All Articles in the Category ‘Teens’

More Teens Getting HPV Vaccine: Boys And Girls

The vaccine schedule is the same schedule for boys and for girls. The path to today’s human papilloma virus (HPV) vaccine has not been entirely straightforward for parents as recommendations have changed over time. Know this: the clear and simple message is that HPV vaccine is safe and effective for boys and girls. We know it works best when given earlier in the tween/teen years and we know the immunity it produces in our bodies is durable and lasting. HPV vaccines is an anti-cancer vaccine that works best when given to boys and girls at age 11. For me it’s a no-brainer to recommend this vaccine enthusiastically before children head off to 6th grade.

Earnestly, it’s not a “new” vaccine as pediatricians began giving the vaccine back in 2007 and it’s been given well over 50 million times. In the U.S. we starting giving the vaccine to girls first yet because human papilloma virus can infect boys and girls, men and women, HPV vaccine is also recommended for boys age 11 and older. Uptake by boys has been fast and steady since recommendations included them. Three different HPV vaccines are now available: a 2-HPV strain (protects against the viral strains that cause 70% of cervical cancer) or a 4-HPV strain vaccine (same 2 strains plus two more that protect against HPV strains causing warts) and now a 9-strain vaccine (expansion of strains causing warts), upping the number of different viruses that the vaccine protects teens against. The new options improve protection against HPV viruses that cause genital warts and also HPV viruses that can cause cancers of the cervix, mouth, throat, vagina and rarely, the penis.

HPV Vaccine Protecting Teens

Although we haven’t reached vaccination rates of countries like Australia (they vaccinate at school which certainly makes the vaccine convenient) our rates of completed HPV vaccine series are up (see graph below). In Australia where the majority of teens have been immunized they have seen remarkable progress:

  • A 77% reduction in HPV types responsible for almost 75% of cervical cancer
  • An almost 50% reduction in the incidence of high-grade cervical abnormalities in Victorian girls under 18 years of age
  • A 90% reduction in genital warts in heterosexual men and women under 21 years of age.

Boys and girls getting the vaccine protect themselves but they also help protect future partners.

Why Does Avoiding HPV Matter?

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4 Things To Know If Your Son Is Off To College

male college prepYou may have already read yesterday’s blog on preparing your daughter for college. Much of my advice for girls, of course, also pertains to boys (and vice versa). I’m writing two separate posts only for the purpose of getting people to read this content, not to differentiate. I added one section here for boys (on alcohol and risks) not because it’s an issue for boys only. In fact, we know that 1 out of every 5 high school girls binge drinks (see below).

If you have a boy heading off to college this fall there are a few things to know to help improve his safety and success this year. Of anything I know from my experience being a previous school teacher, and now pediatrician and mom to boys (still 10 years away from college!) the transition from HS to college-age is one steeped in emotion for all. In addition to the tips I’ve provided for girls, alcohol and the HPV vaccine are topics to discuss to ensure it’s a better and safer year for your son (or daughter) this year.

ONE: Safe Sex & Birth Control – What Your Teen Son May Need To Know:

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It’s Gotta Be Screen Time Somewhere

Illustration by David Rosenman

Illustration by David Rosenman

My boys always want it to be screen time. I don’t think that is changing anytime soon. These apps, shows, games, and devices are only getting smarter at capturing their attention.

It feels like there isn’t a giant list of new advice to share regarding “screen time.” But because of the recent media focus and deluge of content on “screen addiction,” coupled with recommendations for dealing with screens while parenting this summer, I’m here with a few responses and observations. It seems to me, parents (all of us) are looking for a couple of things in the content we read about parenting with screens: permission and hacks for simplicity. This post will perhaps offer neither. Until the end.

Most of us acknowledge that not all screens are the same, nor is all programming, nor are the stages of life where apps and screens are enjoyed (infants versus an 8 year-old). “Screen time” is an issue layered with complexity. Parenting during this explosive device development era demands simple rules and dictums for limiting their use help, but the rules by themselves limit the development of full-on zealots. No one follows the rules like religion. Parents, grandparents and caregivers aren’t devout to recommendations because we claim the rules just don’t fit into the context of our lives. Most of us figure out a way to make justifiable exceptions. It’s simply too easy to pull out your phone, especially when it delights your child the way it does, and entertain. But no question that with the rules out there stressing non-use and limits, we’re left feeling a little guilty anytime we left our children indulge. Imagine knowing that screens before bed interfere with the “sleep hormone” melatonin (the light emitted from the screen limits secretion) but even so still choosing to let your children “chill out” with a video for a 1/2 hour before bed each night. Or imagine following the no-screen-time-before-age 2 religiously for your first child but then breaking this rule routinely when you have a second one! This just happens all the time. Read Why No TV Before Bed Is Better. Read full post »

3 More Things To Know About E-cigarettes

My goal here is to educate people about the risks and realities of e-cigarettes amid an environment full of popular misconceptions and half-truths. Talking about e-cigarette use in adults will NEVER be the same as talking about e-cigarette use and dangers for children and teens. Different groups, different realities, different risks, different use, and different vulnerabilities. Period.

E-cigarette use tripled among high school students last year alone. This is happening RIGHT NOW. Read full post »

What To Do If Your Child Is Drowning: School-Age & Teens

6-2 boy swimmingThis is part two of the “What To Do If Your Child Is Drowning” series. Read about infants/toddlers here.

The purpose of these posts is to find out what you should do if you realize your child is actually drowning or struggling in the water rather than repeat the warnings of how to prevent it. I want to put a couple thoughts and tools in your hands to know WHAT to do if faced with an emergency.

Dr. Linda Quan, an emergency attending physician and drowning expert at Seattle Children’s shares information on what to do if you come upon a school-age child or teenager who is drowning. Preparing for this can help boost awareness and response if ever you support or discover a child in need for rescue. Read full post »

E-Cigs And A Free App To Help Quit Smoking

Last week a proposal was introduced that would give Washington State the toughest e-cigarette laws in the country. If passed, House Bill 1645 would significantly raise the taxes on e-cigarettes, ban the sale of flavored vaping liquids, ban online sales to Washington residents and require producers to list ingredients on labels. And while opponents of the bill argue that e-cigarettes are “healthier” than tobacco, there’s no denying the dangers of having such a highly addictive substance in arm’s reach to children and teens in an unregulated manner. Washington isn’t the only state taking action. This week California released a campaign calling out marketers of e-cigs for targeting teens. Teens are using e-cigs more and more with 1 in 5 high school sophomores here reporting having used them in the last month. E-cigarettes and e-hookahs may carry an illusion of safety they don’t warrant.

What House Bill 1645 Proposes

  • Instill a 95% tax on vaping products similar to tobacco product taxes
    • Right now only North Carolina and Minnesota have imposed taxes on E-cigarettes
  • Make it illegal to sell flavored liquid nicotine or other vaping fluids
  • Ban internet sales to Washington residents
  • Require ingredients list on all labels

Curbing An Urge To Smoke: An App For That

Supporters of e-cigarettes and those fighting against regulation often claim the devices are helpful in helping tobacco users quit, so-called harm reduction. I certainly won’t and can’t argue with anecdotes that this is useful for those wanting to quit. While this concept hasn’t been entirely disproved or entirely proven, there is still a lot we don’t know about vaping and the effects of liquid nicotine. If you or someone you know wants to quit tobacco, there are some new digital resources available to help you kick the habit. The good news is we can be hopeful that dual-pronged approaches may help those wanting to quit earnestly succeed. Download this app?

3-23 smartquit

Image courtesy: Washington Department of Health

Washington State residents have access, for a limited time, to a free app called SmartQuit. Sponsored by the Department of Health, the app is a tobacco cessation program that proved three times more effective than trying to quit on your own, according to a recent study from Fred Hutchinson Cancer Research Center. SmartQuit users create a personal plan to become aware of their urges to smoke, they then learn new ways of thinking about those urges to suppress the desire to smoke. The Washington Department of Health is offering the app for free to a limited number of users. Because the funding is limited, please don’t download unless you’re serious about using the app as the number of free downloads will run out. Consider it? If you or someone you know does, report back on your opinions?

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Sleep Debt And “The Great Sleep Recession”

2-13 teen sleep photoTeens in the U.S. aren’t getting enough sleep and it’s not getting better as time unfolds. After days of too little sleep we accrue a “debt” of sleep. An article out earlier this month details the long-term effects of chronically tired teens, “The Great Sleep Recession” the reality that as teens progress from middle school and into high school, the majority don’t get the sleep they need. National Sleep Foundation has found that over 85% of teens lack adequate sleep. Sleep matters: deprivation and tiredness affect schoolwork, attention, mood, interactions, unhealthy weight risk and lifelong health habits. Teens need between 8 – 10 hours of sleep each night (imagine — that means if in bed at 10:30 a teen shouldn’t hear an alarm prior to 6:30am!) but the data out this month shows a growing number of teens from all ethnicities and backgrounds are getting less than 7 hours of sleep, 2 hours less than what is recommended. This has big effects on the culture we’re rearing. Typically teens won’t naturally get tired and drift off to sleep prior 10 pm, so one way to combat this sleep deficit is to push school start times to a later hour.

Why Teens Need Sleep

Sleep deprivation changes the experience of life. There an increase in risk for anxiety and for depression in young adulthood in those who don’t get adequate sleep and it’s harder to focus, pay attention, perform at school and make decisions when we’re tired.

  • Less sleep leads to more car accidents and poor judgment. Changing the time teens start school can improve safety:
    • Delayed start time lowered one county’s teen crash rates during study, while statewide teen crash rates (that reflected schools that stayed on the same schedule) rose 7.8% over same time period.
    • In a two county comparison in Virginia, the one with an earlier start time had a crash rate of 48.8/1,000 drivers vs the county with later start times 37.9/1,000 drivers.
  • Sleep deprivation can lead to substance abuse later in life and is tied to more use of caffeine and other stimulants.
  • Caffeine in the morning and afternoon, naps throughout the day and evening and/or sleeping in on the weekend help teens cope with fatigue but these band-aids and catch-ups will not restore brain alertness like sufficient sleep does.

“Sleep Recession”: Trends From 1991-2012

Graph data adapted from: http://pediatrics.aappublications.org/content/early/2015/02/10/peds.2014-2707.full.pdf+html

Graph data adapted from: http://bit.ly/1Gm8HbQ

The recession is here, teens are more tired than they were in the 1990’s.

  • Sleep recession trending
    • Teens who get more than 7 hours of sleep in decline
    • Largest decrease in sleep in 15 year-olds.
      • In 1991 72% got >7 hours of sleep
      • In 2012 only 63% got >7 hours of sleep
  • Gender gap in adequate sleep widening as girls getting less sleep than boys

How Later School Start Times Can Help

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Legal Doesn’t Mean Safe: Marijuana

Legal never has meant “safe” but the two words may at times overlap in our minds. When it comes to marijuana I’d suggest there is quite a bit of confusion right now about safety, recreational and medicinal use, and the effects of use on our population. In general, as laws change and access to marijuana increases we have a responsibility to be clear about what is known.

The adverse effects of marijuana in children and teens have been well-documented. Marijuana use can impair memory, decrease concentration, and change problem-solving capacity. It’s not good for the lungs nor long-term health; teens who use pot have a higher likelihood of drug addiction later on in life, the risks increase the earlier they start using. Research also finds that teens who use marijuana are less likely to finish high school, are more likely to use other (illicit) drugs, and have an increase in suicide attempts compared to those who don’t. The more they use, the more the effect. I can’t help but think about what a mom to a teen said to me recently in clinic, “marijuana is everywhere now.”

One in 5 high school students says they have used marijuana in the last month and up to 1 in every 16 students says they use it every single day. Who are we if we ignore these numbers?

As legal may mean “safe” to some a strong statement from pediatricians everywhere from The American Academy of Pediatrics (AAP) was released today to set the record straight. The two things to know:

  1. Research has found marijuana has adverse effects on teen health. It’s now known that the brain isn’t fully developed until the mid-20’s raising real concerns about what the drug does while the brain is still forming. The effects of marijuana change how teens think in school, how safe they are on the road, and potentially how they act for a lifetime (lifelong addiction risks increase with use, teens who use are less likely to finish high school, teens who use have higher suicide risk).
  2. Use Coupled With Criminalization Can Change Lives For Good: Legalization for medical and recreational use may imply marijuana is benign; for children and teens this is untrue. History shows that teens, especially those of racial minority groups, are incarcerated at higher rates secondary to possession or use of marijuana. A criminal record can have lifelong negative effects — the AAP is advocating to decrease marijuana crimes from felonies to misdemeanors, study effects of legalization in states like WA or Colorado, Alaska or in DC, and strictly limit access to and marketing of marijuana to youth. The big concern here as well is that policies that lead to more adult use will likely lead to more adolescent use. Decriminalization is especially important in states where recreational use is legal for those over 21 years of age.

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Pre-Vacation Tanning?

This girl in a tanning bed should provoke the same response in you that a photo of a 5 year-old smoking a cigarette would.

This girl in a tanning bed should provoke the same response in you that a photo of a 5 year-old smoking a cigarette would.

More than a million people go indoor tanning every day and research says the average city has more tanning salons than they do Starbucks or McDonalds (I’m wondering about Seattle though since coffee shops truly dot every block). I’m also guessing the tanning industry is somewhat seasonal; if we did the research on which week people go tanning, we’d find a bump during winter break, yes?

The pre-vacation tan is often used as a handy excuse for hitting the indoor tanning salon this time of year. There’s no such thing as a “safe” tan since tanning is a reflection of damage to the skin cells — a tan is the body’s response to damaged DNA in the skin cells. However, vacationers (lucky you!) often feel that getting a tan before they go to the equator will protect them. Instinct here is wrong.

Data finds that those who indoor tan before their trip are careless while on the trip, thinking they are protected, and in the end have more sun exposure and ultimately more sunburn than those who don’t.

People may visit a tanning salon to prepare the skin for a sunny vacation, the “prevacation tan”, thinking that a “base tan” will protect against subsequent skin damage during the vacation. This leads to extra radiation before the vacation and also afterward, because people may use fewer sun-protection precautions during the vacation because of a mistaken belief that the tan will protect them. The “prevacation tan” results in minimal protection (an estimated SPF of 3) and provides virtually no protection against sun induced DNA damage. ~ Pediatrics, April 2013

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E-Cigarette Use Up, One Dead In New York

WAPC e cigaretteE-cigarette use is growing among teenagers. Vaping is on the rise among high-school students in particular, with rates increasing steadily each year. I still think of e-cigs as the gateway to the gateway drug. In my experience, teens remain confused. They hear about health benefits (harm reduction) in adults and they may think that confers safety. In addition, some teens have reported to me they have heard it will improve their sports and school performance.

Nope. No data to show e-cigs are good for anything in teens, in fact we know nicotine increases HR and BP which in the end could decrease sport skills. Just a teaspoon of liquid nicotine can be lethal to a young child and we know nicotine can have lasting adverse consequences on teen brain development. Becoming addicted to nicotine (the big worry with teen use) could have secondary health effects leading athletes to cigarettes which we know won’t improve their talent on the field.

Rates of e-cig use rose from 4.7% in 2011 to 10% in 2012, now a recent Pediatrics study of 1900 high-schoolers in Hawaii shows 29% have tried e-cigarettes. Only 15% of the same group reported trying a cigarette. These e-cigs are getting around.

It’s not just use among teenagers that’s cause for concern. Young children living with or near nicotine may be at highest risk from e-cigs due to their curiosity and lagging judgment and ultimate exposure. The first child death related to exposure of liquid nicotine was reported last week. A child in NY has died from exposure to liquid nicotine after officials have been warning of the risks from sales lacking regulation. The risks are being felt everywhere as the rates of calls to poison control rose from 1 report in September of 2010 to 215 calls in February of 2014.  This NY death represents an enormous tragedy for this family but also for our ability to prioritize safety over sales. We can’t forget that the flavored nicotine used in e-cigs appeals to many senses in a toddler exploring their environment. Dr Alexander Garrard, Clinical Managing Director of the Washington Poison Center said, “The products smell very sweet, akin to a jolly rancher so they’re enticing to a number of different senses in kids. The packaging is very colorful as well.” All these things draw a child to experiment and possibly ingest.

Protecting children from this toxin, I would say, is a true failure of pediatric public health.

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