Taking Sides: Clashing Views in Adolescence

UNIT 1: Adolescent Health

Issue:  Do Selective Serotonin Reuptake Inhibitors (SSRIs) Increase Adolescent Suicide Risk?
Yes: David R. Camenisch and Robert J. Hilt, from "SSRIs for Anxiety and Depression in Children and Adolescents," Pediatric Annals (2013)
No: Regina Taurines, et al., from "Pharmacotherapy in Depressed Children and Adolescents," World Journal of Biological Psychiatry (2011)

David R. Camenisch and Robert J. Hilt provide information related to the treatment and side effects associated with SSRIs in the treatment of depression and anxiety. They discuss the importance of monitoring and describe how to manage the reported SSRI risk for suicidality in adolescents. Regina Taurines, Manfred Gerlach, Andreas Warnke, Johannes Thome, and Christoph Wewetzer provide a general framework, therapeutic strategies, and the issues of antidepressant pharmacotherapy for the treatment of depression in childhood and adolescence.

Issue:  Should the Human Papillomavirus (HPV) Vaccine Be Mandatory for Early Adolescents Girls?
Yes: Cynthia Dailard, from "Achieving Universal Vaccination Against Cervical Cancer in the United States: The Need and the Means," Guttmacher Policy Review (2006)
No: Gail Javitt, Deena Berkowitz, and Lawrence O. Gostin, from "Assessing Mandatory HPV Vaccination: Who Should Call the Shots?" Journal of Law, Medicine and Ethics (2008)

Cynthia Dailard, a senior public policy associate at the Guttmacher Institute, argues that making universal vaccination against HPV mandatory for school attendance is a necessary step in preventing cervical cancer and other HPV related problems. Rebuttals to the issues of the high cost as well as the suitability for the vaccination in schools are presented, and she marks universal vaccination as a key step in future vaccination policy reform. Gail Javitt, Deena Berkowitz, and Lawrence O. Gostin argue that while the risks of contracting HPV are high, and its demonstrated link to cervical cancer has proven strong, it is both unwarranted and unwise to force mandatory vaccination on minor females. They discuss the potential adverse health effects, both long- and short-term risks, the lack of support for the HPV vaccine within the justifications for state-mandated vaccination, the consequences of a vaccination targeted solely at females, as well as the economic impact that would result from making the HPV vaccination mandatory.

Issue:  Should Terminally Ill Adolescents Have End-of-Life Decision-Making Rights?
Yes: Jo Cavallo, from "The Importance of Including Adolescents and Young Adults with Cancer in Their Advance Care Planning: A Conversation With Chris Feudtner, MD, PhD, MPH," The ASCO Post (2015)
No: Lainie Friedman Ross, from "Against the Tide: Arguments Against Respecting a Minor's Refusal of Efficacious Life-Saving Treatment," Cambridge Quarterly of Healthcare Ethics (2009)

Jo Cavallo in his conversation with Chris Feudtner discusses the importance of including adolescents and young adults in advance care planning and potential ethical dilemmas posed by these conversations. Dr. Feudtner argues that taking part in this helps them gain some sense of independence and control and provides them with a chance to write their legacy and feel less alone or isolated. Lainie Friedman Ross debates different scenarios that are possible in treating adolescents with life-threatening illnesses and states that courts and state legislatures are mistaken in their polices to respect family refusals of treatments aimed at treating these illnesses. Dr. Ross concludes that mature minor laws that permit refusals of effective life-saving treatments by adolescents alone or in conjunction with their parents are morally unjustified.

Issue:  Should Schools Be Responsible for Completing Body Mass Index (BMI) Report Cards in the Fight Against Youth Obesity?
Yes: Cynthia I. Joiner, from "Writing for the PRO Position—Body Mass Index (BMI) Report Cards: Should Schools be Responsible for Screening?” The American Journal of Maternal Child Nursing (2009)
No: Betsy Di Benedetto Gulledge, from "Writing for the CON Position," The American Journal of Maternal Child Nursing (2009)

Cynthia I. Joiner, MPH, RN and nurse research manager at the University of Alabama, views having body mass index (BMI) report cards in the schools as an extension of what schools are already managing to highlight the important role they play in helping to address childhood obesity. Betsy Di Benedetto Gulledge, an instructor of nursing at Jacksonville State University, highlights what she sees as the disadvantages of having body mass index (BMI) report cards in the schools; she challenges the accuracy of BMI measures and notes the risks of labeling on children’s psychological well-being.

UNIT 2: Sex, Sexuality, and Gender

Issue:  Is There Cause for Concern About an “Oral-Sex Crisis” for Teens?
Yes: Sharlene Azam, from Oral Sex Is the New Good Night Kiss: The Sexual Bullying of Teenage Girls (2008)
No: SIECCAN (The Sex Information and Education Council of Canada), from "Do You Think ‘Oral Sex’ Is ‘Having Sex’? Does The Answer Matter?" The Canadian Journal of Human Sexuality (2011)

Journalist Sharlene Azam, in a book about teen prostitution, discusses the cavalier attitude toward oral sex that some girls report. As well, she discusses a famous Canadian case of oral sex with under-aged girls that had major press coverage. The Research Coordinator of the Sex Information and Education Council of Canada reviews the academic research regarding oral-sex practices and their associated meaning for youth. Their take-home message is that oral sex among teens is not at “epidemic” levels and that many youth feel that oral sex is an intimate sexual behavior.

Issue:  Is “Coming Out” As a Sexual Minority Earlier in Adolescence Detrimental to Psychological Well-Being?
Yes: Justin Jager and Pamela E. Davis-Kean, from "Same-Sex Sexuality and Adolescent Psychological Well-Being: The Influence of Sexual Orientation, Early Reports of Same-Sex Attraction, and Gender," Self & Identity (2011)
No: Margaret Rosario, Eric Schrimshaw, and Joyce R. Hunter, from "Different Patterns of Sexual Identity Development over Time: Implications for the Psychological Adjustment of Lesbian, Gay, and Bisexual Youths," Journal of Sex Research (2010)

Using the ADD Health longitudinal dataset, researchers Justin Jager and Pamela E. Davis-Kean investigated the association of early same-sex attraction on mental health outcomes of depressive affect and self-esteem. Those who had early (12–15 years) same-sex attractions and whose attraction remained stable throughout adolescence had the most negative psychological well-being. However, this group of adolescents gained or “recovered” the most, in terms of psychological well-being, over time. In a longitudinal study, Professor Margaret Rosario and colleagues found that early versus later acknowledgment of one’s minority sexual orientation was not related to psychological distress; thus, sexual-minority identity formation was unrelated to psychological distress. Rather, identity integration––how well one accepts and integrates that sexual-minority status into one’s life––was predictive of psychological well-being. Those who had a well- integrated sexual-minority identity had the most favorable measure of psychological well-being, while those with lower sexual-minority identity integration had the poorest measures of psychological well-being.

Issue:  Does a Strong and Costly Sexual Double Standard Still Exist Among Adolescents?
Yes: Derek A. Kreager and Jeremy Staff, from "The Sexual Double Standard and Adolescent Peer Acceptance," Social Psychology Quarterly (2009)
No: Heidi Lyons, et al., from "Identity, Peer Relationships, and Adolescent Girls' Sexual Behavior: An Exploration of the Contemporary Double Standard," Journal of Sex Research (2011)

Derek A. Kreager and Jeremy Staff, both associate professors of sociology and crime, law, and justice at Pennsylvania State University, used data from the National Longitudinal Study of Adolescent Health to examine the existence of a contemporary double standard among adolescents. They found significant differences in peer acceptance among sexually experienced males and females, with higher numbers of sexual partners associated with significantly greater peer acceptance for boys than for girls. Heidi Lyons, assistant professor of sociology and anthropology at Oakland University, and her colleagues, Peggy C. Giordano, Wendy D. Manning, and Monica A. Longmore, all of Bowling Green State University’s Department of Sociology, examined the sexual double standard in a longitudinal, mixed-method study of adolescent girls’ popularity and lifetime number of sexual partners. The results paint a nuanced picture of the contemporary sexual double standard. Number of sexual partners was not associated with negative peer regard, and whereas young women acknowledged the existence of a sexual double standard, violating it did not seem to be associated with significant social costs. In fact, these authors highlight the buffering role of friendships against possible negative outcomes.

Issue:  Do Reality TV Shows Portray Responsible Messages about Teen Pregnancy?
Yes: Amy Kramer, from "The REAL Real World: How MTV’s ‘16 and Pregnant’ and ‘Teen Mom’ Motivate Young People to Prevent Teen Pregnancy," Original Work (2011)
No: Mary Jo Podgurski, from "Till Human Voices Wake Us: The High Personal Cost of Reality Teen Pregnancy Shows," Original Work (2011)

Amy Kramer argues that reality television shows engage teens in considering the consequences of pregnancy before they are ready for it and motivate them to want to prevent it. She discusses some of the other possible influences on the decline of the teen pregnancy rate (e.g., affordable contraception), but also supports her ideas with research that shows a decline in teen pregnancy rates as a result of these shows (e.g., Kearney & Levine, 2014). Mary Jo Podgurski, founder of the Academy for Adolescent Health, Inc., argues that although such television shows have potential benefits, they inadequately address the issue and may even have a negative impact on those who participate in them.

Issue:  Is the Pressure to Have a Muscular Physique Recognized Equally Between Male and Female Adolescents?
Yes: Marla E. Eisenberg, Melanie Wall, and Dianne Neumark-Sztainer, from "Muscle-enhancing Behaviors Among Adolescent Girls and Boys," Pediatrics (2012)
No: Larry D. Burlew and W. Matthew Shurts, from "Men and Body Image: Current Issues and Counseling Implications," Journal of Counseling & Development (2013)

Marla E. Eisenberg, Melanie Wall, and Dianne Neumark-Sztainer looked at how the emphasis of muscularity has increased in recent decades and found muscle-enhancing behaviors were common for both boys and girls. In addition, the rates of engaging in muscle-enhancing behavior were higher than reported previously. The study also suggested that muscularity is an important component of body satisfaction for both genders. Larry D. Burlew and W. Matthew Shurts examined male adolescents and their body image dissatisfaction. More importantly, they looked at how this dissatisfaction is portrayed, and oftentimes missed by the experts in the field. The study examined reasons this occurs and discusses some interventions strategies.

UNIT 3: Peer and Family Relationships

Issue:  Does Having Same-Sex Parents Negatively Impact Children?
Yes: Michelle Cretella, from "Homosexual Parenting: Is It Time For Change?" American College of Pediatricians (2012)
No: Simon R. Crouch, et al., from "Parent-Reported Measures of Child Health and Wellbeing in Same-Sex Parent Families: A Cross-Sectional Survey," BMC Public Health (2014)

Michelle Cretella, a physician writing a position statement for The American College of Pediatricians, argues that having biological, heterosexual parents is the best situation for the development of children. She criticizes the same-sex parenting outcome literature as being fraught with design flaws and she argues that homosexual lifestyles pose dangers to children. Dr. Crouch and colleagues examined the physical, mental, and social well-being of children with same-sex attracted parents. They conducted a cross-sectional survey that included 315 parents and 500 children, which included both female and male index parents. The researchers found children with same-sex attracted parents are faring well on most measures of child health and well-being, and demonstrate higher levels of family cohesion than population samples. However, the researchers found a negative impact on the child’s development due to the “stigma” associated with being raised by a same-sex attracted parent. So any negative impact is not a result of the sexual orientation of the parent, but due to the social stigma associated with the parent’s sexual orientation.

Issue:  Does Dating in Early Adolescence Impede Developmental Adjustment?
Yes: Diann M. Ackard, Marla E. Eisenberg, and Dianne Neumark-Sztainer, from "Associations Between Dating Violence and High-Risk Sexual Behaviors Among Male and Female Older Adolescents," Journal of Child & Adolescent Trauma (2012)
No: K. Paige Harden and Jane Mendle, from "Adolescent Sexual Activity and the Development of Delinquent Behavior: The Role of Relationship Context," Journal of Youth and Adolescence (2011)

Diann M. Ackard, Marla E. Eisenberg, and Dianne Neumark-Sztainer examine dating relationships among adolescent males and females and the possible correlations between dating violence and high-risk sexual behaviors. The researchers note a strong positive correlation between dating violence and high-risk sexual behaviors. They discuss the potential impact on development and health of the adolescent and the need to provide resources and opportunities to talk to adolescents who are dating. K. Paige Harden and Jane Mendle, assistant professors of psychology at the University of Texas and the University of Oregon, respectively, examined the associations between adolescent dating, sexual activity, and delinquency, after controlling for genetic influences. They found evidence for genetic influences on sexual behavior and for a link between these genetic predispositions and an increased likelihood to engage in delinquent behavior. They argue that early dating and/or early sexual activity do not cause delinquent behavior; in fact, this study suggests that sex in romantic relationships is related to lower levels of delinquency in both adolescence and later life.

Issue:  Should Parents Supervise Alcohol Use by or Provide Alcohol to Adolescents?
Yes: Mark A. Bellis, et al., from "Teenage Drinking Alcohol Availability and Pricing: A Cross-Sectional Study of Risk and Protective Factors for Alcohol-Related Harms in School Children," BMC Public Health (2009)
No: Barbara J. McMorris, et al., from "Influence of Family Factors and Supervised Alcohol Use on Adolescent Alcohol Use and Harms: Similarities between Youth in Different Alcohol Policy Contexts," Journal of Studies on Alcohol and Drugs (2011)

Mark A. Bellis, a professor at Liverpool John Moores University in the UK, and colleagues suggest that potential harms to youth can be reduced by having them drink in the safety of their own home where they can be supervised by their parents. Barbara J. McMorris, a senior research associate in the Healthy Youth Development Prevention Research Center within the medical school at the University of Minnesota, and colleagues argue that early alcohol use coupled with adult supervision of alcohol consumption leads to increased alcohol-related problems.

Issue:  Should Parental Consent Be Required for Adolescents Seeking Abortion?
Yes: Teresa Stanton Collett, from Testimony Before the United States House of Representatives Committee on the Judiciary, Subcommittee on the Constitution. H.R. 2299 the "Child Interstate Abortion Notification Act," (2012)
No: Advocates for Youth, from "Abortion and Parental Involvement Laws: A Threat to Young Women’s Health and Safety," Policy Brief: Abortion and Parental Involvement Laws

Teresa Stanton Collett, law professor at the University of St. Thomas School of Law in Minnesota, testified about the “Child Interstate Abortion Notification Act” before a U.S. House of Representatives subcommittee that minors would benefit greatly from parental involvement in youth abortion decisions. She argues a federal law is needed to protect girls from exploitation and improve medical care. Advocates for Youth reviews the differences between parental consent and parental notification and provides data in relation to what different states require in relation to these concepts. The authors put forth the position that parental involvement laws do more harm than good in relation to the well-being of adolescent females.

UNIT 4: Technology, Mass Media, and Criminal Justice

Issue:  Does Playing Violent Video Games Harm Adolescents?
Yes: Benedict Carey, from "Shooting in the Dark," The New York Times (2013)
No: Christopher J. Ferguson and Cheryl K. Olson, from "Video Game Violence Use Among ‘‘Vulnerable’’ Populations: The Impact of Violent Games on Delinquency and Bullying Among Children with Clinically Elevated Depression or Attention Deficit Symptoms," Journal of Youth and Adolescence (2014)

Benedict Carey provides an article examining the relationship between violent video games and violent behavior. In reviewing the relevant research, he states that there is evidence of short-term increases in hostile urges and mildly aggressive behavior. However, upon reviewing the long-term effects, the results are more mixed, and he notes that it is hard to control for all possible variables within the studies that examine this relationship. Some research looks at the socialization effect video games have on adolescents over the long-term, leading to imitation of behaviors seen within the video games and questions the kinds of values and social skills the child is learning. Christopher J. Ferguson and Cheryl K. Olson examine the impact of violent video games on children with clinically elevated depression or attention deficit symptoms. They state that there is a need to examine the impact of video games on vulnerable populations. The researchers found no evidence for increased bullying or delinquent behaviors among youth with clinically elevated mental health symptoms who also played violent video games.

Issue:  Should Juvenile Offenders Be Tried and Convicted as Adults?
Yes: Charles D. Stimson and Andrew M. Grossman, from "Adult Time for Adult Crime. Life Without Parole for Juvenile Killers and Violent Teens," The Heritage Foundation (2009)
No: Laurence Steinberg, from "Adolescent Development and Juvenile Justice," Annual Review of Clinical Psychology (2009)

Charles D. Stimson, senior legal fellow and Andrew M. Grossman, past senior legal policy analyst, Center for Legal and Justice Studies, The Heritage Foundation, argue that for serious offenses, trying juveniles in adult court and imposing adult sentences—such as life without parole—is effective and appropriate because youth who commit adult crimes should be treated as adults. Laurence Steinberg, Distinguished University Professor, Department of Psychology at Temple University, argues that adolescents often lack the cognitive, social, and emotional maturity to make mature judgments and therefore should not be sanctioned in the same way as adults. He supports a separate juvenile justice system where adolescents should be judged, tried, and sanctioned in ways that do not adversely affect development.

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