Table of Contents

1. ADOLESCENTS - DRUGS & ALCOHOL
   • Alcohol & Drug Abuse
   • Piietaa - Parents Involved in Educating Teenagers About Alcohol
   • What seems to work
   • Preventing Substance Abuse
   • When Things Go Wrong
2. ADOLESCENTS - TOBACCO
   • Tips to Keep Your Children Tobacco Free
   • Teenage Tobacco Use
   • Non-Smoking is easy to reason
   • How does smoking affect your health?
   • Why do teenagers smoke?
   • Characteristics of young smokers
   • How to say "NO"?
   • ADA FACTS - Smoking and Adolescents
3. ADOLESCENTS - EATING DISORDERS
   • Common Myths about Eating Disorders
   • Definitions
   • Statistics: How Many People have Eating and Exercise Disorders?
   • Warning Signs
   • How to Help Someone You Care About
   • For Parents, Partners, and Other Family Members
4. ADOLESCENTS - SUICIDE
   • The Jason Foundations, Inc. - "A Promise For Tomorrow" - Facts on Teenage Suicide
   • Teen Suicide
   • Risk Factors For Teenage Suicide
   • Appendix B - Suicide Myths
   • Suicide Prevention Guidelines - For School Staff
   • Teenage Suicide

ADOLESCENTS - DRUGS & ALCOHOL

From American Academy of Child and Adolescent Psychology
http://www.aacap.org/about/glossary/alcohol.htm

ALCOHOL & DRUG ABUSE

Use and abuse of drugs and alcohol by teens is very common and can have serious consequences. In the 15-24 year age range, 50% of deaths (from accidents, homicides, suicides) involve alcohol or drug abuse. Drugs and alcohol also contribute to physical and sexual aggression such as assault or rape. Possible stages of teenage experience with alcohol and drugs include abstinence (non- use), experimentation, regular use (both recreational and compensatory for other problems), abuse, and dependency. Repeated and regular recreational use can lead to other problems like anxiety and depression. Some teenagers regularly use drugs or alcohol to compensate for anxiety, depression, or a lack of positive social skills. Teen use of tobacco and alcohol should not be minimized because they can be "gateway drugs" for other drugs (marijuana, cocaine, hallucinogens, inhalants, and heroin). The combination of teenagers' curiosity, risk taking behavior, and social pressure make it very difficult to say no. This leads most teenagers to the questions: "Will it hurt to try one?"

A teenager with a family history of alcohol or drug abuse and a lack of pro-social skills can move rapidly from experimentation to patterns of serious abuse or dependency. Some other teenagers with no family history of abuse who experiment may also progress to abuse or dependency. Therefore, there is a good chance that "one" will hurt you. Teenagers with a family history of alcohol or drug abuse are particularly advised to abstain and not experiment. No one can predict for sure who will abuse or become dependent on drugs except to say the non-user never will.

Warning signs of teenage drug or alcohol abuse may include:

• a drop in school performance,
• a change in groups of friends,
• delinquent behavior, and
• deterioration in family relationships.

There may also be physical signs such as red eyes, a persistent cough, and change in eating and sleeping habits. Alcohol or drug dependency may include blackouts, withdrawal symptoms, and further problems in functioning at home, school, or work.

Copyright © 1997 by the American Academy of Child & Adolescent Psychiatry.

PIIETAA is creating opportunities to establish the future success of teenagers. Through education and special information we extend learning beyond the classroom, reaching teenagers where they live, play and relax. By fostering safe, healthy and supportive environments teenagers are encouraged to meet the challenges of growing up in a positive way and thus realize their full potential.

PIIETAA is committed to educating and informing our youth to maximize their life events. Through sharing of specific developmental experiences, we enable teenagers to become responsible participants in local and global communities.

Positive information in the area of alcohol and substance abuse is combined with preventative practices in order to overcome obstacles to success. Our younger generation is the greatest and most valued natural resource we have. When this resource is at risk, we must respond to equip them fully.

Do you have a friend that you feel may be having a problem with alcohol and or drugs?

Whether your friend uses alcohol, food, pills meth, pot or coke as their "substance," their problems will get worse, never better. So, when the right time comes you may want to give them a copy of these questions and suggestions. A few facilities are listed where professional help can be found on how to cope with problems in a natural way.

In the phone book:

Alcohol Treatment Centers

Narcotics Anonymous

National Council on Alcoholism and Substance Abuse

All calls are in strictest confidence.

http://www.alcohol.org.nz/effects/parents/whatworks.html    

What Seems To Work

• Communication
• Your Expectations
• Supervision
• Coping Skills
• When Should I Introduce My Child to Alcohol?

Communication

Communicating with your teenager can be hard work, especially when your attempts are met with grunts or silence. Keep at it, even when the going gets tough. Avoid criticism and blaming. Be interested in your teenager's life while respecting their need for privacy.

If you are having problems talking with your son or daughter, get help. Check out the list of resources on parenting teenagers in the help and information section.

Your Expectations

Make clear rules about alcohol use with your teenager and stick to them. Be reasonable, but make sure the know what kind of behaviour you expect. Being too strict in terms of alcohol doesn't seem to work, neither does being very liberal. Somewhere in between is best.

Discuss why these rules are important. For example it may be a rule in your house that your teenager can only take the car to a party if he or she agrees not to drink at all that night. Explain that drinking and driving not only puts them at risk of getting hurt or caught but also affects the rest of the family.

Work out together what will happen if the rules are broken. Be consistent. If they are broken, follow through with the consequences. You won't be popular but your child will know where he or she stands. Some consequences parents have found useful are grounding their teenager or giving them extra household chores.

It is important that you set a good example with your own drinking behaviour. Any hypocrisy on your part will be quickly spotted by your teenager.

If at all possible, both parents should agree and stick to the same rules about alcohol, even if they don't live together. Kids quickly pick up on any inconsistency between their parents and use it to their own advantage! If your partner or ex-partner will not support you, then call on other family members or friends.

Supervision

Young people tend to drink more when their parents are not around. As a parent it is your responsibility to protect your child from harm, as best you can. Adult supervision is often not welcomed by teenagers. Get support from other adults. This might include relatives, close friends or the parents of your teenager's friends.

Try to keep up with what is going on in your teenager's life. Get to know their friends and make sure you know where your teenager is. That doesn't mean you need to follow them around or try to be part of their circle of friends. They need privacy too.

Coping Skills

Some young people use alcohol to try to blot out problems they are having. Teenagers need to learn positive skills to deal with stress, frustration and conflict. You might suggest they:

• go for a walk
• talk the problem over with someone
• listen to soothing music.

If your family has a history of alcoholism, then there is an increased risk that your teenager may become dependent on alcohol. It is important that you tell your teenager this and encourage them to take extra care with their drinking.

When Should I Introduce My Child to Alcohol?

There is no 'right' time to introduce your child to alcohol. Although we hear stories about the French introducing their children to alcohol very early on, research shows that the younger a person starts drinking the more likely they are to run into problems. Don't feel you have to rush it. As a rule of thumb, it is probably better for young people to start drinking later rather than earlier. You will also be guided by what is happening in your child's life and their own interest in alcohol.

From: In Touch With Teens
http://intouch.virtualave.net/newsroom_psa.htm    

'What Can I Do?' (NUI) - One recent study indicated that the "war on drugs" had made little impact on the younger generation. In fact, it found that student use of most drugs had reached its highest level in nine years, although levels of use were still far below those of the 1970s.

Yet, fewer students than ever say that their parents warn them of the risks of drug and alcohol use.

What can parents and other concerned citizens do to stop youth substance abuse in their neighborhoods? The National Crime Prevention Council answers the most frequently asked questions on the topic:

Q. What can I do if I suspect a child of drug use?

A. Communicate with concern, not anger, and focus on specific, suspicious behavior. Don't confront the child while you are angry, or while he or she is under the influence of alcohol or drugs. Finally, don't jump to conclusions. What you suspect may not be fact.    

Q. What role should I play?

A. First, set a good example with your own behavior. Then, help prepare children to make the hard decisions in life, such as saying "no" to peers. Don't ignore problems, and maintain good communication.    

Q. What actions will have the most impact on stopping youth drug use?

A. There are three: strengthening positive family and peer relationships, improving school performance and strengthening ties to the community.    

Q. What community programs keep children safe from drug use?

A. Community anti-drug efforts work best when a coalition of concerned citizens join forces to combine prevention education, intervention, treatment and appropriate sanctions. Push for community policies that reinforce anti-drug, anti-alcohol and anti-tobacco behaviors by young people and penalize those who enable or take part in them. Insist on proven prevention curricula that focus on teaching skills.    

Q. What are signs that a child has a substance abuse problem?

A. Here are several common signs:

• Change in behavior, attitude, opinions or friends; mood swings and defensiveness.

• Drop in grades; unusual school problems.

• Friends with trouble signs.

• Drops old friends and adopts new ones; avoids introducing new friends to parents.

• Unexplained increase or decrease in finances; stealing or borrowing money.

• Spends time in unusual places (storage room, basement or garage).

• Lack of energy or endurance; weight loss or gain; dramatic changes in appearance.

The fact is, "Less Crime is No Accident." It takes people like you and programs that work. To find out more, call 1-800-WE-PREVENT or visit

http://www.alcohol.org.nz/effects/parents/wrong.html

When Things Go Wrong

Even with the best parents in the world, young people can still run into trouble. Most teenagers will experiment with alcohol. Getting it wrong is unfortunately fairly common. This does not mean they will become an alcoholic. Many young people go through a phase of heavy drinking. Very few become alcohol dependent.

Here are some of the problems parents face with alcohol and their teenagers and some suggested action when your teen/s:

• goes to a party when they are not allowed
• is taking alcohol from your drinks cupboard
• becomes violent when drunk
• is very drunk and unconscious
• is vomiting continuously
• school performance is being affected by their drinking
• drinking is out of control

Your teenager goes to a party despite you telling them they are not allowed to

If your teenager is sober when they arrive home and you feel able to control your anger, discuss the situation that night. If they are drunk, or you are too tired or angry to have a reasonable discussion, wait until the morning.

Let them know how you feel about their behaviour including any worries you had for their safety. Give them a chance to explain their behaviour. Go back over the rules you agreed to and make sure there is an appropriate consequence. For example you may ground your teenager for a week, including the following weekend.

Your teenager is taking alcohol from your drinks cupboard

Deal with it as you would deal with any stealing within your family. Discuss what has happened with your son or daughter. Follow through with an appropriate consequence. For example, one parent asked her teenager to pay for the alcohol taken.

Your teenager becomes violent when drunk

You don't need to put up with violence from anyone, even family members. If you don't think you can control the situation, call someone who can come quickly. This might be a friend or the police.

Discuss the situation with your teenager when they have sobered up. Make it very clear that violence is not acceptable in your family. For information about 'stopping violence' programmes check help and information.

Your teenager is very drunk and unconscious

Don't leave them alone. Lie them on their side in the recovery position. Make sure they are breathing and their mouth is empty. Keep them warm. If you are unable to wake them, dial 111 for an ambulance.

Your teenager is vomiting continuously

Call 111 for an ambulance.

Your teenager's school performance is being affected by their drinking and/or drug use

Just because your teenager is having problems with their drinking doesn't mean they are an alcoholic. However, the earlier they sort things out the better. They may be drinking as a way of coping with their troubles. Talk with them about this. By listening carefully and respectfully you are more likely to find out what is worrying them. You may wish to talk things over with somebody else. Check the help and information section for some ideas about who to contact.

You feel your teenager's drinking is out of control

If after discussing things with your teenager the situation doesn't improve then it is important that you discuss your concerns with a professional. There are services available in most towns and cities. The Alcohol Helpline has the contact details for all the alcohol & drug services around New Zealand. You can call them free on 0800 787797.

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ADOLESCENTS - TOBACCO

Parents have an important role in helping their children choose to be tobacco free.
Here are suggestions for how you can help.

Keep your kids active.
Active living makes kids less likely to smoke.

Model a tobacco free home.
If you smoke, show you understand the health risks your smoking presents for both you and your family. Try not to smoke in your own home, or limit your smoking to certain rooms. Better yet, try to stop altogether.

Start the anti-smoking message early.
Good education is a step in the right direction. If you are a smoker yourself, be open and honest about why you started and why it is hard to stop.

Find quiet chances to talk about smoking in a serious way.
Emphasize the benefits of remaining tobacco free such as better health and avoiding the cost.

Encourage teenagers to be in control of their own destiny.
Remind them that it doesn't make sense to express their independence by becoming a "slave" to nicotine. Encourage your child to think ahead and plan how to say "no" to cigarettes.

Did you know...

• Some estimates indicate one-half of all children in Canada try smoking by the time they are twelve years old.
• Thirteen is the average age when young people start smoking every day.
• There has been an increase in the number of Alberta teenagers who smoke and a continuing high rate of smoking among teenage girls.
• 31% of females aged 15-19 were current smokers in 1994, compared to 29% in 1990.
• 20% of young men aged 15-19 were current smokers in 1994, compared to 16% in 1990.
• Smokeless tobacco (chewing tobacco and snuff) rates of use in Alberta, while lower than smoking, are on the increase and are the highest in Canada. A recent Alberta survey indicated 16% of 10-14 year olds and 25% of 15-19 year olds have chewed tobacco at least once.

Sources: Kids decide but parents can tip the balance, Health Canada; Report on the Health of Albertans, Alberta Health, 1996; Youth Smoking Survey, Health Canada, 1994; Alberta Cancer Board, 1997; Alberta Tobacco Reduction Plan, 1996

For more information: Check out www.quit4life.com or contact your Regional Health Authority Office

www.health.gov.ab.ca/public/document/tobacco/tobakids.htm

Cigarette smoking during childhood and adolescence produces significant health problems among young people, including cough and phlegm production, an increase in the number and severity of respiratory illnesses, decreased physical fitness, an unfavorable lipid profile, and potential retardation in the rate of lung growth and the level of maximum lung function. An estimated 430,700 Americans die each year from diseases caused by smoking. Smoking is responsible for an estimated one in five U.S. deaths and costs the U.S. at least $97.2 billion each year in health care costs and lost productivity.

• Each day, 3,000 teens smoke their first cigarette. That's more than one million annually.
• Approximately one-third of these children smokers will eventually die of smoking-related illnesses.
• At least 4 million adolescents are current smokers. According to a 1997 national survey of high school students, the overall prevalence of current cigarette use and frequent cigarette use were 36.4 percent and 16.7 percent, respectively.
• A 1997 survey reported that current cigar use among high school students was 22 percent.
• People who begin smoking at an early age are more likely to develop severe levels of nicotine addiction than those who start at a later age.
• Cigarette advertisements tend to emphasize youthful vigor, sexual attraction and independence themes, which appeal to teenagers and young adults struggling with these issues.
• Of adolescents who have smoked at least 100 cigarettes in their lifetime, most of them report that they would like to quit, but are not able to do so.
• Peers, siblings, and friends are powerful influences. The most common situation for first trying a cigarette is with a friend who already smokes.
• A recent survey indicated that among students under 18 years old who were current smokers, 66.7 percent reported never being asked for proof of age when buying cigarettes in a store.
• Tobacco use primarily begins in early adolescence, typically by age 16; almost all first use occurs before the time of high school graduation.
  • A 1997 survey identified that 9.3 percent of all high school students used smokeless tobacco. Although smokeless tobacco use previously was uncommon among adolescents, more older teens began using it between 1970 and 1985, at the same time that the smokeless tobacco industry was strengthening their marketing efforts.
• In 1996, an estimated six million 14-19 year-olds (26.7 percent of people in this age group) reported having smoked a cigar in the previous year. Of these, cigarette smokers as well as users of smokeless tobacco were more than three times as likely as non-tobacco users to report having smoked a cigar in the previous year.
• Tobacco use is associated with alcohol and illicit drug use, and acts as a "gateway drug." It is generally the first drug used by young people who enter a sequence of drug use that can include tobacco, alcohol, marijuana, and harder drugs. According to the 1994 Surgeon General's report, 12-17 year olds who reported having smoked in the past 30 days were three times more likely to use alcohol, eight times more likely to smoke marijuana, and 22 times more likely to use cocaine, within those past 30 days than those 12-17 year olds who had not smoked during that time.
• The initiation and development of tobacco use among children and adolescents progresses in four stages:
  • forming attitudes and beliefs about tobacco
  • trying to experiment with it
  • regularly using tobacco
  • being addicted
• Sociodemographic factors associated with tobacco use include being an adolescent from a family with low socioeconomic status. Behavioral risk factors for tobacco use by adolescents include:
  • low levels of academic achievement and school involvement
  • lack of skills required to resist influences to use tobacco, and experimentation with tobacco products.
• Personal risk factors for tobacco use by adolescents include:
  • a lower self-image and lower self-esteem than peers
  • the belief that tobacco use serves a function
  • the inability to refuse offers to use tobacco
• Environmental factors for tobacco use by adolescents include:
  • accessibility and availability of tobacco products
  • perceptions by adolescents that tobacco use is normal
  • peers and siblings use and approval of tobacco use
  • lack of parental support and involvement as adolescents face the challenge growing up
• In August 1996, the Food and Drug Administration issued regulations to limit the accessibility and appeal of tobacco products to young people. The regulations include the following:
  • billboards and signs: billboards and signs limited to black-and-white text only, except in adult-only facilities; tobacco billboards banned within 1,000 feet of schools and playgrounds;
  • print ads: black-and-white text-only ads in publications whose youth readership is more than two million, or 15 percent of total readership, prohibited;
  • giveaways: no product giveaways with brand names or logos;
  • sponsorship: entertainment or sporting events sponsored only in the corporate name, not the brand name;
  • photo IDs: buyers under age 27 must produce photo identification;
  • education: industry-run educational campaign, including TV ads, about health risks;
  • samples: no free samples, single cigarette sales or packages of fewer than 20 cigarettes.
  • vending machines: cigarette vending machines limited to facilities where children are
• Tobacco use in adolescence is associated with a range of health-compromising behaviors, including being involved in fights, carrying weapons, engaging in high-risk sexual behavior, and using alcohol and other drugs.

From: Smokefree Class (Finland): www.jyu.fi/no-smoking/eng/econtent.htm

It's not very difficult to find reasons for not smoking. You'll find a list of reasons below, but it is surely not an exhaustive one. The benefits of not smoking are most readily yours if you don't even start smoking in the first place. But also those giving up smoking soon discover and enjoy those benefits.

Why to be a non-smoker?

• You'll stay in better health.
• You're likely to live longer. Although you may know some old-timers who are still live and kicking after decades of smoking, the fact is that smoking shortens lifetime.
• You will stay fitter physically.
• You won't develop any addiction to nicotine.
• Your breath and clothes have a fresh smell not that of tobacco.
• You have a fresh complexion.
• Your teeth will stay white.
• Food tastes better.
• You save money.
• It saves public funds, too. Adverse health-effects of smoking cause substantial costs to the whole society.
• Non-smoking is considerate to other people. Smoking disturbs many non-smokers. For many, mere exposure to smoky air means health-problems. Passive smoking can cause same symptoms as active smoking. Your eyes may smart with the smoke and it makes you cough unless you're used to it. Asthmatic persons may have an attack because of the smoke. Exposure to tobacco smoke is especially dangerous for babies and small children.
• It is important not to smoke during pregnancy. Mother's smoking and also mere exposure to tobacco smoke decreases her baby's birth weight, impedes baby's growth in height and increases the risk of miscarriage.
• Non-smoking serves as a good example to your juniors. "As the old cock crows, so cackles the young."
• Non-smoking helps to protect rain forests or the children labouring at tobacco plantations. Although developing countries gather a substantial income from their tobacco, that income is not enough to satisfy their need for food. If tobacco were replaced with grain growing, the same fields could yield food for 10 to 20 million people in those countries. People also smoke enormously in these countries. Due to their low literacy level, among other things, people are little aware of smoking-related harmful effects.

In many countries smoking is the biggest individual health hazard.

Smoking is a health hazard because of the toxic compounds tobacco products contain. The harms are partly related to how and how much one smokes. When the harms experienced by people smoking to different extents has been compared, it has been shown that in this respect the biggest difference lies between non-smokers and lightly smoking people. Even the slightest-smoking people have considerably greater health-risks than non-smokers. After that level the risks continue to rise, but more steadily. Remember that the part of a cigarette closest to the filter is the most toxic one. If you do smoke, protect also your friend's health: stub out your cigarette early enough, and don't let anybody to have "a spare smoke" from your fag end.

More immediate adverse health-effects

• bronchitis, bronchial irritation
• cough
• flu
• dental problems
• gingivitis (inflammation of the gums)
• headache
• fatigue
• lack of concentration
• decreasing fitness

Long-term adverse health-effects

• heart and vascular diseases
• cancer of the lungs
• many other types of cancer
• chronic lung diseases
• cerebral apoplexy
• impotence

It is easy to think of reasons for non-smoking, but why do young people smoke, then? There are obviously many reasons; studies have revealed some factors common to young smokers.

In many cases smoking begins insidiously. People first try it without much of thinking, often allured by some friends. The next stage is getting used to the new habit of smoking, usually with friends. Finally, it becomes a deep-seated, confirmed habit. At the trial stage a teenager may feel that he or she is gaining something from smoking. Nearly always it turns out that the gains which may have been obtained in the beginning, are lost later on; why, otherwise, would the majority of smokers like to quit. For most teenagers, smoking has not yet become a fixed habit, fortunately enough, this makes it easier to give it up. How does one get rid of smoking, then?

Reasons for teenage smoking

• Most often smoking begins by chance. People don't think much about it, they just go with the flow.
• For many, smoking means something to do. Time passes nicely while you're puffing rings of smoke into the air.
• Some teenagers seek pleasure from smoking and try to soothe their nerves in this way.
• Some people feel that smoking stimulates and helps them concentrate.
• For some teenagers, smoking is a symbol of growing up.
• For some, smoking is a way to get in and belong to the "right circles".
• Some people think they've got style when they smoke. Boys, especially, may think that girls find it attractive. Smoking may be connected to a teenager's general lifestyle.
• Some people smoke to appear more self-confident. By smoking they prop up their self-confidence.
• Some people try tobacco products out of sheer curiosity.
• Some teenagers smoke as a protest against regulations.
• Some people have been seduced byadvertising.
• Also young people may develop addiction to nicotine, which is a compound of tobacco products. The addiction may make it difficult to give up smoking, even if you wanted to.
• Smoking has become a fixed habit for many young people. Some are used to smoke between school- lessons, others like to have a smoke after a meal. The habit, when confirmed, is hard to break.

According to the studies, the typical features of a 12-14-old who is likely to start smoking within next two years are as follows:

• A circle of friends with lots of smoking
• At least other parent smokes
• Rather generous funds available
• Experience from alcoholic drinks
• Little interest towards school or school achievement
• Early biological maturation
• Broken family background
• Piling of many other health-hazarding habits

Young people's smoking may be connected not only with individual features but also with their broader way of life. Teenagers often associate smoking and especially drinking with a characteristically free-and-easy, fun- seeking lifestyle. Friends and leisure are more important than school, and teachers are just a nuisance. Free time is for having fun, "useful" hobbies or other activities with a hint of guidance are not in.

Teenagers often see this fun-seeking group as an opposite of swotters, who they take as bookworms that keep stressing the importance of school achievement. Swotters may be considered a boring, withdrawing bunch, who don't know how to have fun. Useful hobbies are regarded as something typical of a swotter.

This kind of black-and-white thinking is not necessarily very rational or reasonable. It takes also all sorts of teenagers to make a world. A fun-seeking guy does not really need to prop up his lifestyle by smoking and drinking. And on the other hand, a swotter may prove as easy-going and fun-spirited as anyone, also without a cigarette in his/her mouth.

How to say "No"?

Life can save you from lots of troubles if you only know how to say no. Of course, you also need to consider when it is the right thing to say. Abstinence from smoking, alcoholic drinks, or drugs doesn't hurt anybody, does it? Below are some tips as for how to say "No" to someone offering you a cigarette, for example. The same pieces of advice apply to many other situations as well.

It is important to be polite but firm. If your response is not convincing, the one who is offering may think that you're just hesitating and in need of further encouragement. A firm answer saves you both from further ado.

    No thanks

        A polite "no thanks" is often enough. People realize that you don't smoke.

    No thanks, I really don't smoke!

        Sometimes simple "no thanks" does not seem to work. People keep offering you a cigarette although you already refused one. This may stop when you repeat your message.

    Why would you like me to smoke?

        It may happen that somebody really starts harassing you, insisting that you smoke. You may be called yellow or a sissy etc. If this happens, try to stay cool, don't go along with quarrel. Chances are that you can silence your opponent by asking him or her: "Why would you like me to smoke?" The question is too difficult to answer and the situation eases off.

    Well, I should be going...

        Sometimes it's best to give an excuse and leave the scene. In this case you don't even have to refuse.

ADA FACTS

Smoking and Adolescents

At a time when smoking among adults is decreasing in popularity, it is increasing among adolescents and teenagers. Young smokers grow up to be adult smokers, and in many cases, die of smoking-related diseases.

Every day, an estimated 3,000 teenagers begin smoking. According to the Surgeon General, in the lifetimes of those 3,000 teens, 60 will die in traffic accidents, 30 will be murdered, and 750 will die from smoking-related diseases.

Nearly 85 percent of all smokers say they started smoking before age 18. Studies show that the younger a person starts smoking, the more likely they are to become heavy smokers and to develop smoking-related diseases, such as cancer and emphysema.

It is estimated that 3.1 million adolescents smoke. It is most common among high-school seniors, of whom, one in four admits to smoking - even though in most states, Missouri included, it is illegal to sell tobacco products to minors.

Cigarette smoking is seen by some prevention specialists as a "gateway drug," a substance that leads to the use of other drugs. This is because smoking is seen by many adolescents as an act of defiance of authority and often takes place in groups where other acts of defiance also take place.

Cancer and cardiovascular disease

Burning tobacco produces hundreds of chemicals, many of them harmful to humans when inhaled into the lungs. These include tars and nicotine. These chemicals are believed to cause genetic damage to cells, leading to cancer.

Inhaling cigarette, cigar, or pipe smoke also damages the cardiovascular system, leading to heart and respiratory diseases. In all, about 434,000 Americans - more than 10,000 of them from Missouri - die each year from smoking-related cancers, heart disease, and respiratory diseases.

Tobacco smoke contains tar, which is known to cause lung cancer and bronchial disorders. An average cigarette contains 15 mg. of tar. A person who smokes a pack of cigarettes per day inhales about eight ounces of tar each year.

The nicotine in tobacco smoke causes chemical changes in the smoker's brain, making the smoker addicted to tobacco and making it difficult to break the smoking habit.

Second-hand smoke

Also at risk are those who live or work in an environment where others are smoking and where they are inhaling the smoke secondhand. It is estmated that more than 50,000 people die each year from heart diseases alone caused by breathing secondhand smoke.

Especially vulnerable are children, even before they are born. Pregnant women who smoke are more likely to have babies with low birth weights. Smoking by one or more parents also is suspected as one cause of sudden infant death syndrome (SIDS).

Children who live with one or more smoking parents have higher incidences of asthma, bronchitis, emphysema, pneumonia, and influenza. They also have more colds and respiratory infections than children who live in smoke-free homes.

For more information, call 1-800-364-9687.
Sources: Toward a Tobacco-Free Missouri;
Journal of the American College of Cardiology, August 1994.

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ADOLESCENTS - EATING DISORDERS

http://dana.ucc.nau.edu/~kdk2/myths.html

Common Myths about Eating Disorders

BULIMICS AND ANOREXICS ARE UNDERWEIGHT AND COMPULSIVE OVEREATERS ARE OVERWEIGHT

In reality, eating-disordered people (EDs) have many different body weights. Terms like "anorexia", "bulimia", and "compulsive overeating" do not refer to body shape or size, they refer to a behavior. Someone who weighs a great deal can still be eating-disordered if they have food restricting behaviors. A very skinny person can be a compulsive overeater. Eating does not necessarily mean gaining weight. Someone who eats large amounts of vegetables may appear very healthy by society's standards, but the fact that they are compelled to eat and are given to frequent binges makes them a Compulsive Overater (CO). Please consult the DSM-IV for diagnostic criteria.

PEOPLE WHO HAVE EATING DISORDERS ARE WEAK-WILLED

Actually, most EDs are very strong. They may have a problem with food, but typically the eating-disordered person has chosen a private mode of expression that affects themselves directly and everyone else secondarily. Many EDs are "good" people who wish to take care of the world. Most of them over extend themselves and have to find some way to deal with it. Rather than choosing a means that endangers other people or uses illegal substances, EDs have chosen something that is almost always readily available, can be done privately, and can usually be purchased by the ED without help from someone else. Eating disorders are a solitary disease made harder by the fact that their victims must always come in contact with food and cannot survive without it. It takes a strong person to constantly be in contact with their substance and to try to lead a normal life around it. However, almost all EDs will eventually need help with this problem, or at least some kind of support.

ONLY WOMEN HAVE EATING DISORDERS

While women EDs number more than men, at least 10 percent of the adult eating-disordered population and 25 percent of eating-disordered children are male. Men have largely been ignored and thus bulimic/anorexic/CO men have not had as many resources available to them. However, this is changing. I would encourage any male ED to seek out support groups or other forms of support so that you don't feel like you are the only one. IRC server us.undernet.org has a channel called "ased" which might be helpful.

Also see Males & Eating Disorders for more information.

EATING DISORDERS ARE A VAIN, ATTENTION-GETTING DISEASE

Eating Disorders are extremely serious diseases which can and do lead to death. They should never be taken lightly or thought of as a "phase" or a diet. 10 to 15% of anorexics die of malnutrution and approximately 1,000 women die each year of anorexia or bulimia. 1 in 10 cases of anorexia result in death from malnutrition, cardiac arrest, or suicide.

For more statistics visit ANRED's Statistics page

For more information, please see "Old Fashioned Ideas" at http://www.something-fishy.com or "Common Misconceptions" also at www.something-fishy.com

Statistics on these pages were compiled from various sources on the internet.

Due to changes in my personal life and daily routine, I will no longer be keeping up with email regularly. If you need someone to talk to immediately, stop by Concerned Counseling and take a look at their Support Bulletin Board.

Mail me at kdk2@dana.ucc.nau.edu with anything that isn't urgent.

Definitions

Anorexia nervosa: the relentless pursuit of thinness

• Person refuses to maintain normal body weight for age and height.
• Weighs 85% or less than what is expected for age and height.
• In women, menstrual periods stop. In men levels of sex hormones fall.
• Young girls do not begin to menstruate at the appropriate age
• Person denies the dangers of low weight.
• Is terrified of becoming fat.
• Is terrified of gaining weight even though s/he is markedly underweight.
• Reports feeling fat even when very thin.
• In addition to the above, anorexia nervosa often includes depression, irritability, withdrawal, and peculiar behaviors such as compulsive rituals, strange eating habits, and division of foods into "good/safe" and "bad/dangerous" categories.

Bulimia nervosa: the diet-binge-purge disorder

• Person binge eats.
• Feels out of control while eating.
• Vomits, misuses laxatives, exercises, or fasts to get rid of the calories.
• Diets when not bingeing. Becomes hungry and binges again.
• Believes self-worth requires being thin.
• May shoplift, be promiscuous, and abuse alcohol, drugs, and credit cards.
• Weight may be normal or near normal unless anorexia is also present.
• Like anorexia, bulimia can kill. Even though the person puts up a cheerful front, s/he is often depressed, lonely, ashamed, and empty inside. Friends of bulimics may describe them as competent and fun to be with, but underneath, where they hide their guilty secrets, they are hurting. Feeling unworthy, they have great difficulty talking about their feelings, which almost always include anxiety, depression, self-doubt, and deeply buried anger.

Binge eating disorder: sometimes called compulsive eating

• The person binge eats frequently and repeatedly.
• Feels out of control and unable to stop eating during binges.
• May eat rapidly and secretly, or may snack and nibble all day long.
• Feels guilty and ashamed of binge eating.
• Has a history of diet failures
• Tends to be depressed and obese.
• People who have binge eating disorder do not regularly vomit, overexercise, or abuse laxatives like bulimics do. They may be genetically predisposed to weigh more than the cultural ideal (which at present is exceedingly unrealistic), so they diet, make themselves hungry, and then binge in response to that hunger. Or they may eat for emotional reasons: to comfort themselves, avoid threatening situations, and numb emotional pain. Regardless of the reason, diet programs are not the answer. In fact, diets almost always make matters worse.

Anorexia athletica: sometimes called compulsive exercising or activity anorexia

• The person repeatedly exercises beyond the requirements for good health.
• May be a fanatic about weight and diet.
• Steals time to exercise from work, school, and relationships.
• Focuses on challenge. Forgets that physical activity can be fun.
• Defines self-worth in terms of performance.
• Is rarely or never satisfied with athletic achievements.
• Does not savor victory. Pushes on to the next challenge immediately.
• Justifies excessive behavior by defining self as a "special" elite athlete.
• Compulsive exercising is not a recognized diagnosis as are anorexia, bulimia, and binge eating disorder. We include it here because many people who are preoccupied with food and weight exercise compulsively in attempts to control weight. The real issues are not weight and performance excellence but rather power, control, and self-respect.

Statistics: How Many People have Eating and Exercise Disorders?

Research suggests that about one percent (1%) of female adolescents have anorexia. That means that about one out of every one hundred young women between ten and twenty are starving themselves, sometimes to death.
Research also suggests that about four percent (4%), or four out of one hundred, college-aged women have bulimia. About 50% of people who have been anorexic develop bulimia or bulimic patterns.

Only about five to ten percent (5-10%) of people with anorexia and bulimia are male. This gender difference may reflect our society's opposite expectations for men and women. Men are supposed to be strong and powerful. They feel ashamed of skinny bodies. Women, on the other hand, are supposed to be tiny, waif-like, and thin. They diet to lose weight, and if they lose control of the resulting hunger, or develop rigid and compulsive overcontrol, they can become anorexic, bulimic, or both.

Anorexia and bulimia affect primarily people in their teens and twenties, but clinicians report both disorders in children as young as six and individuals as old as seventy-six.

New studies suggest that over half of adult Americans, both male and female, are overweight. About one third (34%) are obese, meaning that they are 20% or more above normal, healthy weight. Many of these people have binge eating disorder.

What about compulsive exercising?

Because anorexia athletica is not a formal diagnosis, it has not been studied as rigorously as the eating disorders. We have no idea how many people exercise compulsively.

Subclinical eating disorders

We can only guess at the vast numbers of people who have subclinical or threshhold eating disorders. They are too much preoccupied with food and weight. Their eating and weight control behaviors are not normal, but they are not disturbed enough to qualify for a formal diagnosis.

Mortality and recovery rates

Without treatment, up to twenty percent (20%) of people with serious eating disorders die. With treatment, that number falls to two to three percent (2-3%).

With treatment, about sixty percent (60%) of people with eating disorders recover. They maintain healthy weight. They eat a varied diet of normal foods and do not choose exclusively low-cal and non-fat items. They participate in friendships and romantic relationships. They create families and careers. Many say they feel they are stronger people and more insightful about life in general and themselves in particular than they would have been without the disorder.

In spite of treatment, about twenty percent (20%) of people with eating disorders make only partial recoveries. They remain too much focused on food and weight. They participate only peripherally in friendships and romantic relationships. They may hold jobs but seldom have meaningful careers. Much of each paycheck goes to diet books, laxatives, jazzercise classes, and binge food.

The remaining twenty percent (20%) do not improve, even with treatment. They are seen repeatedly in emergency rooms, eating disorders programs, and mental health clinics. Their quietly desperate lives revolve around food and weight concerns, spiraling down into depression, loneliness, and feelings of helplessness and hopelessness.

Please note: The study of eating disorders is a relatively new field. We have no good information on the long-term recovery process. We do know that recovery usually takes a long time, perhaps on average five years of slow progress that includes starts, stops, slides backwards, and ultimately movement in the direction of mental and physical health.

If you believe you are in the forty percent of people who do not recover from eating disorders, give yourself a break. Get into treatment and stay there. Give it all you have. You may surprise yourself and find you are in the sixty percent after all.

Determining accurate statistics is difficult.

Because physicians are not required to report eating disorders to a health agency, and because people with these problems tend to be secretive, denying that they even have a disorder, we have no way of knowing exactly how many people in this country are affected.

We can study small groups of people, determine how many of them are eating disordered, and then extrapolate to the general population. The numbers are usually given as percentages, and they are as close as we can get to an accurate estimate of the total number of people affected by eating disorders.

Please Note: ANRED information is not a substitute for medical treatment or psychological care. For help with the physical and emotional problems associated with eating and exercise disorders, talk to your physician and a competent mental health professional.

Warning signs

Because everyone today seems concerned about weight, and because most people diet at least once in a while, it is hard to tell what is normal behavior and what is a problem that may escalate to threaten life and happiness. No one person will show all of the characteristics listed below, but people with eating disorders will manifest several.

In addition, the early stages of an eating disorder can be difficult to define. When does normative dieting become a health and emotional problem? When does weight loss cross the line and become pathological? Answering these questions is hard, especially when the person has not yet lost enough weight to qualify for a clinical diagnosis. Nevertheless, the questions are important. The sooner an eating disorder is treated, the easier it will be for the person to recover. If warning signs and symptoms are allowed to persist until they become entrenched behaviors, the person may struggle for years before s/he can turn matters around.

Food behaviors

The person skips meals, takes only tiny portions, will not eat in front of other people, eats in ritualistic ways, and mixes strange food combinations. May chew mouthfuls of food but spits them out before swallowing. Grocery shops and cooks for the entire household, but will not eat the tasty meals. Always has an excuse not to eat: is not hungry, just ate with a friend, is feeling ill, is upset, and so forth.

Becomes "disgusted" with former favorite foods like red meat and desserts. Will eat only a few "safe" foods. Boasts about how healthy the meals s/he does consume are. Becomes a "vegetarian" but will not eat the necessary fats, oils, whole grains, and the denser fruits and veggies (such as sweet potatos and avocados) required by true vegetarianism. Chooses primarily low-fat items with low levels of other nutrients, foods such as lettuce, tomatos, sprouts, and so forth.

Always has a diet soda in hand. Drastically reduces or completely eliminates fat intake. Reads food labels religiously. If s/he breaks self-imposed rigid discipline and eats normal or large portions, excuses self from the table to vomit and get rid of the calories.

Or, in contrast to the above, the person gorges, usually in secret, and empties cupboards and refrigerator. May also buy special binge food. If panicked about weight gain, may purge to get rid of the calories. May leave clues that suggest discovery is desired: empty boxes, cans, and food packages; foul smelling bathrooms; running water to cover sounds of vomiting; excessive use of mouthwash and breath mints; and in some cases, containers of vomit poorly hidden that invite discovery.

Sometimes the person uses laxatives, diet pills, water pills, or "natural" products from health food stores to promote weight loss. May abuse alcohol or street drugs, sometimes to deaden appetite, sometimes to escape emotional pain, and usually in hopes of feeling better, at least temporarily.

Appearance and body image behaviors

The person loses, or tries to lose, weight. Has frantic fears of weight gain and obesity. Wears baggy clothes, sometimes in layers, to hide fat, hide emaciation, and stay warm. Obsesses about clothing size. Complains that s/he is fat even though others truthfully say this is not so. S/he will not believe them.

Spends lots of time inspecting self in the mirror and usually finds something to criticize. Detests all or specific parts of the body, especially breasts, belly, thighs, and buttocks. Insists s/he cannot feel good about self unless s/he is thin, and s/he is never thin enough to satisfy her/himself

Exercise behaviors

The person exercises excessively and compulsively. May tire easily, keeping up a harsh regimen only through sheer will power. As time passes, athletic performance suffers. Even so, she/he refuses to change the routine.

May develop strange eating patterns, supposedly to enhance athletic performance. May consume sports drinks and supplements, but total calories are less than what an active lifestyle requires.

Thoughts

In spite of average or above-average intelligence, the person thinks in magical and simplistic ways, for example, "If I am thinner, I will feel better about myself." She/he loses the ability to think logically, evaluate reality objectively, and admit and correct undesirable consequences of choices and actions.

Becomes irrational, argues with people who try to help, and then withdraws, sulks, or throws a tantrum. Wanting to be special, s/he becomes competitive. Strives to be the best, the smallest, the thinnest, and so forth.

Has trouble concentrating. Obsesses about food and weight and holds to rigid, perfectionistic standards for self and others.

Feelings

Has trouble talking about feelings, especially anger. Denies anger, saying something like, "Everything is OK. I am just tired and stressed." Escapes stress by turning to binge food, exercise, or anorexic rituals.

Becomes moody, irritable, cross, snappish, and touchy. Responds to confrontation and even low-intensity interactions with tears, tantrums, or withdrawal. Feels she/he does not fit in and therefore avoids friends and activities. Withdraws into self and feelings, becoming socially isolated.

Social behaviors

Tries to please everyone and withdraws when this is not possible. Tries to take care of others when she/he is the person who needs care. May present self as needy and dependent or conversely as fiercely independent and rejecting of all attempts to help. Anorexics tend to avoid sexual activity. Bulimics may engage in casual or even promiscuous sex.

Person tries to control what and where the family eats. To the dismay of others, s/he consistently selects low-fat, low-sugar non-threatening - and unappealing - foods and restaurants that in the past have provided these "safe" items.

Relationships tend to be either superficial or dependent. Person craves true intimacy but at the same time is terrified of it. As in all other areas of life, anorexics tend to be rigidly controlling while bulimics have problems with lack of impulse control that can lead to rash and regretable decisions about sex, money, stealing, commitments, careers, and all forms of social risk taking.

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Please Note: ANRED information is not a substitute for medical treatment or psychological care. For help with the physical and emotional problems associated with eating and exercise disorders, talk to your physician and a competent mental health professional.

How to Help Someone You Care About

Note: The most common e-mail message we receive says something like, "How can I help my friend? I've read your information, but I still don't know what to do, and she/he resists all my attempts to help. Please help me help this person I care about."

Changing the behavior of other people, especially when they do not want to change, or when they are too frightened to change, is not possible. Nevertheless, folks with eating disorders need help and should not be abandoned. In most cases, the best service you can render is to continue being a friend. Encourage the person to seek professional treatment, and then stand by and be supportive, through all the resistance and denial, as the person struggles to gather courage to do the right thing.

We have added more details to the end of this section to explain why it is so hard to reach people with eating disorders even though they are quite obviously endangering their health, spoiling relationships, and making themselves miserable with all their obsessing about food and weight.

Remember, if your friend had cancer, you would urge professional treatment. You would not try to fix the problem yourself. People with eating disorders have a kind of soul cancer. Their minds and hearts are crippled and destroyed by the growing tumors of body dissatisfaction, drive to perfection, and need for control. You cannot fix those things. That is a job for physicians, psychologists, and other mental health therapists who have been trained to work with these desperately needy, yet stubborn and defiant, people who are doing the best they know how to take control of their lives in a world they find scary, lonely, and confusing.

Respect these people and love them, but don't try to fix them. Unless you are a physician or trained therapist, you don't have the skills. Remember that eating disorders can be treated, and people do recover from them, but almost always professional help is necessary.

If your child is younger than eighteen

Get professional help immediately. You have a legal and moral responsibility to get your child the care she/he needs. Don't let tears, tantrums, or promises to do better stop you. Begin with a physical exam and psychological evaluation.

If the physician recommends hospitalization, do it. People die from these disorders, and sometimes they need a structured time out to break entrenched patterns.

If the counselor asks you to participate in family sessions, do so. Children spend only one or two hours a week with their counselors. The rest of the time they live with their families. You need as many tools as you can get to help your child learn new ways of coping with life.

If your friend is younger than eighteen

Tell a trusted adult -- parent, teacher, coach, pastor, etc. -- about your concern. If you don't you may unwittingly help your friend avoid the treatment she/he needs to get better.

If your child or friend is older than eighteen

Legally the person is now an adult and can refuse treatment if she/he is not ready to change. Nevertheless, reach out. Tell her/him that you are concerned. Be gentle. Suggest that there has to be a better way to deal with life than starving and stuffing. Encourage professional help, but expect resistance and denial. You can lead a horse to water, but you can't make it drink -- even if it is thirsty.

Some things to do