From Substances to Sex ůSurgeon General Richard Carmona on Keeping Teens Healthy and Safe

By Bill Lindsay

When it comes to teen health, most parents remain concerned about protecting their children from injury – whether it’s on the playing field, on a bike or in a car. But the topics of most concern to parents of adolescents and emerging adults are inevitably sex and substances – from tobacco to alcohol and illegal drugs.

As with many other areas of public health, when it comes to teens’ health issues, Surgeon General Richard Carmona says “we need to do a better job of raising awareness and health literacy.”

And while the Surgeon General cites improvements in reducing teens’ use of tobacco, alcohol and illegal drugs, he admits that there’s still work to be done in these areas, particularly with smoking.

“We still have about 4,000 kids a day who start smoking. And, of those, about half of them will become chronic smokers,” he says. “Smoking is the single largest preventable cause of death in this country. It’s a huge, huge problem.”

To combat this, Carmona points to a number of initiatives – from toll-free “quit lines” to U.S. Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) Web sites with links to resources and advice on quitting. But when it comes to kids, he says, “We have to figure out how to stop them from starting. After you’re already smoking, then it’s, ‘How do we get you off of this as quickly as possible?’ Because once you’re hooked, it’s real difficult to break the cycle.”

Sexual Health and Education

As worrisome as tobacco, drink or drugs is to parents, teen sexuality and sexual health is one of the more challenging public health issues today, according to the Surgeon General. The problem, he says, is that the health and science aspects get intertwined with ideology, morality and ethics: “And every family, every culture, every religion sees these things differently.”

While some parents believe schools should do more to teach kids about health and sexuality, others adamantly believe that it’s exclusively the parents’ role to do that.

“We hear these battles every day throughout the country as to what should or shouldn’t be in the school curriculum,” the Surgeon General reports. “Sex ed is one of the more hot-button issues of what you can and can’t teach somebody else’s children.”

In an ideal world, Carmona says, “it would be great to have generic sex education as part of home economics, so to speak: ‘Here’s how the system works. Ovaries, blah, blah, blah …’ We don’t do that anymore because it’s kind of taboo. Anytime a school goes in that direction, there’s always somebody who’s willing to litigate and say, ‘Not with my child!’”

What public health officials have tried to do, Carmona says, is make thorough and accurate information available to whomever takes on the role of teaching kids about sexuality and sexual health – whether it’s parents, schools or both.

Again, he cites CDC and the NIH Web sites (see Resources below) as good sources of information that is “not tainted with any ideology. It’s just, ‘Here’s the science. Here’s how kids get pregnant. Here are the consequences. Here’s what constitutes a broad, good, general sex education program.’”

“There are other places that will present you science with ideology,” he cautions. “It’s ‘You can or can’t do this’ because of a religious, ethical or moral preference. We say, ‘Here’s the science. Now you take it into your community and you decide how to best use it for your children.’ It’s ultimately the community standard that’s going to drive this.”

In concordance with the Bush administration’s policy – and undoubtedly the preference of most parents – Carmona says that abstinence is clearly the first choice when it comes to teens and sex. And parents need to be clear with their teens about that, he adds. But the Surgeon General also recognizes that, despite parental warnings, many teens do engage in sexual activity and he believes they should have the information they need to avoid pregnancy and stay healthy.

“Abstinence is really the best-case scenario, but that’s not reality,” he says. “So you also need to make sure kids understand the full array of information and the consequences.”

While the rate of teen pregnancies has leveled off in recent years, the CDC’s estimates that 50 percent of sexually active teens and young adults, ages 15 to 24, have had, or will get, a sexually transmitted disease by age 25 speaks to teens’ need to know the facts about how to protect themselves.

“A sexually transmitted disease in a 15-year-old girl could make her infertile for the rest of her life,” Carmona notes. “There are huge consequences.”

“But, again,” he adds, “that’s when you get into the community standard. Some parents say, ‘Don’t you talk to my kids about contraception, condoms!’ And others say, ‘You’d better talk to them because they need to be protected.’ So what does government do? It’s tough.”

The bottom line, the Surgeon General says, if a community’s schools are not addressing these issues with kids – and that’s up to the local school board – then parents must.

“Shame on you if you abdicate that responsibility,” he says.

As it is, kids get so much misinformation about sex and sexual health, he points out. “What they learn, they learn on the streets from their friends through myths and innuendos.”

An alarming example of this was the recent California study, reported in the April edition of the journal Pediatrics, on young teens’ involvement in oral sex and their perception that oral sex “isn’t really sex” and that it’s “safer than intercourse.” One in five of the young teens surveyed reported having had oral sex and nearly one-third said they intended to have oral sex in the next six months.

“Just as children learn about nutrition and physical activity to make themselves safe and healthy,” Carmona says, “they need to learn about sexual activity – and what are the consequences of that activity.”


U.S. Centers for Disease Control and – Search for information on sex education, STDs, teen pregnancy, teen smoking and substance abuse and more. Check out the Body and Mind Health Topics for Kids section for kid-oriented info on smoking and tobacco, safety and injury prevention, and more.

National Institute of Child Health & – Offers information on adolescent health, teen pregnancy, contraception, sexually transmitted diseases, smoking and substance abuse. Search the drop-down “Subject” menu under the “All” publications category to find information on these topics and more.

More of the Surgeon General’s Views on Children’s Health

Building Healthy Bodies, Minds & Spirits – The Surgeon General’s Vision of What We Must Do to Improve the Well-Being of America’s Children