TEEN HEALTH

WHAT HAPPENED TO THAT SWEET CHILD Major changes in the brain and body of teens that equip them for the passage to adulthood Beginning to handle complex information and make decisions Starting to handle more complex emotions and to control behavior Risk takers as they understand their place in the world Impulse control is not mature Strive for independence Judgment is still mostly primordial and reactive Change from family to peer group as major source of socialization Emotional maturity is still forming

DIET AND EXERCISE

OBESITY

SLEEP 45% of adolescents are sleep deprived <9 hours Onset of puberty is coincident with a shift in circadian rhythm and results in a time delay for sleep Strong affects of hormones on these rhythms Starts in girls around 8 and boys around 10, but peaks in puberty There is decreased sleep pressure and a lengthening of the circadian cycle

AFFECTS OF SLEEP DEPRIVATION Heightened/exaggerated worry Increased susceptibility to anxiety Linked to depression and suicidal ideation Poor school performance Increases weight Increased incidence of driving accidents Sleep disorders

SEXUAL BEHAVIOR 50% report sexual activity: 16% with >one partner Many unprotected Increased use of condoms since 2002 Up to 70-80% of males at first encounter Non-hormonal BC is also on the rise with 8% of girls Overall 75% females and 85% males are employing some form of protection Sexting is a modern invention 13% of HS kids receive sexts; boys>girls 10% have sent them Linked to depressive behaviors Linked to non-heterosexual orientation Hook-ups also a modern form of sex

DRUGS AND ALCOHOL 75% of teens drink or have tried drinking 50% had someone else get it for them 25% had >5 drinks 25% drank before sex 28% rode in a car with driver who had been drinking 10% had driven after drinking 36% have used marijuana 5-10% other drugs

1. The Federal Interagency Forum on Child and Family Statistics 1 DEPRESSION

THE TEEN BRAIN Major growth Particularly in the frontal cortex Higher function/reasoning-CEO setting priorities, organizing plans and ideas, forming strategies, controlling impulses, and allocating attention Socialization Significant growth in neurons in pre-adolescence with a use-it or lose-it maturation process thereafter Increase in dopamine receptors Mechanism for mature judgment and impulse control Reward system, this is where the behavior-reward system matures Increase in neuronal connections Allows for parallel parts of the brain to communicate for enhanced and more intricate learning and ability to handle more difficult information and emotions

EVERYTHING IS IN PROCESS Most areas are not mature until the late 20s Response to stimuli is not based in judgment but is more based in fear (impulsive) Ability to determine outcomes both emotional and rational are very difficult Actions such as pregnancy are not projected into the future

SUPPORT THE CHANGE Brain is well suited to handle the changes of adolescence Since the link between positive experiences and behaviors is so strong at this stage, adolescents can contribute to their own growth What about parents/other adults/institutions They need safe environments and guidance from adults How can adolescents make mistakes and recover Studies show that resilience is one of the key factors that predicts happiness and sucess How do adults and institutions support the adolescent so that at the end they are well adjusted, competent, confident adults

PARENT’S ROLE IS CHANGING Teens do not readily share with adults naturally Need to provide modes for this to occur Be non-judgmental This is a time of heightened sensitivity about who they are, you will loose them if you are not open Set expectations and discuss consequences Support them is they fall short Allow them to take chances and make mistakes Lead by example they are watching

ON-SET OF SOME DISEASES Eating disorders Sleep disorders Autoimmune disease Psychological disorders Asthma Sex related issues Infections 25% of STDs are in teens Abnormal PAP smears Teens are more likely to have abnormalities, are very vulnerable

PHYSICIAN VISIT State your concerns at the beginning of the visit and then leave This is your child’s time to establish a bond and a safe place to share difficult issues If they find their confidence has been broken they will not share You can still be part of the process, and will be asked to consent for medical issues, ie vaccines, tests, etc.

PERTUSSIS

NEISSERIA MENINGITIDIS Highest incidence of disease < 5 yr Case-fatality rate is highest in adolescents ( 20%). Increased risk among college freshman living in dormitories. At least 75% of cases in 11- to 18-year-olds are caused by serogroups A, C, Y, and W % of cases in infants caused by serogroup B- no vaccine for serotype B

NEISSERIA MENINGITIDIS-VACCINES Conjugated tetravalent vaccine (Menactra-MCV4) Licensed by FDA 1.05 Contains serogroups A, C, Y, and W-135 Elicits strong T-cell dependent responses that induce memory

GARDASIL ® (Quadrivalent Human Papillomavirus [HPV Types 6, 11, 16, 18] Recombinant Vaccine) US HPV INFECTION STATISTICS HPV is the most common STD in young sexually active individuals In sexually active individuals 15–24 years of age, ~9.2 million are currently infected. 3 An estimated 74% of new HPV infections occur in this age group. 3 Lifetime risk for sexually active men and women is at least 50%. 1 By 50 years of age, at least 80% of women will have acquired genital HPV infection Centers for Disease Control and Prevention. Rockville, Md: CDC National Prevention Information Network; Cates W Jr, and the American Social Health Association Panel. Sex Transm Dis. 1999;26(suppl):S2–S7. 3. Weinstock H, Berman S, Cates W Jr. Perspect Sex Reprod Health. 2004;36:6– Burk RD, Ho GYF, Beardsley L, Lempa M, Peters M, Bierman R. J Infect Dis. 1996;174:679– Bauer HM, Ting Y, Greer CE, et al. JAMA. 1991;265:472–477.

ESTIMATED ANNUAL BURDEN OF HPV- RELATED DIAGNOSES IN THE UNITED STATES 11,150 new cases of cervical cancer 3,507 new cases of vulvar cancer 2,516 new cases of anal cancer 1,070 new cases of vaginal cancer 330,000 new cases of high-grade cervical dysplasia (CIN 2/3) 1.4 million new cases of low- grade cervical dysplasia (CIN 1) 1 million new cases of genital warts

CANCERS CAUSED BY HPV

GARDASIL: THE FIRST CERVICAL CANCER VACCINE IN THE UNITED STATES Quadrivalent human papillomavirus (HPV) 6/11/16/18 L1 virus-like particle (VLP) vaccine Licensed by FDA in June in Review In Peds ID “The most important new vaccine seems to be human papillomavirus…” Bivalent 16/18-licensed in 2010

GARDASIL: EFFICACY AGAINST HPV 16 – OR 18 – RELATED CIN A 2/3 OR AIS B c2c 2c2c 98% Efficacy (92, 100) 100% Efficacy (87, 100) n=7,402n=7,205n=7,382n=7,316n=8,493n=8, HPV 16/18–RelatedHPV 16–RelatedHPV 18–Related GARDASILPlacebo Related Cases a CIN = cervical intraepithelial neoplasia. b AIS = adenocarcinoma in situ. c One case was a coinfection with HPV 52, the other was a coinfection with HPV 51 and 56. Total 98% Efficacy (94, 100) GARDASIL ® [Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant]

GARDASIL ® (Quadrivalent Human Papillomavirus [HPV Types 6, 11, 16, 18] Recombinant Vaccine) Ph III–P016, 018 Safety/Immunogenicity 9- to 15-year-old adolescents Age at Enrollment (Years) ,100 1,300 1,500 1,600 Serum cLIA GMT with 95% CI, mMU/mL Efficacy ProgramImmunogenicity Bridge *Inclusive of 5 study protocols; all GMTs measured using cLIA. 1. Data on file, MSD. Adolescent Females (aged 9–17) Young Adult Females (aged 18–26) Per-protocol immunogenicity population (ages 9–26)* Neutralizing anti-HPV 6 GMTs at Month 7 NEUTRALIZING ANTIBODIES BY AGE AT ENROLLMENT 1