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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 feeling 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, (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 check with your parents first. (See under 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, 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. Acne 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 feel 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 time frame--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 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 become your period. The amazing thing about it is, you won't feel any of this happening.

If you were to have sexual intercourse at this time, and sperm from a penis fertilizes 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 lining is the fluid and blood your body discharges during your menstrual period, this is often called the menstrual flow or period.

What you'll need

To avoid bleeding on 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. Both he number of days of your period and the amount of menstrual flow is different for every woman. On a heavier flow day it is not uncommon to soak more than six pads or tampons in one day. 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 every month. 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 can 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 could throw it off track. Don't feel discouraged, this may take some getting used to but the more you know about your body and your menstrual cycle, the better you will be able to deal with it. 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, which relieves cramps and perhaps other symptoms. It's important to make sure that you don't have any allergies to this medication 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 a few days before your period each month. 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 when their periods are about to 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 is 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, by exercising and with medications.

If, however, you have any of the following symptoms, discuss them 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 8 days

* bleeding between periods

* skipping a period for six months or longer

For more information, visit the Menstrual Disorders topic at this Web site.

Premenstrual Syndrome

Premenstrual syndrome (PMS) is a term used to describe a group of symptoms that you may experience up to seven to 10 days before your period begins and goes away when your period begins or soon 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, 30 to 40 percent of them experience symptoms severe enough to disrupt their normal activities. These are the symptoms known as PMS.

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 five to seven percent of girls and women who menstruate. The effects of PMDD can make it tough to function at school and in relationships.

Symptoms include:

* Severe mood swings, depression, irritability and anxiety.

Do you experience uncontrollable crying spells or anger, or depression so intense you can't function? Emotional symptoms are the ones most likely to lead your health care professional to conclude you have PMDD.

* Difficulty concentrating.

Is it impossible or nearly impossible 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 might 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 is available that can increase the amount of serotonin in the brain, thereby treating PMDD.

Annual checkups and pelvic exams

Before the onset of puberty, all pre-teens should have a "well-girl 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 STDs. A gynecological (pelvic) examination is usually not a part of this visit. You should be tested for STDs if you have had sex, and should be screened for chlamydia and gonorrhea infections every six to 12 months.

Women should have a pelvic exam within three years after they become sexually active or by the age of 21 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.

Health care professionals realize that a young woman might be nervous and/or embarrassed during her first pelvic exam and will talk to you about what to expect with the exam before starting. You will probably be asked to undress. If you are, 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 that you have a Pap test about three years after you become sexually active, but no later than age 21. Until you turn 30, you should have a Pap test every year, if your health care professional uses a traditional Pap test or every two to three years if the newer liquid-based Pap test is used. Be sure to ask, if you're not sure what type of Pap test is used.

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 self breast 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 might 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 diseases (STDs) and pregnancy. (See under Resources, "What to Ask During Your First Gynecologic Appointment.")


As if puberty isn't sometimes 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 only, some are romantically interested in girls only, 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 that 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 might 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 STD--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 STD 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 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 58 percent of all high school girls are not having sex, according to a 2001 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 contracting 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 STD 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 STD. 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." For more information, visit the Contraception topic at this Web site. No method, however, is 100 percent safe. The only foolproof way to keep from getting pregnant or avoiding getting an STD is not to have sex.

Sexually Transmitted Diseases (STDs)

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

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

You are most likely to get an STD during your teen and young adult years--more than two-thirds of all STDs occur in people younger than 25. Because STDs 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 STDs. 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 STD hotline. There are many places in your local area where you can get free and confidential STD counseling and testing. (See list of hotline numbers on this site)

Treating some STDs is often a snap--just antibiotics--but the health consequences of an untreated STD can be severe. Unfortunately, the most common STDs, human papillomavirus (HPV) and herpes, are viral diseases that can't be cured. No treatment may result in more consequences, including causing permanent damage to your reproductive organs, which could make getting pregnant when you are older difficult. Some STDs can cause problems during pregnancy or during a delivery. (See under Resources, "STD Symptom Checklist")

The more common STDs are listed below:


* human papillomavirus (HPV)

* herpes

* chlamydia

* gonorrhea

* trichomoniasis

* hepatitis B

* syphilis

Having unprotected sex and multiple sex partners places you at higher risk for STDs. Many STDs 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 STD screenings so 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 last time they had sex, according to a 2001 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 STDs, including HIV (the virus that causes AIDS), but male and female latex condoms don't prevent all STDs transmitted by skin-to-skin contact.

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 STDs 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 2001 CDC survey of high school students showed 19 percent had thought about committing suicide and nearly nine percent had tried. 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 them and want to help. Never agree to keep their thoughts about suicide a secret. If another person shares with you that he or she want to dies 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

Teenage girls are increasingly expressing dissatisfaction with their bodies. In one large study, nearly two-thirds of the girls in fifth to 12th grade surveyed said that they thought that they needed to lose weight. However, less than one-third of these girls were actually considered overweight by a health care professional. The study's authors suggested the media, particularly magazines and television, were having negative effects on girls' self-images about their bodies.

Many teenagers are uncomfortable with their appearance. 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 then she or he normally would in an uncontrolled manner, and then does something such as forcing herself or himself to vomit, using laxatives, or exercising excessively, to prevent weight gain. This is often referred to as "bingeing and purging." A person with bulimia typically is of average weight or overweight. This illness can be very dangerous, especially if the teen forces vomiting regularly because 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 up to 25 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. For more information, visit the Eating Disorders topic at this Web site. (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. You are taking a risk, doing something you haven't done before and feeling unsure about it. Usually those risks pay off. You 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, risk-taking behavior, such as drinking alcohol, smoking, using drugs, driving too fast or using a weapon, usually has 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 1997. 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 1996, more than four million youths between ages 12 and 17 are smokers, according to the National Institute on Drug Abuse. (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 Kids1400 Eye Street, Suite 1200Washington DC 20005Phone: 202-296-5469 Fax: 202-296-5427

Substance Abuse

Many people first try alcohol during their teenage years. The average age for girls is 13 years old, according to studies by the CDC and the American Academy of Pediatrics (AAP). You might be surprised to learn that alcohol is a drug. 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 diseases 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, whereas the number of parents as providers of alcohol to underage students has increased. 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 for women in coeducational schools.

Visit the Substance Abuse topic at this Web site for more information about substance abuse and how it affects your health. "Fast Facts for Parents: New Trends in Teen Drug Abuse," at this Web site, might also help you understand how alcohol, cigarettes and other drugs can seriously damage your health and lifestyle.

Problem Drinking

Although it is illegal to drink if you're under 21, many teens do it anyway, and some drink 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 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 1999, nearly half of all high school students had used marijuana, the most commonly used illicit drug. More than a quarter used it more than once in the last month.

Recent data show that drug use among teens has declined by 11 percent over the past two years, which means 400,000 fewer youth used illicit drugs in 2003 than in 2001. This is the most significant decrease in over a decade. 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 an increase in the abuse of certain prescription drugs and inhalants and the abuse of over-the-counter remedies remains a concern.

Visit the Substance Abuse topic at this Web site to learn more about why using drugs is a bad idea and for information on how to stop, if you're using now.

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 to get through it safely. 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; website is 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, often what comes to mind is alcohol or drug abuse. But there are several kinds of abuse, many of which are not 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 is involves someone being made to watch sex acts or looking at or taking 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 Hot Line at 1-800-4-A-CHILD (422-4453) for help.


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 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 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

* You should shave in the direction against hair growth.

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

* Shaving hair in sensitive areas such as the bikini line can cause a rash.

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

* Shaving at the end of the day when your skin is less puffy as well as using 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. 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.

* 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. Remember to apply a moisturizer to reduce irritation.

* Electrolysis uses electricity to destroy the hair follicle and prevent the 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:


Chocolate and oily foods cause acne.


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.


Repeated face washing will get rid of acne.


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 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, you 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. For more information, visit the Depression topic at this Web site.

* 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.)

* 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 20 to 30 minutes at least three times 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 how many symptoms can be reduced 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 for fun.

A third strategy that many teens find helpful is muscle relaxation or deep-breathing exercises to reduce anxiety or 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 for yourself. 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 are interfering 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 be discussing 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 diseases, 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 STDs 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 about yourself. 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, then 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--watch at school or the mall, that attractive people come in all colors, shapes and sizes, that 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 three times to five times a week and eating healthy. 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."

* Make a habit of complimenting yourself: "I'm good at math...I'm really funny sometimes...My hair looks just right today." Don't worry that you'll become conceited. Because we all have a habit of focusing on the negative, these thoughts tend to just balance things out a bit.

* 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, or 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.

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 STD Hotline 1-800-227-8922 1-800-243-7889 (TTY/TDD for the hearing impaired) 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 STD 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 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 STD symptoms and prevention; links to clinics are listed.

SAVE Suicide Awareness Voices of Education National Hotline: 1-800-273-TALK (1-800-273-8255) 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) Crisis Hotline: 1-800-SUICIDE TTY Line: 1-800-433-5959 Provides referrals and information on depression and suicide. Web site provides general information on many types of mental disorders. 1-800-969-NMHA Provides information on depression and local screening sites.

American Psychiatric Association 1-888-35-PSYCH Provides information on depression and other mental disorders and referrals to local psychiatrists.

National Clearinghouse for Alcohol and Drug Information 1-800-729-6686 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 1-847-434-4000 1-847-434-8000 (Fax)

Planned Parenthood Federation of America 1780 Massachusetts Ave, NW Washington, DC 20036 1-800-230-PLAN FAX: 202-293-4349

Students Against Destructive Decisions (SADD) Box 800 Marlborough, MA 01752 1-877-SADD-INC (toll-free) 1-508-481-5759 (Fax)

Consumer Healthcare Products Association 900 19th Street, NW, Suite 700 Washington, DC, 20006 1-202-429-9260 1-202-223-6835 (Fax)

Drug Free America Foundation, Inc. PO Box 11298 St. Petersburg, FL 33733-1298 1-727-828-0211 1-727-828-0212 (Fax)

National Institute on Drug Abuse 6001 Executive Boulevard, Room 5213 Bethesda, MD 20892-9561 1-301-443-1124

Campaign for Tobacco-Free Kids 1400 Eye Street, Suite 1200 Washington, DC 20005 1-202-296-5469

JoinTogether (to advance effective alcohol and drug policy, prevention, and treatment) Boston University School of Public Health One Appleton St., 4th floor Boston, MA 02116-5223 1-617-437-1500 1-617-437-9394 (Fax)

The Partnership for a Drug-Free America 405 Lexington Avenue, Suite 1601 NY, NY 10174 1-212-922-1560 1-212-922-1570 (Fax)

STD Symptom Checklist:

* Burning sensation when urinating.

* Vaginal discharge. Occasional discharge--clear or white, thin, with no smell--is normal, but you may have an STD 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 STDs. 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 STDs are penile irritation or pain, pus or discharge from the penis, or sores or warts on the penis. Men with STDs 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 answer 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. For example, there's one that's been designed especially for teens that the Nemours Foundation has created.

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 consumes 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 ofalcohol:

* 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.


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

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Blackstone, Margaret, and Elissa Haden Guest. Girl Stuff: A Survival Guide To Growing Up. San Diego: Gulliver Books (Harcourt). 2000.

"Public Lice Infestation. Centers for Disease Control and Prevention. Division of Parasitic Diseases. Reviewed October 21', 2004. Accessed June 10, 2005.

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Eating Disorder Info and Resources. National Association of Anorexia Nervosa and Associated Disorders. Published 2000. Accessed June 10, 2005.

The National Clearinghouse for Alcohol and Drug Information. "Tips for Teens: The Truth About Alcohol." No publication date. Accessed June 10, 2005.

"Fact Sheet: Human Papillomavirus and Genital Warts." National Institute of Allergy and Infectious Diseases. Published July 2004. Accessed June 10, 2005.

"Sexually Transmitted Infections." National Institute of Allergy and Infectious Diseases. Accessed June 10, 2005.

National Women's Health Resource Center. "Bacterial Vaginosis." Reviewed 2005. Accessed June 10, 2005.

National Women's Health Resource Center. "Chlamydia." Reviewed 12/2004. Accessed June 10, 2005.

National Women's Health Resource Center. "Gonorrhea." Reviewed 1/2004. Accessed June 10, 2005.

National Women's Health Resource Center. "Trichomoniasis." Reviewed 1/2004. Accessed June 10, 2005.

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TeensHealth (The Nemours Foundation). "Body Image and Self-Esteem." Accessed June 10, 2005.

Editorial Staff of the National Women's Health Resource Center 2002/02/20 2005/06/14 Your body is changing; your moods may be unpredictable and sometimes even unexplainable. Don't worry. These changes during your teen years are normal. Contraception,Depression,Gynecologist,Menstrual cycle,Menstrual disorders,Premenstrual syndrome,Puberty,Teen health
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