Category Archives: Sexual Health

Women’s health – Week 45: Sexually transmitted infections

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tacuin womenFrom the Office of Research on Women’s HealthSexually

Sexually transmitted infections (STIs): also commonly called sexually transmitted diseases (STDs), are infections you can get by having sex with someone who has an infection. Continue reading

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Minnesota, not Florida, not Hawaii, is healthiest state for seniors

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Minnesota_population_map_croppedBy Elizabeth Stawicki,
Minnesota Public Radio

“Minnesota Nice” might be the key to good health for seniors.

America’s Health Rankings Senior Report rated Minnesota the healthiest state in the nation for adults aged 65 and over — beating out Hawaii. And that retiree and snowbird haven, Florida? It came in 28th.

What could put Minnesota, which just weathered arguably the harshest winter in the country, ahead of those sunny climes? Volunteering is one factor. Continue reading

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Growth of Catholic hospitals — by the numbers

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by Nina Martin
ProPublica

The past few years have been a period of unprecedented turmoil for the hospital industry.Now, a new report confirms that Catholic hospitals are emerging as one of the few clear winners — and the study adds its voice to a growing chorus of warnings about how church doctrine could affect women’s reproductive health care.

The report is by MergerWatch, a New York–based nonprofit that tracks hospital consolidations, and the American Civil Liberties Union. It traces the growth of Catholic hospitals across the U.S. from 2001 to 2011, the most recent year for which complete data is available.

It focuses on full-service, acute-care hospitals with emergency rooms and maternity units —settings in which Catholic religious teachings are most likely to come into conflict with otherwise accepted standards of reproductive care.

The report’s major finding is illustrated in the chart below: At a time when other types of nonprofit hospitals have been disappearing, the number of Catholic-sponsored hospitals has jumped 16 percent.

Over the last decade, only for-profit hospitals have fared better. The gains by Catholic providers are especially striking considering the sharp decline in the number of other religious-owned hospitals during the same period.

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Source: MergerWatch

The numbers reflect the huge wave of hospital consolidations triggered by health care reform. For reasons that the report doesn’t delve into, Catholic hospitals have weathered those market upheavals better than other types of community hospitals—so well that they now make up 10 of the 25 largest health-care networks in the U.S.

Not surprisingly, the number of hospital beds at Catholic providers has also increased faster than at other types of nonprofit hospitals.

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Source: MergerWatch

According to the report, Catholic acute-care hospitals now account for 1 in 9 hospital beds around the country, with much higher concentrations in some states, including Washington (the subject of this ProPublica story), Wisconsin, and Iowa.

(When other types of facilities are included, the Catholic share of hospital beds is closer to 1 in 6, according to this fact sheet.)

Keep in mind that these numbers are from 2011. Since then, according to the report, the largest Catholic health hospital networks, Ascension Health and Catholic Health Initiatives, have grown by another 30 percent or more.

“The trend we’ve identified is continuing and perhaps even accelerating,” Lois Uttley, MergerWatch’s director, said in an interview. “These large Catholic health systems are expanding aggressively, taking over other hospitals and smaller health systems, gobbling up non-Catholic hospitals, and gaining more financial power.”

However, the report’s immediate concern isn’t the hospitals’ economic clout, but rather the impact of Catholic health care policy, as embodied by controversial guidelines known as The Ethical and Religious Directives.

Issued by the U.S. Conference of Catholic Bishops, the ERDs govern medical care at all Catholic hospitals — and influence care at secular hospitals that merge or affiliate with Catholic providers.

The directives ban elective abortion, sterilization, and birth control and restrict fertility treatments, genetic testing, and end-of-life options.

Depending on the hospital and the local bishop, they may also be interpreted to limit crisis care for women suffering miscarriages or ectopic pregnancies, emergency contraception for sexual assault, and even the ability of doctors and nurses to discuss treatment options or make referrals.

A spokesman for the Catholic Health Association of the United States said he had not seen the report and could not comment. But in a statement responding to  a recent New York Times editorial, the association provided a spirited defense of its member hospitals.

“Catholic hospitals in the United States have a stellar history of caring for mothers and infants. Hundreds of thousands of patients have received extraordinary care …There is nothing in the Ethical and Religious Directives that prevents the provision of quality clinical care for mothers and infants in obstetrical emergencies. Their experience in hundreds of Catholic hospitals over centuries is outstanding testimony to that.”

But Louise Melling, the ACLU’s deputy legal director and a coauthor of the new study, sees danger as Catholic hospitals expand their market share and the ERDs extend their reach as well.

She cites the case of a Michigan woman who was allegedly denied proper care for a miscarriage at a Catholic hospital in Muskegon because of its interpretation of the directives banning abortion.

In that case — the centerpiece of a high-profile lawsuit by the ACLU against the Catholic bishops last month — the hospital in question had been secular until 2008, when it was merged with a Catholic health care system.

“Ordinary people are not following hospital mergers and acquisitions,” Uttley said. “They don’t know who runs their hospital, especially if it doesn’t have a Catholic name. Even if it does have a Catholic name, people don’t know what that means.”

Archbishop Joseph Kurtz of Louisville, Ky., the newly elected president of the bishops conference, has called the lawsuit “baseless” and “misguided.” “A robust Catholic presence in health care helps build a society where medical providers show a fierce devotion to the life and health of each patient, including those most marginalized and in need,” he said.

The authors of the new report, titled “Miscarriage of Medicine: The Growth of Catholic Hospitals and the Threat to Reproductive Health Care,” assert that the risk to patients is especially great in areas where a Catholic hospital is the sole provider for an entire region.

The report also looks at how much money Catholic hospitals take in from Medicare and Medicaid—a total of $115 billion in gross patient revenues in 2011 — and urges the federal government to enforce laws that protect patients under those programs. (Back in 1999, when MergerWatch issued its first report on the role of religion in health care, the total billed by all religious hospitals — not just Catholic-sponsored ones—was $41 billion.)

One of the more surprising findings is the slightly below-average amount of charity care provided by Catholic acute-care facilities. The numbers are based on Medicare Cost Reports, financial and utilization data filed annually by every hospital, the report said.

ProPublica requested comment from the Catholic Health Association, and we’ll post it if it comes.

But the shift, if true, is a big change from the past, when Catholic hospitals were founded by nuns and brothers to minister to the poor, the report says.

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Source: MergerWatch

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Snohomish County campaign seeks to raise HIV/AIDS awareness in Latino/Hispanic community.

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nlaad-logoDuring the month of October, Snohomish Health District will present a National Latino AIDS Awareness campaign aimed at engaging the Hispanic/Latino community in promoting HIV awareness through testing, prevention and education.

This year’s theme is “Commit to Speak”/“Comprométete a Hablar.”

In Washington state, 12% of all individuals currently living with HIV/AIDS are Latino – but Latinos only compromise approximately 9.4% of the total population.

The rates of new infections among Latino men were more than double that of white men. The rate of HIV infection among Latino women was nearly four times that of white women.

To address this disparity and increase awareness, staff from the Snohomish Health District will be offering free testing at community locations to members of the Latino and general communities who qualify based on their risk factors:

  • Tuesday, Oct. 22, from 4 – 6 p.m. at Everett Sea Mar Behavioral Clinic, 5007 Claremont Way
  • Tuesday, Oct. 22, from 1 – 5 p.m. at Monroe Sea Mar Behavioral Clinic, 14090 Fryeland Blvd. SE, Ste. #347
  • Wednesday, Oct. 23, from 4 – 5 p.m. at Everett Sea Mar Behavioral Clinic, 5007 Claremont Way
  • Wednesday, Oct. 23 from 9-11 a.m. at Everett Sea Mar Behavioral Clinic, 5007 Claremont Way
  • Thursday, Oct. 24, from 4 – 8 p.m. at Everett Sea Mar Medical Clinic, 1920 100th Street SE, Bldng. B
  • Friday, Oct. 25, from 12 – 4 p.m. at Monroe Sea Mar Medical Clinic, 17707 West Main Street
  • Thursday, Oct. 31, from 1 – 4 p.m. at Marysville Sea Mar Medical Clinic, 9710 State Avenue

The Centers for Disease Control and Prevention states the impact of HIV on Hispanics/Latinos is not directly related to race or ethnicity, but rather to challenges faced by some communities, including less awareness of HIV status, poverty, access to care, stigma, migration acculturation (the process of adopting the cultural traits or social patterns of another group) and homophobia.

Learn more about the national awareness campaign from the AIDSinfo website, http://aidsinfo.nih.gov/education-materials/hiv-aids-awareness-days/169/national-latino-aids-awareness-day.

The Health District offers free and confidential HIV testing and counseling for high-risk individuals year-round, in our Everett clinic location, with test results in 30 minutes. Individuals with risk can also be tested for hepatitis A,B, C, and syphilis. For information about HIV/AIDS prevention and testing, call the Health District at 425.339.5298, or visit www.snohd.org.

According to the Washington State Department of Health, 730 people in Snohomish County are assumed to be living with HIV/AIDS.

Information from the US Centers for Disease Control and Prevention:

 Centros para el Control y la Prevención de Enfermedades

Datos breves

  • El VIH afecta de manera desproporcionada a los latinos.
  • En el 2009, los latinos representaron el 20% de las infecciones nuevas con el VIH en los Estados Unidos, aun cuando solamente constituían alrededor del 16% de la población total de los EE. UU.
  • HSH están particularmente afectados con el VIH.

El VIH es un problema de salud pública en la comunidad latina1. En el 2009, los latinos representaron el 20% (9,400) de las infecciones nuevas por VIH en los Estados Unidos, aun cuando solamente formaban alrededor del 16% de la población total de los EE. UU. La tasa de infecciones por el VIH en los latinos en el 2009 fue casi el triple que la de los hombres de raza blanca (26.4 comparado con 9.1 por cada 100,000 habitantes).

Las cifras

Infecciones nuevas por VIH

  • En el 2009, los hombres latinos representaron el 79% (7,400) de las infecciones nuevas en toda la población latina y la tasa de infecciones nuevas entre los hombres latinos fue dos veces y media más alta que la de los hombres de la raza blanca (39.9/100,000 comparado con 15.9/100,000).
  • En el 2009, los hombres latinos que tuvieron relaciones sexuales con hombres (HSH)3 representaron el 81% (6,000) de las infecciones nuevas por VIH entre los hombres latinos. Y a su vez representaron el 20% de todos los HSH. Entre los HSH latinos, el 45% de las infecciones nuevas por VIH correspondió a hombres menores de 30 años de edad.
  • Aunque las mujeres latinas representaron el 21% (2,000) de las infecciones nuevas en los latinos durante el 2009, su tasa de infección por el VIH fue más del cuádruple que en las mujeres blancas (11,8/100,000 comparado con 2,6/100,000).

Estimados sobre infecciones nuevas por el VIH en los Estados Unidos para las subpoblaciones más afectadas, 2009

Esta gráfica no incluye las subpoblaciones que representan el 2% o menos de la epidemia general en los EE. UU.

Diagnósticos y muertes por VIH y SIDA

  • En algún momento de su vida, 1 de cada 36 hombres latinos recibirá un diagnóstico de VIH, al igual que 1 de cada 106 mujeres latinas
  • En el 2009, los latinos representaron el 19% de los 42,959 diagnósticos nuevos de infecciones por VIH en los 40 estados y las 5 jurisdicciones dependientes de los EE. UU. que cuentan con sistema de notificación de infección por VIH de forma confidencial basada en el nombre.
  • En el 2009, se estima que 7,442 latinos recibieron un diagnóstico de sida en los EE. UU. y las 5 jurisdicciones dependientes. Esta cifra ha disminuido desde el 2006.
  • Para finales del 2008, se calcula que 111,438 latinos habían fallecido en los Estados Unidos y las jurisdicciones dependientes con diagnostico de SIDA. En el 2007, el VIH fue la cuarta causa principal de muerte en latinos de 35 a 44 años de edad y la sexta en los latinos de 25 a 34 años en los EE. UU.

Desafíos para la prevención

Varios factores contribuyen a la epidemia del VIH en las comunidades latinas.

  • Los factores de la conducta de riesgo relacionados con la infección por VIH varían de acuerdo al país de origen.Los datos indican que los porcentajes más altos de infecciones con el VIH diagnosticadas en hombres latinos se atribuyen a contacto sexual con otros hombres, independientemente del país de origen, pero los hombres nacidos en Puerto Rico tienen un porcentaje considerablemente más alto de infecciones por el VIH atribuidas al uso de drogas inyectables (UDI) que los hombres latinos nacidos en otros países.
  • Los hombres y mujeres latinas tienen más probabilidad de adquirir la infección por VIH como resultado del contacto sexual con hombres. Las mujeres latinas podrían no estar conscientes de los factores de riesgo de su pareja masculina.
  • El uso de drogas inyectables continúa siendo un factor de riesgo entre los latinos, especialmente para los que viven en Puerto Rico. Además, los usuarios ocasionales y crónicos de alcohol o estupefacientes tienen más probabilidad de practicar conductas sexuales de alto riesgo, como son las relaciones sexuales sin protección debido a que están bajo la influencia de las drogas o el alcohol.
  • Tener ciertas infecciones de transmisión sexual (ITS)puede aumentar, en forma significativa, la posibilidad de que una persona contraiga la infección por el VIH. Una persona que tiene la infección por el VIH y ciertas ITS tiene más posibilidad de infectar a otros con el VIH. Las tasas de ITS permanecen altas entre los latinos.
  • Los factores culturales pueden afectar el riesgo de infección por el VIH. Es posible que latinos eviten hacerse pruebas del VIH y buscar consejería o tratamiento para la infección por temor a la discriminación o la estigmatización o debido a su estatus migratorio. Los roles tradicionales de los hombres y las mujeres y el estigma contra la homosexualidad pueden dificultar la prevención.
  • Una mayor aculturación adoptando la cultura estadounidense tiene efectos tanto negativos (adopción de conductas que aumentan el riesgo de adquirir la infección del VIH) como positivos (comunicación con las parejas sobre las relaciones sexuales más seguras o de menor riesgo) en las conductas relacionadas con la salud de los hombres y mujeres latinos.
  • Los factores socioeconómicos, como la pobreza, los patrones migratorios, el bajo nivel de estudios académicos, la falta de seguro médico, el acceso limitado a la atención médica, o las barreras del lenguaje, contribuyen a las tasas de infección por VIH en los latinos. Estos factores pueden limitar la concientización de los latinos sobre los riesgos de infectarse con el VIH y las oportunidades para participar en consejería, pruebas de detección y tratamiento.
  • Debido al miedo a ser descubiertos y deportados, los inmigrantes indocumentados pueden ser menos propensos a recibir servicios de prevención del VIH, a hacerse pruebas de detección o a recibir atención médica y tratamiento adecuados si es que son diagnosticados positivos o que viven con el VIH.
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Snohomish to offer free HIV tests for eligible gay & bisexual men, Oct. 1

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aids-ribbonIn support of National Gay Men’s HIV Awareness Day, the Snohomish Health District will host a free evening of information and testing from 4-7 p.m., Tuesday, Oct. 1 in Suite 108 at the Rucker Building, 3020 Rucker Ave., Everett, Wash.

The event is directed to gay and bisexual men who are at risk for HIV infection and other sexually transmitted diseases. No appointment needed. The event includes door prizes and light refreshments, and every man screened will receive a financial incentive.

Snohomish County currently ranks third in the state for new HIV cases, following King and Pierce counties. Recent data show that 58 percent of all new HIV cases in Washington State are among men who have sex with other men (MSM). Gay and bisexual men make up less than 10 percent of the population, but account for almost 60 percent of the burden of HIV disease.

The Health District also will offer free testing to qualified men for Hepatitis C and syphilis, and vaccine for Hepatitis A and B. Both the Hepatitis C and HIV tests are “rapid” antibody tests, requiring only a drop of blood pricked from a finger.

Test results will be available within 30 minutes. The tests are anonymous and confidential.

New prevention tool: Pre-exposure prophylaxis –PrEP

Information about a new HIV prevention tool will be shared by Michael Louella, outreach coordinator for the AIDS Clinical Trial Unit in Seattle.

Pre-exposure prophylaxis, or PrEP, is when HIV-negative individuals take a pill to prevent HIV infection.

The medicine currently is used to treat HIV, and has now been approved for this treatment by the Centers for Disease Control and Prevention, and the Food and Drug Administration.

Research studies show that PrEP can lower the risk of HIV transmission when used with other prevention measures, such as condoms.

For more information about HIV testing and risk, please call David Bayless, 425.339.5238.

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Monday’s health tip: Be tested for STDs

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Gonorrhea (Photo: Bill Schwarts/CDC)

Gonorrhea (Photo: Bill Schwarts/CDC)

Nearly 1 in 5 people living with HIV don’t know they have it.

Many other STDs (such as chlamydia, herpes, and gonorrhea) are also unknowingly spread and left untreated.

Because of this, the CDC recommends all adolescents and adults between the ages of 13-64 get tested for HIV at least once in their life, as a routine part of medical care.

More frequent testing should be considered if you have had unprotected sex or multiple partners.

Remember, doctors don’t test for STDs as part of your routine checkup, so be sure to speak up!

If you think you should be tested, schedule an appointment with your doctor or a clinic this week.

 

About the Monday Campaigns:

The Healthy Monday Tips is produced by a national health promotion initiative called the Monday Campaigns.

The thinking behind the initiative derives from two studies done at the Center for a Liveable Future at Johns Hopkins Bloomberg School of Public Health by Jullian Fry and Roni Neff.

In one study, they reviewed the scientific studies that looked at ways to get people to adopt healthy habits.

In that review, they found that one of the most effective ways to keep people on track is simply to remind them from time to time to stick to it.

But when would be the best time send those reminders?

Fry and Neff decided to look at Monday, which many of us consider the start of our week.

To better understand how we thought and felt about Monday, they reviewed the scientific literature as well as cultural references to Monday in movies, songs, books and other forms of art and literature, even video games.

They noted that a number of scientific studies have found that we may suffer more health problems on Monday. For example, a number of studies find that Americans have more heart attacks and strokes on Monday.

There is also evidence that we have more on-the-job injuries on Monday, perhaps because we are not quite back into the swing of things, or are still recovering from our weekend.

Fry and Neff also found that while many of us, facing the return to work, may dread Mondays, Monday is also seen as a day for making a fresh start.

Fry and Neff concluded that Monday might be a good day for promoting healthy habits. Calling attention to the health problems linked to the first day of the work week, such as heart attacks and on-the-job injuries, makes Monday a natural day to highlight the importance of prevention.

And the Monday’s reputation as a day to make a fresh start offers the opportunity to help people to renew their efforts to adopt healthier habits.

Fry and Neff’s findings are put into practice by the Monday Campaigns, which helps individuals and organizations use Monday as a focus for their health promotion efforts, providing free research, literature and artwork, and other support.

To learn more about Healthy Mondays:

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Women’s groups angered by administration morning-after pill policies

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planb-175By Julie Rovner, NPR News

This story comes from our partner ‘s Shots blog.

The Obama administration’s actions this week on emergency contraception have left many women’s health groups sputtering with anger.

But what really has some of the President Barack Obama’s usual allies irritated is the fact that the moves are in direct contrast to speeches he made in just the past week.

Recall that on Tuesday the Food and Drug Administration defied a federal judge’s order to make the morning-after pill available over-the-counter to women of all ages by approving a more limited scheme. On Wednesday, the Justice Department formally appealed the federal judge’s ruling.

Yet only last Friday, Obama became the first sitting president to address Planned Parenthood’s national conference.

His spirited defense of reproductive rights included this statement: “We shouldn’t have to remind people that when it comes to a woman’s health, no politician should get to decide what’s best for you.”

And on Monday, he said this to the National Academy of Sciences: “[I]n all the sciences, we’ve got to make sure that we are supporting the idea that they’re not subject to politics, that they’re not skewed by an agenda, that, as I said before, we make sure that we go where the evidence leads us.”

But now, many women’s health advocates say the administration isn’t putting its actions where the president’s rhetoric has been.

“It doesn’t square and that is what’s so disappointing,” said Nancy Northup. She’s president and CEO of the Center for Reproductive Rights, one of the groups involved in the emergency contraception lawsuit against the administration that’s prompted this week’s activity.

“There couldn’t be a clearer record than there is in this case that emergency contraception is safe and effective for all ages, that we had not one but two administrations who continued to put what they judged as the politics of the issue about contraception ahead of what’s doing right for the public health,” she said.

Health and Human Services Secretary Kathleen Sebelius overrode the FDA’s decision to remove the age restrictions in 2011. She said she was worried that the youngest teens wouldn’t understand how to use the product safely.

But that’s not a concern for the nation’s pediatricians, who support full over-the-counter access to the drug.

“We get derailed over and over again in people’s ethical and moral concerns about whether teens should be sexually active, and not that this is a safe drug that can be and should be available to all women of reproductive age,” said Dr. Cora Breuner.

She’s a professor of pediatrics at the University of Washington and co-author of the American Academy of Pediatrics position paper on Emergency Contraception.

Women’s health advocates say even the steps the FDA did take this week — to lower the age for sale of the drug without a prescription from 17 to 15 — doesn’t do much, because they still have to show identification.

“15- and 16-year-olds are much less likely to have an actual government ID with your birth date on it,” said Susan Wood, a public health professor at George Washington University and a former assistant commissioner for women’s health at FDA. “So that … doesn’t really expand access to that age group very much.”

In fact, what really worries the women’s health groups is that idea that this fight that has already gone on for more than 10 years, now could stretch out years longer.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Teens and Sexual Assault: Developmentally Delayed Teens

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Seattle Children's Whale LogoBy
This article first appeared on Seattle Children’s Teenology 101 blog.

Developmentally delayed teens are at a much higher risk of sexual assault than their non-delayed peers; the numbers are both depressing and well-validated.Despite the high rates of sexual assault in the teenage population, developmentally delayed teens are at even greater risk. The reason is simple: they are seen as an easy target, and there are predators out there looking to take advantage of them.

“Developmental delay” is a vague term (and is starting to become replaced by the phrase “intellectually disability”), encompassing Down Syndrome, autism, and other conditions that may be genetic or acquired. The range of developmental delay spans from teens who cannot communicate in any fashion with their caregivers, to articulate teens who plan to graduate high school and seek higher education or employment. Obviously, discussion and education for a delayed teen is not a one-size-fits-all task.

For the most delayed teens, unfortunately, there is no way to give them information to help protect themselves. It’s vital that anyone who looks after a delayed teen has had a thorough background check, either through a facility or when you hire them directly. Teens who go to public schools are cared for by employees with in-depth, although not infallible, surveys of their background. If your teen attends a private school or day care facility, sit down with the director and ask about how they ensure the safety of their clientele. Your teen should be spending most of their day in a group activity with one or more staff present. Having trust in whoever works with your teen can help relieve your mind, but it’s also important to keep a keen eye out for something that feels wrong.

If your teen can communicate, you may be able to provide helpful knowledge and skills. Of course, you have to modify this advice to fit your teen’s level of cognition and understanding. A good rule of thumb is:  if your teen asks questions, answer them. If your teen seems to be getting confused or frustrated, simplify.

Any teen who can grasp the concept should receive an education on sexuality appropriate to their level. Sit down with a book like Where Do I Come From? and discuss the basics of bodies and sexuality. They should learn about male and female organs, what sex, pregnancy, and childbirth involve, all about privacy and personal space, and that it’s normal to feel sexual feelings.

Most developmentally delayed teens will have strong sexual urges, like their non-delayed peers, and society in general is uncomfortable with this. People tend to think of delayed teens and adults as either “innocent”, with no sexuality whatsoever, or fear their sexual urges as “uncontrollable.” Like non-delayed teens, in the vast majority of cases, neither is true. Even if it makes you feel uncomfortable, the best way to discuss sexual matters with developmentally delayed teens is to approach their sexuality in a calm and informed manner.

Delayed teens should know that nobody is allowed to touch them sexually without their consent, and they are never allowed to touch anyone sexually without the other person’s consent. Tell them that if somebody tries, you want them to say a resounding no (delayed teens are often taught to obey those with authority, so stress that it’s okay to say no in this situation) and tell a trusted adult immediately. If no trusted adults are around, they should run and/ or call 911 if possible. Encouraged them to tell someone, even if it’s a secret, or they’re worried they’ll get into trouble. Be clear that your teen will never get in trouble for telling someone about their concerns.

Some parents are tempted to describe all sexual contact as “bad” for their teen. Understandably, they are nervous about their teen getting into a sexual situation. However, being touched in a sexual way can feel good, and if a teen doesn’t know that about this, they may not stop a situation because it doesn’t feel like the terrible thing they’ve been told about. Giving your teen a realistic view of sex can help them make healthy decisions, now and in the future.

Of course, some developmentally delayed teens will want to consent to sexual contact with someone. The question of whether a developmentally delayed teen can consent to sexual activity is very tricky, and obviously a lot depends on the level of delay. Encourage your teen to come to you with questions about sex, and tell you if they are thinking of starting a sexual relationship with someone. It won’t be an easy discussion if this happens, but it will be a valuable one.

A few resources: This book is written for parents of Down Syndrome children, but has good information for anyone. This short article is a good introduction. This longer piece is written for educators, but might be useful for parents as well, and the multiple links at the end are to great organizations that deal with this kind of issue. If you have access to Seattle Children’s Hospital, many providers in Adolescent Medicine have skill and experience working with developmentally delayed teens and their families around issues of sexuality.

What questions, success stories, or good advice do you have?

About Jen Brown, RN, BSN

Jen Brown, RN, BSN Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington.

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Teens and Sexual Assault, Part 8: The Media’s Response to the Steubenville Convictions

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Photo by Brainloc

Photo by Brainloc

By
This article first appeared on Seattle Children’s Teenology 101 blog.

I thought Part 7 was my last post in the series, but the media response to the sentencing of the two rapists in the Steubenville case has been so outrageous that I’m going to tack on a postscript here.

One of the first news reports to come out after the conviction was from CNN, and it spent much more time sympathizing with the rapists than the victim- in fact, the victim was not mentioned. You can watch the video here.

A concerned Poppy Harlow states, ”It was incredibly emotional, incredibly difficult even for an outsider like me, to watch what happened, as these two young men, that had such promising futures, star football players, very good students, literally watched as they believed their life fell apart…”

She then goes on to describe said emotion in the courtroom, and the offenders’ sadness. Later on, another reporter asked a legal correspondent, “What’s the lasting effect of two young men being found guilty in juvenile court of rape, essentially?”

There is so much wrong there: the concern over the rapists, the “essentially” tacked on to “rape”, the complete and utter absence of any thoughts of the victim. Just as people were beginning to criticize CNN, it turned out that the problem was not just with them.

NBC kept talking about the rapists’ “promising football careers.” I’m not sure why that’s relevant.

ABC News ran a piece on Ma’lik Richmond that talked extensively about his athletic prowess and difficult childhood. And yet, many athletes with difficult childhoods have refrained from raping someone.

Good Morning America mentions that “A juvenile judge will decide the fates of Trent Mays and Ma’lik Richmond, who face incarceration in a detention center until their 21st birthdays and the almost-certain demise of their dreams of playing football.” Perhaps if you dream of playing football, it’s best not to commit a sex crime.

The Associated Press opens a story with “Two members of Steubenville’s celebrated high school football team were found guilty Sunday of raping a drunken 16-year-old girl.” They are celebrated high school football players, the victim is left with the epithet “drunken.”

What none of these major media outlets seem to be addressing is that (ideally) if you rape someone, you pay the consequences for it. None of them are lamenting the long-term effects on a young women of being raped by two young men (and having pictures of it sent to peers). None of them are pointing out that this situation wouldn’t have happened if the two offenders had made the choice not to rape someone. Their promising football careers would be continuing untouched, they might have gone to great universities, and enjoyed all the opportunities and rewards given to people who have chosen not to commit rape.

What are our teens supposed to think when the mainstream media’s treatment of rapists is not full of revulsion, fear, or condemnation, but seems almost… affectionate? At the least, they feel very bad for them.

And they fail to mention concern over the fate of the rape victim. In fact, if she’s mentioned at all, it’s to point out that she was intoxicated. As Henry Rollins (yes, thatHenry Rollins) said in a piece in Raw Story, “It is ironic and sad that the person who is going to do a life sentence is her.”

I spoke earlier in this series about how important it is to talk to your teen about issues regarding sexual consent. It’s also important for you to talk to your teen about rape culture, how they can make sure they’re not a part of it, and what they can do to change it.

About Jen Brown, RN, BSN

Jen Brown, RN, BSN Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington.

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Teens and Sexual Assault, Part 6: Sexual Assault Within A Relationship

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Photo by Sanja Gjenero

Photo by Sanja Gjenero

By
This article first appeared on Seattle Children’s Teenology 101 blog.

When I was about 15, a friend was confiding in me about our friend Sasha’s* fight with her boyfriend James*. Sasha had been dating James for a while, and their relationship included sexual activity. She told me that Sasha had cheated on James, and he had found out and been furious.

“What did he do?” I asked.

“He was really mad. He yelled at her and threw things and made her have sex with him,” she said.

“Like, he made her have sex, when she was saying no?” I said, incredulous.

“Well… I don’t know. I don’t think so. He said she was crying but didn’t fight him or anything.”

Reading this as an adult makes me cringe. But as teens, we were a little confused as to whether James could really rape Sasha, given that they were going out and had had sex before.

When we saw Sasha next, she and James were together and they seemed happy. We concluded that she couldn’t have been sexually assaulted.

When we think of teens being sexually assaulted, we often think of stranger/ acquaintance rape, but teens can and are sexually assaulted by their romantic partners. This can occur even if they have consented to sex in the past, and might again in the future. Consenting to one episode of sexual contact does not mean that there is blanket consent for sexual consent at all times.

This seems like an easy concept for adults to understand, but it’s important to remember that the very idea of date and marital rape wasn’t really addressed by our society until the 1970s. One of my earliest memories of talk radio is listening to (and being confused by) a debate in the early 80s that boiled down to, “Is it really possible to rape your own wife?”

Teens- especially younger teens- can be confused by the concept of sexual assault within the confines of a romantic relationship that has already involved sexual contact. It’s important that teens realize that it’s wrong to make, or coerce, someone into having sex, even if they’ve consented to sex before.

It’s also important that teens know they can say no to someone- with every expectation of an immediate halt to sexual activity- even if they’ve said yes before, no matter what the circumstances. In Sasha’s case, I found out later she felt she’d “deserved it” for having sexual contact with someone else while dating James.

While it’s very important that your teen realize that it’s important to gain consent for sexual contact, they also need to know that consent is important for every sexual contact.

It doesn’t necessarily mean that a teen has to seriously sit down and formally ask for consent every time (although they can if they want to), but they do need to realize that consent is not a one-time process when one is dating someone, or has had sexual contact with them before.

This may not be one of those concepts where you can give a step-by-step guide on how to deal with it, but it’s still important that they’re aware the concept exists.

Once you’ve discussed how important this is with your teen, ask them how they’d go about making sure every sexual contact is consensual. There isn’t one correct answer. Discuss their ideas with them.

Depending on your teen, they may be so embarrassed at the idea of talking to you about this that they stop the conversation, which is fine. Once you’ve asked the question, you can leave their mind to fill in the blanks when it’s time… although bringing it up again when they’re in a romantic/ sexual relationship never hurts.

What conversations have you had with your teen about this? What was their reaction?

*Names changed

Top photo courtesy of Sanja Gienero

About Jen Brown, RN, BSN

Jen Brown, RN, BSN Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington.

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Federal judge strikes down age limits on ‘morning-after’ pill

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planb-175By Scott Hensley, NPR News

This story comes from KHN partner ‘s Shots blog.

A federal judge in Brooklyn, N.Y., has ruled that the morning-after pill for emergency contraception must be made available over the counter to girls 16 and under.

The ruling could end a more than decade-long battle over how easy or difficult it should be for teenage girls to obtain emergency contraception.

The ruling would also make it easier for older women to obtain the drug because it wouldn’t have to be kept behind drugstore counters anymore.

The judge’s order effectively overturns a controversial 2011 decision by Secretary of Health and Human Services Kathleen Sebelius overruling the Food and Drug Administration. A

fter years of study and internal debate, the FDA had decided that Plan B One Step should be allowed for sale without a prescription — and without age restrictions.

In the ruling dated April 4, Senior Judge Edward R. Korman of the Eastern District of New York held that Sebelius’s decision on Plan B was “arbitrary, capricious, and unreasonable.”

On page 47 of the 59-page decision, Korman skewers Sebelius’s decision, calling it “politically motivated, scientifically unjustified, and contrary to agency precedent ….”

He also slammed the FDA’s rejection of a so-called Citizen’s Petition dating to 2005 that argued for the agency to approve unfettered over-the-counter sale of Plan B. That rejection, he said, was a direct consequence of Sebelius’s ruling.

In the decision, Korman sends the Plan B case back to FDA with orders to make the morning-after pill “available without a prescription and without point-of-sale or age restrictions within 30 days.” If the agency decides the instructions for the drugs need tweaks, that’s OK.

When Sebelius essentially vetoed the FDA’s decision in late 2011, women’s health groups erupted in protest. “As doctors and researchers have repeatedly stated, ample research shows Plan B to be safe for women of all ages and appropriate for over-the-counter access.

It is deeply disappointing that this administration would repeat the mistakes of the previous one,” said Susan Wood, an associate professor at George Washington University’s School of Public Health.

Wood was an assistant commissioner for women’s health at the FDA but quit in 2005 over its continued delay on over-the-counter approval for Plan B.

Advocates for Plan B kept up the pressure on the administration to reverse itself. They argued, in part, that the rules were just too complicated.

“The unique dual-labeling of Plan B One Step has led to confusion among consumers and health care professionals alike, particularly regarding age restrictions and whether men and women can purchase non-prescription emergency contraception,” said a letter signed by more than three dozen women’s health, reproductive rights and individual providers of health care.

“A recent Boston University study of 943 pharmacies in five major cities revealed that, when called posed as 17 year olds seeking EC, one in five were told they could not purchase EC under any circumstances,” the letter said at the time. In fact, those 17 and older are eligible to purchase the product without a prescription; those 16 and younger may purchase it with a health provider’s written order.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Teens and Sexual Assault, Part 3: The Age of Consent

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By  This article first appeared on Seattle Children’s Teenology 101 blog.

Calendar

At some point, most teens end up dating someone who is a little older or younger than them. But when that age gap widens, teens can be putting themselves or their partner in danger of legal (and emotional) consequences if the relationship involves sexual contact.

This week we’re going to take a look at the legal implications of the age of consent and statutory rape.

In the United States, the most common age of consent is 16, although in some states, it is 17 or 18. This means that someone under the age of 16 cannot legally give consent to sexual contact with an adult, while once a teen turns 16 they can consent to sex with anyone they choose (with a few exceptions, such as teachers, foster parents, and supervisors.)

An important caveat to this rule occurs when two teens around the same age have sexual contact. A 15-year-old having sex with a 15-year old is not a prosecutable offense.

However, once there is an age gap, it gets a bit confusing; you can access the legal details here. Basically, it is illegal to have sexual contact with: a 12-year-old if the other person is more than 2 years older; a 12-to-14 year old  if the other person is more than 3 years older; a 14-to-16 year old if the other person is more than 4 years older.

These crimes can be labeled as child rape or child molestation, and they are felonies. Anyone found guilty of these crimes will be labeled a sex offender, including minors.

Teens tend to overestimate their maturity and ability to deal with adult situations. To a teen, an older person finding them attractive is not alarming; it may even serve to demonstrate to the teen how mature and desirable they are.

The older person in the relationship may believe that they have found that unusual young teen who is wise beyond their years and can make an equal partner in the relationship.

I can say this from experience, as I dated a 19-year-old when I was 15. I was thrilled with how mature I must be, and he swore that he would normally never date someone so young, but I was much older than my years.

(After we  broke up, his next two girlfriends were also 15; we must have been a particularly mature cohort.)

Can some teens be unusually mature? Sure. Some older teens and young adults can be unusually immature, too. But the fact remains that any sexual relationship that breaks the laws above can end with one partner being labeled a sex offender, possibly for the rest of his or her life.

A good way to broach this subject with your teen is to gauge their views on it. Sit down, tell them about the laws, and ask what they think. If they think the laws are unnecessary, or that they’re too strict, start gauging where their comfort level lies. Is it okay for an 18-year-old to have sex with a 12-year-old? (That should be an obvious question.) Start closing the age gap. Talk about different ages, and see what they would do differently.

Talk about how having sexual contact with someone much younger than them is illegal, it is wrong, and it is sexual assault. Explain how the adolescent brain has different capacity at different ages.

Even when someone much younger may seem like they are able to give full consent, they can’t. It is like someone very drunk agreeing to sexual activity; they are not capable of making that decision.

Explain that “sexual contact” is not just vaginal or anal sex; it includes oral sex and touching as well.

If someone much older wants to have sexual contact with them, that is also wrong and they should seriously question why someone that much older wants a younger partner.

It may be that your teen is unusually mature, or it may be that this older person prefers younger partners. Talk about why that might be. (If your teen is 16 or above, it’s not illegal for them to have sexual contact with a much older person, but feel free to give them your views on that as well.)

Explain to them what it means to be labeled as a sex offender, including publicly available registration, and limited educational, job, and living opportunities. Remind your teen that even if they are in a situation where they think the law shouldn’t apply to them, it still does.

Hopefully this is an issue you and your teen will only have to deal with in the abstract, and you won’t have to deal with the pain of your teen being involved in statutory rape.

But getting it out into the open, and talking about why it’s an issue, may make the different between a hasty decision, and a smarter one.

It’s hard to convince a teen when they are already madly in love with an older/ younger person that it’s a bad idea; if they have the knowledge beforehand, they may  be able to rein in their emotions.

About Jen Brown, RN, BSN

Jen Brown, RN, BSN Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington.

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Teens and Sexual Assault, Part 2: Drinking and Drugs

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By  This article first appeared on Seattle Children’s Teenology 101 blog.

Picture of a table after a party with wine and beer bottlesIn this post, and posts to come, I’m going to talk about safety measures that teens can take to try and lower their risk of sexual assault. However, that comes with two important caveats.

The first is that, unfortunately, there is nothing a teen can do to keep themselves 100% safe from sexual assault.

The second is that if a sexual assault occurs, the blame is 100% on the perpetrator. It does not matter how the victim was acting, or what risks they took, or whether or not they showed good judgment in the situations leading up to the assault; a person who sexually assaults another person is the only one who bears responsibility for that assault.

The tips I am giving in the next few posts are ways to possibly lower risk, but someone who chooses to ignore all of them should never be blamed if they are attacked.

Sometimes I wonder if we spend time teaching our teens to take safety measures and then forget to teach our teens to not sexually assault people.

Like I mentioned in my last post, take the time to discuss with your teen, no matter what their gender, what is and is not acceptable.

Again, I’m not implying your teen is the type of person to victimize someone, but they might be able to speak up to help someone else.

If one teen had chosen to call the police when they saw what was happening during the Steubenville incident, the victim’s assaults- or at least some of them- might never have happened.

Let’s discuss ways to talk to your teen about increasing their safety, and possibly decreasing their risk of being seen as an “easy target” (again, there are unfortunately no guarantees.) And we’ll start by talking about drinking and drugs.

When someone is intoxicated or under the influence of drugs, their judgment and decision-making capacity is lowered and sometimes nonexistent.

This means that they may not be able to assess risk like somebody sober. They may decide to spend time with someone who, were they sober, their gut instinct would warn them away from.

They may be unable to see the danger of a situation that would normally set off alarm bells. If the effects of alcohol or drugs are visible, someone who is seeking a vulnerable person may be drawn to them. Or, if their impulse control is lowered, they may act aggressively towards somebody else.

If your teen decides to drink- hopefully once they are over 21, but the majority of teens do experiment with alcohol before then- they can avoid drinking to the point of severe impairment, especially when in large groups (keeping in mind, however, that most sexual assaults involve someone known to the victim).

When I was in college, we usually had a friend who agreed to be the “lookout” for an evening of parties, someone to avoid intoxication and make sure that nobody was taken advantage of, and that everyone got back to their dorm room safely. Groups of friends can rotate this responsibility among them.

This is obviously not a sure thing- the designated lookout can be drunk him or herself, they can assume one of their charges is having a good time when really they are quite incapacitated… etc.

But it’s never a bad idea for teens to look out for each other in party or group settings, and speak up if they are concerned that someone is being taken advantage of.

Sometimes teens can become incapacitated without having the chance to consider whether or not they want to drink or take drugs. Another important thing for teens to consider is the possibility that someone might slip a drug into their drink to render them less able to respond to or remember incidents.

When possible, teens should get their own drinks, or at least watch them being poured from a previously unopened container, and never leave their drink unattended. You and your teen can find out more about “date-rape drugs”, and ways to avoid them, here.

There are, of course, many other risks to drinking and drugs, many of which are discussed in the “Drug Use Among Teens” post by Dr. Evans.

But encourage your teen to think about drinking and drugs in terms of sexual assault as well. This may help them increase their own safety, or be able to help a friend when they need it most.

About Jen Brown, RN, BSN

Jen Brown, RN, BSN Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington.

 

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Teens and Sexual Assault, Part 1: The Steubenville Incident

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Seattle Children's Whale LogoBy

This article first appeared on Seattle Children’s Teenology 101 blog.

The small town of Steubenville, Ohio, has suddenly become reluctantly but internationally famous, and events there have made headlines around the world.

The story of a teen girl, dragged unconscious from party to party, her repeated assaults known of and even witnessed by peers, is a nightmare.

It chills any parent’s heart, for multiple reasons: the young woman’s vulnerability, the callous nature of the assault, the youth and former promise of the young men who committed it, and the small town politics that many allege obstructed the initial investigation (the mother of one of the accused is the town’s prosecuting attorney).

I want to go over how to talk to your teens about sexual assault and consent. I touch on this in item number three of “10 Tips For Talking to Your Teen About Sex“, but it deserves further discussion.

It’s vital that you have a frank discussion with your teen about sexual assault, and the media coverage of the Steubenville incident gives parents a perfect opportunity to bring it up.

Your teen needs to know the importance of taking “no” for an answer.

First of all, nobody wants to think their child is capable of sexually assaulting someone else. I’m not trying to imply that your child is a budding sexual predator who would perform the acts the young men are accused of in the Steubenville case.

However, bringing up the topic of sexual assault and sexual consent can help your teen with situations that some teens don’t know how to handle, or where others have made the wrong decision.

You can also hear what your teen thinks, both about Steubenville and sexual assault among teenagers.

Rape and sexual assault are terms that apply to a wide variety of circumstances, not just a man forcing sex on a resisting woman. A woman can sexually assault a man, and same-sex sexual assault occurs all too frequently.

Some victims are temporarily incapacitated by drugs or alcohol (or permanently incapacitated by disabilities, which is beyond my scope here), and under these conditions, cannot consent.

Having sex with a partner who is much younger than the other partner is also a form of sexual assault, and can be prosecuted as such.

Your teen needs to know the importance of taking “no” for an answer- you can’t really be too firm on this point- but that also that consent goes deeper than that.

If someone is intoxicated or their thinking is altered by drugs, they do not have the capacity to choose whether or not they want to have sex.

The one extreme of this is the victim of the Steubenville incident, who either was intoxicated to the point of unconsciousness, or was drugged by her aggressors; reports are unclear.

However, people can be awake and still too intoxicated to consent. Someone who is obviously under the influence is not someone that anyone should be physically intimate with.

Encourage your teen to seek consent from their partner, as opposed to just assuming it. Sometimes when a person perceives that a situation is getting out of control, they may “freeze” instead of fighting back.

This happened to someone I knew in college; in the boy’s mind, she was going along and didn’t say “no,” and in the girl’s mind she had frozen on perceiving danger, and he had continued anyway.

Instead of waiting for “no,” talk to your teen about the important of a “yes.” A simple “Is this okay?” shows not only respect for their partner, but helps a teen know that they are with someone who is truly willing, and is enjoying the experience as much as they are.

Make sure your teen knows that sexual activity with someone younger than them, even if that person gives a resounding “yes,” may be illegal. If they have detailed questions, direct them here to see the specifics.

Have you tried to talk to your teen about this? How did it go? Did they say anything that surprised (or impressed) you? Are teens watching the Steubenville incident unfold, and what do they think about it?

About Jen Brown, RN, BSN

Jen Brown, RN, BSN Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington.

 

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Fewer students smoking and drinking alcohol in Washington state

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Picture of a table after a party with wine and beer bottlesFewer students in Washington state are smoking cigarettes or drinking alcohol, according to the state’s latest Healthy Youth Survey.

The survey is taken every two years by students in grades 6, 8, 10, and 12 in more than 1,000 Washington public schools.

 

Among the findings:

Tobacco:

  • Cigarette smoking is down in all grades. About 10 percent of 10th graders reported smoking a cigarette at least once in the past 30 days —  down from nearly 13 percent in 2010 and from 25 percent in 1999.
  • Nearly as many 10th graders smoked tobacco from a hookah pipe as from a cigarette, and about 7 percent said that they smoked a cigar in the last month.
  • Statewide, about 50,000 youth smoke – and 40 start smoking every day.

Alcohol:

  • Nearly 11,000 fewer students are using alcohol compared to 2010. Still, more than 115,000 youth currently drink.  Twelve percent of 8th graders, 23 percent of 10th graders, and 36 percent of 12th graders used alcohol in the past 30 days.

Marijuana:

  • The  number of secondary school students who believe using marijuana is risky dropped to the lowest level since the state started collecting data and the percentage of Washington 10th and 12th graders who smoke marijuana is nearly double the percentage of cigarette smokers.

Suicide and Depression:

  • About 8 percent of 8th and 10th graders attempted suicide in the past year.
  • Over 100,000 youth, ages 12-17, seriously considered suicide – about one in every six students.
  • More than one in four teens surveyed said they felt so sad or hopeless for two weeks in a row that they stopped doing usual activities: 26 percent in 8th grade, 31 percent in 10th grade, and 30 percent in 12th grade.
  • These numbers haven’t changed much over the past 10 years.

Sex:

  • Nearly one third (32 percent) of 10th graders and more than half (55 percent) of 12th graders reported having ever had sexual intercourse.
  • About 7 percent of 10th graders and 16 percent of 12th graders reported they had four or more sexual partners.
  • About 6 percent of 10th graders and 5 percent of 12th graders reported having sex for the first time at age 12 or younger.

To learn more:

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