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• American Academy of Child & Adolescent Psychiatry. (2019). Stress Management and Teens.
• American Academy of Pediatrics. Clinical Report. (2020). Long-Acting Reversible Contraception: Specific Issues for Adolescents. Pediatrics, 146(2): e2020007252.
• American Academy of Pediatrics. Clinical Report. (2017). Sexual and Reproductive Health Care Services in the Pediatric Setting. Pediatrics, 140(5): e20172858.
• American Academy of Pediatrics. (2019). Policy Statement: Unique Needs of the Adolescent. Pediatrics, 144(6), e20193150.
• American Academy of Pediatrics. (2019). Role of the Pediatrician in Youth Violence Prevention. Pediatrics 124 (1): 393–402.
• Balocchini E, Chiamenti G, Lamborghini A. (2013) Adolescents: which risks for their life and health? J Prev Med Hyg. 54(4):191-4.
• Centers for Disease Control and Prevention. (2024). About Chlamydia.
• Centers for Disease Control and Prevention. (2024). About Genital Herpes.
• Centers for Disease Control and Prevention. (2023). About Trichomoniasis.
• Centers for Disease Control and Prevention. (2023). Adolescents Are Experiencing Violence, Sadness, and Suicide Risk.
• Centers for Disease Control and Prevention. (2019). Annual Surveillance Report of Drug-Related Risks and Outcomes.
• Centers for Disease Control and Prevention. National Health Statistics Reports. (2023). Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2015-2019.
• Centers for Disease Control and Prevention. National Vital Statistics Reports. (2021). Births: Final Data for 2019. 
• Centers for Disease Control and Prevention. (2021). Changes in Suicide Rates — United States, 2018–2019
• Centers for Disease Control and Prevention. (2024). E-Cigarette Use Among Youth.
• Centers for Disease Control and Prevention. (2022). High-Risk Substance Abuse Among Youth. 
• Centers for Disease Control and Prevention. (2024). High School Youth Risk Behavior Survey: Texas 2021 and United States 2021 Results.
• Centers for Disease Control and Prevention. (2024). About HPV.
• Centers for Disease Control and Prevention. (2020). Injury Prevention and Control. WISQARS™ — Web-based Injury Statistics Query and Reporting System.
• Centers for Disease Control and Prevention. (2020). National Center for Health Statistics. Sexual Activity and Contraceptive Use Among Teenagers Aged 15–19 in the United States, 2015–2017.
• Centers for Disease Control and Prevention. (2023) Overview and Methods for the Youth Risk Behavior Surveillance System — United States, 2021.
• Centers for Disease Control and Prevention. (2016). Public Health Law: Graduated Driver Licensing.
• Centers for Disease Control and Prevention. Reproductive Health. (2024). Unintended Pregnancy.
• Centers for Disease Control and Prevention. (2024). Maltreatment, Violence, and Self-Injury.
• Centers for Disease Control and Prevention. (2020). Sexual Activity and Contraception Use Among Teenagers Aged 15-19 in the United States, 2015-2017.
• Centers for Disease Control and Prevention. (2024). Sexually Transmitted Diseases (STDs).
• Centers for Disease Control and Prevention. (n.d.) Sexually Transmitted Infections (STIs).
• Centers for Disease Control and Prevention. (2024). Sexually Transmitted Infections Prevalence, Incidence, and Cost Estimates in the United States. 
• Centers for Disease Control and Prevention. (2023). Smoking and Tobacco Use.
• Centers for Disease Control and Prevention. (2019). Substance Use and Sexual Risk Behaviors Among Youth.
• Centers for Disease Control and Prevention. National Center for Health Statistics. Teen Birth Rate by State.
• Centers for Disease Control and Prevention. Youth Violence Prevention. (2020). Risk and Protective Factors.
• Centers for Disease Control and Prevention. (2024). About Youth Violence.
• Centers for Disease Control and Prevention. (2023). WISQARS™ — Web-based Injury Statistics Query and Reporting System
• Child Mind Institute. (n.d.). Teen Suicides: What Are the Risk Factors?
• Duell, N., & Steinberg, L. (2019). Positive Risk Taking in Adolescence. Child Development Perspectives, 13(1): 48-52. [Abstract only]
• Grossman, J. M., Jenkins, L. J., & Richer, A. M. (2018). Parents' perspectives on family sexuality communication from middle school to high school. International Journal of Environmental Research and Public Health, 15(1):107.
• Guttmacher Institute. (2020). Reducing STI Cases: Young People Deserve Better Sexual Health Information and Services.
• Insurance Institute for Highway Safety. (2023). Fatality Facts 2022: Teenagers.
• Klein, D. A., Goldenring, J. M., & Adelman, W. P. (2014). HEEADSSS 3.0: The Psychosocial Interview for Adolescents Updated for a New Century Fueled by Media. Contemporary Pediatrics.
• Krentzman AR, Robinson EA, Moore BC, Kelly JF, Laudet AB, White WL, Zemore SE, Kurtz E, Strobbe S. (2010). How Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) Work: Cross-Disciplinary Perspectives. Alcohol Treat Q; 29(1):75-84. 
• Kuntic, M., Oelze, M., Steven, S., Kröller-Schön, S., Stamm, P., et al. (2020). Short-term e-cigarette vapour exposure causes vascular oxidative stress and dysfunction: evidence for a close connection to brain damage and a key role of the phagocytic NADPH oxidase (NOX-2). European Heart Journal. Vol. 41:26, pp 2472–2483.
• Ladegard, K., Thurstone, C., & Rylander, M. (2020). Marijuana Legalization and Youth. Pediatrics, 145(Supplement 2), S165-S174.
• March of Dimes. (n.d.). One Key Question.
• Molla-Esparza, C., Losilla, J. M., & López-González, E. (2020). Prevalence of sending, receiving and forwarding sexts among youths: A three-level meta-analysis. PLoS One, 7;15(12):e0243653.
• Mori, C., Temple, J., Browne, D., & Madigan, S. (2019). Association of Sexting with Sexual Behaviors and Mental Health Among Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatrics, 173(8):770-779. 
• National Institute of Mental Health. (2021). Suicide.
• National Institute of Mental Health. (2020). The Teen Brain: 7 Things to Know.
• National Library of Medicine. (2023) An epidemiological study of unintentional pediatric firearm fatalities in the USA, 2009-2018.
• Raising Children.Net. (n.d.) Risky behaviour in pre-teens and teenagers.
• Raising Children Network. (2020). Brain development: teenagers.
• Ryan, S.A., Ammerman, S.D., COMMITTEE ON SUBSTANCE USE AND PREVENTION; Gonzalez, P.K., Patrick, S.W., Quigley, J., Walker, L.R. (2017). Counseling Parents and Teens About Marijuana Use in the Era of Legalization of Marijuana. Pediatrics 139 (3): e20164069.
• Texas Child Mental Health Care Consortium. The University of Texas System. Child Psychiatry Access Network (CPAN).
• Texans for Safe and Drug Free Youth. (2019).
• Texas Constitution and Statutes. (n.d.). Communicable Diseases, Chapter 97, Title 25, Texas Administrative Code. 
• Texas Constitution and Statutes. (2021). Texas Occupations Code, Sec. 159.005. Physician-Patient Communications.

• Texas Constitution and Statutes. (2017). Texas Penal Code, Sec. 21.18. Sexual Coercion.

  Texas Constitution and Statutes. (2017). Texas Penal Code, Sec. 21.11. Indecency with a Child.

• Texas Health and Human Services Commission. (2020). Epi Profile Section 2 - Texans Living with HIV in 2018.
• Texas Health and Human Services Commission. Responsibilities for Treatment of Minors within the Family Planning Program and Healthy Women Program. 
• Texas Department of State Health Services. (n.d.) HIV/STD Program
• Texas Department of State Health Services. (2024). List of all Texas Notifiable Conditions – 2024.
• Texas Health and Human Services Commission. (2021). Outreach, Screening, Assessment and Referral Centers (OSARs).
• Texas Health and Human Services. Texas Health Steps. (2021). Periodicity Schedule. 
• Texas Medicaid & Healthcare Partnership. (n.d.). Comprehensive Care Program.
• Texas Medicaid & Healthcare Partnership. (n.d.). Texas Medicaid Provider Procedures Manual. 
• Texas Penal Code. (2023). Unlawful Electronic Transmission of Sexually Explicit Visual Material.
• Texas State Texas School Safety Center. ‘Before You Text’ Bullying And Sexting Course. 
• Texas Workforce Commission. (2023). One Pill Kills.
• U.S. Department of Health and Human Services. (2020). HIV National Strategic Plan, 2021-2025.
• U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2017). Screening, Brief Intervention, and Referral to Treatment (SBIRT).
• U.S. Department of Justice Office of Justice Programs. (2006). Who Facts on: Intimate Partner Violence and Alcohol. 
• U.S. Food and Drug Administration. (n.d.) Consumer Updates. What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD.
• Widman, L., Nesi, J., Kamke, K., Choukas-Bradley, S., & Stewart, J. L. (2018). Technology-Based Interventions to Reduce Sexually Transmitted Infections and Unintended Pregnancy Among Youth. The Journal of Adolescent Health, 62(6), 651-660. 
• Youth.gov. (n.d.). Risks and Protective Factors.
• Youth.gov. (n.d.). Risks and Protective Factors. Substance Abuse Warning Signs.

Medical Definitions

The medical definitions in this module were obtained or adapted from the American Academy of Pediatrics, Anxiety and Depression Association of America, Mayo Clinic, Megan Meier Foundation, Merriam-Webster, Montana Department of Public Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, National Institute of Diabetes and Digestive and Kidney Diseases, Orthorexia.com, Oxford University Press, ScienceDirect, Texas Department of Family and Protective Services and The Nemours Foundation.

Continuing Medical Education

The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians. 

The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) of Continuing Nursing Education.

Certified Health Education Specialists

Sponsored by The Texas Department of State Health Services, Continuing Education Service, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES®) and/or Master Certified Health Education Specialists (MCHES®) to receive up to 1.25 total Category I contact education contact hours. Maximum advanced-level continuing education contact hours available are 1.25.

Social Workers

The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 hours of credit.

Certificate of Attendance

The Texas Department of State Health Services, Continuing Education Service has designated 1.25 hour(s) for attendance.

Certified Community Health Worker

The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.25 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.

General Disclosure

One of the requirements of continuing education is disclosure of the following information to the learner:

1. Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
   • Create a Texas Health Steps account.
   • Complete on-line registration process.
   • Thoroughly read the content of the module.
   • Complete the on-line examination.
   • Complete the evaluation.
2. Commercial Support.
   The THSTEPS Web-based Continuing Education Series has received no commercial support.
3. Disclosure of Relevant Financial Relationships.
   The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
4. Non-Endorsement Statement.
   Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
5. Off-Label Use.
   Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).

The following are policies and definitions of terms related to continuing education disclosure:

The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.

All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.

Glossary of Terms

Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.

Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.

Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).

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