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This article about the risks of tobacco from Medline Plus details how tobacco use can lead to serious health issues. Tobacco is very addicting because of a chemical called nicotine. The smoke from tobacco carries thousands of harmful chemicals that can cause cancer. Tobacco use can lead to blood clots in the body, high blood pressure, and coronary artery disease. Cancer can also be caused from tobacco usage, with lung cancer, mouth cancer, or larynx cancer all being common ones. Second hand smoking is when you are not smoking, but are around others who do. This can also pose health risks such as cancers, asthma flare-ups, heart attacks, and lung damage. It is important for PK-4th students to learn about the negative effects of tobacco use because it can have severe impacts on health. Students can create posters about choosing not to smoke and to say no as a way to enforce making healthier choices.

U.S. National Library of Medicine. (n.d.). Risks of tobacco. MedlinePlus. Retrieved from https://medlineplus.gov/ency/article/002032.htm

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Tobacco is a plant. Its leaves are smoked, chewed, or sniffed for a variety of effects.

Tobacco contains the chemical nicotine, which is an addictive substance.

Tobacco smoke contains more than 7,000 chemicals, at least 70 of which are known to cause cancer.

Tobacco that is not burned is called smokeless tobacco. Including nicotine, there are at least 30 chemicals in smokeless tobacco that are known to cause cancer.

HEALTH RISKS OF SMOKING OR USING SMOKELESS TOBACCO

There are many health risks from smoking and using tobacco. The more serious ones are listed below.

Heart and blood vessel problems:

Other health risks or problems:

Cancer (more likely in the lung, mouth, larynx, nose and sinuses, throat, esophagus, stomach, bladder, kidney, pancreas, cervix, colon, and rectum)

Poor wound healing after surgery

Lung problems, such as COPD, or asthma that is harder to control

Problems during pregnancy, such as babies born at a low birth weight, early labor, losing your baby, and cleft lip

Decreased ability to taste and smell

Harm to sperm, which may lead to infertility

Loss of sight due to an increased risk of macular degeneration

Tooth and gum diseases

Wrinkling of the skin

Smokers who switch to smokeless tobacco instead of quitting tobacco still have health risks:

Increased risk of cancer of the mouth, tongue, esophagus, and pancreas

Gum problems, tooth wear, and cavities

Worsening high blood pressure and angina

HEALTH RISKS OF SECONDHAND SMOKE

Those who are often around the smoke of others (secondhand smoke) have a higher risk of:

Heart attack and heart disease

Lung cancer

Sudden and severe reactions, including of the eye, nose, throat, and lower respiratory tract

Infants and children who are often exposed to secondhand smoke are at risk of:

Asthma flares (children with asthma who live with a smoker are much more likely to visit the emergency room)

Infections of the mouth, throat, sinuses, ears, and lungs

Lung damage (poor lung function)

Sudden infant death syndrome (SIDS)

Like any addiction, quitting tobacco is difficult, especially if you are doing it alone.

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Risks of tobacco: MedlinePlus Medical Encyclopedia

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Tobacco is a plant. Its leaves are smoked, chewed, or sniffed for a variety of effects. Tobacco contains the chemical nicotine, which is an addictive substance. Tobacco smoke contains more than 7,000 chemicals, at least 70 of which are known to cause cancer. Tobacco that is not burned is called smokeless tobacco.

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This article on trauma that can be experienced and how to give support by CBS News Miami details a recent shooting in a Nashville school. This is a traumatic event for many and oftentimes takes a lot of time to process information. It is important to have these discussions about traumatic events with younger students. Younger than age eight, it is recommended to not bring up this type of event, unless they have already heard about it and you can correct or clear up any information. Additionally, with younger people it is important to not get too detailed. Slightly older students may know more details and it is important to be honest and to have a script prepared. Gun violence is traumatic and to help process what happened parents can have a discussion or have their children write their feelings or draw an image. As a PK-4th grade teacher, this article is important to teaching health because teachers can learn ways to help students cope with traumatic events, and how to offer support during these times. Teachers can also learn different techniques or approaches to helping students.

Quynh, J. (2023, March 30). Parents can help children cope with the news of another school shooting. CBS News. Retrieved from https://www.cbsnews.com/miami/news/parents-children-cope-another-school-shooting/?intcid=CNM-00-10abd1h

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Parents can help children cope with the news of another school shooting

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Dealing with yet another school shooting never gets any easier, especially considering the age of some of the victims

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This article on efforts to curtail drug use from National Institute on Drug Abuse details how telehealth for opioid-use disorders, especially during the pandemic, was related to a lower number of overdoses in the Medicare beneficiaries. In a study, two groups of Medicare beneficiaries were studied about the impact of telehealth and medications with opioid usage; one group before the pandemic and during the pandemic. The study concluded that there was a 33% decrease in a drug overdose with the group of beneficiaries using telehealth and opioid-related care. People who were given medication for opioid use disorder also reduced their drug overdose risk. There is a call to action for there to be more equitable telehealth options for those with opioid usage. In the PK-4th grade classroom, teachers can help students understand the importance of this topic by discussing the effect opioids can have on the body. Teachers can calmly talk to students about the importance of keeping their bodies healthy and read a book about making healthy choices.

Increased Telehealth Services, OUD Medications During COVID-19 Associated with Reduced Fatal Overdose Risk. (2023, March 29). Retrieved from

https://nida.nih.gov/news-events/news-releases/2023/03/increased-telehealth-services-oud-medications-during-covid-19-associated-with-reduced-fatal-overdose-risk

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The expanded availability of opioid use disorder-related telehealth services and medications during the COVID-19 pandemic was associated with a lowered likelihood of fatal drug overdose among Medicare beneficiaries, according to a new study.

"The results of this study add to the growing research documenting the benefits of expanding the use of telehealth services for people with opioid use disorder, as well as the need to improve retention and access to medication treatment for opioid use disorder," said lead author Christopher M. Jones, PharmD, DrPH, Director of the National Center for Injury Prevention and Control, CDC. "The findings from this collaborative study also highlight the importance of working across agencies to identify successful strategies to address and get ahead of the constantly evolving overdose crisis."

Published today in JAMA Psychiatry, this study is a collaborative research effort led by researchers at the National Center for Injury Prevention and Control, a part of the Centers for Disease Control and Prevention (CDC); the Office of the Administrator and the Center for Clinical Standards and Quality, both part of the Centers for Medicare & Medicaid Services (CMS); and the National Institute on Drug Abuse, a part of the National Institutes of Health (NIH).

"CMS is committed to ensuring that the beneficiaries we serve can access the high-quality behavioral health services they need," said senior author Dr. Shari Ling, M.D., Deputy Chief Medical Officer at CMS. "This study shows that many beneficiaries were able to utilize opioid use disorder-related telehealth services during the pandemic, but we need to continue our efforts to broaden the use of telehealth, particularly in underserved communities."

In this national study, researchers analyzed data among two cohorts of Medicare beneficiaries to explore receipt of opioid use disorder-related telehealth services, receipt of medications for opioid use disorder, and fatal overdoses before and during the COVID-19 pandemic. To do this, they compared data from two cohorts of Medicare beneficiaries across two time periods. The first cohort was constructed with data from September 2018-February 2020 and included 105,162 Medicare beneficiaries with opioid use disorder (the "pre-pandemic cohort"). The second cohort was constructed with data from September 2019-February 2021 and included 70,479 Medicare beneficiaries with opioid use disorder, (the "pandemic" cohort). In addition, the researchers conducted an analysis to examine the demographic and clinical characteristics associated with fatal overdose in the pandemic cohort.

Key findings of this study include:

Medicare beneficiaries that began a new episode of opioid use disorder-related care during the pandemic and received opioid use disorder-related telehealth services were found to have a 33% lower risk of a fatal drug overdose.

Medicare beneficiaries who received medications for opioid use disorder from opioid treatment programs (OTP) and those who received buprenorphine, one of the medications for opioid use disorder, in office-based settings also had reduced odds of a fatal drug overdose of 59% and 38%, respectively.

Mortality rates (classified as all-cause mortality and drug overdose mortality specifically) were higher in the pandemic cohort compared to the pre-pandemic cohort; however, the percentage of deaths due to drug overdose were similar between the two cohorts.

"At a time when more than 100,000 Americans are now dying annually from a drug overdose, the need to expand equitable access to lifesaving treatment, including medications for opioid use disorder, has never been greater," said Wilson Compton, M.D., M.P.E, deputy director of the National Institute on Drug Abuse and senior author of the study. "Research continues to indicate that expanded access to telehealth is a safe, effective, and possibly even lifesaving tool for caring for people with opioid use disorder, which may have a longer-term positive impact if continued."

Although the results of this study were able to identify the positive impact opioid use disorder-related telehealth services had on lowering the risk for fatal drug overdose in the pandemic cohort, the authors note that only 1 in 5 Medicare beneficiaries in the pandemic cohort received OUD-related telehealth services. Similarly, only 1 in 8 beneficiaries in the pandemic cohort received medications for opioid use disorder. These findings underscore the need for continued expansion of these potentially life-saving interventions across clinical settings.

Find Treatment for Substance Use Disorder, including Opioid Use Disorder:

If you or someone close to you needs help for a substance use disorder, talk to your doctor or call SAMHSA's National Helpline at  1-800-662-HELP or go to SAMHSA's Behavioral Health Treatment Services.

Additional Resources:

If you have questions about any medicines, call the U.S. Department of Health and Human Services Poison Help Hotline at 1-800-222-1222.

###

About CDC: CDC works 24/7 protecting America's health, safety and security. Whether disease start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America's most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.

About the Centers for Medicare & Medicaid Services (CMS):  CMS provides health coverage to nearly 150 million people through Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace. A component of the U.S. Department of Health and Human Services, CMS serves the public as a trusted partner and steward, dedicated to advancing health equity, expanding coverage, and improving health outcomes.

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world's research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit  www.nida.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit  www.nih.gov.
NIH...Turning Discovery Into Health®

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Increased Telehealth Services, OUD Medications During COVID-19 Associated with Reduced Fatal Overdose Risk | National Institute on Drug Abuse

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The expanded availability of opioid use disorder-related telehealth services and medications during the COVID-19 pandemic was associated with a lowered likelihood of fatal drug overdose among Medicare beneficiaries, according to a new study.

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School Safety (Intentional Injury and Violence)

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School Safety (Intentional Injury and Violence)

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This article on school safety from CBS News details parents' concerns about the safety of Denver Public Schools. Two recent shootings occurred at East High School and parents are demanding action be done to make the schools safe. They demanded the Board of Education have more transparency and no more closed door meetings. Parents have considered taking their children out of the school if there is no action being done. The district has placed school resource officers in the high schools, but parents do not think this is a long-term solution to the problem. The Superintendent was given the task of creating a long-term plan for security. It is essential for teachers to know about this topic because it is important for them to know the safety precautions put in place at their school, and what to do in case of an emergency. This is important for PK-4th grade students as well, so that they feel safe in school and know what to do in the case of an emergency.

Young, O. (2023, April 10). East High School parents advocate for transparency from DPS on school safety. CBS News. Retrieved from https://www.cbsnews.com/colorado/news/east-high-parents-transparency-denver-public-school-board-safety/?intcid=CNM-00-10abd1h

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East High School parents advocate for transparency from DPS on school safety

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A newly-formed group of DPS parents is frustrated by what they call a lack of transparency and action from the Board of Education on school safety.

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This article on allergies from CNN details how having pets in the house may help children develop less food allergies as they get older. A study in Japan found that 13-16% of children exposed to pets at home had less food allergies than those with no animals at home. Pet exposure may strengthen the gut microbiome, the bacteria in our gut, which is what effects if we develop allergies or not. Additionally, the dirt and materials produced by pets could strengthen the immune system. This can help sensitize allergies later in life. It is essential for PK-4th grade teachers to know about this topic because allergies are a very common part of society. Some students cannot sit at certain tables or be around certain foods. This may be taught in the elementary school classroom by having students become aware of foods they can and cannot eat through a food project or by finding alternative choices.

Chavez, J. (2023, March 29). Pet cats and dogs may help protect infants from food allergies, study suggests. CNN. Retrieved from https://www.cnn.com/2023/03/29/health/pets-food-allergy-risk-wellness/index.html

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Children who live with cats or dogs during fetal development and early infancy may be less likely than other kids to develop food allergies, according to a new study.

The study, published Wednesday in the journal PLOS One, analyzed data from over 65,000 children from Japan. It found that children exposed to cats or indoor dogs had a 13% to 16% lower risk of all food allergies compared with babies in pet-free homes.

"Our findings suggest that exposure to dogs and cats might be beneficial against the development of certain food allergies, thereby alleviating concerns about pet keeping and reducing the burden of food allergies," the authors wrote.

The study found that children exposed to cats were less likely to develop egg, wheat and soybean allergies, while those exposed to dogs were less likely to have egg, milk and nut allergies.

Although there was no association between turtles and birds and food allergies, hamster exposure during fetal development was linked with nearly twice the risk of nut allergies. The authors speculate that nuts that hamsters consume may sensitize infants through physical contact or house dust.

The exact mechanism remains unclear, but experts say pet exposure may strengthen an infant's gut microbiome, either directly or indirectly though changes in the parent's or home microbiome.

"We know from a lot of studies that the microbiome - which are the bacteria that live within us, thousands and millions of them inside everybody's gut - affect our immune responses and our immune system, particularly whether we develop allergies or not," said Dr. Amal Assa'ad, director of the Food Allergy Program at Cincinnati Children's Hospital, who was not involved with the new research.

Dr. Jonathan Bernstein, president of the American Academy of Allergy, Asthma, and Immunology, says dirt and other materials secreted by pets could be a good thing.

"It is critical to have these exposures early on as the immune system is developing, as the gut is developing, because it does seem to be an important route for sensitization," said Bernstein, who was not involved with the study.

Previous research has had mixed results. Some have linked pet exposure to decreased risk of food allergy, but others have found no association.

"The data is all over the place," Assa'ad said.

Although the researchers on the new study accounted for several factors that could influence the participant's risk of food allergy - including mother's age, history of allergic disease, smoking status and place of residence - they say it's possible that other factors influenced the results.

Additionally, food allergy data was self-reported, which relies on accurate diagnosis from participants, the researchers say.

"There's a need to really confirm these types of studies," Bernstein said. "So I wouldn't necessarily change lifestyles based on this data, but I wouldn't certainly get rid of pets in the home."

Experts hope these results can help guide research into the drivers behind childhood food allergies and reassure pet owners.

"If you're thinking about having an animal and you're concerned because you have allergies ... there may be an added benefit to having an animal, not just in terms of what it does for families and people's general love of pets, but also, it could be potentially protective if there's an early life exposure," Bernstein said.

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Pet cats and dogs may help protect infants from food allergies, study suggests | CNN

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Children who live with cats or dogs during fetal development and early infancy may be less likely than other kids to develop food allergies, according to a new study. The study, published Wednesday in the journal PLOS One, analyzed data from over 65,000 children from Japan.

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Sun Safety (Safety and Preventing Unintentional Injury) 

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Sun Safety (Safety and Preventing Unintentional Injury) 

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This article on sun safety from CBS News details actor Hugh Jackman having basal cell carcinoma treated. He urged his fans about the importance of wearing sunscreen. Basal cell carcinoma is a common skin cancer that can occur when your skin is not protected from harmful UV rays. There are many ways to protect yourself from UV rays. Wearing sunscreen with an SPF of 30 or more on sunny and cloudy days, reapplying sunscreen regularly, and applying it on all parts of the body exposed to sunlight are important ways to protect against sun. Limiting exposure to harmful UV rays from 10 a.m. to 2 p.m. when the sun is the strongest can also help with sun safety. It is essential for teachers to know about this topic to encourage their students to make their health a priority. Teachers can inform students about the importance of sun safety and how over the years this damage can affect their skin. Teachers can have students practice sun safety by applying sunscreen before they go outside for extended periods of time.

Moniuszko, S. (2023, April 4) Hugh Jackman urges sunscreen use amid his latest skin cancer scare. What to know about SPF. CBS News. Retrieved from https://www.cbsnews.com/colorado/news/hugh-jackman-skin-cancer-sunscreen-spf/?intcid=CNM-00-10abd1h

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/ CBS News

Hugh Jackman is urging his followers to wear sunscreen amid his latest skin cancer scare. In a video posted to his social media Monday, the actor, wearing a bandage on his nose, shared he had two biopsies done.

"I just went to my doctor... and she just saw little things - could be or could not be basal cell, in her opinion. She doesn't know," the 54-year-old shared. "Summer is coming for those of us here in the Northern Hemisphere. Please wear sunscreen. It's just not worth it no matter how much you want to tan. Trust me, trust me, trust me."

According to the American Cancer Society, basal cell carcinoma is the most common type of skin cancer. About 8 out of 10 skin cancers are basal cell carcinomas. It's the same type President Biden was recently treated for.

Skin cancer is also the most common form of cancer in the United States, according to the Skin Cancer Foundation.

You've heard me talk about my basal cell carcinomas before. And I'm going to keep talking about them, if need be. If just one person remembers to put on sunscreen with a high SPF, I'm happy. pic.twitter.com/J1srAzWQt0
- Hugh Jackman (@RealHughJackman) April 3, 2023

This isn't the first time the "Wolverine" star has spoken out about his skin health. Jackman was previously treated for basal cell carcinoma in , and - and posted similar warnings on social media urging others to learn from his mistakes.

So, how can you protect yourself?

Wear sunscreen: The American Cancer Society recommends using a broad spectrum sunscreen (which protects against both UVA and UVB rays) with a sun protection factor, or SPF, value of 30 or higher. You should be wearing this level of sunscreen every day, even on cloudy days, according to the American Academy of Dermatology.

Use the right amount: "Apply enough sunscreen to cover all skin not covered by clothing. Most adults need about 1 ounce - or enough to fill a shot glass - to fully cover their body," the American Academy of Dermatology advises, adding not to forget the tops of your feet, neck, ears and head. "When outdoors, reapply sunscreen every two hours, or after swimming or sweating."

Wear sun-protective clothing: In addition to sunscreen, wearing lightweight and long-sleeved shirts, pants, wide-brimmed hats and sunglasses with UV protection agains the sun's ultraviolet rays can also help protect your skin. "For more effective sun protection, select clothing with an ultraviolet protection factor (UPF) label," the American Academy of Dermatology says.

Limit exposure: Try to limit exposure to the sun's UV rays by seeking shade, especially when the sun is at its strongest, typically between 10 a.m. to 2 p.m. While most exposure to UV rays comes from the sun, it can also come from man-made sources, including indoor tanning beds and sun lamps, the American Cancer Society adds. Skin health experts recommend avoiding those.

Check yourself: If you notice new or suspicious spots on your skin, including anything changing, itching or bleeding, see your dermatologist.

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Hugh Jackman urges sunscreen use amid his latest skin cancer scare. What to know about SPF.

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CBS News Hugh Jackman is urging his followers to wear sunscreen amid his latest skin cancer scare. In a video posted to his social media Monday, the actor, wearing a bandage on his nose, shared he had two biopsies done. "I just went to my doctor...

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Longer Dinner Times and Healthier Eating

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Longer Dinner Times and Healthier Eating

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This article on the connection between longer dinner times and healthier eating from The Washington Post, examines the positive impact a longer dinner with parents can have on children and how portion sizes may entice healthy eating. There is a study where 10 extra minutes was added to dinner, and during this time children ate more fruits and vegetables, as opposed to the regular dinnertime length. Eating more of these nutritious foods can decrease the risk of future food related health issues. Furthermore, there is a positive impact of turning the TV off and having parents model healthy eating choices. Bite-sized portions potentially made the food look better, but ultimately a longer dinner time period was important in increasing healthier food choices. Longer eating times may decrease unhealthy food consumption as the brain has more time to realize the body is full from eating. It is essential for PK-4th grade teachers to know about this topic because they can assist students in eating healthier in the classroom by potentially extending snack times or making the portions of food smaller during this time. The home and school connection with healthy eating can be bridged together.

Cimons, M. (2023, April 18). An extra 10 minutes at dinner may help kids eat more healthy foods. The Washington Post. Retrieved from

https://www.washingtonpost.com/wellness/2023/04/18/kids-healthy-eating-extended-dinner-time/

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Risk Factors Influencing Mental/Emotional Health

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Risk Factors Influencing Mental/Emotional Health

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This article on risk factors influencing mental/emotional health from ABC News discusses a rising trend of teenage depression and sadness. Teenage girls seem to be particularly affected by a rise in these feelings, and the question is why? In an interview with five girls from four different states across the country, they noted reasons why they feel the way they do. Bullying, negative friendships, and negative interactions with boys at school contribute to these feelings. Some of the girls also note school pressure, college stress, and pressure at home to excel in school. Appearance was mentioned and how societal standards, harassment, and catcalling are all things these girls have experienced. The stigma of mental health is also something that contributes to these feelings, along with social media, and the pandemic. In the PK-4th grade classroom, teachers can help students learn about this topic by addressing issues sooner rather than later. Teachers can do check-ins with students by asking them how they feel, or by providing students with a journal where they can write down any thoughts or worries they may be having. Teachers should stress the importance of mental health.

Tanner, L. (2023, April 17). Why are teen girls in crisis? It’s not just social media. ABC News. Retrieved from

https://abcnews.go.com/Health/wireStory/teen-girls-crisis-social-media-98633069

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Anxiety over academics. Post-lockdown malaise. Social media angst.

Study after study says American youth are in crisis, facing unprecedented mental health challenges that are burdening teen girls in particular. Among the most glaring data: A recent Centers for Disease Control and Prevention report showed almost 60% of U.S. girls reported persistent sadness and hopelessness. Rates are up in boys, too, but about half as many are affected.

Adults have theories about what is going on, but what do teens themselves say? Is social media the root of their woes? Are their male peers somehow immune, or part of the problem?

The Associated Press interviewed five girls in four states and agreed to publish only their first names because of the sensitive nature of the topics they discussed. The teens offered sobering - and sometimes surprising - insight.

"We are so strong and we go through so, so much," said Amelia, a 16-year-old Illinois girl who loves to sing and wants to be a surgeon.

She also has depression and anxiety. Like 13% of U.S. high school girls surveyed in the government report, she is a suicide attempt survivor. Hospitalization after the 2020 attempt and therapy helped. But Amelia has also faced bullying, toxic friendships, and menacing threats from a boy at school who said she "deserved to be raped."

More than 1 in 10 girls said they'd been forced to have sex, according to the CDC report, the first increase noted in the government's periodic survey. Sexual threats are just one of the burdens teen girls say they face.

"We are trying to survive in a world that is out to get us," Amelia said.

Emma, an 18-year-old aspiring artist in Georgia with attention deficit disorder and occasional depression, says worries about academics and college are a huge source of stress.

"Lately in myself and my friends, I realize how exhausted everyone is with the pressures of the world and the social issues and where they're going to go in the future," Emma added. "All of these things pile up and crash down."

Zoey, 15, was raised in Mississippi by a strict but loving single mother who pressures her to be a success in school and life. She echoes those feelings.

"School can be nerve racking and impact your mental health so much that you don't even ... recognize it, until you're in this space where you don't know what to do," Zoey said. She's also had friendship struggles that ended in deep depression and felt the discomfort of being the only Black kid in class.

Several girls said they face added pressure from society's standards that put too much focus on how they look.

"A lot of people view women's bodies and girls' bodies as sexual," Emma said. "It's overwhelming to have all these things pushed on us."

The #MeToo movement began when these girls were quite young, but it intensified during the pandemic and they're hyperaware of uninvited sexual advances.

Boys are less aware, they suggest. The girls cite crass jokes, inappropriate touching, sexual threats or actual violence. Girls say the unwanted attention can feel overwhelming.

"We deserve to not be sexualized or catcalled, because we are kids," Amelia said.

Siya, an 18-year-old in New Jersey, said almost every girl she knows has dealt with sexual harassment. "That's just been the normal for me," she said.

"When you're walking alone as girl, you're automatically put in this vulnerable situation," Siya said. "I think that's so sad. I don't know what it feels like to not have that fear."

Makena, a high school senior in Mississippi, said she and her friends sometimes wear baggy clothes to hide their shapes but boys "comment, no matter what."

She has had depression and therapy, and said she has grown up in a community where mental health is still sometimes stigmatized.

"Often in the Black community we aren't as encouraged to express emotion" because of what previous generations endured, said Makena, who works with a teen health advocacy group. "We're expected to have hearts of steel," she said. "But sometimes it's OK to not be OK."

Social media platforms contribute, with their focus on superficial appearances and making perfectionism seem attainable. Girls say they're just part of the problem.

"Social media has completely shifted the way we think and feel about ourselves" in good and bad ways, Makena said.

She's felt pressure to be perfect when comparing herself with others online. But she also follows social media influencers who talk about their own mental health challenges and who make it seem "OK for me to feel sad and vulnerable," she said.

Girls have historically been disproportionately affected by depression and anxiety. But those statistics at least partly reflect the fact that girls are often more likely than boys to talk about feelings and emotions, said Dr. Hina Talib, an adolescent medicine specialist and spokesperson for the American Academy of Pediatrics.

Zoey, the Mississippi 15-year-old, says boys have to keep up a "macho facade" and are less likely to admit their angst.

"I feel like they might feel that way, we just don't see it," she said.

A study published in March in The Journal of the American Medical Association found that in 2019, before the pandemic, about 60% of children hospitalized for mental health reasons were girls. A decade earlier, the difference was only slight.

COVID-19 lockdowns added another dimension, thrusting academic and social lives online, Talib said. Some kids entered the pandemic as youngsters and emerged with more mature bodies, socially awkward, uncertain how to navigate friendships and relationships. They live in a world beset with school shootings, a rapidly changing climate, social and political unrest, and restrictions on reproductive care and transgender rights.

The CDC report released in February included teens queried in fall 2021, when U.S. COVID-19 cases and deaths were still high. Other data and anecdotal reports suggest many teens continue to struggle.

"The pandemic as a percentage of their lives is huge," said Talib.

Expecting kids to be unscathed may be unrealistic.

"It's going to change a generation," she said.

___

Follow AP Medical Writer Lindsey Tanner at @LindseyTanner.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Science and Educational Media Group. The AP is solely responsible for all content.

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Why are teen girls in crisis? It's not just social media

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Anxiety over academics. Post-lockdown malaise. Social media angst. Study after study says American youth are in crisis, facing unprecedented mental health challenges that are burdening teen girls in particular. Among the most glaring data: A recent Centers for Disease Control and Prevention report showed almost 60% of U.S.