Supported by an educational grant from Merck

1. ROADMAP TO TEEN HEALTH This counseling tool has been developed by the American Academy of Nurse Practitioners SupportedbyaneducationalgrantfromMerck

2. TableofContentsand KeyTakeaways HealthcareProvider:Pleaseusethistableofcontentstodetermine which sections of this educational tool to share with your patient and their parent(s)/guardian. THELEADINGRISKSTOTEENHEALTH ………………………………….. 1 HEALTHYBODYWEIGHTANDHEALTHYEATING ……………………… 2 PHYSICALACTIVITY …………………………………………………………. 9 PROTECTIONFORYOURSKIN ……………………………………………... 13 SLEEPANDTEENS ……………………………………………………………14 IMMUNIZATIONSFORTEENS …………………………………………….. 15 TEENSAFETY …………………………………………………………………. 19 SEXUALHEALTH …………………………………………………………….. 21 TOBACCOUSE ……………………………………………………………….. 23 ALCOHOLANDDRUGUSE ………………………………………………… 27 MENTALANDEMOTIONALHEALTH …………………………………….. 30

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

4. Tips to Help you Stay Healthy • 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 2

5. Healthy Body Weight A healthy body weight is based on your: • Weight • Sex • Age • Height 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 0 OBESE OVERWEIGHT BEST BODY WEIGHT PERCENTILE UNDERWEIGHT 3

6. What is a Healthy Diet? 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. Vegetables & Fruits Grains Protein Dairy Food & Drinks high in fat and/or sugar A healthy diet is balanced with all kinds of foods in the following groups: 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 Fat—daily fat intake 25% to 35% total calories per day • Less than 10% from saturated fat and no trans fats 4

7. 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 5

8. TipstoHelpyouEata Healthydiet • 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 6

9. How to Read Food Nutrition Labels 7

10. 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 8

11. TheBenefitsofRegular PhysicalActivity Being active helps you: • Improve the way you look • Lower your chance of illnesses, such as: • Cancer • Diabetes • Heart disease • High blood pressure • Stroke • 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 9

12. Planningfor 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 10

13. TipstoHelpyouStartand Stayphysically 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 11

14. TipstoStaySafe During PhysicalActivity • 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 12

15. TipsforYear-Round SkinProtection • 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 13

16. 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 14

17. 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. 15

18. RecommendedImmunizations forTeens11to18Years 16

19. Why Are Immunizations ImportanttoYourHealth? • Tetanus:Abacterialinfectionthatcausesstiffnessofthejawandothermuscles thatcancause: • Painfulmusclespasms • Death • HPV(HumanPapillomaVirus):Avirusthatcausesgenitalwarts,themostcommon sexuallytransmittedinfection(STI)thatcancause: • Cervicalcancer • Genitalwartsinmalesandfemales • Otherkindsofcancer • • Meningitis:Aviralorbacterialinfectionthatcausesinflammationand swellinginthe brainandspinalcordthatcancause: • Seizures • Brainorkidneydamage • Lossofeyesightorspeech • Learningdisabilities • Paralysis • Influenzaortheflu:Avirusthatcausesarespiratoryillnessthatcancause: • Death,especiallyinpeoplewithotherhealthproblemsthatweakentheir immunesystem 17

20. WhyAreImmunizations ImportanttoYourHealth? • 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:Aviralinfectionthatcancause3typesoftheinfection(A,B,orC) • thatcancause: • Liverdamage • Livercancer • Death • Measles: Avirusthatlivesinthenoseandthroatthatcancause: • Earinfections • Bronchitisorlaryngitis • Pneumonia • Braininflammation • mumps:Avirusthatcausespainfulswellingintheglandsbelowandinfrontoftheears • thatcancause: • Swellingofthetesticlesthatmaycauseinfertility • Inflammationoftheovaries • Braininflammation,meningitis,orlossofhearing • Chickenpoxorvaricella:aninfectioncausedbythevaricellazostervirusthatcauses • feverandanitchyrashthatcancause: • Skininfections • Brainswelling • Pneumonia 18

21. 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 19

22. TipstoKeepYoufrom BeingHurtbyOthers • 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 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 20

23. WhattoConsiderifYou’re ThinkingaboutHavingSex 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) • Chlamydia • Genital Herpes • HPV • Gonorrhea • Hepatitis • HIV • Syphilis • Trichomonas HOW CAN YOU PREVENT A SEXUALLY TRANSMITTED INFECTION (STI)? • Uselatexcondomswhenhavingalltypesofsexualintercourse, includingoralandanalsex • Knowtherightwayto usecondom • Useanewcondomwith each • newsexualact • Talkwithyourpartner about • safesexandtheir exposure • toSTIs 21

24. TipstoSaferSexif YouChoosetoHaveSex • 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

25. TobaccoHealthEffects • 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 • 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 Cadmium (Batteries) Butane (Lighter Fluid) Stearicacid (CandleWax) Nicotine (Insecticide) ammonia (ToiletCleaner) Hexamine (Barbecue Lighter) toluene (Industrial Solvent) aceticacid (Vinegar) methane (SewerGas) Carbon Monoxide arsenic (Poison) Methanol (RocketFuel) • Tobacco product smoke contains more than 4000 chemicals with nicotine the most common and addictive “ingredient”. 23

26. Smokelesstobacco • 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 24

27. TipstoHelpYou QuitUsingTobacco • 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. WhatisSecond-HandSmoke? • 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 26

29. Short-andLong-termEffects ofDrugsandAlcohol • 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. TipstoAvoidUsing DrugsandAlcohol • 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’ 28

31. TipstoStopUsing AlcoholandDrugs • 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 29

32. Eating disorders • Eating Disorders can cause: • 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 Signs of Eating Disorders • 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 30

33. SignsofMentalor EmotionalProblems 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 Changes in usual behaviors . . . • 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 Start of new behaviors . . . • Use of alcohol or drugs • Dieting or over-exercising • Hurting yourself or doing risky behaviors • Acting violently toward others • Thinking about suicide 31

34. GettingHelpforaMentalor EmotionalProblem • 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 Relationship You may be in an unsafe relationship if: • 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 • 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 33

36. TipstoHave SafeRelationships • 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