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Tuesday Feb 09, 2016

A Primary Care Approach to Curbing Dangerous Teen Trends

Teenagers, no matter how smart, sometimes do senseless things. There are countless viral challenges and trends online, ranging from silly to downright dangerous, that physicians and parents should be aware of.

Need a few examples?

Two Tennessee teens died in mid-January after drinking "dewshine,"(time.com) a toxic mixture of racing fuel and Mountain Dew.

That same week, a 14-year-old boy in Washington shattered his eye socket and cheek bone and landed in the hospital with a brain aneurysm after suffering a fall during a "duct tape challenge."(abcnews.go.com)

And car surfing(abc7.com) resulted in the deaths of several young people in the past year.

Risky behavior during adolescence is not new. Historically, physicians have associated risky behavior in youth with drugs, sexual activity and alcohol. These days, the modern influence of technology has added additional concerns such as texting while driving, meeting strangers online, participating in social media trends and a host of other issues that have parents unnerved.

Predictors of risky teen behavior(psycnet.apa.org) are often complicated but include parental monitoring, peer influence and the teen’s mental health. Violence at home, academic difficulties, poverty and lack of extracurricular activities are also associated with risky behavior.

For physicians, helping to curb risky teen behavior is a complex proposition. Screening tools such as the Rapid Assessment for Adolescent Preventive Services(www.raaps.org) (RAAPS) are validated but underutilized because of limited evidence on outcomes. Primary care teams of physicians, behavioral health specialists and social workers should be comfortable with any followup preventive interventions based on the screening results.

The HEADSS assessment(depts.washington.edu) (home/habits, education/employment/exercise, accidents/ambition/activities/abuse, drugs/diet/depression, sexual activity/suicidal ideation) is a standard part of the adolescent exam, but physicians should make sure they are careful, not cursory, in their history-taking. Awareness of current trends can narrow the societal gap between patients and their physicians.

Communication is also key to adolescent care. Physicians should approach teens in a way that is nonjudgmental with open-ended questions. Although most of the exam should be done without a parent in the room, including a parent in the discussion at the end of a visit offers a unique opportunity to start a conversation. Physicians can often play a powerful role in creating a safe space to facilitate discussions between teens and their caregivers.

Parents can minimize risky behavior though open communication and social media monitoring. They should be aware of and connected to their child’s peer network, teachers, etc.

Society can address some dangers through legislative efforts, such as banning texting while driving, but these efforts cannot guarantee teenagers will be safe from their own poor decision-making. Nonetheless, as times change, our approaches to adolescent care should evolve as well.

Natasha Bhuyan, M.D., is a board-certified family physician in Phoenix. You can follow her on Twitter @NatashaBhuyan(twitter.com).

Posted at 01:10PM Feb 09, 2016 by Natasha Bhuyan, M.D.

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