What Drugs Do to Teens: Bodies

Welcome to the second in our series about how drugs affect teens. This time we will focus on the physical effects of drug use on the body. Addiction can develop in anyone, but adolescence is a time of life when individuals are more vulnerable to the impact of substance use and abuse.

In 2013, there were just over 2.8 million new users of illicit drugs. More than half (54.1%) were under the age of 18.[1] According to National Institute on Drug Abuse, high school seniors that use drugs most commonly use marijuana followed by amphetamines and prescription painkillers. This same study reveals that Adderall is the top prescription amphetamine being abused and Vicodin and OxyContin are at the top of the list of abused painkillers.[2]

Why Teens Use Drugs

There are many reasons teens experiment with illicit or unprescribed drugs including peer pressure or an attempt to deal with problems. They may start to use them socially or because a friend does and spiral out of control. As we talked about in our post about the impact of drugs on teens brains, the adolescent brain is also still developing and learning, so teens are wired to seek out new experiences and take risks.[3] But what also comes with this developing brain is a body still in progress as well. This means that the effect of teen substance abuse is that much more harmful.

Substances often fit into these categories: depressants, stimulants, hallucinogens, and opiates. So let’s break down each to see how they can impact the teen body.

How Do Depressants Affect the Teen Body?

Depressants slow down the functions of the body, including the brain, and often cause a drowsy feeling. Depressants include marijuana, Valium, Xanax, Librium, and barbiturates as well as alcohol. Their use can lower energy, slow breathing, slow heart rate, and lower body temperature.[4] They can affect your coordination and concentration and impair the ability to drive. Interestingly, marijuana can be categorized as a depressant, stimulant or hallucinogen thanks to mind-altering THC and variety of effects it can cause.[5]

How Do Stimulants Affect the Teen Body?

Stimulants speed up the brain, increase heart rate, blood pressure and breathing as well as raise body temperature.[6] They can also elevate mood and feelings of well-being. Stimulants include cocaine, methamphetamine, and amphetamine. Cocaine use can cause extreme sensitivity to sound, light and physical touch as well as headaches, convulsions, and seizures.[7] Prescription amphetamines such as Adderall, often given to treat ADHD, can also be misused when used by someone for whom it was not prescribed, or used in excess.[8] This can lead to risk of seizures, a lack of interest in eating, or decreased sleep.

How Do Hallucinogens Affect the Teen Body?

Hallucinogens, including LSD, PCP, MDMA, mescaline, and psilocybin, alter the brain and body’s perception of reality creating sensations and images that seem real. Use of hallucinogens can cause delusional thoughts and bizarre physical movement because they work on the way nerve cells communicate with one another.[9] In addition to hallucinations, LSD can increase cardiac activity and body temperature as well as loss of appetite, dry mouth and sweating.[10] MDMA, also known as Ecstasy or Molly, is a drug that acts like a stimulant by increasing energy and pleasure but alters perception and sense of reality.[11] This makes it difficult to categorize or to know how it will affect the body.

How Opiates Affect the Body

Opiates are powerful painkillers that change how the brain perceives pain. They can also produce feelings of euphoria. Opiates such as heroin, morphine, hydrocodone, oxycodone, fentanyl slow cardiac function and breathing as well as impacting nerve cells in the brain, spinal cord, gastrointestinal tract and other organs.[12] Opiates can be natural or synthetic, but all kick off the release of dopamine in the brain to control pain and create feelings of pleasure. With heroin, that rush usually comes with flushing, intense itchiness, nausea, and vomiting.[13]

Physical Dependency vs. Addiction

It’s important to make a distinction between addiction to a substance versus physical dependence. Addiction is a preoccupation to the point of obsession with obtaining a drug. It is a loss of control over its use. Physical dependency, the feeling of withdrawal if a drug is stopped suddenly, can be part of addiction or not.[14]

Any type of drug can be harmful to the body, whether it is misuse of prescribed medications or illicit substances, because of the risk factors that go along with drug use. Pride Surveys developed its Risk and Protective Factor (RPF) student perception survey, a hybrid version of the Communities That Care (CTC) Youth Survey and the Pride Questionnaire for Grades 6 to 12 to measure the risk factors that show the strongest correlation to drug use. It contains the updated Core Measures required by the Substance Abuse and Mental Health Services Administration (SAMHSA) for their Drug-Free Communities Grant that went into effect February 2013 and asks about incidences of alcohol, tobacco, and other drug use plus perceptions of availability and disapproval of use from parents and friends.

The benefit of choosing a survey company is that we take the guesswork out of the surveying process to ask the difficult questions. For more than thirty years, Pride Surveys has been helping schools collect data on teen substance abuse perceptions and drug use trends in their communities through scalable survey products. We offer multiple drug-free community survey options as well as student risk perception surveys designed to help assess teen substance abuse and risk, including our student surveys for grades 6-12, and our supplemental surveys like the Drug-Free Community Survey Supplement.

Browse the different types of scalable student surveys we offer and find out why Pride Surveys is the best choice to help you survey your school. Questions? Give us a call at 800-279-6361 or contact us here.

[1] “Nationwide Trends” Retrieved 24 April, 2018 at https://www.drugabuse.gov/publications/drugfacts/nationwide-trends

[2] “What Drugs Are Most Frequently Used by Adolescents?” Retrieved 24 April, 2018 at https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/frequently-asked-questions/what-drugs-are-most-frequently-used-by-adolescents

[3] “The Influence of Substance Use on Adolescent Brain Development.” Retrieved 19 March 2018 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827693/

[4] “Which Classes of Prescription Drugs Are Commonly Misused?” Retrieved 24 April, 2018 at https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/which-classes-prescription-drugs-are-commonly-misused

[5] “Profile: Marijuana.” Retrieved 24 April, 2018 at http://www.cesar.umd.edu/cesar/pubs/marijuana.pdf

[6] “Illegal Drugs and Heart Disease.” Retrieved 24 April, 2018 at http://www.heart.org/HEARTORG/Conditions/Cocaine-Marijuana-and-Other-Drugs_UCM_428537_Article.jsp#.Wt8pilMvyql

[7] “What is Cocaine?” Retrieved 24 April, 2018 at https://www.webmd.com/mental-health/addiction/cocaine-use-and-its-effects#1

[8] “Prescription Stimulants.” Retrieved 24 April, 2018 at https://www.drugabuse.gov/publications/drugfacts/prescription-stimulants

[9] “How do Hallucinogens Affect the Brain and Body?” Retrieved 24 April, 2018 at https://www.drugabuse.gov/publications/hallucinogens-dissociative-drugs/how-do-hallucinogens-lsd-psilocybin-peyote-dmt-ayahuasca-affect-brain-body

[10] Ibid.

[11] “What is MDMA?” Retrieved 24 April, 2018 at https://www.drugabuse.gov/publications/drugfacts/mdma-ecstasymolly

[12] America’s Addiction to Opioids: Heroin and Prescription Drug Use.” Retrieved 24 April, 2018 at https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse

[13] “What is Heroin?” Retrieved 24 April, 2018 at https://www.drugabuse.gov/publications/drugfacts/heroin

[14] “Physical Dependence vs. Addiction.” Retrieved 24 April, 2018 at https://blogs.psychcentral.com/blog/2017/03/physical-dependence-vs-addiction/

Impact of Bullying and Youth Violence in High Schools

School violence isn’t easy to understand, but it is something we seem to hear about more and more. Bullying, while nothing new, is of growing concern to parents at home and educators in schools because of its impact on children, learning, and the educational environment. So, let’s talk about youth violence and bullying to see how it impacts our kids and what adults can do to help.

Bullying is “unwanted aggressive behavior” that involves a real or perceived power disparity that repeatedly occurs over time. It can include intimidation, spreading rumors, physical or verbal attacks, or purposely excluding people from a group.[1] Perhaps once seen as part of growing up, bullying in the United States is now recognized as a type of youth violence that interferes with learning. It not only creates a poor learning environment for students but also impacts the teaching and working atmosphere for educators.

Violence is the intentional use of physical force or power against oneself or another person intended to cause injury, death, or bodily harm. It may be physical, sexual, psychological or involve deprivation.[2] A push on the playground might be an aggressive expression of frustration from elementary school students, but when it escalates to ongoing harassment and creates fear of going to school, learning and much more are impacted.

Research over the last several years has explored the overlap between bullying and other forms of youth violence as well as related behavioral health risks, such as mental health and substance use. A 2011 study showed that bullying at age 14 predicted violent convictions between ages 15 and 20, self-reported violence at age 15 to 18, low job status at age 18, and drug use at 27 to 32 years of age.[3]

Bullying doesn’t only involve violence. It can also include teasing as well as social exclusion and online taunts. Parents, counselors, and educators should also be on the lookout for circumstances where students purposely leave someone out, tell others not to be friends with someone, spread rumors, or deliberately embarrass someone in public. Intimidation and bullying behavior can be:

• Verbal
• Social
• Physical
• Cyberbullying[4]

Beginning in 1990, the Centers for Disease Control started their Youth Risk Behavior Surveillance System to collect data from more than 3.8 million high school students over 1700 surveys.[5] The national study monitors teen health risk behaviors including those that contribute to violence on school property. Over 15 years of surveying, it has started to spot some trends.

• The number of kids who carried a weapon (including guns, knives and more) to school decreased from 11.8% in 1993 to 4.1% in 2015.
• In 2015, 6% of kids surveyed said they were threatened or injured with a weapon on school property. In 1993 this number was 7.3%.
• The number of kids who were involved in a physical fight at school decreased over the study period from 16.2% to 7.8%.
• In 1993, 4.4% of kids surveyed said they did not go to school because they felt unsafe either in school or on their way to or from the property. By 2015, this number was 5.6%.
• The CDC survey began asking about bullying behaviors on school grounds in 2009 and has seen an increase since then from 19.9% to 20.2%.[6]

What we can take away from this data is that physical fights and the presence of weapons may be decreasing over time, but intimidation and terrorization appear to be impacting children to the extent that they will avoid the school learning environment to get away from the threat.

Research on youth violence has increased our understanding of factors that make some populations more vulnerable. Based on statistics beginning in 1992, LGBTQ students are two to three times more likely than their peers to be physically assaulted or threatened at school.[7] Students may feel depressed and hopeless or isolated and excluded by their peers. Sometimes, people who turn to violence are victims of bullying who feel they have hit a breaking point and would do anything to make it stop.

The federal government began collecting data on school bullying in 2005, when the prevalence of bullying was around 28%, according to the US Department of Education.[8] What may come as a surprise is that more middle schools reported daily school bullying (22%) than high schools (15%) or primary schools (8%).[9]

Anti-bullying and Violence Awareness Resources

Where can parents and educators look for tools to begin conversations with students about youth violence and bullying? Pride Surveys’ own Social, Emotional and Bullying Behavior Survey collects data and delivers reports that assess middle school students’ bullying perceptions and problem behaviors that affect student engagement. With SEBBS, schools can discover underlying causes for unwanted conditions such as increased absenteeism, lower academic achievement, and increased substance abuse.

The Johns Hopkins Bloomberg School of Public Health Center for the Prevention of Youth Violence offers several youth violence and bullying resources for educators, students, and parents including Teaching Tolerance lessons from the Southern Poverty Law Center. The renowned Children’s Hospital of Philadelphia has developed an online resource of Violence Prevention Tools. Students who experience bullying appear to be more likely to find peer interventions helpful rather than educator or self-actions, according to the Youth Voice Project.[10] So anti-bullying programs focused on peer education and school climate may find more success.

Violence and social and emotional intimidation have an impact on student success and academic achievement. That’s why Pride Surveys created our learning environment survey to measure students’ perceptions and behaviors that affect student engagement. Some of the questions we ask as part of this survey are:

• While at school have you carried a handgun?
• While at school have you threatened to hurt a student by hitting, slapping or kicking?
• While at school have you had a student threaten to hit, slap or kick you?
• While at school have you been afraid a student may hurt you?
• While at school have you hurt a student who hit, slapped or kicked you?

The benefit of choosing a survey company is that we take the guesswork out of the surveying process to ask the difficult questions. Browse the different types of scalable student surveys we offer and find out why Pride Surveys is the best choice to help you survey your school. Questions? Give us a call at 800-279-6361 or contact us here.

[1] “What is Bullying?” Retrieved 12 March, 2018 at https://www.stopbullying.gov/what-is-bullying/index.html

[2] “Definition and typology of Violence.” Retrieved 12 March, 2018 at http://www.who.int/violenceprevention/approach/definition/en/

[3] “Bullying as a predictor of offending, violence and later life outcomes.” Retrieved 12 March, 2018 at https://www.ncbi.nlm.nih.gov/pubmed/21370294

[4] “What is Bullying?” Retrieved 12 March, 2018 at https://www.stopbullying.gov/what-is-bullying/index.html

[5] “Youth Risk Behavior Surveillance Systems (YRBSS) Overview.” Retrieved 12 March, 2018 at https://www.cdc.gov/healthyyouth/data/yrbs/overview.htm

[6] “Trends in the Prevalence of Behaviors that Contribute to Violence on School Property National YRBS: 1991—2015.” Retrieved 13 March, 2018 at https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trends/2015_us_violenceschool_trend_yrbs.pdf

[7] “Violence and LGBTQ+ Communities What Do We Know, and What Do We Need to Know?” Retrieved 13 March, 2018 at http://www.rti.org/sites/default/files/rti_violence_and_lgbtq_communities.pdf

[8] “New Data Show a Decline in School-based Bullying” Retrieved 13 March, 2018 at https://www.ed.gov/news/press-releases/new-data-show-decline-school-based-bullying

[9] “Crime, Violence, Discipline, and Safety in U.S. Public Schools Findings from the School Survey on Crime and Safety: 2015–16” Retrieved 12 March, 2018 at https://nces.ed.gov/pubs2017/2017122.pdf

[10] “Youth Voice Research Project: Victimization & Strategies.” Retrieved 12 March, 2018 at http://njbullying.org/documents/YVPMarch2010.pdf

What Drugs Really Do to Teens: Brains

“This is your brain on drugs.”

An iconic ad campaign that influenced an entire generation of young people. But what do drugs really do to your brain when you’re a teen? Welcome to the first in our series about how drugs affect teen bodies.

When drugs enter the brain, they inhibit natural functions and development, and can ultimately lead to changes in how well the brain works. To understand the effect that drugs have on adolescents, it’s important to realize that teenagers are not just smaller, less-experienced adults; Neuroscientists have reported for years that the human brain is not fully mature until around the age of 25.[1]

Different drugs work on the brain in different ways because of their chemical structures. Marijuana is the most commonly used illicit drug in the U.S. with upwards of 11 million young adults ages 18-25 using in 2015.[2] THC, the primary psychoactive component of cannabis, overstimulates receptors in the brain that react naturally to chemicals similar to this chemical in marijuana. This overreaction is key in creating the high that people experience.[3]

Some short-term brain-related effects of marijuana are:[4]
• Temporary memory loss
• Altered perception of time
• Difficulties thinking or problem-solving

According to Staci Gruber, PhD, a neuroscientist and director of the Cognitive and Clinical Neuroimaging Core and the Marijuana Investigations for Neuroscientific Discovery (MIND) Program at McLean Hospital/Harvard Medical School, there are reasons to believe that adolescents may be exceptionally vulnerable to lasting damage from marijuana use at least until their early to mid-20s. “The brain is still under construction,” she explains.

The teenage mind is still developing physically, intellectually and emotionally. The frontal lobe of the brain, an area associated with “planning, inhibition, emotion regulation, and integration of novel stimuli,” goes through extensive development during puberty.[5] As teens mature, they are going through a crucial developmental stage when they are not only learning to make sound judgments but are also sensitive to psychoactive substances.[6] This can be a dangerous combination.

Our brains are hardwired to ensure that we’ll repeat specific actions by connecting those activities (like eating and sleeping) with a reward – feeling good – by releasing a chemical called dopamine. Dopamine, a neurotransmitter, is associated with the motivation aspect of reward-motivated behavior and links parts of the brain together that are home to personality, decision-making and social conduct.

Stimulants like meth and cocaine, the second most commonly used category of drugs in teens, also create a rush of dopamine in the brain.[7] These drugs can be destructive not only to intellectual development but also to the fundamental ability of a user to feel contentment and satisfaction.[8] Because they hamper the brain’s ability to sense rewards correctly in everyday life, it is believed that alterations in neurotransmitter function are involved in substance addiction.

Some short-term brain-related effects of meth are:[9]
• Increased energy and mania
• Insomnia
• Paranoia
• Obsessive focus on performing repetitive actions

Some short-term brain-related effects of cocaine are:[10]
• Feelings of euphoria
• Increased energy
• Inflated self-esteem
• Elevated mood

Adolescents are at risk of substance addiction from drug use more than any other age. And, more than any other age group, teens risk long-term “intellectual and emotional damage” as a result of abusing drugs.[11]

Pride Surveys developed its Risk and Protective Factor (RPF) student perception survey, a hybrid version of the Communities That Care (CTC) Youth Survey and the Pride Questionnaire for Grades 6 to 12 to measure the factors that show the strongest correlation to drug use. It contains the updated Core Measures required by the Substance Abuse and Mental Health Services Administration (SAMHSA) for their Drug-Free Communities Grant that went into effect February 2013 and asks about incidences of alcohol, tobacco, and other drug use plus perceptions of availability and disapproval of use from parents and friends.

[1] “Adolescent Maturity and the Brain: The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy.” Retrieved 19 March 2018 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892678/

[2] “Substance Abuse Center for Behavioral Health Statistics and Quality. Results from the 2015 National Survey on Drug Use and Health.” Retrieved 19 March 2018 at https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf

[3] “What is marijuana?” Retrieved 19 March 2018 at https://www.drugabuse.gov/publications/drugfacts/marijuana#ref

[4] “The Effects of Marijuana Use.” Retrieved 19 March 2018 at https://drugabuse.com/library/the-effects-of-marijuana-use/

[5] “The Influence of Substance Use on Adolescent Brain Development.” Retrieved 19 March 2018 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827693/

[6] “The Effects of Drugs and Alcohol On the Adolescent Brain.” Retrieved 19 March 2018 at http://www.samafoundation.org/the-effects-of-drugs-and-alcohol-on-the-adolescent-brain.html

[7] ibid

[8] ibid

[9] “The Effects of Meth Use.” Retrieved 19 March 2018 at https://drugabuse.com/library/the-effects-of-meth-use/

[10] “The Effects of Cocaine Use.” Retrieved 19 March 2018 at https://drugabuse.com/library/the-effects-of-cocaine-use/

[11] “Adolescent Maturity and the Brain: The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy.” Retrieved 19 March 2018 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892678/

Parents: How Can You Help Teens Make Smart Choices?

Spring Break is just around the corner and summer isn’t far behind – both times when parental supervision levels may change as kids are away from home more. But even beyond these big events, kids need to be making good decisions about their lives and the things that might impact them every day. So, how can you help kids make smart choices?

Teaching kids decision-making skills helps them become more independent, responsible, and self-confident, so it’s an important skill to focus on since it also helps them develop into successful, happy adults. Making good choices requires an appreciation of two elements: how different choices can impact different results and how those outcomes are desirable – or not.[1]

Help kids to learn to think before they leap by asking questions like:

• “Why do I want to do this?”
• “What are my options in this situation?”
• “What are the consequences of my actions?”
• “How much trouble will I get in?”
• “Is this decision in my best interests? Or “How will this decision affect others?”

Then come up with lots of answers and options.[2] They may know that doing something is unwise, but children can make snap judgments and act on them without thinking. Peer pressure can get them into situations where they feel stuck having to make a certain choice – one that may not be their own. Take every opportunity to remind your kid that he doesn’t have to do everything that his peers do.

Age 14 seems to be a critical point in solidifying decision-making skills; that’s when most kids start to resist peer influence, rather than just following the leader, according to a study published in Developmental Psychology.[3] Decision-making and risk-taking behaviors also involve brain areas that develop and change during adolescence. As these different of parts of the brain mature, those changes may play a role in making choices made based on a preference towards immediate gratification.[4]

Learning good decision making is complex and takes years of experience (even adults do foolish things sometimes). Don’t be afraid to talk to teens about difficult subjects like substance use, relationships, sexuality, online footprints, bullying, body awareness, and safety. Watch for teachable moments and be open and available when they are ready to talk or ask questions.[5]

The key to helping teens make good decisions on their own is providing guidance but not overdoing it. Be willing to give input when necessary, but don’t be afraid to step back.[6] Because you can’t always be looking over their shoulder, you can use times when they do leap without thinking (and things don’t turn out so well) to ask them how they could have made a different choice in hindsight. Bad decision making is almost an essential part of growing up. While kids may make bad decisions and suffer for it, they can learn from the experience and make better decisions in the future.

Social and emotional learning have an impact on student success and academic achievement. That’s why Pride Surveys created our learning environment survey to measure students’ perceptions and behaviors that affect student engagement.

[1] “3 Ways to Improve Your Decision Making.” Retrieved 26 February, 2018 at https://hbr.org/2018/01/3-ways-to-improve-your-decision-making

[2] “Steps to Good Decision Making Skills for Teens.” Retrieved 26 February, 2018 at https://www.verywellfamily.com/steps-to-good-decision-making-skills-for-teens-2609104

[3] “School Readiness and Later Achievement.” Retrieved 26 February, 2018 at http://psycnet.apa.org/record/2007-16709-012

[4] “Risk-taking and decision-making in youth: relationships to addiction vulnerability” Retrieved 26 February, 2018 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840427/#R9

[5] “Life with Teens.” Retrieved 26 February, 2018 at https://smartchoicessafekids.org/life-with-teens

[6] “Steps to Good Decision Making Skills for Teens.” Retrieved 26 February, 2018 at https://www.verywellfamily.com/steps-to-good-decision-making-skills-for-teens-2609104

Kids & Smartphones: Just How Bad (or Good) is Screen Time for Teens and Tweens?

Every day kids are flooded by messages on their screens intended to inform, amuse, and influence them. At the same time, it’s getting more and more difficult for parents and caregivers to monitor everything their kids see and do on that screen. What does that inundation do to their psyche? How do you know what is the right amount of screen time for kids? It turns out, there are differing opinions. Let’s take a look at whether screen time is good or bad for kids when it comes to self-esteem and overall mood.

A November 2015 survey by Common Sense Media found that two-thirds of teens have smartphones. But less than half say they use social media on a daily basis. That same study also noted that kids aged 8 and younger spent about 15 minutes per day looking at mobile screens in 2013. By 2017 that number had more than tripled to 48 minutes per day.[1] But the American Academy of Pediatrics warned in 2017 that overuse of digital media and screens could put teens at risk of obesity, sleep problems, cyberbullying and negative performance at school.[2]

One national survey found that increased use of social media sites Snapchat, Facebook, Twitter and Instagram led to increased feelings of teen depression, anxiety, poor body image, and loneliness. But YouTube had a positive impact on teens.[3] Could this be because social media has become a personal highlight reel of the good things in our lives? Teens who’ve created idealized personas online may feel discouraged and depressed at the gap between who they pretend to be online and who they truly are. Think of it as the digital generation’s version of “keeping up with the Joneses.” Researchers found that the happiest teens used digital media for less than an hour per day. After a daily hour of screen time, unhappiness rose steadily along with increasing screen time.[4]

After 2010, teens who spent more time on screens were more likely to report mental health issues than those who spent time on non-screen activities. Is it possible that kids with low self-esteem or those struggling with depression just spend more time on their phones and other screens? The author of one study was quick to suggest that her research doesn’t prove cause and effect, simply a correlation.[5] Overall, the evidence uncovered in these studies indicates moderate use of social media and digital technology is not intrinsically harmful and may be advantageous in a connected world, but finding the right balance is important – and challenging.[6] So does that mean screen time isn’t bad? Like many things when it comes to raising teenagers, it’s not so easy.

So what can parents do, short of taking away phones from their kids and watching everything they do online? Here are some recommendations:

1. Take Social Media Seriously
When talking about social media make sure you’re sincerely listening and being careful not to dismiss or minimize your teen’s experiences. Chances are you’re another one of the 1 billion people on Facebook connecting with old classmates, and you may well remember the stings of adolescence.

2. Actively talk about the meaning and effects of media – including social media
It takes commitment and effort on the part of parents to monitor and help interpret these external influences on kids. Having conversations about what you see in movies you watch together or in magazines opens up ways to discuss how we present ourselves to the world and interpret how others do as well.

3. Screen Time Shouldn’t Be Treated as a Reward – Or a Punishment
Making screen time a non-event means playing down its importance. While it can be an enjoyable diversion, screens shouldn’t be treated as a reward, and their absence shouldn’t be thought of as punitive.

4. Establish Device-free Times and Zones
It goes without saying that students should not be using their smartphones in the classroom, but where else is the screen off limits? Setting boundaries for your teenagers for where they can access their phones may offer parents the ability to better monitor what their kids are seeing.

5. Limit Bedtime Screen Time
Screen time can disrupt sleep and throw off the body’s internal clock leading to hormonal imbalances and inflammation.[7] Because of this, it is often recommended that kids (and adults) turn off their device 60 minutes before bedtime. Bedroom media also impact risk for obesity and video game addiction.[8

6. Set the Example
Healthy habits start with parents because kids are watching and learning all the time, so maybe now is the time to consider giving everyone in the house needs an electronic curfew. Being a role model is important when using digital devices and with how we present ourselves in social media and on-screen. Kids need to know its ok to be real online and that everyone struggles sometimes.

We’ve talked about body image and self-esteem in adolescence before. A child’s self-esteem affects how he or she feels day-to-day, impacting their relationships with others and how they do at school and in social situations.[9] Social and emotional learning and school climate both have an impact on student success and academic achievement. That’s why Pride Surveys created our learning environment survey to measure students’ perceptions and behaviors that affect student engagement.

[1] “The Common Sense Census: Media Use by Tweens and Teens.” Retrieved 20 February, 2018 at https://www.commonsensemedia.org/research/the-common-sense-census-media-use-by-tweens-and-teens

[2] “Why to Limit Your Child’s Media Use.” Retrieved 20 February, 2018 at https://www.healthychildren.org/English/family-life/Media/Pages/The-Benefits-of-Limiting-TV.aspx

[3] “Instagram Ranked Worst for Mental Health in Teen Survey.” Retrieved 20 February, 2018 at https://www.nhs.uk/news/food-and-diet/instagram-ranked-worst-for-mental-health-in-teen-survey

[4] “Screen-Addicted Kids Are Unhappy.” Retrieved 20 February, 2018 at https://www.sciencedaily.com/releases/2018/01/180122091249.htm

[5] “Decreases in Psychological Well-Being Among American Adolescents After 2012 and Links to Screen Time During the Rise of Smartphone Technology.” Retrieved 20 February, 2018 at http://psycnet.apa.org/record/2018-02758-001

[6] “A Large-Scale Test of the Goldilocks Hypothesis.” Retrieved 20 February, 2018 at http://journals.sagepub.com/doi/abs/10.1177/0956797616678438?journalCode=pssa

[7] “Screentime Is Making Kids Moody, Crazy and Lazy.” Retrieved 20 February, 2018 at https://www.psychologytoday.com/blog/mental-wealth/201508/screentime-is-making-kids-moody-crazy-and-lazy

[8] “Bedroom media: One risk factor for development.” Retrieved February 20, 2018 at https://www.ncbi.nlm.nih.gov/pubmed/28945440

[9] “11 Facts About Teens and Self-Esteem.” Retrieved 20 January, 2018 at https://www.dosomething.org/us/facts/11-facts-about-teens-and-self-esteem

The Impact of Taking Part in School Activities on Drug and Alcohol Use in Teens

Research shows there is a link between teen substance abuse and how well kids do in school. Teens who abuse drugs have lower grades, a higher absentee rate from school and other activities, and an increased potential for dropping out.[1] By participating in extracurricular activities like athletics, taking music lessons, or joining the newspaper staff, teens have a framework for their free time. They are also involved with a network of coaches, teammates and bandmates, and advisors who may be less tolerant of the use of illicit or illegal substances. While there is some debate about whether student-athletes, especially boys, are more susceptible to the influence of drugs from peers, most of the news is good.

In our Pride Surveys Report: 2015-16 National Summary, we noted that more than 30% of 6^th and 7^th graders take part in school activities “a lot” as do about 24% of 11^th and 12th graders.[2] In the national summary, you can see the correlations between extracurricular activities and drug use in our chapter that cross-tabs risk and protective factors with substance use.

High school girls who participate in sports are significantly less likely to use marijuana, cocaine, or most other illicit drugs. This protective effect of sports appears to be most influential for white girls. Some research does suggest that girls may be at a higher risk of illicit drug use than boys because they are more vulnerable to influences such as partner, peer or parental drug use. This statistic changes though when girls participate in sports, showing lower rates of drug use by female athletes as compared to their non-athlete peers.[3]

Sports help keep girls active and make them feel like a part of a team, which in turn can lead to a desire to be their healthiest and perform their best as well as a feeling of accountability towards other team members.[4] A national study of U.S. public high school students even found organized sports participants were 22% less likely to smoke cigarettes. Both male and female high school students who were involved in sports tended to rate themselves as being popular and more involved in extra-curricular activities. Playing sports and being part of a team can also give youth a strong social network that allows them to develop social skills that help them better adjust at school.[5]

However, a study published in the Journal of Child & Adolescent Substance Abuse does reveal that those most at risk for addiction to pain medications are sometimes high school athletes.[6] One of the key findings of this survey was that high school athletes more commonly used drugs than their peers; another was that boys were more likely to be drug users than girls. Finally, it was found that football players led their peers in drug use. One of the most troubling findings in the survey was that more teens are abusing prescription drugs including painkillers.[7]

What does all of this mean? It’s essential that parents are involved in their child’s lives and begin having conversations early about alcohol, tobacco, and other drugs. If a teen believes that his or her parents will allow substance use, he or she is more likely to try drugs or alcohol.[8] Substance abuse can lead to addiction or incarceration or other problems such as poor schoolwork, loss of friends, problems at home, and lasting legal problems.

It’s important for parents, educators, and coaches to learn about community and school activities that may interest teens and encourage them to participate. Relationships with educators and counselors are among the most significant and influential ones for many students. Adolescents who perceive that their teachers care about them are less likely to start using marijuana, smoking cigarettes, drinking to get drunk, and other behaviors that are barriers to education.[9]

But if school sports or other activities are not appealing to your teens, consider volunteer opportunities. Volunteering or after-school jobs can provide young people with a chance to become more responsible, to be exposed to other adults, and to develop new skills and interests. Some families even look for opportunities for teens and parents to volunteer together. It’s important, though, to remember not to push too hard. Look for signs that teens are overwhelmed with activities, volunteering, school work and other obligations.

Pride Surveys developed its Risk and Protective Factor (RPF) student perception survey, a hybrid version of the Communities That Care (CTC) Youth Survey and the Pride Questionnaire for Grades 6 to 12 to measure the factors that show the strongest correlations to drug use. It contains the updated Core Measures required by the Substance Abuse and Mental Health Services Administration (SAMHSA) for their Drug-Free Communities Grant that went into effect February 2013 and asks about incidences of alcohol, tobacco, and other drug use plus perceptions of availability and disapproval of use from parents and friends.

For over thirty years, Pride Surveys has been helping schools collect data on teen substance abuse perceptions and drug use trends in communities through scalable survey products. We offer multiple drug-free community survey options as well as student risk perception surveys designed to help assess teen substance abuse and risk, including our student surveys for grades 4-6, grades 6-12, and our supplemental surveys like the Drug-Free Community Survey Supplement. Please contact us online or call (800) 279-6361 for more information.

[1] “Adolescent Substance Abuse: America’s #1 Health Problem.” Retrieved 26 January, 2018 at https://www.centeronaddiction.org/addiction-research/reports/adolescent-substance-use-america%E2%80%99s-1-public-health-problem

[2] “Pride Surveys Questionnaire for Grades 6 thru 12 Standard Report 2015-16 Pride National Summary.” Retrieved 26 January, 2018 at https://www.pridesurveys.com/customercenter/us15ns.pdf

[3] “HER LIFE DEPENDS ON IT III: Sport, Physical Activity, and the Health and Well-Being of American Girls and Women Executive Summary.” Retrieved 26 January, 2018 at http://www.womenssportsfoundation.org/wp-content/uploads/2017/06/hldoi-iii-report-executive-summary.pdf

[4] “Her Life Depends On It III: Sport, Physical Activity, and the Health and Well-Being of American Girls and Women Executive Summary.” Retrieved 26 January, 2018 at http://www.womenssportsfoundation.org/wp-content/uploads/2017/06/hldoi-iii-report-executive-summary.pdf

[5] “How Your Daughter’s Sports Team Could Be Enhancing Your Family Life.” Retrieved 26 January, 2018 at https://www.womenssportsfoundation.org/education/how-your-daughters-sports-team-could-be-enhancing-your-family-life/

[6] “Abuse of Prescription Painkillers on the Rise Among High School Athletes: Survey.” Retrieved 26 January, 2018 at https://health.usnews.com/health-news/articles/2014/08/04/abuse-of-prescription-painkillers-on-the-rise-among-high-school-athletes-survey

[7] “Survey Says High School Athletes More At Risk for Prescription Abuse Problems.” Retrieved 26 January, 2018 at http://www.narconon.org/blog/narconon/survey-says-high-school-athletes-risk-prescription-abuse-problems/

[8] “Talking to your middle school-aged child about alcohol, tobacco, and other drugs: a 10-step guide for parents.” Retrieved 26 January, 2018 at http://www.needhamma.gov/DocumentCenter/Home/View/3387

[9] “The Role of Schools in Combatting Illicit Substance Abuse.” Retrieved January 26 at http://pediatrics.aappublications.org/content/120/6/1379#ref-2

How Teachers Can Help Students Who’ve Survived Trauma

For children who have experienced trauma, learning can be a struggle. Trauma can cause physiological symptoms like stomachaches, headaches, and poor sleep habits. The impacts of a traumatic experience can affect a child well after the event into adulthood.[1] A child may feel hopeless, helpless, out of control and experience feelings of anxiety that won’t stop. The classroom can be a safe haven or an additional point of stress. This begs the question, how can educators help these students?

What is Trauma?
Trauma is damage that results from a severely distressing event that exceeds one’s ability to cope and integrate the emotions involved in that event.[2] Trauma may not involve violence; kids can suffer significant stress from a variety of difficult situations including divorce, transitions and mobility, drug or alcohol use in the home, or bullying. It also may not be one event triggering the feelings, but the culmination of chronic stress.[3]

Childhood trauma can negatively affect the way the brain develops, leading to stress, anxiety or difficulty in controlling emotions. Learning about the impacts of trauma can help educators understand a child’s underlying difficulties with learning, behavior and relationships. Students can often be misdiagnosed with anxiety, behavior disorders or attention disorders, rather than understanding the trauma that’s driving those reactions. Symptoms can go unrecognized because they can manifest like frustration and acting out or difficulty concentrating, following directions and working in a group. But once trauma is identified as the root cause, educators can help kids cope with the aftermath.

In addition to behavioral issues, trauma can disturb a student’s development of the foundations necessary for learning from the development of language and communication skills to interfering with the ability to organize and remember new information.[4]

Adverse Childhood Experiences
Early traumatic experiences are an important public health issue. Research suggests that approximately 25% of American children will experience at least one traumatic event by the age of 16.[5] The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse, trauma and neglect and later-life health and well-being. The original ACE Study was conducted at Kaiser Permanente from 1995 to 1997 with more than 17,000 HMO members from Southern California completing confidential surveys regarding their childhood experiences and current health status and behaviors.[6]

It found that as the number of ACEs increased, so did the risk of alcoholism, depression, COPD, ischemic heart disease, liver disease, suicide attempts, adolescent pregnancy, poor academic achievement and financial stress. When a child has more than four ACEs, the impact lasts for decades. It can be seen not only in mental health but in the incidence of chronic diseases and even cancer.[7] Childhood experiences, both positive and negative, also have a tremendous impact on future violence, both as victim and perpetrator, and lifelong health and opportunity.[8]

While the young brain is impressionable to trauma, it can also be resilient. There’s interesting research showing that the brain is able, under certain conditions, to rewire itself. This neuroplasticity – the ability of the brain to grow, change and form new connections into adulthood – may help to ameliorate the behavioral and emotional problems caused by the original damage.[9]

What Can Teachers Do to Help?
Create a Safe Space: Let children know you recognize they are struggling and are there to support them through it.
Provide Routine: A daily routine in the classroom can be reassuring, so try to provide structure and predictability whenever possible.
Give Choices: When stress is at the center of a child’s life, having some control over the projects they work on, aspects of them or the order in which they are done may help. Knowing what’s coming next makes a big difference.
Be There to Listen: Teachers don’t have to solve a child’s problem in order to help. Sometimes simply listening can make all the difference to a child.
Ask Questions: Checking in with your student directly and asking what they need to cope may get you the guidance you need. When it comes to larger issues, a school survey can also help discover what the faculty and administration can do to make a difference
Work with Counselors, Social Workers and School Psychologists: Mental health professionals can facilitate the creation of timely, effective, and culturally-responsive mental and behavioral health services.
Recess and Downtime: A child may be better able to make it through a block of work knowing there will be a break afterward to rest and recharge.
Find a Toolkit: The National Child Traumatic Stress Network has created a Child Trauma Toolkit for Educators.
Create a Trauma-Sensitive School Environment. Since 2005, schools across the US have adopted some type of trauma-sensitive approach. Trauma-sensitive schools promote[10]:

feelings of physical, social, and emotional safety in students
a shared understanding among staff about the impact of trauma and its adversity on students
positive and culturally responsive discipline policies and practices
access to comprehensive school mental and behavioral health service
effective community collaboration.

The Every Student Succeeds Act (ESSA) provides opportunities to increase access to school mental and behavioral health service and expands local power over decision-making to help address specific issues, including trauma.[11]

Pride Surveys offers opportunities for tweens and teens to share their thoughts on violent or threatening behavior, bullying and other issues that impact student engagement through our Learning Environment Survey as well as our Social, Emotional and Bullying Behavior Survey. The benefit of choosing a survey company is that we take the guesswork out of the surveying process to ask the difficult questions. Browse the different types of scalable student surveys we offer and find out why Pride Surveys is the best choice to help you survey your school. Questions? Give us a call at 800-279-6361 or fill out our quick online contact form.

____________________________________________________________________

[1] “5 Ways Teachers Can Help Kids Who Have Experienced Trauma.” Retrieved 10 January, 2018 at http://stateofopportunity.michiganradio.org/post/5-ways-teachers-can-help-kids-who-have-experienced-trauma

[2] “Emotional and Physical Trauma: Healing from Trauma and Moving On.” Retrieved on 12 January, 2018 at https://www.helpguide.org/articles/ptsd-trauma/coping-with-emotional-and-psychological-trauma.htm

[3] “10 Things About Childhood Trauma Every Teacher Needs to Know.” Retrieved 12 January, 2018 at https://www.weareteachers.com/10-things-about-childhood-trauma-every-teacher-needs-to-know/

[4] “Helping Traumatized Children Learn.” Retrieved 12 December, 2018 at https://traumasensitiveschools.org/trauma-and-learning/the-problem-impact/

[5] “Child Trauma Toolkit for Educators.” Retrieved 12 January, 2018 at

http://www.nctsn.org/resources/audiences/school-personnel/trauma-toolkit

[6] “About the CDC-Kaiser ACE Study.” Retrieved 10 January, 2018 at https://www.cdc.gov/violenceprevention/acestudy/about.html

[7] “How Schools Use Brain Science to Help Traumatized Kids Heal and Learn.” Retrieved 10 January, 2018 at https://ww2.kqed.org/mindshift/2017/06/12/how-schools-use-brain-science-to-help-traumatized-kids-heal-and-learn/

[8] “Adverse Childhood Experiences (ACEs).” Retrieved 12 January, 2018 at https://www.cdc.gov/violenceprevention/acestudy/

[9] “Neuroplasticity and Rewiring the Brain.” Retrieved 12 January, 2018 at http://healingtraumacenter.com/neuroplasticity-and-rewiring-the-brain/

[10] “Trauma-Sensitive Schools.” Retrieved 12 December, 2018 at http://www.nasponline.org/resources-and-publications/resources/mental-health/trauma-sensitive-schools

[11] “Trauma-Sensitive Schools.” Retrieved 12 December, 2018 at http://www.nasponline.org/resources-and-publications/resources/mental-health/trauma-sensitive-schools

Student Mental Health: Teens and Depression

It can be easy to write off moodiness as hormones or teen drama, but could there be something more to it? The results from a Columbia University Mailman School of Public Health and the CUNY Graduate School of Public Health and Health Policy Study show that depression increased significantly in the U.S. from 2005 to 2015 with the most rapid rise among kids ages 12 to 17 to 12.7%.[1] Suicide is the second leading cause of death for youth ages 12-18.[2] And depression that goes untreated is the strongest risk factor for suicidal behavior.[3] There are several theories about why this increase is occurring, from the negative influence of social media to bullying in schools to peer pressure.

While this data may seem scary, equipped with information, you can help the tweens and teens in your life begin to identify the symptoms of depression and seek help.

Here are some things to look out for:
-Persistent sad, anxious, or “empty” mood
-Feelings of hopelessness, or pessimism
-Poor performance in school
-Absenteeism
-Increased substance abuse
-Troubled relationships
-Irritability and anger
-Feelings of guilt, worthlessness, or helplessness
-Loss of interest or pleasure in hobbies and activities
-Decreased energy or lethargy
-Feeling restless or having trouble sitting still
-Difficulty concentrating, remembering, or making decisions
-Sleep disturbances including difficulty sleeping, early-morning wakefulness, or oversleeping
-Appetite and or weight changes
-Thoughts of death or suicide, or suicide attempts
-Aches or pains, headaches, cramps, or digestive problems without a clear physical cause that do not ease even with treatment
-Risky behavior or questionable decisions

Not everyone who is depressed experiences every one of these symptoms. Some people experience only a few while others may experience many.[4] Teens specifically may have signs of extreme irritability, amplified reactions, anger, or anxiety instead of the overwhelming sadness often associated with depression.[5] Because symptoms can vary, a diagnosis is often challenging to make because clinical depression can manifest in so many different ways.

This is why recognizing and responding to student mental health issues is so important when spotting changes in behavior.[6] Talking to kids and asking the right questions from one-on-one conversations to anonymous surveys can help schools discover underlying causes for worrying situations, such as increased absenteeism, lower academic achievement, and increased substance abuse.

How Can Schools Help?
Educators and administers can be first to notice changes in physical and mental health in students. Here are a few ways to help teens and their families you observe struggling:

-Help ensure a positive, safe school environment
-Encourage them to seek help
-Educate staff, parents, and students on symptoms of and help for mental health problems
-Promote social and emotional competency and build resilience
-Teach and reinforce positive behaviors and decision-making
-Encourage good health – physical and mental
-Help ensure access to school-based mental health supports[7]

Pride Surveys offers opportunities for tweens and teens to share their thoughts on problem behaviors, bullying, and other issues that impact student engagement through our Learning Environment Survey as well as our Social, Emotional and Bullying Behavior Survey. The benefit of choosing a survey company is that we take the guesswork out of the surveying process to ask the difficult questions. Browse the different types of scalable student surveys we offer and find out why Pride Surveys is the best choice to help you survey your school. Questions? Give us a call at 800-279-6361 or fill out our quick online contact form.

[1] “Depression is on the Rise in the US, Especially Among Young Teens.” Retrieved 12 December, 2017 at https://www.mailman.columbia.edu/public-health-now/news/depression-rise-us-especially-among-young-teens

[2] “Suicide Survivor Inspired Teens and Adolescents.” Retrieved on 12 December, 2017 at http://centerfordiscovery.com/blog/suicide-survivor-inspires-teens-adolescents/

[3] “Depression is on the Rise in the US, Especially Among Young Teens.” Retrieved 12 December, 2017 at https://www.mailman.columbia.edu/public-health-now/news/depression-rise-us-especially-among-young-teens

[4] “Teenage Depression Study: Understanding Depression in Teenagers.” Retrieved 12 December, 2017 at https://www.nimh.nih.gov/health/topics/depression/index.shtml

[5] “Teen Depression: Symptoms and Tips for Parents.” Retrieved 12 December, 2017 at https://www.webmd.com/parenting/depression#1

[6] “Position Statement 41: Early Identification of Mental Health Issues in Young People.” Retrieved 12 December, 2017 at http://www.mentalhealthamerica.net/positions/early-identification

[7] “Talk About Mental Health: For Educators.” Retrieved 12 December, 2017 at https://www.mentalhealth.gov/talk/educators

What You Need to Know About Alcohol and Tobacco Use in Middle Schools

Why is adolescence a critical time to intervene in smoking and alcohol use? Early introduction of these substances can lead to a variety of adverse consequences, including addiction later in life, not to mention the impact on a developing brain and body. Identifying adolescents at greatest risk can also help stop problems before they develop.

Alcohol is the most commonly used drug among adolescents.
The average age teen boy first tries alcohol at age 11, for teen girls, it’s 13.[1] In 2015, the Monitoring the Future Survey reported that 10% of 8th graders drank during the past 30 days, and 5% of 8th graders binge drank during the past two weeks.[2] Because their organs and brain are still growing and mental capabilities are developing, the risk of adverse health effects on young drinkers are increased.

A young person’s body cannot cope with alcohol the same way an adult’s can. Middle school students most frequently drank at home parties with three to four other kids and reported alcohol-related troubles including conflicts with friends or parents, memory loss, nausea, and doing things they would not usually do.[3]

Smoking is the leading cause of preventable death.
Although tobacco use by adolescents and young adults has substantially declined in the last 40 years, in 2015, almost one in 17 high school seniors was a daily smoker, and almost one in 10 had smoked within the last 30 days.[4] If you smoke, your kids are more likely to smoke. Middle school students are three times more likely to try smoking if there’s a smoker at home.[5]

According to the CDC, the majority of daily smokers (82%) began smoking before 18 years of age, and more than 3,000 young people still start smoking each day.[6] If smoking continues at the current rate among US youth, 5.6 million of today’s Americans younger than 18 years of age are expected to die prematurely from a smoking-related illness. This represents about one in every 13 Americans aged 17 years or younger who are alive today.[7]

According to our national survey data, the percentages of 6^th through 8^th graders who use tobacco (5.5%), alcohol (11.6%) – and even marijuana (4.8%) are concerning.[8] What this tells us is that schools need to begin conversations about alcohol use and smoking with students by the fourth or fifth grade and continue those conversations for the rest of their school career.

Some scary stuff. But it’s not all doom and gloom.
It’s important to remember that most adolescents do not use alcohol, tobacco, or other drugs. And, as we discussed in a previous post regarding talking to kids about drug use, parents can have a strong influence on their kids when it comes to starting – even if it doesn’t always seem that way. Family involvement is essential to the success of alcohol use and smoking prevention. Educators play a vital role too; Schools have the opportunity to work with healthcare professionals, community organizations and specialists to identify students who show behavioral risks for smoking, alcohol and drug-related problems.

For over thirty years, Pride Surveys has been helping schools collect data on teen substance abuse perceptions and drug use trends in their communities through scalable survey products. We offer multiple drug-free community survey options as well as student risk perception surveys designed to help assess teen substance abuse and risk, including our student surveys for grades 4-6, grades 6-12, and our supplemental surveys like the Drug-Free Community Survey Supplement. Please contact us online or call (800) 279-6361 for more information.

Note: If you need help quitting smoking, call 1-800-QUIT-NOW.

[1] “Teenage Drinking.”

[2] “Monitoring the Future: National Survey Results on Drug Use 1975 – 2015.” Retrieved 12 December, 2017 at http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2015.pdf

[3] Middle School Drinking: Who, Where and When.” Retrieved 12 December, 2017 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543295/

[4] “Monitoring the Future: National Survey Results on Drug Use 1975 – 2015.” Retrieved 12 December, 2017 at http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2015.pdf

[5] “Talking to your middle school-aged child about alcohol, tobacco, and other drugs: a 10-step guide for parents.” Retrieved 12 December, 2017 at http://www.needhamma.gov/DocumentCenter/Home/View/3387

[6] “Guidelines for School Health Programs to Prevent Tobacco Use and Addiction.” Retrieved 12 December, 2017 at https://www.cdc.gov/mmwr/preview/mmwrhtml/00026213.htm

[7] “2014 Surgeon General’s Report: The Health Consequences of Smoking-50Years of Progress.” Retrieved 12 December, 2017 at https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm

[8] “Pride Surveys Questionnaire for Grades 6 thru 12 Standard Report” Retrieved 12 December, 2017 at https://www.pridesurveys.com/customercenter/us15ns.pdf