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

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

The Leading Risks to Teen Health 1 Unhealthy diet Physical inactivity Accidents and injuries injury from others Tobacco product use alcohol or drug use The Leading Risks to Teen Health

Tips to Help you Stay Healthy 2 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

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

What is a Healthy Diet? The eatwell plate Food & Drinks FOOD GROUP 4 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 5 to 9 Protein (meat, tofu, beans) 2 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:

The Benefits of Healthy Eating 5 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

Tips to Help you Eat a Healthy diet 6 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

How to Read Food Nutrition Labels 7 How to Read Food Nutrition Labels

Tips for Healthy Weight Loss 8 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

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

INDIVIDUAL ACTIVITIES 10 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

Tips to Help you Start and Stay physically Active 11 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

Tips to Stay Safe During Physical Activity 12 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

Tips for Year-Round Skin Protection 13 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

Health Benefits of Sleep for Teens 14 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

Why Teens Need Immunizations 15 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.

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

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 •

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

Tips to Help You Stay Safe 19 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

Tips to Keep You from Being Hurt by Others 20 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

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

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

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

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

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

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

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

Tips to Avoid Using Drugs and Alcohol 28 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

Tips to Stop Using Alcohol and Drugs 29 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

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

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 . . .

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

Signs of an Unsafe Relationship 33 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

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