Narcissists, Sex Education, E-Cigarettes – PediaCast 313

Show Notes

Join Dr Mike in the PediaCast Studio for another edition of News Parents Can Use. This week’s topics include raising little narcissists, divorce & obesity, sex education, pre-teen depression, smoking and E-cigarettes.

Raising Little Narcissists
Divorce & Obesity
Sex Education
Pre-Teen Depression
Smoking & E-Cigarettes

Sex Ed Library (SIECUS)
Talking to Your Child About Sex (AAP)
Adolescent Sexuality: Talk the Talk Before They Walk the Walk (AAP)
Helping Teens Resist Sexual Pressure (AAP)
Effective Birth Control for Sexually Active Teens (AAP)
Teaching Health Education in School (AAP)
Birth Control for Teens Program at Nationwide Children’s

Contact Dr Mike – Show Questions, Comments, Topic Ideas
Nationwide Children’s – Request an Appointment or Referral
Nationwide Children’s – Non-Urgent Medical Questions


Announcer 1: This is PediaCast.


Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It is April 1st, 2015, Episode 313. Were calling this one "Narcissist, Sex Education and E-cigarettes". 

I want to welcome everyone to the program. 

So, I got a little frog on my throat. You know, it's a hazard of the job. When you're a pediatrician or in pediatrics of any kind taking care of kids — and I'm sure teachers go through this as well — we got sick sometimes. But life goes on, and so my throat's a little scratchy, but just bear with me and we'll get through this together. 

We do have another News Parents Can Use edition of the show lined up for you this week. Lots of great topic coming your way including the ones I mentioned in the show's title, but others as well. I'll have the entire lineup for you in a moment, but first I want to remind you about our 700 Children's blog where we call upon the collective pediatric expertise of our entire institution and present a fantastic collection of articles for moms and dads written in the way you can understand and find useful at

Some recent topics: how to talk to your children about death, why I created the Make Safe Happen app from the author of that technology, car seat safety – are you listening? And again, you can find these articles and more at


Also launching today, April 1st over at, I  have a brand new podcast for you. So, this is really exciting. PediaCast CME, we've been talking about this, really since last December. I had mentioned that this was going to be coming your way and it has finally arrived. 

Today is the day we open the doors. It's a companion podcast, and while this program is aimed at moms and dads, the new one is for the providers in the crowd. Although moms and dads are welcome as well, especially for topics and issues that affect your family. We're going to turn up the science, interview the experts and offer free Category 1 Continuing Medical Education credit for those who participate. 

Anyone can listen to the podcast and explore the Show Notes over at Those podcasts are also available on iTunes and most podcasting apps for iPhone and Android. If you want the free Category 1 CME, you'll need to sign up for a PediaCast CME account, which takes just a couple of minutes of your time, and it's free. That way, we can show you the brief post-test for each episode. 

So, basically, the way it works is the Show Notes look like they do for this Show Notes at PediaCast. We put all the basic information, plus the continuing medical education information. So you get the disclaimers and you get all of the goals, and the educational objectives, and all of that. But in order for the post-test to appear, you do have to log in so, you have to sign up for that free account. And then, once the post-test shows up, you just take the post-test, submit it. If you get a score of 75% or higher, then you'll get a certificate of participation that's e-mailed to you right then and there.

In addition, the CME Office or the Education Office at Nationwide Children's will keep track of your participation and automatically add it to your CME transcript, which is important for anyone affiliated with our institution, but also it's a free service if you're not. 

So moms and dads, be sure to let your pediatric providers know. And pediatric providers, be sure to let your colleagues know, shows and free CME credits start today. You can find the podcasts and all the information over at


All right, so what are we covering this week on this particular show. First up, raising little narcissist. We all want our children to grow up with a healthy dose of self-esteem, but what happens when we go too far? What happens when our truly children believe they're the best of the best in everything they do? 

Well, not only they become annoying adults, they also surround themselves with difficult-to-jump hurdles — ones which affect their success in relationships and careers. So how do you promote healthy self-esteem without crossing that line? We'll take a look at that.

And then, divorce and obesity — you know divorce is a huge stress on the entire family. It's also a time when  unhealthy habits can take root, which can have long-lasting effects on healthier kids. What particular habits are we talking about, and how can you or a family you know and love avoid the pitfalls? So that's coming up.

And then we're going to talk about sex education. It's not going to be graphic, but if you do have little ones in the car and you're listening to this when we get to the sex education  part, you might want to pause it if you haven't had that talk  yet and you don't want some questions to be generated at this particular time, on this particular car trip. I'll just give you a warning ahead of time. Again, not graphic, it's clean, but if there's little ones listening, it might stimulate them to ask some questions, and you might want to be prepared for that.

Because kids do have questions, and parents should have answers, but it can be a sensitive and sometimes embarrassing topic for moms and dads. School should have the answers, but are they answering the right questions? Which are the questions your children have? We'll take a look at the answer to that questions and we'll put some great resources into your hands to prepare you to answer questions — answers which are medically accurate, age-appropriate, comprehensive, but still respective of your religious and cultural beliefs. So, that's coming your way in a bit with lots of links to resources available in the Show Notes. 


And then, we're going to talk about pre-teen depression. This is something that can be difficult to diagnose, but it's important to do so because help is available and lack of help can lead to major depression during the teenage years. So we'll take a look at the symptoms, let you know what to do if you think your pre-teen is depressed, and also talk about a study that looks at the best  way to treat it. 

Finally, smoking an e-cigarettes. The use of tobacco  products is associated with long term health risks. We all  know that. It's a little established fact. But what about e-cigarettes? Are they any better? If not, why not? And what's  the best way to keep your kids from picking up a real cigarette or an e-cigarette in the first place? We'll give careful consideration to all these questions a bit later in  the program.

One more reminder for you, if you have a question for me or you want to suggest a topic idea, or you want to point me in a direction of a journal article or a news article, it's really easy to get in touch. Just head over to, click on the Contact link, and I do read each and every one of those that come through. 
The PediaCast voice line is back in business. So if you want to leave a message that way, just call 347-404-KIDS. That's 347-404-K-I-D-S, and you can leave a message that way, and we'll even get your voice on the program if you do that.

And also, I want to remind you the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child's health, be sure to call your doctor and arrange a face-to-face interview and a hands-on physical examination. 

Also, your use of this audio program is subject to the  PediaCast Terms of Use Agreement which you can find at

All right, let's take a quick break. I'll grab a sip of water  for my scratchy throat, and we'll get right to News You Can Use. It's coming up right after this.



Dr. Mike Patrick: All right, so children whose parents think they're God's gift to the world tend to outshine their peers. Unfortunately, the  manner in which they do the outshining is annoying at best and at its worst, a socially unacceptable hurdle to success. So here's the problem, parents who think their children are God's gift to the world tend to raise little narcissists.  That's according to the researchers at the Ohio State  University and the University of Amsterdam in the  Netherlands and reported recently by the Proceedings of the National Academy of Sciences. 

The study, which aimed to find the origins of narcissism involved researchers surveying parents and their children four times over 1 1/2 years to see if they could identify which factors led children to have inflated views of themselves. Results show that parents who "overvalued" their children when the study begin ended up with children who scored higher on tests of narcissism later on. 

Overvalued children were described by their parents in surveys as more special than other children and as kids who deserve something extra in life. 

Dr. Brad Bushman, co-author of the study and professor of Communication and Psychology at the Ohio State University says: "Children believe it when their parents tell them they're more special than others, which may not be good to them or for society."  

Lead author of the study, Dr. Eddie Brummelman, a post-doctoral researcher at the University of Amsterdam adds, "Parents with the best of intentions may overvalue their children thinking that will help boost their self-esteem, but rather than raising self-esteem, overvaluing practices may inadvertently raise levels of narcissism."

While the dangers of narcissism are well-known, its origins  are not. And this is the first prospective study to see how  narcissism develops over time.

The study involved 565 children and their parents in the  Netherlands. The children were 7 to 11 years of age when the study began and the families completed  surveys 4 times, 6 months apart during the course of the study.

Parental "overvaluation" of children was measured with a scale that asked moms and dads how much they agreed with statements such as, "My child is a great example for other children to  follow."

Both children and parents reported how much emotional  warmth the parents showed, with participants indicating how  much they agreed with statements like, "I let my child know I love him or her," or, "My father and mother lets me know he or she loves me." 

Children were measured for levels of both narcissism and self-esteem. While many people believe that narcissism is just self-esteem  on steroids, researchers say this is not exactly true. For example, in this study, children with high self-esteem, rather than seeing themselves as more special than others, agreed with statements that suggested they were happy with  themselves as a person and like the kind of person they were.  Dr. Bushman says people with high self-esteem think they're as good as others, whereas narcissist think they're better than others.
Investigators found that self-esteem and narcissism develop in different ways. While parental overvaluation was associated  with higher levels of child narcissism over time, it was not associated with more self-esteem. In contrast, parents who showed more emotional warmth had children with higher self-esteem over time. Parental warmth was not associated with narcissism.

In fact, Dr. Bushman says, "Overvaluation predicted narcissism, not self-esteem, whereas warmth predicted self-esteem, but not narcissism."


Parental overvaluation was connected to narcissism even after the researchers took into account the narcissism levels of the parents themselves. In other words, it's not just that narcissistic parents have narcissistic children, the parental overvaluation really played a key role.

A previous study by Drs. Bushman and Brummelman showed just how much some parents overvalue their children. In that study, parents were presented with topics their 8 to 12-year-old children should be familiar with, such as the astronaut, Neil  Armstrong, and the book, Animal farm. The parents were asked how familiar they believe their children were with those items, but the researchers also included items that did not exist such as Queen Alberta and The Tale of Benson Bunny.

Dr. Brummelman says, "Overvaluing parents tend to claim their children have knowledge on many different topics, even non-existent ones." But the researchers also note that parental overvaluation is not the only cause of narcissism in children. Like other personality traits, it is partly the result of genetics and the temperamental traits of the children themselves.

Dr. Bushman says, "Some children may be more likely than others to become narcissistic when their parents overvalue them." Kind of a pre-disposition. He adds that his narcissistic research has changed his parenting style when interacting with his three children. He says, "When I first started doing this research in the 1990s, I used to think that my children should be treated like they were extra special. I'm careful not to do that now. It's important to express warmth into your children because that may promote self-esteem, but overvaluing them may promote higher narcissism."

Dr. Brummelman points out a practical way this research may help parents. He says, "Parent-training interventions can teach parents to express affection and appreciation toward their children while being careful not to communicate that their kids are superior to others or entitled to privileges."

He adds, "Future studies should test whether this strategy can work."


So, there you have it, parents. At least, according to the present study, warm expressions of affection and appreciation will boost your child's self-esteem. That's a good thing, but overvaluing them, not so good, as this may lead to narcissism. Unless, of course, you're a narcissist yourself and you're convinced your overvaluing style of parenting is better. In which case, you probably tune me out awhile back because there's no way your child will grow up to be an annoying adult with unnecessary social hurdles blocking his or her path to success. Your kids are too perfect for that, right? Yeah, right. But for the rest of us, it's not too late to make an evidence-based difference in helping our children develop a healthy sense of self-esteem without crossing that line into narcissism.

All right, let's move on. Children of recently separated or divorced families are more likely to drink sugar-sweetened beverages than children in families where parents are married, putting them at a higher risk of obesity later in life. This, according to a new study from San Francisco State University. However, researchers also found that maintaining family routine can protect children from developing unhealthy eating habits during and after a divorce, which means families have some say in promoting their children's health during times of family transition.

According to the study, recently published in the journal, Childhood Obesity, shared routines like carving out time to talk each day or sitting down to eat together appear to guard children following divorce.

Dr. Jeff Cookston, lead researcher of the study and chair of Psychology at San Francisco State says when families separate, one of the things that is most impacted for kids is their day to day routines. Children are looking for consistency in their family environment, and family routines provide that security and continuity. 


The study is the first to examine the real-time eating habits of divorced and married families rather than relying on family members' recollections of past meals and behavior. 

Dr. Cookston and his colleagues interviewed the participants, parents and children of both married and divorced families, and asked them to keep a five-day diaries of their eating habits. When they looked at the data, they found that children whose parents were separated or recently divorced were much more likely to drink 
sugar-sweetened beverages than children whose parents are  married. Divorce did not appear to have a major impact on other unhealthful behaviors such as skipping breakfast or eating dinner outside the home.

Dr. Cookston says, "The reason is likely ease in access." Divorce can put a great deal of stress on families including children, and drinking sugary beverages can be a quick fix for dealing with that stress. He adds, "Sugary beverages are quite pleasurable, and they're accessible. The brain reacts with a great deal of enjoyment when we have a soda or an energy  drink. It also doesn't involve much thinking except for the decision to purchase them or bring them into the house." 

In addition, researchers were surprised to find that the more a divorced family maintain routines, such as eating a regular dinner together or making time for family activities, the less likely children were to drink sugary beverages.
Now, other behaviors such as how much time a parent spend with their child and warm parenting behavior, these did not have a similar benefit. The results have significant implications for public health. More than 1 million children experience divorce annually, and 34% of US' 6 to 11 year old are overweight putting  
them at risk for adult obesity. 

Dr. Cookston says, rather than feeling hungry or having a glass of water, it's easy during times of stress to turn to the quick enjoyable experience of drinking a sugary beverage, which is a problem. Because drinking sugary beverages, along with increased carbohydrate consumption is one of the things we've identified as strongly associated with the obesity epidemic in the United States.


He goes on to say, the good news is that routines can be modified. If a family recognizes an activity as important, they will be more willing to adjust their schedules to make time for it. To bring this research into practice, he is working with Dr. Gretchen George, an assistant professor of Consumer and Family Studies and  Dietetics at San Francisco State to develop a family cooking, a Nutrition Education Program to teach families how to plan, cook and eat healthful meals together. 

He says, the family meal is an opportunity for interaction collaboration that fills an essential need which is the food, but it can also be a fun, shared experience. 

So, a divorce is a big stress on any family, and it's easy to  understand why a mom and dad would allow their children to indulge on sugary beverages during that stressful time, right?  But keep in mind, even during this stressful time, choices and actions easily become lifelong habits. And you don't want the over-consumption of sugary beverages to become one of those  habits.

So if your family is going through a divorce, just be mindful of this study. Limit the availability of sugary beverages and make time together as a family. You really need to support one  another during that transition anyway; and especially making an eating family meals together seems to help. 

All right, so now that topic that I warned you about. We're going to talk about sex education. So you've been warned.

More young people than ever are getting most of their information about sexual matters from school. But the majority feel they are not getting all of the information they need and, young men in particular are missing out. 

This is according to the new research published by the British Medical Journal. The findings come from the third National Survey of Sexual Attitudes and Lifestyles, the largest scientific studies of sexual health and lifestyles in Great Britain. The research was carried out by the University College London, the London School of Hygiene and Tropical Medicine and NatCen Social Research.

Researchers compared data from nearly 4,000 men and women between the ages of 16 and 24 years of age taken from the National Survey of Sexual Attitudes and Lifestyles between 2010 and 2012. Their answers were compared to those previous surveys taken in 1990 to '91 and 1999 to 2001, to see how sources of information about sex have changed. Researchers also analyzed the data to  identify associations between where young people get most of their information and sexual behavior and outcomes, such as  what age they first had sex. 

So what do they find? Well, researchers say that for both men and women, school is now the most commonly reported main source of information about sexual matters,  having risen from  28% in 1990 to 40% in 2012. Parents were the main source of information for just 7% of men and 14% of women, and health  professionals for only 1% of men and 3% of women. Around half of men and women reported getting most of their information from less authoritative 'other' sources such as their first  
sexual partner, friends, siblings, media sources, and pornography.

Both men and women who learned about sexual matters mainly from school experienced first sexual intercourse at later age than those who got most of their information from other sources. They were also less likely to report unsafe sex or have been diagnosed with sexually transmitted infection.

Additionally, for young women, school acquired information was associated with them being less likely to have felt distressed about their sex life or experiencing sex against their will. But this was not the case for young men. Most people in the study, at 70%, said, 'they felt they ought to have known more' when they first felt ready for some sexual experience. 

Importantly, the findings indicate a gap between the types of information young people wanted and what they currently receive. They specifically said they would've liked more information about sexual feelings, emotions, and relationships as well as sexually transmitted infections; and for women, contraception.

Wendy MacDowall, study author and lecturer at the London School of Hygiene and Tropical Medicine says, "Our results suggest we need a broader framing of sex education in schools that addresses the needs of both young men and women with a move away from the traditional female-focused 'period, pills and pregnancy' approach." 

She adds, "Our research is timely with the current British debate on sex and relationship education in schools, but it's also important to remember that introducing statutory sex and relationship education in British schools won't solve everything. The factors influencing poor sexual health in multiple and complex and so too must be the solutions to them. 


"When asked for their preferred source of additional information, young people most commonly reported school, followed by parents and health professionals."

Dr. Claire Tanton, study author and senior research associate at the University College London, says, "Although our findings show there have been progress in sex and relationship education over the past two decades, we still have a long way to go to meet the needs of young adults."

"The terrain young people have to navigate as they are growing up has changed considerably over the past 20 years, and it will inevitably continue to do so. This means that whilst we need a more structured approach towards sex and relationships education, we must also be able to adapt to these changing needs." 

"The fact that many young people told us they wanted more information from a parent shows that parents also have an important role to play. There needs to be a combined approach which also supports parents to help them take an active role in teaching their children about sex and wider relationship issues.”

Dr.behavior Neha Issar-Brown, Programme Leader for the Population and Systems Medicine Board at the Medical Research Council, says, "Sexual behavior, or rather risky sexual behavior, can have a negative impact on several other areas of a young adult's life, including their general well-being and health."

She adds, "Not only does this research highlight the importance of responsible sexual information from all sources, but also the urgent need to tackle the current gender disparity in sexual and relationship education."


So, there you have it parents, your children — like those involved in this study in the United Kingdom — likely have lots of questions about sex and relationships. And while your local school district likely has a sexual education program in place, the quality and content of that program is gone to vary greatly from school district to school district.
Now, I know it can be embarrassing for some of us to discuss these topics with our children. But I think we can all agree these are important topics our kids want to know. And we owe it to them to help inform them with evidence-based sources — sources that answer their questions in an honest straight-forward and easy-to-understand way. Sources that are medically accurate, age-appropriate and comprehensive, covering topics such as abstinence and contraception, sexually-transmitted  infections, pregnancy and all topics in between. This way, you have access to whatever topic you're looking for when you need it. 

OK, so where can you find these collection of resources? Well, I'm glad you asked. I really like the library put together by the Sexuality Information Education Council of the United States also known as SIECUS, S-I-E-C-U-S. They're a clearing house of sex education resources. They don't develop the resources themselves, but they bring together a collection of the best resources from all corners of the Internet. 

They make sure the information is medically accurate, age appropriate, and comprehensive, and then they categorize it in such a way that you can find what you need. They keep this collection in a convenient location. It's I'll put link in the Show Notes for this episode, PediaCast 313.


And by the way, I do want to point out, there's nothing wrong with infusing these conversations with your family's cultural, and religious beliefs. In fact, if you're being genuine you should infuse your conversation with these things. But you also don't want to sweep things completely under the rug because your child is going to get the information somewhere, and you have the opportunity to present them with the best content. But you have to answer the questions they really have, and the topics they really want to know about.  

That's why I think it's important to have and extensive and comprehensive library at your fingertips. Review the lessons first, pick out  the best. I think you owe that to your kids. Sure it can be uncomfortable at times, but in the end the effort will be well worth it.

The American Academy of Pediatrics also has some great resources at, including the information on talking to your child about sex, adolescent sexuality, talk the talk before they walk the walk, helping teens resist sexual pressure, effective birth control for sexually active teens and teaching health education in school.

So lots of great resources all around, and I'll include these along with the link to the Sex Ed Library over at our landing site, in the Show Notes for this episode, again, 313.

Recent study published in the March 2015 issue of the Journal of the American Academy of Child and Adolescent Psychiatry finds that family-based interpersonal psychotherapy is more effective in treating preadolescent children with depression compared to child-centered therapy.

Preadolescents with depressive disorders may be under-diagnosed and go untreated because those presenting for out-patient treatment with clinically significant depressive symptoms in preadolescents often do not meet full diagnostic criteria for Major Depressive Disorder. However, preadolescents with depressive symptoms are at increased risk of experiencing Major Depressive Disorder in adolescence.


To date, no psychosocial intervention has been established as the superior treatment for preadolescents diagnosed with depression. For this study, researchers at the University of Pittsburgh School of Medicine randomly assigned 42 preadolescents (ages 7 to 12) with depression to one of two therapy groups: family-based interpersonal psychotherapy, an  intervention that includes parents in the child's treatment and  focuses on improving family and peer relationships, or to child-centered therapy group, which involves supportive counseling focused primarily on the child.

Depressive symptoms in children were measured by a clinician-rated children's depression rating scale, and mood questionnaires that both the child and parent completed.

Preadolescents receiving family-based interpersonal psychotherapy had higher rates of remission (66% versus 31%) when compared to just child-centered therapy. They also had a greater decrease in depressive symptoms from pre- to post-treatment, and lower depressive symptoms at post-treatment than did preadolescents with depression receiving child-centered therapy.

Children receiving family-based interpersonal psychotherapy also reported significant reductions in anxiety symptoms than did preadolescents in the child-centered therapy group. In addition, the study demonstrated that family-based interpersonal psychotherapy helped to reduce social impairment in depressed preadolescents, and these changes were associated with decreases in their depressive symptoms.

Dr. Laura Dietz, principal investigator of the study and  professor of Psychology and Psychiatry at the University of Pittsburgh School of Medicine, says, "These findings provide strong support for family-based interpersonal psychotherapy as an effective treatment for depression in children between the ages of 7 and 12. It also highlights the importance of early intervention for depressed preadolescents who are at risk for depression as teenagers."


So what are the take-home points here for moms and dads? Well, first, pre-teens (7 to 12 year olds) can and do have symptoms of depression, and left unchecked, these symptoms can evolve into full-blown Major Depressive Disorder during the teenage years.

Second, if your concerned your pre-teen is suffering from depression, be sure to let your doctor know. Symptoms of depression and anxiety at this age can vary from one child to another, and includes such things as changes in their emotions, their interests, their eating, their sleeping, their school  work and their relationships.

Third, if your pre-teen is suffering from depression, according to this study, it's important to include the entire family in counseling and therapy, right from the get-go, with family-based interpersonal psychotherapy, which focuses on the family, relationships within the family, and relationship that the child has with their peers, their friends. Why? Because we have evidence available to show this works.

All right, let's move on to smoking an e-cigarettes. Global review from the University of Calgary in Canada and Queensland University of Technology in Australia into the effectiveness of family-based programs has found that these programs can be highly effective in stopping children from taking up smoking.

This is according to findings recently published in the Cochrane Library of the Cochrane Collaboration, a worldwide independent network of health care providers, practitioners, researchers, patient advocates and other forms of health professionals from a 120-plus countries preparing high quality evidence-based information to support health decisions.

Dr. Philip Baker from Queensland University of Technology's Institute of Health and Biomedical Innovation says, "Preventing  children from starting to smoke is important to avoid a lifetime of addiction, poor health, and social and economic consequences." 

According to the Australian government's Department of Health, each year smoking kills an estimated 15,000 Australians and costs the nation $31.5 billion in health and economic costs.

Dr. Baker says the University of Calgary and Queensland University of Technology research teams found that high intensity family-based programs might reduce experimentation and uptake of smoking by as much as 32%.


Dr. Baker says, "The common feature of the effective high-intensity interventions were encouraging authoritative parenting, where parents show a strong interest in and care for their teenagers, often with a rule setting. This is different from authoritarian parenting, where parents direct "do as I say," or neglectful parenting,  or unsupervised parenting."

He says, "Many of the programs were aimed at families with youth between the ages of 11 and 14 and focus on family functioning."

He goes on to explain, "We found the most effective interventions are those which encourage parents to think they can make a difference in their adolescent's tobacco-related behavior, strengthen their nurturing skills, encourage the setting of limits, and provide strategies for meaningful discussion with their adolescents about substances. This approach helps strengthen their children's ability to push back peer pressure."

Dr. Roger Thomas from the University of Calgary says, "The review also found that family-based programs can be combined with school-based programs to increase overall effectiveness.

"In Canada, rates of smoking in adults are at the lowest level for years through control efforts and people quitting. However, preventing addiction in the first place, especially during childhood, is critical to living a smoke-free life in keeping those numbers down." 

He adds, "Our review demonstrates an opportunity for families, the community and the government to invest in family programs which offers a lifetime benefit."

The research team examined 27 randomized controlled studies of over 36,000 participants. Fourteen of the studies reported measures of smoking which enabled meta-analysis, a research technique which combines individual studies for a larger, more powerful conclusion.

Dr. Baker points out, "The evidence is predominantly from the United States which conducted 23 of the 27 trials, with an additional two from Europe, one from India and one from  Australia. So the evidence is mainly from one country, on one continent." Ours.


So parents, here's another example of the importance of the entire family in improving outcomes and making a healthy difference in the lives of our children. Be the positive role model. Seek out a smoking cessation program for your own deadly addiction and get the entire family involved with the anti-smoking program.

What about e-cigarettes? What role do they play in smoking cessation and smoking alternatives? Well, the Canadian Pediatric Society recently had some strong words to say about this developing trend and since I agree with those words, I wanted to share them with you.

With the use of e-cigarettes growing among kids, the Canadian Pediatric Society is calling on governments around the world to curb and control the industry.

Dr. Richard Stanwick, past president of the Canadian Pediatric Society and author of the statement says, "Our youth are experimenting with e-cigarettes in increasing numbers. Without regulatory controls and appropriate warnings, this is another generation at risk of becoming addicted to nicotine. Our governments urgently need to start treating e-cigarettes like traditional tobacco products."

He says using e-cigarettes, which are marketed as safer alternatives to traditional smoking, risks opening the door to nicotine dependency. He is concerned that the devices will reverse decades of hard-fought decreases in tobacco use among children and youth.

E-cigarettes generate a substantial amount of toxins and heavy  metals at levels that can exceed conventional cigarettes. Children and youth are particularly at risk for harm from these toxins, which may cause or worsen breathing problems such as asthma.

In addition, nicotine poisonings from e-liquids and discarded cartridges are on the rise among children, with toxic effects rivalling and sometimes worse than those of conventional cigarettes.

In their statement, the Canadian Pediatric Society recommends that government expands regulations governing marketing, packaging and labeling of e-cigarettes as has been done with conventional tobacco products, strictly enforce maximum dosage of nicotine in e-liquids and the use of child-resistant containers, and ban e-cigarette-related advertising intended to appeal to children and youth.


They are also calling upon local governments to make it illegal for anyone to buy, possess or use e-cigarette products if they are not old enough to buy tobacco products, require e-devices and e-liquids to be sold only in places where tobacco is legally sold, and expand all current restrictions on smoking in public spaces or workplaces to include the use of e-cigarettes.

Dr. Stanwick says, "As Canadians, we have a right to clean air. All levels of government should continue a legacy of protecting this right for children and youth."

And I say, I agree. E-cigarettes are a very real and increasing danger to the health of our children, and as we saw earlier in this report, families in addition to government can make a difference in the choices and habits our children make. So moms and dads, recognize the hazards, be that positive role model and take the message to your kids. As it relates to traditional tobacco products and e-cigarettes.

All right, that's all the time we have for our News Parents Can Use this week. I will be back to wrap up the program, right after this.


Dr. Mike Patrick: All right, we have just enough time to say thank you to all of you for taking time out of your day to make PediaCast a part of it. Always appreciate that. 

I do want to remind you that launching today, April 1st 2015, PediaCast CME over at So this is a sibling or a companion podcast to PediaCast, but instead of being primarily aimed at moms and dads, we're aiming this one at healthcare providers. So if you are a healthcare provider or you know a healthcare provider, please check out PediaCast CMES or let your healthcare providers or your colleagues know about PediaCast CME.


Our intention is to make it easy and useful. And we're going to be covering lots of different topics, kind of split between faculty development. So that means that those who are involved in medical education, not just doctors who are at a teaching hospital, but there's a lot of community practitioners out there who teach medical students in their office. They have someone shadows them, maybe introduction to chemical medicine or maybe they have a resident rotating through their office. Also nurse practitioners, they train nurse practitioner students, and nurses training nursing students. Really, anyone who's involved in medical education of any type will likely find the faculty development topics useful.

Just a couple of examples that we have there or we have planned — microteaching, what is that? We know the five minutes that you have with a learner to talk about patients, so they give you a presentation and you want to do a little bit of the teaching, but you have like five minutes together. How do you make that five minutes count in a busy office? So that's what we call microteaching. 

We're going to talk about difficult learners, doctors teaching doctors, faculty development, medical mentorship, how to stay connected in the medical world through the use of digital technology. So lots of cool stuffs there with faculty development.

And then, we're also going to cover general pediatrics topics and just sort of some topics we have on the horizon. We're going to talk about medical marijuana as that is kind of a controversial issue right now.

We're also going to talk about the diagnosis and treatment of mood disorders in a primary care office. Things like anxiety, depression, bipolar disorder, aggression, obsessive-compulsive disorder, even schizophrenia. So how do primary care doctors who may have limited resources to mental health, or it may take awhile to get your patient in to see a mental health specialist, how do you diagnose and treat mental disorders in a primary care office? I think that's going to be a really good series and that's going to be coming your way in a not too distant future over at 

So again, check that out. And if you're a parent, let your doctor know not only about this program, but about that program as well. 


And we will be offering free Category 1 AMA-accredited CME, Continuing Medical Education. So all of you physicians and medical providers out there have requirements in terms of how many hours of CME you get each year and you can count participating with PediaCast CME among those hours. 

So we're really excited  about being able to offer that to you.

All right, that is all the time we have today. PediaCast is a production of Nationwide Children's Hospital. Podcast are available on iTunes, under the Kids and Family Section of their directory, and reviews there are always welcome and helpful. 

We're also on iHeart Radio, simply search for PediaCast. And you'll also find PediaBytes, B-Y-T-E-S, on iHeart Radio. These are shorter clips from the show and a bit  easier to take in if you only have a few minutes. 

We are in most podcasting apps for iPhone and Android including the Apple podcast app, Downcast, iCatcher, Pod Bay, Stitcher and TuneIn. 

And of course, there's the landing site,, where you will find an archive of more than 300 episodes, our Show Notes, written transcripts of each program, our Terms of Use, and an easy Contact Page to ask your questions and suggest show topics. 

You can also call our voice line and leave a message that way. The number again is 347-404-KIDS, 347-404-5437. 

And then, there's social media, PediaCast is on Facebook. Be sure to follow us there for breaking news and commentary on pediatric topics. Plus it's a cool community of moms and dads supporting one another. We're also on Google Plus, Twitter and Pinterest — less of a community feel on those spaces, but if you're there, follow and share to keep up-to-date with the latest show topics. 


And then, of course, there's good old fashion face-to-face media. We always appreciate you talking us up with your family, friends, neighbors and co-workers, anyone with kids or anyone who takes care of children. And finally, please tell your child's doctor about the program. Next time you're in for a check-up, say, "Hey, doc, there's a great evidence-based pediatric podcast for parents called PediaCast and you should share it with your families," and to help you do that, they have posters available under the Resources tab at

And while you're at it again let your providers know we have that podcast for them as well, PediaCast CME launching today, similar to this program, but we turn up the science a notch or two and provide free Category 1 CME credit for listening. Shows and details are available at

All right, that is a wrap for this one. Until next time, this is Dr. Mike, saying stay safe, stay healthy, and stay involved with your kids. So long everybody.


Announcer 2:  This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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