Archive for 2014

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 »

Eight Ways Families Can Help End the Normalization of Sexual Violence

momanddaughterIn my last post, I discussed sexual violence and sexual harassment, and how common it can be in a teen environment. This week, as promised, I want to discuss how parents can try to help their teens recognize and reject this type of behavior, and the type of environment where it is tolerated.

I’ve posted about this in the “Teens and Sexual Assault” series, but I wanted to address a few more recommendations, and repeat a few key ones. These recommendations are not gender-specific; while the study that sparked my first post was about teen girls, any gender can perpetrate, or be the victim of, sexual violence.  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

Teen Girls and the Normalization of Sexual Violence

sad teen girlAn article was recently published in the journal Gender & Society that is enlightening, sad, and for me, brought back memories. The researchers interviewed a hundred adolescent girls referred for sexual abuse about their lives, and discussed themes regarding not only specific incidences of sexual abuse, but day-to-day life as a teen girl. The teen girls interviewed seemed to view sexual harassment, and even sexual violence, as part of everyday life. A common viewpoint was that boys have uncontrollable sexual urges, and it was the responsibility of girls- for better or for worse- to try and dodge them.

As I read the article, I began recalling my own life as an adolescent girl, and how normal a lot of sexual violence seemed. I’ve touched on this topic before, and yet it was startling how familiar some of these themes were to me. I wanted to discuss some of the ideas presented in the study, as well as the overwhelming questions that emerge: Why aren’t teens experiencing sexual harassment or violence seeking help from adults? Why do the teens perpetrating sexual harassment and violence think that their actions are okay?

Read full post »

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

Helping Teens Respond to Sudden Loss

lonelyteenThe recent murder of Maren Sanchez at Jonathan Law High School hit close to home, since I grew up one town over from Milford, and had friends who went to school there. I also have friends and relatives who teach in Connecticut, and have been trying to help their students cope with not only the loss of a sense of safety, but in some cases, the death of a friend.

When adolescents lose a peer, it is likely to be to a quick and violent death. The top three causes of death for teens are car accidents, suicide, and homicide. Sudden deaths can be harder to cope with than deaths that were expected, and violent deaths can be the hardest of all.

There was an excellent article in the Huffington Post about some differences between adolescent and adult grieving. After reading his piece, I wanted to give some tips for how to help your teen move through the terrible experience of losing a peer.

Read full post »

Christine and Pepper’s Story: a Journey to recovery from anorexia

Healthy living is a very hot topic for most of Americans. Unfortunately, for some teens, the quest to be ‘healthy’ can morph into an eating disorder. In this video blog, we asked a young adult and her mother to share their journey towards recovery from anorexia nervosa. Thank you Pepper and Christine!

Can Sports be used to help prevent dating violence

teens holding handsOne of the questions I ask every teen I meet is whether or not they’re in any kind of intimate relationship. Much of the time the answer is ‘yes’ or ‘I have been.’ My follow up question is usually about how their partner treats them and whether or not they feel safe. A recent study has looked at the association between athletics and intimate partner violence. The results surprised me.

In the study, researchers asked ~1,600 boys who were participating in a school based program on coaching boys into men about dating and their sports participation. They first asked about gender equitable attitudes in their sport (generally whether or not boys and girls were equal). They then asked if the teen had been in a heterosexual (with only a female partner) relationship for more than a week and if they had every perpetrated any of 10 different abusive acts (including physical, emotional, or sexual abuse). What they found was that boys who played both football and basketball held less equitable attitudes about gender and sports. Those boys who played both football and basketball or just football alone were more likely to have been abusive in a relationship.

Does this mean that boys who play basketball and football are going to abuse their girlfriends? No, but it does make me think that it might be hard to ‘turn off’ the aggressive behavior that is encouraged on the court or playing field when not in the game. The promising part of this study was that the boys who received violence prevention messages from coaches were less likely to be abusive.

The Centers for Disease Control reported in 2011 that 9.4% of high school students had been hit, slapped or physically hurt on purpose by a partner. They also found that 8% had been forced to have sex. Dating violence amongst adolescents is preventable, but we as adult role models, definitely have more work to do to recognize when dating violence is occurring and prevent the behaviors.

Warning signs that a teen may be in an abusive relationship:

  • social isolation
  • their partner checks their email/cell phone/social network page without permission
  • put downs/name calling either face to face on via social media
  • extreme jealousy from a partner
  • a partner is possessive/controlling
  • physical injury

Here are some great websites for information on dating violence prevention:

Violence Prevention works

Centers for Disease Control and Prevention

Office of Adolescent Health

Love is Not Abuse (LINA)

We’re Number Six! Looking More Closely at the Youth Well-Being Index

teen couple youngThe Center for Strategic and International Studies, along with the International Youth Foundation, recently came out with a report where countries were ranked according to the “Global Youth Well-being Index“. Out of 30 countries, the United States came in sixth, topped by Australia, Sweden, South Korea, the U.K., and Germany.

What does this mean? As usual, it depends on how you look at the data. There are certainly more than 30 countries in the world; our neighbor Canada is missing, and only five European countries are considered. Some nations listed in the survey- like Tanzania, Uganda, and Kenya- are developing nations where parts of the population struggle for things we take for granted (usually), like clean water.

The rankings are based on six areas of youth health, and I wanted to comment on the U.S. and how we scored on specific measures. Read full post »