Wednesday, May 27, 2009

Over the past few weeks . . .

Over the past few weeks I have been crawling and climbing up the learning curve on blogging. I have been exploring a multitude of websites and news publications on parenting teens. There are some wonderful whacky things out there. Everything from moms sharing news on diapers to true confessions about terrible parenting errors people have committed. I have discovered a sorority of bloggers at blogher.com.

In addition I am discovering how to get my self into the blogoshpere by "introducing myself" online to other bloggers. I was able to connect with a reporter who is interested in how doctors are beginning to use social media as a part of their practice,either as promotion or as a way to communicate with patients. Since I do both, I was written up in their blog.

I love that line about "limitless knowledge and a connection on a whole new level is the true power of the healthcare/social medical relationship." I have no illusions: I will never catch up to my kids or my patients when it comes to this stuff, but I feel a whole lot more savvy and linked in than a month ago!

Sunday, May 24, 2009

So we know they're drinking. Now what?

This week I hosted a group of nine local moms in my office to chat about the realities of alcohol and our kids. We talked about how the "just say no" campaign does not really appear to have worked so well. The numbers of kids drinking and the frequency and amounts consumed are remarkable, as recent surveys and my office contact with kids show.

A few random but important points emerged from our conversation:
  • The debate about lowering the drinking age back to 18 is a real one, especially on college campuses (and initiated by college administrators)
  • The culture among teens has become one of binge drinking, often with the goal being drunkenness, just shy (hopefully) of illness.
  • We need to consider carefully the value of "teaching our kids how to consume alcohol" even if that takes place in our own homes and with us before they go off to college.
  • We need to look at how we adults consume alcohol. Recent US government-sponsored programs are helping folks Rethink drinking
  • Data shows that binge drinking before age 16 increases the risk of alcoholism in a vulnerable child by eight fold.
  • It is possible to enforce certain absolutes: curfew time, checking in upon returning home; never, ever, driving after drinking; protecting friends from dangerous alcohol poisoning or vulnerable social situations;holding off on drinking altogether until at least age 16 (or more).
  • It is possible to teach some safe drinking rules without endorsing illegal imbibing. Kids should be taught to avoid alcohol when tired, depressed, hungry, angry, thirsty, sad, or alone.
There are no easy answers to this problem. But it is worth considering the merits of a "risk reduction" approach to alcohol and teens rather than avoidance of the issue or punishments that do not teach or lead to underground, even more worrisome activities. Cheers!

Monday, May 18, 2009

Dads' and daughters' discoveries

A recent study of teen sex has shown that in two-parent households, when Dads get wind of their daughters’ sex lives—especially when the girls’ self-described behavior is “risky” (“premature”, multiple recurrent partners, or poor use of birth control)--fathers ratchet up their attention.

This increased attention from Pop apparently has a measurable effect on girls’ subsequent sexual behavior. This effect is small (7% change—whatever that means in real life) but apparently deviates from previously held notions that parents look the other way or become less involved when risky teen sex is involved. The study (published in the journal Child Development, May/June 2009*) whose lead author is Rebekah Levine Coley, did not discuss how exactly Dads showed their increased interest or involvement in daughters’ lives.

Did they ground them?
Did they punish them?
Were they just "disappointed"?
Did they play more Scrabble with them?
Did they take them to a doctor and get them birth control pills?
Did they just talk to them? What did they say?

How many ways can we imagine that a Dad might react to his daughter’s “risky sex” in ways that would lead her to curtail her activity? Send your ideas to me, please!

*This article in its entirety is not available free online so I have pasted together bits and pieces from multiple on-line reviews.

Saturday, May 9, 2009

Pedal Power

How many bikes do you and your friends have rusting and gathering dust in your basement or garage? With my large family that rides, we have collected more than a few over the years. Today, at last I was able to recycle them to a cause I want to share with you. Pedals for Progress organized a collection station in the driveway of a local church. Within minutes of my arrival volunteers had de-pedaled and rotated the handlebars on my two old Treks and were ready to stack them in a UHaul to ship off to one of many countries they supply. Nicaragua, one of the nations highest on my radar screen since I worked there last year building houses with Bridges to Community, has received over 30,000 bikes through P4P.

Pedals for Progress points out that they ship more than mere bikes. A bike can provide access to a livelihood or an education for the poor of the world. And what does this have to do with adolescents? As our world shrinks to a more global neighborhood, our responsibility toward our brothers and sisters abroad is as great as toward those at home. I remember meeting teens in Nicaragua who could not get to junior high or high school because they had no transportation (or means to pay for public access to) public schools that were several kilometers away.

I urge you to check out Pedals for Progress and put your used bikes to work for others! It feels great. And saves our landfills too.

Thursday, May 7, 2009

OOPS! It's the Morning After!

Just kidding.

But actually, yesterday, May 6, was the National Day to Prevent Teen Pregnancy! The most recent US data (2007) shows that the teen (15-19 year olds) birth rate has crept upward to 42.5 births per 1000 population. Read that another way: 4.25% of teens ages 15-19 had a live birth in 2007. Not pregnancies, not sex, not abortions, not the morning after pills. Live Babies! The data does not tell us how many of these were planned pregnancies, but most child and adolescent experts would agree that the risk to the health and long term well-being to the mother(education, earning potential, physical and mental health) and to the child (risk of prematurity, abuse, learning disabilities, school problems and more) is significant in teen mothers

If you know a teen or are one, first bookmark my blog, and then check out this website:

www.stayteen.org

and take the scenario-based quiz that will test your savvy on issues of sex and contraception. If you are a teen, ask your parents to take it too! Then go back to my earlier post on sex education by cell phone and the Morning After Pill.

And I promise the next post will not be about sex!

Wednesday, May 6, 2009

National School Nurse's Day

As a school district physician as well as a practicing doctor for teens, this has been some crazy week. On some of the first days of the Novel H1N1 (alias Swine Flu) news there were nearly hourly updates in my email from the CDC, the New York State health department, the school nurses with whom I work and the superintendent and other important administrators who were working in good faith to stay abreast of the latest news. School nurses' offices bore the brunt of the onslaught as jittery parents arrived wearing masks and hundreds of anxious calls were fielded so no major individual or public health mistakes were made.

All this took place while the daily work of the school nurses continued apace: checking for head lice, listening to an allergic child wheeze, putting band-aids on minor booboos, helping a diabetic child with her insulin, referring an injury to the emergency room, and many more.

So it is fitting that this day is designated an official day to recognize the work of the school nurse. Even in my relatively well-to-do community there are hundreds of children without an accessible or available doctor who takes their insurance plan and many more who have no insurance at all. For these children (and often for their parents as well) the school nurse is the first line of information, comfort, and help.

It is my honor to work with these soldiers of public health. It is my hope that as we move into a new era of health and insurance coverage, the school will continue to be a center of community well-being and will be allowed to extend its reach and even be reimbursed adequately for its work.

Tuesday, May 5, 2009

Cinco de Mayo

Dinner time is always a time for me to challenge assumptions. So last night after watching President Obama flub the Cinco de Mayo greeting (because it was Quatro de Mayo), we began discussing what it really is. There was one vote for Mexican independence, another for the Day of the Dead and one "not sure/undecided.

Well turns out to be "none of the above. Cinco de Mayo is a regional holiday, according to Wikipedia, that celebrates the 1862 victory of a poorly armed, small Mexican army from the state of Puebla against the French military who were widely expected to win. Sounds like Hannukah and the Macabees to me!

Although it is widely celebrated in the Mexican diaspora in the US, "Cinco de Mayo is not "an obligatory federal holiday" in Mexico, but rather a holiday that can be observed voluntarily," according to Wikipedia sources. Wouldn't it be nice, since so many in Mexico are still quarantined from public places and staying home to prevent the spread of H1N1 influenza, if the government would just declare it a big day of fiesta and allow el pueblo to let its hair down. A sort of Passover, come to think of it, for those who have come through this plague that, so far anyway, isn't one. Masks or no masks, Feliz Cinco de Mayo!

Sunday, May 3, 2009

Sex Ed by Text

Today's New York Times Style Section (why does most news related to teens seem to appear in this section?) has a lead story about a pregnancy prevention program in North Carolina. What makes this program different is that teens can anonymously text a query to a Text Line and within 24 hours, often faster, they will get a reply from a trained, live counselor.

Brilliant. Kids don't get complete sex ed in high school (in North Carolina schools are mandated to teach an abstinence-only curriculum);they forget what they are told in class; they make dumb mistakes; they have a hard time talking with parents; and devour any opportunity to talk privately and confidentially to an adult (no question is off limits in my office and I am amazed at what kids need to know).

Not without controversy. Those who would rely on abstinence only education prefer to do their teaching at home and not lose control to a cellphone! Data unfortunately shows that this tack has not been working too well, both in terms of the knowledge imparted (values and plumbing both get short shrift) and in terms of prevention of unwanted pregnancy.

From my opportunities to chat with parents about teen sexuality and sexuality in general, I would say someone should start a hotline like this for ADULTS!

Friday, May 1, 2009

FDA Approval of Plan B for 17 year olds

For the past two years, Plan B or the Morning After Pill, has been approved as an over the counter medication for use by women and can be purchased over the counter by men or women over age 18 with ID. For young women under 18, a prescription is necessary in addition. There has never been any scientific doubt as to the safety and efficacy of the medication for women under age 18. The current policy was agreed upon by the Bush administration as a sort of compromise between the medical and the conservative communities.

However, now it appears the FDA is set to extend approval of its sale over the counter to women (and men) 17 and over. What difference does a year make? Let’s look at the CDC data from the 2003 National Youth Risk Behavior Survey (an enormous study that polled almost 200 high schools across the country. According to my back-of-the-envelope calculations, there are approximately 12 million teens who are sexually active between the ages of 17 and 18. If we consider that only about half of all episodes of intercourse in this age group are protected by a condom we can see that there are literally millions of moments when a morning after pill could be a wise choice.

Of course, better to use a condom each and every time since nothing protects better against STDs.