self-confidence, curiosity, joy, creativity, and yes, responsibility.

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Labels: Education, Healthline, Parenting

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Sports and Injuries in Teens - Tennis Elbow

Tennis elbow or a unilateral collateral ligament (UCL) tear is common in young athletes that play baseball or football and throw javelin, but can occur at any age. This injury seems to occur more in less-skilled players, suggesting that good technique and conditioning are important.

It is a tear in the UCL that normally occurs when the strain of one pitch/throw becomes too much for the ligament to take. This doesn’t build up over time as other injuries do, but is an acute injury that happens all at once. The over use causes inflammation & pain in the muscles that attach to the elbow. It gets sore to the touch and hurts to grab (grip) things and shake hands.

The treatment is generally reconstruction. The UCL is removed and then replaced with a tendon from the wrist or a section of the hamstring. However, if surgery is not required you can cut back on the activities that hurt and avoid repetitive activities. You can ice the area and take Ibuprofen to reduce the inflammation. Finally, as it gets better, do wrist curls with increasing weight – palm down.

It will take several weeks to six months for people to get better, but most do. Take it slowly and use a brace or tennis elbow strap to reduce the muscle pulling on the elbow. Physically therapy helps some people, as does ultrasound therapy.

Prevention includes two-handed back strokes, which is less hard on the body than a one-handed back stroke.

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Labels: Healthline, Sports, Teen Health

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Sports and Injuries in Teens - Osgood Schaltter

Osgood-Schlatter disease (also called Schlatter's disease or osteochondrosis of the tibial tubercle) is inflammation in the top of the shinbone (tibia) where the patellar tendon attaches to a bony mound in the knee called the tibial tubercle. This disease, a common cause of knee pain in children between the ages of 10 and 15, usually flares during periods of rapid growth and then goes away at the end of the child's growth spurt.

This injury is commonly seen in volleyball, basketball, track, soccer and field hockey athletes. It is brought on by banging the knees – a direct injury and overuse of tendon. Seen in girls earlier than boys because girls go through puberty earlier. Frequently seen in girls around 11-12 and boys 13-14.

Signs and symptoms of Osgood-Schlatter disease include pain and tenderness in front of the knee and mild swelling or a bump below the kneecap at the top of the shin. This disease usually affects only one knee, though occasionally it affects both knees. Symptoms get worse with exercise or activity, such as jumping, that stretches the tendon and puts traction on the tibial tubercle. Teens usually start feeling pain and then a bump below the knee comes up after about 1-2 months of pain/discomfort. The bump hurts because the place where the tendon attaches to the tibia is inflamed.

The condition does not require any specific medical treatment. Most children outgrow the problem within two years. To lessen symptoms the teen first needs to reduce the jumping. S/he can also ice the area after playing, and take Ibuprofen to reduce the inflammation. All activity does not need to stop, but reducing the activity for 6-18 months might be required. The athlete can actually play with the pain – unlike many other injuries.

There is no quick cure. Sometimes (rarely) surgery is required to trim the bone and reattach the tendon, but that will shut down an athlete for a long time.

There are things you can do to prevent this like wearing knee pads in volleyball and basketball – to protect the knee if you hit it on the court.

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Labels: Healthline, Sports, Teen Health

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Thank You - Grand Rounds 4.49

Thanks to Theresa Chan at Rural Doctoring for including my Back-To-School post in this week's Grand Rounds.

This week was a beautiful read - I loved the Shakespearean theme and my fvorite line was "Create for eternity. Let every word pierce the heart."

Photo credit: Ed Bierman

Labels: Grand Rounds, Healthline, Parenting, School

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Helping Teens and Preteens With Homework

Sticking to the back-to-school theme, homework is likely to become an issue for most families very soon. For many families, the quantity, organization, completion, and thoroughness of homework is a serious source of stress.

I humbly suggest that before the nagging or argument starts, that you sit down with your preteen or teen during the first week of school and have a serious conversation about homework - what the issues have been in the past, expectations for this year, and ways to get around any issues you have had in the past. As always let your child know that this conversation is happening because you really love him or her, want him or her to be successful in school, and are willing to help with that goal. If you agree with the premise, remind them that you are more worried about the learning than the scoring.

Lay out the school expectation that your child can expect 30-120 minutes of homework a day (depending on their age) and then talk about what the issues have been in the past. If it helps, talk to teachers that you and your child like at school to get some suggestions. Then ask your child what they think is going on - is it not having a set place or time of day or evening to complete the work, is the schedule too busy, do they feel like they study enough but still do not do well on tests, does the T.V. or computer get in the way? Do they have difficulty concentrating?

You may find that the child's study skills are not what you thought or that they need some reminders to use flash cards, memorizing help, or that there are really auditory or visual learners and need to study in a different way. If they have not been doing well in a particular class, try different ways of studying. Maybe they learn by listening, so try asking them to explain the concepts to you, or maybe they need help memorizing, so prepare flashcards and drill them each day during a time they are usually relaxed and happy. Maybe the issue is concentration and some meditation training can help.

Whatever method you come up with, try and arrange your life so you can be with your child(ren) when they study, be interested in the subjects and offer to help and even check their work when they are done. If just being close is enough, you can do your own work at the same table, gladly helping if they need the support.

When it gets tough, just remember that most children want to succeed and please the adults they love - they are not trying to do poorly and chances are good that if you set your mind to it, you can find a way to help them succeed. Good luck!

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Labels: Healthline, Parenting, School

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Back-To-School Boot Camp

It is that time again - school is starting or will be starting soon. You can make the transition a little smoother by starting a week early to get those school-related habits back into your lives.

Schedule
It is time to start going to bed earlier and getting up earlier, or with teenagers, sometimes it means just getting them up and out of the house earlier and after a few days they drop off earlier - due to sheer exhaustion. Remember teenagers need 9 - 10 hours of sleep a night. If they are not getting it, try to make some changes in your family schedule so that they can start.

Organization
Is their locker stocked? Are their binders set up? Do they have PE clothes and shoes that fit? Is there a clear place on their desk or the kitchen table where they can do their homework? Have you talked about how they will get to and from school, practice, classes, appointments?

Who makes lunches and what goes into them? Do they need to do morning chores? Who makes breakfast and what are the options? Do your kids need to have their clothes laid out and everything packed in their backpacks near the front door before they go to bed at night? You might start practicing that.

Expectations
Have you taken some time and talked about the expectations you have for your child this academic year? Is it their freshman year and you just want them to "get a grip" on the high school work load, is it their sophomore year and you expect strong grades before they start driving, is it their junior year when grades might really matter? You may have some really clear expectations, but unless you share them with your teen, they may not share you thoughts.

Good luck and have a great school year!

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Labels: Healthline, Parenting, School

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Thank You - Grand Rounds 4.48

Thanks to Kerri at Six Until Me for hosting Grand Rounds 4.48 this week and including a post from Teen Health 411 about stress fractures.

This week was fun reading and I loved the theme of the card catalog - which I know my kids have never even seen.

Photo credit: Ed Bierman

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Happy 2nd Anniversary Teen Health 411 Readers

Hard to believe that Teen Health 411 has been around for two years, but to celebrate, I thought I would give a gift to you, the readers. Below is an index of articles from the last two years, by label!

I hope you enjoy being able to read posts on Teen Health 411 by subject, and thank you for being a reader! Let me know if you like this - and I will pass it along to Healthline.

Abortion (4)
When Denial is Not the Best Choice
Unwanted and Teen Pregnancy in the Media
Supreme Court Restricts Women's Reproductive Freedom
Confidential Reproductive Health Care and Teens

Advertising (4)
Can't Buy My Love ...
Shame on RJ Reynolds Tobacco Company
U.S. Food Companies Promise to Limit Food Advertising to Kids
Selling Food to Children: Why is Obesity a Problem?

Alcohol (9)
Alcohol Use and Teens: The Role of Adults
Teens and Alcohol: What is Normal?
Social Norms and Teen Drinking
College Students and Stress
Drugs, Brains, and Behavior: The Science of Addiction
Alcohol Use and School Attachment
Teens Who Work May Be In Danger
Unintentional Injuries ...
Substance Abuse: Teens & Young Adults

Beauty (7)
For Goodness Sake - Cosmetics Can Kill You
Protect and Care For Your Skin
Seventeen Magazine and the Body Peace Project
Onslaught Video by Dove
Hair Removal and Beauty
Embracing Healthy Skin
Reality TV and Teen Health
Shaving Pubic Hair

Biking (1)
Bike Safety and Manners

Body Art (3)
Tattooing & Body Piercing
Oral & Dental Complications of Piercing
Piercing & Teens

Body Image (8)
The Care & Feeding of Adolescents
Protect & Care for Your Skin
Girls & Body Image
Body, Self-Esteem, Gender & Race
Prom Dresses for Girls Size 16+
Weight Loss Ads & Young Girls
Healthy Living: A Teen Perspective
Teen Body Image

Boys (7)
A Boy Crisis
Males, Romance & Success
Teen Boys & Romance
Boys: The Teens We Ignore
Teen Boys & Healthcare
Are Males Dominant, Disconnect & Dangerous
Manorexia: Males & Eating Disorders
Boy's Guide To Becoming A Teen

Bullying (11)
Cyberbullying & Fear
Fashion Bullies in Middle School
Setting an Example
Best Practices in Bullying Prevention
School Bullying
Cyberbullying
LGBTQ Harassment
Schools & Parents Taking Action
Harassment & Bullying
Cyberbullying
Bullying & Teens

College (13)
The Used To Be Empty Nest
The Launching Years Part 1
The Launching Years Part 2
College Students & Stress
Education Update
A Gap Year
Stanford Here We Come
College Applications & Facebook
Is Character As Important As Grades?
PSAT Scores & College Prep
When Your Kid Goes To College
Are Teens Emotionally Ready For College?
Teens Leaving For College

Community Service (2)
Traveling With Teens: Part 3
Community Service & Teens

Divorce (1)
Now What Do I Do: A Guide For Teens

Driving (7)
Hands Free Law
Fewer 16-Year-Olds Driving
July 2008 Bans Cell Phones
Preparing Parents for Teens to Drive
Teens Admit Risky Driving Habits
Teen Driving Risks, Guidance for Parents
Drivers Education & Teen Fatalities

Eating Disorders (5)
Eating Disorders and Teens 1
Eating Disorders and Teens 2
Weight Control in Middle School
Eating Disorder Support On The Web
Orthorexia: The Newest Eating Disorder

Emergency Contraception (4)
Plan B Use Increases
Emergency Contraception Survey
Plan B Available to Teens One Way of The Other
Plan B or The Morning After Pill

Emotional Health (4)
Teens and Depression
Mentors Make A Difference
Parenting As Inspiration
Cutting To Relieve Emotional Pain

Employment (7)
Gen Y Employees Not Engaged
Which Teens Work - If They Can Find A Job
The First Day At Work - for Teens And Parents
Labor Force Participation For Teens Is Only 41%
Finding A First Job As A Teen
Teens Who Work May Be In Danger
Teens And Work

Financial Education (3)
Families Struggle To Make Ends Meet
Vacation & Financial Education
Your Kids & Investing
Financial Fitness For Teens & Preteens

Fitness and Sports (7)
Youth Need More Exercise
Girls Are Champions
Celebrating Girls & Women In Sports
Sports & Injuries In Teens - Stress Fractures
Girls & Sports
Sports and Injuries In Teens - ACL
Sports-Related Injuries Among High School Athletes

GLBT (10)
In Memory Of Larry King
Bullying Of LGBT Teens
Rainbow Project Book List
Literature For Transgender Youth
Talking To Your Kids About Homosexuality
Colage: Children of Lesbian & Gay Parents
GLBT Movies To Share With Your Teens
Gay Teens
Suicide Risk & LGBT Youth
LGBTQQ Youth

Health Care (8)
HIV & Your Grandparents
One In 150 Children Has Autism
High Blood Pressure Undiagnosed in Teens
Staph Infections & School
Heart Attacks Can Occur In Teenagers
Teen Health Rights
Getting Teens Hooked Into Preventive Health Care
Breast Cancer & Teens

Health Facts (6)
For Goodness Sakes - Cosmetics Can Kill
FDA Warning About Products
Sleep Awareness
The Muscle Cramp
A Quart Of Mucus Every Day
Body Drama Review

Hobbies (2)
News For Twilight Fans
Breaking Dawn Review

Holidays (11)
Happy Valentine's Day
Post Holiday Blues
Looking Back on 2007
Happy Thanksgiving
Gratitude & Abundance
Holiday Letters
Teens & Mothers
Coming Of Age
New Year Ritual
Blessings For The Holidays
Teen Health & Holidays

Injuries (4)
Emergency Preparedness For Teens
Unintentional Injuries
Sports-Related Injuries
Leading Causes Of Injuries

IUD (2)
IUDs For Teenagers
The Intrauterine Contraceptive (IUC)

Media (20)
Youth Trends Entertainment Results
New Media In The Everyday Lives Of Youth
Unwanted And Teen Pregnancy In The Media
Pew Report On Teens & Social Media
Provocative Campaign On Childhood Mental Illness
Web Resources For Parents, Tweens & Teens
Manhunt 2 Rating: Mature or Adults Only
Judge Blocks State Video Game Ban
Teens, Tweens & Technology
Cybering - Scary Or Safe?
It Is T.V. Turn Off Week
Are Violent Video Games Really Bad?
Sexy Girls
Violent Girls: Who Do You Believe?
Turn Off The T.V.
Media Multitasking Among Young People
Teen Hearing & Music
Teens And The World Wide Web
Reality T.V. & Teen Health
Media Literacy & Smoking

Mental Health (13)
Do You Have A Cutting Problem?
DNA And Autism Risk
Successful Health Teens Are Often Ignored
Surviving Teen Suicide Attempt
Teens & Stress
Mental Health Challenges & Resources - Older Adolescents
Connection
Emotional Well-Being
Post-Traumatic Stress Disorder Research
Surviving A Borderline Parent
Helping Stressed Students
Get Ready for That Feeling of Rejection & Failure
CA & College-Bound Grads

Mentoring (2)
Mentors Make A Difference
School-Based Mentoring Programs

Nutrition (3)
Sugar And A Soda Free Summer
Free Fast-Food Nutritional Details
Carbohydrate Counting; Teens Beware

Obesity (12)
Weight Loss Confidential
Metabolic Syndrome & Teens
Meals Matter: Dairy Council
Obesity Rising Among Asian Children
High Blood Pressure Undiagnosed In Children & Teens
Summer Vacation & Obese Teens
US Companies Promise to Limit Food Advertising
Selling Food To Children: Why Is Obesity A Problem
Are You Or Your Teen A Couch Potato?
Online Food Advertising
Health Consequences Of Soda Consumption
The Epidemic Of Childhood Obesity

Online/Internet Safety (7)
Totally Wired
Family Internet Safety Site
What Puts Teens Online At Risk?
Technology & Today's Tweens And Teens
Teens, Privacy & Online Social Networks
A New Online Safety Group
Child Internet Safety

Parenting (33)
I Won't Grow Up 1
I Won't Grow Up 2
Great Parent Resource
Happy Mother's Day
A Parenting Book That Could Change Your Life
Unconditional Love: How Hard Can It Be?
Preeten PMS: What Is A Parent To Do?
Dear Ms. President
Post Holiday Blues?
Looking Back on 2007: Teen Health
Bring Back Home Economics!
UCAN Teen Report Card - Teens Grade Parents
Safety & Empowerment - How To Balance Risk For Teens
Preteen Summit - Food For Thought
Does My Tween Or Teen Need A Flu Shot?
In Case Of Emergency (ICE)
Parenting Teens Online Resource
A History of Manga
Tea Time With TeensTotal Momsense by Anita Renfroe
MOMfulness Book Review
Peaceful Meditation For Parents Of Teens
Board & Card Games For Family Bonding
Parenting As Inspiration
Cyber Chores
Mothers & Community
Parenting In The 21st Century & Blogs
What Every Parent Should Know About School Involvement
The Importance Of Touch And Teens
Parent-Child Connectedness
Support For Depressed Parents Of Teens
Organized Activity Participation Or Over-Scheduling - Which is Better For Youth?
At-Risk, Privileged, and Pressured
Parenting Preteens

Pregnancy (7)
Stigma & Teen Pregnancy
Teenage Birth Rate Increased in 2006
Six Steps to Increase Unintended Pregnancy
Reasons For Unprotected Sexual Intercourse
Contraceptive Use is Reducing Adolescent Pregnancy

Preteens (4)
Girls Guide To Becoming A Teen
The Care & Feeding Of Adolescents
Early Pubertal Development - Girls
Preteen PMS - What Is A Parent To Do?

Relationship Violence (5)
Dating Violence In The News
Abusive Relationships
Internet-Based Abuse Hotline
Dating Violence 1
Dating Violence 2

Relationships (4)
Love is Respect
Males, Romance & Success
The ABCs of Healthy Teen Relationships
Teen Boys & Romance

Research (2)
Summary Of Health Statistics
Abstinence Only Programs

Safety (3)
Stroke - Do You Know The Warning Signs
Stranger Danger
Violence & Schools

School (13)
Homeschooling Banned In CA?
Small Class Sizes & Health
Expanded Learning Time in School
Back-To-School Basics

Self-Injury (1)
Bodily Harm

Sexuality (17)
Freedom = Less Sex
Are Teens Having More Oral Sex?
A Global Perspective on Teen Sex Habits
What is Hooking Up?
Unhooked
Loose Women On Campus
Speaking Out About Adolescent Sexuality
Relationships & Sex
Good Sex = Good Communication
The Incredible Melting Condom
YRBS
Motivation To Have Sex?
Religion & Teen Sexual Behavior
Is It Consensual Sex Or Rape?
Abstinence In The News
Sexuality Education Is Failing Miserably
Facts About Teen Sexual Activity

Sexuality Education (13)
Sexual Risk Reduction Information To Parents
Congress Extends Funding For Abstinence Education
Parents & Sexuality Education
Plain Talk About Adolescent Reproductive Health
The Birds, The Bees, and Me
Condom Availability In Schools
Fathers, Daughters & Virginity
Religious Declaration On Sexual Morality
Teens & Sexual Health
Teens & Sex
HIV Among US Adolescents
Abstinence-only versus Comprehensive Sexuality Education
Teens & Condoms

Sexually Transmitted Infection/Disease
Birth Control In Middle School?
Mycoplasma Genitalium
Telling Someone They May Have An STD

Chlamydia (5)
1-in-4 Sexually Active Girls May Have An STI
US #1 In Chlamydia Cases
Condoms Prevent STD: Duh!
Chlamydia & Teens
Reproductive Health & Teens

Herpes (1)
Genital Herpes (HSV 2) And Teens

HIV (11)
HIV Infection in People Over 50
Role Of Fathers in HIV Prevention
HIV & Your Grandparents
Girl Positive
Internet & HIV Prevention
HIV & African American Teens
Hormonal Contraception & HIV
HIV Infection & Teens
Teens & HIV Vaccine Trials
Routine HIV Testing

HPV (8)
New HPV Vaccine
HPV Update
HPV Vaccines For Boys?
More Q & A About HPV Vaccine
Link Between Oral Cancer & HPV
Could 1 In 4 Women Have HPV?
New Hampshire Offers Free HPV Vaccine
Adolescent Immunizations

Sleep (6)
Women & Sleep
Sleep Awareness
Summer Slugs - Sleep & Teens
Teens Having Trouble With Sleep
Sleep In The News

Smoking (1)
ADHD, Lead & Smoking

Substance Abuse (9)
Social Norms & Teen Drinking
Teen Marijuana Use
Drugs, Brains & Behavior
Alcohol Use & School Attachment
Caffeine & Youth
Substance Abuse
Misuse Of Stimulants
Teen Smoking
Drug & Alcohol Use Leveling Off

Suicide (2)
Youth Suicide Rates
Helping Prevent Suicide

Tanning (2)
Sun Safety
Skin Cancer & The Beautiful Tan

Tragedy (1)
Virginia Tech

Travel (6)
Summer Camp & Independence
Staycations With Teens
Planning Vacations With Teens
Traveling With Teens 1
Traveling With Teens 2
Preparing Your Teen/Preteen For Being Away From Home

TV (1)
TV May Hurt Attention & Learning Skills

Photo credit: WxMom

Labels: Healthline, Index, Teen Health

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Sports and Injuries in Teens - Stress Fractures in the Lower Back

A doctor I work with recently said she was concerned by the increase in lumbar stress fractures she was seeing in young athletes. She said she used to see it mostly in gymnasts but now she was seeing it in teens who play all kinds of sports.

We hypothesized it might be the long hours of practice and tournaments on weekends that sometimes include 6-8 hours of play a day. I also think it may reflect the increasing tendency for parents and teens to "raise the bar," in academics, athletics, everything - to give our children the best chance of success that we can.

To get some more information, and a different perspective, I went to Jolie Bookspan, my favorite Fitness Fixer. Jolie had a couple of interesting hypotheses including an increase in lumbar stresses from severely overarching (increasing inward curve) of the lower back, and some really bad sitting posture habits. In addition, Jolie is concerned that teens are not getting enough exercise or spending enough time in the sun to have the strong muscle and healthy bones that would protect them from these fractures.

Another concern is that the young athletes have typically been experiencing pain for quite a while before seeking care, making the diagnosis and treatment more difficult. Teens should not be experiencing back pain. If your teen complains of back pain, please see his or her doctor.

Photo credit: Fitness Fixer

Labels: Healthline, Sports, Teen Health

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Gen Y Employees Not Engaged?

Results from a global study by Blessing White called "The State of Employee Engagement 2008" reported that Generation Y employees are the least engaged in the workplace on four continents. In North America, the report suggests that only one out of three employees is engaged.

The report is based on 7,500 individuals and interviews with 40 senior human resource and line managers, with the bottom line being, the older the employee, the more engaged the employee. This left me wondering if engagement leads to power and position or if power and position leads to engagement?

When trying to get a grip on what they meant by "engaged," I loved this line: "engaged employees stay for what they give, while disengaged employees stay for what they get." That pretty much said it all to me. Engaged employees plan to stay with a company while disengaged employees are always looking for a higher salary, better stock options, etc... The report suggests that engaged employees are more productive, committed, proud, passionate, and enthusiastic compared to unengaged employees who tend to feel underutilized, disconnected and negative.

Just FYI, the highest rate of engaged Gen Y employees, and the happiest employees were in India, which may reflect expanded opportunities from that growing economy.

Photo credit: debaird

Labels: Employment, Healthline

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Thank You - Grand Rounds 4.47

Thank you Daniel Goldberg at Medical Humanities Blog for hosting Grand Rounds 4.47 this week and including a post about ACL injuries from Teen Health 411.

This week was very diverse and the posts were interesting to read. I liked the personal statements you inserted - as a way of getting to know you.

Photo credit: EdBierman

Labels: Grand Rounds, Healthline, Injuries, Sports

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Girls and Sports - Results from Seventeen and WNBA

Seventeen Magazine and the Women's National Basketball Association (WNBA) recently conducted a survey about how sports impact the lives of teen girls. The results may surprise you - they did me. According to this survey (of only about 1,000 young women), 83% of girls participated in sports and basketball was the number one sport.

The results suggest that girls play for exercise, to develop and maintain friendships, compete, and represent their schools. The girls that do not do sports say it is becasue they doubt their athlectic ability, do not have access to needed equipment at their schools, or worry about being perceived as a lesbian by peers. [Seriously?]

The impact of sports on young women is profound - results suggest that the participation in sports helps people develop emotionally and physically, experience the rush of competition and winning and learn lessons about losing -lessons that create future leaders.

Photo credit: tata aka T

Labels: Healthline, Sports

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The "Used To Be" Empty Nest

Here is a new parenting issue - how do parents handle having their college graduate come home to stay? According to Collegegrad.com it seems that more and more (77% last year) college graduates are not getting a job after college or setting up their own homes, but are moving back in with mom and/or dad.

Is it the recession or is it that this generation (Gen Y) is just more attached to family and home, and maybe less motivated? I cannot help thinking that this phenomenon is related to the issues experienced by college freshmen, too!

In previous posts I have talked about the higher numbers of first year college students who seem emotionally unprepared for college in spite of wonderful academic, music, sports, and community service records. What seems to be missing are the skills required to be an adult, manage time, handle problems and negotiate "the real world." Maybe this generation of students are all struggling, but the ones making it through four years of college are suffering, at the other end.

Photo credit: ktyleconk

Labels: College, Healthline, Parenting

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Sports and Injuries in Teens - ACL Injuries

I am learning a huge amount about sports and injuries this summer while working with the teen writers for the We're Talking Teen Health site at the Palo Alto Medical Foundation. I am by no means an expert in sports, but I think parents and teens need to be aware that the rate of injury in teen athletes is going up, but injuries can be prevented.

This week we interviewed a doctor about ACL (anterior cruciate ligament) injuries in the knee and I wanted to share what I learned.

How does this injury happen?
This injury is specific to sports that involve starting, stopping, pivoting and turning with some speed – particularly in sports like basketball, soccer, volleyball, football, field hockey, skiing, and lacrosse. There are primarily two ways the injury happens:

• landing on an over-straight (hyper-extended) knee, and
• with a foot planted a person pivots inward (internal rotation) without the foot coming, too.
  

This can happen in contact and non-contact injuries.

How is this injury usually diagnosed?
Usually there is significant swelling, and there are only a few injuries with this amount of swelling; there is an exam maneuver that is done to test for looseness of the ligament (if it is firm it is not torn, and if it is loose, it is likely torn), and an MRI is usually done to confirm the diagnosis. An x-ray will not help because it only shows the bones. The MRI will also identify whether the meniscus (shock-absorbing cartilage) was damaged (torn) during the injury.

How is this injury typically treated?
If the injury is in an adolescent who intends to go back to sports in which s/he will need to do pivoting, they will need surgery. If the injury is in an older person who jogs, bikes, or swims, activities that do not require the pivoting, the injury may not need to be repaired. If the meniscus was damaged, then during surgery the doctor will smooth it out so there is not a frayed area that will cause irritation, or sew it back together, depending on the nature of the tear. The doctor will try to preserve as much of the meniscus as possible given that it is the shock-absorber for the knee.

What is the recovery like if this injury is treated with surgery?
A person will need to be on crutches for about one week, have physical therapy twice a week for a month, and then they can start biking, jogging, swimming, but need to wait approximately four months before going back to the sport that requires any pivoting or turning. This is because the surgery includes adding some new ligament, which will get weaker before it gets stronger and takes a long time to heal.

How can teens prevent an ACL injury?
This is really a hot topic because ACL tears are much more common in female than male athletes. In fact, it is not uncommon during a single season that one out of 12 females on a team will experience an ACL injury.

There has been a lot of research done about why this is the case, and the results suggest that it is not because of the physiology or hormones of the female body, as was previously hypothesized, instead it is more likely to be:

• muscle imbalance in the thigh as the quadriceps muscles overpower the hamstring muscles which need to work together to straighten (extend) and bend (flex) the leg; or
• the way female athletes move during their sport, remaining more upright with their knees less bent than their male counterparts that puts the ACL in a vulnerable position.

In addition, you may have heard someone say “you run like a girl,” which usually means that when a person runs, their feet kind of go out, and knees bend in, instead of the knees staying straight over the foot, which is how girls tend to run (post-puberty), without training.

Prevention of this injury should include 15 minutes several times a week training to learn how to:

• stop and start keeping the knee straight over the foot, avoiding the knock-knee position which makes the ACL vulnerable,
• standing on a block and jumping, keeping the knee straight over the foot, and
• hamstring strengthening exercises.

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Labels: Healthline, Injuries, Sports, Teen Health

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Book Review: Breaking Dawn

Wow, 754 pages later I have emerged from the Twilight Series and Stephenie Meyer's latest book, Breaking Dawn! I got it Sunday and have not wanted to do anything but read all week.

What a great book. This is the fourth - it follows Twilight, New Moon and Eclipse - finishing a story of passion, the meaning of family, coming of age, the supernatural, good versus evil, diversity, and love. If you have not read these four books with your teenage daughters and sons, it is not too late - there are still a few weeks of summer left - get reading! Breaking Dawn starts off with a long awaited wedding but within 138 pages the totally unexpected has happened and the rest of the book is a huge surprise!

I do not want to give away the fabulous ending, so let it suffice to say - this is a must read for summer! It will fill your spirit with a belief that anything is possible!

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Book Review: The Launching Years (Part 2)

Once your teen actually leaves for college, the authors of this wonderful book suggest that your relationship with him or her will likely improve, overnight!

Part 2 of this review focuses on what to expect the first year your teen is in college. I remember leaving my children at kindergarten for the first time, and driving away while they stand at the curb in front of their dorm sounds a little like that! (Ouch!)

This book will help you dry your eyes and move through your grief, or maybe joy that your teen is at college. Some parents are happy and some are devastated with their new "emptier nest," but the second half of this book can help with whatever reaction you are having. In theory, you have gotten them to college, they have everything they need, and the university is supposed to take over.

There will be orientations, social events, resident assistants, dorm parents, counselors, advisers, and peer counselors to help with anything that goes wrong, but the authors suggest you should be prepared for some hysterical phone calls, anyway! Chapter four has some great suggestions for handling what the authors call "the dump call," and for knowing when a situation may require that you step in.

Just a few hints - no matter how much you miss them, the correct response to a dump call is NOT "come home - who needs college anyway!" A better response is to listen, provide a little empathy, and let them move on, as the authors suggest they will. Another call you may get is "I need more money," and the correct response, unless you are very wealthy, is NOT "sure, how much shall I send." (I liked that advice!)

During this emotional time, like so many other life transitions, you might not just be dealing with the loss of your teen, your relationship with your spouse may need some extra attention, and if there are siblings at home, they may need some extra support, too! Go figure! Whatever your family is feeling in reaction to this transition, the authors have some great advice and include stories from families just like yours.

The Launching Years is a great book for parents of older teens and college-aged students - the strategies it provides are priceless, even for families in which teens do not leave home but stay at home for a few more years. Every family is different, but all teens have to start being responsible adults at about age 18 and this book can help!

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Freedom is Associated with Less Sexual Activity

Authoritarian parents take note - a new study in the Journal of Adolescent Health suggests that teens with more flexible parents are actually less likely to start having sex than teens with rigid and controlling parents.

Warm, more democratic relationships - in which parents do not use negative and controlling behaviors - are more likely to produce children who respect the parental values, making healthier decisions about their health, and keep away from negative peer influences.

Of course, this is not a controlled study but it appears that parents who talk to their children about sexuality, using condoms, and birth control, as well as spend time with them and are nurturing and supportive have children less likely to engage in sexual abehavior.

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Labels: Healthline, Parenting, Sexuality

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Thank You - Grand Rounds 4.45

Thanks to Edwin Leap at EdwinLeap.com for hosting Grand Rounds 4.45 this week and including my post about sending teens off to college. It was interesting to read answers to Dr. Leap's question of "why do we do it," which helped me answer the question, too.

I do this blog because I think people who are raising teens need support, attention and encouragement to feel blessed that they can spend each day with teens - who are creative, intelligent, and magical beings!

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Dating Violence in the News

A recent study described in the Journal of the American Academy of Child and Adolescent Psychiatry suggests that 3 percent of 12-to-17-year-old girls and 0.6 percent of boys report being physically or sexually assaulted by a romantic partner or date. These results do not include being slapped or verbally abused, which would push those rates up much higher.

Teens at greater risk for experiencing violence in their relationships are those with a history of stressful traumatic events like losing a sibling, parent or friend. Because we know who may be at risk, we could target teens the most at risk for relationship violence with prevention messages that help them develop healthy teen relationships. The authors also suggest that all teens be taught how to report violence experienced by friends.

The consequences of being exposed to relationship violence includes being four times more likely to experience symptoms of post-traumatic stress disorder (PTSD) or major depression.

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Labels: Healthline, Relationship Violence, Teen Health

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Book Review: The Launching Years (Part 1)

The Launching Years: Strategies for Parenting from Senior Year to College Life, by Laura Kastner and Jennifer Wyatt is a must read for parents of juniors or seniors in high school, as well as parents of college-aged young adults. With steadfast encouragement these authors give practical suggestions for doing a great job launching your teens, not just coping with the problems that sometimes creep into our families during this exciting period of life.

There was so much information in this book that I decided to have two reviews. This first section is for parents of high school students, and Part 2 will be for parents of college-aged children. The only "issue" I had with the book is that it describes the college process and launching as occurring in the senior year, which I disagree with. Launching, and preparing a child to leave home with all of the assets they will need to be successful really needs to start much earlier, and the launching process for college-bound youth really needs to begin in the junior year of high school. Pushing all of the college-preparation activities into senior year demands a crisis!

Apart from that, I think the authors did a great job identifying how important this phase of parenting is, and how little attention and support parents get during this challenging time. They also describe the barriers to successful launching, from both the child and parent perspectives, and provide comfort and practical strategies to overcome the typical hurdles. There are suggestions for how to mitigate the stress associated with college applications, and what to do when college-bound teens suddenly get clingy, dependent or rebellious.

Some of the reassurances that may calm parents of younger teens include the fact that with over 3,000 accredited colleges in the United States, there will be a spot for your child. Students with a C average can actually be admitted to more than 1,000 colleges, and B students can attend all but the top 200 schools! Other encouraging facts are that "where" a person goes to college seems to be less important to success than the number of years spent in higher education and the actual completion of the degree.

Instead of worrying about "where" a child goes to college the authors suggest parents focus on:

• Whether teens are building strong interests both within and outside of school;
• How motivated a teen is;
• Whether a teen know how to take advantage of whatever resources are available;
• Whether a teen is engaged, aware, resilient, responsible and committed to living a productive life; and
  
• What goals and values a teen is reflecting with their behavior.

There are great stories about real families, with real, not perfect children, and gentle reminders to handle our own personal issues outside of our relationships with our children that will bolster all parents. There is a section about the ADHD child, gap years, alternatives to college, boomerang teens who need some more time at home before going off to school, and even teens who seem to go off the deep end while preparing to launch. Basically, this book includes something for everyone.

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Labels: College, Healthline, Parenting

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Thank You - Grand Rounds 4.44

Thanks to Allen at GruntDoc for hosting Grand Rounds 4.44 (the 200th Edition) this week and including my post about Youth and Exercise.

This week was very interesting - lots of great stories and ideas. I especially loved Kim's suggestion about a league of our own!

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Abusive Relationships

A recent report from Teenage Research Unlimited that was sponsored by Liz Claiborne and loveisrespect.org included some disturbing findings last week. The findings stated that young females are at risk for being abused in relationships, particularly those who start being sexually active early (at or before age 14).

In addition, and more bothersome to me, was that in spite of the fact that many teens report being abused in relationships or knowing someone who has been abused in relationships, most did not know the warning signs for unhealthy relationships or what to do if a friend was being abused by a romantic partner.

If you are wondering if your relationship is healthy, ask yourself if the other person:

• Puts you down?
• Gets extremely jealous or possessive?
• Constantly checks up on you?
• Tells you how to dress?
• Tries to control what you do and who you see?
• Has big mood swings?
• Makes you feel nervous (like you are walking on eggshells)?
• Criticizes you?
• Threatens to hurt you?

If the answer to any of those things was yes, talk to someone about this relationship and be aware that it might not be a healthy relationship for you. Love is respect operates the National Teen Dating Abuse Hotline (1-866-331-9474).

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Labels: Healthline, Relationship Violence

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Summer Camp & Independence

Well it is summer again and if your kids are lucky, they are preparing for summer camp. Our family favorite is the old-fashioned camp - crafts, campfires, silly songs, talent shows, mess halls, pools, and ropes courses.

Preparation means writing your last name on everything, deciding which clothes and towels you never need to use again, buying aloe vera gel for sunburns, biodegradable soap, Costco sized sunscreen, enough toiletries for everyone to take some, and my favorite, bug sprays - from 99% deet for spraying at the bottom of pants and around the edges of bedding to 30% deet for arms. legs, and scalps!

If this is your child's first time at camp, last summer's post about preparing your child for being away from home might be useful. If your child is a seasoned camper, they are probably just excited, but I encourage you not to let them pack by themselves. I cannot tell you how many times I say, "are you packed?" and the answer is "yes," and then I march in, ask for the packing list, and as my child puts stuff in the suitcase, I start down the list, "14 pairs of underwear," "check," "14 pairs of socks," "check," "7 pairs of pants," "check," "7 pairs of shorts," "check," "2 towels," "oops," "sleeping bag," "oh I'll get that," and it goes down hill from there!

"Packed" seems to be a relative term to teenagers, so beware! Nothing will help you worry less than knowing you watched the important things go into the suitcase! Remember if they are traveling alone to get to the airport early, request a gate pass to walk them to the gate through security, and have them show you their passport, boarding tickets, money, etc... before you leave them.

Apart from knowing they have the "things" they need, if you are the parent of a junior or senior in high school, preparing for your teen being away this summer may bring up some anxiety about how close you are to having your teen leave home for college. As teens get older, they also are gone for longer periods of time, which adds to our anxiety. Try hard not to let it show - teens need our support and encouragement - and they may already be nervous.

For parents of the older teens trying to get your kids ready for two to four weeks away at camp, I send peaceful blessings! I know this phase of parenting is tough, but remember, this is our job - we are supposed to prepare them to be independent and happy adults. Helping them manage being away from home for a couple of weeks is a good trial for leaving home and being away for months at a time.

You can send them with the required summer reading, laundry soap and money for free time, remind them to take their vitamins and floss their teeth, and not lose their retainer, but then, you sit back and let them grow up. They will forget the bug spray until they get bit, forget the sunscreen until they burn, choose not to floss for a while, and forget to sort the clothes when doing laundry, but they need to learn.

They will also miss you, even if they never say it, so remember to plan ahead and send letters so they get them during camp - but no pictures - that might make them cry!

Have fun and remember to ask them to teach you a silly camp song when they return - next year you can hum it while they are gone!

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Labels: Healthline, Parenting, Travel

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Stigma and Teen Pregnancy

Yesterday I spoke with a reporter about teen pregnancy and have been stewing over something she said ever since. She suggested that the "teen pregnancy" media in the last year or so, including films like Knocked Up and Juno, Jamie Lynn's pregnancy, and even the teens making a pact to get pregnant, might actually help reduce the stigma around teen pregnancy, and wouldn't that be a good thing?

The stigma around teen pregnancy facilitates people not talking about sexually active teens, teens not getting in to see doctors so they have adequate prenatal care and real options, illegal abortions, pregnant girls dropping out of school, and a host of consequences to the children of teen parents. None of those things are good - true!

If there was no stigma - if we acknowledged that "it just happens," would people get the information they need about teen pregnancy? Would the fact that teen moms get less education and have babies with more health concerns become everyday knowledge? Would parents talk to kids about the power and pleasure of sex in light of the emotional and physical risks or preventing diseases and unwanted pregnancy? Would schools have day care centers, would employers give extra money to families with small children to cover day care costs? Would teens go to their doctors more frequently and as soon as they start being sexually active - to be screened for infection and start reliable birth control?

I have to say that I am not so sure reducing the stigma is a good thing, or that any of those possible benefits would happen because if the stigma disappeared because as a society we are still in denial about the impact of our sexualized media. We do not want more teens having babies, and we do need parents to talk to their kids about not having sex, using barrier methods to prevent pregnancy and sexually transmitted infections if they are sexually active, and going to the doctor to get screened for chlamydia. We need comprehensive sexuality education in schools and for our society to stop sexualizing young girls and being surprised when they become sexually active. We also need the media to be a little more responsible by adding some scenes of regret about not using a barrier method, or better yet - the use of barrier methods! We can make a difference!

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Labels: Healthline, Pregnancy, Teen Health

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Youth Need More Exercise

I am as serious as a heart attack! Given all the press about the growing obesity rates, particularly in children, at one time or another all of us have probably thought our families needed a healthier diet and more exercise, and we were right.

Last week the American Academy of Pediatrics recommended that children from families with a history of heart disease and high cholesterol be screened for high cholesterol every 3-5 years after the age of two, and that cholesterol-reducing drugs (called statins) be considered for children as young as eight!

Everyone knows that obesity is related to higher risks for Type 2 Diabetes, heart disease, hypertension, and stroke, but for some reason, we are ignoring these risks and our children may pay a very steep price.

The best way to prevent all of these health outcomes is to eat well and get at least an hour of exercise each day, so step away from the computer and get active!

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Labels: Fitness, Healthline, Teen Health

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Families Struggle to Make Ends Meet

Do you know that a job making minimum wage ($8) brings in an annual salary of $16,640? A parent with two children living in the San Francisco Bay Area would need to work three full-time minimum wage jobs just to make ends meet.

The updated 2008 California Family Economic Self-Sufficiency Standard reports that the median self-sufficiency standard for the state of California has increased by $14,420 for a family of three while the minimum wage has increased by only $2,600, leaving most families unable to meet the cost of basic needs. When I say basic, I mean basic - housing, food, utilities, child care, health care, and transportation.

So, what does it cost to live in the SF Bay Area? Well, if a family lives in Marin County, the self-sufficiency standard is $73,576. If you live in Solano County, you can "get by" with $54,668! Santa Clara County is $68,430 and Santa Cruz County is $65,726. So, in Santa Clara County, a single adult with two kids would have to make at least $33 an hour just to cover the basics!

We are in so much trouble! No wonder families cannot provide health insurance, medications, clothes, and school supplies to their kids, and the credit debt in our country is skyrocketing! How can we focus on our families when we have to struggle to make ends meet?

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Labels: Financial Education, Healthline, Parenting

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Staycations with Teens

Last month when my teens and I were planning our road trip to do community service at our beloved wolf sanctuary (Howling Acres) and to see the University of Oregon, at Eugene, which is on my eldest daughter's short list for college, I heeded my own advice and "checked in" with them about how excited they were about the trip.

What they said surprised me, and led to a radically different vacation. My teens were thinking that with camps and half the summer spent with their other parent, the two weeks we would be traveling were their only two weeks at home this summer and they were thinking maybe they would rather stay home!

After I picked my jaw up off the floor, my teens and I joined the thousands of families in the United States this summer who, faced with very busy school year schedules, rising gas prices, an uncertain economy, and one income that does not seem to go as far as it used to, decided to stay at home instead of taking our annual summer vacation.

We made a list of all of the cool places in the San Francisco Bay Area that we had not visited ever or recently, activities we wanted to do including an all day Monopoly game, days with friends, the beach, baking pies, picking blackberries, visiting IFly, and then developed a calendar in which we could sleep late, eat out a lot, and do at least one thing someone wanted to do each day.

We are one week into our "staycation" and I have to say we are all relaxed, happy, well into our summer reading books, and completely enjoying our family time. My house has seen better days, and there is a lot of laundry to do next week, but I recommend this to everyone!

Here's to lazy summer days!

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Labels: Healthline, Parenting, Travel

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Thank You - Grand Rounds 4.42

Thanks to The Blog that Ate Manhattan for hosting Grand Rounds 4.42 this week and including a post about women and sleep from Teen Health 411.

This week was really interesting, and as someone who does not watch Seinfeld, I loved all the funny clips!

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Fungus Among Us!

Just a reminder that as teens get older, and some get more modest, you may see less of their bodies, therefore they need to know how to recognize and treat assorted fungus they may pick up at school, the gym, or the pool. Specifically, athletes foot and ringworm, which for some reason I have heard more about lately.

Ringworm is actually NOT a worm, but a term used to describe a fungal infection of the skin. It typically looks like a pink raised area in the shape of an “O” or “C” with a scaly or flaky edge – looking very much like a worm that may be under the skin. But it’s not. It’s just a fungus called “tinea” that normally lives on your skin, and is not a problem unless it multiplies rapidly.

Athletes foot is usually diagnosed because of cracked, peeling and flaking skin between the toes. The skin can be red and itchy, too. You are more at risk if you wear closed shoes, sweat a lot, or have a cut. You can prevent it by wearing flip flops in public showers, as well as keeping your feet clean and dry.

Warm, moist conditions are what make the fungus grow, or breaks in the skin. You can also get the fungus from someone else – from dirty clothes, infected combs, and skin-to-skin contact - gym class, pools or gym shower floors are common places to pick it up. Cats and dogs can also carry the fungus.

You can try to prevent getting this infection by making sure you don’t touch someone who has tinea, until they have been treated, making sure that you change out of sweaty, damp exercise clothes to dry clothes as soon as possible, and wear flip-flops at the pool or the gym shower.

The infection is easily treated with an antifungal cream - the kind they treat athlete's foot with - which you can get at any pharmacy without a prescription. Using the cream 1-2 weeks until there is no sign of the problem usually gets rid of the infection.

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Labels: Healthline, Teen Health

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Women and Sleep

There was an interesting article 7/3/08 in Ms.Magazine by Gayle Greene suggesting that trouble sleeping may be related to fluctuating hormones, which can be more difficult to deal with than usual, at several particular points in a woman's life. In particular, Ms. Greene reported that twice as many women have trouble sleeping than men and that about 67% of women report frequently having trouble sleeping.

Of course, we know that stress can lead to insomnia, as can being poor, subjected to violence, being hot, or eating or exercising too close to bedtime. However, Ms. Greene suggests that we also sleep worse when our hormones are fluctuating - at menarche, during puberty when surges of estrogen and progesterone occur, and the estrogen increases cortisol levels, promoting a stress response, before our periods start, after childbirth, and during menopause.

One way that the fluctuating hormones impact sleep is because changes in hormone levels make us hot - hot flashes for sure, but did you know that women with PMS have higher body temperatures, as do women taking birth control pills?

There are some interesting facts about women and sleep at the National Sleep Foundation as well as some good sleep tips for everyone.


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Labels: Healthline, Sleep, Teen Health

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Abortion: When Denial is Not the Best Choice

Putting aside any values, religious beliefs and thoughts about what is "right," it is important that teens understand their medical choices if they do become, or get someone pregnant.

I know that denial works in some situations and teens who are afraid of their parents knowing that they had sexual intercourse may try very hard to hope that the missed periods do not mean they are pregnant, but there are some very important time considerations to take into account.

If a medical or surgical abortion is an option for a woman, she needs to understand that a non-surgical, or medical abortion can be done within seven weeks from the first day of the woman's last menstrual period, or within three weeks of missing one period. A medical abortion is done with medicine (mifepristone or RU486) that end the pregnancy and a second medicine (misoprostol) causes the uterus to empty. It may take up to a few days for a woman to abort, and it is not uncommon to bleed for up to four weeks.

A surgical or aspiration abortion is usually done between six and sixteen weeks of pregnancy and uses a vacuum to remove the fetus. The longer the woman is pregnant, the more complicated the abortion and the higher the risks, so making a decision quickly is important. After 16 weeks after the last period, and D & E - dilation (of the cervix) and evacuation (of the uterus) will be done. After 24 weeks, abortions are only performed for serious health concerns. All surgical abortions will include antibiotics to prevent infection.

If you are pregnant, please go to your doctor or a local Planned Parenthood Clinic to discuss your options. The longer you wait, the fewer options you have.

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Labels: Abortion, Healthline, Teen Health

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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!

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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.

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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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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!

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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!

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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

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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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Do You Have A Self-Injury (Cutting) Problem?

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. Once people learn to express themselves in other ways – verbally, or in writing – the impulse to harm the self subsides. The unpleasant feelings may not go away, but the coping mechanism becomes a healthy one.

The first step is to acknowledge that you have a problem, and that you are not alone. Self-injury is a choice and you can choose to not injure yourself. I am not saying it will be easy - in fact, people say it is harder to stop than cigarette smoking. The important thing is that you can do it, with help! It will take work, but you can live without self-injury.

To help you decide if you have a problem, ask yourself these questions:

1. Do you cut or burn your skin habitually?
2. Do you feel compulsively drawn to cut, pierce, or burn your skin?
3. Do you get “high” from the way the activity feels physically?
4. Does the behavior consume your thoughts or interfere with your ability to function normally?
5. Realistically, could you stop the behavior today if you wanted to?
6. Do you use cutting, burning, piercing, compulsively exercising, or any other self-injurious behavior as your primary method of releasing internal tension or distress?
7. Is your self-injuring behavior “ritualized,” meaning it must be done in a certain way, and more frequently?
8. If you do not self-injure do you panic, get disorganized, or distressed?

“Yes” answers to any or all of these questions suggest that you should get help, and the earlier the better. Please call S.A.F.E. Alternatives at the number on the right (1-800-Don’t Cut) or visit their web site (http://www.selfinjury.com). They have a great book you can order called “Bodily Harm: The Breakthrough Healing Program for Self-Injurers,” as well.

Please take the first step and reach out for help!

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Labels: Healthline, Mental Health, Self-Injury

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Are Teens Really Engaging In More Oral Sex?

There seems to be a belief that teens are participating in more oral sex than ever before, possibly to avoid emotional involvement, vaginal sex and pregnancy risk, partially because some teens do not think of oral sex as "real" sex, therefore do not consider themselves sexually active if they are only participating in oral sex.

A recent study by Duberstein Lindberg and Santelli, "Non-coital sexual activities among adolescents," suggests it might be true. These authors used the 2002 National Study of Family Growth data from 2,271 teens aged 15 to 19 to report that oral sex was much more common than vaginal sex, but both seemed to occur for the first time within six months.

Their results suggest that slightly more than half of the teens had engaged in oral sex, and in fact, more had participated in oral sex than vaginal sex, but their evidence suggests that female teens who are having oral sex, have only done so with one partner.

These results suggest it is very important that teens be provided education and risk counseling about the sexually transmitted infection risks associated with both vaginal and oral sex. By ignoring oral sex in sexuality education, we are allowing teens to believe they are "safe" if they are only having oral sex.

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Labels: Healthline, Sexuality, Teen Health

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I Won't Grow Up! Part 2

I promised follow-up, and here it is, although not very dramatic. The weekend arrived, and of course, the list remained undone, but my resolute teen started on the list, and stayed focused for about four hours. She then took a break and enjoyed walking to have dinner out with the family, and then she came home and set back to work, finishing the largest of the tasks before (a late) bedtime.

Saturday morning came and she asked if she could read and have coffee with everyone else versus starting right away, which her younger sister told her was a brilliant move! After breakfast the girls were focused and had their room clean and all the other tasks done by 2 PM.

So the fun began and we still have two days of beautiful weather, plenty of time, and new movies in the theaters. The only nasty task is mega homework, which she can work on for several hours each day, without my supervision. I have to say that this experiment was painless and I think what I learned is that patience is better than anger with my older teen, and being clear with expectations, and consequences, in addition to providing a timeline lets her take control.

My teen is very conscious of her responsibilities, but not above ignoring them if she thinks she can. I guess that makes her normal!

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Labels: Healthline, Parenting, Teen Development

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Sexual Risk Reduction Information to Parents

Statistics from the 2005 Youth Risk Behavior Survey, a representative survey of high school youth, indicated that 47% of adolescents in grades 9 through 12 engaged in sexual intercourse, and 6.2% did so before the age of 13.

The good news is that 53% had not had sex, which is good news for all parents. Given the high rates of sexually transmitted infections and pregnancies among sexually active teens, knowing that the majority of teens are choosing not to be sexual is comforting to those of us who worry about teens and should be passed on to teens, to normalize their choice not to be sexually active.

I think parents are an underutilized source of prevention education. The literature suggests that teens who talk to their parents about sex are less likely to engage in sex and more likely to use protection if they do. The literature also supports the fact that teens want to hear from parents and the fact that parents are the best educators of their teens, because they can pass on family values, in addition to information, whereas doctors and teachers focus on facts.

Since pediatricians and parents are both important components of sexual risk prevention efforts for adolescents, it would be great if pediatricians promoted parent-child communication during annual visits. Maybe at the same time the doctors suggest parents leave the exam room for a few minutes, and they explain state laws about confidential reproductive health care, they could suggest parents talk to kids about risk behaviors.

There are many resources to help, and here are a few:

Web Sites
Palo Alto Medical Foundation provides health information for parents and children.

• Parent Resources -- for parents of children of all ages.
• We're Talking -- Teen Health Info. -- for children, ages 13 to 18 and their parents. The purpose is to help youth find medically accurate information about health, and to stimulate important conversations between parents and children.
• We’re Talking, Too: Preteen Health Talk -- for children, ages 9 to 12 and their parents. The purpose is to help students learn about such topics as growing up, friendship, hygiene, empathy, divorce, stress, fitness, bullying and body changes, and to stimulate important conversations between parents and children.

Talking with Kids About Tough Issues is a national campaign by Children Now and the Kaiser Family Foundation. You can find tips, resources, and facts about sex, HIV & AIDS, violence and drugs.

The National Campaign to Prevent Teen Pregnancy seeks to improve the well-being of children, youth, and families by reducing teen pregnancy. The Campaign's goal is to reduce the teen pregnancy rate by one-third between 1996 and 2005.

Planned Parenthood is the world's largest and oldest voluntary family planning organization. Planned Parenthood is dedicated to the principles that every individual has a fundamental right to decide when or whether to have a child, and that every child should be wanted and loved.

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Labels: Healthline, Parenting, Sexuality Education, Teen Health

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Thank You - Grand Rounds 4.35

Thank you #1 Dinosaur at Musings of a Dinosaur for hosting Grand Rounds 4.35 this week and including my post about a new nutritional resource to help teens, or anyone, deciding to eat fast food restaurants.

This week was very interesting and a great way to start my morning!

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I Won't Grow Up!

What does it look and sound like when a very responsible 16-year old apparently decides that growing up isn't all it's cracked up to be and refuses to practice the independence you have tried to give her - for several weeks?

I think it looks like this:

• I forgot my article for the school paper was due today;
• I forgot to take the sheets of my bed so they could be washed;
• I would rather not drive myself to work, will you please drive me;
• I can't walk the dog, there is not enough time;
• I was too busy to study for the test;
• Could you change that medical appointment for me, I have to work that day;
  
• I have not had time to complete that ...

but,

• I need you to make an appointment for my haircut;
• I would like to go see that new movie;
• I would like my clothes clean for work tomorrow;
• I need to be early for work;
  
• I should be able to stay up until 10 PM now;
• I would like to spend time with my friends; and
• I would like to read that new book by Meyer.

Confused as any parent would be, let's take this problem apart. It would seem that the teen above is only able to find time to do the things she likes and is only "forgetting" the things she does not want to do, and given this is a bright, articulate young woman, without any health problems, selective amnesia is my only conclusion.

Now, given this teen asks for little direct nurturing and care taking these days, it might be easy to do these things for her, cut her some lack and forgive the amnesia, which I have done for several weeks, but her luck has run out. In this house, we believe that completing our responsibilities makes us feel loved and strong, so there must be a way to help her back into the groove.

What shall I do with this selectively forgetful teen who seems to want to be a young child if it means having things done for her, but an independent teen when it comes to the privileges that age has to give her. I thought about this dilemma all weekend and came to the following conclusion. Let me know what you think of this natural consequence, and I promise to let you know how it goes.

Next weekend being a long weekend, there will be plenty of time to complete all of the things she has been forgetting, and to help her do that, the "fun"parts of the weekend - seeing a new movie, a fondue party, and a trip to the beach - will not happen until she has taken care of everything that has been sliding in the last month.

To prepare her, I have created a list of what those things are, and last night we discussed the list, and she knows when the fun stuff is planned during the weekend. She now has the option of doing all the backed up projects during the week, or leaving them for the weekend potentially missing the family fun during the weekend. I admit a little surprise at her response to my proposal - she said "seems fair," and the evening went on ...

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Labels: Healthline, Parenting, Teen Development

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Free Fast-Food Nutritional Details

Oh, I wish I would quit learning about nutrition. The more I learn, the less I can eat out!

If you want to know about the nutritional information of more than 400 chain and fast-food restaurant choices and healthier alternatives at that restaurant - there is a new free website called "Wellternatives," that you should check out. You can also use your phone to get there - by sending a text message to 878787 with the word "diet" followed by the name of a chain restaurant and a menu item.

This new site launched recently by Wellsphere.com is totally easy to use and really interesting. This web site seems to have been created in reaction to the fact that consumers want nutritional information that will support making healthy choices and attempts to get laws enacted that require restaurants to provide it - keep getting stalled or vetoed by our elected officials.

To test the site, I compared hamburgers at Jack-in-the-Box, McDonalds, and Wendys, with the following results:

Burgers
Jumbo Jack 598 (Calories) 51.3 (Carbs/gm) 34.6 (Fat/gm) 2.5 (Fiber/gm)
Big Mac 539 (Calories) 45.0 (Carbs/gm) 29.0 (Fat/gm) 3.0 (Fiber/gm)
Baconater 839 (Calories) 38.0 (Carbs/gm) 51.0 (Fat/gm) 1.0 (Fiber/gm)
Ultimate Cheeseburger 1011 (Calories) 52.7 (Carbs/gm) 71.4 (Fat/gm) 2.1 (Fiber/gm)

Alternatives Suggested
Hamburger Deluxe (with cheese) 462 (Calories) 33.1 (Carbs/gm) 27.8 (Fat/gm) 1.6 (Fiber/gm)
Double Cheeseburger 439 (Calories) 34.0 (Carbs/gm) 23.0 (Fat/gm) 2.0 (Fiber/gm)
Jr. Cheeseburger 319 (Calories) 34.0 (Carbs/gm) 13.0 (Fat/gm) 1.0 (Fiber/gm)
Jr. Bacon Cheeseburger 428 (Calories) 30.5 (Carbs/gm) 25.4 (Fat/gm) 1.1 (Fiber/gm)

Not only is the nutritional information available at this site, but you can use something called wellphone to get all sorts of support to reach your health goals. I hope you enjoy using this amazing new resource.

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Labels: Healthline, Nutrition

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Great Parent Resource

The Palo Alto Medical Foundation (PAMF) offers a wonderful online resource for parents of children of all ages. The physicians and staff members of the PAMF know there are many questions and concerns that come with raising a child.

Whether a parent is looking for answers about a newborn's development, seeking advice on talking to a preteen about difficult topics or watching a teen struggle with making the right decision, PAMF is a great place to look.

Labels: Healthline, Parenting, Preteens, Teen Health

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Thank You - Grand Rounds 4.34

Thank you David E. Williams at the Health Business Blog for hosting Grand Rounds 4.34 this week and including my post about the Care and Feeding of Adolescents.

This week had some very interesting posts included and I loved all the humor!

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Labels: Grand Rounds, Healthline, Nutrition

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Happy Mother's Day

Happy Mother's Day everyone! I hope that you managed to mother yourself, your children, your own mother, your partner, your pets, your house, your work, the earth, and the people you came into contact with today.

What a wonderful opportunity Mother's Day is to appreciate all of the unconditional love and attention that we enjoy every day and all of the blessings of love and attention we are able to bestow on others. Today is a chance to be thankful for all of the opportunities we have to teach, love, nurture, care for, and sustain the people in our lives!

I hope you find joy and love today!

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Labels: Financial Education, Healthline, Holidays, Parenting, School

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The Care and Feeding of Adolescents

Given that food is a basic need and we all know that the obesity rate among children has tripled in the last 40 years, and that more and more people are living with Type 2 Diabetes, you would think that there would be lots of support for eating a healthy, well-balanced diet and exercising daily. Riiiight!

That would be in the perfect world, where preteens and teens did not care what their peers think, manufacturers did not advertise food that will make us fat and sick with skinny, beautiful people, school lunch programs did not (usually) suck, and where our children did not spend more time in front of "screens," being bombarded with advertising each year, than they spend in school!

Sadly enough, the best time to instill healthy eating habits is with their first solid food, but if you have gotten past 13 years old and have a teen you are encouraging to eat better, here are some tips:

• Be a role model - exercise daily and eat well;
• Set screen time limits;
• Do outside activities together;
• Cut the portions you usually serve down;
  
• Do not keep the unhealthy, sugary, easy foods in the house;
• Make the healthy foods easy - keep fruit cut up in the fridge with a tasty yogurt, and granola on the counter;
• Pack snacks they can take to school, practice, work, and other outside the home activities;
• Try new recipes until you find the ones they like;
• Go to local farmer's markets and cook meals together using the ingredients; and
  
• Make food something that the family enjoys preparing and sharing.
  

One great resource for helping preteens eat right and understanding the marketing that goes into what we eat is Shaping Youth. I heard the Founder, Amy Jussel, speak last week and couldn't wait to send parents, teachers, and teens to her Blog. This is a new organization so I think the web site will continue to grow.

Good luck and keep up the fight!

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Labels: Body Image, Healthline, Preteens, Teen Health

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Thank You - Grand Rounds 4.33

Thanks to Dr. Bates at Suture for a Living for hosting Grand Rounds 4.33 this week and including my post from Teen Health 411 about the danger of cosmetics.

This week was really interesting and the photos from Arkansas were beautiful!

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Labels: Grand Rounds, Healthline, Teen Health

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Social Norms and Teen Drinking

Oh my, teachers are having DUI courts in middle school these days, suggesting that teen drinking and driving is a frequent enough occurrence to warrant early prevention, but the data says otherwise.

I believe it is our own bad habits and the media that are driving our perception that teens are drinking and driving more frequently. In fact, in 2006 there were 63% fewer teen DUI-related deaths than there were in 1982! Teens are getting it - drinking and driving do not mix! In fact, they are getting many of the anti-drug messages and rates of marijuana use are declining, as are rates for alcohol and other drug use. You can check out the Monitoring the Future Report for more information, and the California-specific press release at safestate.org.

If we continue to portray drug and alcohol use as "normal," we are doing serious damage to all teens - we are not acknowledging those making healthy decisions and we are ignoring those who may be developing addictions. The social norms campaigns being waged by PTAs across the country are trying to do just that and are worth taking some time to explore.

Photo credit: Mike "Dakinewavamon" Kline

Labels: Alcohol, Healthline, Substance Abuse, Teen Health

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For Goodness Sake - Cosmetics Can Kill You

Why must everything be a struggle? I think I am doing my teenage girls a favor by buying what I consider to be high-end facial cleansers, moisturizers and make-up, in hopes that their chance of getting cancer will be reduced through the use of "organic, natural" products. Silly me - just because it says it is organic does not mean it really is - for goodness sake - what was I thinking?

A friend sent me to a web site called safecosmetics.org which completely undermined my sense of trust in the company making our "natural" cosmetics. The first story I read was about Herbal Essence, of course a favorite in our house with their bright packaging and great names like "drama clean" and "none of your frizziness," as well as catchy ads about "organic experiences." Little would you know that the maker of herbal essence products, none other than Proctor & Gamble, puts chemicals linked to cancer and reproductive problems and fragrance in their products.

Then I read a 2007 report from their News Room about the amount of lead in lipstick, which was just as disturbing. I learned that Maybelline, Cover Girl, Dior, L'Oreal all produce lipsticks with higher than acceptable lead levels.

The Campaign for Safe Cosmetics recommends avoiding products with "fragrance" on the label and using things only scented with essential oils because companies are not required to list any of the chemicals used in a fragrance mixture on the product label - who would have known?

If you want to know how safe your personal care products are, you can go to Skin Deep, the cosmetics safety database and have your confidence destroyed, too! There is also an interesting-looking book called "Not Just a Pretty Face" The Ugly Side of the Beauty Industry," which I may just have to review.

There was some good news - Whole Foods Market just introduced a "Premium Body Care" seal that will appear on products that are free of synthetic fragrance or any of 250 chemicals on a “unacceptable list” that do not meet a high standard for efficacy, safety and environmental impact. Oh my, never a dull moment!

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Labels: Beauty, Health Fact, Healthline

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Teenage Birth Rate Increased in 2006

Well now there is something President Bush can take credit for - the teenage live birth rate increased by 3% in 2006, the first increase since 1991, according to the Centers for Disease Control and Prevention (CDC).

We do not know if this is the start of a trend back up to the high of 61.8 live births per 1,000 females of 1991, but it sure is not a good sign, and can be added to the long list of evidence that abstinence-only education is not working for teens. We already know that abstinence-only education and not teaching teens about birth control leads to higher birth rates and sexually transmitted infection, and yet, the federal government continues to support it.

The other option is to teach comprehensive sexuality education which leads to delayed onset of sexual activity, higher rates of birth control use, higher rates of condom use, and fewer cases of sexually transmitted infection. Gee, it does not seem like a tough decision to me, but I guess that is why I am not the president.

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Labels: Healthline, Pregnancy, Sexuality Education

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The First Day at Work - for Teens and Parents

For teens, congratulations - you have done it - you have a job and today is the first day! Take a deep breath, be early and enthusiastic. Remember that every person working where you work now had a first day and will understand when you have questions and worries. Do not be shy - ask away. It is better to ask then do things incorrectly. Here are a few things to keep in mind:

• Be clear with your manager about how many hours you think you can work each week and still get your homework done;
• Ask for the combination of after school and weekend hours that you think will work for you;
• If you work in the food industry, like many teens, ask if you get a free meal each day;
• Ask for a break after four hours;
• If there is a tip jar, ask how the tips get divided each day;
• Know when paydays are, if you have to complete a time sheet, and when the schedule is posted each week; and finally,
• Do not call to ask when you are working the following week - go by and write your schedule down.

Welcome to the world of us working stiffs - enjoy the first paycheck, sense of accomplishment and the freedom that comes with growing up!

For parents, remember that your teen does not know business etiquette and is trying to make a good first impression. The type of job s/he has may also be very different and she may not know when s/he is working until each week starts. Be tolerant when s/he does not ask for a day off knowing a family event or school performance is coming up, do not be critical when they wash dishes for an entire shift, or volunteer to take an extra shift for someone, or do not know the answers to your questions. We have been working for many years and things that seem logical and easy to us make intimidate your teen.

Try to see the world through their eyes - their peers have been working longer, seem more competent, and seem to know exactly what is going on - and your son or daughter does not want to rock the boat. Encouragement and love will go a lot further than pushy and critical - let them learn slowly and make a few mistakes - it will not be the end of the world. Finally, help them be proactive about finding a balance between school, work, family and social time - we all know how hard it can be, and avoiding teenage meltdowns is always a good thing.

Congratulations to you, the parent, too, this is a milestone for you, as well.

Photo credit: KM Photography

Labels: Employment, Healthline, Parenting

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Thank You - Grand Rounds 4.32

Thank you Doc Gurley for hosting Grand Rounds 4.32 this week and including my post about parents and teen media. The WWF theme was amazingly fun to read and bloggers really "put out" in response to the call to beat their chests!

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Labels: Grand Rounds, Healthline, Media

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New Media In The Everyday Lives of Youth

I went to the public forum presented by commonsense media and the MacArthur Foundation at Stanford last Wednesday and was pleasantly surprised by the range of information presented during the two hours, particularly that it was primarily qualitative. Sadly, after a 12-hour day I had to get home to kids and missed the reception, but the conversations started in the forum were very interesting.

Basically, the MacArthur Foundation, under the competent guidance of Connie Yowell has funded a tremendous amount of research about how digital technologies and new media are changing the way that young people learn, socialize, and participate in civic life. I should probably admit here that I am one who usually is arguing in favor of turning off the TV, the computer, the phone, and anything else that pulls teens away from families, free time, and old-fashioned "face time."

What surprised me Wednesday was that some of the character-building experiences I associated with real-time face-to-face contact may actually be occurring while kids are mixing music, making videos, or publishing on fanfiction sites. I found the "presentation of self" on social networks research by Danah Boyd (UC Berkeley) really interesting and wished that the research presented in the first half of the presentation was being integrated more by the media and technology leaders present in the panel discussion.

I walked away with two very strong feelings. First, more work needs to be done to connect different generations via media - children and teens need (safe, supportive, asset-building) relationships with older people to grow, expand their realities, and learn skills they will need in their futures. With media being second nature to the current generation, we need more tools to bring those of us who are older into the conversation, in a painless way, that does not make us feel stupid, I might add. Related to that, there is some immediate parent-education to be done about not only Internet Safety, and how to keep boundaries, so that kids are not forgoing sunshine, nutrition and exercise for excessive screen time, but also about the benefits of media, and how publishing a story on a fanfiction site, may be as beneficial to the self-esteem of a "non-cookie cutter teen" as being a star athlete is to another teen.

Here is the chest-beating: Parents need to start engaging in the media that our children participate in. We used to say watch the TV shows your kids are watching, listen to their music ... but the world has changed and now we need to add, visit their social network sites, read their online writing or blogging. Do not be afraid of appearing stupid - just accept it and move through it - our children need us present where they are learning about the world and themselves! We cannot fight progress!

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Labels: Healthline, Media, Parenting

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A Parenting Book That Could Change Your Life

OK, I know, I sound like an infomercial, but I am serious. How does never being angry at your teenager again sound? How about raising happy and responsible children? Who could not want to experience those things?

Dr. Greg Baer, the author of "Real Love in Parenting," thinks he can teach you the way to raise wonderful children and be a happier person in the process. I tell you, I keep looking for something to be suspicious about this guy, but I am in the middle of my second book and am loving it.

I do not think I have a read a book that impacted so much of my life since I was in college. This book is also having an effect on my kids. I keep reading sections out loud and both kids really enjoy what this man has to say.

The basic premise is that people need to know they are unconditionally loved, and as parents we think we do love our children unconditionally, until you read this book and start to realize how much of our connection is conditional - and not about our children, at all.

There are definitely some things you will not like, for example, he believes that most of us are woefully unprepared to be parents and that our lack of parenting skills is the reason we have rebellious, angry, disobedient children. The nice part of his message is that we need to forgive ourselves - because no one has ever taught us to be good parents and we cannot give away what we do not have.

He describes our children as suffering, and believes that if we feel loved and love our children, we will never be disappointed or angry at them again. He illustrates the truth in this over and over with real-life situations and solutions. Every family, every parent should read this book.

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Photo credit: bookglutton (below)
Don't forget that Healthline has been nominated for the prestigious Webby Award in the category of “Health." Before April 30th, simply log on to http://peoplesvoice.webbyawards.com/ and vote today!

Labels: Healthline, Parenting

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Thank You: Grand Rounds 4.31

Thank you Dr. Val for hosting Grand Rounds this week and including my post about Sun Safety. There were some great posts this week and I really liked your tagging system!

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Labels: Grand Rounds, Healthline, Tanning

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News for Twilight Fans

Good news Twilight fans. You can purchase "Breaking Dawn," Book #4 in the series by Stephenie Meyer, at Amazon.com, although it will not be delivered until 8/2/08.

Another piece of good news is that "Twilight," the movie based on Book #1 in the series, is expected to be out in theaters 12/12/08. It is currently being filmed at Madison High School in Portland, Oregon. Soon we will be able to see Edward and Bella on the big screen!

The series has now sold more than 5.5 million books in the United States and has been translated into 20 languages published in 34 countries. Preteens and teens make up the majority of Ms. Meyer's slightly fanatical fan base, although I am looking forward to the next book, too!

In the new movie, Robert Pattinson plays Edward, the 180-year old vampire stuck in a 17 year-old body. You may recognize Mr. Pattinson, as he played Cedric Diggory in Harry Potter and the Goblet of Fire. His co-star is Kristen Stewart.

If you want to provide a review of Twilight, New Moon, or Eclipse, please post a comment below. Remember not to use your whole name, but include your age!

Photo credit: TaborLucy (above)

Photo credit: bookglutton (below)
Don't forget that Healthline has been nominated for the prestigious Webby Award in the category of “Health." Simply log on to http://peoplesvoice.webbyawards.com/ and vote today!

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Sun Safety

It is time for the summer sun reminder. At least in California, the sun is out and it is easy these beautiful days to stay outside too long, or forget to wear sunscreen. Please be careful with your skin when you are exposed to the sun.

Skin cancer is one of the most insidious, widespread and dangerous forms of cancer. It develops invisibly over the years, primarily through overexposure to the sun's dangerous rays. Two common types of skin cancer are carcinoma and melanoma. It is easy to not think about the damage the sun is doing to your skin when being tan makes most of us feel healthy.

To be sun-safe:

• Keep babies under six months old out of the sun completely.
• Remember to avoid the hottest sun, between 10 AM and 4PM.
• Cover all of your skin with sunscreen, at least SPF 30.
• Apply sunscreen every few hours, and especially after swimming, perspiring, or toweling off.
• Put lipbalm, with SPF 15 on, whenever you are outside.
• Wear a wide-brimmed hat.
• Wear UV protective sunglasses.
  
• Remember that UV rays bounce off concrete, water, sand, and snow.
• Never use tanning beds or sun lamps.

Resources
Sun Safety Alliance

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Photo credit: bookglutton (below)
Don't forget that Healthline has been nominated for the prestigious Webby Award in the category of “Health." Simply log on to http://peoplesvoice.webbyawards.com/ and vote today!

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Vote for Healthline @ The People’s Voice Webby Awards!

Healthline has been nominated for the prestigious Webby Award in the category of “Health."

The International Academy of Digital Arts and Sciences will choose Webby Award winners, but the People’s Choice Webby lets you decide. It’s easy:

• Simply log on to http://peoplesvoice.webbyawards.com/
• Register to vote (or log in if you are a returnee)
• After registration, click on the Web site icon and find the Living section, under which the Health category falls
• Vote for Healthline!

And be sure to pass this pass along to your friends and encourage them to vote as well!

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Labels: Healthline, Media

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Internet-Based Hotline to Counsel Abused Young People

The Rape, Abuse & Incest National Network (RAINN.org) has run an anti-sexual-assault telephone hotline for 14 years. Trained operators for RAINN do not press callers for revealing information but connect a person to a local resource, counselor, or authority, when the person is ready. Most other hotlines work the same way because hotlines are frequently the first stop to recovery after cutting, suicidal feelings, abuse, rape, or incest, so they have to be anonymous and non-threatening.

Believing that teens are more comfortable typing on a computer than speaking on the phone, this month RAINN will reach out to a new generation with an anonymous, instant messaging-based hotline. RAINN is one of a growing number of organizations reaching out to young people growing up with video games, cell phones, and the Internet. The National Suicide Prevention Lifeline has a page on MySpace that leads 20,000 visitors each month to their website. Sexuality Information Services in Oakland offers teens teens information about sexually transmitted infections via cellphone instant-messaging, and the National Domestic Violence Hotline has both phone and Internet hotlines for teens.

Making it easier for teens to reach out for support is extremely important given the estimates that 46% of teens are victims of partner violence. Communities need to find ways to prevent violence, but also support the victims of violence.

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Labels: Healthline, Relationship Violence, Teen Health

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Grand Rounds 4.30: Thank You

Thank you to Rachel Warden at Women’s Health News for hosting Grand Rounds this week and including my post about IUDs and teens.

This week was interesting, funny and included some of my favorite bloggers!

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Labels: Grand Rounds, Healthline, IUD

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IUDs for Teenagers

To emphasize the "importance of appropriate contraception" for teenagers, the American College of Obstetricians and Gynecologists' (ACOG) Committee on Adolescent Health Care has issued an opinion (#392) that is strongly in favor of providing IUDs to adolescents.

In the opinion statement that addresses common misperceptions about teenagers' use of these devices as well as possible adverse effects and contraindications to use, the committee reviewed data on the safety and efficacy of the IUD and said: "Because adolescents contribute disproportionately to the epidemic of unintended pregnancy in this country, top tier methods of contraception including IUDs ..., should be considered as first-line choices" for them. "After thorough counseling regarding contraceptive options, health care providers should strongly encourage young women who are appropriate candidates to use this method."

In spite of this recommendation, we have heard from teens that their doctors will not provide them with IUDs, so teens may have to call a few doctors before they find one willing to insert an IUD.

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Labels: Birth Control, Healthline, IUD, Teen Health

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Treating the Whole Person

The habits we form from childhood make no small difference, but rather they make all the difference. - Aristotle

In education and medicine we struggle to educate and treat the whole person, because it is the whole person walking through a day, a disease, and a life. But what does it mean to take the "whole" person into account? Where do you start if you want to consider a person's intellectual life, relationships, home, job or career, character, parenting, spirituality, leisure activities, happiness, body, and ability to contribute to our society?

Where are the scripts, the behavioral objectives, checklists, and goals? Even if I wanted to, how can I do a "life assessment" on any teen in my life? As a parent, I am finding that even with my own teens, I have to "pick a piece" each day to worry about. Some days I worry about the pressure they feel to "do it all." Other days I worry about their sleep, eating, and exercise patterns, peer relationships, education, spirituality, exercise, and safety habits. But as professionals, aren't we a safety net for the teens we educate or treat? Aren't we somehow more responsible, and held to a higher standard?

I hear the echoes of "give me a break," "no one can do it all," "I am an expert in ____," "that is for someone else to worry about," and "I do not have time," but hey, who does?" If each of us does our "part" in treating the whole person - a doctor makes sure a teen is immunized, the teacher educates the teenager well-enough to get into college, the parents provide the best moral and spiritual base they can, and the community monitors the safety of this imaginary teen at work, who catches them if they fall?

What if a parent is unable to worry about these things? What if a child isn't getting regular medical care and screening? What if a child has no spiritual counseling, and is exposed to violence, or is hopeless and self-destructive? Who is responsible for identifying what is missing and "rescuing" that teen? Who makes sure that the habits they develop in childhood will lead to their happiness and health?

In my way of thinking, "not my department," just isn't in option. Every time we come in contact with a teen, whether it is for 50 minutes in a classroom or 12 minutes in exam room, I think we are morally obligated to look each teenager in the eyes and ask, "how are you?" "who are you?" "what is important to you?" and maybe "what do you think is missing in your life?" Then, we are obligated to follow-up on their answers. Sorry, but sometimes we need a reminder!

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Labels: Healthline, Teen Development

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Eating Disorders and Teens

The term "eating disorders" includes a wide range of illnesses that continue to impact young people, particularly teens. With media personalities who are stick-shaped and the focus on dieting in our culture, children as young as five an six are worrying about what they eat and their size. Puberty is particularly tough on youth who on average gain about 40 pounds and grow about 10 inches during a two-to-three year period. If their family is "image-focused" and worried about weight, puberty tends to be one of the triggers for an eating disorder.

You can help by throwing away the fashion magazines and not judging your teens by their size. Please do not comment on how good people look because they have lost weight, or talk disparagingly about heavy people in front of your teens - they are using that information to judge themselves. If you want to do some reading, below are some young adult titles on eating disorders:

Block, F. L. (2002). Echo.
Greenfield, L. (2006). Thin
Hornbacher, M. (2006). Wasted: A memoir of anorexia and bulimia.
Menzie,M. (2003). Diary of an anorexic girl.
Newman, L. (1996). Fat chance.
Petit, C. (2003). Starving: A personal journey through anorexia.
Petit, C. (2006). Empty: A story of anorexia.
Rio, L. (2003). The anorexia diaries: A mother and daughter's triumph over teenage eating disorders.

Resources
National Eating Disorders Association (NEDA)

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Labels: Eating Disorders, Healthline, Teen Health

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Thank You - Grand Rounds 4.29

Thanks to Dr. Wes Fisher at DrWes for hosting Grand Rounds 4.29 this week and including my poem in tribute to Larry King, a teen killed for being gay.

This week's Grand Rounds was a wonderful way to start my day - and not bad for a cardiologist - tweeners, sex, carbs and eavesdropping - it did get my heart pumping!

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Cell Phones and Teen Health

The Journal of Adolescent Health published an article this month describing a pilot study with 15 girls looking at the feasibility of using a GPS-enabled cell phone to track adolescents' whereabouts and study the health risks that teenagers face when not at home or school, and possibly to intervene. The research hopes to develop a way to intervene with teenagers at the time, and in the place, they are likely to make poor health decisions and engage in smoking, drinking, or sexual activity. The cell phones work like diaries, as well, allowing teens to document where they are, with whom and describe the decisions they are making.

Although the goal is not for parents to be able to "track" their kids, I am sure knowing where they were would give some parents security. It would also violate a teens privacy and be a little risky if the "diary" information was not erased forever after it was sent. I also wonder if the text of the health messages could be seen by parents, which would give them a clue as to which risky behaviors their kids were participating in.

All-in-all this concept makes me a little nervous, and I wonder if kids would actually open the text message that got sent in response to a diary entry about a risky situation, or make a different decision because a text message flashed at them saying, "Sara, you are 12 miles from home, is one of your friends the designated driver so you will be able to get home safely?" or "Henry, remember, that in your county, one out of four sexually active teen girls has Chlamydia - is what you are about to do worth the risk?"

Maybe it is a great idea - I would love to see their faces! It would be like carrying your mom around in your pocket.

Photo credit: joshuaone6to9

Labels: Healthline, Teen Health

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Collge Students and Stress

Stress is actually a pretty normal part of college and adult life. Stress tends to result from balancing different aspects of our lives. Schoolwork has to be done, there are financial worries, extracurricular activities that can add pressure, as well as family issues back home, relationships, friends, work, health, and worrying about getting a job or into graduate school after college. Stress is not always a bad thing - for many of us, it keeps us focused and productive.

Stress can be a problem if you find you cannot sleep, or wake up after a few hours of sleep, do not feel like eating, are feeling too tired to do things you usually enjoy, find yourself pulling away from social activities or friends, or get agitated more easily than usual. If you are experiencing any of those symptoms for more than a few days, it is a good idea to call your college health center and ask about resources for stress.

Most adults develop strategies for coping with stress that include exercise, meditation, or regular activities with friends, which are healthy ways to cope with stress. If you find yourself using drugs, alcohol, or risky sex to manage stress, those behaviors suggest some counseling is in order.

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Labels: Alcohol, College, Healthline, Mental Health

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Emergency Preparedness for Teens Home Alone

I have encouraged parents to put an In Case of Emergency (ICE) number into their children's cell phones, as well as some names of adults you trust to help in an emergency when the parents cannot be reached, but what I forgot was to encourage parents to program in the phone number of your local advice nurse.

As our teens get older and start staying at home alone, or with their siblings, stuff is going to happen, so help them be prepared. All teens should know how to turn off the water, gas, and electricity to your home, as well as know where to find the emergency numbers for the utility company, police, and maybe a neighbor. I also recently learned the hard way that they should know to call the advice nurse at your doctor's office in case of a medical emergency.

The other day my teens were with their "other" parent, who lives in a rural area, and I did not realize they were alone when I answered my cell phone at work with, "hey there terrific kid, I just muted a conference call, so be quick." My eldest was silent a brief second and then asked for a friend's number, because she did not have her cell phone with her. I gave it to her, told her I loved her, and went back to my conference call. That night when I called to say goodnight, my youngest told me that she had experienced a nosebleed from hell that morning that resulted in the bathroom looking like a CSI crime scene, a blood clot that she had to spit out that left her dizzy and pale, and a couple of scared teenagers.

Oh my goodness, I could not believe that my oldest daughter had not told me what was happening when she called, just gotten the number of a local mom who she called, and all was good, but I could not believe she decided to "handle it," so my call would not be disturbed. We talked, the advice nurse number is now programmed in both cell phones, and my oldest is clear that parents need to know what is going on. However, I also realize that from her perspective - it was an adult-like moment - she was trying to honor the fact that I was busy and felt like she could handle it. Sweet girl, rotten idea.

So there you have it. Live and learn, and please give your kids the information they may need to handle a medical emergency.

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Labels: Healthline, Injuries, Parenting, Teen Health

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In Memory of Larry King

Larry King was murdered on February 12, 2008 at his junior high in Oxnard, CA. Larry was only 15 years old and liked to come to school in makeup, high heels, and earrings. When teased by the other boys, he teased them right back and was confident in his own gay, brave self.

The eighth-grade boy who shot him "because he was gay" is being tried as an adult and will likely go to prison for life, which means two lives were lost that day because letting other people be "different" is not OK with some people. I say being different should not matter, at school, work, and especially in our families. Please share the poem below with anyone who you think needs to know they are OK.

Labels: GLBT, Healthline, Preteens, Tragedy

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Family Internet Safety Site

Google & Common Sense Media have teamed up to launch a new site about family Internet safety. The new site has a great video for parents that includes useful "how to" tips about keeping kids safe while they are browsing the Internet. It shows parents how to check which pages and sites kids have been visiting, use filters and includes suggested rules for families.

The only suggestion I would like to add is that parents of preteens also go to the Palo Alto Medical Foundation preteen health site, We're Talking, Too: Preteen Health, and print and sign a copy of the Online Safety Pledge to keep posted near the computer.

Safe surfing everyone!

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Labels: Healthline, Online/Internet Safety, Preteens

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Bullying of LGBT Teens Encourages Antibullying Initiatives

Call me old, but isn't it amazing that LGBT kids are even identifiable in schools? The idea that these kids are brave enough to come out so young speaks well of our society's ability to adapt and accept diversity. Do not get me wrong - bullying is not OK, I just had to say that having kids come out while they are still in school might be a sign of progress. Now that they are out, we do have a responsibility to protect them.

We all have been the target of discrimination, bias, teasing, and bullying. At some point in most people's lives they are targeted for being too fat, too skinny, too nerdy, too short, too tall, too rich, too poor, too dark, too light, too smart, too dumb, too Jewish, not Christian, too athletic, too wimpy, too sexual, not sexual, and the list goes on and on. Many schools stop kids from using ethnic slurs, or picking on people because of their size or social status, or brains, but few stop kids from saying things like "that's gay."

A recent Harris Interactive Survey of 3,400 students and 1,000 educators conducted by the Gay, Lesbian and Straight Education Network (GLSEN) reported that 65% of the participants reported verbal abuse or physical assaults related to homophobia in the last year. In addition, 84% of the participants reported hearing derogatory remarks such as "faggot" or "dyke" at school, and 38% of the students said they had been subjected to physical harassment because of their sexual identity.

When school is unsafe, kids skip school and fail to go on to college, which is a tragedy for them as well as our economy. The things schools can do to support LGBT students include:

• Start young - include books about diversity in libraries for all ages;
• Use the use lesbian, gay, bisexual in discussions about tolerance and diversity;
• Have a LGBT "safe" teacher - too talk to and learn about community resources;
• Have a Rainbow Alliance or club to celebrate diversity;
• Do teacher training to encourage them not to tolerate harassment based on sexual identity; and
• Have antibullying policies that clearly make harassment based on sexual orientation unacceptable.

If the conversation at your school is lacking - start one. There will be many kids safer because you had the courage to include them in your antibullying campaigns.

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Labels: GLBT, Healthline, School

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Thank You - Grand Rounds 4.27

Thank you to Jeffrey at Monash Medical Student for hosting Grand Rounds 4.27 this week and including my post about ineffective products to "cure STDs" for sale on the Internet.

This week was really interesting and I enjoyed the surgical focus, music, and reminder that my daily reality is truly blessed.

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Labels: Grand Rounds, Healthline, STD, Teen Health

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Teens and Depression

I am very concerned about the number of teens who seem to be depressed these days. Granted, I understand that our society is a little out-of-control and we seem to instill in people at a very young age that they are entitled to a perfect life - romance, cars, homes, vacations, great-paying jobs, recreational toys, and a beautiful body - without hard work or effort, I might add - but is having these delusions causing mass depression?

About Teen Depression reports that one out of eight adolescents may suffer from depression, and only about 30% of those teens get diagnosed, treated, and receive therapy. Depression is more common in teens with chronic disease, who have been abused or neglected, have experienced a recent trauma, or lost of a loved one.

Parents need to know that although the teen years can be tough and all teens feel pressured at times, most teens balance out the rough spots with friends, hobbies, success in school or extracurricular activities, church, or sports. If a teen experiences any of the following symptoms for more than two weeks, it is time to find help - from a doctor or counselor.

Signs of Depression

• Sadness or hopelessness
• Irritability, anger or hostility
• Tearfulness or frequent crying
• Withdrawal from friends and family
• Loss of interest in activities
• Changes in eating or sleeping habits
• Restlessness or agitation
• Feelings or worthlessness and guilt
• Lack of enthusiasm and motivation
• Fatigue or lack of energy
• Difficulty concentrating
• Thoughts of death or suicide

Untreated depression can lead to problems at school, substance abuse, eating disorders, self-injury, reckless behavior, violence and suicide - do not hope it goes away. If you think your teen is depressed, offer support and let him or her know you are there for them. Validate their feelings, listen them, do not criticize them or trivialize the things that are overwhelming them, encourage regular sleeping and waking patterns, healthy diet, exercise and make an appointment to see your doctor or a counselor.

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Labels: Emotional Health, Healthline, Teen Health

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Homeschooling Banned in CA?

On February 28, 2008 the Second District Court of Appeal ruled that California law requires parents to send their children to full-time public or private schools or have them taught by credentialed tutors at home. Specifically, California's compulsory education statutes require children ages 6 to 18 to attend a full-time day school, either public or private, or to be instructed by a tutor who holds a state credential for the child's grade level. This seems to be news to the ~166,000 children who are apparently truant and whose parents risk prosecution.

The ruling was in response to a child welfare dispute with one family in Los Angeles County that homeschools their eight children, but who are not registered with the state as a private school, which is how many families get around the law. Their opinion is not new, and the 3-0 ruling sites cases in 1953 and 1961 reiterating that parents do not have a constitutional right to homeschool their children.

California might be the only state to make homeschooling illegal, if it started prosecuting families not in compliance with the law. I have to say I have feelings on both sides of this issue - I know homschooled kids who are below grade level academically and I know of a few who have soared into top-notch colleges - but underneath it all - I believe kids deserve an education that teaches them how to be good citizens, and will give them the opportunity to participate in our economy at whatever level they choose to in the future. What do you think?

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Labels: Healthline, Parenting, School

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FDA Warning About Products That May be Harmful to Teens Health

Teens Beware! There are products sold on the Internet and on EBay to treat herpes and AIDS and to prevent sexually transmitted diseases that do not work and may harm you! The FDA says there are no natural products proven to treat oral or genital herpes, genital warts, HPV or HIV.

A word of advice, if it sounds too good to be true, it probably is. And if in doubt, if it sounds shady or suspicious, ask your doctor, or a trained health care professional that you trust.

The following products have all been removed from the market by the FDA:

• Safe Lips by Tetrasol
• Aviralex topical solution
• Oxi-MED cream
• Imulux Lamps Device
• Beta-mannum
• Micronutrient
• Qina Device
• SlicPlus Lubricant

If you are sexually active, there is no better way to avoid sexually transmitted infections than to use condoms and avoid exchanging body fluids. If you think you have been exposed to a sexually transmitted infection, see your doctor or a clinician at Planned Parenthood to be tested and treated, as needed. In most states this visit will be confidential - meaning your parents will not be told.

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Labels: Health Fact, Healthline, STD

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1-in-4 Sexually Active Teen Girls May Have An STI

Oh my! I hope everyone has heard about the announcement from the Centers for Disease Control and Prevention (CDC) this week that 1-in-4 teen girls is likely to have at least one sexually transmitted disease. HPV is by far the most common sexually transmitted infection in teen girls (18%), but chlamydia was prominent (4%), as was trichomoniasis (2.5%) and herpes (2%). - nearly half of the African American girls and 20% of white and Mexican American girls were infected. Left undiagnosed and untreated these infections are likely to to cause cervical cancer and infertility in these young women.

What seems to missing in all the hoopla about this fact this week is the question - how? How is it that teenage girls are getting infected with sexually transmitted infections? Why is it that no one is pointing out the fact that these girls are very likely having unprotected sex with adult men, who have had multiple sexual partners.

Have you vaccinated your daughters against HPV yet? The CDC recommends vaccinating all 11-12 year-olds, and it is time we all accept that our daughters are at risk - talk to them about using barrier methods if they are having any sexual contact and please make sure they understand that adults who show sexual interest in them are breaking the law and are not concerned about what is in their best interest.

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Labels: Chlamydia, Healthline, Sexuality Education, STD

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Bike Safety and Manners

Please share the road with bicycles!

The other day my daughters were biking home from their school and my daughter signaled a left turn, pulled from the right to the left in the lane and made her left turn, but while the car behind her went past her, an adult male yelled out his window at her that she needed to stay in the "*&^&" bike lane and use the crosswalks.

Excuse me, but if you drive a car you are expected to share the road with bicycles. In addition, many of the people on those bicycles are youth who deserve your protection and respect.

Parents like me take great care to make sure that our children take a bicycle safety class before they share the road with cars and in those classes, we were taught that a bike is like a car and needs to follow the same traffic rules.

Here is the DMV rule: 21202. (a) Any person operating a bicycle upon a roadway at a speed less than the normal speed of traffic moving in the same direction at that time shall ride as close as practicable to the right-hand curb or edge of the roadway except under any of the following situations:

1. When overtaking and passing another bicycle or vehicle proceeding in the same direction.
2. When preparing for a left turn at an intersection or into a private road or driveway.

In our class we were told if you use a crosswalk, you are a pedestrian and need to walk your bike. I think maybe people who drive cars need a little more training about bikes and sharing the road. Adult men who yell at teenage girls need more social training, as well.

Drivers - please follow some basic bike safety rules around bikes, especially near schools:

• Check the bike lane. When turning right across a bike lane, always look behind you for a bicyclist. If someone is approaching, wait rather than trying to “beat” them.
• Pass with ample room. Except over a double yellow line, you can cross the center line to pass a bicyclist safely, as long as oncoming traffic is clear. Passing close, especially over 25 mph, is very scary for cyclists.
• Don’t honk to communicate with cyclists unless there’s an emergency. If your horn sounds loud from inside your car, imagine how loud and shocking it is from just in front of it.
• Be cautious in residential neighborhoods. Children riding bikes or running on the sidewalk may not see you and if you aren't slowing down before they cross the street, you could run them over.
• Look for cyclists before opening your door. When parking on the street, make sure you’re not opening your car door into the path of a cyclist.
• Use good manners. Apologize if you make a mistake and it will go a long way; eye contact and waves are very humanizing, especially in the stress of rush-hour traffic.
• Give children extra space. Children on bicycles are often more wobbly than adults, and more likely to turn or stop suddenly without looking or signaling. It is best not to pass a child on a bicycle unless you have many feet of space and proceed extremely slowly.

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Labels: Biking, Healthline

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Education Update - Is it Good News or Not?

Keeping to the educational theme this week, it seems more CA students are passing college-level exams than in previous years. A recent article in our local paper suggested that according to the California Department of Education, about 20% of the kids in CA score at least a "3" on an advanced placement (AP) test, which is a passing score on the 5-point scale. Students who pass the test can earn credit and advanced placement in college. Across the country, only about 12% of students are passing an AP test, although there are state differences. In New York 23% pass; in Maryland 22% pass; Virginia is coming in at 22%, and Connecticut, Massachusetts and Vermont are at about 20%. There are ethnic disparities however - in California, only about 2% of the passing scores are African American students, compared to the 7% of students who are African American in our schools.

I really am ambivalent about AP classes, overall, especially given the concern about "raising the bar" and making it so hard to get into universities. More than 90% of four-year colleges and universities in the United States recognize the AP program for credit, placement and admissions decisions, adding it to the list of "must dos" for the college bound among our children. One of my own daughters is finishing her sophomore year and is staring down the barrel of AP courses next year, on top of thoughts about where to attend college, and I dare say, it seems a little intense.

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Labels: College, Healthline, School

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A Boy Crisis?

My daughter cut an interesting article out of the PARADE magazine for me a few weeks ago entitled, "Does America Have a Boy Crisis?" which really surprised both of us, and has made for several very interesting discussions about school and gender.

The article had caught her eye because it had a little quiz:

• At your school, do most boys do as well academically as girls?
• Are boys more disorganized than girls?
• If there really is a boy crisis, what is the best solution?
• Boys-only schools?
• More male teachers?
• Different schedules?
• Tutors?
• Other

Now, she was not pretending to be an expert as she attends a girls-only school and her closest male friend just scored 99th percentile across every category of the PSAT, but hey, this looked interesting.

The article suggested that girls outperform boys on high school report cards, get higher GPAs in college, and actually attend college more often than males. The article suggested that these outcomes are due, in part, to the fact that boys (in general) seem more unorganized than girls, are uninterested in homework, do not turn things in on time, do poorly on standardized tests and find it difficult to get their college applications completed.

It would suggest to me that our education system may have a "female" bias toward verbal skills and if you think about it, sitting still, listening, and writing are very "female," characteristics and probably not the best situation for males who prefer activity and spontaneity. I look forward to comments.

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Labels: Boys, Healthline

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The Intrauterine Contraceptive (IUC) - Mirena

I got a couple of odd questions on the We're Talking Teen Health site recently that confused me - asking about a new kind of IUD, and finally a friend recorded the TV commercial that seems to have triggered the questions.

I guess the IUD has enough bad press that the maker (Bayer) of a new birth control device decided it would be better to call it something else, like an IUC. The Mirena is an estrogen-free intrauterine contraceptive (IUC) made of soft flexible plastic advertised to "keep life simple," which may also reducing cramping and give women shorter, lighter periods. This is not an alternative more most teens however - read on!

The important safety information on their site suggests it is only the right choice for women who:

• have had a child;
• are in a stable relationship (assuming that predicts monogamy I assume);
• have no risk or history of ectopic pregnancy or pelvic inflammatory disease.

In addition, it does not protect against HIV or sexually transmitted infection and ovarian cysts may occur and typically disappear. Complications may occur from placement and missing periods or irregular bleeding is common in the first few months, followed by shorter, lighter periods. Some other side effects, more common during the first three months, have included cramps, acne or skin problems, back pain, breast tenderness, headaches, mood changes, and nausea.

Mirena, which can las up to five years, is a levonorgestrel-releasing intrauterine system, that delivers a small amount of hormone directly to the uterus, which may block the sperm from reaching or fertilizing the egg, thinning out the lining of the uterus, and possibly stopping the egg from being released.

The Mirena is inserted through a thin plastic tube through your vagina and cervix into your uterus. The tube is then removed, leaving the Mirena in your uterus. The string that is attached to it and used to remove it is trimmed and you are done. Once a year, during your pap exam, the clinician check on the IUC and when you want it removed, it can easily be removed by a clinician.

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Labels: Birth Control, Healthline, IUD, Teen Health

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HIV Infection in People Over 50

To follow up on my post about talking to your grandparents about HIV last month, I wanted to point you to the newest topic on the CDC's HIV/AIDS web page - "Persons Aged 50 and Over."

The new site suggests that the increase in the number of people aged 50 years and older living with HIV is due in part to highly active antiretroviral therapy (HAART), which makes it possible for people infected with HIV to live longer, and partly due to an increase in newly diagnosed infections in persons over the age of 50.

Based on data from 33 states with long-term, confidential name-based HIV reporting, the CDC estimates that in in 2005 people over the age of 50 accounted for:

• 15% of new HIV/AIDS diagnoses and
• 24% of the people living with HIV.

Just like in people under 50, there are ethnic disparities - the rates of HIV infection among black people over the age of 50 are 12 times higher than among whites, and 5 times higher among Hispanics, as compared to whites.

Everyone needs to understand HIV transmission and practice safer sex. If you have not talked to a grandparent yet, how about doing that now?

Resources
CDC's Persons Aged 50 and Over
HIV Wisdom for Older Women
NAHOF (National Association on HIV Over Fifty)

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Labels: Healthline, HIV

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Sleep Awareness

March 3-8 is National Sleep Awareness Week, and just FYI healthy adults are supposed to get 7-9 hours of sleep each night. Unfortunately, the CDC reports that from 1985 to 2006 the number of adults reporting fewer than six hours of sleep each night has increased in all age groups, particularly among people between the ages of 30 and 64.

Curious about whether this sleep loss in their parents transferred to preteens, the Palo Alto Medical Foundation asked preteens on We're Talking, Too: Preteen Health how much sleep they got a night (on average) and were surprised to learn that 52% of the first 317 youth who answered the survey reported they got less than eight hours of sleep a night. Another 38% reportedly got 8 to 9 hours sleep each night and only 10% reported that they got 10 or more hours of sleep each night, which by the way is the recommended amount.

Chronic loss of sleep has a cumulative effect on physical and mental health, can reduce the quality of life and productivity, increase the use of health-care services, and result in illnesses and injuries. According to the National Sleep Foundation, children aged 5 to 12 require 9 to 11 hours of sleep a night and adolescents require 8.5 - 9.5 hours each night.

If you are having trouble getting a good nights sleep, talk to your doctor and make sure you are:

• keeping a regular sleep schedule;
• sleep in a dark, quiet, well-ventilated room with a comfortable temperature;
• avoiding stimulating activities within 2 hours of going to bed; and don't go to bed on an empty or full stomach.

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Labels: Health Fact, Healthline, Sleep

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Thank You - Grand Rounds 4.24

Happy Spring everyone - the ultimate new beginning!

Thanks to Jenni Prokopy, founder and editrix of Chronic Babe - a site for young women with chronic illness who strive to live well in spite of health-related limitations...to be babes! for including a book review about "Now What Do I Do?" a book for teens dealing with divorce from Teen Health 411 in Grand Rounds 4.24 this week.

This week was interesting, and several of the posts made me laugh - a great way to start the day!

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Labels: Divorce, Grand Rounds, Healthline

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A Gap Year - What is That?

My daughter has a friend whose family is into "gap years" between high school and college and when she first suggested the idea I have to admit I was a bit reluctant, but it was because I did not understand what a "gap year," was. I thought it meant putting off applying to college for a year, but in fact, there are several ways gap years happen. Basically, a gap year is a structured program the year after high school and before college, and even during or after college. The idea seems to be much more popular in Europe than it has been here, and the key is "structured."

There are two types of kids that this gap year works for: the first is the highly motivated student who has already been accepted into college, and defers starting for one year, and the second is the student who struggled through high school and needs a break from the academic pressure before applying to college. For the highly motivated student, the gap year can provide a year to gain maturity, get an international perspective, and maybe do service work or an internship. For the struggling student, the gap year can provide an opportunity to explore possible careers and also regain focus and drive to get more out of an academic program when they do apply.

Harvard has been encouraging youth to do this for many years with up to 20% of their students taking some time off and Princeton University recently announced a program starting in 2009 that will send 10% of their incoming frosh to do social service work in a foreign country before they start their freshman year.

There are two agencies that help match students with a gap year opportunity - the Center for Interim Programs and the Dynamy Internship Year. Both programs describe the gap year as helping students be self-reliant, self-confident, and more focused for academics the following year. To find out if the idea of a gap year is right for your teen, the first step is probably meeting with the college counselor to discuss it and exploring the two web site links above.

Given that there is some concern about the emotional preparedness of our high school seniors and their readiness to live independently, as well as the consequences of the academic pressure they experience, I have to admit a gap year is not looking like a bad idea.

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Labels: College, Healthline, Parenting

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Stanford Here We Come!

How does free tuition sound to you parents of high school students? Well it is true! On Wednesday, February 20, 2008 Stanford announced that families earning less than $100,000 a year will not have to pay tuition for their children to attend Stanford University. In addition, if a family makes less than $60,000, the university will throw in the cost of room and board and other expenses - I am assuming they mean books.

This new (and largest increase in its history) commitment to financial aid means the university will allocate $114 million to its financial-aid program for the 2008-2009 academic year which will likely increase the aid provided to three out of four current students, as well as providing support for new students. The goal of this new program is to eliminate the need for student loans to cover the current annual undergraduate expense of about $45,606 a year ($34,800 of which is tuition). Stanford University John Hennessey said that "no high school senior should rule out applying to Stanford because of the cost," which is truly reminiscent of the Stanford's goal of founding the university "for the children of workers."

My graduate degree is from Stanford and as a person from blue-collar roots I can tell you that it may take a while for the impact of this new program to take hold, but it will be wonderful for youth from all socioeconomic status (SES) levels to be able to walk onto the Stanford campus and feel like they belong there because of their brain and character, not their SES. It would be naive however to trust that every youth who gets accepted has had the same academic preparation though and I predict that the university will also have to increase the budget for the programs providing mentorship and small class sizes that actually facilitate faculty and students getting to know one another, one example being Freshman and Sophomore Programs, which happens to be celebrating its 10 year anniversary.

Look out Stanford here comes some amazing young people - and thanks from all of us parents who want our children to be able to see their dreams come true!

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Labels: College, Healthline, Parenting

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Book Review: Now What Do I Do? A Guide to Help Teenagers with Their Parents' Separation or Divorce

Lynn Cassella-Kapusinski wrote this book in 2006 to share her own experiences and help teens deal with the feelings that naturally accompany the family changes that divorce brings with it. She is also the author of "Making Your Way After Your Parents' Divorce," and the founder of Faith Journeys Foundation.

Now What Do I Do? is a workbook to help teens identify and process their feelings, and provide comfort as well as strategies to handle feeling guilty, ashamed, lonely, sad, and left out of an absent parents life. This book is the most appropriate for Christian-identified youth who have experienced a divorce in which one of their parents becomes an absent parent. There is nothing in this book about families that divorce and then attempt to co-parent on a daily basis or share daily or weekly custody. There also is nothing about gay, lesbian, or alternative family structures of any kind, limiting the audience.

The strengths of this book include her suggestions for letting anger out, understanding and encouraging forgiveness, and some great communication guidelines, particularly in Chapter 5. She acknowledges that parents should be the adults and responsible for keeping the communication healthy, but some parents cannot "be there" for their kids during divorce, and she basically says, get over it and learn how to be a healthy communicator for your own sake.

A couple of things I wish the author focused more on are that all of the feelings teens experience are "normal," and getting teens into a group or working with a counselor is really important. Parents see their kids through a "filter" of their own experiences and most teens need an outsider to help them stay out of the issues related to the divorce and the middle of any conflict. I personally do not believe teens have any place talking about infidelity, emotional maturity of parents, or the emotional baggage parents bring into relationships. I also was concerned that this author suggests that the impact of divorce will give the teens baggage in their own relationships, and never get over their grief, which does not give them much hope.

My own advice is that parents not talk to teens about the reasons the relationship failed or any of the conflict surrounding money, new relationships, or parenting decisions. Kids will be happier and healthier if parents handle the conflict and encourage kids to have the healthiest relationship they can with the other parent. Every child is better off having as many positive relationships with adults as they can, and each parent is responsible for supporting the relationship with the other parent.

There should never be any bad-mouthing or anger in front of the kids - and that is a bottom line. Granted, some parents are unable to do this, because they are depressed, or unable for whatever reason to move on with their own lives, and if that is the case, the children should be encouraged to seek the support of their counselors and other adults to set limits and boundaries on the negative behavior.

Divorce is tough on every family and the more resources we can provide our teens, the better. This is a good resource for teens who relate it to the situation of having a newly absent parent and identify as Christian.

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Labels: Book Review, Divorce, Healthline, Teen Development

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Early Pubertal Development - Girls

Of the 1,250 women answering a recent poll on the We're Talking Teen Health Web site, 37% of them had started their period before they were 13, and 9% had started when they were only 9 years old. In addition, in another poll, 76% of 617 people reported that they started developing hair under their arms and on their genitals before they were 14, and 28% of them had started before they were 11.

There was a time when an 8- or 9-year old girl who started to develop breasts would have been considered abnormal, but that is no longer the case. More and more pediatricians are seeing breast development in younger girls. Now it is only breast development under age 8 that prompts a referral to to an endocrinologist for evaluation. Another change is the length of time between breast development and the onset of periods. It used to take about a year, but now it is not uncommon for there to be a three year gap between breast development and the beginning of periods.

What we do not know is why puberty is starting earlier, particularly in girls. There are theories out there that the early trend in pubertal development is related to better nutrition and health care, or the chemicals in our air, food, and water, which is mighty scary. There is also a tie between obesity rates and early development, with estrogen rates higher in heavier girls (the traditional early developers). There are also some health risks, for example, earlier breast development, and therefore a longer lifetime exposure to estrogen, is a known risk factor for breast cancer, but with the age dropping, "early" might now mean age 6 or 7.

There are three stages of puberty: breast development, pubic hair growth, and finally, menstruation. The average age for menstruation in the U.S. is now 12.5 for white girls, 12.06 for black girls, and 12.09 for Latinas. Another interesting change I have noticed is that we used to say that periods can be sporadic when they start - a young girl might only have one or two during the first year, but more and more I notice that when young girls start, they are quite consistent, with 21 - 35 day cycles.

The parenting implication for this drop in the age of puberty is that we have to have "the talk" with kids who seem way too young to be worrying about reproduction. However, if your daughter is starting to have breasts in third grade, then in 4th grade it is time to start keeping a calendar of mood swings and headaches that may be cyclical, give her the heads up about what her period will look and feel like, give her a Period Pack to start carrying with her, and start talking about growing up.

Sorry, but it's true - whatever the explanation, our daughters bodies are maturing when we still want them to be little girls.

Photo credit: independentman

Labels: Healthline, Preteens, Teen Development

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The Muscle Cramp

I am not talking menstrual cramp, I am talking about the common cramp (a charley horse) - when out of the blue a muscle contracts violently and will not let go - until it is good and ready. Most people have experienced a cramp, which usually comes as a surprise, and can drop even the strongest athlete to their knees. Cramps can happen during or after exercise, up to six hours later, and during sleep (called night cramps). The cramp can last seconds or up to 10 minutes and the muscle can be sore up to 24 hours later.

What causes cramps - who knows! It seems to be a medical mystery. More importantly, what can you do about them? Everyone seems to have an answer - including taking potassium, zinc and magnesium, drinking plenty of water, stretching before and after exercise, turning your toes toward your head, and massaging it out. One theory that seems reasonable to me is that we need more fluid - simple dehydration, Another is that we really need sodium and potassium and when we sweat too much the fluid that bathes the connection between the muscle and nerve is depleted of sodium and potassium, which are lost through sweat, so the nerve becomes hypersensitive.

Preteens and teens who are growing a lot seem to get more cramps, which is not really explained by any of the common explanations, and are not worrisome unless they happen frequently. If they happen at night, try stretching your legs before bed, particularly the calf muscles, keeping blankets loose around the feet, and not sleeping with knees bent and toes pointed down, which shortens the calf muscles.

There are medical reasons cramps occur, particularly in adults, so they should not be brushed off, especially if they are recurring. Narrowed blood vessels, usually from atherosclerosis (hardening of the arteries), compression of a nerve, possibly from spinal stenosis, hypothyroidism, and potassium deficiency can cause cramps, as can medications like diuretics used to lower blood pressure.

Photo credit: heyerin

Labels: Health Fact, Healthline

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