Tuesday, July 26, 2011

Can Me and My Boyfriend Have a Sleepover?

image from blogs.marinij.com
"Normalizing teenage sex under the family roof opens the way for more responsible sex education."

It turns out that this thoughtful statement is pretty radical in the United States.  And that is probably why Amy Schalet's article in the New York Times is one of the top ten most frequently emailed articles today.  Although her data is based on a very small (130) and narrow ("all white, middle class and not particularly religious")  sample of people, it is provocative for many. It's difficult for most Americans to "normalize" teenage sex when such a loud section of the national discourse looks at sex as "urges" that people cannot manage well, that inevitably end in bad things like pregnancy, STD's and broken hearts.  Teen sex is seen by  many as something to be tamed, ignored, suppressed or at worst denied.

Some parents sanction a fully open relationship over sexuality and others, whether by tradition, faith, politics, or squeamishness, prefer to be discrete. All parents need to be as clear as possible about their values and the expectation that teens will be safe-emotionally and physically.


Schalet makes the interesting (and for many, counter-intuitive) point that parental involvement in their childrens' emotional and intimate lives allows them more ability to influence and protect.  She nicely calls it "control through connection." 

However, when I look at teenage sex through a developmental lens, whereby we expect adolescents to become independent, to make mistakes, to take risks and to experiment with lifestyles and relationships (meaning that sometimes they decide to breakup), it might be more difficult for the average teen to traverse these waters if the boyfriend or girlfriend has become part of the family. 

Monday, July 18, 2011

Medical Care for Young Adult Men

A recent article in the Journal of Adolescent Health focussed on the health care access of young adults  (19-24).  Available in abstract here, it makes a number of points:
insurance matters: "young adults are twice as likely to be uninsured than any other age segment of the population"
males have greater barriers to accessing primary care than females: increasing numbers of young women seek care from their gynecologists rather than  primary care providers but clearly young men do not have such an option.
clinical guidelines need to be developed for primary care: other than in the specialties of Ob/Gyn and Adolescent Medicine, there are few guidelines for managing the health of young adults.
young adulthood remains a missed opportunity for preventive interventions: all of the health issues of middle age take root in the younger years (overweight, heart disease, diabetes, bad habits, poor stress management) and anticipatory guidelines should be laid  out early.

For young men ages 15-29, two thirds of deaths are accounted for by "unintentional accidents", homicide and suicide. In other words, behavior and mental health are more responsible for losing our young people than infections, cancer, or heart disease. And the behaviors we are talking about here are excessive and dangerous drinking; reckless driving; risky athletic pursuits; untreated anger, depression and anxiety; and unsafe, unhealthy or unethical sexual practices.

How upsetting that young men in our midst get the shortest end of the stick when it comes to health care!  In spite of the fact that young adults have higher rates of mortality, more at risk behaviors, and more chronic disease than teens, they have much less access to medical care. Just when young adults start to "think clearly again" after the fog of adolescence they are rudderless when it comes to their health care. A larger proportion of their care is delivered in emergency departments and is not covered by insurance thereby almost ensuring poor follow-up. There are numerous missed opportunities for behavioral counselling on anger management, smoking cessation, prudent alcohol use, safe driving and athletic activities.

We can hope that as more allied professionals (nurses, nurse practitioners, medical assistants) join other providers in caring for this population they will receive the hands-on approach they have been accustomed to with their pediatricians and adolescent medicine providers. In the mean tim, orthopedists, emergency room doctors, urologists, and dermatologists can all pitch in to ask the questions young men need to answer and learn from.

Wednesday, July 13, 2011

Exergaming: A New Kid Friendly Way to Exercise?

Kids playing Sportwall
What the heck is "Exergaming"?


According to a new study in the July issue of Archives of Pediatrics and Adolescent Medicine, "exergaming" is "interactive digital exercise that features player movement." Games you may know of this ilk include Dance, Dance, Revolution; LightSpace; Nintendo's Wii, Sportwall; and Xavix to name a few.

Part of me wonders if this encouragement of electronically based indoor activity is the equivalent of the smartboard replacing the black (or white) board, when we all know that kids need to get outside, enjoy nature, and discover their bodies in the big open spaces (see my  June 30 blog post
http://www.annengellandmd.com/.)

So I was curious to see the conclusions of this ingenious study conducted with middle school after school programs in Boston, Massachusetts.  Most of the games resulted in increases of energy expenditure over the equivalent of walking at 3 miles per hour.  The researchers also studied enjoyment of these activities and interestingly discovered that kids with higher BMI values actually got more fun out of them.   "Such a result,"  says an editorial in the same journal, "suggests that exergames may be an attractive mode of activity for overweight and obese adolescents."  The authors discuss ways to promote  longterm use of the games as a means of exercise since even in this study--with lots of encouragement and followup-- use fell off over time.  One suggestion is the idea of using games at home and in group activities in an after school, gym or club setting. Religious groups, scout troups, gyms with teen programs, and even day camps with rainy day activities might be interested in investing in this technology.

Although pediatricians generally want to promote outdoor activities, the authors and editors of this journal article maintain that exergames "can contribute to daily physical activity, their purchase encourages the electronics industry to invest more heavily in innovation and promotion of such games, and they could help keep adolescents fit enough to enjoy doing other forms of physical activity."

In my experience there are very few acceptable activities for the non-athletic overweight adolescent who more than most needs a fun, acceptable and sustainable form of safe exercise.  Wouldn't it be great if our schools health programs could team up with athletics to purchase and promote a program that would do just that!