1. ROADMAP TO
TEEN HEALTH
This counseling tool has been developed by the American Academy of Nurse Practitioners
Supported by an educational grant from Merck

2. Table of Contents and Key Takeaways
Healthcare Provider: Please use this table of contents to determine which sections of this educational tool to share with your patient and their parent(s)/guardian.
THE LEADING RISKS TO TEEN HEALTH ………………………………….. 1
HEALTHY BODY WEIGHT AND HEALTHY EATING ……………………… 2
PHYSICAL ACTIVITY …………………………………………………………. 9
PROTECTION FOR YOUR SKIN ……………………………………………... 13
SLEEP AND TEENS …………………………………………………………… 14
IMMUNIZATIONS FOR TEENS …………………………………………….. 15
TEEN SAFETY …………………………………………………………………. 19
SEXUAL HEALTH …………………………………………………………….. 21
TOBACCO USE ……………………………………………………………….. 23
ALCOHOL AND DRUG USE ………………………………………………… 27
MENTAL AND EMOTIONAL HEALTH …………………………………….. 30

3. The Leading Risks to Teen Health1
Unhealthy diet
Physical inactivity
Accidents and injuries
injury from others
Tobacco product use
alcohol or drug use
The Leading Risks to Teen Health

4. Tips to Help you Stay Healthy2
Eat a healthy diet
Maintain a healthy body weight
Be active 30 to 60 minutes each day
Don’t use any kind of tobacco products
Avoid second hand smoke
Don’t drive if you have been drinking or using drugs
Don’t text or use a cell phone when driving
Don’t use drugs or alcohol
Don’t ride with drivers who are distracted, have been drinking, or using drugs
Always wear your seat belt
Use the right safety equipment for activities
Remember: the “safest” sex is no sex
If you choose to have sex, practice safe sex
Avoid people and places where you might be hurt
Talk with a trusted adult if you feel sad, upset, or depressed
Stay up to date on your immunizations
Tips to Help you Stay Healthy

5. Healthy Body Weight Age Height Weight Sex
A healthy body weight is based on your:
Healthy Body Weight
Age
Height
Weight
Sex 3
Your body mass index (BMI) is a number based on your
Height and weight that indicates your amount of body fat
And helps screen for weight categories that may lead to
Health problems.
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
PERCENTILE
BEST BODY WEIGHT
OBESE
OVERWEIGHT
UNDERWEIGHT

6. What is a Healthy Diet? The eatwell plate Food & Drinks FOOD GROUP4
The eatwell plate
Use the eat well plate to help you get the balance right.
It shows how much of what you eat should come from each food group.
Fat—daily fat intake 25% to 35% total calories per day
• Less than 10% from saturated fat and no trans fats
FOOD GROUP
SERVINGS PER DAY
Grains (whole grain breads, cereals, rice, pasta) 6 to 11
Vegetables and fruits to 9
Protein (meat, tofu, beans) to 3
Dairy (milk, yogurt, cheese) 2 to 3
Vegetables & Fruits
Grains
Dairy
Food & Drinks
high in fat and/or sugar
Protein
A healthy diet is balanced with all kinds of foods in the following groups:

7. The Benefits of Healthy Eating5
The Benefits of Healthy Eating
Healthy eating helps you…
Stay at your best body weight
Think more clearly
Feel good about yourself
Have healthier hair, nails, and skin
Have more energy and feel stronger
Improve your sleep
Lower your chance of illnesses, such as:
Cancer
Diabetes
Heath disease
High blood pressure
Stroke

8. Tips to Help you Eat a Healthy diet6
Eat regular meals, starting with breakfast
Eat healthy snacks in between meals
Eat at least 5 fruits and vegetables each day
Watch the size of food portions
Eat only when you feel hungry
Stop eating when you feel full
Drink at least 8 glasses (8 ounces each) of water each day
Read and understand food nutrition labels
Make healthy choices when eating out
Limit amount of fast foods, soda, desserts, and junk foods
CALORIC INTAKE CHART
ACTIVITY LEVEL * FEMALES MALES
Low 1800 calories 2200 calories
Medium 2000 calories 2400 to 2800 calories
High 2400 calories 3000 cal
Tips to Help you Eat a
Healthy diet

9. How to Read Food Nutrition Labels7
How to Read Food Nutrition Labels

10. Tips for Healthy Weight Loss8
Tips for Healthy Weight Loss
Set a weight loss goal with your health care provider
Try for slow weight loss, about 1 to 2 pounds per week
Choose healthy foods
Eat meals on a smaller plate
Don’t skip meals or wait too long between meals
Eat more salads, veggies, and fruit
Eat slowly and chew well
Drink at least 8 glasses of water each day
Watch the size of food portions
Read and understand food nutrition labels
Make healthy choices when eating out
Don’t deprive yourself of your favorite foods
Limit amount of fast foods, soda, desserts, and junk foods
Keep a food diary and write down what, how much, and when you eat
Be active 30 to 60 minutes each day
Limit the time you spend on the computer
Limit your time spent on video games, the phone, and watching TV

11. The Benefits of Regular Physical Activity
Reach and stay at your best body weight
Help you think clearly
Improve your strength, endurance, and energy
Help you feel positive
Improve your sleep
Lower your chances of injuries
Improve the way you look
Lower your chance of illnesses, such as:
Cancer
Diabetes
Heart disease
High blood pressure
Stroke
Being active helps you:
The Benefits of Regular
Physical Activity 9

12. INDIVIDUAL ACTIVITIES10
Planning for Regular
Physical Activity
Stretch and warm-up first
Cross-train to develop different parts of your body
Strength-train 3 times per week with 1 day of rest in between
Focus on major muscle groups in your upper body, core, and legs
Stay flexible by doing yoga, Pilates, or T’ai chi
Increase your heart rate by doing aerobic activities (dancing, walking, running, cycling, swimming basketball, soccer, etc.)
Stretch and cool down
Find activities you can do at home that are on TV, videos or the internet
Pick activities you enjoy doing by yourself
Pick activities that you can do with your family and friends
TEAMSPORTS
INDIVIDUAL ACTIVITIES
Such as baseball, football, basketball, hockey, soccer, or cheerleading may:
Help you make new friends and spend time with them
Help you feel part of a group with a shared goal
Have fun playing with others for a shared goal
Such as bicycling, running,
swimming, and walking may:
Make you feel independent
Be easier to fit into your schedule
Allow you to set your own goals
Give you some fun time on your own

13. Tips to Help you Start and Stay physically Active11
Tips to Help you Start and
Stay physically Active
Set specific, realistic goals
Make a contract with yourself or another person
Start with small steps and take it slow
Keep an activity log and write down each activity you do and how long
Give yourself time for being active to become a habit
Mix it up by doing strength, aerobic, stretching, and flexibility activities
If you stop for a while, remember you can start again
Write down your progress as you become stronger, work out longer, more often, and feel more healthy
Ask for support from family and friends

14. Tips to Stay Safe During Physical Activity12
Use the right kind of safety equipment for your sport such as:
The right kind of helmet for cycling, skating, skateboarding, or contact sports
Eye protection for soccer, basketball, racquetball, and snow sports
A face guard for football, hockey, and baseball
A mouth guard for contact sports
Wrist, knee, elbow, and shin guards for inline skating, scooters, and skateboarding
Wear sunscreen and sunglasses when outside
Males should wear a protective cup to protect their testicles
Wear the right kind of shoes, fitted correctly, and tied
Take 10 to 15 minutes to warm up
Drink plenty of water before, during and after being active
Know and follow the rules of the game in team sports
Stick to a regular practice schedule
Rest between workouts
Don’t’ work out when sick or injured
Tips to Stay Safe During
Physical Activity

15. Tips for Year-Round Skin Protection13
Try to stay out of the sun from 10 AM to 4 PM
Wear long sleeves and long pants
Wear a hat with a wide brim
Use sunscreens with SPF 30 or higher
Put on 2 coats of sunscreen, 20 minutes apart at least 30 minutes before going outside
Re-apply sunscreen every 1 to 2 hours
Wear sunglasses with UVA and UVB light-absorbing lenses
Never use tanning beds

16. Health Benefits of Sleep for Teens14
Health Benefits of Sleep for Teens
Getting enough sleep helps you…
Improve your performance in school
Listen, learn, think, and solve problems
Have healthier skin
Stick to a healthy diet
Feel better physically and mentally
Lowers your chances of getting sick
TIPS FOR HEALTHY SLEEP
DOS
DON’TS
Go to bed around the same time each night
Get up at the same time each morning
Avoid bright light in the late evening
Turn off your computer, TV, and phone
Make sure your bedroom is quiet, dark, and relaxing
Pick relaxing activities (reading or warm shower) before bedtime
Drink or eat any foods with caffeine late in the day
Eat, drink, or exercise just before you go to bed
Use tobacco or drink alcohol
Start stimulating activities before bedtime (study, texting, conversations)
Change your sleep pattern more than 2 to 3 hours on weekends

17. Why Teens Need Immunizations15
Why Teens Need Immunizations
Shots are not just for little kids
Teens need vaccines or immunizations to “boost” the ones they received as children
Teens also need vaccines to avoid infections that are problems that occur in the teen years
If you missed your pre-teen immunizations, you need to “catch-up”
There are many serious diseases that are prevented by vaccines
Vaccines are safe
Teens should keep a copy of their immunization record and know when their next shots are due.

18. Recommended Immunizations for Teens 11 to 18 Years
VACCINE
AGE
11 to 12
13 to 18
Tetanus, diphtheria, pertussis
1dose
1 dose for catch-up if needed
HPV
3 doses
3 doses for catch-up if needed
Meningitis Meningococcal
1 dose
Influenza
1 dose each year
Pneumonia Pneumococcal
Certain high-risk groups
Hepatitis A
2doses
For high-risk groups
2 doses for catch-up if needed
Hepatitis B
3 doses for catch-up regardless of risk (or 2 doses of adult vaccine ages 11-15)
Measles, mumps, rubella
Catch-up if needed
Chicken pox (varicella)
2 doses
Series for catch-up if needed 16

19. Important to Your Health?17
Why Are Immunizations
Important to Your Health?
Tetanus: A bacterial infection that causes stiffness of the jaw and other muscles that can cause:
Painful muscle spasms
Death
HPV (Human Papilloma Virus): A virus that causes genital warts, the most common sexually transmitted infection (STI) that can cause:
Cervical cancer
Genital warts in males and females
Other kinds of cancer
Meningitis: A viral or bacterial infection that causes inflammation and swelling in the brain and spinal cord that can cause:
Seizures
Brain or kidney damage
Loss of eyesight or speech
Learning disabilities
Paralysis
Influenza or the flu: A virus that causes a respiratory illness that can cause:
Death, especially in people with other health problems that weaken their immune system •

20. Important to Your Health?
Why Are Immunizations
Important to Your Health?
Pneumonia (high risk teens only): Inflammation of the lungs caused by a virus, fungus, or bacteria that can cause:
Fluid in the lungs
Serious respiratory problems
Infection that spreads in the bloodstream throughout the body
Hepatitis: A viral infection that can cause 3 types of the infection (A, B, or C)
that can cause:
Liver damage
Liver cancer
Death
Measles: A virus that lives in the nose and throat that can cause:
Ear infections
Bronchitis or laryngitis
Pneumonia
Brain inflammation
mumps: A virus that causes painful swelling in the glands below and in front of the ears
Swelling of the testicles that may cause infertility
Inflammation of the ovaries
Brain inflammation, meningitis, or loss of hearing
Chickenpox or varicella: an infection caused by the varicella zoster virus that causes
fever and an itchy rash that can cause:
Skin infections
Brain swelling 18

21. Tips to Help You Stay Safe19
Tips to Help You Stay Safe
Always wear a seatbelt when driving or riding in a car
Always wear a helmet when you ride your bicycle, a motorcycle, or as needed for sports
Don’t drive if you have been drinking or using drugs
Don’t text or use a cell phone when driving
Don’t ride with drivers who are distracted, have been drinking, or using drugs
Stay away from places and people where you may be hurt
Stay away from persons who are quick to get angry
Learn how to control your own anger

22. Tips to Keep You from Being Hurt by Others20
Tips to Keep You from
Being Hurt by Others
WHAT TO DO IF YOU OR OTHERS ARE HURT
If you are hurt or attacked, call 911 and get help from your parent(s)/guardian or a trusted adult
Ask for medical care if you need it
If someone else has been hurt or attacked, call 911 or get help from a trusted adult
If you feel that you someone is trying to hurt you, try to get to a safer place or safer people
Stay in areas where there are other people
Stay away from people carrying guns, knives, or other weapons

23. HOW CAN YOU PREVENT A SEXUALLY TRANSMITTED INFECTION (STI)?
What to Consider if You’re
Thinking about Having Sex
Having sex can …
Lead to pregnancy
Cause feelings or emotional reactions you did not expect
Put you at risk for dating violence
Increase your chance of getting a sexually transmitted infection (STI)
HOW CAN YOU PREVENT A SEXUALLY TRANSMITTED INFECTION (STI)?
Use latex condoms when having all types of sexual intercourse, including oral and anal sex
Know the right way to use condom
Use a new condom with each
new sexual act
Talk with your partner about
safe sex and their exposure
to STIs
Chlamydia
Genital Herpes
HPV
Gonorrhea
Hepatitis
HIV
Syphilis
Trichomonas 21

24. Tips to Safer Sex if You Choose to Have Sex Remember:
Not having sex is always a choice
You can still show caring by hugging, holding hands, and giving your partner loving massages
Talk with your partner about your needs, limits, and feelings
Choose to do sexual behaviors that feel comfortable to you
Plan ahead:
Make sure you have a latex condom
Make sure you know how to use a condom
Use latex condoms with all kinds of sexual intercourse, including oral and anal sex
Use a new condom each time
Remember when you have sex with your partner, you are exposed to everyone your partner may have had sex with
If you have unprotected intercourse, see your health care provider (women should see their provider within 3 days)
See your healthcare provider if you think you have a STI, are pregnant, have questions about sex, or feel that you are not safe 22
Tips to Safer Sex if
You Choose to Have Sex

25. Tobacco Health Effects
Hurts your lungs and can lead to more frequent asthma attacks, coughing, and respiratory infections
Causes your skin to be dry, yellow, and wrinkled at an earlier age
Limits amount of oxygen that reaches your muscles, making it harder to be physically active
Causes long-term effects such as cancer, emphysema, heart disease and infertility
Causes addiction
Makes you feel anxious, nervous, moody, and depressed
Causes headaches and dizziness
Stains your teeth and causes bad breath
Makes your clothes and hair smell
Changes the taste of foods
Makes your heart work harder when you are physically active
Tobacco product smoke contains more than 4000 chemicals with nicotine the most common and addictive “ingredient”.
toluene
(Industrial
Solvent)
Hexamine
(Barbecue
Lighter)
Stearic acid
(Candle Wax)
Carbon
Monoxide
arsenic
(Poison)
Butane
(Lighter
Fluid)
acetic acid
(Vinegar)
methane
(Sewer Gas)
Nicotine
(Insecticide)
ammonia
(Toilet Cleaner)
Cadmium
(Batteries)
Methanol
(Rocket Fuel) 23

26. 24
Smokeless tobacco
Smokeless tobacco (also called spit tobacco, chewing tobacco, chew, and dip) has 2 forms
Snuff
Chewing tobacco
Snus is a moist, smoke-free, spit-free form of smokeless tobacco
Smokeless tobacco has 28 substances in it that can cause cancer
Use of smokeless tobacco can lead to nicotine addiction and make it more likely you will smoke cigarettes
Smokeless tobacco can cause:
Low or abnormal sperm count that can lead to infertility
Gum disease
Pre-cancerous lesions in the mouth that look like white patches
Cavities

27. Tips to Help You Quit Using Tobacco
Get a check-up and set a date with your health care provider to quit
Find a friend who will quit with you
Get support from friends and family members
Wash all your clothing to get rid of the tobacco smell
Avoid triggers that make you want to smoke
Switch to gum, carrot sticks, or sunflower seeds instead of using tobacco
Be ready for the physical and emotional effects of quitting such as:
Headache, fatigue, dry mouth, sore throat, urge to eat more, feeling crabby, jumpy or depressed
Remember the withdrawal symptoms last for only a short time and the benefits of quitting start right away
Keep busy and distracted
Some quit best old-turkey
Throw away all of the tobacco products you use
Others quit best if they slowly lower the amount of tobacco they use 25

28. What is Second-Hand Smoke?
Second-hand smoke is:
Smoke that is exhaled by a smoker
Smoke that comes from the end of a lighted cigarette, pipe, or cigar
Tips to Avoid Second-Hand Smoke
Stay away from second-hand smoke at school and work
Ask family members you live with to smoke outside or quit smoking
Don’t ride in the car with someone who is smoking
Stay away from public places that do not ban smoking
What is Second-Hand Smoke? 26

29. Short- and Long-term Effects of Drugs and Alcohol
Confused thinking and memory loss
Slower reaction times
Loss of balance
Slurred speech
Distorted or blurry vision and hearing
Bad breath
Poor performance at school
Difficulty having an erection
Accidental injury to yourself or others
Alcohol poisoning, accidental overdose, and death
Increased risk of sexual assault or high-risk sexual behaviors
Addiction and the development of tolerance so you need more to have the same effect
Unhealthy diet and serious vitamin deficiencies 27

30. Tips to Avoid Using Drugs and Alcohol28
Say no with or without an explanation or reason
Say no and ‘blame’ an adult for your refusal
Have a plan to leave if you are someplace where others are using alcohol or drugs
Be the ‘designated driver’
Tips to Avoid Using
Drugs and Alcohol

31. Tips to Stop Using Alcohol and Drugs29
Tips to Stop Using
Alcohol and Drugs
Learn more about the harmful effects of alcohol and drugs
Get a check-up and set a date with your health care provider to quit
Find a friend who will quit with you
Get support from friends and family members
Throw away all of the alcohol or drugs you use
Eat healthy foods, drink plenty of juice and water, and get enough sleep
Prepare for the physical and emotional effects caused by quitting
Join a support group such as Alcoholics Anonymous or Narcotics Anonymous
Stay away from people, situations, and places that make you want to drink or use drugs
Keep yourself busy and distracted
Reward yourself each time you do not use alcohol or drugs when you have a craving

32. Eating disorders Eating Disorders can cause: Signs of Eating Disorders
Heart disease including an abnormal heart rate and heart failure
Low red blood cell count (anemia) that causes fatigue
Weak immune system that increases your chances of getting infections
Kidney problems
Stopping your regular menstrual periods
Thinner, weaker bones that increase your chances of breaking a bone
Stomach problems
Eating when you are not hungry
Eating large amounts of food
Eating alone or in secret
Hiding what you have eaten
Using diet pills, diuretics, or laxatives, especially after eating large amounts of food
Making yourself vomit
Feelings of disgust, embarrassment, shame, or guilt about food and eating
A negative body image
Exercising too much
Strictly limiting the amount of food you eat
Weighing the foods you eat, counting calories, and strictly monitoring portion sizes
Being very concerned with how much you weigh
Eating disorders
Signs of Eating Disorders 30

33. Signs of Mental or Emotional Problems Feelings . . .
Sad or hopeless for no reason
Irritable or angry
Crying a lot
Anxious, restless, fearful, or worried a lot
Feeling guilty, worthless, or embarrassed
Use of alcohol or drugs
Dieting or over-exercising
Hurting yourself or doing risky behaviors
Acting violently toward others
Thinking about suicide 31
Wanting to be alone and not spend time with friends and family
Loss of interest in your usual activities
Changes in your eating and sleeping habits
Physical symptoms such as blushing, sweating, trembling, and feeling sick to your stomach
Feeling tired or loss of energy
Having trouble concentrating
Not completing tasks
Poor performance in school
Changes in usual behaviors . . .
Feelings . . .
Start of new behaviors . . .

34. Getting Help for a Mental or Emotional Problem
Talk with your parents(s)/guardian, or another trusted adult
See your health care provider
If you are given medication, make sure you take it as prescribed and don’t stop taking it suddenly
Join a support group
Stay active
Stay in touch with your friends and family even if you feel like being alone
Eat a healthy diet, get regular activity, and the right amount of sleep
Try to stick to your usual routine 32

35. Signs of an Unsafe Relationship33
You feel afraid of your partner or afraid of what your partner will do to you if you break up
Your partner calls you names, makes you feel stupid, criticizes you, or puts you down
Your partner is very jealous
Your partner tries to cut you off from your friends and family
You feel afraid of your partner if you say “no” to touching or sex
Your partner blames you for his or her violent behaviors
Signs of an Unsafe Relationship
You may be in an unsafe relationship if:
Your partner physically hurts you
Your partner is really nice sometimes and then changes and becomes really mean
Your partner promises not to hurt you any more but then repeats his or her behavior

36. Tips to Have Safe Relationships
Get to know a person first before becoming close or intimate
‘Hangout’ in groups first
Find out if you share similar interests
Have relationships based on respect and honesty
Make sure your parent(s)/ guardian(s) know your friends
Let your parent(s)/ guardian(s) know where you are going, who you are going with, and when you will be home
Make sure you can get home or to a safe place on your own by driving yourself or having enough money to take the bus or taxi
Know the address and phone numbers of people you trust and can call if you need help
If you don’t feel safe, talk with your parent(s)/ guardian(s), or other trusted adults such as a teacher, minister, or your health care provider 34
Tips to Have
Safe Relationships