tag:theconversation.com,2011:/uk/topics/youth-health-21071/articlesYouth health – The Conversation2024-03-10T13:17:33Ztag:theconversation.com,2011:article/2242382024-03-10T13:17:33Z2024-03-10T13:17:33ZCanada is falling behind other countries in meeting the needs of former youth in care<p>Can we do better in Canada to meet the needs of former youth in care?</p>
<p>Young adults across Canada continue to struggle with the <a href="https://leger360.com/surveys/2023-youth-study-report-millennials-and-gen-zs-employment-finances-and-future/">high cost of living</a>. Statistics Canada highlights a 20-year trend <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/220713/g-a005-eng.htm">of Canadians aged 20-34 remaining in their familial home with at least one parent</a>. </p>
<p>In contrast, young adults aging out of government care (those with lived experience in child welfare systems) are expected to rapidly transition to adulthood much earlier, many <a href="https://rcybc.ca/wp-content/uploads/2019/04/relationships_matter_research_report_fall_2018_final_0.pdf">without the support of their families</a>.</p>
<h2>OECD data</h2>
<p>While Canada is among 38 member countries of the Organisation for Economic Co-operation and Development (OECD) working toward developing policy standards in relation to economic development, Canada is failing to meet the social, educational and economic realities facing people with lived experience in child welfare systems. </p>
<p>Recent <a href="https://doi.org/10.1787/1939a9ec-en">OECD data indicate that</a> people who have had experience in care as children have worse mental health, greater levels of homelessness, higher incarceration rates and higher rates of suicide. </p>
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Read more:
<a href="https://theconversation.com/health-of-former-youth-in-care-could-be-bolstered-by-stronger-tuition-waiver-programs-189056">Health of former youth in care could be bolstered by stronger tuition waiver programs</a>
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<p>Collectively, these indicators suggest the need for greater attention to youth leaving care. In particular, we need to do better at evaluating which types of interventions provide for positive long-term effects on youth’s education, mental health and employment after they leave care. </p>
<p>Available data suggest Canada is falling behind other countries in terms of meeting the unique needs of former youth in care. </p>
<p>This has direct implications for the individuals, their communities and the economy, and yet we continue to see a patchwork approach taken by the federal and provincial governments. </p>
<h2>Patchwork approaches</h2>
<p>Existing aging-out-of-care policies continue to have very real consequences for youth, including barriers <a href="https://www.oecd-ilibrary.org/education/education-at-a-glance-2023_e13bef63-en">to access to education</a>, employment and housing — all of which are <a href="https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html">key determinants of health</a>.</p>
<p>The consequences of continued inaction will inevitably result in worse health, social, economic and other life outcomes for thousands of people. </p>
<p>These consequences <a href="https://www150.statcan.gc.ca/n1/pub/46-28-0001/2023001/article/00004-eng.htm">will be felt for generations</a>, with many former youth in care experiencing continued cycles of poverty. </p>
<h2>Worse labour market outcomes</h2>
<p>We know that many former youth in care have intersecting <a href="https://doi.org/10.1080/02671522.2013.767370">experiences and identities</a>. Many face adversity or oppression related to class, gender identity, sexual orientation or racism that can limit their life chances and attainment in <a href="https://doi.org/10.1080/15548732.2017.1347551">terms of education, employment</a> and health outcomes. </p>
<p>Former youth in care are more likely to be from groups that have worse educational and labour market outcomes to begin with, and youth who are <a href="https://42bf8e9c-2414-4457-bac7-f47eccf53bff.filesusr.com/ugd/6548f4_7ba391d9a4b54e7a972c1314de2cefca.pdf">from Black, Indigenous and 2SLGBTQIA+ populations remain over-represented</a> in care systems. </p>
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<img alt="People seen walking on a campus path." src="https://images.theconversation.com/files/579318/original/file-20240301-51556-jndcqr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579318/original/file-20240301-51556-jndcqr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579318/original/file-20240301-51556-jndcqr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579318/original/file-20240301-51556-jndcqr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579318/original/file-20240301-51556-jndcqr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579318/original/file-20240301-51556-jndcqr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579318/original/file-20240301-51556-jndcqr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Access to education, employment and housing are all key determinants of health.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Perhaps not surprisingly, given these disadvantages and lack of opportunities afforded to youth with experience in care, former youth in care are more likely to <a href="https://doi.org/10.1016/j.childyouth.2018.08.027">be involved in criminal activity</a>, particularly for those placed by agencies <a href="https://www.justice.gc.ca/socjs-esjp/en/Youth/yij">in group care settings</a>. </p>
<p>Given that individuals with criminal records, particularly women and Indigenous applicants, can find it almost impossible to find work, this can lead <a href="https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/2021-r002/index-en.aspx#sA">to a life of economic dependence on social welfare services</a>.</p>
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Read more:
<a href="https://theconversation.com/high-school-dropouts-cost-countries-a-staggering-amount-of-money-115396">High school dropouts cost countries a staggering amount of money</a>
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<h2>Quality education?</h2>
<p>In terms of Canada’s standing in relation to United Nations Sustainable Development Goals (SDGs), <a href="https://www.undp.org/sustainable-development-goals/quality-education">particularly SDG 4 (Quality Education)</a>, SDG 1 (no poverty) and SDG 3 (good health and well-being) is also at issue.</p>
<p>The UNSDG data indicates that education is widely regarded as a key factor in mitigating the impacts of experiences in care as well as other related childhood traumas. </p>
<p>Our recently published review of research about barriers to post-secondary education among former youth in care found <a href="https://doi.org/10.1016/j.ijedro.2023.100303">that more attention is needed in the intersecting system-level factors that impact access to education</a>. These barriers include poverty, as well as adverse health and well-being. Many <a href="https://bit.ly/3InfGdn">of these circumstances</a> begin in care, and well before high school or post-secondary studies. </p>
<h2>Barriers to post-secondary study</h2>
<p>Of the 58 studies that met our inclusion criteria, the majority cite issues of highly variable requirements for funding supports for post-secondary education. These variables include: </p>
<ul>
<li>differing provincial and institutional age caps;</li>
<li>verification processes to determine who is eligible;</li>
<li>limitations on program duration;</li>
<li>eligible program types and level of study.</li>
</ul>
<p>These varied requirements limit financial supports, and can result in financial gaps. </p>
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<a href="https://images.theconversation.com/files/579316/original/file-20240301-51515-hsbkv7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Mural of a hand holding a growing plant." src="https://images.theconversation.com/files/579316/original/file-20240301-51515-hsbkv7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/579316/original/file-20240301-51515-hsbkv7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=676&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579316/original/file-20240301-51515-hsbkv7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=676&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579316/original/file-20240301-51515-hsbkv7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=676&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579316/original/file-20240301-51515-hsbkv7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=850&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579316/original/file-20240301-51515-hsbkv7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=850&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579316/original/file-20240301-51515-hsbkv7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=850&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A focus on trauma-informed policy approaches is needed.</span>
<span class="attribution"><span class="source">(Noemi Macavei Katocz/Unsplash)</span></span>
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<p>Many studies noted the need for greater attention to how existing policies may inadvertently exclude former youth in care. </p>
<p>A <a href="https://theconversation.com/why-taking-a-trauma-and-violence-informed-approach-can-make-sport-safer-and-more-equitable-213349">focus on trauma-informed</a> policy approaches, including a greater level of psycho-social supports in higher education, is urgently needed. </p>
<p>As <a href="https://www.cwlc.ca/post/equitable-standards-for-transitions-to-adulthood-for-youth-in-care-evaluation-model">noted in research we covered</a>, once youth age out of care, they are expected to find their way in an adult world that often renders them invisible. </p>
<h2>Need to track and monitor youth</h2>
<p>To fully understand and address the interconnected and systemic issues facing former youth in care, Canada needs to focus on tracking, monitoring and evaluating the economic, health and social outcomes of these youth. This is the case especially as they transition from government care into adulthood. </p>
<p>As it now stands, Canada’s national statistics agency and most provincial agencies do not provide the longitudinal data needed to systematically track after-care outcomes like education, employment, income and health among people with experience in child welfare systems.</p>
<p>This in turn makes it highly challenging to know which types of policies, programs and supports are truly meeting the needs of former youth in care. It also makes it difficult to know which are helping Canada achieve its <a href="https://sdgs.un.org/goals">commitments to the SDGs</a> and the <a href="https://www.canada.ca/en/public-health/services/national-child-day/united-nations-convention-rights-of-the-child.html">United Nations Convention on the Rights of the Child</a>.</p>
<p><em>Sue McWilliam, Trauma Informed Care Research and Evaluation Lead in Mental Health and Addictions at IWK Health co-authored this story.</em></p><img src="https://counter.theconversation.com/content/224238/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacquie Gahagan receives funding from the Canadian Institutes of Health Research (CIHR), Social Sciences and Humanities Research Council (SSHRC), and Research Nova Scotia (RNS). </span></em></p><p class="fine-print"><em><span>Dale Kirby receives funding from the Social Sciences and Humanities Research Council.</span></em></p><p class="fine-print"><em><span>Steven Smith receives funding from the Social Sciences and Humanities Research Council of Canada, Mitacs, and Research Nova Scotia.</span></em></p><p class="fine-print"><em><span>Kristyn Anderson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Canada needs to focus on tracking, monitoring and evaluating the economic, health and social outcomes of former youth in care, especially as they transition from government care.Jacquie Gahagan, Full Professor and Associate Vice-President, Research, Mount Saint Vincent UniversityDale Kirby, Professor, Faculty of Education, Memorial University of NewfoundlandKristyn Anderson, PhD candidate (health), Dalhousie UniversitySteven Smith, Professor of Psychology, Saint Mary’s UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2214122024-01-23T19:00:02Z2024-01-23T19:00:02ZFor the new vape laws to succeed, these 3 things need to happen – or users may look to the illicit market<figure><img src="https://images.theconversation.com/files/570782/original/file-20240123-15-tpau1a.jpg?ixlib=rb-1.1.0&rect=17%2C511%2C5973%2C3476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/a-woman-sitting-on-a-bench-next-to-a-man-IktGJT61bG4">Ernst Gunther Krause/Unsplash</a></span></figcaption></figure><p>This year, the Australian government will progressively <a href="https://theconversation.com/from-today-new-regulations-make-it-harder-to-access-vapes-heres-whats-changing-218816">ban</a> the retail sale of all e-cigarettes, known as vapes. Vapers will <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">only be allowed</a> to use nicotine vapes that comply with <a href="https://www.tga.gov.au/products/unapproved-therapeutic-goods/vaping-hub/reforms-regulation-vapes">Therapeutic Goods Administration</a> (TGA) product requirements – and only to help them quit or manage their nicotine dependence, if prescribed by a doctor and dispensed by a pharmacy.</p>
<p>This will be <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">accompanied by</a> increased funding for law enforcement to prevent illegal importation of vapes, a public education campaign about the risks of vaping, and greater efforts to encourage smokers to only obtain their vapes on prescription.</p>
<p>But for the scheme to be successful, three things need to happen: vaping products that vapers will use need to be available, GPs need to be willing to write prescriptions, and pharmacies need to be able to meet the demand. None of these are guaranteed. </p>
<p>Failure to do so could see some people continue to use the illicit market for vapes, or to switch to traditional cigarettes. </p>
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Read more:
<a href="https://theconversation.com/from-today-new-regulations-make-it-harder-to-access-vapes-heres-whats-changing-218816">From today, new regulations make it harder to access vapes. Here's what's changing</a>
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<h2>The previous vape policy failed</h2>
<p>The new policy tightens the enforcement of a <a href="https://link.springer.com/chapter/10.1007/978-3-031-23658-7_1#Sec5">retail sales ban on vapes containing nicotine</a> first introduced in <a href="https://www.aph.gov.au/DocumentStore.ashx?id=b57abf1c-0e4f-49a5-a3a3-2bb02ea76bf3&subId=401164">2011</a>. This only allowed smokers to use nicotine vapes if they had been approved for smoking cessation (quitting) by the TGA and were prescribed by a doctor to help them quit smoking. </p>
<p>The TGA’s expectation was that nicotine vapes would eventually be produced that would be approved for prescription. When no vapes had been approved by 2021, the TGA <a href="https://www.tga.gov.au/resources/publication/scheduling-decisions-final/notice-final-decision-amend-current-poisons-standard-nicotine">reclassified nicotine</a> to allow doctors to prescribe unapproved nicotine vapes.</p>
<p>But these policies didn’t meet their objectives. <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">Fewer than 10% of vapers</a> obtained a prescription.</p>
<p>The TGA’s <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">impact assessment</a> of the 2021 policy shows it failed to prevent vaping among Australian youth or give smokers legal access to vapes. This was in large part because vape retailers illegally sold nicotine vapes as nicotine-free products (which were not banned) and sold colourful, flavoured disposable vapes that appealed to young people.</p>
<figure class="align-center ">
<img alt="Colourful vapes in a shop" src="https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Retailers illegally sold nicotine vapes as ‘nicotine-free’ products.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/man-in-black-long-sleeve-shirt-holding-black-dslr-camera-hVcmxpYg1Gc">e Liquids UK/Unsplash</a></span>
</figcaption>
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<p>By the end of 2023, an <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">estimated</a> 1.3 million Australian adults were using vapes containing nicotine. The largest uptake was among young adults aged 18 to 24 and there was a worrying uptake among young people aged 14 to 17. More than <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">90% of vapes</a> were obtained illegally from retail vape stores and via internet sales.</p>
<h2>What are the new rules, and what are their aims?</h2>
<p>From January 1, the importation of disposable vapes <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">is banned</a>. </p>
<p>From March, there will be a <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">complete ban</a> on the import of non-therapeutic vape products. Importers of therapeutic vapes will need a licence and permit from the government’s Office of Drug Control to import them. </p>
<p>The government will <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">later set product standards</a> that limit flavours, reduce permissible nicotine concentrations and require pharmaceutical packaging of therapeutic vapes.</p>
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Read more:
<a href="https://theconversation.com/my-teen-is-addicted-to-vaping-how-can-i-help-them-quit-and-manage-their-withdrawal-symptoms-208586">My teen is addicted to vaping. How can I help them quit and manage their withdrawal symptoms?</a>
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<p>The policy <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">aims</a> to reduce adolescent vaping by 2026 while allowing adult smokers to use vapes for quitting and managing nicotine dependence, by making them easier to access. </p>
<p>But there are major challenges in achieving these goals. </p>
<h2>1. Enough therapeutic products</h2>
<p>The TGA will need to ensure there are enough products that meet their product standards and that vapers will use. </p>
<p>It’s unclear how vape producers will be encouraged to notify the TGA that their device meets standards and whether vapers will be interested in using them. </p>
<p>However, vapes exist with specified nicotine levels that could be plain-packaged, if required.</p>
<h2>2. Doctors will need to prescribe them</h2>
<p>The new regulations allow any medical or nurse practitioner to prescribe nicotine vapes for smoking cessation and to manage nicotine addiction. </p>
<p>Given the existing <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">low uptake of vape prescribing</a> and strong discouragement from the <a href="https://www.ama.com.au/qld/news/Vaping-package-good-step-in-nicotine-control#:%7E:text=%E2%80%9CThere%20is%20little%20evidence%20to,use%20as%20a%20cessation%20aid">Australian Medical Association</a> and <a href="https://www.racp.edu.au/docs/default-source/advocacy-library/policy-on-electronic-cigarettes.pdf">medical colleges</a>, more medical practitioners will need to be persuaded to prescribe vapes. </p>
<figure class="align-center ">
<img alt="Doctor writes prescription" src="https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Uptake of vape prescribing has been low.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-patient-consulting-room-gp-surgery-2367985555">Stephen Barnes/Shutterstock</a></span>
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<p>GP guidelines for quitting recommend prescribing nicotine gum and patches, and vapes only if these products are unsuccessful. However, a <a href="https://pubmed.ncbi.nlm.nih.gov/38189560/">Cochrane review</a> of clinical trials found vapes were more effective for smoking cessation than nicotine gum and patches.</p>
<h2>3. Pharmacies need to dispense them</h2>
<p>There must be enough pharmacies prepared to dispense vapes. Pharmacy organisations are <a href="https://www.psa.org.au/nicotine-vaping-product-access-changes-coming/">cautiously supportive of the new regulations</a> but it’s unclear how many pharmacies will provide vapes. This may depend, in part, on demand for these products. </p>
<h2>Risks of the illicit market</h2>
<p>All of these challenges need to be met in two years. Failure to achieve these aims will sustain the illicit market for vapes. </p>
<p>Vapers who are unconcerned about the possibility of arrest for possessing vapes without a prescription (a <a href="https://www.criminaldefencelawyers.com.au/blog/is-vaping-illegal-in-australia/?utm_source=Mondaq&utm_medium=syndication&utm_campaign=LinkedIn-integration">criminal offence</a> in most states) may continue to use the illicit market.</p>
<p>Australian Border Force officials <a href="https://www.smh.com.au/politics/federal/smoke-alarm-warning-to-border-force-it-won-t-stop-vape-black-market-20240101-p5eujs.html">have conceded</a> they will not be able to prevent the illicit importation of vaping devices. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tiktok-promotes-vaping-as-a-fun-safe-and-socially-accepted-pastime-and-omits-the-harms-203423">TikTok promotes vaping as a fun, safe and socially accepted pastime – and omits the harms</a>
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</em>
</p>
<hr>
<p>There is also a risk some vapers will switch to cigarettes which, while expensive, are readily available. Vapes are not without harm, but toxicological analyses <a href="https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-021-01737-5">conclude</a> they are <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html">less harmful</a> than conventional cigarettes.</p>
<h2>What if the vape regulations fail?</h2>
<p>If the vape laws aren’t successful, regulators must find another way to meet the policy’s goals of minimising youth vaping and reducing the size of the illicit vaping market. </p>
<p>One way would be to allow the sale of approved vapes to adult smokers under much tighter regulations than apply to cigarettes. This could mean banning disposable vapes and restricting sales of other vapes to licensed tobacconists on the condition that they will lose their licence if they sell to youth. This could be enforced by requiring the installation of CCTV in stores, as occurs in US cannabis retail outlets. </p>
<p>This alternative model could include many of the other regulations proposed: only allowing approved vaping devices, plain packaging, flavour restrictions and no advertising. But this <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.13663">model</a> wouldn’t require a doctor’s prescription or restrict dispensing to pharmacies.</p><img src="https://counter.theconversation.com/content/221412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wayne Hall has been a paid advisor to the Therapeutic Goods Administration on the safety and effectiveness of medical cannabis (2017-2019) and was a member of Australian Advisory Council on Medicinal Uses of Cannabis, Commonwealth Department of Health, February 2017-2021. He has advised the World Health Organization on the health effects of cannabis, 2019-2023. He has not received any funding from the alcohol, pharmaceutical, tobacco or e-cigarette industries. His past research on tobacco related topics was funded by the National Health and Medical Research Council. The opinions expressed in this article are those of the author and do not necessarily reflect the view of the organisation where he works or its funders.</span></em></p>If the scheme isn’t successful, some people may continue using illicit vapes, or to switch to traditional cigarettes.Wayne Hall, Emeritus Professor, The National Centre for Youth Substance Use Research, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2158922024-01-14T19:05:46Z2024-01-14T19:05:46ZHelp, I’ve just discovered my teen has watched porn! What should I do?<figure><img src="https://images.theconversation.com/files/562600/original/file-20231130-15-eyet8z.jpg?ixlib=rb-1.1.0&rect=122%2C0%2C8057%2C5297&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/worried-teenage-girl-sitting-desk-bedroom-2261420967">Shutterstock</a></span></figcaption></figure><p>Unlike in previous generations, you’re unlikely to discover your adolescent’s first exposure to adult sexual content from finding a scrunched-up Playboy magazine under their mattress. </p>
<p>With easy access to the internet and the use of tablets and mobile phones, it’s more likely to be from free, mainstream online porn. And it can be a very shocking introduction to sex.</p>
<p>But it’s <a href="https://doi.org/10.1111/1753-6405.12678">common</a> and has become normalised among young people. The <a href="https://doi.org/10.1111/1753-6405.12678">median age</a> for boys to first view pornography is 13, while for girls it’s 16. </p>
<p>OK, so your child or adolescent has watched a porn video. First, stay calm. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tiktok-has-a-startling-amount-of-sexual-content-and-its-way-too-easy-for-children-to-access-216114">TikTok has a startling amount of sexual content – and it's way too easy for children to access</a>
</strong>
</em>
</p>
<hr>
<h2>Start a discussion about what porn is – and isn’t</h2>
<p>How much detail you go into and what’s appropriate for them to know will depend on their age and level of maturity. </p>
<p>Many parents let their adolescents know porn is not real – it’s a fantasy. But it’s not enough to just say, “that’s not real”. They also need to know what reality is. </p>
<p>Explain that porn is not what sex is like – and what’s wrong with depictions of sex in porn: everyone who’s involved should be enjoying it, not just the man. </p>
<p>In porn, you don’t see all the normal things that happen around sex, like discussions on how to ask about consent, or even the bloopers of sex, such as when people change positions, negotiate, and move around. </p>
<p>Porn is not designed to show sex the way it would be experienced as pleasurable, or show what positive relationships are meant to look like. People don’t tend to ask, “do you want to do that?” And if they do, you won’t see what happens if someone says “no”. The performers aren’t doing it in a way that feels good, but instead focus on what is deemed to “look good”. </p>
<p>Porn doesn’t present sex in a real way, and it can change young people’s ideas and expectations about <a href="https://www.thegist.org.au/topics/how-porn-is-different-from-sex-in-the-real-world/">what sex is</a>. </p>
<h2>How are adolescents accessing porn?</h2>
<p>Adolescents are used to discovering things on their own using the internet and are naturally curious about sex. Their exposure to porn can come from something as simple as googling a term they’ve never heard of before, or their friends <a href="https://doi.org/10.1111/1753-6405.12678">sending them a link</a>. </p>
<p>They’re most likely to come across mainstream porn. With lots of flesh, quick movements and closeups, it can be very graphic and can come across as violent to someone seeing it for the first time. </p>
<p>This becomes how adolescents, who don’t have personal experiences of sex, or have the information they need, learn about sex. Just as they go to YouTube to learn how to cook a meal or fix the tap, they are used to watching and following. </p>
<p>And for something private and stigmatised like sex, there are limited good alternatives for them to learn how it really works.</p>
<figure class="align-center ">
<img alt="Girl looks at her phone while sitting at her desk" src="https://images.theconversation.com/files/562596/original/file-20231130-21-lxi54r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562596/original/file-20231130-21-lxi54r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562596/original/file-20231130-21-lxi54r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562596/original/file-20231130-21-lxi54r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562596/original/file-20231130-21-lxi54r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562596/original/file-20231130-21-lxi54r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562596/original/file-20231130-21-lxi54r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are limited alternatives to learn how sex really works.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/worried-teenage-girl-sitting-desk-bedroom-2261420967">Shutterstock</a></span>
</figcaption>
</figure>
<h2>When should we have ‘the talk’?</h2>
<p>An open conversation about safety, sex, consent and relationships and gender roles is important throughout their whole life. Introduce the topic of sex gradually, depending on your child’s age. It doesn’t have to be a big sit down, to have a big talk.</p>
<p>It’s best to bring it up in relevant situations, particularly on seeking ongoing consent, because that applies to all aspects of life. Everyone has the right to make decisions about their own body, and it’s up to them if they <a href="https://www.thegist.org.au/topics/enthusiastic-consent-and-communication">want to be</a> touched, hugged, kissed or have sex. It’s also important to reinforce that women and girls have feelings and needs, and they’re not just there to look pretty. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-you-teach-a-primary-school-child-about-consent-you-can-start-with-these-books-190063">How do you teach a primary school child about consent? You can start with these books</a>
</strong>
</em>
</p>
<hr>
<p>If they’re asking questions, then they’re old enough to talk about it. Ideally, you won’t wait for them to ask. You should be having conversations about consent, positive relationships, and sex from an early age. But it’s important to talk about it earlier rather than later, even if you don’t think they’ve watched porn. </p>
<p>Instead of saying “have you heard about porn?”, let them know from a young age they can trust you if they see something online that they don’t like or confuses them. Assure them you can’t believe everything you see online and you’re a safe person to go to with any questions.</p>
<p>Let them know it’s not their fault if they see something they don’t like, make sure they are OK and ask how it made them feel. Remind them to simply close the browser or turn off the screen if they see something that <a href="https://www.esafety.gov.au/kids/i-want-help-with/i-saw-something-online-i-didn%E2%80%99t-like">upsets them</a> or makes them feel yuck. </p>
<h2>Can I prevent my child accessing porn?</h2>
<p>Your children will <a href="https://www.sciencedirect.com/science/article/pii/S1326020023010269?via%3Dihub">probably see porn</a> at some point, but the older they are when they first see it, <a href="https://www.sciencedirect.com/science/article/pii/S1326020023010269?via%3Dihub">the better</a>.</p>
<p>Data shows watching porn is <a href="https://doi.org/10.2196/16702">associated with</a> poor mental health, riskier sexual behaviours, and attitudes <a href="https://doi.org/10.1080/00224499.2017.1417350">supporting violence against women</a>.</p>
<p>Unlike with adolescents where conversations are paramount, restrictions can prevent and protect young children from seeing porn. These include <a href="https://www.esafety.gov.au/parents/issues-and-advice/parental-controls?gclid=CjwKCAjws9ipBhB1EiwAccEi1HAKM-aKbxzwQ2oY8BM7Jpi4yjP4QPSK1vOk7GIy9d7xLyfEtM9CuBoCI1EQAvD_BwE">parental controls</a> on devices, apps or browsers, or establishing rules about when, where and with whom they can access their phones, computers or tablets. Yes, older teenagers can probably get past them, but younger kids can’t.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-we-need-to-talk-about-porn-when-we-talk-about-andrew-tate-201059">Why we need to talk about porn when we talk about Andrew Tate</a>
</strong>
</em>
</p>
<hr>
<p>Be open and honest with your kids about using internet restrictions – don’t spy on them. Let them know why you’re doing it, explaining there are bad things online you need to protect them from – it’s about building trust.</p>
<p>If you find your child showing unusual behaviour or acting out towards other children, or your teen shows signs of addiction (where their viewing activities interfere with their day-to-day lives), <a href="https://www.thegist.org.au/support-services/">seek</a> professional <a href="https://www.esafety.gov.au/">help</a>. </p>
<p><em><a href="https://www.thegist.org.au/">The GIST</a> is a great resource for parents and older teens about how to approach difficult topics like this. If you’re a child or adolescent and need support, you can call the <a href="https://kidshelpline.com.au/">Kids Help Line</a> on 1800 55 1800.</em></p><img src="https://counter.theconversation.com/content/215892/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Megan Lim receives funding from the National Health and Medical Research Council, VicHealth, Westpac Foundation, and the Office of the eSafety Commissioner. </span></em></p>Chances are, your teenager has already seen online porn. How should you respond if you find out they are watching it? What conversations should you be having with young children to prepare them?Megan Lim, Head of Young People's Health Research, Burnet InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2188162023-12-31T20:28:06Z2023-12-31T20:28:06ZFrom today, new regulations make it harder to access vapes. Here’s what’s changing<figure><img src="https://images.theconversation.com/files/565086/original/file-20231212-23-grq40b.jpg?ixlib=rb-1.1.0&rect=5%2C1988%2C3946%2C3443&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/man-in-gray-sweater-smoking-cigarette-sitting-on-bench-during-daytime-3athPFPd5rs">Ryan Grice/Unsplash</a></span></figcaption></figure><p>This year the Australian government is introducing a <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">series of measures</a> to restrict the availability of vapes, starting today.</p>
<p>The new reforms address loopholes in the current laws that allow easy access to highly addictive, flavoured, cheap, and harmful vaping products that are <a href="https://theconversation.com/tiktok-promotes-vaping-as-a-fun-safe-and-socially-accepted-pastime-and-omits-the-harms-203423">marketed to kids</a>. </p>
<p>Vaping products will still be available through a prescription for anyone using them to quit smoking. But the Therapeutic Goods Administration will <a href="https://www.tga.gov.au/news/media-releases/new-regulations-place-stronger-controls-importation-manufacture-and-supply-vapes">tightly regulate</a> prescription-only vapes.</p>
<p>So what are the new regulations? And why are they needed? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-in-vapes-toxins-heavy-metals-maybe-radioactive-polonium-210462">What's in vapes? Toxins, heavy metals, maybe radioactive polonium</a>
</strong>
</em>
</p>
<hr>
<h2>What was wrong with the previous regulations?</h2>
<p>Before the 2024 rule changes, vaping products imported and sold in Australia were required to be nicotine-free, unless accessed through a pharmacy with a prescription from a qualified health professional. </p>
<p>Individual users were also allowed to import nicotine-vapes from overseas through the <a href="https://www.tga.gov.au/products/personal-importation-scheme">Personal Importation Scheme</a>, provided they had a valid prescription. </p>
<p>The vaping industry – including manufacturers, importers and retailers – exploited these loopholes and openly sold <a href="https://www.health.nsw.gov.au/tobacco/Publications/e-cigarette-analysis-project-summary-report.pdf">products containing nicotine</a> to young people by falsely claiming the products were “nicotine-free”. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1575083639586660353"}"></div></p>
<p>But the only way to tell the difference between a nicotine and nicotine-free vape is to test it in a lab – a time consuming and expensive endeavour, given the high volume of products imported. </p>
<p>So enforcing the nicotine/nicotine-free standards essentially proved <a href="https://www.theguardian.com/australia-news/2023/nov/29/nsw-vape-sales-retailers-increase-government-ban-2023">near impossible</a> against an industry determined to addict a new generation of users.</p>
<h2>So what’s changing?</h2>
<p>The new laws help tidy up the confusion and make the rules much clearer and easier to enforce. </p>
<p>They also address the ready access to vapes, which is the single <a href="https://theconversation.com/we-asked-over-700-teens-where-they-bought-their-vapes-heres-what-they-said-190669">biggest challenge</a> to preventing young people from vaping.</p>
<p>The regulatory changes will be rolled out in three phases:</p>
<h2>1. Importation ban</h2>
<p>The first phase, being implemented from today, includes a ban on the importation of all disposable, single-use vapes. These are the products that are <a href="https://www.cancercouncil.com.au/wp-content/uploads/2023/10/Gen-Vape-W4-Infographic-National.pdf">most popular with young people</a> and come in a variety of flavours, including fruit, confectionery, cocktails and tobacco. </p>
<p>Single-use, disposable vapes cannot be refilled, but <a href="https://www.health.nsw.gov.au/tobacco/Pages/vaping-types.aspx">come in a wide range</a> of sizes, from a few hundred of puffs, to upwards of 10,000 puffs. </p>
<p>Disposable vapes have flooded into Australia and fuelled the explosive rise in vape use among teens and young adults.</p>
<figure class="align-center ">
<img alt="Vape liquids in a shop" src="https://images.theconversation.com/files/565088/original/file-20231212-17-1bwxdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565088/original/file-20231212-17-1bwxdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565088/original/file-20231212-17-1bwxdr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565088/original/file-20231212-17-1bwxdr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565088/original/file-20231212-17-1bwxdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565088/original/file-20231212-17-1bwxdr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565088/original/file-20231212-17-1bwxdr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Disposable vapes come in a range of flavours that appeal to young people.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-in-black-shirt-standing-in-front-of-store-shelf-8RN9UZeL-fo">E-Liquids UK/Unsplash</a></span>
</figcaption>
</figure>
<p>The importation of all other vapes, including refillable products, will be banned from March 1 2024, unless importers hold a licence and permit from the <a href="https://www.odc.gov.au/">Office of Drug Control</a> to lawfully import vapes. These legally imported vapes will only be sold in pharmacies to users with a prescription. </p>
<p>The Personal Importation Scheme allowance for vapes will also end on March 1 2024, meaning all vape users must access vaping products from a pharmacy in Australia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tga-review-strengthens-case-for-much-tighter-vape-restrictions-at-the-border-202506">TGA review strengthens case for much tighter vape restrictions at the border</a>
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</em>
</p>
<hr>
<p>This initial phase, while effectively stopping illegal vapes from coming in to Australia, doesn’t address the high volume of product that is already here. Retailers will be able to continue to sell their existing stock of “nicotine-free” vapes. But as we know, these products often <a href="https://www.tga.gov.au/news/media-releases/infringement-notices-totalling-588840-issued-three-sydney-based-tsg-stores-and-jaradat-and-sabbagh-group-pty-ltd">do contain nicotine</a>. </p>
<h2>2. Domestic manufacture and sales ban</h2>
<p>The next phase of reforms, expected to come into effect in late 2024, will eliminate the retail sale of all types of vaping products, regardless of their claimed nicotine content.</p>
<p>This second phase will include a ban on the manufacture, supply, advertising and commercial possession of vapes that fall outside of the prescription framework. </p>
<p>These changes will require amendments to the <a href="http://www6.austlii.edu.au/cgi-bin/viewdb/au/legis/cth/consol_act/tga1989191/">Therapeutic Goods Act 1989</a>, and will likely be introduced in Autumn 2024 for federal Parliament’s consideration, but the exact date is yet to be set.</p>
<h2>3. Prescription access</h2>
<figure class="align-center ">
<img alt="GP listens to patient" src="https://images.theconversation.com/files/565089/original/file-20231212-29-grq40b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565089/original/file-20231212-29-grq40b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565089/original/file-20231212-29-grq40b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565089/original/file-20231212-29-grq40b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565089/original/file-20231212-29-grq40b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565089/original/file-20231212-29-grq40b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565089/original/file-20231212-29-grq40b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vapes will only be available on prescription.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-consultant-meeting-teenage-patient-284516786">Shutterstock</a></span>
</figcaption>
</figure>
<p>The prescription access to vapes for therapeutic purposes is also being changed to allow access to products that meet a quality standard. </p>
<p>From today, all medical and nurse practitioners will now be able to prescribe therapeutic vapes for quitting smoking or to manage nicotine dependence. </p>
<p>Further changes that strengthen the standards for therapeutic vapes are expected to be made by March 1 2024. For example, prescription vapes will have limits on the amount of nicotine, the types of flavours permitted, and be in standardised medical-style packaging. </p>
<h2>What do the changes mean for vape users?</h2>
<p>Vapes for therapeutic purposes will continue to be permitted in Australia and more medical professionals will be able to prescribe them. Prior to 2024, only select medical professionals could prescribe vapes (they had to register as an authorised prescriber). This is being widened to ensure the prescription model works as intended. </p>
<p>While vaping products will be available by prescription it’s important to know they <a href="https://www.tga.gov.au/resources/resource/guidance/nicotine-vaping-products-information-prescribers">remain unapproved medicines</a> that have not been subjected to the same rigorous safety and effectiveness testing as other evidence-based quit smoking aids. </p>
<p>If you’re thinking of quitting smoking (or quitting vaping), get support by talking to your doctor, calling the Quitline (13 7848), or accessing <a href="https://www.icanquit.com.au/">help online</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/my-teen-is-addicted-to-vaping-how-can-i-help-them-quit-and-manage-their-withdrawal-symptoms-208586">My teen is addicted to vaping. How can I help them quit and manage their withdrawal symptoms?</a>
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<img src="https://counter.theconversation.com/content/218816/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Becky Freeman is an Expert Advisor to the Cancer Council Tobacco Issues Committee and a member of the Cancer Institute Vaping Communications Advisory Panel. These are unpaid roles. She has received relevant competitive grants that include a focus on e-cigarettes/vaping from the NHMRC, MRFF, NSW Health, the Ian Potter Foundation, VicHealth, and Healthway WA; relevant research contracts from the Cancer Institute NSW and the Cancer Council NSW; relevant personal/consulting fees from the World Health Organization, the Hong Kong Special Administrative Region Department of Health, BMJ Tobacco Control, the Heart Foundation NSW, the US FDA, the NHMRC e-cigarette working committee, NSW Health, and Cancer Council NSW; and relevant travel expenses from the Oceania Tobacco Control Conference and the Australia Public Health Association preventive health conference.</span></em></p>Vapes will be harder to access from today, but the restrictions are staged, with some due to roll out later in the year. Here’s what’s changing.Becky Freeman, Associate Professor, School of Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2138692023-09-21T04:34:46Z2023-09-21T04:34:46ZExcessive screen time can affect young people’s emotional development<figure><img src="https://images.theconversation.com/files/549484/original/file-20230921-25-olhs9k.jpg?ixlib=rb-1.1.0&rect=12%2C269%2C4268%2C2574&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-negative-surprised-face-looking-something-771061159">Shutterstock</a></span></figcaption></figure><p>A recent Beyond Blue <a href="https://www.abc.net.au/news/2023-09-18/mental-health-depression-anxiety-support-coming-for-schools/102831464?utm_source=abc_news_app&utm_medium=content_shared&utm_campaign=abc_news_app&utm_content=twitter">survey of more than 2,000 teachers</a> identified mental ill-health and excessive screen time as the biggest problems facing their students. </p>
<p>Comments from teachers revealed a perceived lack of social skill development in children and teens. As one wellbeing specialist said, young people:</p>
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<p>are not learning social awareness. They’re not learning how to read emotions. They’re not learning body language. </p>
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<p>There’s <a href="https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-And-Watching-TV-054.aspx">no definitive measure</a> of what constitutes “excessive” screen-time, although research is <a href="https://pubmed.ncbi.nlm.nih.gov/30908423/">beginning to suggest</a> four hours per day or more is potentially risky.</p>
<p>Although COVID lockdowns played a role in disrupting normal social learning processes, concerns about social and emotional development in our teens has been bubbling away for some time across cultures that have easy access to screen-based technologies and social media. COVID may have thrown petrol on the flames, but it did not light this fire.</p>
<p>So what is going on? Does overexposure to screens lead to social impairments, and if so, how?</p>
<h2>Displacing children’s development</h2>
<p>The developing brain wires itself to the environment in which it finds itself. The skills you use most often will become almost automatic, such as driving a car. But skills you use infrequently need more concentration and effort, especially if you didn’t practice them much when your brain was still developing. </p>
<p>Important social experiences such as emotion recognition, reciprocal play and perspective-taking are potentially being sidelined by screen-time. In other words: when children are preoccupied with their screens, what are they <em>not</em> learning?</p>
<p>“Theory of Mind” is a brain function that allows people to understand the mental states of others. Theory of Mind starts with the realisation that everyone has different perspectives, mental states and understandings of our own. </p>
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Read more:
<a href="https://theconversation.com/understanding-others-feelings-what-is-empathy-and-why-do-we-need-it-68494">Understanding others' feelings: what is empathy and why do we need it?</a>
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<p>Developmentally, Theory of Mind explains quite a lot about child and adolescent behaviours. </p>
<p>Most parents recall, with some horror, their toddlers’ “terrible twos” stage. One of the reasons for these tantrums is a lack of Theory of Mind, which doesn’t kick in until the age of three or four. Toddlers just can’t understand why their carers don’t have the same perspective as them. “I feel thirsty – why is mum not getting me a drink?” Cue tantrum. </p>
<p>This intense frustration is one factor that drives the development of language, as the toddler finally realises other people don’t intuit their every thought or feeling and they need to learn to communicate. </p>
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<figcaption><span class="caption">Theory of mind develops at around age three or four.</span></figcaption>
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<p>As children grow and develop, Theory of Mind underpins the development of all sorts of social skills, such as recognising others’ emotional state and developing empathy. This is crucial to developing friendships, romantic partnerships and other kinds of social relationships as we move through life. </p>
<p>By adolescence, Theory of Mind gets really sophisticated. Teenagers are good at understanding socially complex processes such as lying, masking or amplifying true emotions, socially appropriate behaviours such as when not to take a joke too far, and nuanced language expression. </p>
<h2>How does this affect mental health?</h2>
<p>A child or teenager without age-appropriate social skills will have difficulty developing and maintaining friendships. Given human beings are, by their nature, social creatures, this <a href="https://link.springer.com/article/10.1007/s10826-021-02066-3">may lead to</a> isolation, loneliness and mental health issues. </p>
<p>Social media further inhibits perspective-taking by operating as an echo chamber, where a teen’s beliefs, interests and ideas are assessed via algorithms and parroted back to them. Rarely is an alternative idea or perspective presented, and, when it is, a teen with already impaired social-communication skills may react with anxiety instead of interest and curiosity. </p>
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Read more:
<a href="https://theconversation.com/teens-with-at-least-one-close-friend-can-better-cope-with-stress-than-those-without-126769">Teens with at least one close friend can better cope with stress than those without</a>
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<p>The time young people spend on screens has been <a href="https://pubmed.ncbi.nlm.nih.gov/25657166/">linked with</a> an array of mental health issues. Longitudinal research is beginning to demonstrate higher screen time is associated with a raft of <a href="https://pubmed.ncbi.nlm.nih.gov/35099540/">social-skill impairments</a> at increasingly <a href="https://pubmed.ncbi.nlm.nih.gov/32310265/">early ages</a>. </p>
<p>Brain-imaging research shows higher screen use is <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2754101">associated with</a> lower white matter tracts (the information superhighways of the brain) that underpin language and cognitive skills. In contrast, spending a great deal of time in the outdoors is associated with <a href="https://ehp.niehs.nih.gov/doi/10.1289/ehp1876">higher grey matter</a> in regions associated with working memory and attention. </p>
<h2>So what can parents and teachers do to help?</h2>
<p>In the early years, parents and educators can focus on reciprocal play with lots of turn-taking and emotional engagement. When reading books or discussing everyday social interactions, talk about what you or another person was thinking or feeling and how that was expressed.</p>
<p>Delay any form of social media engagement for as long as possible. Encourage your child to critically think about people’s agendas when posting online: what are they really trying to get across, what is their motivation, what are they selling? Focus on building in-real-life friendships at school, your local community or sporting club, and within families. </p>
<p>Overall, limiting screen time and encouraging in-real-life play and an array of social engagement opportunities is the best way to improve a child’s prospects of developing good social-emotional skills.</p><img src="https://counter.theconversation.com/content/213869/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachael Sharman and Michael Nagel have written a book covering these issues.</span></em></p><p class="fine-print"><em><span>Michael Nagel does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Teachers are reporting a perceived lack of social skill development in children and teens. How might excessive screen time affect this development?Rachael Sharman, Senior Lecturer in Psychology, University of the Sunshine CoastMichael Nagel, Associate Professor - Child Development and Learning, University of the Sunshine CoastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1963932022-12-14T06:15:17Z2022-12-14T06:15:17ZWhat is meningococcal disease? What symptoms should I look out for? And how can I prevent it?<figure><img src="https://images.theconversation.com/files/500634/original/file-20221213-1960-92q4xe.jpg?ixlib=rb-1.1.0&rect=301%2C684%2C6408%2C3782&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/unhappy-young-adolescent-12s-kid-girl-1971214970">Shutterstock</a></span></figcaption></figure><p>Parents and doctors alike fear meningococcal infection, which has been <a href="https://www.abc.net.au/news/2022-12-06/nsw-meningococcal-disease-kills-young-woman-third-death-this-yea/101736686">in the news</a> again. Doctors never want to miss a diagnosis, as early treatment with antibiotics may be life-saving. Parents fear the disease because <a href="https://doi.org/10.1016/j.vaccine.2019.04.020">up to 10%</a> of children who become infected die from the disease and its complications.</p>
<p>Another <a href="https://doi.org/10.1097/INF.0000000000000043">40% of children</a> will have ongoing disability from one or more complications. These include deafness, blindness, skin scarring, or surgical amputation of limbs that may be required to save the child’s life in some situations. </p>
<p>In other cases, children will initially be acutely unwell but then recover within a few days of starting antibiotics. Many, though, will have ongoing fatigue, forgetfulness and difficulty concentrating. For most, it’s a life-changing illness.</p>
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<strong>
Read more:
<a href="https://theconversation.com/we-can-expect-more-colds-and-flu-as-covid-restrictions-lift-5-germs-to-look-out-for-170263">We can expect more colds and flu as COVID restrictions lift. 5 germs to look out for</a>
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<h2>What causes it and who most at risk?</h2>
<p>Meningococcal disease is caused by the meningococcus bacteria, also known as <em>Neisseria meningitidis</em>. The bacterial infection causes meningitis (infection of the lining around the brain) and/or sepsis (blood poisoning).</p>
<p>The <a href="https://doi.org/10.33321/cdi.2022.46.46">highest risk</a> of disease is in children under four years, and adolescents and young adults aged 15-24. </p>
<figure class="align-center ">
<img alt="Teens in a school corridor" src="https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Australian adolescents are now offered a vaccine to protect against four types of the disease.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/students-in-the-school-hallway-8419516/">Rodnae Productions/Pexels</a></span>
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<p>Aboriginal infants and young people are at <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4001e.htm">higher risk</a> of meningococcal disease than non-Indigenous children.</p>
<h2>What are the symptoms?</h2>
<p>Young infants who become unwell with this infection usually develop symptoms such as a fever, irritability, vomiting and poor feeding.</p>
<p>Young people who develop the infection may complain of a headache, neck stiffness, fever, vomiting or feeling generally tired and unwell with “flu-like” symptoms.</p>
<p>Unfortunately, these symptoms are fairly general and occur with many other infections, making this disease hard to diagnose. This may result in delayed diagnosis and treatment.</p>
<p>A more unusual symptom children or young people may experience is feeling they have cold hands and feet. </p>
<p>The classic <a href="https://www.doctorsofsouthmelbourne.com.au/meningococcal-rash/#:%7E:text=A%20meningococcal%20rash%20is%20caused,bleeding%20occurs%20(i.e.%20haemorrhages).">dark red-purple rash</a> associated with the infection is often a later sign of the disease. Ideally, antibiotic treatment should be started before the rash appears, to combat the infection as early as possible.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-whats-meningococcal-meningitis-and-what-are-the-signs-64170">Explainer: what's meningococcal meningitis and what are the signs?</a>
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<h2>How does it spread?</h2>
<p>The meningococcus bacteria usually enter the bloodstream through the throat.</p>
<p>The bacteria live quite happily <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/meningococcal-disease">in the throat</a> of around 10% of the population, without causing any symptoms. Young people in particular have a higher chance of having the bacteria in their throat and passing it to each other through air droplets from coughing or through kissing.</p>
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<img alt="Teens legs in photo booth" src="https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Young people pass it to each other through coughing or kissing.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/person-in-blue-denim-jeans-and-white-sneakers-4858872/">Cottonbro studio/Pexels</a></span>
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<p><em>N. meningitidis</em> is often referred to as an “accidental pathogen” because it prefers to live at the back of the throat, with no intent to cause meningitis or sepsis. It can invade the lining of the throat during a throat infection, which disrupts the barrier in the throat and allows the bacteria to enter the bloodstream.</p>
<p>It may also be more likely to invade the bloodstream and multiply if the person has a problem with their immune system.</p>
<p>Once in the bloodstream, the bacteria multiply very quickly and the body reacts with a very robust immune response, which unfortunately can contribute to some of the complications.</p>
<p>The bacteria primarily damage the walls of the blood vessels in the body and the blood vessels become leaky. This results in bleeding into the skin, which causes a rash, and lack of blood supply to the limbs, resulting in breakdown of the tissues in the limb. Sometimes this requires surgical amputation of the limb or multiple limbs to save the child’s life.</p>
<h2>What are the different types of meningococcal disease?</h2>
<p>There are <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal-disease">13 different types</a> of meningococcus, however almost all disease in humans is caused by six groups: A, B, C, W, Y and X.</p>
<p>Group W is <a href="https://doi.org/10.1016/j.vaccine.2019.04.020">associated with</a> a higher risk of dying from the infection (around 10-15%), whereas with group B there is a lower risk of dying (around 5-10%).</p>
<p>In Australia, group B causes the <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/2A15CD097063EF40CA2587CE008354F1/$File/australian_meningococcal_surveillance_programme_annual_report_2021.pdf">highest number</a>, however there are significant differences between different states. Most cases in temperate climates occur in winter and early spring. Viral infections, in particular influenza, <a href="https://doi.org/10.1016/j.cmi.2020.01.004">increase the risk</a> of meningococcal infection. </p>
<h2>How can you protect against it?</h2>
<p>The best way to protect against meningococcal disease is through vaccination.</p>
<p>From 2003 to 2013 in Australia, there was a <a href="https://doi.org/10.5694/mja2.51463">decrease</a> in meningococcal disease cases, following the introduction of the free meningococcal C vaccine onto the National Immunisation Program for children aged 12 months.</p>
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<img alt="Baby's leg after a vaccination" src="https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Babies are routinely vaccinated against four types.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-bandaid-after-vaccination-needle-sore-261449495">Shutterstock</a></span>
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<p>A free, combined meningococcal ACWY vaccine is now available on the National Immunisation Program for all children at 12 months of age (this replaced the meningococcal C vaccine) and for adolescents aged 14-16 years through a school-based program from April 2019. </p>
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Read more:
<a href="https://theconversation.com/health-check-which-vaccinations-should-i-get-as-an-adult-81400">Health Check: which vaccinations should I get as an adult?</a>
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<p>A meningococcal B vaccine has been more difficult to produce and requires a different vaccine manufacturing approach. Two meningococcal B vaccines are available and licensed in Australia.</p>
<p>One of these meningococcal B vaccines is now provided on the National Immunisation Program for Aboriginal and Torres Strait Islander infants due to their higher risk of meningococcal B than non-Indigenous infants.</p>
<p>In South Australia, where historically most cases have been caused by group B, the meningococcal B vaccine is <a href="https://doi.org/10.1016/S1473-3099(21)00754-4">provided free</a> through a state-funded program for infants from six weeks of age and for Year 10 students through the school immunisation program.</p>
<p>This followed a large study I led in South Australia of 35,000 senior school students across SA. It <a href="https://doi.org/10.1056/nejmoa1900236">showed</a> the meningococcal B vaccine was highly effective in preventing meningococcal B disease but not in reducing the number of young people carrying the disease-causing bacteria in their throat. So the vaccine needs to be given to age groups at highest risk of disease rather than expecting a herd immunity effect by reducing the number of young people carrying the disease causing bacteria in their throats.</p>
<p>In other states, the meningococcal B vaccine <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal">can be purchased</a> for around A$120-$140 per dose and is provided through a script from a GP.</p><img src="https://counter.theconversation.com/content/196393/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Marshall receives funding from the National Health and Medical Research Council. Her institution receives funding from GSK, Sanofi-Pasteur and Pfizer for clinical vaccine trials of which Helen Marshall is an investigator. The herd immunity study in South Australia was sponsored by The University of Adelaide and funded by GSK.</span></em></p>Early treatment with antibiotics can be life-saving.Professor Helen Marshall, Professor in Vaccinology, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1890562022-09-12T18:59:25Z2022-09-12T18:59:25ZHealth of former youth in care could be bolstered by stronger tuition waiver programs<figure><img src="https://images.theconversation.com/files/483034/original/file-20220906-26-rcb2f6.jpg?ixlib=rb-1.1.0&rect=0%2C176%2C7360%2C3900&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In-depth interviews with former youth in care described barriers and challenges to attending post-secondary education once they received a tuition waiver. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Post-secondary education systems tend to reproduce existing social inequalities and inequities. This is in part because post-secondary success is strongly connected with <a href="https://doi.org/10.1353%2Fmpq.0.0030">parents’ educational attainment, social support and other social determinants of health</a>. </p>
<p>As post-secondary education <a href="https://www.ei-ie.org/en/workarea/1312:fighting-the-commercialisation-of-education">has become more commercialized</a>, debates about enrolment and engagement frequently centre on appropriate levels of student financial aid and debt, without considering what people need to succeed holistically. </p>
<p>We propose provincial governments, in collaboration with post-secondary institutions, should direct funding toward improved affordability and supports for those who face both greater financial and systemic challenges in accessing post-secondary education. </p>
<p>Some governments focus on <a href="https://novascotia.ca/studentassistance/financing/NeedsResources.asp">student and family income levels</a> when designing and implementing broadly targeted free tuition programs. Other approaches target tuition assistance toward specific groups <a href="https://theconversation.com/youth-who-grew-up-in-care-have-the-right-to-post-secondary-education-and-tuition-waivers-open-doors-160972">such as former youth in care</a>.</p>
<figure class="align-center ">
<img alt="Post-secondary students seen walking in a corridor." src="https://images.theconversation.com/files/483038/original/file-20220906-5322-hcnvv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483038/original/file-20220906-5322-hcnvv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483038/original/file-20220906-5322-hcnvv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483038/original/file-20220906-5322-hcnvv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483038/original/file-20220906-5322-hcnvv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483038/original/file-20220906-5322-hcnvv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483038/original/file-20220906-5322-hcnvv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Educational attainment is an important determinant of a person’s economic successs.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Higher earnings, health outcomes</h2>
<p>While education has indisputable intrinsic value, educational attainment is perhaps the single most important determinant of a person’s economic success. It is well-established that <a href="https://www12.statcan.gc.ca/census-recensement/2016/as-sa/98-200-x/2016024/98-200-x2016024-eng.cfm">individuals with higher levels of education tend to have higher earnings</a>. </p>
<p>In addition to economic benefits, there is a <a href="https://doi.org/10.1016/j.ypmed.2015.12.011">positive correlation between education and health outcomes</a>. Health researchers are interested in how <a href="https://doi.org/10.1016/S2468-2667(20)30144-4">modifiable determinants of health can include education level</a> and socio-economic status. Youth in care may not have the ability to change their family circumstances, but they should have the opportunity to augment their education level.</p>
<p>Education has also been positively correlated with <a href="https://doi.org/10.1007/s11162-018-9504-4">civic participation, such as voting, charitable giving and volunteerism</a>, <a href="https://doi.org/10.1007/s10734-014-9788-z">appreciation of diversity</a>, and <a href="https://doi.org/10.1257/000282804322970751">reduced crime rates</a>.</p>
<p>In Canada, about 85,000 youth are in care, and <a href="https://cwrp.ca/sites/default/files/publications/en/report-exploring-youth-outcomes.pdf">most do not complete high school or attend post-secondary institutions</a>. </p>
<p>Integrated interventions to ensure that those <a href="https://cwrp.ca/sites/default/files/publications/FOSTERING-_0.pdf">in care across Canada are afforded the same access to education</a> as those without experience in the child welfare system are long overdue. </p>
<p>According to a Child Welfare League of Canada 2021 report, “<a href="https://www.cwlc.ca/post/equitable-standards-for-transitions-to-adulthood-for-youth-in-care-public-report-policy-brief">Equitable Standards for Transitions to Adulthood for Youth in Care</a>,” governments at all levels, as well as service providers, should be held to the same set of standards to ensure the transition to adulthood for youth in care are upheld regardless of where youth live. </p>
<h2>Tuition waiver programs</h2>
<p>Early childhood experiences of instability, discrimination and violence can have <a href="https://doi.org/10.1017%2FS0954579413000801">lasting impacts that extend into adulthood</a>.</p>
<p>To address barriers to post-secondary education among former youth in care, tuition waiver programs must acknowledge and accommodate for the impact of complexity and trauma in the lives of this population.</p>
<p>The limited data available on the numbers of youth aging out of care each year suggest that the majority face a variety of challenges, including homelessness and <a href="https://en.unesco.org/gem-report/report/2020/inclusion">barriers to education </a> due, in part, to the lack of standardized supports and nationally legislated entitlements for youth leaving care. </p>
<p>Existing data clearly indicate the link between not having a post-secondary education and poorer health outcomes across the life course. Yet having poor health in the first place can impact the decision to continue with formal education: <a href="https://www.uvic.ca/hsd/socialwork/assets/docs/misc/Is%20Anybody%20There%20article%20Feb%202016.pdf">when youth are aging out of care</a>, experiencing poor health can lead them to determine that post-secondary study isn’t a feasible option.</p>
<p><a href="https://www.childwelfarepac.com/_files/ugd/6548f4_03fb7160fbd34b66bcfff23583710238.pdf">Tuition waiver programs</a> waive the cost of post-secondary education and, in some instances, provide additional wrap-around supports such as counselling, books, food and so on. </p>
<figure class="align-center ">
<img alt="Youth seen in a circle with a counselor." src="https://images.theconversation.com/files/483037/original/file-20220906-22-rcb2f6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483037/original/file-20220906-22-rcb2f6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483037/original/file-20220906-22-rcb2f6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483037/original/file-20220906-22-rcb2f6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483037/original/file-20220906-22-rcb2f6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483037/original/file-20220906-22-rcb2f6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483037/original/file-20220906-22-rcb2f6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some tuition waiver programs provide additional supports such as counseling.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>To understand how these interventions support former youth in care, cross-institutional evidence-based practices are needed. There is no national standard on what needs to be included in tuition waiver programs. The lack of standards and associated data means that we cannot compare across programs to determine what fosters the best possible outcomes for recipients. </p>
<h2>Atlantic study</h2>
<p>In a recent study in the four Atlantic provinces, qualitative data from twenty-two in-depth interviews with former youth in care <a href="https://www.cbc.ca/news/canada/nova-scotia/research-free-tuition-child-welfare-system-1.6573757?cmp=rss">described barriers and challenges to attending post-secondary education once a tuition waiver was received</a>.</p>
<p>These include the need for programs to be flexible to accommodate a variety of competing demands, including financial, health, caregiving, work responsibilities and limited options in rural communities. </p>
<p>Data collection and evaluation approaches pertaining to tuition waivers and youth in care must account for these issues. </p>
<h2>Holistic programs needed</h2>
<p>Tuition waiver program staff, recipients, and community organizations must collaboratively develop programs that support the whole person.</p>
<p>By considering how programs affect health, we can create programs that are accessible and supportive. </p>
<p>These programs can help build identity, financial security, trusting relationships, community and improved well-being. <a href="https://en.unesco.org/gem-report/report/2020/inclusion">Getting them right and removing barriers matters.</a></p>
<p><em>Sue McWilliam, who works as the trauma-informed care research and evaluation lead with IWK Health in Halifax, co-authored this story.</em></p><img src="https://counter.theconversation.com/content/189056/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacquie Gahagan receives funding from Social Sciences and Humanities Research Council and Research Nova Scotia. </span></em></p><p class="fine-print"><em><span>Dale Kirby receives funding from the Social Sciences and Humanities Research Council and Research Nova Scotia</span></em></p><p class="fine-print"><em><span>Krista C Ritchie receives funding from the Nova Scotia Department of Education and Early Childhood Development. </span></em></p><p class="fine-print"><em><span>Kristyn Anderson is affiliated with the Child Welfare Political Action Committee Canada (Child Welfare PAC)</span></em></p>To understand how tuition waivers and associated supports can help former youth in care complete post-secondary education and positively affect their health, evidence-based practices are needed.Jacquie Gahagan, Full Professor and Associate Vice-President, Research, Mount Saint Vincent UniversityDale Kirby, Professor, Faculty of Education, Memorial University of NewfoundlandKrista C Ritchie, Associate Professor, Faculty of Education, Mount Saint Vincent UniversityKristyn Anderson, PhD candidate, Health, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1419862020-07-13T06:06:39Z2020-07-13T06:06:39ZMaking it harder to import e-cigarettes is good news for our health, especially young people’s<figure><img src="https://images.theconversation.com/files/346250/original/file-20200708-3974-1t0zycd.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C685&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ecig-addiction-young-people-electronic-cigarette-1346973122">Shutterstock</a></span></figcaption></figure><p><a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/prescription-nicotine-based-vaping">From next year</a>, access to e-cigarettes and related products containing liquid nicotine will require a doctor’s prescription. This is to ensure liquid nicotine is handled like the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561260/">poisonous, addictive</a> substance it is and not promoted to young people. It’s good news for public health and bad news for the tobacco and e-cigarette industries.</p>
<p>This restriction comes into effect <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/prescription-nicotine-based-vaping">from January 1 2021</a>, six months later than <a href="https://www.odc.gov.au/news-media/news/australian-government-proposes-strengthening-its-stance-against-e-cigarettes">originally proposed</a>. </p>
<p>It’s not a ban on importing e-cigarettes. But it will <a href="https://www.tga.gov.au/behind-news/prohibition-importing-e-cigarettes-containing-vaporiser-nicotine">close loopholes</a> between established prohibitions on the supply and sale of nicotine at the federal level, and state and territory laws restricting access to nicotine.</p>
<p>Here’s the evidence to show why closing the loophole between health regulations, customs regulations and state and territory laws is good news for the nation’s health.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/twelve-myths-about-e-cigarettes-that-failed-to-impress-the-tga-72408">Twelve myths about e-cigarettes that failed to impress the TGA</a>
</strong>
</em>
</p>
<hr>
<h2>The so-called benefits of e-cigs don’t stand up</h2>
<p>There have only been a small number of quality reviews on the harms and benefits of
e-cigarettes for the whole population (rather than for individual people). They draw the same conclusions. </p>
<p><a href="https://www.csiro.au/en/Research/BF/Areas/Nutrition-and-health/Public-health-and-wellbeing/Case-studies/E-cigarettes-report">CSIRO</a> and the US <a href="https://www.nationalacademies.org/news/2018/01/new-report-one-of-most-comprehensive-studies-on-health-effects-of-e-cigarettes-finds-that-using-e-cigarettes-may-lead-youth-to-start-smoking-adults-to-stop-smoking">National Academies of Science, Engineering and Medicine</a> reviews found the evidence for e-cigarettes helping people quit smoking is inconclusive. The reviews also found e-cigarettes are harmful in their own right and associated with increased smoking and nicotine use in young people.</p>
<p>A 2017 review from Australia’s National Health and Medical Research Council drew <a href="https://www.nhmrc.gov.au/health-advice/all-topics/electronic-cigarettes">similar conclusions</a>.</p>
<p>Australian regulator, the <a href="https://www.tga.gov.au/community-qa/electronic-cigarettes">Therapeutic Goods Administration</a> or TGA, found no evidence to support the sale of e-cigarettes as a “therapeutic good”; the evidence of therapeutic benefit was inconclusive. Nor has the TGA found evidence to relax existing poison safety controls that require liquid nicotine access to be authorised by a doctor.</p>
<p>Despite the e-cigarette industry’s <a href="http://eprints.lse.ac.uk/56631/1/__lse.ac.uk_storage_LIBRARY_Secondary_libfile_shared_repository_Content_Phillips,%20L%20D_Estimating%20harms_Phillips%20_Estimating%20harms_2014.pdf">claims</a> and further promotion that “<a href="https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review">e-cigarettes are 95% less harmful</a>” than smoking traditional cigarettes, there is <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2019.305424">no scientific basis</a> for this either.</p>
<h2>Protecting young people</h2>
<p>Tobacco companies and retailers <a href="https://www.reuters.com/article/us-philipmorris-ecigs-instagram-exclusiv/exclusive-philip-morris-suspends-social-media-campaign-after-reuters-exposes-young-influencers-idUSKCN1SH02K">claim</a> e-cigarettes are an effective quit aid and are targeted at adult smokers who need them.</p>
<p>However, the tobacco industry and retail sector <a href="https://tobaccocontrol.bmj.com/content/28/e2/e162">promote</a> e-cigarettes through youth-friendly events, such as music festivals, and through social media by using influencers and celebrities, including singer <a href="https://www.bbc.com/news/technology-50821476">Lily Allen</a>.</p>
<p>And the promotion of flavoured e-cigarette products — strawberry, doughnut or banana, for instance — could create a generation of nicotine addicts.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/UKZIcRSFJaU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Flavoured e-cigarettes can be appealing to children.</span></figcaption>
</figure>
<p>So, Australia’s latest move will protect young people and avoid the fate of countries like the US, where e-cigarette use in secondary school children has <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/surgeon-general-advisory/index.html">increased 78% in just 12 months</a>. </p>
<p>Parents and teachers are now seeing <a href="https://www.smh.com.au/lifestyle/health-and-wellness/principals-sound-alarm-as-students-take-up-vaping-become-black-market-dealers-20200703-p558vv.html">more e-cigarette use in Australian schools</a>. It is telling that the <a href="https://www.smh.com.au/politics/federal/vaping-a-harmless-alternative-or-a-dangerous-gateway-to-smoking-20200702-p558e7.html">largest growing segment</a> in e-cigarette use in Australia is in 18 to 24-year-old non-smokers and use has <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/contents/table-of-contents">also risen</a> among 12 to 17-year-olds.</p>
<h2>What about quitters?</h2>
<p>There are individuals who feel e-cigarettes help reduce the harms of smoked tobacco, and doctors who agree with them. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-the-ban-on-nicotine-vape-fluid-will-do-more-harm-than-good-141365">Why the ban on nicotine vape fluid will do more harm than good</a>
</strong>
</em>
</p>
<hr>
<p>Given the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561260/">toxicity and addictiveness</a> of liquid nicotine, it is entirely appropriate to close loopholes that until now have enabled it to be acquired with no medical authority.</p>
<p>This is no different from controls around other harmful substances, such as methadone for treating heroin addiction.</p>
<p>There are two key differences with e-cigarettes. One, the case has not been made within an evidence-based framework that the products are safe and effective for widespread distribution; and two, they are being pushed through retailers operating outside the health system.</p>
<h2>Is this the end of the line for e-cigarettes in Australia?</h2>
<p>The government’s proposal is not closing the door to evidence or to options that may work for some individuals with a legitimate need to access these products. It is closing a door that exploits a disconnect between the poison and import laws to protect young Australians.</p>
<p>The restrictions will also prevent profiteers from addicting young Australians to harmful, novel products. Evidence on the benefits of e-cigarettes remains inconclusive but the risks to young Australians are increasingly clear.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-decisive-win-on-plain-packaging-paves-way-for-other-countries-to-follow-suit-140553">Australia's decisive win on plain packaging paves way for other countries to follow suit</a>
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</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/141986/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Becky Freeman has received funding from NHMRC, WHO, the Australian Government, Australian National Preventive Health Agency, NSW Health, Cancer Council Australia, Cancer Council NSW, NSW National Heart Foundation, Cancer Council Victoria, Healthway WA, Cancer Institute New South Wales, and the Australia-Indonesia Centre. She is a member of the NHMRC Electronic Cigarettes Working Committee.</span></em></p><p class="fine-print"><em><span>Matthew Peters is a member of the NHMRC Electronic Cigarettes Working Committee, is Co-Chair of the Thoracic Society of Australia and New Zealand Working Party on Electronic Cigarettes and also a member of the RACGP Smoking Cessation Guidelines Advisory Committee. </span></em></p><p class="fine-print"><em><span>Paul Grogan is a Senior Strategic Adviser, Cancer Research Division, Cancer Council NSW; While not politically active in any partisan sense, Cancer Council advocates for evidence-based cancer control public policy. I have represented Cancer Council as an independent/not-for-profit delegate on a number of government bodies, though none specifically focused on tobacco control. </span></em></p>From 2021, it will be harder to import e-cigarettes. That protects young people, in particular, who are increasingly being lured into nicotine and tobacco addiction.Becky Freeman, Senior Research Fellow, University of SydneyMatthew Peters, Professor of Respiratory Medicine, Macquarie UniversityPaul Grogan, Adjunct Senior Lecturer, School of Public Health, University of Sydney, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1384752020-06-09T14:18:54Z2020-06-09T14:18:54ZHow to support kids’ and teens’ mental health during the COVID-19 pandemic<figure><img src="https://images.theconversation.com/files/339615/original/file-20200603-130903-bujamd.jpg?ixlib=rb-1.1.0&rect=408%2C74%2C1508%2C1192&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children and teens with pre-existing mental health conditions are vulnerable to stressors during the pandemic.</span> <span class="attribution"><span class="source">(Pixabay) </span></span></figcaption></figure><p>Throughout the COVID-19 pandemic, there has been a significant amount of attention on our mental health. While organizations are compiling a wide range of <a href="https://cmha.ca/news/covid-19-and-mental-health">online toolkits</a> and <a href="https://www.mentalhealthcommission.ca/English/news-article/13950/mental-health-commission-canada-launches-free-online-crisis-training-essential">templates</a>, the impact of the pandemic on those with pre-existing mental health challenges seems to be missing from our collective conversation. Although all of us are feeling more vulnerable, there are members of our community who were already struggling before physical distancing restrictions were in place. </p>
<p>Among the most vulnerable individuals are children and youth with pre-existing mental health challenges. Before the pandemic, rates of mental illness and emergency department visits had been <a href="https://doi.org/10.1503/cmaj.190188">steadily increasing</a>. Years of chronic underfunding have led to a fragmented system marked by excessive wait times and <a href="https://doi.org/10.7870/cjcmh-2017-003">difficulty accessing treatment</a>. </p>
<p>As the pandemic unfolded, my clinical work as an academic child and adolescent psychiatrist also changed. Some of the families I work with are doing better, yet many are experiencing more extreme and varied struggles than they were before the pandemic hit. Although the proliferation of online supports has been helpful for many individuals with mild difficulties, every young person and family is unique. </p>
<h2>Calm is contagious</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/339616/original/file-20200603-130961-1txj8es.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/339616/original/file-20200603-130961-1txj8es.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/339616/original/file-20200603-130961-1txj8es.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/339616/original/file-20200603-130961-1txj8es.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/339616/original/file-20200603-130961-1txj8es.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/339616/original/file-20200603-130961-1txj8es.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/339616/original/file-20200603-130961-1txj8es.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">By regulating their own anxieties, caregivers can help kids by enhancing a sense of control and moderation.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>Alongside the many young people who are suffering, caregivers are also struggling. For many caregivers, trying to help our loved ones can be profoundly challenging when we feel overwhelmed and helpless. The most important thing we can do is to take care of ourselves. We have to put our oxygen masks on before we try to help others. </p>
<p>Although anxiety and fear can be contagious, calm is also contagious. The work of Dr. Bruce Perry, a child psychologist and trauma expert, highlights that <a href="https://www.youtube.com/watch?v=orwIn02h6V4&t=145s">caregivers can help their kids regulate</a> by modifying the strategies they use to control their own anxiety, to enhance a sense of control, predictability and moderation. </p>
<h2>Structure and sleep</h2>
<p>Enhancing control, predictability and moderation at home can be addressed through balancing structure and flexibility in daily routines. Some caregivers have found it difficult to implement a routine while juggling their responsibilities. </p>
<p>Others have tried to implement routine but have been too rigid. Most often, I recommend a “Goldilocks” approach to structure and routine during the pandemic. Avoid extremes, be easy on yourself and keep in mind that balance is everything.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/339222/original/file-20200602-133855-1e8n3km.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/339222/original/file-20200602-133855-1e8n3km.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/339222/original/file-20200602-133855-1e8n3km.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/339222/original/file-20200602-133855-1e8n3km.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/339222/original/file-20200602-133855-1e8n3km.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/339222/original/file-20200602-133855-1e8n3km.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/339222/original/file-20200602-133855-1e8n3km.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A ‘Goldilocks’ approach to routines avoids extremes.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
</figcaption>
</figure>
<p>For example, if your child or teen is experiencing “sleep cycle reversal,” where they are up for most of the night and sleeping during most of the day, try to encourage small steps towards improving their routine. Dial back the time they wake up slightly instead of making drastic changes. Discourage naps during the day, encourage them to come out of their room at scheduled times or for a specified amount of time each day. </p>
<p>Be flexible and take baby steps. Let them sleep in a little, and ensure that any changes are discussed, negotiated and fine-tuned to your loved one’s needs. </p>
<p>Child and adolescent psychiatrists have published some fantastic <a href="https://www.covidwithkids.org">tools that help with structure</a>.</p>
<h2>When existing strategies don’t work</h2>
<p>Another issue for caregivers of young people with pre-existing mental health challenges is that using existing strategies to regulate anxiety may not be sufficient. The chronic stress of the pandemic can amplify existing anxiety. Many caregivers have said that tried-and-tested tools such as <a href="https://www.scientificamerican.com/article/proper-breathing-brings-better-health/">paced breathing</a> are not enough. </p>
<p>Meanwhile young people have said they are experiencing a complex mix of emotions that they struggle to describe. They want to feel better, but when existing strategies don’t seem to work, they experience a cycle of frustration, helplessness and hopelessness that leads them to feel worse. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/339637/original/file-20200603-130917-198u3ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/339637/original/file-20200603-130917-198u3ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=260&fit=crop&dpr=1 600w, https://images.theconversation.com/files/339637/original/file-20200603-130917-198u3ar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=260&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/339637/original/file-20200603-130917-198u3ar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=260&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/339637/original/file-20200603-130917-198u3ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=327&fit=crop&dpr=1 754w, https://images.theconversation.com/files/339637/original/file-20200603-130917-198u3ar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=327&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/339637/original/file-20200603-130917-198u3ar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=327&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Young people may be experiencing a complex mix of emotions that they find difficult to describe, and existing strategies may not help them feel better.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>Many approaches to addressing anxiety encourage us to try to reason with our emotions. These approaches emphasize how we can <a href="https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/">fix our feelings</a> through changing how we talk to ourselves. During the pandemic, however, there is a tremendous amount of uncertainty around things that are simply outside of our control. When we are confronted with major stress or trauma, trying to fix how we are feeling can sometimes <a href="https://www.researchgate.net/publication/283110037_Difficulties_in_the_therapeutic_relationship_in_cognitive-behavioral_therapy_Marsha_M_Linehan%27s_dialectical_behavior_therapy_in_work_with_borderline_personality_disorder">make things worse</a>. </p>
<h2>Acceptance-based strategies</h2>
<p>When encountering stressors that are significant and persistent, I encourage the families I work with to shift to acceptance-based strategies. </p>
<p>Acceptance involves being aware of your present experience so that you can accept your thoughts and feelings as valid and reasonable while working to prevent them from controlling you. For caregivers, this means accepting what you cannot control and encouraging your loved one to do the same. By accepting that the emotions we are feeling are <a href="https://psycnet.apa.org/record/2005-02461-002">normal and valid</a> given the circumstances, acceptance helps us to avoid falling into a spiral of self-blame. </p>
<p>Validating our emotions and the emotions of our kids and teens helps to prevent these emotions from taking over. When we try to ride an emotional wave, it is also natural that there will be times when these emotions may feel particularly intense or threatening. Rather than try to fight them too hard or swim against the current, we can remind ourselves that we are built for resilience, wired to survive and that with every hardship comes ease. </p>
<p>Although none of us knows exactly what lies ahead, whatever comes our way, we will get through it together. For any young person or caregiver who is struggling and feels like they cannot cope, please do not forget that the mental health system is still open and here for you. Please do not be afraid to reach out and ask for help.</p><img src="https://counter.theconversation.com/content/138475/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Javeed Sukhera receives funding from the Academic Medical Organization of Southwestern Ontario and the Physician Services Incorporated Foundation.</span></em></p>COVID-19 is affecting many people’s state of mind, but some of the most vulnerable members of our communities are children and youth with pre-existing mental health challenges.Javeed Sukhera, Associate professor, Psychiatry, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1209812020-01-20T01:41:22Z2020-01-20T01:41:22ZWhat makes a good psychologist or psychiatrist and how do you find one you like?<figure><img src="https://images.theconversation.com/files/307303/original/file-20191217-124027-10vmjfi.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We all struggle from time to time, but many people benefit from seeing a therapist.</span> </figcaption></figure><blockquote>
<p>Hi, I have mental health issues and I would like to know what makes a good or bad psychiatrist, psychologist or neuropsychologist.</p>
</blockquote>
<h2>Key points</h2>
<ul>
<li><p>Understanding the different roles of psychologists and psychiatrists, and how they align with your needs, will help you decide what type of therapist to see</p></li>
<li><p>find a therapist you feel safe and secure with, even if that means trying a few before finding one you like</p></li>
<li><p>find out how much they charge in advance. If cost or access are issues, or if it would make you more comfortable, consider going online for help.</p></li>
</ul>
<p><a href="https://theconversation.com/au/topics/i-need-to-know-66587"><img src="https://images.theconversation.com/files/290837/original/file-20190904-175686-polw3q.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=90&fit=crop&dpr=2" width="100%"></a></p>
<h2>Who does what in mental health care?</h2>
<p>Each type of mental health worker will have a different area of speciality, as well as different qualifications, training and experience. </p>
<p>In your question, you talked about psychologists and different areas of specialisation like clinical psychologists, neuropsychologists and psychiatrists, all of whom play a role in the assessment and treatment of mental health conditions. </p>
<p>Understanding the role of each and how it aligns with your needs may help you in your decision. </p>
<p><strong>Psychologists in general</strong></p>
<p>Psychologists provide assessment and therapy to clients, either through individual or group format and aim to enhance a person’s well-being. </p>
<p>A psychologist typically completes a minimum of six years of training, including university and practical experience, and is required to be registered with the <a href="https://www.psychologyboard.gov.au/">Psychology Board of Australia</a>.</p>
<p><strong>Clinical psychologists</strong></p>
<p>Clinical psychologists provide a range of psychological services to people across their life. Services typically focus on the assessment, diagnosis and treatment of mental illness. </p>
<p>Clinical psychologists complete additional supervision in the practice of clinical psychology beyond their six years of university. </p>
<p><strong>Clinical neuropsychologists</strong></p>
<p>Clinical neuropsychologists assess and treat people with brain disorders that affect memory, learning, attention, reading, problem-solving and decision-making. </p>
<p>Like clinical psychologists, neuropsychologists complete those six years and receive additional supervision in the practice of clinical neuropsychology.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/307305/original/file-20191217-123987-41ce7g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307305/original/file-20191217-123987-41ce7g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307305/original/file-20191217-123987-41ce7g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307305/original/file-20191217-123987-41ce7g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307305/original/file-20191217-123987-41ce7g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307305/original/file-20191217-123987-41ce7g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307305/original/file-20191217-123987-41ce7g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Psychologists and psychiatrists have different backgrounds but both assess and treat mental illness.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/P3kPTq5x_7s">Kaleidico</a></span>
</figcaption>
</figure>
<p><strong>Psychiatrists</strong></p>
<p>Psychiatrists are doctors who are experts in mental health. They diagnose and treat people with mental illness and prescribe medications, if appropriate. </p>
<p>Psychiatrists typically complete four to six years of an undergraduate medical degree before undergoing general medicine training within a hospital. Then they complete several years of specialist training in psychiatry and must be registered with the <a href="https://www.ahpra.gov.au/">Australian Health Practitioner Regulation Agency</a>.</p>
<h2>You might need to try a few therapists to find the right one</h2>
<p>Therapy requires a person to feel safe and secure and establish trust with another person. So the fit between the two of you matters. </p>
<p>In the same way you may try a few hairdressers or GPs before you feel in safe hands, you may need to try out a few therapists before you find the right one. </p>
<p>Try not to feel disheartened; your persistence in this area will pay off.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-of-seeing-a-psychologist-heres-how-to-choose-the-therapy-best-for-you-114294">Thinking of seeing a psychologist? Here's how to choose the therapy best for you</a>
</strong>
</em>
</p>
<hr>
<p>Ideally, you should select a therapist who is appropriately qualified but also, one you can connect and engage with. To test this, you should leave the first session with a sense of hope, even in the face of challenges. </p>
<p>This is not to say therapy will always be a comfortable process. It will be your therapist’s job to encourage and support you in making uncomfortable changes, so there may be times where you feel challenged or uncomfortable. It’s helpful to communicate this openly with your therapist and allow space to explore this with their support. </p>
<h2>Ask your community for recommendations</h2>
<p>Word of mouth can be an excellent tool when sourcing a good therapist. Consider asking your GP, family, friends or local community who they recommend. </p>
<p>Once you have some names, do your homework. Look up their qualifications, read about them if you can, and make sure that they practise in the area that you need. </p>
<p>Mental health is a broad term and as such, therapists may choose to focus on particular areas within it. If the therapist you’ve chosen doesn’t practise in your area, don’t worry – just ask them if they have a referral suggestion for you.</p>
<h2>Find out how much they charge</h2>
<p>In Australia, there are a lot of different ways to access mental health support. Some options include private practitioners working in clinics or schools, community services and public mental health services. Each of these settings will have a different fee or access structure associated. </p>
<p>For example under Medicare, a person may be eligible for up to ten sessions (individual and/or group) with a registered psychologist per calendar year with a referral from their GP. </p>
<p>These sessions may be bulk billed (with no out-of-pocket expense), or there may be a fee associated and rebates available. Fees can vary greatly, however <a href="https://www.psychology.org.au/for-the-public/about-psychology/what-it-costs">the Australian Psychological Society recommends</a> a fee of A$251 per 50-60 minute session. Medicare rebates range from <a href="http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&qt=ItemID&q=80110">A$86</a> (for psychologists) to <a href="http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=80011&qt=item">A$126.50</a> (for clinical psychologists and neuropsychologists). This would leave you out of pocket A$124.50 or A$165. </p>
<p>Out-of-pocket costs for private psychiatrists also vary. They may be bulk billed, or charge a fee. An initial consultation <a href="https://www.yourhealthinmind.org/getmedia/47ab2215-38e7-4184-9515-2e1f1237e215/Cost-to-see-psychiatrist-YHIM.pdf.aspx?ext=.pdf">may cost around A$400</a>, with a Medicare rebate of <a href="http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&qt=ItemID&q=296">A$201.35</a>, leaving you out of pocket A$178.65.</p>
<p>Mental health services at <a href="https://headspace.org.au/young-people/how-headspace-can-help/">headspace</a> are either free or low cost. And some schools also offer free psychological services.</p>
<p>Ask your GP about the specific costs and rebates when you discuss referral options. </p>
<h2>Consider going online</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/307306/original/file-20191217-124004-1fme77n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307306/original/file-20191217-124004-1fme77n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307306/original/file-20191217-124004-1fme77n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307306/original/file-20191217-124004-1fme77n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307306/original/file-20191217-124004-1fme77n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307306/original/file-20191217-124004-1fme77n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307306/original/file-20191217-124004-1fme77n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Online therapy will be a good fit for some young people.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/teen-surfing-net-bedroom-288897185">Will Rodrigues/Shutterstock</a></span>
</figcaption>
</figure>
<p>While there is much to be gained from the personal experience of therapy, access can be a problem in some regional and remote area of Australia. </p>
<p>Thankfully, there are a number of excellent online resources available:</p>
<ul>
<li><p><a href="https://www.cci.health.wa.gov.au">Centre for Clinical Interventions</a> provides online resources and self-directed therapy modules for bipolar, anxiety, depression, eating disorders and other mental health conditions</p></li>
<li><p><a href="https://beyondblue.org.au">Beyond Blue</a> provides support for anxiety, depression and suicide prevention</p></li>
<li><p><a href="https://www.blackdoginstitute.org.au">Black Dog Institute</a> is dedicated to understanding, preventing and treating mental illness. It has a range of resources, particularly for depression and anxiety</p></li>
<li><p><a href="http://www.brave-online.com">Brave</a> supports young people to overcome anxiety.</p></li>
</ul>
<p>Remember, we all struggle from time to time. For many, therapy plays an important role in improving their mental health and setting them back on their path. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/online-therapies-can-improve-mental-health-and-there-are-no-barriers-to-accessing-them-111357">Online therapies can improve mental health, and there are no barriers to accessing them</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/120981/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jade Sheen is a recipient of an Australian Government Office and Learning and Teaching grant and several Department of Health and Ageing grants.
</span></em></p><p class="fine-print"><em><span>Amanda Dudley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>You might need to visit a few therapists to find one you can connect and engage with. If cost or access are issues, you might even like to go online.Jade Sheen, Associate Professor, School of Psychology, Deakin UniversityAmanda Dudley, Psychologist and Lecturer, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1251352019-12-09T01:11:07Z2019-12-09T01:11:07Z‘How do I clean my penis?’<figure><img src="https://images.theconversation.com/files/305101/original/file-20191204-70167-1dlj45h.png?ixlib=rb-1.1.0&rect=538%2C0%2C2958%2C2000&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Wes Mountain/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><blockquote>
<p>Growing up, no one ever gave me the rundown on how or what I should do to keep my penis clean […] I’ve never read any reliable answer beyond washing it with water. Do I use soap? Any soap? How normal is smegma? If my penis gets itchy from smegma should I go see a doctor? If so, my GP or a urologist? — Anonymous</p>
</blockquote>
<h2>Key points</h2>
<ul>
<li>clean under the foreskin, using soap, but not too much</li>
<li>smegma is normal</li>
<li>if you have any concerns, see your GP.</li>
</ul>
<p><a href="https://theconversation.com/au/topics/i-need-to-know-66587"><img src="https://images.theconversation.com/files/290837/original/file-20190904-175686-polw3q.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=90&fit=crop&dpr=2" width="100%"></a></p>
<p>It’s a shame some people think talking about cleaning and caring for our genitals is embarrassing or taboo. We probably know more about hair care than penis care.</p>
<p>The penis is simply another part of our anatomy, so cleaning should be relatively straight forward.</p>
<p>If you’ve been circumcised, where your foreskin was removed soon after birth, your penis will look something like the one in the diagram (below, right), with the head (or glans) always exposed.</p>
<p>But if you have a foreskin (below left and centre), there are some extra things to think about when washing, which we’ll get to soon.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Foreskin facts</h2>
<p>But first, some foreskin facts. From around the time you turn five, your foreskin <a href="http://www.cirp.org/library/hygiene/camille1/">separates</a> from the head of your penis, bit by bit. This allows you to pull back your foreskin (retract it). In some boys, the foreskin can stay partially stuck to the head of the penis until puberty.</p>
<p>You should <a href="https://www.berghahnjournals.com/view/journals/boyhood-studies/1/2/bhs010206.xml">never forcibly pull back</a> your foreskin. That’ll be painful, you could bleed, you could scar, or have other complications.</p>
<h2>OK, now for the washing part</h2>
<p><a href="http://www.cirp.org/library/hygiene/camille1/">Once your foreskin separates easily from the glans</a>, gently retract and clean underneath the foreskin with each bath or shower. Then, after washing, pull the foreskin forward to its normal position.</p>
<p>When it’s time to dry off, retract the foreskin again so you can dry the head of the penis with a towel. Then, you guessed it, pull the foreskin forward to its normal position.</p>
<p>It’s OK to clean with soap whether you have a foreskin or not. But generally, too much soap is worse than none at all. Excessive cleaning removes essential body oils that would normally keep our skin moist and reduce friction. If you have sensitive skin, you can use a soap-free wash from the chemist.</p>
<h2>What about smegma?</h2>
<p><a href="https://www.healthline.com/health/smegma">Smegma</a> is a thick, whitish discharge consisting of a build-up of dead skin cells, oil and other fluids under the foreskin. And it’s very useful. It protects and lubricates the penis. </p>
<p>Some people have oilier skin than others and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1464-410x.1999.0830s1034.x">tend to have more smegma</a>.
So some smegma is normal, but if you have too much or it becomes smelly, you may need to clean more.</p>
<h2>Things to watch out for (and when to see your GP)</h2>
<p>If the head of your penis becomes painful, red, itchy and has a discharge, you may have a treatable condition called <a href="https://www.mshc.org.au/SexualHealthInformation/SexualHealthFactSheets/BALANITIS/tabid/134/Default.aspx#.XcJiPfZuKUk">balanitis</a>.</p>
<p>It’s more common if you have a foreskin. And the bacteria and fungus that cause it like the warm and moist conditions under there.</p>
<p>Skin disorders, infection, poor hygiene, friction from sexual activity, and using too much soap all <a href="https://www.dermnetnz.org/topics/balanitis/">cause the condition</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-make-your-next-sexual-health-check-less-erm-awkward-72498">How to make your next sexual health check less, erm ... awkward</a>
</strong>
</em>
</p>
<hr>
<p>You can clear a mild case with good hygiene and simple treatments, such as an antiseptic or antifungal cream. You can buy these from any pharmacy. In addition to the medication, the cream itself helps protect and moisturise the inflammed skin. </p>
<p>If you have balanitis you may need to be more careful than usual to avoid urine irritating your inflamed skin. Retract your foreskin when you urinate. Dry the head of the penis gently after you finish.</p>
<p>If your penis is still inflamed after a week of these simple measures it’s <a href="https://www.aafp.org/afp/2018/0115/p102.html">best to see your GP</a>. They can then investigate other causes, such as <a href="https://www.ncbi.nlm.nih.gov/books/NBK537143/">psoriasis or an allergy</a>.</p><img src="https://counter.theconversation.com/content/125135/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s a surprisingly common question. Here’s what you need to know.David King, Senior Lecturer in General Practice, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1242552019-10-08T22:39:12Z2019-10-08T22:39:12ZCompassionate ‘zero-suicide’ prevention on campuses urgently needed<figure><img src="https://images.theconversation.com/files/295871/original/file-20191007-121088-tq0o7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When a student dies by suicide, university communities grapple with the fact that an opportunity for a suffering person to receive help was missed. </span> <span class="attribution"><span class="source">(Pexels)</span></span></figcaption></figure><p>Even with a concerted response to improve <a href="https://www.theglobeandmail.com/canada/article-faced-with-long-waits-for-mental-health-care-students-and/">mental health at universities</a>, mental health crises still occur. The issue of <a href="https://www.cbc.ca/news/health/suicide-who-1.5276263">suicide</a> has been in the news lately, and students are looking to universities to respond.</p>
<p>The National College Health Assessment (NCHA) shows that Canadian post-secondary students’ mental health is doing fairly well. In the NCHA 2019 survey of 55,284 students from 58 post-secondary campuses across Canada, <a href="https://www.cacuss.ca/files/Research/NCHA-II%20SPRING%202019%20CANADIAN%20REFERENCE%20GROUP%20DATA%20REPORT.pdf">88 per cent of students indicated moderate (average) to better-than-average mental health. Among that group, 44.7 per cent of student respondents said their mental health was flourishing</a>. </p>
<p>But a remaining 12 per cent said their mental health was “languishing” (not doing well). Mental health disorders are treatable, but are these students finding adequate help? </p>
<p>At the University of Calgary, we have been involved with developing, overseeing and implementing the campus’s <a href="https://www.ucalgary.ca/mentalhealth/">Mental Health Strategy</a>. Reports of mental health issues at post-secondary institutions have been prevalent, resulting in an increase in campus supports at our school <a href="https://umanitoba.ca/student/mentalhealth/mh-strategy.html">and at other universities</a>. Post-secondary institutions have collaborated with mental health professionals to develop <a href="https://healthycampuses.ca/wp-content/uploads/2014/09/The-National-Guide.pdf">recommended frameworks and approaches</a>. </p>
<p>At our school, among other guiding principles, our mental health strategy and related campus activities are informed by ongoing research in <a href="https://psyc.ucalgary.ca/profiles/andrew-szeto">reducing stigma</a>. We are also launching an initiative to develop a suicide prevention and awareness framework, with a series of student consultations.</p>
<h2>Suicide prevention framework</h2>
<p><a href="https://www.ualberta.ca/campus-life/suicide-prevention">Suicide prevention</a> frameworks aim to increase awareness of suicide, reduce the barriers that prevent those with suicide-related behaviour to seek and receive help, and increase the campus community’s ability to support students and refer students to resources. </p>
<p>The <a href="http://zerosuicide.sprc.org/about">Zero Suicide initiative</a> has been implemented in United Kingdom health-care settings for over a decade and has been adopted by post-secondary institutions. Canada post-secondary institutions should follow suit. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/K3cBzqrly0M?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">About the Zero Suicide initiative and framework.</span></figcaption>
</figure>
<p>Universities face multiple challenges in establishing practices for mental health referrals, suicide prevention and intervention and knowing how to <a href="https://www.sprc.org/news/postvention-prevention">respond after a suicide to reduce risk and promote healing</a>. </p>
<h2>When a student dies by suicide</h2>
<p>It is a difficult and exceptionally emotional event when a student dies by suicide: people confront the fact that somehow an opportunity was missed to help a suffering person. The way a university responds can <a href="https://doi.org/10.1111/sltb.12450">reduce the potentially harmful impact on affected students and family members</a> and <a href="https://www.chronicle.com/article/After-a-Suicide-What-Colleges/242234">support the well-being of the campus community</a>. </p>
<p>However, responding to suicide is complicated. Information is often limited and there are multiple demands for action and support. Typically institutions have protocols in place, but there is not a lot of research about <a href="https://www.suicideinfo.ca/resource/after-a-student-suicide/?mc_cid=841339368e&mc_eid=8307fa7275">what campuses should do</a>. </p>
<p>We believe institutions should focus on reducing risk and promoting healing from a place of compassion. </p>
<h2><em>1. Talking with the family</em></h2>
<p>Notification to the university of the death of a student can come from many sources. It is critical to verify the information, and where and who it is coming from, before taking any action. </p>
<p>Where a death has occurred on campus, notification of the death to the family comes under the responsibility of law enforcement agencies. </p>
<p>After the initial notification, establishing an early connection with the family allows the institution to demonstrate respect and care. It provides an ability to share condolences and determine family wishes about sharing information and approving communications. </p>
<p>The sudden passing of a student, including by suicide, can be a tremendous shock — and also a time of disbelief and anger, sometimes directed at the institution. Navigating unpredictable responses takes skill and experience. An institutional response should be framed by listening. </p>
<p>Early conversations with the family can be meaningful and helpful to the family, with the opportunity to talk about their family member. Beyond personal support and establishing what kind of communication the family wants, a university spokesperson will need to alleviate any practical concerns such as payment of student loans, return of personal belongings and so on. </p>
<h2><em>2. Determining affected communities</em></h2>
<p>Collaborating to identify affected communities is essential in establishing an outreach response. Plans should remain flexible to accommodate arising needs. Psychologist Ellen Zinner, formerly a professor at the University of Baltimore, developed a model for <a href="https://doi.org/10.1002/ss.37119853107">considering five levels of survivorship of people impacted by suicide</a>. </p>
<p>People impacted range from those most closely affiliated with the deceased such as close friends, roommates, teams or lab groups, to more peripheral relations in classrooms, to the campus at large if the death is highly publicized.</p>
<p>Considering levels of survivorship and relationships with the deceased should guide actions dedicated to providing information, supporting people, promoting healing and reducing risk. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/295794/original/file-20191007-121051-1kbotzx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/295794/original/file-20191007-121051-1kbotzx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/295794/original/file-20191007-121051-1kbotzx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/295794/original/file-20191007-121051-1kbotzx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/295794/original/file-20191007-121051-1kbotzx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=494&fit=crop&dpr=1 754w, https://images.theconversation.com/files/295794/original/file-20191007-121051-1kbotzx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=494&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/295794/original/file-20191007-121051-1kbotzx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=494&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">When a suicide happens, the entire campus may be impacted, so responding in multiple ways to promote a sense of safety, calm, connectedness and hope is important.</span>
<span class="attribution"><span class="source">(University of Calgary)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2><em>3. Consideration of culture</em></h2>
<p>Consideration of <a href="https://www.sprc.org/sites/default/files/resource-program/AfteraSuicideToolkitforSchools.pdf">diversity — whether ethnic, linguistic, religious, or due to sexual orientation, gender, racialization or ability — affects responses to the death and the most appropriate way to provide support</a>. University leaders must consider information about the person’s background and identity and the context of the death, and what details the family wishes to share. Cultural competence is considered a core skill. </p>
<p>When information is initially lacking about the deceased, leaders can ask the those most closely affected. People who provide support do not need to be experts; however, it is imperative not to assume to know the “best” response.</p>
<h2><em>4. Honouring students</em></h2>
<p>Affected individuals have a right to grieve individually and collectively. A forum to honour the deceased student can be supportive. A campus organized memorial <a href="https://www.sprc.org/sites/default/files/resource-program/AfteraSuicideToolkitforSchools.pdf">is challenging, and not always recommended</a>; however, students or the chaplaincy may organize an informal gathering. Input from the family is critical. </p>
<p>Some guiding principles for what to do after a suicide are pursuing actions which promote a sense of <a href="https://doi.org/10.1521/psyc.2007.70.4.283">safety, calm, connectedness, and hope for self and community</a>. </p>
<p>These principles can shape a collective gathering to honour the deceased student.</p>
<h2><em>5. Communications</em></h2>
<p>In deciding how and when to communicate about the suicide, respect for family wishes are paramount. This is so even while timing is challenging in today’s age of instant communication and social media. </p>
<p>This said, if there is high visibility of first responders and vehicles on campus, it is important to release a campus-wide short statement indicating that a death has occurred on campus, there is no risk to the community, and out of respect to the family no more information is available at this time. </p>
<p>Further communications would be tailored to the communities known to be impacted, as identified above. A final communication, with family approval, could be a half-masted flag, typically on the day of a funeral or memorial service. This could be accompanied by an “in memoriam” on the university website, adapted from an obituary.</p>
<p>Also important are communications that honour the student and respond to the community in ways that educate about suicide prevention. </p>
<h2><em>6. Compassion fatigue</em></h2>
<p>Providing support after a student death is emotionally engaging and demanding. Compassion fatigue for staff who respond to student death is inevitable and universities should take measures to support them. </p>
<p>Meaningful conversations provide opportunities to talk about personal responses, deepen relational connections between colleagues and enhance learning for future situations.</p>
<p>As universities advocate for “zero suicide” frameworks alongside health partners, it is important for university leaders to continue to work at suicide awareness and prevention, and to take actions to reinforce a culture of compassion and care. </p>
<p><em>This story was co-authored by Ann Laverty, PhD, Senior Counsellor, Student Wellness Services.</em></p>
<p><em>If you are experiencing suicidal thoughts, you need to know you’re not alone. If your life or someone else’s is in danger, call 911 for emergency services. Or, download <a href="https://thelifelinecanada.ca/lifeline-canada-foundation/lifeline-app/">The LifeLine App</a> to find one-touch hotline crisis call, text and chat options and prevention and awareness tips; or call Canada Suicide Prevention Service (CSPS) at 1-833-456-4566.</em> </p>
<p>[ <em><a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/124255/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Szeto receives funding from the Mental Health Commission of Canada and CIHR. He is affiliated with the Mental Health Commission of Canada. </span></em></p><p class="fine-print"><em><span>Debbie Bruckner and Susan Barker do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As universities advocate for ‘zero suicide’ frameworks, it is important for university leaders to work at suicide awareness, prevention and response, and to reinforce a culture of compassion.Debbie Bruckner, Adjunct Professor (Field Education), Faculty of Social Work and Director of Student Wellness, Access & Support, University of CalgaryAndrew Szeto, Associate Professor, Department of Psychology, and Director, Mental Health Strategy, University of CalgarySusan Barker, Vice-Provost (Student Experience) & Professor, Werklund School of Education, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1146142019-05-31T04:22:23Z2019-05-31T04:22:23Z‘Do I need to shave my pubic hair before having sex?’<figure><img src="https://images.theconversation.com/files/274020/original/file-20190513-183086-usifug.jpg?ixlib=rb-1.1.0&rect=89%2C71%2C3898%2C1688&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No one can decide what to do with your body but you!</span> <span class="attribution"><span class="source">Nina Maile Gordon/The Conversation, </span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em><a href="https://theconversation.com/i-need-to-know-the-conversation-launches-a-qanda-service-for-teens-103432">I Need to Know</a> is an ongoing series for teens in search of reliable, confidential advice about life’s tricky questions</em>.</p>
<hr>
<blockquote>
<p>Do you need to shave your vagina before having sex?
Anonymous</p>
</blockquote>
<h2>Key points</h2>
<ul>
<li>An estimated 60% of young women remove their pubic hair</li>
<li>Pornography does not reflect women’s diversity</li>
<li>If you’re shaving your pubic hair, use a mirror and clean razor</li>
<li>Shaving before sex is your choice. </li>
</ul>
<hr>
<p>It can be challenging for girls and women to learn how to relate to their bodies because there are so few resources available to adequately guide us. It’s no wonder, then, that you ask this important question!</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/274550/original/file-20190515-60529-1yd8oa7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/274550/original/file-20190515-60529-1yd8oa7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/274550/original/file-20190515-60529-1yd8oa7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/274550/original/file-20190515-60529-1yd8oa7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/274550/original/file-20190515-60529-1yd8oa7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/274550/original/file-20190515-60529-1yd8oa7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/274550/original/file-20190515-60529-1yd8oa7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>Before we get any further, I want to clarify that pubic hair grows on and around your vulva, not the vagina. The vagina is internal. Here’s a helpful graphic of what is going on down there.</p>
<p>While I can’t tell you what you should do with your pubic hair (in fact, no one should tell you what to do with your body), I can give you some information to help you make an informed decision. So, to shave or not to shave? Here are five things to consider.</p>
<h2>1. More than half of young women remove their pubic hair</h2>
<p>One <a href="https://link.springer.com/article/10.1007/s11199-008-9494-3">study</a> of young Australian women found 60% of them removed some of their pubic hair, compared with 96% who regularly removed their leg and underarm hair. While removing pubic hair is becoming more common, it is still not as typical as removing leg and underarm hair. </p>
<p>This might tell us something about the social pressures we face when it comes to our body hair: the more visible the hair, the more likely we are to remove it. Social norms about body hair can sometimes make choice feel impossible. </p>
<p>But there is also a growing wave of young women taking to social media to talk back to these pressures. They celebrate our natural diversity and difference, and embrace their relationships with body hair.</p>
<p><iframe id="tc-infographic-393" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/393/0fac7360e455b21512ca55bcbb34109c101f1036/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>2. It’s fashion</h2>
<p>Just as the hair on our head is subject to changing fashions and trends, so too is pubic hair! Over the past few decades, women’s pubic hair has undergone dramatic refashioning. </p>
<p>Fashions range from the full bush in the 1970s to the “Brazilian” in the 1990s, to a more recent move towards complete hairlessness, aided by <a href="https://www.amazon.com/Plucked-History-Hair-Removal-Biopolitics/dp/1479852813">new technologies</a> such as laser hair removal. Remember, behind our beauty work sits an <a href="https://newmatilda.com/2018/05/19/beauty-myth-3-0/">entire industry that profits from our insecurities</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/270616/original/file-20190424-19300-1hakodi.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/270616/original/file-20190424-19300-1hakodi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/270616/original/file-20190424-19300-1hakodi.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/270616/original/file-20190424-19300-1hakodi.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/270616/original/file-20190424-19300-1hakodi.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/270616/original/file-20190424-19300-1hakodi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/270616/original/file-20190424-19300-1hakodi.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/270616/original/file-20190424-19300-1hakodi.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There’s a lot of money to be made (and time spent) removing hair.</span>
<span class="attribution"><span class="source">Nina Maile Gordon/The Conversation</span></span>
</figcaption>
</figure>
<h2>3. Pubes and porn</h2>
<p>Popular culture is influential in how we think about the female body. With the growing availability of pornography, young people increasingly see it as a “normal” representation of how people have sex. Perhaps you’ve looked at porn before and thought, wow, is that what I should do and what I should look like while doing it?</p>
<p>Remember, porn is a performance and is highly stylised. It does not reflect our “real”, non-Photoshop world. For example, one of the many reasons that porn tends to show women without pubic hair is that it allows the camera to capture graphic shots. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-kegel-exercises-actually-good-for-you-111747">'Are Kegel exercises actually good for you?'</a>
</strong>
</em>
</p>
<hr>
<h2>4. Sex, STIs and shaving</h2>
<p>Some <a href="https://sti.bmj.com/content/93/3/162">studies</a> suggest shaving pubic hair may increase the risk of getting a sexually transmitted infection. One reason is that shaving can cause micro-tears in the top layer of the skin, which can lead to bacterial buildup and transmission. More research is needed to substantiate these claims. </p>
<p>If you do shave, use a mirror so you can see what you’re doing, and take extra care around the outer lips of your vulva where cuts are more common. Make sure your razor is clean and use warm water. Alternatively, you can trim the hair, or wax (while this prolongs hair regrowth it may present other health risks such as infection).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-it-normal-for-girls-to-masturbate-112393">'Is it normal for girls to masturbate?'</a>
</strong>
</em>
</p>
<hr>
<h2>5. Demanding bodily autonomy!</h2>
<p>We are raised to think of our vulvas as our “private parts”, belonging purely to ourselves. The world around us comes to influence what we do and feel about our bodies. What we do with our hair is no different. </p>
<p>Hair has always been a site for political intervention: whether it’s the military exercising discipline by shaving men’s hair, or the “body police” mandating that body hair is <a href="https://www.foxnews.com/lifestyle/nike-ad-featuring-woman-unshaven-armpits-prickly-reactions">less acceptable on women than it is on men</a>. To dictate what someone does with their hair is to take away their bodily autonomy. </p>
<p>One of the ways to assert control over our own bodies is to recognise that the ideas and practices available to us as girls and women are often so habitual that they’re rarely questioned. Considering how some young women are renegotiating femininity might be a good start. From there, you can negotiate which practices best suit your values and beliefs, which may change over time. And in direct response to your question, shaving before sex is your choice!</p><img src="https://counter.theconversation.com/content/114614/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Barcham is a member of staff in the Office of the Vice-Chancellor at Western Sydney University. </span></em></p>While we can’t tell you what to do with your body, we can give you some information to help make an informed decision about shaving your pubic hair.Helen Barcham, PhD candidate, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1117102019-02-17T19:00:42Z2019-02-17T19:00:42ZIt’s time to change our drug dog policies to catch dealers, not low-level users at public events<figure><img src="https://images.theconversation.com/files/258955/original/file-20190214-1751-1urdp1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The use of drug dogs leads to riskier drug-taking at festivals.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/audience-outdoor-music-festival-204811402?src=8GgEsaqISluaooaqNz2Pnw-1-65">Shutterstock</a></span></figcaption></figure><p>In the early 2000s New South Wales became the first Australian state to introduce drug detection dogs for policing, with the aim of “targeting drug supply” and “attacking the root causes of drugs” in <a href="https://journals.sagepub.com/doi/abs/10.1177/0004865816642826">society</a>. It gave police powers to use specially trained dogs to sniff for drugs in designated public places without the use of a <a href="http://www8.austlii.edu.au/cgi-bin/viewdb/au/legis/nsw/repealed_act/ppdda2001338/">warrant</a>. </p>
<p>Drug dog policies have since expanded across all states of Australia and many other parts of the <a href="https://www.sciencedirect.com/science/article/pii/S0955395918300756?via%3Dihub">globe</a>. </p>
<p>But our <a href="https://www.tandfonline.com/doi/abs/10.1080/10345329.2018.1556280?journalCode=rcic20">new research</a> shows it’s an ineffective tool for targeting drug supply because it catches low-level users rather than suppliers. We also show this is an inevitable byproduct of where drug dogs are deployed: public settings such as licensed premises and festivals. </p>
<p>After almost 20 years of such policies, it’s time for reform. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-drug-detection-dogs-are-sniffing-up-the-wrong-tree-57343">Why drug-detection dogs are sniffing up the wrong tree</a>
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</em>
</p>
<hr>
<h2>The wrong targets</h2>
<p>In 2006 the <a href="https://www.ombo.nsw.gov.au/news-and-publications/publications/reports/legislative-reviews/review-of-the-police-powers-drug-detection-dogs-act-2001">NSW Ombudsman</a> released a comprehensive review of the dogs, finding evidence of a high “false positive” rate. In 74% of occasions when a dog indicated they smelled a prohibited substance, no drugs were found. </p>
<p>The review also found dogs predominantly targeted young male drug users and not suppliers.</p>
<p>This led the Ombudsman to conclude the dogs were an “ineffective tool”. The Ombudsman also questioned whether the additional powers to use drug dogs should be retained. </p>
<p>But since then, these powers have expanded, including across the entire Kings Cross entertainment precinct and all Sydney public transport lines. Concern about their use continues to grow.</p>
<h2>Nothing has changed</h2>
<p>Our new <a href="https://www.tandfonline.com/doi/abs/10.1080/10345329.2018.1556280?journalCode=rcic20">research</a> provides the most comprehensive analysis of the use of drug detection dogs since the NSW Ombudsman review more than a decade ago. We used <a href="https://www.bocsar.nsw.gov.au/">data</a> on all recorded criminal incidents and persons of interest involving drug detection dogs that led to a formal police response from June 2008 to June 2018.</p>
<p>We found little has changed in the police use of drug detection dogs.</p>
<p>The main group detected by the dogs were young males detected for use or possession offences (86.4% of incidents). Supply offences were only detected in 4.8% of incidents. Use or possession detections were 18 times more likely than those for supply. </p>
<p>Most of the young people who were detected had only small quantities of cannabis or ecstasy. These are the <a href="https://www.sciencedirect.com/science/article/pii/S0140673607604644">least harmful of all illicit drugs</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/three-charts-on-who-uses-illicit-drugs-in-australia-110169">Three Charts on who uses illicit drugs in Australia</a>
</strong>
</em>
</p>
<hr>
<h2>Target dealers, not users</h2>
<p>We also looked at when and where drug detection dog encounters occurred, and whether circumstances for detection of suppliers differed. Our <a href="https://www.tandfonline.com/doi/abs/10.1080/10345329.2018.1556280?journalCode=rcic20">findings showed</a> they did. </p>
<p>Consumer offences (use or possession) were most detected on weekends and in licensed premises, on public transport or in public places. In contrast, supply offences were most detected midweek in residential premises.</p>
<p>But only 10.9% of all deployments were at residential settings (compared with 83.3% at public settings). </p>
<p>Our research provides the first evidence that if dogs were deployed differently – less at recreational settings and more at residential premises with the use of a warrant – they could be more effective at detecting drug suppliers. </p>
<p>When police dogs are deployed at residential premises, suppliers are detected in 52.5% incidents. In contrast, suppliers are only detected in 5.9% and 13.4% of incidents when dogs are deployed on public transport or at licensed premises, respectively. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/our-drugs-policies-have-failed-its-time-to-reinvent-them-based-on-what-actually-works-69984">Our drugs policies have failed. It's time to reinvent them based on what actually works</a>
</strong>
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</p>
<hr>
<p>The current deployment strategy will not be able to detect drug suppliers and will disproportionately target drug users and young people. This raises both <a href="https://theconversation.com/why-drug-detection-dogs-are-sniffing-up-the-wrong-tree-57343">civil liberty concerns</a> about <a href="https://www.abc.net.au/news/2018-11-13/nsw-police-strip-search-rise-triggers-law-commission-inquiry/10491032">the use of public searches</a> and concerns for the safety of people who use drugs in recreational and public settings.</p>
<h2>Time for policy reform</h2>
<p>Research has suggested the presence of drug detection dogs at festivals and other public places <a href="https://www.sciencedirect.com/science/article/pii/S0955395916303899">seldom deters drug-taking</a>. But it often leads to more risky drug behaviour from people who use drugs, such as <a href="https://www.sciencedirect.com/science/article/pii/S0955395916303899">purchasing drugs inside rather than outside festivals</a>, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1465-3362.2009.00065.x">switching to less detectable but more harmful drugs</a>, and <a href="https://www.sciencedirect.com/science/article/pii/S0955395918302081#!">hurried consumption of drugs upon sight of dogs</a>. </p>
<p>The deployment of drug detection dogs at festivals raises particular concerns in light of <a href="https://www.sbs.com.au/news/nsw-coroner-to-investigate-spate-of-music-festival-deaths">five recent deaths at festivals</a> in Sydney, and the broader debates about how to improve festival <a href="https://static.nsw.gov.au/1540188213/Keepingpeoplesafe.pdf">safety</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/258956/original/file-20190214-1742-1szizb7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/258956/original/file-20190214-1742-1szizb7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/258956/original/file-20190214-1742-1szizb7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/258956/original/file-20190214-1742-1szizb7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/258956/original/file-20190214-1742-1szizb7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/258956/original/file-20190214-1742-1szizb7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/258956/original/file-20190214-1742-1szizb7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The use of drug dogs rarely deters people from taking drugs at festivals and public events.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/331484618?src=K3Dkbaqdun0O9Mz6rnoToQ-1-31&size=huge_jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p>Our new study adds to existing research and continued opposition by various groups, including NSW Greens MP David <a href="https://davidshoebridge.org.au/sniffoff/">David Shoebridge</a> and drug harm reduction group <a href="https://www.unharm.org/drug_detection_dogs">Unharm</a>. It suggests that a change in the deployment of drug dogs is possible and could lead to the detection of drug suppliers, not drug users. </p>
<p>Policy reform could reduce some of the unintended consequences of the current policies governing drug detection dogs, such as the risks to public health, and ensure a better use of scarce drug policy resources.</p><img src="https://counter.theconversation.com/content/111710/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caitlin Hughes works at the National Drug and Alcohol Research Centre which receives funding from the Commonwealth Department of Health. This research was funded by the Australian Research Council Discovery Project DP150100910.</span></em></p><p class="fine-print"><em><span>Winifred Agnew-Pauley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s ineffective to use drug dogs at festivals and in public places because they’re much more likely to catch small-time users than suppliers.Caitlin Hughes, Senior Research Fellow - Criminologist and Drug Policy Researcher, UNSW SydneyWinifred Agnew-Pauley, PhD Candidate, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/887692017-12-07T05:41:39Z2017-12-07T05:41:39ZWhat is meningococcal disease and what are the options for vaccination?<figure><img src="https://images.theconversation.com/files/198090/original/file-20171207-31539-fgs9bf.jpg?ixlib=rb-1.1.0&rect=5%2C142%2C992%2C523&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children aged under two are at increased risk of meningococcal disease.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cute-little-boy-stting-on-mother-767951725?src=0popTvu1ZqoPELcl7VVUCQ-1-7">Shutterstock</a></span></figcaption></figure><p>As a medical researcher and parent of two teenagers there is one bug, <em>Neisseria meningitidis</em>, that really scares me. This is mainly because of the speed and severity of the infection it causes, called <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">meningococcal disease</a>, and its predilection for infecting healthy adolescents and younger children. </p>
<p>Meningococcal is a rare but very serious infection that <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">can lead to</a> blood poisoning (septicaemia) and/or brain infection (meningitis). </p>
<p>The initial symptoms can be vague and non-specific. This includes the sudden onset of fever and a rash. The rash can be either red-purple spots or bruises – detected by the classic <a href="http://www.meningococcal.org/the_rash.html">pushing-a-glass-on-the-skin test</a> to see if the rash goes away (and is therefore less likely to be meningococcal) – or a flat or raised non-specific rash. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-whats-meningococcal-meningitis-and-what-are-the-signs-64170">Explainer: what's meningococcal meningitis and what are the signs?</a>
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<p>Other symptoms can be mistaken for disease like the flu and include headache, neck stiffness, reduced consciousness, muscle aches, joint pain, nausea and vomiting. If you are at all worried see your GP.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Symptoms of meningoccal disease can be vague and non-specific, or mistaken for other illnesses.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/291045173?src=X8ALwvwlKUCxgYFHvEroRQ-1-3&size=vector_eps">Shutterstock</a></span>
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<p>Once infected the <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">death rate</a> is around 5–10%. About 10–30% of children and adolescents who survive the disease <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">can develop permanent complications</a>, such as limb deformity, skin scarring, deafness and neurological deficits. </p>
<p>Early diagnosis and treatment with antibiotics can improve the patient’s outcomes but the disease can largely be prevented by vaccination.</p>
<h2>How common is meningococcal disease?</h2>
<p>Using differences in the surface “sugars” (polysaccharides) of the <em>Neisseria meningitidis</em> organism’s outer membrane capsule, we are able to classify the bacteria into serogroups (types), and each serogroup is given a letter of the alphabet, for example, A, B, C and so on. There are 13 different serogroups. </p>
<p>Globally, most meningococcal disease is caused by serogroups A, B, C, W and Y. These were chosen as the targets for vaccines. </p>
<p>The bug poses the greatest risk of infection in those people with immune system weaknesses. But healthy people in our community who are smokers, live in crowded living conditions, engage in intimate kissing with multiple partners (hence adolescents and young adults), and those with a recent or current viral respiratory infection are also targets.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-which-vaccinations-should-i-get-as-an-adult-81400">Health Check: which vaccinations should I get as an adult?</a>
</strong>
</em>
</p>
<hr>
<p>The burden of meningococcal disease fluctuates naturally over time. The rate declined from 2002 to 2013, but has been on the increase since 2014. </p>
<p>Serogroup C disease has become very rare (<a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">accounting for only 1.2% of cases</a> in 2016) since the introduction of a free vaccine in 2003. </p>
<p>Serogroup B disease <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">has been dominant until recently</a>, but has been naturally declining in most states and territories, even without widespread vaccination against this serogroup. </p>
<p>Serogroup W disease has increased since 2013. This is now the main cause of meningococcal disease in Australia, <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">accounting for 44.7% of cases</a> in 2016. </p>
<p>Children aged under two years have the highest rates of meningococcal W and Y disease, followed by older adolescents. </p>
<h2>Vaccination options</h2>
<p>No single vaccine offers protection against all serogroups that cause meningococcal disease, but there are safe and effective vaccines that can protect against five serogroups (A,B,C,W,Y). The vaccines cover different serogroups and it does get confusing so here are the basics.</p>
<p>There are three types of meningococcal vaccines registered in Australia, which cover the following serogroups: </p>
<ul>
<li>Meningococcal C (MenC)</li>
<li>Meningococcal B (MenB) </li>
<li>Meningococcal A, C, W, Y (MenACWY). </li>
</ul>
<p>All these vaccines include “killed” parts of the bacteria in order to stimulate an immune response. This means if someone comes into contact with the bacteria, for example via kissing, then they already have immunity and don’t get the nasty disease. It’s not possible for the vaccine to cause meningococcal disease.</p>
<h2>Menigococcal C vaccine</h2>
<p>The MenC vaccine is given for free to all Australian infants at 12 months of age under our <a href="http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/national-immunisation-program-schedule">National Immunisation Program</a>. It’s given as a combination vaccine with the trade name Menitorix® and protects against meningococcal C and another bacteria called <a href="http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-hib"><em>Haemophilus influenzae</em> type b</a>.</p>
<p>The MenC vaccine has reduced the rate of meningoccocal C <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">by 96%</a> since its introduction. </p>
<p>Although serogroup C disease is now not common, it’s not completely eradicated so get your child vaccinated at 12 months. </p>
<h2>Menigococcal B vaccine</h2>
<p>The <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-FAQ.pdf">MenB vaccine</a>, which has the trade name Bexsero®, is not on the national immunisation program and will cost you around A$95-150 per dose, depending on what your pharmacist or GP charges. It might be worth calling a few different pharmacies to check their price. </p>
<p>It’s strongly recommended for people who either have immune system weaknesses, work in environments where there’s a high chance of exposure (such as health care or laboratory workers), or live in close proximity to others (such as military recruits and those in boarding houses or residential accommodation). </p>
<p>Children, especially those aged under two, and adolescents aged 15 to 19 years are also at increased risk. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-reason-to-use-meningococcal-b-vaccine-it-could-also-cut-the-clap-80739">More reason to use Meningococcal B vaccine – it could also cut the Clap</a>
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<p>The younger you start the MenB vaccine the more doses you need. If starting between six weeks to five months old, the child needs three doses* plus a booster dose at 12 months old; if over six months old, then two doses as a minimum and a booster dose depending on the age at which you started. Adolescents need two doses.</p>
<p>Infants should be given a medicine like paracetamol at the time of vaccination to reduce the chance of the vaccine causing a fever. </p>
<h2>Menigococcal ACWY vaccine</h2>
<p><a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-FAQ.pdf">Three vaccines</a> are available in Australia, which have the trade names of Menveo®, Menactra® and Nimenrix®. </p>
<p>Like the MenB vaccine, the number of doses needed depends on the age you start vaccinating (babies under six months need four doses; 7- to 11-month olds need two doses and 12-23 month olds need one or two doses (either one dose of Nimenrix® or two doses of Menveo®); and if started over two years, the child only needs one dose). Menveo® is the only vaccine registered for use in babies under one. </p>
<p>In all states except South Australia (where a MenB program is currently underway), MenACWY will be given to adolescents in years 11 and 12 via high school-based programs. This is in response to the recent emergence of MenW disease around parts of the country. </p>
<p>Parents wanting to vaccinate younger children will have to pay around A$55-90 per dose, depending on the brand you choose and what your pharmacist and GP charges. (Again, different pharmacies may have different prices).</p>
<h2>What should you get?</h2>
<p>The inevitable question parents ask is, “should I pay to get my child vaccinated against MenB and MenACWY?” </p>
<p>In an ideal world, the answer would be “give both vaccines”. If you or your child has immune system weaknesses then definitely <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-FAQ.pdf">go for both optional vaccines</a>.</p>
<p>Another way to answer would be to state what we know. We know both vaccines are effective against severe disease. We know they can be given on the same day safely. But we also know no vaccine is 100% effective, and a person may still become infected even after immunisation. </p>
<p>If you are very worried your child may have meningococcal disease, whether vaccinated or not, seek medical advice immediately.</p>
<p><em>Editor’s note: since this article was first published, the meningococcal ACWY (Nimenrix®) vaccine has been added to the <a href="https://beta.health.gov.au/health-topics/immunisation/immunisation-throughout-life/national-immunisation-program-schedule">National Immunisation Program Schedule</a> for children at 12 months. The vaccine will also be available for all adolescents aged 14-19 from April 2019.</em></p>
<p><em>*Correction: this article originally said adolescents needed one dose of the MenB vaccine, rather than two, and did not mention boosters.</em></p><img src="https://counter.theconversation.com/content/88769/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Wood receives funding from the NHMRC. The CHildren's Hospital at Westmead has had GSK support for investigator-initiated studies in the past. </span></em></p>Meningococcal is a rare but very serious infection that can lead to blood poisoning and brain infection. But no single vaccine protects against all the strains.Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/773332017-09-26T17:07:13Z2017-09-26T17:07:13ZAt last, young people’s voices are being heard about the future of the NHS<figure><img src="https://images.theconversation.com/files/187357/original/file-20170925-17421-1j1c1um.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Making their mark: the NHS England Youth Forum.</span> <span class="attribution"><span class="source">University of Hertfordshire</span>, <span class="license">Author provided</span></span></figcaption></figure><blockquote>
<p>For me, [being part of the NHS forum] was like being introduced to a whole new world. I wasn’t aware that young people could be offered opportunities like that, to actually talk to key decision makers and get people from really important organisations wanting to come and talk to us … It’s helped me with my communication skills … it’s taught me how to speak properly and confidently.</p>
</blockquote>
<p>This was Georgia talking about her involvement in the NHS England Youth Forum (NHSEYF) in 2016. It aims to improve health services for young people and to give them a voice on health issues that matter most to them.</p>
<p>A team from the University of Hertfordshire carried out <a href="http://researchprofiles.herts.ac.uk/portal/files/10549906/An_examination_of_the_work_of_the_National_Health_Service_NHS_England_Youth_Forum_11.10.16_both_logos.pdf">an examination</a> of the work of this forum. We found that the young people were highly motivated and committed to being involved in decision-making about NHS services. They found contributing to society through this forum a valuable opportunity and welcomed having their voices heard.</p>
<p>What emerged from our interviews was how much commitment there is among young people about the future of the NHS. Here’s Josh: </p>
<blockquote>
<p>It’s a major concern for me about the NHS … and I want to improve it,
I want to give back … After being elected as young mayor in our local
area … we get lots of opportunities about how we can contribute back
to society and one of them was the NHS Youth Forum … I saw it and I
thought what a brilliant opportunity that would be to kind of get my voice
heard, obviously as a service user but also as someone who represents
young people locally. It was a brilliant opportunity.</p>
</blockquote>
<p>Georgia, who we have heard from before, had another more personal reason for being committed to having a say in the running of the NHS:</p>
<blockquote>
<p>The reasons behind why I wanted to join were more personal … I was
quite passionate about mental health because my [relative] suffers from schizophrenia.</p>
</blockquote>
<p>It is important to listen to young people about services that directly affect them. In the UK, the idea of youth forums is now well recognised. There are more than 620 youth councils and forums in existence aiming to give young people the opportunity to be involved in decision-making in their local communities. One example is the <a href="http://www.high-trees.org/our-services/children-young-people-families-services/youth-forum/">High Trees Community Development Trust</a> which focuses on social issues that affect young people and provides training and support so that they can feel confident to participate in the decision-making process.</p>
<h2>What is the NHS England Youth Forum?</h2>
<p>The NHSEYF was established in 2014 to allow young people to participate in decision-making about the NHS. The aim was to <a href="http://www.byc.org.uk/wp-content/uploads/2016/09/NHS-Youth-Forum-Tip-Brochure-FINAL.pdf">give young people the opportunity</a> to have a voice and “to contribute to improving and developing services for young people”. </p>
<p>There are 25 members of the NHSEYF ranging between the ages of 11 and 25. Publicity snowballed with the introduction of <a href="http://www.england.nhs.uk/tag/nhs-youth-forum/">their own website</a>, <a href="http://www.facebook.com/NHSEnglandYF">Facebook page</a> and <a href="https://twitter.com/nhsyouthforum?lang=en">Twitter feed</a>.
Following the establishment of the NHSEYF, a number of other local forums for children and young people have developed within local hospitals and other areas across the UK including <a href="http://www.gosh.nhs.uk/teenagers/teengosh-community/young-peoples-forum">England</a>, <a href="http://www.nhsgrampian.co.uk/nhsgrampian/InvolvingYou.jsp?pContentID=8975&p_applic=CCC&p_service=Content.show&">Scotland</a>, <a href="http://www.caerphilly.gov.uk/News/News-Bulletin/June-2017/Caerphilly%E2%80%99s-Youth-Forum-makes-great-progress-with">Wales</a> and <a href="https://www.niyf.org/ukyp-ukirc/">Northern Ireland</a>.</p>
<h2>Getting involved</h2>
<p>We found that NHSEYF members were involved in an extensive range of activities and commitments at local level – including hospital committee membership, local youth forum events and seminars as well as high-profile national events such as the <a href="http://www.nhssurveys.org/surveys/769">National Children’s Inpatient Survey</a>, national conferences and attendance at the <a href="https://www.england.nhs.uk/participation/get-involved/how/nhs-citizen/">NHS Citizen’s Assembly</a>.</p>
<p>Attending these events raised the profile of children and young people’s needs and allowed the NHSEYF’s members to be active in consultancy-type roles. Our interviews with participants provided clear evidence that the young people were highly motivated and committed to the giving of their own time to ensure the youth voice was heard and represented.</p>
<p>The young people play a pivotal role within NHS England and their knowledge of their home community enabled them to network with professionals and peers within local and national government arenas in order to influence and get involved in decisions about children and young people’s care needs. Evidence from the data collected suggests that the personal growth and development of the young people involved is also likely to have influenced the success of the NHSEYF.</p>
<h2>Measuring impact</h2>
<p>Our evaluation of the NHSEYF clearly demonstrates the impact of the voice of young people. The Youth Forum Wheel (below) was developed to highlight key areas of importance, as a model that can be applied elsewhere. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/182963/original/file-20170822-22283-s7pnzw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/182963/original/file-20170822-22283-s7pnzw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=574&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182963/original/file-20170822-22283-s7pnzw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=574&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182963/original/file-20170822-22283-s7pnzw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=574&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182963/original/file-20170822-22283-s7pnzw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=721&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182963/original/file-20170822-22283-s7pnzw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=721&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182963/original/file-20170822-22283-s7pnzw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=721&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The YFW is offered as a model that has the potential to underpin the development of other youth forums, both within and outside of a health context.</span>
<span class="attribution"><span class="source">University of Hertfordshire</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>It’s important that central and local government measures improvement outcomes for people’s health and/or lifestyles by listening to their views directly rather than focusing on statistics or figures. There is also a recent growing emphasis on services actively involving children, young people and parents and/or carers in the commissioning, development and evaluation of services. </p>
<p>There is a need for ongoing research and funding to ensure that this youth forum model is widely recognised and extended. At the heart of this is recognising the commitment, motivation and enthusiasm shown by these young people in positively influencing service provision for children and young people. As one of our interview subjects concluded:</p>
<blockquote>
<p>I think the most key point is showing adults that young people want to have their voices heard … yes the NHS England Youth Forum has done its job because health professionals were coming to speak to us and saying: ‘Oh, how do we engage with people?’</p>
</blockquote>
<p>It is about time we listened to the young people who will determine the future health of the country and take their views seriously. The NHS England Youth Forum aims to do just that.</p>
<hr>
<p><em>Youth Forum members’ names have been changed in line with the ethics requirements of the project.</em></p><img src="https://counter.theconversation.com/content/77333/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Whiting receives funding from NHS England.</span></em></p><p class="fine-print"><em><span>Gary Meager receives funding from NHS England</span></em></p><p class="fine-print"><em><span>Julia Petty is affiliated with the Neonatal Nurses Association UK</span></em></p><p class="fine-print"><em><span>Sheila Roberts receives funding from NHS England</span></em></p>Youth forums are valuable in giving young people a say about health provision in their communities.Lisa Whiting, Principal Lecturer and Professional Lead, Children's Nursing, University of HertfordshireGary Meager, Lecturer in Children's Nursing, University of Hertfordshire & Children's Community Rapid Response Nurse Practitioner, University of HertfordshireJulia Petty, Senior Lecturer in Children's Nursing, University of HertfordshireSheila Roberts, Senior lecturer, Children's Nursing, University of Hertfordshire, University of HertfordshireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/816022017-07-28T03:06:57Z2017-07-28T03:06:57ZThe D.A.R.E. Sessions wants is better than D.A.R.E.<figure><img src="https://images.theconversation.com/files/180105/original/file-20170727-11584-2hqdvk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Has D.A.R.E. moved beyond the "just say no" days of the '80's and '90's?</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Watchf-Associated-Press-Domestic-News-Californi-/981a4164f44143b1aaf907a3ed7fba02/4/0">AP Photo/Nick Ut</a></span></figcaption></figure><p>Americans of a certain generation will remember this mantra from the 1980s: Just say no.</p>
<p>This simple phrase was the cornerstone of Nancy Reagan’s drug abuse awareness initiative, rolled out in response to perceptions of sharp increases in youth drug use from the <a href="http://monitoringthefuture.org/data/16data/16drfig1.pdf">late 1970s and into the early 1980s</a>. It was also the cornerstone of D.A.R.E., the controversial youth substance abuse prevention program.</p>
<p>Recently, Attorney General Jeff Sessions announced that he would like to <a href="http://www.nydailynews.com/news/national/ag-jeff-sessions-bring-back-anti-drug-program-e-article-1.3318619">reinvigorate D.A.R.E.</a>, a move that was met with considerable skepticism in the media.</p>
<p>As a professor of psychology and director of the <a href="http://youthviolence.rutgers.edu/">Center on Youth Violence and Juvenile Justice</a> at Rutgers University-Newark, I welcome any and all efforts to support positive youth development and prevent youth substance abuse – but only if those efforts are in line with evidence from scientific research. Does that include D.A.R.E.?</p>
<h2>‘Just say no’</h2>
<p>The origins of “Just say no” are by now apocryphal, with potential attributions to a California elementary school student during a <a href="https://reaganlibrary.archives.gov/archives/speeches/1989/010489a.htm">school drop-in from the first lady</a> or a New York City <a href="https://www.nytimes.com/2016/06/23/business/media/robert-cox-man-behind-the-just-say-no-antidrug-campaign-dies-at-78.html">advertising executive</a>.</p>
<p>The command, however, is carved deeply into the foundation of over 30 years of U.S. drug prevention policy.</p>
<p>The idea of just saying “no” to drugs emanates from a simplified view on “<a href="http://criminal-justice.iresearchnet.com/criminology/theories/rational-choice-theory/">rational choice theory</a>,” which contends that people choose their behaviors in order to maximize rewards and minimize costs.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/180095/original/file-20170727-9209-86ljn2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/180095/original/file-20170727-9209-86ljn2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=757&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180095/original/file-20170727-9209-86ljn2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=757&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180095/original/file-20170727-9209-86ljn2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=757&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180095/original/file-20170727-9209-86ljn2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=951&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180095/original/file-20170727-9209-86ljn2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=951&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180095/original/file-20170727-9209-86ljn2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=951&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">D.A.R.E. originally operated on the premise of teaching kids to simply ‘say no’ to drugs. It proved ineffective.</span>
<span class="attribution"><a class="source" href="http://clipart-library.com/clipart/pTqdzM7Bc.htm">Clipart-Library.com</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>It was also the central concept of the D.A.R.E. (Drug Abuse Resistance Education) program, when it was initiated in 1983. The goal was to help youth see that the costs of drug use far outweighed any rewards, and could be avoided by refusing to use drugs. This original model of D.A.R.E. seemed to rely on just a few key points: 1) drugs are bad; 2) if kids knew how bad drugs were, they would never choose to use them; and 3) this would be especially true if police officers were the ones telling kids about drugs.</p>
<p>Very simply, D.A.R.E. was a program that rested on the premise of training kids how to say “no.”</p>
<p>Of course, anyone who has ever been a parent knows that kids already know full well how to say “no.” But D.A.R.E. developers and interventionists knew they were laboring against <a href="https://www.aacap.org/aacap/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Peer_Pressure_104.aspx">peer pressure</a> and a popular culture that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805125/">glorified recreational drug use</a>.</p>
<h2>Where D.A.R.E. failed</h2>
<p>By now, it’s fairly well-known that the first version of D.A.R.E. was a <a href="http://content.time.com/time/nation/article/0,8599,99564,00.html">failure</a>: Studies of the program found that not only did D.A.R.E. <a href="https://doi.org/10.1006/pmed.1996.0061">fail to prevent</a> students from using drugs, in some cases it actually <a href="https://doi.org/10.1177/0022427898035004002">increased the likelihood</a> that students would use drugs.</p>
<p>Part of the difficulty with any substance use prevention program is that experimentation and risk-taking are <a href="https://doi.org/10.1111/j.1467-8721.2007.00475.x">part of youth development</a>, and providing students with more elaborate information about the effects of different substances could pique their interest even more, <a href="https://www.scientificamerican.com/article/why-just-say-no-doesnt-work/">particularly if the information is not presented appropriately</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/180096/original/file-20170727-27682-l8plys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180096/original/file-20170727-27682-l8plys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180096/original/file-20170727-27682-l8plys.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180096/original/file-20170727-27682-l8plys.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180096/original/file-20170727-27682-l8plys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180096/original/file-20170727-27682-l8plys.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180096/original/file-20170727-27682-l8plys.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Substance abuse prevention programs like D.A.R.E. must contend with a popular culture that often glamorizes drugs, alcohol and tobacco.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/markjsebastian/2752162749">Mark Sebastian</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Bringing back D.A.R.E.</h2>
<p>Regardless of how the first D.A.R.E. program fell short, its failure was acknowledged. According to D.A.R.E. publicity materials, the program is still in place in approximately <a href="http://www.dare.org/about-d-a-r-e/">75 percent of American school districts</a>, but D.A.R.E. has fallen from grace and is no longer as central to U.S. anti-drug policy as it once was.</p>
<p>D.A.R.E. developers revised the program in the late 1990s and early 2000s, attempting to bring the program in line with scientific research and theories on youth drug use prevention. Yet these changes appeared unconvincing and failed to bring D.A.R.E. back to its former prominence.</p>
<p>When Jeff Sessions announced that he would like to revitalize D.A.R.E., reporters and pundits alike seemed troubled: Does Sessions want to return to implementing a verifiably ineffective program? In his announcement, Sessions seemed to paint a picture of the early glory days of D.A.R.E., and those in the media who have been <a href="http://www.huffingtonpost.com/entry/jeff-sessions-dare_us_596648c2e4b005b0fdca6695">covering</a> and <a href="https://www.washingtonpost.com/news/wonk/wp/2017/07/12/a-brief-history-of-d-a-r-e-the-anti-drug-program-jeff-sessions-wants-to-revive">writing</a> about the announcement are justifiably concerned.</p>
<p>But given the history of D.A.R.E., it’s hard to imagine that we’ll be seeing “Just say no” redux anytime soon.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/180098/original/file-20170727-8525-559zl7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180098/original/file-20170727-8525-559zl7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180098/original/file-20170727-8525-559zl7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180098/original/file-20170727-8525-559zl7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180098/original/file-20170727-8525-559zl7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180098/original/file-20170727-8525-559zl7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180098/original/file-20170727-8525-559zl7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Jeff Sessions wants to bring D.A.R.E. back to classrooms, but the program will likely be very different from its previous incarnation.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Pence/33f8e4fe7dbe47c09e73838a4227c9a9/9/1">AP Photo/Jacquelyn Martin</a></span>
</figcaption>
</figure>
<h2>New D.A.R.E. isn’t D.A.R.E.</h2>
<p>You might be surprised to learn this, but the contemporary version of D.A.R.E. isn’t really D.A.R.E. at all – it’s a D.A.R.E.-branded adaptation of a highly successful, evidence-based substance use prevention program that rests on a body of scientific research documenting its effectiveness.</p>
<p>The program is called <a href="http://kir.psu.edu/index.shtml">“Keepin’ It REAL”</a> and was developed originally by prevention scientists at Penn State University. On its face, KIR looks like another “just say no” program: It relies on the acronym REAL, applied as “refuse,” “explain,” “avoid” and “leave.”</p>
<p>But while the theme of KIR rests on refusal and avoidance (i.e., just saying no), the curriculum addresses many of the issues that contribute to drug use in the first place, by <a href="http://kir.psu.edu/curriculum/">teaching and working with youth</a> on communication skills, self-regulation, cognitive problem-solving and emotion knowledge.</p>
<p>This approach to substance use prevention is in line with other, similar programs such as <a href="https://lifeskillstraining.com/">Life Skills Training</a> (developed by Cornell University researchers) and <a href="http://tnd.usc.edu/">Toward No Drug Abuse</a> (from scientists at the University of Southern California). These sorts of substance use prevention programs have been proven to reduce the likelihood of <a href="http://www.blueprintsprograms.com/factsheet/project-towards-no-drug-abuse">substance use</a>, but also the likelihood of <a href="http://www.blueprintsprograms.com/factsheet/lifeskills-training-lst">problem behavior and violence</a> – with the added benefit of improving positive behavior and interpersonal skills.</p>
<p>The new D.A.R.E.-branded KIR program hasn’t yet been subjected to formal evaluation: The biggest question is that we don’t yet know whether KIR can be delivered effectively by police officers. But KIR has <a href="http://kir.psu.edu/research/publications.shtml">passed muster</a> through a variety of prior adaptations, and the track record of the Penn State research team for implementing effective programs is promising.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/180115/original/file-20170727-8486-1szfj5e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180115/original/file-20170727-8486-1szfj5e.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180115/original/file-20170727-8486-1szfj5e.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180115/original/file-20170727-8486-1szfj5e.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180115/original/file-20170727-8486-1szfj5e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180115/original/file-20170727-8486-1szfj5e.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180115/original/file-20170727-8486-1szfj5e.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The D.A.R.E. you remember from the ‘80s or '90s is very different from what’s taught in classrooms today.</span>
<span class="attribution"><span class="source">Photo Courtesy of Michael Hecht</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>The future of D.A.R.E.</h2>
<p>When Sessions called for renewed, large-scale implementation of D.A.R.E., many in the media <a href="http://www.dare.org/flawed-faulty-and-wrong-media-reports-on-2017-d-a-r-e-curricula/">seem to have missed</a> that he’s talking about the current configuration of the program – a new methodology that’s a <a href="http://www.dare.org/wp-content/uploads/2017/07/Curriculum-Support-Sheet.pdf">more likely recipe for success</a> than the infamously ineffective original D.A.R.E. What’s more, the D.A.R.E. folks have made it clear over the years that they will not be going back to the approach that was proven at best ineffective and at worst harmful.</p>
<p>In fact, the biggest obstacle to D.A.R.E.’s efficacy may be the D.A.R.E. brand itself, which has clearly been tarnished after decades of research criticizing the program.</p>
<p>If they can overcome that obstacle, the D.A.R.E. delivery system is optimal for large-scale substance abuse prevention. Schools are great venues for the delivery of health promotion programming, and police officers can convey the seriousness of the topic. </p>
<p>Fortunately, there have been <a href="http://monitoringthefuture.org/pubs/monographs/mtf-vol1_2016.pdf">notable declines</a> in underage tobacco and alcohol use in the last several years. However, with <a href="https://theconversation.com/the-opioid-epidemic-in-6-essential-reads-79243">opioid abuse on the rise</a> and students still engaging in relatively high rates of <a href="http://monitoringthefuture.org/pressreleases/16ESPADpr.pdf">other illicit drug use</a>, there is good cause for a new commitment to D.A.R.E.</p><img src="https://counter.theconversation.com/content/81602/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Boxer does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Jeff Sessions was met with considerable skepticism when he announced his desire to revive D.A.R.E. But it turns out that the current program is nothing like the ineffective D.A.R.E. of the ‘80’s and '90’s.Paul Boxer, Professor of Psychology, Rutgers University - NewarkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/783072017-06-13T02:58:12Z2017-06-13T02:58:12ZAre jokesters screwing up our data on gay teenagers?<figure><img src="https://images.theconversation.com/files/172766/original/file-20170607-29582-8vx74s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Should we trust what they say?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-teenagers-class-writing-exam-124813966?src=JCGEV5Q-nOHIOtVgW_GdlQ-1-0">Shutterstock</a></span></figcaption></figure><p>Teens are mischievous, not to be trusted. You’ve probably heard the trope before – maybe you even believe it yourself. But is the stereotype now warping our trust of scientific results? </p>
<p>Surveys can help researchers better understand the lives of teens, but skeptics argue that <a href="https://www.amazon.com/Scapegoat-Generation-Americas-War-Adolescents/dp/1567510809">youth are often dishonest</a> and that the results cannot be trusted. </p>
<p>This idea led into a study published a few years ago, which <a href="http://articles.latimes.com/2014/jan/03/science/la-sci-sn-gay-youth-research-jokesters-20140102">called into question</a> over a decade of research on the health and well-being of lesbian, gay and bisexual (LGB) youth.</p>
<p>In a <a href="https://link.springer.com/article/10.1007/s10508-017-0993-6">new study</a>, we challenged this idea with our own search for jokesters in this data. We discovered that more than 98 percent of youth told the truth on self-report surveys. We also found that LGB youth were not any more likely than heterosexual youth to provide mischievous responses.</p>
<h1>Questioning the data</h1>
<p><a href="http://www.cpc.unc.edu/projects/addhealth">The National Longitudinal Study of Adolescent to Adult Health</a> (Add Health) is one of the largest U.S. studies following youth into adulthood. Add Health was the first national study in the U.S. to include questions identifying same-sex attracted youth and their disproportionate risk for poor mental health. </p>
<p>Because it was the only national study to include these data, it was instrumental for science about youth sexual development, and launched the current body of science that documents mental and behavioral health risk for gay youth. </p>
<p>The data were used in studies that were among the first to show that LGB teens are at greater risk for <a href="https://www.ncbi.nlm.nih.gov/pubmed/26772206">poor mental health, greater substance use, strained parental relationships and a lack of school belonging</a>. These experiences disproportionately undermine positive development for LGB youth.</p>
<p>A <a href="https://link.springer.com/article/10.1007/s10508-013-0219-5">controversial article</a>, published in 2014, argued that these findings may be the result of some number of youth responding mischievously to surveys about themselves.</p>
<p><a href="http://journals.sagepub.com/doi/abs/10.3102/0013189X14534297">Other studies</a> suggest that youth might intentionally misreport outlandish behaviors, like never having sex but being a parent to three children. Teens have claimed to have strange characteristics, like the lowest percentile for weight and the highest for height. Others falsely report their romantic attractions and sexual identities. All this could lead to biased results that overestimates problematic outcomes. </p>
<p>If some jokesters are pretending to be gay, their false reports would overestimate – or even invalidate – findings related to elevated risk for LGB youth. After the study claiming Add Health data may have been contaminated was published, we noticed that peer reviewers started to express skepticism of the data in other research articles on sexual minorities. </p>
<p>What’s more, the Add Health results have been important for establishing the need for policies and programs to support LGB youth. The comment on jokesters discouraged others from using or publishing the data, and thus from producing knowledge to inform programs, policies and practices to promote LGB youth health.</p>
<h1>Our study</h1>
<p>The argument that jokesters marred the Add Health data received quite a bit of scientific and media attention, but there have been no specific studies to test those assertions. </p>
<p>We <a href="http://journals.sagepub.com/doi/abs/10.1177/152822X06289161">used two</a> <a href="http://journals.sagepub.com/doi/abs/10.3102/0013189X14534297">common measures</a> of mischievous reporting.</p>
<p>First, we compared teenagers’ responses to those of their parents, who were also questioned in Add Health. If we identified glaring inconsistencies – like being adopted or having a false limb – then those responses were flagged. </p>
<p>Second, we calculated the statistical likelihood of 10 low-frequency traits, such as having two or more pregnancies or children, or being involved in two or more stabbings or shootings in the past year. If there was an improbable number of these responses, then those youth were more likely to be mischievous. </p>
<p>Consistent with other <a href="http://journals.sagepub.com/doi/abs/10.3102/0013189X11422112">prior studies</a> that investigate mischievous responding, we found that less than two percent of youth in the Add Health data could be classified as “mischievous.” And we found that same-sex attracted youth were no more or less likely than heterosexual youth to be mischievous.</p>
<p>More importantly, we tested whether accounting for mischief altered longstanding conclusions of LGB youth health and well-being. We did this by replicating previously identified health disparities between heterosexual and LGB youth and tested these differences with and without adjustments for youth’s mischief. Our findings indicated that the risks for LGB youth of poor mental health remained. </p>
<p>The implications of our findings for those who study the health and well-being of gay youth are critical. The evidence of important health disparities is real.</p>
<p>In today’s world, we are confronted with accusations of “fake news” and “alternative facts.” The facts about health risks for LGB youth are important – there are <a href="https://www.ncbi.nlm.nih.gov/pubmed/26772206">serious disparities</a> that continue to need attention from researchers, policymakers, educators and families.</p><img src="https://counter.theconversation.com/content/78307/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessica Fish receives funding from the National Institute on Alcohol Abuse and Alcoholism (F32AA023138).</span></em></p><p class="fine-print"><em><span>Stephen Russell receives funding from NICHD, the New Ventures Fund, and the University of Texas at Austin.</span></em></p>Surveys can help researchers better understand the lives of teens, but skeptics argue that youth are often dishonest and that the results cannot be trusted.Jessica Fish, Assistant Professor, University of MarylandStephen Russell, Regents' Professor and Chair, Human Development and Family Sciences, The University of Texas at AustinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/575642016-04-12T05:24:58Z2016-04-12T05:24:58ZSkateboarding is good for you – and good for public places<figure><img src="https://images.theconversation.com/files/118273/original/image-20160412-15858-iee25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Skateboarding is an increasingly popular activity.</span> <span class="attribution"><span class="source">A man skateboards in Moscow. Maxim Shemetov</span></span></figcaption></figure><p>The City of Melbourne is spending <a href="http://www.melbourne.vic.gov.au/about-council/committees-meetings/council-meetings/MeetingAgendaItemAttachments/713/49/nov15-council-agenda-item-6-2.pdf">hundreds of thousands of dollars</a> to resurface Lincoln Square, a popular square in inner-city Carlton, to make it unsuitable for skateboarders. </p>
<p>The square is widely regarded as one of Australia’s best skateboarding spots. According to a <a href="http://www.theage.com.au/victoria/melbourne-council-destroys-australias-best-skate-spot-for-little-bogans-20160226-gn4l9r.html">council spokeswoman</a>, a law making skateboarding illegal in the square was passed in 2009, but it was hard to enforce because of the site’s popularity.</p>
<p>“Complaints are regularly received about noise, skating at unreasonable hours of the night, anti-social behaviour, pedestrian safety, and skating on the Bali bombing memorial,” she told Fairfax Media.</p>
<p>The memorial to the Bali bombings is at the centre of the square. It consists of 91 jets of water in a fountain representing each Australian who lost their life. (All 202 bombing victims are represented by 202 lights in the memorial.)</p>
<p>This memorial clearly deserves respect – as does public property. But might a compromise solution to these competing tensions have been found? Elsewhere, in disputes over shared public space, young people have sometimes come up with innovative solutions, particularly when it concerns places they are passionate about.</p>
<p>From my perspective, as a public health expert who has studied skateboarding, this case is replete with ironies. My interest in this topic grew out of earlier research into urban environments and wellbeing in which adolescents lamented their exclusion from many places in the public realm.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/118264/original/image-20160412-15891-64ta00.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/118264/original/image-20160412-15891-64ta00.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/118264/original/image-20160412-15891-64ta00.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/118264/original/image-20160412-15891-64ta00.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/118264/original/image-20160412-15891-64ta00.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/118264/original/image-20160412-15891-64ta00.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/118264/original/image-20160412-15891-64ta00.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Bali Memorial Fountain at Lincoln Square.</span>
<span class="attribution"><span class="source">Chris Samuel/Flickr</span></span>
</figcaption>
</figure>
<h2>Developing life skills</h2>
<p>Concerns about anti-social behaviour are often cited by those opposing skateboarding in public places, but empirical evidence is sparse. In fact, a greater weight of evidence suggests that it is the lack of things for young people to do that is more likely to fuel undesirable activity. </p>
<p>Of course there are sometimes complaints as seen in the case of Lincoln Square, but in my decade of researching and speaking with local governments about skateboarding, this is typically a vocal minority, and “shutting it down” doesn’t have to be the answer. </p>
<p>Rarely mentioned in these kinds of debates, is the capacity of skateboarding to generate positive social behaviours. </p>
<p>In a community survey (387 people, including non-skaters) we undertook for an inner metropolitan local council in Western Australia, pro-social behaviours (such as socialising with friends, respecting others and cooperation) were far more likely to be reported. </p>
<p>Anti-social behaviours (including drinking, drug use, graffiti, vandalism and collisions) were typically reported as <a href="http://file.scirp.org/pdf/CUS_2014033113554322.pdf">rarely or never occurring</a>. </p>
<p>These are more than just social niceties. Developmentally, important life skills are informally fostered when a bunch of young people learn to take turns, share a confined space, face new challenges publicly, and pick themselves (or others up) after a fall.</p>
<h2>Enlivening the street</h2>
<p>“Activitating” public places has become a buzzword in urban planning policies and local government initiatives. Having people out and about not only adds to a community’s social vibrancy but also contributes to safety by having more “eyes on the street”. </p>
<p>Conversely, deserted streets and public places erode perceptions of safety and are more likely to engender undesirable activity. Skateboarding can thus help “activate” public places – in a low cost and uncontrived way. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/118275/original/image-20160412-15871-uo7tu0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/118275/original/image-20160412-15871-uo7tu0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/118275/original/image-20160412-15871-uo7tu0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/118275/original/image-20160412-15871-uo7tu0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/118275/original/image-20160412-15871-uo7tu0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/118275/original/image-20160412-15871-uo7tu0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/118275/original/image-20160412-15871-uo7tu0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/118275/original/image-20160412-15871-uo7tu0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Fernando de Sousa</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>In sharp contrast to events in Melbourne, the mayor of the West Australian city of Fremantle Brad Pettit has championed the recent building of a skate and youth plaza. He argued it was the lack of people around in public places that could foster anti-social behaviour and make people feel unsafe. </p>
<p>And while it might not to be to everyone’s taste, skateboarding can contribute to a place’s ambience. This is something that some local councils have sought to create – for example with the skateable surfaces at the Geelong waterfront – or preserve, as seen with the Southbank undercroft popularised by skaters in London.</p>
<h2>Moving beyond the stereotypes</h2>
<p>The prevailing stereotype of skateboarding as the pastime of a minority of teenage males is enormously out of step with reality. </p>
<p>The ABS reports that youth participation in activities such as skateboarding and scootering now outnumbers participation in more traditional sport, with up to 21 per cent of Australian young people estimated to <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Products/62EF29AC7C6F95DDCA257AD9000E260D?opendocument">engage in skating</a>.</p>
<p>Similarly, a <a href="https://www.ausport.gov.au/__data/assets/pdf_file/0019/523450/The_Future_of_Australian_Sport_-_Full_Report.pdf">report to the Australian Sports Commission</a> noted the rising popularity of skateboarding and a shift towards less formally organised recreational activity. </p>
<p>Its popularity among younger children and girls is also evident, with a study of Western Australia students in primary years 5–7 finding that <a href="http://www.beactive.wa.gov.au/assets/files/Research/Updated%20CAPANS%202008%20reprot.pdf">33.8 per cent of boys and 18.3 per cent of girls</a> had skated in the previous week.</p>
<p>Growing concerns about the alarming rates of obesity, physical inactivity and screen use among young people, would suggest that skateboarding should be encouraged – not sanctioned. </p>
<p>Indeed, it ticks many boxes as the ideal recreational activity. There is no fee, uniform or coach required, and it can be paced to your own ability or level of coordination. For many young people it also doubles as a cheap and easy mode of transport.</p>
<p>Of course skateboarding is not immune from injury risk. But increasing evidence – and our own research around children’s play – suggests that risk aversion and the phenomenon of “cotton wool kids” have greater adverse impacts on child development and resilience.</p>
<h2>‘Designing out’ young people</h2>
<p>The final irony lies in the mixed messages society signals to young people when it discourages or “designs out” their recreational pastimes, as will occur with the Lincoln Square makeover. </p>
<p>For younger children, playgrounds are visual signals of their inclusion in community, but teens often feel they are viewed warily in the public realm. </p>
<p>Adults might associate young people “hanging out” with loitering or time wasting, but for adolescents particularly, it’s a vital part of their social development.</p>
<p>The council spokeswoman has reportedly said “more appropriate spots would be sought for skateboarders in the city”. But Lincoln Square is a place that young people have already identified as important to them.</p>
<p>Dedicated skate facilities have their role but young people want to feel included across the city. Young skaters are citizens too.</p><img src="https://counter.theconversation.com/content/57564/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Wood does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Skateboarders are being driven from Melbourne’s Lincoln Square after community complaints. But skaters are citizens too, and with obesity on the rise, their activities should be encouraged.Lisa Wood, Associate Professor Centre for Social Impact and School of Population Health, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/569852016-03-30T05:01:27Z2016-03-30T05:01:27ZWhen is a smoker an adult? Why we shouldn’t raise the legal smoking age to 21<figure><img src="https://images.theconversation.com/files/116728/original/image-20160330-28472-1skt5vv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">I support nudging smoking choices by taxation policy, packaging, warnings and information campaigns. But redefining adulthood is a step too far.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-309161084/stock-photo-cigarette-in-the-hands-of-men-close-up.html?src=AjNe5iYlqphlAKybL-NIAw-1-61">Lana Veshta/Shutterstock</a></span></figcaption></figure><p>The <a href="http://www.abc.net.au/news/2015-12-21/state-plan-to-lift-tasmanias-legal-smoking-age-above-18/7044622">Tasmanian government</a> is considering whether to raise the age at which people can legally purchase tobacco products from 18 to 21 or possibly even 25. <a href="http://www.nytimes.com/2016/03/06/opinion/sunday/raise-the-legal-age-for-cigarette-sales-to-21.html?_r=0">California</a> is also moving to increase the legal age to 21. </p>
<p>The rationale being made for the move is that Tasmania has the highest smoking prevalence in the country and that the number of people who ever take up smoking after the age of 25 is as rare as rocking horse poo.</p>
<p>No one is arguing that such a plan would stop those aged 18 to 21 or 25 from buying tobacco entirely. </p>
<p>Juvenile smoking suppression acts have existed in state legislation since the early years of last century. But these long-standing laws that can fine retailers from selling tobacco to those under 18 have not stopped 5.1% of 12- to 17-year-olds from smoking in the most recent <a href="http://www.cancervic.org.au/about/media-releases/2015-media-releases/november-2015/tobacco-use-secondary-school-students.html">national survey</a>. </p>
<p>Young people can ask older people to purchase for them, they can get given occasional cigarettes from smokers or sneak them from family members’ supplies. </p>
<p>And with prosecutions of shopkeepers for selling cigarettes being <a href="http://www.canberratimes.com.au/act-news/retailers-nabbed-selling-cigarettes-to-children-20130219-2eqan.html">very uncommon</a>, many would reason that the risks of being caught selling, let alone of being fined, are minuscule. </p>
<p>So many kids who smoke know that buying cigarettes is still child’s play.</p>
<p>It hardly follows from this though, that such laws should be abandoned and cigarettes should be able to be sold to children of any age. Your ten-year-old included. </p>
<p>In 2011, <a href="http://www.abc.net.au/news/2012-03-30/retailers-caught-selling-cigarettes-to-minors/3922902">40%</a> of Perth shops were found to be selling tobacco to children, but this means 60% didn’t. </p>
<p>While kids’ intelligence networks quickly spread word of which shops will sell cigarettes, if all did, access would be far easier and an important step taken to re-normalise a product that is deservedly subjected to exceptional regulations such as plain packaging, advertising and retail display bans. </p>
<p>Children’s smoking rates today are the lowest on record, an achievement worth keeping and furthering.</p>
<p>But what would be the merits of bumping up the legal purchase age to 21 or 25? </p>
<p>Tasmanian retailers argue that it would be unworkable because young cashiers would be intimidated by 18- to 24-year-old customers. </p>
<p>Hire car company staff are apparently made of sterner stuff. That industry has long run its own version of moving the boundaries of the effective definition of being an adult. Avis, Budget, Hertz, and Thrifty will not rent cars to those under 21, and if you are under 25 you will pay a steep premium.</p>
<p>But the retailers’ main concerns are unabashed anxiety that the move would reduce cigarette sales, which is clearly the intended outcome. A Tasmanian Small Business Council <a href="http://www.abc.net.au/news/2015-12-21/state-plan-to-lift-tasmanias-legal-smoking-age-above-18/7044622">spokesperson</a> said:</p>
<blockquote>
<p>Tobacco products are a legal thing to sell and for lots of small businesses, especially in rural and remote areas, it’s a significant part of their daily income. It’s a major part of their convenience offering… it’s going to have a significant effect on their viability. The last thing we’re going to do is stop our regional areas from having any sort of good-quality businesses just for some idiot sort of policy like this.</p>
</blockquote>
<p>While I have great sympathy with my Tasmanian colleagues’ desires to pull smoking rates to at least national parity, I am personally unsupportive of the proposal. </p>
<p>Supporting efforts to symbolically reduce retail access to tobacco has long been a card played by Big Tobacco. For many years it has enthusiastically supported efforts to put notices in shops advising that kids will not be sold cigarettes and encouraging prosecutions of retailers who sell. </p>
<p>But they know that the signs are useless, that retailers are rarely prosecuted and most of all, how vital to their future it is to capture and hold teenage smokers as customers.</p>
<p>But my concerns go wider. An argument often against raising the legal smoking age to 21 is that legal adult age for many significant rights is 18. At 18 you can vote, sign contracts, get married without parental consent, join the armed forces, be held criminally responsible for your actions, and serve custodial sentences in adult jails. </p>
<p>The argument here is that in all these areas sentience and responsibility are assumed. The freedoms involved carry consequences (both positive and negative) for which those engaging in those freedoms should take personal responsibility. I find that argument pretty hard to disagree with.</p>
<p>I support nudging smoking choices by taxation policy, packaging, warnings and information campaigns, ingredient controls, and not forcing non-smokers to breathe second-hand smoke. But redefining adulthood is a step too far.</p>
<p>The simplest and most obvious way of addressing controls on retailers selling to kids would be to ban any shop or shop owner found selling tobacco to minors from ever having a tobacco retail license. Full stop.</p>
<p>When I recently put my concerns about the redefinition of adulthood to a Facebook page on global tobacco control that I moderate, one reply came back that in the United States the 1984 National Minimum Age Drinking Act puts the legal age to purchase alcohol at 21. This person said:</p>
<blockquote>
<p>and there is virtually no opposition to it. The difference between smoking and the other behaviours you mention is that none of them are addictive, whereas cigarettes are.</p>
</blockquote>
<p>Yes, that is certainly a difference. But the ethical test of a policy or law is not its popularity.</p>
<p>I’m unaware of any social justice arguments that elevate potential for addiction way ahead of all the other risks that go along with the other things that society deems mark the difference between being a non-legally consenting child from a fully legally consenting adult at 18. </p>
<p>For example, are we all comfortable arguing that young adults aged 18,19 or 20 who have committed a crime could be sentenced to jail and subjected to the brutalities of living among hardened criminals, but could not legally purchase a cigarette outside jail?</p>
<p>The US’s attitude to legal drinking age is deeply rooted in its historical puritanism. I remember going to a baseball game in Virginia when I was in my 40s and having to produce ID to show I was over 21 to buy a beer. I can see the tobacco law is consistent with that, but I’m not sure that this is an argument that would wash outside the US with that culturally puritanical heritage.</p>
<p>Another person replied that “Sixteen year olds are allowed to drive here – another activity where sentience is assumed, with the freedoms involved carrying consequences.” Does that argue for raising the driving age or lowering the age of everything else? That stuck me as the nub of the debate.</p>
<p>What do you think?</p><img src="https://counter.theconversation.com/content/56985/count.gif" alt="The Conversation" width="1" height="1" />
The Tasmanian government is considering whether to raise the age at which people can legally purchase tobacco products from 18 to 21 or possibly even 25. California is also moving to increase the legal…Simon Chapman, Emeritus Professor in Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/430662015-11-25T19:08:02Z2015-11-25T19:08:02ZIt may be awkward, but we need to talk to kids about porn<figure><img src="https://images.theconversation.com/files/102440/original/image-20151119-19365-eamvdu.jpg?ixlib=rb-1.1.0&rect=0%2C411%2C5616%2C3329&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's normal for young people to want to learn about sex and relationships.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-68905897/stock-photo-three-young-female-students-surprised-while-looking-at-a-computer.html?src=7q1-So33iEvhteN0WSEhIg-1-9">Creatista/Shutterstock</a></span></figcaption></figure><p>The ease of access to pornography has changed rapidly. The stash of hidden magazines you might remember from your youth is vastly different from the sexually explicit content children can be exposed to today. And <a href="http://onlinelibrary.wiley.com/doi/10.1111/jcc4.12040/abstract">parents often underestimate</a> the extent of their child’s exposure to online porn.</p>
<p>International <a href="http://eprints.mdx.ac.uk/10692/">estimates of the proportion</a> of children and young people who have viewed porn vary, from around 43% to 99% in older age groups. Exposure to online porn often begins around the age of ten or 11, and increases with age. </p>
<p><a href="mailto:www2.lse.ac.uk/media@lse/research/EUKidsOnline/EU%20Kids%20III/Reports/Intheirownwords020213.pdf">Research suggests</a> young porn users are more likely to have unrealistic attitudes about sexual activity and relationships. They tend to be more accepting of stereotyped gender roles. </p>
<p>While young porn users often have a more relaxed and permissive attitude to sex, they may not have a clear understanding about the importance of consent, pleasure, sexual health or safety in their sexual relationships.</p>
<p>The <a href="http://pediatrics.aappublications.org/content/127/3/494.long">benefits</a> of having open, clear, factual discussions with children about online media and digital relationships are clear. Children who receive sex and relationship education from an early age are more likely to: </p>
<ul>
<li>understand and accept physical and emotional changes with confidence</li>
<li>feel positive about their bodies </li>
<li>appreciate and accept individual differences </li>
<li>make informed and responsible sexual decisions later in life </li>
<li>feel good about themselves and their gender </li>
<li>be capable of communicating about sexual matters<br></li>
<li>understand what constitutes appropriate and inappropriate behaviour. </li>
</ul>
<p>They’re also less likely to be exploited or sexually abused.</p>
<p>So we need to talk to our kids about sex, and porn, without sending them cringing back to their bedrooms. </p>
<h2>Overcoming the barriers</h2>
<p>Your own views about porn and respectful relationships are likely to influence how you feel about discussing the issue with your children.</p>
<p>But regardless of whether your view is that consensual adult porn is a normal and enjoyable part of adults’ sex lives, or an exploitative practice, the most important thing you need to do is to keep open the channels of communication with your children. </p>
<p>Discuss your family’s values and beliefs as well as the continuum of beliefs that may be held in the community. In response to a young person’s exposure to material online, for example, a parent could say:</p>
<blockquote>
<p>I can see you were a bit worried about what you saw this morning on the computer. There were some pretty explicit sex acts shown there. </p>
<p>What’s important to remember is that people have different ideas about pleasure and how they express their sexuality, and that may not agree with our values and how you or I view things. </p>
<p>I’d really like to hear what you thought about it and how you felt… </p>
</blockquote>
<p>Children are more likely to keep the communication lines open if you are being honest and truthful.</p>
<h2>Dealing with young children</h2>
<p>Young children under the age of seven or eight are unlikely to understand the meaning of any pornography that they see. </p>
<p>At this age, the best approach is to focus on accurate and open information about bodies being private, and on consent, personal space and safety. You don’t have to go into great detail about pornography; you can tell them that sex is an adult or older person’s activity. </p>
<p>But don’t avoid or ignore their questions if they ask. Keep conversations brief, factual and honest, and use correct terminology for body parts. </p>
<p>Monitor your child’s use of electronic devices and the internet, but also let your child know you are always happy to talk with them. Tell them that if they see something in public – and the internet is public – to let you know.</p>
<h2>Older children and adolescents</h2>
<p>It’s normal for young people to want to learn about sex and relationships, and they will access online media for all forms of learning. Monitoring what older children and adolescents access is important, but open, honest communication is even more critical. </p>
<p>If you’ve laid the groundwork, as your child gets older and becomes more interested in the topic, it will be easier to have conversations about sex, what’s good and not so good about it, and about portrayals of sex, relationships and sexual identity in the media. </p>
<p>There is no one right age for these discussions, but you’ll want to tailor your conversations so they’re age-appropriate. If your four-year-old comes home and tells you that Johnny has two mummies, for instance, you might use it as an opportunity to discuss how families are different. </p>
<p>If you notice your 11-year-old giggling at the cover of a women’s magazine’s “ten tips for better sex”, take the time to engage in a conversation about what they find amusing or uncomfortable. </p>
<p>If your child is either purposefully or accidentally accessing porn, rather than shaming them or getting angry, talk calmly to them about what they saw, how it made them feel, and the implications of what they saw. </p>
<p>Regardless of your own views about porn, it’s important to let children know that what is portrayed is not reflective of most relationships. The actors and the sex acts may not represent reality and may present a simplified and incorrect – and sometimes non-consensual – image of sex and relationships. </p>
<p>Note that any material involving sexual activity with or between people under 18 years of age may constitute child abuse material. To a child or young person, these actors may look like peers. So it’s important to discuss age, power and consent.</p>
<p>When parents are able to <a href="http://www.tandfonline.com/doi/abs/10.1080/14681811.2014.996213">respond to children’s curiosity</a> and talk about porn, they can help young people develop safety skills and recognise the importance of their own sexual health and well-being.</p>
<p>If you think your child may be excessively viewing pornography, viewing violent or degrading material, or not processing the fiction of the content, you may want to seek the advice of a sexual health provider, such as state-based family planning clinics.</p>
<hr>
<p><strong><em>This article was co-authored by Melanie Grabski from <a href="http://www.true.org.au">True: Relationships and Reproductive Health</a>.</em></strong></p><img src="https://counter.theconversation.com/content/43066/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alina Morawska receives funding from the Australian Research Council, and she has received funding from Family Planning Queensland.
The Triple P – Positive Parenting Program is owned by The University of Queensland. The University, through its main technology transfer company, UniQuest Pty Ltd, has licensed Triple P International Pty Ltd to publish and disseminate the program worldwide. Royalties stemming from published Triple P resources are distributed in accordance with the University’s intellectual property policy and flow to the Parenting and Family Support Centre, School of Psychology, Faculty of Health and Behavioural Sciences, and contributory authors. No author has any share or ownership in Triple P International Pty Ltd. Alina Morawska is an author of various Triple P resources. </span></em></p>The stash of hidden magazines you might remember from your youth is vastly different from the sexually explicit content children are exposed to today.Alina Morawska, Deputy Director (Research), Parenting and Family Support Centre, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/447652015-10-04T19:21:52Z2015-10-04T19:21:52ZAlert and ready for action: why it’s time to ban energy drinks for under-18s<figure><img src="https://images.theconversation.com/files/96912/original/image-20151001-5818-xdu2t9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Energy drinks are often promoted alongside extreme sports, video games and youth-centric activities such as lifesaving.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/tambako/2361526167/">Tambako The Jaguar/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Energy drinks are highly sweetened, caffeinated beverages that are packaged in brightly coloured, slimline containers. They’re sold virtually everywhere. </p>
<p>Advertised as “enhancing alertness and performance”, energy drinks are regularly promoted alongside extreme sports, video games and youth-centric activities such as lifesaving. </p>
<p>Youth patterns of energy drink consumption are not well-reported. But the <a href="http://www.sciencedirect.com/science/article/pii/S0091743514000504">few studies conducted with children</a> have shown up to two-thirds (62%) of grade 7 to 12 students drank energy drinks in the past year. </p>
<p><a href="http://www.deakin.edu.au/psychology/energy-drink-conference">A recent Australian study</a> suggests the average youth energy drinker starts at the age of ten. </p>
<p>Energy drinks may pose serious harm for people aged 18 years or younger. <a href="http://www.biomedcentral.com/content/pdf/1475-2891-6-35.pdf">Research with young adults</a> indicates the stimulant effects can cause headaches, sleeping difficulties and heart palpitations. These side-effects are generally attributed to the primary ingredient, caffeine. </p>
<p>The effects of energy drinks typically mimic those reported in cases of caffeine intoxication, such as anxiety, agitation, insomnia, heart palpitations. The cardiovascular <a href="http://www.biomedcentral.com/content/pdf/1475-2891-6-35.pdf">effects</a> of caffeine, such as higher blood pressure, may be contributing to increased disease.</p>
<p>Young people have a lower caffeine tolerance and are therefore more vulnerable to the negative effects of caffeine. Data from the <a href="http://rischiochimico.it/drupal/sites/default/files/energy_drinks_health_risks_and_tossicity_0.pdf">New South Wales Poisons Information Centre</a> and <a href="http://www.tandfonline.com/doi/abs/10.3109/15563650.2013.820310#.VbnzWPmqpBc">the United States National Poison Data System</a> show the majority of energy drink cases involved children and adolescents. Use by young people with pre-existing heart problems is particularly worrisome, given <a href="http://pediatrics.aappublications.org/content/early/2011/02/14/peds.2009-3592.full.pdf">increased risk</a> of high blood pressure, arrhythmia, and sudden death. </p>
<p>Given the heightened risk of harm, <a href="http://www.deakin.edu.au/psychology/energy-drink-conference">governments should ban</a> the sale of energy drinks to anyone under the age of 18 years old. </p>
<h2>What safety measures do we have in Australia?</h2>
<p>The <a href="https://www.comlaw.gov.au/Details/F2013C00107">Australia New Zealand Food Standards Code</a> specifies that energy drinks may contain a maximum of 80 milligrams of caffeine per standard 250 millilitre energy drink. This is equivalent to the amount of caffeine in a cup of instant coffee (77.5mg/250ml). </p>
<p>Standards for the package labelling mean manufacturers must provide a maximum recommended daily intake, and warn against consumption by pregnant women, those who are sensitive to caffeine and children. </p>
<p>In practice, labelling is typically of poor visibility (located near nutrition information in indistinct text colour and size), with no specific age limit for children. </p>
<p><a href="https://www.researchgate.net/profile/Raimondo_Bruno/publication/230869044_Patterns_of_Use_and_Motivations_for_Consuming_Alcohol_Mixed_With_Energy_Drinks/links/02e7e514a7aff064a1000000.pdf">Research suggests</a> energy drink users often exceed recommended maximum daily intakes. This is particularly easy to do when purchasing a four-can packaging, which doubles or quadruples recommended maximum daily intake. </p>
<p>Despite claims from the Australian beverage industry that our regulations are among the tightest in the world, energy drink manufacturers and distributors currently operate with no restrictions applied to access, availability and marketing to children. </p>
<p>The Australian Beverages Council released <a href="http://australianbeverages.org/wp-content/uploads/2013/03/EnergyDrinks_AnIndustryCommitment.pdf">An Industry Commitment</a> that “marketing and advertising are not directed at children”. But research suggests Australian children <em>are</em> influenced and <a href="http://www.sciencedirect.com/science/article/pii/S0195666314002153">describe</a> energy drink marketing as humorous, entertaining and relatable. </p>
<h2>How do our policies compare internationally?</h2>
<p>Lithuania made headlines in November 2014 when it banned the sale of energy drinks (containing more than 150mg of caffeine per litre) to anyone under 18 years old. Despite being the strongest regulatory approach taken so far, Lithuania did not impose restrictions on the amount of caffeine which can be included in beverages sold to over-18s. </p>
<iframe src="https://datawrapper.dwcdn.net/YgTcJ/2/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="471"></iframe>
<p>The <a href="http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2011:304:0018:0063:en:PDF">European Commission Regulation</a> specifies “high caffeine content” labelling in the same field of vision as the beverage name. The label must also state it is not suitable for children. </p>
<p>More comprehensively, <a href="http://www.hc-sc.gc.ca/fn-an/legislation/guide-ld/guidance-caf-drink-boiss-tma-amt-eng.php">Health Canada</a> provides guidelines restricting caffeine content, regulating labelling, and banning marketing to children.</p>
<p>Perhaps unsurprisingly, energy drinks are poorly regulated in the United States, which has one of the largest energy drink markets worldwide. The US does not impose a maximal limit on caffeine content for energy drinks, or have any restrictions on the sale or marketing to children. </p>
<p>In 2014, the US <a href="http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/DietarySupplements/ucm381189.htm">Food and Drug Administration</a> indicated energy drinks should be classified as beverages, which means manufacturers must report the presence of caffeine on packaging. But these guidelines are non-binding. </p>
<p>Similarly to our Australian Beverages Council, the <a href="http://www.ameribev.org/files/resources/2014-energy-drinks-guidance--approved-by-bod-43020.pdf">American Beverage Association</a> issued voluntary industry guidelines specifying that energy drinks should not be marketed to children. However, a 2013 US Senate Hearing exposed aggressive marketing to children by major energy drink manufacturers.</p>
<h2>Australia’s response</h2>
<p>There is a lack of evidence showing energy drinks are safe. So as a precautionary measure, <a href="http://www.deakin.edu.au/psychology/energy-drink-conference">governments should ban</a> their sale to anyone under the age of 18 years.</p>
<p>Logistically, this is achievable from a retail perspective, where supermarkets, service stations, newsagents and milk bars already stock age restricted products such as tobacco, pornography and scratch-to-win lottery tickets. </p>
<p>An extension of this model could reflect changes recently introduced in France, where <a href="http://investors.monsterbevcorp.com/secfiling.cfm?filingID=1104659-15-15731">manufacturers</a> reduced the caffeine content of beverages in order to avoid a tax levy based on caffeine content. </p>
<p>Such a ban could be lifted if, down the track, the evidence shows they are indeed safe. </p>
<p>As with many products that are commercially available and can adversely affect health, the industry associated is extremely powerful. It has sophisticated marketing techniques to groom children and ten-year strategies to engage and coerce governments. Their sole motive is profit. </p>
<p>In the end, it is the government’s responsibility to act to prevent harm to our children in the absence of evidence of safety. We need to move beyond relying on voluntary industry guidelines and further regulate labelling and marketing, avoiding loopholes which allow companies to disguise product information and warnings.</p><img src="https://counter.theconversation.com/content/44765/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Peacock has received grants from the NSW Government and National Drug Law Enforcement Research Fund, as well as an untied educational grant from Mundiapharma for a post-marketing surveillance study. She received placebo samples from Red Bull GmbH for an experimental study in 2011; no financial support was provided and this organisation had no involvement in design, interpretation, or reporting of the work. </span></em></p><p class="fine-print"><em><span>Nic Droste receives a PhD stipend from the Australian Research Council, and has received funding from the National Health and Medical Research Council, Foundation for Alcohol Research and Education, New South Wales Health, and St John of God.</span></em></p><p class="fine-print"><em><span>Peter Miller receives funding from Australian Research Council and Australian National Health and Medical Research Council, grants from NSW Government, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, Cancer Council Victoria, Queensland government and Australian Drug Foundation, travel and related costs from Australasian Drug Strategy Conference. He is affiliated with academic journal Addiction. He has acted as a paid expert witness on behalf of a licensed venue and a security firm.</span></em></p>Given the heightened risk of harm, governments should ban the sale of energy drinks to anyone under the age of 18 years old.Amy Peacock, Postdoctoral Fellow (Psychology), University of TasmaniaNic Droste, PhD Candidate, School of Psychology, Deakin UniversityPeter Miller, Principal Research Fellow, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.