For Teens, Privacy May Trump Health Care

If teens' desires for health care privacy aren't respected, their care could be compromised, a new study suggests. Teens are cautious about revealing sensitive information to health care providers for fear of being judged, and are reluctant to talk to unfamiliar or multiple medical staff, according to researchers at Cincinnati Children's Hospital Medical Center. The researchers conducted 12 focus groups for 54 teenagers and found that keeping health care information private was their most important issue. They also found that younger teens were more likely than older adolescents to want parental involvement.

In fact, some older adolescents said they might avoid a health care visit to prevent information being shared with their parents. Among the other findings:

* Teens of all ages said they would not discuss sensitive topics with health care providers if they thought the provider would judge them or "jump to conclusions."

* Younger teens said they did not have personal discussions with providers they didn't know or like, or if they believed the provider did not need to know the information.

* Only younger adolescents said they had concerns about violations of physical privacy.

* Kids with chronic illnesses better understood and accepted the need to share information with health care providers.

Doctors and other health care professionals need to make it as easy as possible for teens to share information, and need to respect their readiness or reluctance to disclose information, said lead author and adolescent medicine physician Dr. Maria Britto. "If the information isn't urgent, such as a routine health visit, providers may be better off waiting to ask sensitive questions until they know the teen better and can get better information once they've established trust," Britto said in a hospital news release.

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Teens, Parents Often Lie About Illicit Drug Use

Don't expect teens or their parents to be honest about their drug use, a new study shows. Researchers often survey teens to determine the extent of drug use, but this new research finds that respondents frequently lie even if they know they'll be tested for drugs or they're told the results will be confidential.The findings are important for pediatricians to understand, said study lead author Dr. Virginia Delaney-Black. "If you think it's important to know whether a kid is doing drugs specifically heroin, prescription pain killers or cocaine then don't rely on what the teens report," she said.

Perhaps some folks don't trust the confidentiality agreement; others may think their behavior is no one else's business or they may fear reprisal. "Many of us feel that this kind of personal information is personal, and that we don't have to tell other people what the truth is," said Delaney-Black, a professor of pediatrics at Children's Hospital of Michigan. For this study, researchers surveyed more than 200 teens and 200 caregivers 80 percent were mothers about their drug use and then analyzed their hair for at least one drug. The participants were black, poor and from an inner-city urban area.

The study findings, reported in the November print issue of the journal Pediatrics, were published online Oct. 25. No teens said they'd recently used opiates such as heroin or prescription painkillers, but the hair tests showed that nearly 7 percent had. Among parents, 3 percent admitted using opiates while testing revealed use by 7 percent. About 1 percent of teens reported recent cocaine use, while testing revealed the actual number was about one-third. Hair analysis showed 28 percent of parents had used cocaine but only about 6 percent admitted it.

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For Many Gay Youth, Bullying Exacts a Deadly Toll

A series of suicides involving bullied gay teens has shocked much of America this past month. On Sept. 9, 15-year-old Billy Lucas of Greenburg, Ind., hanged himself after enduring constant taunts from bullies at school. Two weeks later, 13-year-old Asher Brown from suburban Houston shot himself soon after revealing he was gay. And on Sept. 27, another 13-year-old, Seth Walsh of Techachapi, Calif., died after injuries sustained from hanging himself. He too, had endured "relentless" bullying from other kids, according to The New York Times.

One more death the Sept. 22 suicide of 18-year-old Rutgers University freshman Tyler Clementi catapulted these and other suicides of young gay teens into the media spotlight. Clementi's roommate, Dharun Ravi, allegedly broadcast surreptitious video footage over the Internet of Clementi in an intimate encounter with a young man. Last week, Clementi left a message on his Facebook page: "Jumping off bridge sorry," and then did just that. Cases like these are far from rare, and "this may be the tip of the iceberg," said Dr. David Reitman, chair of the Gay, Lesbian, Bisexual Transgender and Questioning Special Interest Group, part of the Society for Adolescent Health and Medicine.

In a statement, he said "the tragic outcome in these cases underscores the profound consequences that bullying and harassment can have on a young person." Of course any child, gay or straight, can become victims of bullying, as the much-publicized suicide in January of 15-year-old Phoebe Prince of South Hadley, Mass., showed all too tragically. She had withstood months of bullying from schoolmates after moving from Ireland. But experts say adolescence renders young people especially vulnerable to harassment, and the difficulties of grappling with sexuality can complicate that further.

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Discrimination Can Hurt Teens, Body and Soul

Discrimination experienced by U.S. teens from Latin American and Asian backgrounds can affect their grades and health, and is associated with depression, distress and reduced self-esteem, a new study has found. University of California, Los Angeles researchers asked 601 high school seniors, who generally range in age from 17 to 19 years, to record any discriminatory events or comments they experienced over two weeks. They were also asked to note any physical symptoms, such as headaches, stomachaches and general pain.

Nearly 60 percent of the teens reported discrimination from other teens, 63 percent reported discrimination from adults, and 12 percent said they experienced discrimination every day. Latin American teens reported more adult discrimination than Asian American teens, while Asian American teens reported more adult discrimination than white teens of European descent. Both Latin American and Asian American teens reported more discrimination by their peers than the white teens. Teens who experienced higher levels of peer or adult discrimination reported more aches, pain and other symptoms, and had lower overall grade-point averages, the investigators found.

The study was released online in advance of publication in an upcoming print issue of the Journal of Research on Adolescence. Discrimination can be especially hard on teens, the study authors noted. "These are the years when social identity is arguably more salient among teenagers who are struggling with defining who they are. Adding on a 'layer' of discrimination is not an easy thing for them to deal with," one of the study authors, Andrew J. Fuligni, a professor of psychiatry at UCLA's Semel Institute for Neuroscience and Human Behavior, said in a university news release. "Discrimination significantly predicted lower, higher levels of depression, higher levels of distress, lower self-esteem and more physical complaints," Fuligni added. "So the bottom line? Discrimination is harmful."

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Clearing Kids for Sports Participation Sparks Conflicts

Most teenagers think they're invincible, and that goes double for talented teenage athletes. They're young, immortal, at the top of their game, the envy of their friends. So when news hits that an apparently healthy, high school or college athlete has dropped dead in the midst of playing his or her favorite sport, millions of parents get understandably anxious. The uppermost question becomes: Should my child be screened before participating in sports? What tests are needed? And how can we be sure that he or she is truly healthy enough to compete? Everyone agrees that a medical checkup before participating in sports is crucial. But the agreement seems to stop there. At the core of the conflict over further testing is how extensively young athletes' hearts should be tested before they're cleared for athletic participation.

"I think everyone should have a doctor who evaluates them, and the doctor should know the child is going to be participating in athletics," said Dr. Paul Thompson, the director of preventive cardiology at Hartford Hospital in Connecticut, who helped write a joint position statement in 2007 from the American College of Sports Medicine and the American Heart Association. That statement recommends cardiovascular screening for high school and college athletes before they start participating in athletics and at two- to four-year intervals. The screening should include a family history, a personal history and an exam "focused on detecting conditions associated with exercise-related events," according to the groups' recommendation.

But, there's more: "The AHA does not recommend routine, additional noninvasive testing such as a routine EKG." The American Academy of Pediatrics seems to agree. "Every athlete should have a thorough history [taken] from the athlete as well as the athlete's family," explained Dr. Reginald Washington, a pediatric cardiologist and chief medical officer at Rocky Mountain Hospital for Children in Denver and past chairman of the academy's committee on sports medicine and fitness.The doctor should ask about any chest pain and dizziness, and whether the athlete has ever passed out or experienced a racing or unusual heartbeat, Washington said. The physician should also ask if the athlete's parents have had early heart disease, before age 55 for a man and 65 for a woman. And the physical exam, he said, should be thorough and include listening to the heart, taking blood pressure and feeling the pulse.

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Unvaccinated Teen's Life Forever Changed

Carl Buher came home from the football game feeling rotten. A strong, healthy, 14-year-old high school freshman, Carl had attended a day's worth of school and then played in the game, but it felt as if he were coming down with the flu. That made sense: A lot of his teammates had recently had the flu, and he figured they'd just passed it on to him. So he came home, ate, did his homework and went to bed, recalled Carl's mother, Lori Buher of La Conner, Wash. When she woke him up in the morning, Carl told her he'd been up all night vomiting. "We figured he had the flu, so he stayed home from school," Buher said. The first sign that Carl might be sicker than they thought came in the form of purple bruises that began to form, first on his face and then down his arms and legs. By 2 p.m., Buher took her son to the doctor, concerned for his health.

The doctor diagnosed Carl quickly and, as it turned out, accurately: The teen had contracted meningococcal meningitis. The diagnosis took Buher by surprise. "He had none of the symptoms you hear about," she said. "No stiff neck. No terrible headache. No high fever." The family physician sent Carl to the local hospital's emergency room. Within hours he was being airlifted to Seattle Children's Hospital. "His heart stopped twice on the helicopter," Buher said. "They had to revive him." This was in 2003, and Buher knew about meningitis and knew that a vaccine was available to prevent it. But at the time, the vaccine Menomune wasn't recommended for kids Carl's age. Teens headed for college were supposed to get the vaccine, but even that was a shaky proposition.

Buher's two college-age kids were on a waiting list for Menomune vaccination but hadn't received it yet because supplies were short. Now her son Carl was incredibly sick with the disease. She and her husband hurriedly made the hour's drive to Seattle. "When we got there, they had a social worker waiting to help us prepare for his death," she remembers. "It was so overwhelming." Doctors put Carl in a drug-induced coma, in which he lingered for five weeks. His mother recalls that he was given more than 25 different medications to keep his body functioning. Nonetheless, meningitis ravaged Carl's body. He had to have both legs amputated below the knee, and he also lost three fingers. The purple bruising turned out to be his skin dying, which led to gangrene. Carl endured skin grafts all over his body, 13 in all, and still bears the scars. His weight fell from 185 to 119 pounds.

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Sleep-Deprived Teens Eat More Fat, Study Finds

Teens who sleep less than eight hours a night are more likely to eat a high-fat diet that puts them at risk for obesity and the many health problems connected with it, new research shows. The study, published in the Sept. 1 issue of the journal Sleep, found that these sleep-deprived teens consumed 2.2 percent more calories from fat, and ate more snacks than those who slept eight hours or more a night. They also ate more total calories. "There's been a lot of research over the last five years implicating insufficient sleep with obesity," said study author Dr. Susan Redline, of Brigham and Women's Hospital and Beth Israel Deaconess Medical Center in Boston.

"Some experimental studies on sleep deprivation in controlled laboratory environments show a craving for fatty foods among the participants" who got less sleep, she said. Redline, a professor of medicine with the school's division of sleep medicine, said sleep-deprived teens may suffer from metabolic disturbances that have been linked to obesity and insulin resistance in other research with shift workers whose sleep was also irregular. Metabolism is the body's process for turning calories into energy. Lack of sleep can affect metabolism by changing the level of appetite-regulating hormones like leptin and ghrelin, setting the stage for poor eating habits, Redline explained.

In addition to being a possible cause of metabolic problems, fewer hours of sleep provided teens with "more opportunities to eat," Redline said. Teens need about nine hours of sleep every night to feel rested and alert the next day, but few teens get that amount, experts said. "I almost never see anyone who is sleeping more than seven hours a night," said Dr. Paula Elbirt, an associate professor of pediatrics and adolescent medicine at Mount Sinai Medical Center in New York City. Insufficient sleep among teens is "the rule, not the exception," she said. Elbirt said the "adolescent lifestyle" encourages teens to stay up late.

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