Teen Health; Overview.

Your body is changing; your moods may be unpredictable and sometimes even unexplainable. Don't worry. These changes during your teen years are normal.

Both boys and girls go through many changes during the teenage years. And while changes in girls are different than those experienced by boys, all of these changes are a natural part of your development into an adult. These changes are called puberty.

Puberty--How Your Body Changes

Puberty lasts for several years and marks the life stage when your body is changing from a child to an adult. Hormones help trigger and guide this process. Hormones are natural chemicals in your body that produce gradual physical changes during this time and may also cause emotional changes that can sometimes seem uncontrollable. These changes are common during puberty and they happen to everyone. Although it may seem that these changes and feelings are out of your control, don't worry, you're still you, just the "growing up" version.

Girls, one of the first changes you will notice are your breasts growing, usually between the ages of eight and 12. Sometimes, one breast might grow larger than the other. Don't worry--they will most likely even out before they are finished developing. Just like your ears, they aren't always a perfect match. This is true for every young woman. Once your breasts start growing, you will most likely want to buy a bra. (See under Resources, "Checklist for choosing a bra")

Another change you will notice is hair growth. Hair will grow under your arms, on your legs and on your pubic area. Shaving your underarms and legs is a personal choice. Some women do, others don't. It's your choice. If you decide to shave, make sure you use your own razor. Don't share razors with friends. And use either shaving cream or soap and water as a lubricant for shaving. If you want to shave, you should talk about it with one of your parents first. (See Resources, "Shaving: Do's and Don'ts.")

A less noticeable change is the widening of your hips and the slimming of your waist. Your stomach, bottom and legs might change shape, too. All of these changes are making you look more like a woman than a girl, and they are all normal, expected changes. Another sign of puberty could be all over your face. It's called acne (otherwise known as pimples, or "zits"). This aggravating condition may be mild (blackheads and whiteheads), moderate (larger inflamed-looking blemishes) or severe (large cysts or nodules). Greasy foods and dirt do not cause acne; acne is caused by a build-up of oil, microorganisms and dead skin cells in the hair follicles under the skin. When whiteheads rupture, the "acne cascade" is triggered and surrounding tissue is affected. Keeping your face clean is one way to combat acne. Also, don't squeeze pimples. This can make them much worse and increase the chance of scarring. Often the condition of your skin during puberty will be similar to what your parents experienced when they were teenagers. If your acne concerns you, talk to your parents and/or a health care professional. The condition can be treated. (See Resources, "Myths and Facts about Acne")

Your menstrual period

The most significant change during puberty for many girls is their first period. Menstruation is a turning point in your development from a child to a teenager. Among other things, it means you are capable of becoming pregnant. Your first period can be unexpected, and you might be surprised to find that you have some bleeding from your vagina. Many young women might feel frightened by the sight of this bleeding or embarrassed if it causes a stain on their underwear or clothing. It's important to remember that this is a natural process and something that makes being a woman special. You can avoid any embarrassing situations by talking to your mom or another adult (even some dads know about these things, too!) about being prepared for your period.

Your first period is likely to occur between the ages of nine and 16. It usually lasts for three to seven days and then stops until the next period begins--usually about 21 to 28 days after your period started. This timeframe--from the first day you begin to bleed until the first day of your NEXT menstrual period--is called your "menstrual cycle."

During your menstrual cycle, one of your two ovaries releases one microscopic egg, called an ovum. (Your ovaries are reproductive organs approximately one and a half inches long and located in your lower abdomen, one on each side of your uterus; ovaries also release hormones that help to control your menstrual cycle.) The egg's release from the ovary is called "ovulation," and it usually happens in the middle of your cycle--around day 12 to 14 in a 28-day cycle. Ovulation can be irregular, though, when you first start having your period.

The egg then moves through one of the two fallopian tubes (the two tubes attached to the top of the uterus that lead to the ovaries). At the same time, body tissues and blood cells are beginning to line the walls of your uterus, forming a thin layer of material that will eventually be shed as your period. The amazing thing is, you won't feel any of this happening.

If you were to have sexual intercourse at this time, and sperm from a male partner would fertilize your egg on its way to the uterus, you would become pregnant. The egg would attach itself to the lining of the uterus and a fetus would grow inside of you. However, if sperm does not fertilize the egg, your body does not need this lining to support the fertilized egg. So, hormones trigger a different process and this lining gently falls away from the walls of your uterus and is released from your body through your vagina. This is often called the menstrual flow or period.

What you'll need

To avoid staining your clothes, you will need to use sanitary pads, pantiliners or tampons during your period. Sanitary pads and pantiliners fit inside your underwear and are kept in place with an adhesive strip on the back of the pad. There are a variety of pads with various thickness, lengths and absorbencies available for your use. Don't worry, you will find one that fits your body and absorbs your menstrual flow well. Pantiliners can be used at the beginning or end of your period when your flow is lighter.

Tampons are inserted into the vagina to absorb menstrual flow. Make sure you read the manufacturer's directions for putting a tampon in your vagina correctly. Both pads and tampons should be changed every four to eight hours or more often if needed. The number of days of a period lasts and the amount of menstrual flow is different for every woman. On heavier flow days, it is not uncommon to soak more than six pads or tampons. But if you find yourself needing to change your pad or tampon more often than that, you should talk to your parent, school nurse or health care professional.

It might take a while, perhaps even a year or longer, for your periods to become regular. During the first year, you may have your period as often as every two or three weeks, or as infrequently as every few months. Your periods may be heavy or light and blood flow may change from month to month. Even after your periods become regular, exercise, stress or a change in diet may throw it off track. Don't feel discouraged--over time you will learn more about your body and your menstrual cycle and be better prepared to deal with your period. If you anticipate your period is approaching, you may want to wear a pantiliner for extra protection.

Here are some things you might want to consider keeping with you:

Two pads, liners and/or tampons, depending on your preference, in case your period begins unexpectedly.

A medication, such as ibuprofen, to relieve cramps and perhaps other symptoms. It's important to make sure that you don't have any allergies to ibuprofen before taking it, and you should talk with your parent and/or health care professional about how much you can take for your menstrual discomfort. Check with your school about the rules for carrying medication; you may need to leave your medication with the school nurse.

How you might feel

You may feel uncomfortable for the few days leading up to your period. Your uterus may contract, causing cramps around your pelvic area (below your belly button). You may also feel bloated or "puffy." Breast tenderness and swelling, headaches, moodiness, back and leg aches, acne breakouts and nausea are also common symptoms for many young women before their periods start. These symptoms usually stop or aren't as bad a day or two after your period starts. If any of these or other symptoms are too much for you to deal with, discuss them with a parent and/or your health care professional. Many of these symptoms can be relieved by lifestyle changes, such as changing certain eating habits, exercising and with medications.

If, however, you have any of the following symptoms or if there is a possibility that you may be pregnant, talk with a parent and/or call your health care professional immediately:

severe pain

heavy bleeding (for example, soaking a pad or tampon every hour)

bleeding that lasts more than eight days

bleeding between periods

skipping a period for six months or longer

Premenstrual Syndrome 

Premenstrual syndrome (PMS) is a term used to describe a group of symptoms you may experience seven to 10 days before your period begins. These symptoms go away when your period begins or shortly after. PMS can include emotional symptoms such as crying or crankiness, and physical symptoms such as bloating, breast tenderness or headaches. If you have PMS, you're not alone. While about 75 percent of girls and women who menstruate experience some type of menstrual-cycle discomfort, three to eight percent of them experience symptoms severe enough to disrupt their normal activities--a condition known as premenstrual dysphoric disorder.

Under Resources, see "Premenstrual Syndrome (PMS): Signs and Symptoms")

Premenstrual dysphoric disorder

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS that affects about three to eight percent of girls and women who menstruate. In severe cases, PMDD can interfere with school activities and relationships.

Symptoms include:

Severe mood swings, depression, irritability and anxiety. Do you experience uncontrollable crying spells, anger or depression so intense you can't function? Emotional symptoms are the ones most likely to lead your health care professional to diagnose you with PMDD.

Sleep disturbance. Do you experience insomnia (inability to sleep) or need excessive sleep just before your period?

Difficulty concentrating. Is it impossible or nearly impossible for you to study or pay attention in class?

Breast tenderness and bloating. Do your clothes feel too tight? Do your breasts ache?

If you think you may have PMDD, try lifestyle modifications recommended for PMS and talk to a health care professional. Many of the emotional symptoms appear to be associated with low levels of a brain chemical called serotonin. Medication can increase the amount of serotonin in the brain, thereby minimizing PMDD.

Annual checkups and pelvic exams

Before the onset of puberty, all pre-teens should have an exam, according to the Adolescent Wellness and Reproductive Education Foundation. This visit is an opportunity to discuss your questions and concerns with your health care professional. It is also a time for you to gather printed material on a variety of health issues, including your menstrual cycle, contraception and STIs. A gynecological (pelvic) examination is usually not a part of this visit. You should be tested for STIs if you have had sex, and you should be screened for chlamydia and gonorrhea infections every six to 12 months.

Women should have a pelvic exam when they become sexually active or by the age of 18 if they have never been sexually active. A woman may need to have a pelvic exam before that if she has any health problems with her vagina, uterus or ovaries. And these days, many health care professionals recommend that young women be seen before their first sexual experiences. This way, they can provide young female patients with information about abstinence, contraception and STIs before they become sexually active.

Health care professionals realize that most young women are nervous and/or embarrassed during their first pelvic exams; your health care professional will most likely talk to you about what to expect before the exam. You will probably be asked to undress. If you are asked to undress, don't worry; you will be given a disposable robe or cover-up to wear and only those parts of your body being examined will be exposed. Some young women prefer to have their mothers or another person with whom they feel comfortable accompany them on the first few visits. You can decide whether that person comes into the exam room or not.

A Pap test is part of your annual pelvic exam. It examines the cervix for the presence of any abnormal cells that could be early signs of cancer, or cancer itself. The American Cancer Society recommends you have a Pap test when you become sexually active, but no later than age 18. Until you turn 30, you should have a Pap test every year. Your health care professional may use a traditional Pap test or a liquid-based Pap test. If you're not sure, ask your health care professional what type of Pap test she uses.

If you have three normal tests in a row, you may be able to wait for about three years before having another test. Ask your health care professional when you should schedule your next one.

Here's how a regular Pap test is done:

In an examination room, after you are comfortably lying on an examination table, a health care professional will gently insert a small plastic or metal instrument called a speculum into your vagina and lightly brush cells from your cervix. The cell sample will be placed on a slide and sent to a laboratory where it will be examined under a microscope for abnormalities in the cell structure.

If any abnormalities are found, you may need to have a Pap smear more often than one time per year. Abnormalities could be signs of cervical cancer or viral infections such as human papillomavirus (HPV).

Your annual visit may include a breast exam. If so, your health care professional will examine both of your breasts for any unusual lumps and other abnormalities such as redness, pain or discharge. He or she will do this both by sight and by touch. You may feel embarrassed during this exam. Try to keep in mind, however, these types of examinations are critical for your health and are part of learning to take good care of yourself as you grow older. Your health care professional can also teach you how to do regular breast self-exams so that you can monitor your own body and become aware of any concerning changes.

Remember: the discussions you have with all of your health care professionals are confidential. Some of the topics you may discuss with your health care professional include menstrual problems and general women's health including mental health issues, sexual activity or sexual problems, contraception, preventing and screening for sexually transmitted infections (STIs) and pregnancy. (See under Resources, "What to Ask During Your First Gynecologic Appointment.")

Dating

As if puberty isn't confusing enough, this is also the time most teenagers start dating. School dances and parties are dating opportunities, although most of these activities do not require a date. Rather, some girls choose to go to these events and others like them with another girl or a group of friends. And while some girls are romantically interested in boys, some are romantically interested in girls, and some are romantically interested in both. Sexual orientation is defined by whether you fall in love with, are attracted to, or engage in behaviors with someone of the same sex or someone of the opposite sex. Sometimes, if your sexual orientation is not toward the opposite sex, you may feel sad, worried or even different. Talking to a health care professional about these issues may help you feel better or get you the support that you might need.

If you are asked on a date, ask yourself these questions to help make sure it's something you want to do and that you'll be safe and have fun:

Do you trust the person?

Do you have common friends and/or interests?

Do you feel pressure from this person in any way at all, to become sexually intimate or to do something you feel is wrong?

If this person is someone you decide you would like to spend time with, starting a relationship and friendship could be exciting. This person could become someone special in your life--someone you can trust and depend on. You could be the same to him or her. Through your relationship, you could teach each other about respect, honesty, communication and loyalty.

If you date one person for a while, you might feel pressure to become sexually intimate. Friends will be curious and question you whether you've "done it." Your parents might start talking to you about making the right choices about sex, and your partner may start letting you know that he or she would like to have a more sexually intimate relationship. But just because you have been dating the same person for a while is not a reason to have sex, especially if you're not ready!

Besides the possible physical outcomes--such as getting pregnant or becoming infected with an STI--there are emotional factors connected to sex to consider as well. You could feel regret, anger, shame or guilt afterwards. Most parents, health care professionals and others will advise you to wait until you are an adult to have sex. You'll be far more able to handle the personal and health responsibilities that go along with having sex. Consider these issues before you have sex:

If you don't want to get pregnant, are you prepared to use contraception?

What if you became pregnant? What would you do?

What if you contracted HIV and developed AIDS? Are you ready to deal with a heavy-duty sickness and possibly the end of your life?

What if you contracted another STI and got sick, or and passed it on to another person? How would you feel?

What if you had sex with someone before you were really ready and it turned out to be an unhappy experience?

Can you consider saying "no" to your partner if you're not ready to have sex, and not feel pressured by friends who ask you about your sexual experiences?

Your parents, a health care professional or any adult with whom you can confide can help you to think through these issues before you find yourself in a situation where you might feel pressured to have sex before you're really ready.

Self-Esteem

Self-esteem is the way you think about yourself and what you expect of yourself. The foundation for positive self-esteem is built at an early age and is influenced by relationships between you and your family. Your feelings about yourself will change as you grow. Praise and criticism from parents, friendships at school and attitudes from teachers will continue to affect you from preschool through high school. Persistent criticism, teasing and failures can make you feel worthless. Praise, support and finding something you are good at can help you develop confidence in yourself.

That confidence, or lack of it, may affect decisions made during puberty. All kinds of peer pressure and outside influences can guide you as a teenager and affect your decision making process. The depth of your self-esteem also affects those decisions, whether it's about playing one sport over another, who to hang out with, which electives to take in school or other situations such as smoking, drinking or deciding to have sex. (See under Resources, "Boosting Your Self-Esteem")

Tough Decisions

Are you ready for sex? Deciding when to engage or not engage in sexual relations is one of the most important decisions a person, of any age, can make. Some girls you know may already be sexually active. About 53 percent of all teenage school girls are not having sex, according to a 2002 study by the U.S. Centers for Disease Control and Prevention (CDC). It is a decision that could affect the rest of your life. Take it seriously and know the risks, from getting pregnant to becoming infected with a sexually transmitted disease, not to mention other emotional and physical risks that can come into play when teenagers have sex.

If you are sexually active, the best way to prevent getting a STI is by using a latex condom. This is true for oral, vaginal and anal sex. Lesbian couples who practice oral sex can use a dental dam to prevent getting an STI. The use of latex condoms during vaginal sex also prevents pregnancy. You can also use additional forms of birth control to prevent getting pregnant. These other types of birth control are called "contraception." No method, however, is 100 percent safe. The only foolproof way to keep from getting pregnant or avoiding getting an STI is not to have sex.

Sexually Transmitted Infections (STI)

STIs are spread by sexual intercourse or genital contact. You can contract an STI from having oral, vaginal and/or anal sex with an infected partner. Almost four million cases of sexually transmitted infections occur among teenagers every year, according to the CDC.

You may have heard about some STIs, such as HIV/AIDS, chlamydia, gonorrhea and herpes. But there are many other STIs to know about, so read on.

You are most likely to get an STI during your teen and young adult years--more than two-thirds of all STIs occur in people younger than 25. Because STIs often cause no symptoms (especially in girls and women), health care professionals recommend that sexually active girls and women routinely be tested or screened for STIs. If you are too embarrassed to talk to your health care professional, discuss the issue with a school nurse or call your local health department, Planned Parenthood or the U.S. Centers for Disease Control and Prevention's STI hotline. There are many places in your local area where you can get free and confidential STI counseling and testing. (See list of hotline numbers at this Web site)

Treating some STIs is a snap--you simply have to take antibiotics. But the health consequences of an untreated STI can be severe. Unfortunately, the most common STIs, human papillomavirus (HPV) and herpes, are viral diseases that can't be cured. Lack of treatment may result in more consequences, including permanent damage to your reproductive organs, which could make getting pregnant when you are older difficult. Some STIs can also cause problems during pregnancy or delivery. (See under Resources, "STI Symptom Checklist")

The more common STIs are listed below:

HIV/AIDS

human papillomavirus (HPV)

herpes

chlamydia

gonorrhea

trichomoniasis 

hepatitis B 

syphilis

Having unprotected sex and/or multiple sex partners places you at higher risk for STIs. Many STIs have no symptoms when you are first infected, so you may have an infection without knowing it. If you are sexually active, be sure to have regular check-ups that include STI screenings; that way if you have an infection, it can be detected and treated (if possible) at its earliest stages.

More than half of teens who are sexually active say they used a condom the first time they had sex, according to a 2002 CDC survey. However, only about one quarter of teens say they regularly use a condom.

When used correctly, male latex condoms and female condoms used during sexual intercourse can help reduce your risk of getting many STIs, including HIV (the virus that causes AIDS); male and female latex condoms don't prevent all STIs transmitted by skin-to-skin contact, however.

And for HPV, now there is something you can use to protect yourself against HPV/cervical cancer in addition to regular pap tests and safe sex: An HPV vaccine. The FDA recently approved the vaccine--called Gardasil--for women ages 13 to 26 after clinical trials showed the vaccine is safe and 100 percent effective in preventing HPV strains 16 and 18, which cause 70 percent of cervical cancers. Gardasil, given in three injections over six months, is also 99 percent effective in preventing HPV strains 6 and 11, which cause about 90 percent of genital wart cases. Although Gardasil prevents the bulk of HPV strains, it doesn't protect against all of them, so the FDA recommends it as a complement to pap tests. Furthermore, the vaccine does not work if you are already infected with one of these HPV types. It has to be given before infection. Talk to your health care professional about Gardasil if you are sexually active or considering having sex.

You may feel awkward and embarrassed to ask questions about sex, but if you are sexually active or even considering having sex, not knowing about how to prevent STIs and pregnancy is dangerous. That lack of knowledge can harm you. Get the facts from someone who knows, whether it's a parent, brother or sister, health care professional or teacher.

Mental Health

Overall health means more than simply being in shape and eating properly. Mental health, which includes your thoughts and feelings, is just as important as physical health.

During your teenage years, various things may make you sad or get you down. For example, if someone makes fun of your clothes or if you don't do well on a test for which you thought you were prepared. But if you are constantly feeling down or upset about something, you could be depressed. Depression is a mental illness, but it is treatable once it is accurately diagnosed. Many teenagers experience depression.

Take the following quiz:

Do you cry more now than you used to?

Do you think your life is hopeless or meaningless?

Do you have a hard time sleeping, either sleeping too much or falling asleep at night?

Do you spend more time alone than you used to?

Do you ever think of hurting yourself?

Do you often feel worn out?

Have you felt unusually irritable lately?

Have you gained or lost weight in the last month or two?

How is your appetite? Are you overeating or undereating?

If you answered "yes" to several of these questions, talk to someone about getting help and feeling better. This person could be a teacher, a coach, your parent, an older sibling or someone else you trust, but TALK WITH SOMEONE. Take a few minutes to make a list of people who you can call.

Depression, if untreated, may cause you to feel like hurting or killing yourself. Suicidal feelings are a very real problem that should be taken seriously. According to the American Academy of Pediatrics, suicide is the fourth leading cause of death for adolescents between 10 and 14 years of age and the third leading cause of death for those 15 to 24 years old. A 2003 CDC Youth Behavior Risk survey showed 21.3 percent of girls and 12.8 percent of boys had thought about committing suicide and nearly nine percent had tried. If you are thinking about suicide, talk to someone--there are lots of ways to help teens feel better when they are depressed and/or suicidal.

The following is a list of behaviors that a person who is suicidal might show:

Has the person become withdrawn from friends and/or family or undergone a dramatic personality change?

Does the person have trouble concentrating or always seem bored?

Does the person often act rebellious?

Is the person having a hard time coping with a major life event such as divorce of parents, death of a sibling or being pregnant?

Is the person abusing drugs or alcohol or both?

Is the person giving away prized personal possessions?

Does the person write poems or notes about death?

Does the person talk or even joke about suicide?

If this person is you, your friend or family member, reach out for help and do not keep quiet. Suicide is preventable, but you must act quickly. If you are an adolescent yourself, it is important to involve an adult first. Consider these steps:

Get help from a professional immediately. Don't wait or hesitate. Call this suicide crisis hotline number (toll-free nationwide): 1-800-SUICIDE (1-800-784-2433) for guidance or 911 to speak with your local emergency services.

Ask the person directly if they are thinking of committing suicide. Sometimes just saying the word helps the person feel like they are understood and their cries for help have been heard. Actions or talk of suicide are cries for help. Most teenagers are looking for acceptance, understanding, attention and love.

Reassure the person that you care about him or her and want to help. Never agree to keep their thoughts about suicide a secret. If another person shares with you that he or she wants to die or kill himself or herself, tell an adult.

Get rid of or lock up all guns, pills and medications of every kind, sharp tools including saws, knives, razors and scissors and remove all ropes and belts.

Eating Disorders

These days, many teenage girls express dissatisfaction with their bodies. According to the National Eating Disorders Association (NEDA), 40 percent of newly identified cases of anorexia are in girls ages 15-19, and over one half of teenage girls use unhealthy weight control behaviors, such as skipping meals, fasting, smoking cigarettes, taking laxatives, and vomiting. And the obsession with weight starts early--the NEDA reports that 42 percent of 1st to 3rd grade girls want to be thinner, and 82 percent of 10-year-olds are afraid of getting fat. Many teenage girls strive to look like fashion models, but the NEDA reports that most fashion models are thinner than 98 percent of the population.

This preoccupation with appearance and weight can become extreme and develop into an eating disorder. An eating disorder is a serious mental illness during which a person takes drastic measures to control her or his weight. Although the popular press paints eating disorders as affecting only girls, they can also affect boys, with the same devastating consequences.

Bulimia is a disorder in which a person eats larger amount of food than she or he normally would in an uncontrolled manner, and then does something such as force herself or himself to vomit, use laxatives, or exercise excessively, to prevent weight gain. This is often referred to as "bingeing and purging." A person with bulimia is typically of average weight or overweight. This illness can be very dangerous, especially if the teen forces vomiting regularly--this can disrupt normal blood chemistry and can cause problems with vital organs such as the heart.

Anorexia nervosa is another eating disorder. A young person with anorexia nervosa has a distorted body image and sees herself or himself differently than the rest of the world does (often a much larger size than they really are), and has an intense fear of gaining weight. This person usually diets severely and loses a large amount of weight, and often denies that there is a problem, or that she or he is too thin. Females with anorexia who lose a significant amount of weight often stop menstruating.

Other eating disorders include binge eating disorder (bingeing without purging), which contributes to an estimated 30 percent of cases of obesity in adult women. Additionally, obesity is affecting young people at alarmingly increasing rates and, along with smoking, is a leading contributor to serious health problems such as heart disease and diabetes among adults.

Again, like many of the other topics discussed in this article, if you or anyone you know has either condition, seek help from your health care professional. (See under Resources, "How to Tell If You or a Friend May Have an Eating Disorder")

Taking Risks

During your teenage years, some risks are good, like trying new activities or sports. Going away to camp or to school in a different place from where your family lives can be exciting; it's an adventure. Usually those risks pay off. You may make new friends, develop new talents, expand your interests and increase your self-confidence. You become more independent with every challenge you successfully tackle.

However, some risk-taking behaviors such as drinking alcohol, smoking, using drugs, driving too fast or using a weapon, usually have negative effects. Luckily, according to a survey by the U.S. Centers for Disease Control and Prevention (CDC), some risk-taking behaviors among teenagers have declined since 1993. Injury-related behaviors, such as carrying and using a weapon or being involved in a physical fight, have decreased. But the number of teenagers abusing drugs, alcohol and cigarettes and other tobacco products is still high. Although the number of teens who currently smoke has gradually declined since the mid 1990s, more than four and a half million teens are smokers, according to the American Lung Association. (See under Resources, "How to Tell If You're Addicted to Smoking")

To find more information about smoking and how to stop, contact:

Campaign for Tobacco-Free Kids

1400 Eye Street, Suite 1200

Washington DC 20005

Phone: [phone]

Fax: [phone]

www.tobaccofreekids.org

Substance Abuse

Many people first try alcohol during their teenage years. The CDC reports that Monitoring the Future, an ongoing study of American youth, found that more than 40 percent of eighth graders have tried alcohol and more than 75 percent of 12th graders have. Alcohol is the number one drug problem among adolescents even though it is illegal for persons under 21 to purchase or drink it. Alcohol is associated with all the leading causes of death among teenagers, including traffic accidents, homicides and suicides, and may be a factor in unprotected sex resulting in unplanned pregnancies, sexually transmitted infections and AIDS. In addition, many young people also die from alcohol poisoning. (See the Resources, "Alcohol Poisoning" section for symptoms of alcohol poisoning.)

Binge drinking (consumption of five or more drinks on a single occasion within the past two weeks) is a major problem on our college campuses. Binge drinking causes most of the alcohol-associated harm occurring on campuses and in students' lives. A major, eight-year study (the 2001 Harvard School of Public Health College Alcohol Study) involving the drinking habits of thousands of college students recently reported their findings in the Journal of American College Health. Results of the study revealed that, in 2001, approximately two in five (44.4 percent) college students engaged in binge drinking, a rate almost identical to rates reported in the previous eight years. Among the underage students, half of those surveyed reported obtaining alcohol easily from other students as their primary source. Since 1993, the use of fake identification cards to obtain alcohol illegally has declined. In addition, a sharp rise (from 5.3 percent in 1993 to 11.9 percent in 2001) in frequent binge drinking was noted among women attending all-women's colleges, and a lesser, but still significant, increase of the same behavior was reported for women in coeducational schools.

Problem Drinking

Although it is illegal to drink if you're under 21, many teens do it anyway, and some do so in excess. The following are warning signs of a problem with alcohol:

Getting drunk on a regular basis

Getting drunk even when striving not to

Lying about drinking

Believing that alcohol is necessary to have fun

Drinking because of problems or to relax

Drinking because of anger

Drinking alone

Trying to stop drinking and failing

Having frequent hangovers

Feeling run-down, depressed or even suicidal

Having "blackouts" --forgetting what you did while drinking

Having problems at school or work, or getting in trouble with the law

Drinking in the morning

Gulping drinks

Thinking it's cool to be able to hold your liquor

Drinking then driving

Going to school intoxicated

Alcoholics Anonymous (AA) and other agencies offer support groups nationwide designed especially for teens with drinking problems. At AA, help from peers with similar problems is available on a confidential, free basis. Look in the phone book under Alcoholics Anonymous for chapters in your area, or visit the organization on the Web at www.aa.org. You can also talk to your health care professional confidentially about accessing professional mental health services to deal with a drinking problem.

Other Drug Use

In 2003, an estimated 32 percent of all high school students had used marijuana, the most commonly used illicit drug. About 15 percent reported using it in the previous month.

Recent data from the National Institute on Drug Abuse shows that drug use among teens has declined over the past two years. Use of the popular drug Ecstasy declined by half, cigarette smoking by 18 percent, marijuana use by 11 percent, and alcohol consumption by seven percent. But, there has been a recent increase in the abuse of certain prescription drugs and inhalants, and the abuse of over-the-counter remedies remains a concern.

Ask for Support

No matter how good your intentions may be, you may at some time find yourself in a situation where you need the support of your parents or a trusted adult. It's important to open the doors of communication with your parents before you ever find yourself in dangerous situation. Ask your parents or a reliable trusted adult for a "no-questions-asked" or a "free-ride" policy, meaning, if you find yourself in a difficult situation, you can call your parents and get a free ride with no questions asked until the next day. That way your parents can trust you to use your best judgment in strange and difficult situations, and you can be comfortable knowing that if you make a mistake, you won't be ridiculed by your parents for it.

The process of putting down thoughts on paper can clarify expectations on both sides. An organization called Students Against Destructive Decisions (SADD; Web site is www.saddonline.com) promotes its Contract For Life for just this purpose. You can use this as the basis of your own agreement. (See "Contract For Life -- A Foundation for Trust and Caring," a contract for teens and their parents to sign)

Other Types of Abuse

When the word "abuse" is used in conjunction with teenagers, drug or alcohol abuse is often what comes to mind. But there are several kinds of abuse, many of which do not involve a decision made by the adolescent. There is also physical, sexual, verbal and psychological or emotional abuse.

Physical abuse is hitting, slapping, beating, cutting, burning or some other type of physically harmful assault.

Sexual abuse is unwanted or coercive sexual contact; it also can involve someone being forced to watch sex acts or to look at or take part in pornography.

Psychological or emotional abuse is regular or persistent threats, screaming, humiliation or emotional mistreatment. Bullying is a form of psychological abuse.

Neglect, such as a parent not providing adequate food, clothing and shelter, or exposing a child to environments where unsafe behaviors occur, is also abusive.

Anyone--rich or poor--can be a victim of abuse. And the abuse can come from many sources--a parent, an older sibling, a teacher, coach or school administrator, a boyfriend or girlfriend, a neighbor, a peer, a boss or anyone. If you or someone you know is a victim of abuse, call the National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453) for help.

RESOURCES

Below you will find links to checklists and how-to articles; a list of teen crisis hotlines; and contact information for organizations that provide information about Teen Health.

Checklists and Other "How-To" articles:

Checklist for Choosing a Bra

When your breasts begin to jiggle, feel sensitive when you run or feel heavy, it's time for you to consider a bra. The best advice for choosing a bra is to get one that fits and is made of comfortable fabric. A bra is right next to your skin all day long, so if it's a little scratchy or tight when you try it on in the store, it will drive you crazy by the end of the school day.

To determine your bra size, use a tape measure to measure around your chest just under your breasts. If the number is even, add four inches to get your chest size. If you measure 28, for example, add four and look for bras in size 32. If the number you measure is odd, add five to get your size. So if you're 29 inches, you'll look for bras in size 34. Bras typically come in chest sizes ranging from 28 to 44, with larger sizes available at specialty stores and through catalogs.

Next you need to determine your cup size, or the size of your breasts. Cup sizes range from AAA (very small breasts) to EE (very large breasts). Measure around your chest, this time lining up the tape with your nipples. If the measurement is the same as the first one you took, your cup size is AA or AAA. If it's one inch larger, your size is A; two inches larger, size B; three inches, size C; four inches, D; five or more, DD or EE.

The measurements will give you some guidance, but in the real world bras marked the same size vary considerably, so you may have to try on several sizes and styles to determine which is best; the fit should be smooth and not too tight. Do not buy a bra that puckers or squeezes your breasts, leaving bulges of flesh poking out around the sides. A saleswoman can help you find a bra that fits.

Shaving: Dos and Don'ts

Do shave in the direction of hair growth.

Do change the blade or switch to a new razor often. A dull razor can cut or cause a rash.

Do be careful when shaving hair in sensitive areas such as the bikini line--shaving without proper lubrication or with a dull razor can cause a rash.

Do not shave facial hair; shaving your face will leave stubble and can make hair grow back dark and thick.

Do shave at the end of the day when your skin is less puffy.

Do use water and shaving cream will also help you get a close shave without nicks.

Other options

(always talk to an adult before trying a new hair-removal option):

Tweezing is an option for isolated hairs. But keep in mind that tweezing can harm hair follicles and make hairs even more stubborn.

Waxing is a longer-term, somewhat painful option for removal of hair across wide areas, such as legs or hair around the bikini line. Some people have their underarm hair or facial hair waxed. The procedure can leave skin temporarily red and irritated, however.

Chemical hair removers, such as Nair, are also effective for large areas of the body, but they can leave a rash. Be sure to follow label instructions and use a product made for the area you plan to use it on. Remember to apply a moisturizer to reduce irritation.

Electrolysis uses electricity to destroy the hair follicle and prevent hair from regrowing. The technique, which can be painful, is used primarily for facial hair.

Laser hair removal, effective for fair-skinned individuals with dark, coarse hair, is an increasingly popular, expensive option. It is less painful than electrolysis and may offer permanent hair removal.

Myths and Facts about Acne:

MYTH:

Chocolate and oily foods cause acne.

FACT:

There is no evidence that these foods cause acne. But you should avoid overindulging in chocolate and oily foods because they are typically high in calories and saturated fats and don't provide much nutrition.

MYTH:

Repeated face washing will get rid of acne.

FACT:

If you have oily skin and/or acne, you should wash your face no more than two times a day. Over-washing can dry out the skin, prompting the oil glands to work harder.

What you can do about acne:

Wash your face in the morning and at night, and after you work out. You may want to try a cosmetic face mask (usually a combination of moisturizers and other products that help remove dead and dry skin) once a week or a daily benzoyl peroxide product. Benzoyl peroxide comes in strengths ranging from 2.5 percent to 10 percent. You should start out with a low strength once a day and use a stronger product if needed.

Keep your hair off your face and don't squeeze or pick at your pimples. Wash your hands before touching your face.

Experiment with makeup products; ask a parent, friend or sales clerk for help choosing the right product and guidance in putting it on. Some makeup products are oil free and may be a better choice if you have acne. While makeup usually can't make a pimple invisible, it can minimize the blemish and give your skin a smoother overall tone.

Breakouts are loosely associated with stress, so take note of what's going on when your skin erupts. You may find your acne is associated with your period, a challenging test at school or other stress. If you see such a pattern, you may be able to lessen the problem through stress reduction techniques, such as yoga, breathing exercises or just doing something fun.

Talk to your health care professional or dermatologist if your acne seems worse than average or if it's especially bothersome to you. A variety of prescription treatments are available to combat acne.

Premenstrual Syndrome (PMS): Signs and Symptoms

Here is a checklist of possible signs and symptoms of PMS:

Bloating and weight gain. Do your jeans feel tighter as your period approaches?

Tension, anxiety or crying spells. Do you find yourself overreacting to stress or setbacks? Do you have a "short fuse" just before your period?

Depression. Do you feel sad for no reason? Feeling sad or blue for a day or two can be normal, but feeling down for a longer period of time may be one symptom of clinical depression, a serious, but common mental health condition experienced by many teens, as well as adults. Depression causes other symptoms, too, such as feeling tired or sleeping all of the time, or not being able to sleep at all; overeating or not eating enough; feeling no joy in activities you used to enjoy a lot. Usually, when a person is depressed, she may experience several of these or related symptoms. If you are experiencing any one or more of these symptoms, don't wait or hesitate to speak with your parents and/or a health care professional.

Breast tenderness. Do your breasts hurt when touched? Does your bra feel uncomfortably tight?

Food cravings. Do you need chocolate, potato chips or other foods (particularly salty or sweet foods)?

Joint or muscle pain. Do you wake up feeling achy even though you haven't strained anything?

Nausea or vomiting. Does your stomach feel upset, even though you're not eating anything unusual?

Headache. Do you have a pattern of headaches in the premenstrual period?

Trouble with concentration. Is it harder to study or pay attention in class?

Fatigue. Do you feel tired early in the day? Do you feel exhausted when you get home?

Things you can do to avoid or relieve PMS symptoms:

Eat right.

It may take a couple of months for some effects to kick in, but you'll be surprised at the difference the following steps may make:

Eat more frequently, but make your portions smaller.

Consume 1,200 milligrams a day of calcium, whether through diet or a supplement. (Talk to a health care professional or your parents to make sure you don't take too much.)

Consume 200 milligrams per day of magnesium, whether through diet or a supplement. (Talk to a health care professional or your parents to make sure you don't take too much.)

Consume 200 milligrams per day of magnesium, whether through diet or a supplement. (Talk to a health care professional or your parents to make sure you don't take too much.)

Eat a lot of fruits, vegetables and whole grains.

Cut back on salt, salty foods and refined sugar, especially during the seven to 10 days before your period begins.

Cut out the caffeine, which can worsen irritability and breast tenderness.

Drink low-fat milk, eat low-fat yogurt, cheese and other calcium rich foods.

Many researchers find that the standard Food Pyramid originally designed by the U.S. Department of Agriculture (USDA) falls short of being realistic and healthy for many people for a variety of reasons. The USDA revised the Food Pyramid most recently in April 2005 and some modifications have been made. Be sure to talk to your health care professional about what dietary approach would work best for you and your lifestyle.

Exercise.

You need to get aerobic exercise for at least 30 minutes most days a week in order to boost your health and well-being. (A brisk walk, a short run or a bike ride are examples of aerobic exercises.) Exercise can reduce feelings of fatigue, depression and moodiness.

Lower your stress levels.

First, be sure to get adequate sleep. Most teens do not get the eight to nine hours or more of sleep they need to feel their best. You'll be surprised by how many symptoms you can reduce when you get enough sleep.

Second, no matter how busy you are with school, after-school activities or a job, be sure to take time to do something fun for yourself--see a movie, hang out with friends or read a book.

A third strategy many teens find helpful is relaxation. Muscle relaxation or deep-breathing exercises can reduce anxiety and improve sleep. Try breathing deeply, using your lower abdomen, not your chest. Hold a deep lungful of air for five seconds, and then release it slowly. Repeat several times.

Yoga and meditation are popular (and effective) ways to relax, de-stress or just find a quiet place to be alone. There are several different approaches to both of these disciplines. Check one out to see if might work for you--consider going with a friend to a community center or gym that offers yoga and meditation and making it a regular practice.

Record your symptoms.

Keep a notebook of your symptoms--what they are, when they occur and for how long, when they go away and any factors you think make them worse or better. What you learn from your record keeping, such as a pattern to your symptoms and things that relieve them, may help you manage your symptoms, or will give your health care professional some clues about effective treatments.

Talk to your health care professional.

If do-it-yourself strategies aren't working, describe your symptoms to your health care professional or a school nurse or pharmacist. If symptoms are severe or interfere with your ability to do schoolwork or the activities you want to do, you need to take action. There are treatments that can make a dramatic difference in PMS symptoms: antidepressants, birth control pills or injections (these products minimize hormone fluctuations) and pain medications such as ibuprofen (e.g., Advil) or naproxen sodium (e.g., Aleve), which can reduce cramping and breast pain.

What to Ask During Your First Reproductive Health Appointment

It's normal to be a bit nervous about your first appointment with an obstetrician-gynecologist or other health care professional who will discuss reproductive health issues with you. This appointment also will likely include an internal pelvic exam. To get the most out of your appointment, make a list of questions that address any concerns you have about your periods, sexually transmitted infections, breast health (including soreness) and birth control.

What can I do to be more comfortable during this exam?

How long will the exam take?

How will my privacy be protected? Will you share information about this exam with my parents?

What tests should I take based on my health and sexual history?

Am I developing normally? Is there anything I should be concerned about?

I feel fine, but could I still have a sexually transmitted disease or vaginal infection? What tests can you do to find out?

What can I do about my PMS symptoms? Would birth control pills or an antidepressant help?

What are my birth control options? How do I decide which is best for me?

How can I tell my parents about my decision to use birth control?

If I have sex and then want emergency contraception, what should I do? Can I get a prescription now?

How can I tell my parents about my prescription to clear up an infection?

What are some precautions I should take to protect myself from STIs and unwanted pregnancy?

What should I do if I think I'm pregnant?

What are some things I should be doing to improve my health?

Boosting Your Self-Esteem

As your body changes, you may feel unattractive, awkward or even ugly. But believe it or not, you can change the way you feel about yourself--and the way other people perceive you--just by changing the way you think. First of all, if you are worried that your weight, height or anything else is unhealthy, talk to your health care professional. If everything is okay physically, you can begin dealing with the image problem.

First of all, accept the fact that there are many things that make you a unique person--your eye color, skin shade, height, facial shape--that cannot be changed. And note, as you watch television and movies, or people, that attractive people come in all colors, shapes and sizes, and that many girls and women who are not supermodels are, in fact, loved and adored for who they are.

If you do want to make a change, such as losing weight, don't set unrealistic goals ("I want to be a size five," or "I want to lose 50 pounds in three months"). Instead, set realistic goals you know you can achieve, such as exercising for at least 30 minutes most days of the week and eating healthfully. The pounds will come off and you'll enjoy a feeling of success each time you meet your goal. Consider talking with your health care professional for more information about healthy weight loss.

Next, the most important thing: When your inner voice starts putting you down, counter those comments with positive or neutral ones.

Replace "I'm fat" with "I exercise and eat right."

Replace "I bombed that test; I'm just stupid" with "I'm smart and I can do better. I'll ask for help if I don't understand something next time."

At the end of the day, think about three things that were good about the day. Maybe you heard an old favorite song on the radio, polished off a good book under the shade or knew the right answer in class. It's a rare day that doesn't supply us with something that makes us happy--the hard part is being aware of that something.

STI Symptom Checklist:

Burning sensation when urinating.

Vaginal discharge. OOccasional discharge--clear or white, thin, with no smell--is normal, but you may have an STI or vaginal infection if you experience discharge that doesn't seem normal for your body--for example, large amounts of discharge, an unusual color--yellow, yellowish-green, or bloody; has an unusual odor; or is persistent.

Pain or discomfort during sex

An unusual, "fishy" vaginal odor after sex

Vaginal irritation, soreness or itching

Pain in your lower abdomen (the area below your belly button where you may feel menstrual cramps)

Warts, lesions or bumps in or around the vagina, vulva, anus or on the thigh

Bleeding during sex or between periods or increased menstrual cramping

A skin rash

Note: Girls and women frequently do not experience symptoms from STIs. If you are sexually active, you should talk to a health care professional about being screened (call your local health department or Planned Parenthood, if you are uncomfortable with your regular health care professional). If a sexual partner has any symptoms, get tested immediately. For boys and men, the most frequent symptoms of STIs are penile irritation or pain, pus or discharge from the penis, or sores or warts on the penis. Men with STIs only occasionally experience pain or burning sensation when urinating.

How to Tell If You or a Friend May Have an Eating Disorder

Teenage girls and college-age women--and increasingly teenage boys and young men--are especially prone to developing eating disorders, mental illnesses characterized by a dangerous obsession with losing weight or staying thin. Teens with eating disorders may starve themselves (anorexia nervosa), or they may binge on food and then throw up or exercise excessively or take laxatives to purge themselves of the food (bulimia). How can you tell if a diet has progressed to something dangerous?

Anorexia nervosa

Teens with anorexia nervosa starve themselves because they have a distorted body image and believe that they are overweight even when they aren't. They have an irrational fear of becoming fat and are obsessed with food and weight control.

These behaviors and emotional symptoms suggest anorexia nervosa:

Loss of a significant amount of weight

Continuing to diet and "feeling fat" even after reaching a goal weight, or becoming visibly thin

Irrational fear of gaining weight

Obsession with food, calories, fat content and nutrition

Weighing oneself once a day or more

Refusal to discuss a diet with others

Cooking for others but not eating

Compulsive exercising

Lying about eating

Hyperactivity

Depression and anxiety

Eating large amounts of food and getting rid of it by throwing up, fasting, taking laxatives or exercising excessively. This is called bingeing and purging.

Physical symptoms:

Hair loss

Loss of monthly menstrual period

Cold hands and feet

Weakness and exhaustion

Trouble concentrating

Constipation

Growth of body hair on arms, legs and other body parts

Irregular heartbeats

Dry skin and brittle nails

Bulimia nervosa 

Bulimia nervosa is characterized by binge eating--the frequent consumption of large amounts of food in a short period of time. A person with bulimia often feels ashamed and/or guilty after binging and as a result "purges" by making himself or herself vomit, using laxatives or other medication to control weight, exercising excessively or fasting. A person with bulimia usually has a normal or a somewhat above normal weight.

Behaviors and emotional symptoms:

Binge eating, or eating uncontrollably and/or secretively

Purging by dieting, fasting, exercise, vomiting or using laxatives or diuretics

Using the bathroom frequently after meals

Obsession with weight

Depression

Mood swings

Feelings of being out of control

Other symptoms

Swollen glands in the neck and face

Heartburn

Bloating

Irregular periods 

Dental problems

Constipation

Indigestion 

Sore throat 

Vomiting blood

Weakness and exhaustion

Bloodshot eyes

Binge eating

People with binge eating disorders also compulsively overeat. However, they do not regularly purge and are often overweight. Some people may overeat throughout the day rather than sporadic binging.

Behaviors and symptoms:

Binge eating episodes

Eating when not hungry

Frequent dieting

Uncontrollable eating

Awareness that eating patterns aren't normal

Feelings of shame, depression or antisocial behavior

Obesity

Weight fluctuations

How To Tell if You're Addicted to Smoking

You have no intention of becoming a "smoker;" it's just for fun, right? Well, you'd be surprised at how an addiction to nicotine, the ingredient in cigarettes that gives a stimulating effect, can creep up on you. Ask yourself these questions: :

Do you smoke every day, or almost every day?

If you don't smoke for a day, do you feel a craving for a cigarette?

Did you start out by smoking with your friends, but now smoke alone?

Are you gradually smoking more and more cigarettes?

Are you spending more money than you'd like on cigarettes?

Do you ever feel like you "need" a cigarette?

Do you feel anxious if you run out of cigarettes?

Have you tried to quit smoking and failed?

Do you ever find yourself lighting up a cigarette almost unconsciously, without really thinking about it?

Have you ever been surprised at how fast you went through a pack of cigarettes?

Do you need to have a cigarette first thing in the morning?

If you answered yes to any of these questions, you are may already be addicted to nicotine. Talk to a health care professional about strategies for quitting. But whether you're addicted or not, you should try to quit. There are multiple health problems associated with regular tobacco use including stained yellow teeth and bad breath, breathing difficulties and the increased risk of developing lung cancer. There are dozens of online programs designed especially for teens who want to quit.

Alcohol Poisoning

Below is a list of critical signs for alcohol poisoning. If you notice any of the following symptoms in a friend after he or she has consumed alcohol, get help immediately.

Person seems to be acting strangely or seems unusually sleepy and you can't wake him or her up

Vomiting while sleeping

Seizures

Slow breathing

Irregular breathing

Hypothermia (low body temperature), bluish skin color or paleness

What to do if you suspect that someone may have ingested a fatal dose of alcohol:

Call 911 or the emergency number IMMEDIATELY.

Tell emergency medical technicians the symptoms and, if you know, how much alcohol the victim drank. Prompt action may save the life of a friend, or your own.

Stay with the person.

Keep the person from choking on vomit.

STUDENTS AGAINST DESTRUCTIVE DECISIONS (SADD) CONTRACT FOR LIFE: A Foundation for Trust and Caring

This contract is designed to facilitate communication between young people and their parents about potentially destructive decisions related to alcohol, drugs, peer pressure and behavior. The issues facing young people today are often too difficult to address alone. SADD believes effective parent child communication is critically important in helping young adults make healthy decisions.

Young Person:

I recognize there are many potentially destructive decisions I face every day and commit to you that I will do everything in my power to avoid making decisions that will jeopardize my health, my safety and overall well being, or your trust in me. I understand the dangers associated with the use of alcohol and drugs and the destructive behaviors often associated with impairment. By signing below, I pledge my best effort to remain alcohol- and drug-free, I agree I will never drive under the influence of either, or accept a ride from someone who is impaired, and I will always wear a seat belt. Finally, I agree to call you if I am ever in a situation that threatens my safety and to communicate with you regularly about issues of importance to us both.

________________________________ Young Person

Parent (or Caring Adult):

I am committed to you, and to your health and safety. By signing below, I pledge to do everything in my power to understand and communicate with you about the many difficult and potentially destructive decisions you face. Further, I agree to provide for you safe, sober transportation home if you are ever in a situation that threatens your safety and to defer discussion about that situation until a time when we can both discuss the issues in a calm and caring manner. I also pledge to you that I will not drive under the influence of alcohol or drugs, I will always seek safe, sober transportation home, and I will always remember to wear a seatbelt.

________________________________ Parent/Caring Adult

Hotlines

When you have a problem too big to handle and you don't feel comfortable sharing with adults you know, you can call on outside help. These agencies provide free information and confidential, caring support over the phone with no long-distance charges. When you need a lifeline, these are the people to call.

U.S. Centers for Disease Control and Prevention

National STI Hotline

1-800-232-4636 (toll-free)

1-800-243-7889 (TTY/TDD STI/AIDS hotline for the hearing impaired; toll-free)

A major government organization whose mission is promoting health and preventing disease. Provides a wide range of health-related information at its Web site, including STI information.

Covenant House Nineline

1-800-999-9999

1-800-999-9915 (TTY/TDD for the hearing impaired)

Provides help for teens in crisis.

Planned Parenthood

1-877-4ME-2ASK (toll-free)

www.teenwire.org

Provides health care through a nationwide network of clinics, as well as offers health information on many reproductive health issues, such as teen sexuality, contraceptive options and STI symptoms and prevention; links to clinics are listed.

SAVE

Suicide Awareness Voices of Education

1-800-273-TALK (1-800-273-8255; toll-free)

www.save.org

Web site has information about suicide prevention, depression and coping with suicidal threats or actions from loved ones.

National Mental Health Association

Mental Health Resource Center: 1-800-969-NMHA (1-800-969-6642; toll-free)

Crisis Hotline: 1-800-SUICIDE (toll-free)

TTY Line: 1-800-433-5959 (toll-free)

www.nmha.org

Provides referrals and information on depression and suicide. Web site provides general information on many types of mental disorders.

Depression-Screening.org

1-800-969-NMHA (toll-free)

www.depression-screening.org

Provides information on depression and local screening sites.

American Psychiatric Association

1-888-35-PSYCH (toll-free)

www.psych.org

Provides information on depression and other mental disorders and referrals to local psychiatrists.

National Clearinghouse for Alcohol and Drug Information

1-800-729-6686 (toll-free)

www.health.org

Offers information about alcohol abuse and prevention.

Organizations to contact for useful information about Teen Health:

American Academy of Pediatrics

141 Northwest Point Boulevard

Elk Grove Village, IL 60007-1098

847-434-4000

www.aap.org

Planned Parenthood Federation of America

1780 Massachusetts Ave, NW

Washington, DC 20036

1-800-230-PLAN (toll-free)

www.plannedparenthood.org

Students Against Destructive Decisions (SADD)

255 Main St.

Marlborough, MA 01752

1-877-SADD-INC (toll-free)

www.sadd.com

Consumer Healthcare Products Association

900 19th Street, NW, Suite 700

Washington, DC, 20006

202-429-9260

www.chpa-info.org

Drug Free America Foundation, Inc.

2600 9th St. N, Suite 200

St. Petersburg, FL 33704-2744

727-828-0211

www.dfaf.org

National Institute on Drug Abuse

6001 Executive Boulevard, Room 5213

Bethesda, MD 20892-9561

301-443-1124

www.nida.nih.gov

Campaign for Tobacco-Free Kids

1400 Eye Street, Suite 1200

Washington, DC 20005

202-296-5469

www.tobaccofreekids.org

JoinTogether (to advance effective alcohol and drug policy, prevention, and treatment).org

Boston University

School of Public Health

One Appleton St., 4th floor

Boston, MA 02116-5223

617-437-1500

www.jointogether.org

The Partnership for a Drug-Free America

405 Lexington Avenue, Suite 1601

NY, NY 10174

212-922-1560

www.drugfree.org

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