Author: Yolanda Evans, MD, MPH

Addressing Traumatic Events in the Media

family watching tvOver the past 2 weeks, multiple events have been receiving media coverage. These range from the death of a beloved celebrity to the shooting of an unarmed African American young man in Missouri; reaching as close as the death of a shooting instructor by a very young student to as far as the conflict between Israel and Palestine.  These events often stir up strong emotions as well as strong opinions amongst colleagues and friends. Teens are using social media on a regular basis and are likely well aware of the trending news stories. As parents, how do we address these events with our children? Some of the topics may hit close to home and others may seem like they are happening a world away, but all of them can lead to conversations and provide opportunities for reflection and learning. Read full post »

What is a hookah and is it safe

Girl smoking waterpipeAs fewer teens are smoking cigarettes, other trends in tobacco and nicotine use are starting to rise. One of these is the use of e-cigarettes or e-vapes. E-cigarettes include the use of a nicotine containing cartridges that is vaporized so the use can inhale the product. A second trend is one I hadn’t given much thought to until recently: smoking a hookah. Is this dangerous? How does it compare to smoking a cigarette?

The hookah (aka water pipe) is a pipe where tobacco (or other leaves, like herbs or marijuana) is heated, the smoke passes through water to cool it into a vapor, and this vapor is inhaled through an individual mouth piece. Hookah use originated in Asia and the Middle East, but it’s popularity is growing in urban settings in the US. Unlike cigarette smoking, most states do not have a ban on hookah use inside public settings so hookah bars are starting to pop up. Teens are also finding their way to using the hookah. Read full post »

Sexting and cellphones

Unrecognizable young girl using a touch phone modern gadget.We’ve posted about online safety as well as the dangers of sending sexually explicit text messages in the past, but a recent study in the journal Pediatrics, highlights the importance of making sure we educate teens and tweens about sexting early on.

In the study, researchers looked at the results of a national survey of middle school students. They found that 20% of students who had a cell phone reported receiving a sext and 5% reported sending a sext. For those students who send more than 100 text messages each day, they were over 2 times more likely to receive a sext and 4.5 times more likely to send a sext. They also found that those same students were more likely to be sexually active. In general, students who sent or received sexts were more likely to be sexually active and higher rates of texting were associated with higher rates of unprotected sex. Read full post »

Recreational marijuana and a parent’s role in prevention

store openingThis week the first recreational marijuana stores opened in Washington State. Initiative 502 was passed in 2012 to legalize marijuana in the state without a physician’s recommendation, but it was just yesterday that recreational stores could legally sell it. One store opened in Seattle, the others were in Bellingham, Prosser, and Spokane. It remains illegal for anyone under age 21 to use or possess marijuana, but legalizing recreational use does send a message to those who aren’t yet adults: it’s legal now, so it must be ok, right? We’ve had posts on marijuana legalization and teen marijuana use in the past, but here we wanted to highlight the importance of parents in preventing underage use. Read full post »

Fourth of July Safety

teen divingFriday marks the Fourth of July and we’ll have an entire weekend to celebrate. This time of year the weather is usually great, people are in a good mood, and school is out. While we all have fun events planned, this is also a time when accidents can occur. One of the main themes you’ll see on this list is to avoid alcohol and drugs during fun activities. Being under the influence of substances can alter judgement and have deadly consequences. We’ve had posts on summer safety including drowning prevention, water safety, and driving in the past. Here we’ll highlight some of our tips for having a great and safe 4th of July weekend. Read full post »

The importance of failure

frustrated male studentI’ve spent the last couple of weeks meeting new high school graduates and having conversations with students who are transitioning to a higher grade level. An interesting pattern emerged amongst many of the top performing students: some had never experienced a failure, but those that had described learning a lot from it. As a teen, I was a perfectionist. I had a 4.0, was active in extracurricular activities, I never broke curfew, and I worked part time. It wasn’t until my senior year physics course that I really experienced my first taste of not doing something exactly right. I received a C grade at the end of the quarter. We’ve written about perfectionism before, but I wanted to highlight some of the lessons learned from not always succeeding on the first attempt.  Read full post »

Supportive Parenting

paper cutout family of three with paper messagesParenting is an amazing journey that comes with joys and challenges. Children bring to their families their unique personalities the moment they’re born and as parents, it can sometimes be challenging to recognize that what we always imagined our children would be may not be the same as what our kids actually see as a future for themselves. This week a story has been trending on social media about a set of parents who are a great example of how to be supportive of your child, even if they are different than who you imagined they would be. As parents, your child will likely surprise you be being even more amazing than you could have thought! Read full post »

A project to prevent unplanned pregnancy

The Centers for Disease Control shared an update that the teen pregnancy rate dropped by 8%. This was exciting news, but teen births for young women ages 15-19 are still exceedingly high in our nation at 31 out of  1000. Unplanned pregnancy is not just an adolescent concern. It is estimated that nearly 50% of pregnancies in the US are unplanned, however for teens the consequences are often more life changing. A few of the consequences of becoming a teen parent include: being more likely to be poor, less likely to complete their education, and more likely to have daughters who become teen mothers and sons with a criminal record.

I think most experts would agree there is not a single solution to prevention, but instead multiple things that can be done to help prevent unintended pregnancies. For teens, this includes parental involvement, teaching about reproductive health (including the importance of empowering youth to say no to sex if they’re not ready), delaying sexual debut, practicing abstinence, using effective birth control if sexually active, and perhaps most importantly, teaching/role modeling healthy relationships.

One research group in Missouri offered over 9,000 women extremely effective and reliable birth control in the form of long acting reversible contraception including the intrauterine device or progesterone implant. These methods are over 99% effective and 100% reversible. They don’t require a woman to remember to take a pill or go in at regular medical visits for a shot so once they’re in place, they work for years without any effort. The study found that most women chose one of these methods when offered. The amazing conclusions from this study were that unplanned pregnancies dropped significantly and so did abortion rates. To see more on this project click here for the YouTube video.

Why am I mentioning this study to parents?

Many teens who seek out birth control only know about the pill or the shot. In fact, the birth control pill is the number one method of hormonal contraception used by teens. However, this method also has the highest failure rate. With perfect use, about 8 out of 100 teens will get pregnant in a year if using the pill (about a quarter of teens who use the pill will get pregnant in a year with typical use). Only a little over 20% of sexually active teens used contraception at all with their last sexual encounter (60% used a condom, but condoms are better at preventing infection than pregnancy). It’s exciting that our teen birth rates have dropped, but we can do better!

Here are a few tips for parents:

Start talking to your teen early about relationships. Role model healthy relationships starting in childhood.

Educate about sex. Include the pros (pleasure, intimacy, affection, desire) and cons (pregnancy, sexually transmitted infection, strong emotions). Encourage your teen to be fully ready for all of these things before they embark on their sexual debut.

Discuss your family values. Talk about why you encourage abstinence until marriage or why you want your teen to wait until they’re ready.

Listen to your teen. They may have questions they’ve been embarrassed to ask, or worried about what you would think of their behavior. When having a discussion, remember that your teen as a point of view as well.

See a medical provider and ask about different forms of birth control. Both boys and girls need education about contraception. Some providers may not know that all options can be used safely in teens and the options are constantly being improved. If the provider isn’t comfortable, ask for a referral to a pediatric and adolescent gynecologist.

For previous blog posts on teen long acting reversible contraception check out the posts below:

More on birth control: long term options

More on birth control: long term options placement and removal

Ten tips for talking to your teen about sex

10 million males struggle with eating disorders

Eating disorders affect millions of people in our country. They can range from restriction of food to binge eating. Though our culture typically considers eating disorders to be a disease of females, around 10 million males are actually affected by eating disorders in our country.

Disordered eating behavior often starts in adolescence and for some, the behaviors go undiagnosed for months to years. The Centers for Disease Control asked high school students about their eating behaviors. Among boys, 7% skipped eating for an entire day in order to lose weight, 4% took diet pills, liquids, or powders in order to prevent weight gain, and almost 3% actually vomited or took laxatives within the past 30 days in order to not gain weight.

More boys are starting to share their struggles with eating disorders. A recent National Public Radio (NPR) story shared the story of Jonathan. Hearing his journey highlighted to me the importance of listening to my patients and as a parent, not ignoring any gut instinct that may say ‘something’s not right here.’ His mother is very open in the story about what she observed and that she didn’t initially consider an eating disorder.

So what are some warning signs of an eating disorder:

  • Concern about body shape/size
  • social isolation
  • odd food behaviors (only eating certain foods, avoiding eating around other people, cutting food into small pieces, hiding food or throwing it away)
  • excessive weight loss
  • intense fear of gaining weight
  • excessive exercise
  • use of diet pills, laxatives, or supplements to lose weight
  • vomiting after meals

If you suspect your son may be struggling with his weight (whether over or underweight), seek the help of a medical professional. Be open with your concerns as eating disorders are not always the first thing that comes to mind in a medical encounter.

Organizations with resources include:

National Eating Disorder Association

Something Fishy

Previous posts on eating disorders include:

Eating Disorders: Signs and Symptoms post 1 (from a series of 8 posts)

When weight loss is an eating disorder

E-Cigarettes and marijuana

e-cigaretteIn the past few months I’ve had the privilege to speak with parents of high school students about the prevention of drug use. One of the questions that’s come up repeatedly from school staff has been: ‘What do we do about e-cigarettes?’ Now I’ve noticed the e-cigarette vendor signs in urban areas and have read the media hype about e-cigarettes, but I hadn’t realized how prevalent they were in schools, nor had I understood another common use for these mini vaporizers: they’re a way to use marijuana undetected.

E-cigarettes are small vaporizers that look like a pen. The American Academy of Pediatrics highlighted this week that half the Poison Center calls on e-cigarette liquids involved children, so they are becoming more and more common in households. To use an e-cigarette, the nicotine liquid is heated and the user can inhale to receive the same sensation as smoking a cigarette, but without as much of the smell as traditional cigarettes. The people who advertise e-cigarettes state that their advantage is that the user does not receive all the toxins, but what they don’t tell you is that a user is still receiving the nicotine and continues to be addicted to it. Nicotine itself is a toxin that can lead to heart and large vessel disease and as a physician, I recommend avoiding it.

Marijuana, in the form of concentrated hash oil, can be used in place of the nicotine with an e-cigarette. When used, the vapor does not have the pungent smell of the typical joint or bong which makes it extremely difficult for anyone to know if the oil is nicotine or hash. Teens can use the e-cigarette to take a hit while sitting in class (it may look like they’re chewing on a pen) and a teacher may not even notice. If an e-cigarette is found by school staff, they have no way of knowing what is in it.

The Centers for Disease Control (CDC) found that amongst those in high school, tobacco use has declined overall, but the use of e-cigarettes has doubled. In WA, where marijuana has been legalized for those age 21 and over, we’re finding that marijuana use among 12th graders has exceeded tobacco use with 27% reporting use of marijuana and 16% using tobacco. Both drugs can have harmful effects on the body. Marijuana affects the teen’s developing brain and can drop IQ points, lead to lack of motivation, and is associated with poor school achievement. Teens who use marijuana are also more likely to use other substances.

What does this mean for parents?

Be aware of drug paraphernalia and if you find something, but aren’t sure what it is, ask your teen about it.

Communicate with your teen your expectations about behavior, including substance use.

Seek help if you suspect your teen is using. Some great resources include NIDA and SAMHSA.

For more information please check out:

Our previous posts on marijuana here and here

A recent post by seattlemamadoc on e-cigarettes

How to talk to your teen about your own history

How to talk to your teen about drugs