Latest / Morning Medical with Dr. Chow / Adolescent Sexual Health, Hormone Therapy, and FDA Tobacco Updates

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Adolescent Sexual Health, Hormone Therapy, and FDA Tobacco Updates · Morning Medical with Dr. Chow

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Good morning and welcome to Morning Medical with Dr.
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Chow, your daily update on the latest in medical and health news from around the world.
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I'm your host, Dr.
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Chi-Ming Chow.
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Today, we're diving into some pressing issues affecting public health globally.
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Let's get started with our first story.
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An alarming decline in condom use is putting young people’s health at risk, the World Health
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Organization has warned.
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A comprehensive survey conducted by the World Health Organization involving nearly 250,000
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15-year-olds across 42 countries and regions in Europe and Canada found that between 2014 and
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2022, condom use among sexually active adolescents declined significantly.
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This troubling trend puts these young individuals at considerable risk of contracting
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sexually transmitted infections, experiencing unplanned pregnancies, and undergoing unsafe
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abortions.
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Almost one-third of 15-year-olds reported that they did not use a condom or take the
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contraceptive pill.
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While the rates of sexual activity remained relatively stable—with 20 percent of boys and
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15 percent of girls reporting that they had had sex in 2022—the proportion of those who used a
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condom during their last intercourse fell.
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Specifically, among boys, condom use dropped from 70 percent to 61 percent, and among girls,
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it declined from 63 percent to 57 percent.
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The United Kingdom has some of the lowest rates of condom use, with teenagers in Wales and
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Scotland reporting among the sharpest declines.
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Only 37 percent of girls in Scotland and 40 percent in Wales said a condom was used the
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last time they had sex, a steep drop from 2014 when it was 60 percent and 57 percent,
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respectively.
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The number of boys using protection also fell, with under half in Scotland (47 percent) and
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Wales (46 percent) saying they used a condom in 2022, down from 59 percent and 69 percent in
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2014.
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In England, the decline was slight, from 62 percent to 61 percent.
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By contrast, countries like France and Spain reported higher rates of condom use.
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In 2022, more than two-thirds of girls and around three-quarters of boys in these
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countries said they used a condom.
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In Germany, the figures for boys and girls were just under 60 percent.
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The highest rates of condom use were observed in Armenia, Switzerland, and Greece, with
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around three-quarters of adolescents using condoms.
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The report from the World Health Organization calls on governments to ensure access to
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high-quality sex education and to make it easier for young people to access contraception
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services.
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Dr.
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Hans Henri P.
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Kluge, the World Health Organization’s regional director for Europe, stated, “While the
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report’s findings are dismaying, they are not surprising.
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Age-appropriate comprehensive sexuality education remains neglected in many countries
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and, where it is available, it has increasingly come under attack in recent years on the false
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premise that it encourages sexual behavior.
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The truth is that equipping young people with the right knowledge at the right time leads to
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optimal health outcomes linked to responsible behavior and choices.”
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Lisa Hallgarten, the head of policy and public affairs at the sexual health charity Brook,
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said that their own data showed “a concerning reliance in the United Kingdom on the
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withdrawal method, which offers no protection against sexually transmitted infections and is
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extremely unsafe in preventing pregnancy.” She stressed the importance of creating a culture
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of condom use, especially at a time when sexually transmitted infection rates are
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soaring.
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Hallgarten called for a national public health campaign around safer sex and condoms, as well
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as proper funding for sexual health services to ensure that condoms are free and accessible for
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all who need them.
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Amelia Whitworth, the head of policy, campaigns, and research at the children’s
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charity Plan International United Kingdom, emphasized that the report should serve as a
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red flag for Europe’s governments.
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She highlighted the alarming rise in anti-rights movements that seek to strip girls
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and women of their existing rights in law, from removing women’s right to an abortion to
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limiting what girls are taught about their bodies.
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Whitworth stressed the need for all children and young people to have access to
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comprehensive sexuality education to learn about their bodies, their sexuality, and what
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healthy relationships look like.
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Without meaningful action, she warned, we risk girls and young women being robbed of their
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right to choose their own future.
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The president of the Faculty of Sexual and Reproductive Healthcare, Dr.
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Janet Barter, echoed these concerns, calling the report a “worrying trend.” She pointed out
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that those most at risk of unintended pregnancy are even less likely to use contraception.
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Dr.
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Barter emphasized that young people should receive high-quality, evidence-based education
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on issues across sexual and reproductive health so they can make healthy reproductive choices
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for themselves and their partners.
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“Anything less than that fails our young people and future generations,” she added.
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A government spokesperson acknowledged the issue, stating, “We know there is much work to
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do to make sure everyone has timely access to sexual health services, and we are determined
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to shift the focus from treatment to prevention and reduce the inequalities that drive poor
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health.” The spokesperson also mentioned that a consultation on proposed changes to the
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statutory guidance on teaching relationships, health, and sex education has recently closed,
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and the government will carefully consider the next steps.
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Postmenopausal women who have used hormone therapy may be biologically younger than those
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who have not, a retrospective study of women in the United Kingdom Biobank suggested.
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Examining nine biomarkers linked with mortality risk, adjusted analyses showed historical use
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of hormone therapy to be associated with a smaller discrepancy between phenotypic and
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chronological age.
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Specifically, the discrepancy was -0.17 years compared to those who never used hormone
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therapy, with a 95% confidence interval ranging from -0.23 to -0.10.
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This association was more evident in women of lower socioeconomic status.
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Furthermore, analyses showed that this phenotypic age discrepancy mediated the
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association between hormone therapy use and decreased mortality risk.
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Chenglong Li, PhD, of the National Institute of Health Data Science at Peking University, and
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Yufan Liu, of Capital Medical University, both in Beijing, reported these findings.
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They wrote, “These findings support hormone therapy use in postmenopausal women to promote
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healthy aging and address related health inequalities” in JAMA Network Open.
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While any duration of hormone therapy use was linked with a smaller biological age
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discrepancy, the largest magnitude of effect was seen with four to eight years of use.
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The discrepancy was -0.25 years, with a 95% confidence interval from -0.35 to -0.15.
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This could translate to about a 2.25% decreased risk of all-cause mortality and a 5% decreased
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risk of cause-specific mortality, according to Li and Liu.
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“Therefore, the observed magnitude of associations in our study could be relevant for
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current clinical practice,” they wrote.
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However, further investigations capable of making causal inferences are warranted to
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confirm these findings, Li told MedPage Today, as hormone therapy does not come without its
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concerns.
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“There have been debates regarding the risk and benefit of hormone therapy in postmenopausal
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women,” he said.
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“For instance, the Women's Health Initiative Hormone Trials revealed that hormone therapy
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increased the risks of stroke and probable dementia.
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However, reports from the Nurses' Health Study showed potentially protective roles of hormone
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therapy against major coronary events.
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These inconsistent findings raise concerns about the appropriateness of initiating hormone
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therapy.”
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The Menopause Society states that the benefit-risk ratio of hormone therapy is
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favorable to treat vasomotor symptoms and prevent bone loss for women 60 and younger or
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those who are within 10 years of menopause onset and have no contraindications.
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But the benefit-risk ratio may be less favorable for women over 60 or those who start
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hormone therapy more than 10 years from menopause onset due to risks of coronary heart
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disease, stroke, venous thromboembolism, and dementia.
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For their population-based cohort study, Li and Liu looked at 117,763 postmenopausal women, 96
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percent of whom were white, with a mean age of 60.2 years, registered in the United Kingdom
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Biobank.
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Baseline surveys from 2006 to 2010 captured the use of hormone therapy and the biomarkers of
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biological aging.
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Of those women, 40.3 percent had ever used hormone therapy.
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The average chronological age in the cohort was 61.6 years for ever users and 59.3 years for
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never-users, while the average phenotypic age was 53.5 and 51.2 years, respectively.
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Phenotypic age was calculated using chronological age plus nine biomarkers
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associated with mortality risk: albumin, creatinine, glucose, C-reactive protein,
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lymphocyte percent, mean cell volume, red blood cell distribution width, alkaline phosphatase,
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and white blood cell count.
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Analyses adjusted for sociodemographic and lifestyle characteristics, major chronic
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diseases, and a history of bilateral oophorectomy and hysterectomy.
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Women who started hormone therapy at age 44 or younger were found to be 0.33 years older in
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phenotypic age than never-users, while those who started at age 45 were biologically
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younger: by 0.20 years for those starting at ages 45 to 49 and by 0.32 years for those
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starting at age 50 or older.
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Together with these findings, Li said that “the optimal hormone therapy duration for
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significantly decreasing aging discrepancy can also inform flexible hormone therapy treatment
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plans in clinical settings.”
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The link between hormone therapy and a smaller aging discrepancy was more strongly evident in
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women with disadvantaged socioeconomic status, defined as having an annual household income
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under £31,000 (approximately 40,000 United States dollars), lacking higher education, not
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being employed, or having a higher Townsend Deprivation Index.
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It was also stronger in women with lower levels of physical activity and those who had
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hypertension, cardiovascular disease, diabetes, and chronic kidney disease.
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Phenotypic aging discrepancy mediated 12.7 percent of the lower all-cause mortality risk
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with historical hormone therapy use.
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The association also explained 19.3 percent of the non-significant link with cardiovascular
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mortality and 8.3 percent of the association with cancer-related mortality.
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The adjusted hazard ratios were 0.92 for all-cause mortality, 0.93 for cardiovascular
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mortality, and 0.92 for cancer-related mortality.
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Limitations to the study included the reliance on self-reported data regarding hormone
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therapy.
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Also, biological age measurements only reflected a single point in time rather than a
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long-term biological aging trajectory.
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The study was supported by the Postdoctoral Fellowship Program of China Postdoctoral
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Science Foundation.
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Li and Liu reported no disclosures.
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The Food and Drug Administration has released a final rule that will require retailers to check
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the identification of any customer purchasing tobacco products who appears to be under the
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age of 30.
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This new rule is part of the agency's ongoing efforts to curb underage tobacco sales and is
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set to take effect on September 30.
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The regulation raises the age from the current 27 to 30 for mandatory identification checks.
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This rule is in line with the Further Consolidated Appropriations Act, which was
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signed into law in December 2019.
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This act immediately raised the federal minimum age for the sale of tobacco products in the
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United States from 18 to 21.
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The new rule aims to further decrease underage tobacco sales by ensuring stricter age
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verification processes.
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According to the Food and Drug Administration, it is essential for retailers to request and
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examine photo identifications to verify the age of anyone under 30, regardless of their
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appearance.
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Research has shown that it is challenging for retailers to accurately determine a customer's
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age based solely on their appearance, making this precaution necessary.
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Additionally, the rule stipulates that retailers can no longer sell tobacco products
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in vending machines located in places where individuals under 21 are present or permitted
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to enter.
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Previously, this restriction applied to locations that served individuals under 18.
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This change is another measure aimed at reducing the accessibility of tobacco products
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to young people.
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Brian King, PhD, MPH, director of the Food and Drug Administration's Center for Tobacco
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Products, emphasized the importance of this new rule.
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"Today's rule is another key step toward protecting our nation's youth from the health
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risks of tobacco products," King said.
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"Decades of science have shown that keeping tobacco products away from youth is critical to
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reducing the number of people who ultimately become addicted to these products and suffer
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from tobacco-related disease and death."
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The Food and Drug Administration highlighted that more than 95 percent of United States
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adults who smoke daily had their first cigarette by the age of 21.
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Therefore, robust enforcement of the federal minimum age for tobacco sales is crucial for
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public health.
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The agency has conducted over 1.5 million compliance checks of tobacco retailers to
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ensure adherence to federal age restrictions.
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These inspections have resulted in 134,000 warning letters, more than 33,000 civil money
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penalties, and 230 no-tobacco-sale orders for violations related to age restrictions.
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To assist retailers in complying with these regulations, the Food and Drug Administration
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is providing various resources.
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Retailers can access information on legally marketed tobacco products in the United States
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through the agency’s Searchable Tobacco Products Database.
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These resources are designed to help retailers understand and follow the new age-of-sale
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restrictions effectively.
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The Food and Drug Administration's final rule represents a significant step in the ongoing
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federal efforts to protect young people from the dangers of tobacco products.
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By tightening age verification requirements and limiting the availability of tobacco products
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in certain locations, the agency aims to reduce the prevalence of tobacco use among youth and
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improve public health outcomes.
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Cannabis and hallucinogen use stayed at historically high levels among both younger and
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middle-age adults in the United States in 2023, according to the latest survey from Monitoring
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the Future.
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This study, conducted by researchers at the University of Michigan since 1975 and funded by
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the National Institutes of Health, provides a crucial look into substance use trends among
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the adult population in the United States.
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Dr.
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Wilson Compton, the deputy director of the National Institute on Drug Abuse, emphasized
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the importance of the survey, stating, “The survey is an important source of information
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about substance use trends among the adult population in the United States.”
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The survey revealed that about 42 percent of adults between the ages of 19 and 30 reported
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using cannabis in the previous year, with approximately 10 percent of that group
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indicating they used cannabis nearly every day.
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Notably, for the first time, more women in this age group reported using cannabis than men,
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although a higher prevalence of men using cannabis was observed in the older age group.
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About 29 percent of midlife adults, those aged 35 to 50, reported using cannabis at least once
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in the past year, with 8 percent using it daily.
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Dr.
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Compton expressed his surprise at the frequency of daily cannabis use, noting, “I’m kind of
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struck at how frequent daily cannabis use is.
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You know, about 10 percent of the 19- to 30-year-olds; that’s 1 in 10.
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On average, a certain number of people in any group that’s a sizable portion are using
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marijuana on a daily or near-daily basis.
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And I think that bears watching, and those levels are at a historical high.
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Although they didn’t increase this year compared to the previous year, they’re still at
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quite high levels.”
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Cannabis vaping saw a slight increase among younger adults, with about one in five adults
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in that age group reporting they had used it at least once in the past year.
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For midlife adults, about 9 percent reported vaping cannabis in the past year, a figure that
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remained consistent with the previous year.
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Nicotine vaping also stayed high among both groups of adults.
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The use of hallucinogens, such as lysergic acid diethylamide (LSD), mescaline, peyote,
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phencyclidine (PCP), and psilocybin (shrooms), in the past year hovered around the same levels
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as in 2022.
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It was reported by 9 percent of adults aged 19 to 30 and 4 percent of those aged 35 to 50.
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Dr.
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Nora Volkow, the director of the National Institute on Drug Abuse, highlighted the
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shifting trends in substance use.
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She stated, “We have seen that people at different stages of adulthood are trending
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toward use of drugs like cannabis and psychedelics and away from tobacco cigarettes.
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These findings underscore the urgent need for rigorous research on the potential risks and
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benefits of cannabis and hallucinogens – especially as new products continue to emerge.”
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Despite these trends, alcohol remains the most-used substance among adults, with over 84
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percent of younger adults reporting drinking in the past year.
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However, frequent drinking—whether monthly, daily, or binge drinking—decreased in 2023
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compared to the previous decade among 19- to 30-year-olds.
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The survey also noted decreases in other forms of drug use, reflecting a shift in habits.
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Cigarette smoking, the use of opioid medications, and the nonmedical use of
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prescription drugs have all maintained five- and 10-year declines for both age groups.
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Dr.
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Compton pointed out the positive trends in cigarette smoking but also raised concerns
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about the rise in vaping.
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He said, “I think we’ve had very good news now for a number of years about declines in
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cigarette smoking.
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That’s been particularly true for the younger cohorts, and so our concern has been with the
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rise in vaping – and much higher rates of nicotine vaping in the last few years – might
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represent a new entry into nicotine addiction and eventual transition to the smoked products,
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which are so strongly associated with cancer and lung damage.
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I’m a public health official, so I’m always pleased when we see progress, but I also want
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to point out the concerns that may be there in some of the other data.”
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In 2023, drug overdose deaths decreased for the first time since 2018, according to preliminary
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data from the United States Centers for Disease Control and Prevention’s National Center for
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Health Statistics.
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About 107,500 people died from a drug overdose in 2023, driven primarily by fentanyl and
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synthetic opioids.
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While the Monitoring the Future survey did not show many significant changes from the previous
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year, the researchers emphasized the importance of long-term data in understanding substance
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use trends.
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Megan Patrick, a research professor at the University of Michigan and principal
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investigator of the Monitoring the Future panel study, said, “The data from 2023 did not show
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us many significant changes from the year before, but the power of surveys such as
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Monitoring the Future is to see the ebb and flow of various substance use trends over the
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longer term.
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As more and more of our original cohorts – first recruited as teens – now enter later
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adulthood, we will be able to examine the patterns and effects of drug use throughout the
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life course.
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In the coming years, this study will provide crucial data on substance use trends and health
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consequences among older populations, when people may be entering retirement and other new
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chapters of their lives.”
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Our final story today focuses on a phenomenon many parents might find familiar: 'soiling the
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nest.' This term refers to the often challenging behavior exhibited by teenagers as
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they prepare to leave home, particularly for college.
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According to clinical psychologist Regine Galanti, founder of Long Island Behavioral
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Psychology and author of 'Anxiety Relief for Teens,' this phase is a normal part of growing
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up.
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It involves teens becoming more difficult at home, picking fights, talking back, and
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generally putting stress on their relationships with their parents.
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Roseanne Buckley, a mother from Medford, New Jersey, experienced this firsthand with her
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18-year-old son.
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She described how her son, once a mild-mannered homebody and excellent student, suddenly
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developed a defiant attitude and started acting out of character.
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'He was doing things out of character or without mentioning it first,' Buckley said.
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She later learned that this behavior is a part of 'soiling the nest.'
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Dr.
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Galanti explains that this behavior is often a way for teens to assert their independence and
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create space between themselves and their parents.
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This separation makes the transition to adulthood easier for some teens.
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'Recognize that, as a parent, this is not about you,' Galanti said.
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'This is about your child having difficulty figuring out how they’re going to manage the
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next phase of their lives.
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Pushing you away might make it easier for teens to launch themselves into independence.'
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Gabriella Neske, a mother from Tampa, Florida, also experienced 'soiling the nest' with her
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oldest daughter as she prepared to head to college.
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Neske described her daughter as acting 'generally sullen' and defying her requests,
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such as leaving piles of wet laundry atop the dryer.
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Neske tries to balance giving her kids independence while still keeping guardrails up
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to help them develop their own identities.
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Psychologist Lisa Damour, author of 'The Emotional Lives of Teenagers,' advises parents
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not to take this behavior personally.
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'Trust it will be one chapter in a long book of raising that child,' Damour said.
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She notes that the months leading up to a child leaving for college are emotionally charged for
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both parents and teens.
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While parents may want to savor every moment and impart final life lessons, teens are often
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focused on spending time with friends they’ll soon be missing.
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This can lead to a mismatch of priorities.
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Damour also points out that not all teenage defiance is deliberate.
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'They’re not always deliberately choosing to be prickly,' she said.
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For many teens, leaving home is hard, even if they are excited about what lies ahead.
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Sometimes being difficult makes it easier to say goodbye.
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She suggests coordinating with your teen’s schedule to make necessary conversations
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smoother.
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For instance, saying, 'I’m going to need 10 minutes to talk to you about your packing.
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When is a good time tomorrow?' can help.
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Parents should also be mindful of how younger siblings are affected by an older sibling
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moving out.
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Damour advises parents to take care of their emotional needs so they can support the younger
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children through this transition as well.
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Interestingly, many parents report that once their teens have settled into their new
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independent lives, their relationships with their teens improve.
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Roseanne Buckley noticed that her son reverted to his normal self as his move-out day
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approached.
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Lisa Damour finds that teenagers often become warmer and friendlier after they've established
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their independence.
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'It may take a full freshman year, but teenagers tend to be warmer, friendlier, and in
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fact quite wonderful to interact with in their increasingly adult form,' she said.
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That wraps up today’s episode of Morning Medical with Dr.
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Chow.
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I hope you found these stories insightful and informative.
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We'll be back tomorrow with more updates on the latest in medical and health news from around
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the world.
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Until then, stay healthy and take care.