1. education
2. school

05/08/2015
Adolescent Hot Topics:
Cybersafety, Piercings/Tattoos, and Teen Driving
Aneesh K. Tosh, MD, MS
Associate Professor
Division of Adolescent Medicine
Disclosure
• I have no disclosures or conflicts of interest.
• I will not be discussing any off‐label treatments.
Thank You!
• 508 Adolescent Medicine board certified physicians in the U.S.
• U.S. Census Bureau (2012)
– 41,844,000 youth age 10‐19 in the United States – 14% of the total U.S. population
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Outline
• Overall Adolescent Health Trends
• Cybersafety
– Cyberbullying
– Beyond Facebook: New Social Media Trends
• Piercings/Tattoos
– Trends
– Health considerations
• Teen driving
– Distracted driving
– Strategies
Shakespeare on Adolescence
• From The Winter’s Tale:
“I would there were no age between ten and three‐and‐twenty, or that youth would sleep out the rest; for there is nothing in the between but getting wenches with child, wronging the ancientry, stealing, fighting.”
The Kids are Alright
• 80% of adolescents become well‐functioning adults
• Youth Risk Behavior Survey statistics
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Percentage of High School Students Who Ever Tried Cigarette Smoking, 1991‐2013
Birth rates per 1,000 females ages 15‐19, by race/ethnicity, 1990‐2013
Source: Martin, J.A., Hamilton, B.E., & Ventura, S. J.
(2015). Births: Final Data for 2013. Hyattsville, MD: National
Center for Health Statistics.
Percentage of High School Students Who Never or Rarely Wore a Seat Belt, 1991‐2013
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Percentage of High School Students Who Ever Had at Least One Drink of Alcohol, 1991‐2013
Cybersafety
• Cyberbullying
• Beyond Facebook: New Social Media Trends
Cyberbullying Statistics
• 7 out of 10 young people have been victims of cyberbullying.
• 20% of young people have experienced extreme cyberbullying on a daily basis
• 54% of young people using Facebook reported that they have experienced bullying on the network.
• 28% of young people using Twitter reported that they have experienced bullying on the network.
• 11% report that embarrassing or damaging photographs were taken without their knowledge or consent.
Ditchthelabel.org 2013 Cyberbullying Report
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How is this different?
Perpetrator can be anonymous.
May not know what’s being said about victim.
Can occur at any time.
Can be distributed to a wide audience very quickly.
It can be difficult and sometimes impossible to trace the source.
• Deleting inappropriate or harassing messages, texts, and pictures is extremely difficult after they have been posted or sent.
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Effect on Bullying Victims
• Physical and psychological problems
– Lower self‐esteem, depression, suicide
• School absenteeism
• Poorer academic performance
– “You can’t learn if you’re being bullied, if every day you’re frightened of how you’re going to be treated.” ‐ William Pollack, PhD
• Retaliation may occur – bullying others
Missouri Statute 160.775
• “All students need a safe learning environment”
• Mandates that every district must adopt an antibullying policy.
• Policy must state consequences of bullying.
• Requires district employees to report any instance of bullying.
• Requires training of employees in the policy.
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Megan’s Law ‐ 2008
• Expanded the definition of “harassment” to include knowingly intimidating or causing emotional distress anonymously, either by phone or electronically, or causing distress to a child." • Increased the penalty for harassment from a misdemeanor to a felony, carrying up to four years in prison, if it’s committed by an adult against someone 17 or younger, or if the criminal has previously been convicted of harassment.
Advice for Physicians
• Screen for bullying behavior.
• Screen for psychiatric comorbidities, refer if necessary.
• Advocate for bullied patients and their parents with school administration.
Social Media
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Instagram
Instagram
• A way to snap photos, enhance them with filters and quickly share them with friends. • The default setting for Instagram is for photos to be public.
• Require users be 13 or older but does not ask for date of birth.
Snapchat
• Popular because photos “self‐destruct” a few seconds after they're viewed
• Perception: kids don't have to worry about the long‐term implications of having pictures permanently on the Internet.
• Federal Trade Commission complaint
• There are ways to capture the screen and even undelete pictures so kids need to still be careful not to post anything that can get them into serious trouble.
• Requires users be 13 or older but does not ask for date of birth.
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Taking a screenshot on an iPhone
Yik Yak
• Social media app that allows users anonymously to write, view and vote on posts made within a 1.5‐mile radius.
• Has been used to post school bomb threats.
• Has been banned from many schools.
• Does leave a digital trail.
• First FAQ: “Can I post a threat with no repercussions?” • The answer: "No! Don't be dumb. DON'T POST A THREAT. We take threats to safety very seriously and cooperate with local authorities if there's a post that poses a threat to people."
Ask.fm
• Allows users to post anonymously, often with mean‐spirited or X‐rated comments.
• More popular in UK, but becoming more popular because adults are not aware.
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Tips for Parents
• The Internet is Forever
– Start discussions with children at an early age about internet safety and avoiding problems.
• Be familiar with what social media your child is using.
• Should I snoop? Yes!
• Report concerns to school or police.
Tattoos
• In Missouri: Tattooing/body piercing of a person under 18 requires the consent of a parent or guardian.
• Estimated that 20‐36% of college age adults have at least one tattoo. (Pew Research Center)
• While a 2002 Pediatrics article associated tattooed adolescents (13%) with high‐risk behavior, this is likely no longer the case.
(Pediatrics 109;2002:1021 ‐1027)
Self‐Tattooing
32-47% of first tattoos <18 years are done outside a professional
studio
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Regret
• Facial plastic surgeon D.J. Verret, MD:
"The biggest age group coming for repair are high school and college graduates entering the job market."
Other Piercing Locations
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Eyebrows
Tongue
Nose
Tragus
Nipple
Navel
Genitalia
Risks
• Regret and bias in college admissions/hiring
• Medical
– Typically rare if done in a licensed setting.
– Risks obviously greater if done in an unlicensed setting or at home.
– Infection (Skin infections including MRSA, Tetanus, Hepatitis, HIV). Confirm HAV, HBV, Tdap status.
– Poor cosmetic outcome
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Teen Driving
“The odds that a teenage driver will be involved in an accident increases ten‐fold the instant
the parents leave the vehicle.”
Dr. Beth Ebel, University of Washington
Driving Fatalities By Age
Distracted Driving
• 60% of teen drivers involved in a crash were distracted (AAA).
• Travel distance of a football field while sending or reading a typical text (4.6 seconds).
• Any cell phone use equivalent to 0.08% BAC
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AAA Distracted Driving Video
• https://youtu.be/r3MlUA0qkiQ
Missouri Revised Statute
• 304.820. 1. Except as otherwise provided in this section, no person twenty‐one years of age or younger operating a moving motor vehicle upon the highways of this state shall, by means of a hand‐held electronic wireless communications device, send, read, or write a text message or electronic message. • A violation of this section shall be deemed an infraction and shall be deemed a moving violation (2 points) for purposes of point assessment.
Technology
• “Technology got us into this; technology can get us out.”
• Cell/Text Blocker Apps
– Live2Txt (Android)
– DriveMode, Canary (Android, iOS)
• Drive‐Cam (now Lytx)
– Reduced safety events by 70‐88%
– Offered for free by some insurance companies
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Car Safety Technology
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Self‐braking
Lane‐keep assist
Blind‐spot monitor
Automatic high beams
• Coming soon: “Connected” cars?
Role of Provider
• Adults need to role model.
• Screen for distracted driving practices.
• Provide education and resources to adolescents and their parents.
– Phones should be turned off when driving.
– Hands‐free is no safer.
– Parents should not text their children if there is any possibility that they are driving.
Consumer Reports Safest Used Cars for Teen Drivers under $10,000
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Looked for electronic stability control, number of air bags, and crash‐test data
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Chevrolet Malibu Ford Focus Ford Fusion Hyundai Sonata Kia Soul Mazda3 Mazda6i Toyota RAV4 Volkswagen Jetta Volkswagen Rabbit/Golf (2009‐2012, 4‐cyl.)
(2009‐2011)
(2010‐2012, 4‐cyl. and hybrid)
(2006‐2014, 4‐cyl., non‐turbo)
(2010‐2011)
(2011‐2013)
(2009‐2013, 4‐cyl.)
(2004‐2012, 4‐cyl.)
(2009‐2010, 4‐cyl.)
(2009‐2014)
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What about Driver’s Ed?
• Indiana BMV study
– Teen drivers who completed a driver’s education course were 4 times more likely to be in an accidents
• In general, driver’s ed doesn’t seem to help
– In many states, can get a license earlier if you complete a driver’s ed course
– Lack of quality control
– Not a substitute for experience
Graduated Driver Licensing
• Reduction in crashes involving young drivers (2007‐2010, NHTSA)
– 16 – 47%
– 17 – 48%
– 18 – 35%
– >19 ‐ 20%
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