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By E. Roland. Regis College. 2019.

Men in general seem to hold more permissive attitudes toward sex order viagra sublingual once a day, to desire a greater variety of sexual partners and behaviors buy viagra sublingual paypal, and to seek sexual sensations more frequently than women do purchase viagra sublingual 100mg fast delivery. In addition to information about gender roles discount viagra sublingual 100 mg overnight delivery, values, and so forth, there is a wide array of factual information pertaining to sex that can have important consequences; this includes topics such as possible unwanted consequences of sex, the prevention of such consequences, sexual disorders such as erectile dysfunction or vaginitis, the prevention and treatment of such disorders, and so on. That such information is vital is reflected in the facts that over one-third of adult women in the United States have a limited or incorrect understanding of how STDs can be contracted and that one in five adults in the United States have genital herpes (Kaiser Family Foundation, 2003). Adolescents and young adults receive information about sex from a number of sources; parents, peers, churches, media sources, and schools all make a contribution. When adolescents or young adults are asked to indicate their first or predominant source of information about sex, many cite peers or friends (Andre, Dietsch, & Cheng, 1991; Andre, Frevert, & Schuchmann, 1989; Ballard & Morris, 1998; Kaiser Family Foundation et al. Other research, drawn from diverse samples and conducted over many years, suggests that for most topics related to sex, however, independent reading is a more important source of information than parents, peers, or schools (Andre et al. Further, these same studies suggest that this is true for both men and women, and for the sexually experienced as well as the less experienced. Though materials used for independent reading certainly vary, magazines are definitely one such source. Researchers who have employed diverse methods have arrived at the conclusion that adolescents and young adults use magazines to gain information about sexual topics including sexual skills and techniques, reproductive issues, sexual health, and alternative sexualities (Bielay & Herold, 1995; Treise & Gotthoffer, 2002), and that they often prefer magazines over other sources of information (Treise & Gotthoffer, 2002). These findings, coupled with those that document independent reading as an important source of information about sex, suggest that magazines may be very important to the development of knowledge about, beliefs about, and attitudes toward sex, especially for young people. There are theoretical reasons to believe that reading magazines to obtain sexual information may have effects on attitudes, beliefs, and behaviors, as well as information-type knowledge. Cultivation theory has long held that exposure to a consistent set of media messages can lead to altered beliefs about the nature of the real world (Gerbner, Gross, Morgan, Signorielli, & Shanahan, 2002). There is little available research that deals with the issue of what effects, if any, independent reading about sex in general, or reading about sex in magazines in particular, has on readers. What is available is largely correlational in nature. There is an association between receiving more sexual education from independent reading and better performance on a test of knowledge about sex (Andre et al. There is also some evidence that receiving more information from independent reading as opposed to other sources may be associated with more sexual experience (Andre et al. In addition, in one study, reading sex manuals and reading Playboy were each associated with beliefs about greater frequency of behaviors including sexual intercourse, oral sex, and erotic dreams, and reading Playboy was associated with beliefs that sex without love, the use of stimulants for sex, and the exchange of sex for favors were relatively more common (Buerkel-Rothfuss & Strouse, 1993). Limited experimental evidence also indicates that viewing nonpornographic sexual images from magazines can lead to greater endorsement of rape-supportive attitudes (Lanis & Covell, 1995; MacKay & Covell, 1997). Given the apparent influence of magazine content and the importance of independent reading in general, and magazines in particular, as sources of sexual information for young people, it is important to understand what messages about sex are contained in the magazines read by young people. Relatively little research is available on this topic, and what is available is largely concerned with magazines targeted at young women. Magazines targeted at adolescent girls, such as Seventeen and YM, have been found to contain conflicting messages about sex; they encourage girls to be sexy, emphasize the importance of romantic relationships, instruct young women on how to please young men, and simultaneously emphasize patience and control (Carpenter, 1998; Durham, 1998; Garner et al. Studies of magazines targeted at adult audiences, both male and female, such as Cosmopolitan, Self, GQ, and Playboy, have demonstrated that their contents treat women as sex objects, both through use of objectifying images (Krassas, Blauwkamp, & Wesselink, 2001) and the written content of articles about relationships (Duran & Prusank, 1997). Further, magazines such as Playboy, despite their ostensible status as "lifestyle magazines," seem to be in a very different category than lifestyle magazines such as Cosmopolitan that are oriented toward women. That includes enjoying sex and intimate relationships. Like adults of all ages, you probably want to continue sharing your life in a fulfilling relationship. A healthy sexual relationship can positively affect all aspects of your life, including your physical health and self-esteem. Most people still have sexual fantasies and desires well into their 80s and 90s. As you know, your body changes as you age, and these changes can affect your sexual relationships. Jokes abound about the rapaciousness of senior females in quest of a male functional enough to engage in it. And my teenage son wrinkles up his nose and says "Eewww! Media coverage of aging baby-boomers and their older cousins would have us believe that seniors are a homogeneous group jumping into bed and "hooking up - with great regularity. In fact, the level of sexual interest and activity among people over the age of 65 is as diverse as the individuals who make up that population. A recent survey of married men and women showed that 87% of married men and 89% of married women in the 60-64 age range are sexually active. Those numbers drop with advancing years, but 29% of men and 25% of women over the age of 80 are still sexually active. So clearly, the older years can be a time of relief that children are no longer lurking in nearby bedrooms, and there is no longer a need to jump up early in the morning for work. For some, older age is a time of freedom to explore sexual expression in ways never before realized. A time to cast away the "shoulds" of earlier years, the societal expectations. For others, they are more than happy to forget about sexual performance, and to seek other forms of companionship and interpersonal sharing. One of the most significant losses with advancing age is the loss of intimacy. Many seniors have no opportunity for physical contact, affectionate dialogue, snuggling, or shared secrets. The actual act of intercourse is only one possible form of sexual expression. The continuing development of your sexual identity and the evolution of your own form of sexual expression with advancing years represents, in many ways, the most basic expression of your self. One fascinating recent study showed that men who have more than two orgasms per week have lower mortality statistics. But these numbers only demonstrate a correlation between sexual activity and longevity, they do not prove that sex prolongs life. What is probably true is that people who are well, and vigorous enough to engage in sexual activity are also healthier in general. But I believe that sexual activity, in its many forms, can be physically, intellectually, and even spiritually fulfilling. It is often a good form of exercise, and it can stimulate the brain and promote good mental function. For some, sexual expression represents the most elemental manifestation of true self. What is most important is to find the type of sexual expression that suits you best. Some people, either by choice or by necessity, find much gratification in sexual self-stimulation. There may be some resistance to this form of self-exploration by people who were raised with the idea that self-stimulation is "dirty" or perverted. But many who have overcome this resistance have been exhilarated by a whole new experience. Others explore sexual sharing in new ways with a longtime partner, or with a new partner. And still others, especially elderly women, have discovered new intimacies with same-sex partners, even after spending most of their adult lives in heterosexual relationships. Again, the key to satisfaction and fulfillment with sexual experience in later life is individual choice. There are many changes that happen in our bodies as we age, and some of these changes can modify sexual experience in later years. Both women and men experience slower arousal responses. This can lead to anxiety in people who do not understand that this change is normal. The clitoris can become highly sensitive, even too sensitive. Uterine contractions with orgasm may at times be painful. The entire male sexual response tends to slow down in the following ways:There is a delay in erection. There is a need for more manual stimulation to achieve an erection.

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The endpoint associated with each instrument is change from baseline in the total score to the end of week 6 generic viagra sublingual 100 mg visa. These changes are then compared to placebo changes for the drug and control groups generic viagra sublingual 100mg mastercard. The results of the studies follow:In a 6-week cheap viagra sublingual 100 mg fast delivery, placebo-controlled trial (N=145) involving two fixed doses of Latuda (40 or 120 mg/day) order discount viagra sublingual, both doses of Latuda at Endpoint were superior to placebo on the BPRSd total score, and the CGI-S. In a 6-week, placebo-controlled trial (N=180) involving a fixed dose of Latuda (80 mg/day), Latuda at Endpoint was superior to placebo on the BPRSd total score, and the CGI-S. In a 6-week, placebo and active-controlled trial (N=473) involving two fixed doses of Latuda (40 or 120 mg/day) and an active control (olanzapine), both Latuda doses and the active control at Endpoint were superior to placebo on the PANSS total score, and the CGI-S. In a 6-week, placebo-controlled trial (N=489) involving three fixed doses of Latuda (40, 80 or 120 mg/day), only the 80 mg/day dose of Latuda at Endpoint was superior to placebo on the PANSS total score, and the CGI-S. Thus, the efficacy of Latuda at doses of 40, 80 and 120 mg/day was established in two studies for each dose. However, the 120 mg dose did not appear to add additional benefit over the 40 mg dose (Table 10). Table 10: Summary of Results for Primary Efficacy Endpointsa Least Squares Mean (Standard Error)LS Mean (SE)a Difference from Placebo in Change from BaselineExamination of population subgroups based on age (there were few patients over 65), gender and race did not reveal any clear evidence of differential responsiveness. Latuda tablets are white to off-white, round (40 mg), or pale green, oval (80 mg) and identified with strength specific one-sided debossing, "L40" (40 mg), or "L80" (80 mg). Tablets are supplied in the following strengths and package configurations (Table 11):Table 11: Package Configuration for Latuda TabletsStore Latuda tablets at 25`C (77`F); excursions permitted to 15` - 30`C (59` - 86`F). The information in this monograph is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects. This information is generalized and is not intended as specific medical advice. If you have questions about the medicines you are taking or would like more information, check with your doctor, pharmacist, or nurse. Saphris (asenapine) is an antipsychotic medication used for the treatment of bipolar disorder and schizophrenia. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of 17 placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in the drug-treated patients of between 1. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. SAPHRIS^ (asenapine) is not approved for the treatment of patients with dementia-related psychosis [see Warnings and Precautions (5. SAPHRIS is indicated for the acute treatment of schizophrenia in adults [see Clinical Studies (14. The physician who elects to use SAPHRIS for extended periods in schizophrenia should periodically re-evaluate the long-term risks and benefits of the drug for the individual patient [see Dosage and Administration (2. SAPHRIS is indicated for the acute treatment of manic or mixed episodes associated with bipolar I disorder with or without psychotic features in adults [see Clinical Studies (14. If SAPHRIS is used for extended periods in bipolar disorder, the physician should periodically re-evaluate the long-term risks and benefits of the drug for the individual patient [see Dosage and Administration (2. Usual Dose for Acute Treatment in Adults: The recommended starting and target dose of SAPHRIS is 5 mg given twice daily. In controlled trials, there was no suggestion of added benefit with the higher dose, but there was a clear increase in certain adverse reactions. The safety of doses above 10 mg twice daily has not been evaluated in clinical studies. Maintenance Treatment: While there is no body of evidence available to answer the question of how long the schizophrenic patient should remain on SAPHRIS, it is generally recommended that responding patients be continued beyond the acute response. Usual Dose for Acute Treatment in Adults: The recommended starting dose of SAPHRIS, and the dose maintained by 90% of the patients studied, is 10 mg twice daily. The dose can be decreased to 5 mg twice daily if there are adverse effects. In controlled trials, the starting dose for SAPHRIS was 10 mg twice daily. On the second and subsequent days of the trials, the dose could be lowered to 5 mg twice daily, based on tolerability, but less than 10% of patients had their dose reduced. The safety of doses above 10 mg twice daily has not been evaluated in clinical trials. Maintenance Treatment: While there is no body of evidence available to answer the question of how long the bipolar patient should remain on SAPHRIS, it is generally recommended that responding patients be continued beyond the acute response. To ensure optimal absorption, patients should be instructed to place the tablet under the tongue and allow it to dissolve completely. SAPHRIS sublingual tablets should not be crushed, chewed, or swallowed [see Clinical Pharmacology (12. Patients should be instructed to not eat or drink for 10 minutes after administration [see Clinical Pharmacology (12. In a study of subjects with hepatic impairment who were treated with a single dose of SAPHRIS 5 mg, there were increases in asenapine exposures (compared to subjects with normal hepatic function), that correlated with the degree of hepatic impairment. While the results indicated that no dosage adjustments are required in patients with mild (Child-Pugh A) or moderate (Child-Pugh B) hepatic impairment, there was a 7-fold increase (on average) in asenapine concentrations in subjects with severe hepatic impairment (Child-Pugh C) compared to the concentrations of those in subjects with normal hepatic function. Therefore, SAPHRIS is not recommended in patients with severe hepatic impairment [see Use in Special Populations (8. Dosage adjustments are not routinely required on the basis of age, gender, race, or renal impairment status [see Use in Specific Populations (8. There are no systematically collected data to specifically address switching patients with schizophrenia or bipolar mania from other antipsychotics to SAPHRIS or concerning concomitant administration with other antipsychotics. While immediate discontinuation of the previous antipsychotic treatment may be acceptable for some patients with schizophrenia, more gradual discontinuation may be most appropriate for others. In all cases, the period of overlapping antipsychotic administration should be minimized. SAPHRIS 5 mg tablets are round, white to off-white sublingual tablets, with "5" on one side. SAPHRIS 10 mg tablets are round, white to off-white sublingual tablets, with "10" on one side. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. SAPHRIS is not approved for the treatment of patients with dementia-related psychosis [see Boxed Warning ]. In placebo-controlled trials with risperidone, aripiprazole, and olanzapine in elderly subjects with dementia, there was a higher incidence of cerebrovascular adverse reactions (cerebrovascular accidents and transient ischemic attacks) including fatalities compared to placebo-treated subjects. SAPHRIS is not approved for the treatment of patients with dementia-related psychosis [see also Boxed Warning and Warnings and Precautions (5. A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with administration of antipsychotic drugs, including SAPHRIS. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure. A syndrome of potentially irreversible, involuntary, dyskinetic movements can develop in patients treated with antipsychotic drugs. Although the prevalence of the syndrome appears to be highest among the elderly, especially elderly women, it is impossible to rely upon prevalence estimates to predict, at the inception of antipsychotic treatment, which patients are likely to develop the syndrome. Whether antipsychotic drug products differ in their potential to cause Tardive Dyskinesia (TD) is unknown. The risk of developing TD and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of antipsychotic drugs administered to the patient increase. However, the syndrome can develop, although much less commonly, after relatively brief treatment periods at low doses.

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However order viagra sublingual online from canada, several factors or symptoms help us to distinguish between the hard worker and the workaholic:The workaholic not only works hard but also sets impossibly high standards and is beset by a sense of never being good enough order viagra sublingual. He/She has a strong need to control other people and situations purchase viagra sublingual paypal, and he/she finds it difficult to delegate responsibilities purchase viagra sublingual with mastercard. The workaholic life is characterized by a striking lack of balance. The workaholic gives himself little time to develop and enjoy personal relationships. Caring for herself is low on her priority list, and health problems are often ignored until they become debilitating. Moving from task to task, deadline to deadline, the workaholic feels most alive when totally immersed in a project or dashing between several projects. The workaholic may become addicted to the adrenaline rush generated by dealing with a crisis. The workaholic uses work to escape from difficult feelings and in this process loses awareness of her desires and needs. The family members and friends of the workaholic experience themselves as a lower priority than his/her work, and this experience frequently erodes relationships. If you answer yes to 3 or more questions, you may have a problem worth discussing with a mental health counselor or your doctor. Do you get more excited about your work than about family or anything else? Is work the activity you like to do best and talk about most? Do you turn your hobbies into money-making ventures? Do you take complete responsibility for the outcome of your work efforts? Have your family or friends given up expecting you on time? Do you underestimate how long a project will take and then rush to complete it? Do you believe that it is okay to work long hours if you love what you are doing? Do you get impatient with people who have other priorities besides work? Is the future a constant worry for you even when things are going very well? Do you do things energetically and competitively including play? Do you get irritated when people ask you to stop doing your work in order to do something else? Have your long hours hurt your family or other relationships? Do you think about your work while driving, falling asleep or when others are talking? Do you believe that more money will solve the other problems in your life? Learn about work addiction treatment through therapy and support groups like Workaholics Anonymous and what recovery from workaholism really means. Confronting the workaholic will generally meet with denial. They may enlist the help of a therapist who works with workaholics to assess the person and recommend treatment options for work addiction. The work addict has often taken on parental responsibilities as a child to manage a chaotic family life or to take refuge from emotional storms, or physical or sexual abuse. Cognitive-behavioral therapy will assist him/her to examine the rigid beliefs and attitudes that fuel overwork. A core belief such as "I am only lovable if I succeed" may be replaced by the more functional belief, "I am lovable for who I am, not for what I accomplish. In treatment for work addiction, the workaholic develops a moderation plan that introduces balance into life, including a schedule that allows time for physical health, emotional well-being, spiritual practices, and social support. Setting boundaries between home and work is critical, as is scheduling daily and weekly time for self-care, friendships, and play. Each day, the recovering workaholic makes time for a quiet period, for prayer or meditation, listening to music, or engaging in another "non-productive" activity. Meetings of Workaholics Anonymous, a 12-step program, can provide support and tools for recovery. In some cases, Attention Deficit Disorder (ADD) underlies workaholism. Assessment by a psychologist can clarify whether ADD or ADHD is a factor. If anxiety or depression is a contributing factor, medication may help to provide a more stable emotional climate as the workaholic makes the needed behavioral changes. The work addiction treatment can also provide an occasion for the co-workers, family members and friends to examine themselves. Do tensions exist at work or home that the workaholic and others avoid by overworking or other addictive behaviors? Do family members hold an ideal of "the good father/mother" that does not allow for the normal successes and failures of human life? As the others who surround the workaholic examine their own lives, these people will be better able to support the workaholic as he/she continues his/her recovery. These workaholic articles provide insight into the life of the workaholic. Get in-depth information on work addiction, from signs and symptoms of a workaholic to work addiction treatment. Urschel was a guest on the HealthyPlace Mental Health TV show talking about his new, revolutionary, science-based program for addictions recovery. Keith MillerReader Comment: "I found this book well written and comprehensive, but what was the most moving to me was the way in which it touched the most painful, sad and hidden part of my relationships. Shaw, Jane Irvine, Paul RitvoReader Comment: "Covers all the most important treatment approaches without moralizing and helps you choose what is most helpful or appropriate to your situation. Ruden, Marcia Byalick, Marcia Byalick Reader Comment: "It provides a good, solid scientific understanding of addiction in simple language and offers useful guidelines about moving beyond sobriety and toward cure. Washton, Donna Boundy, Donn Boundy Reader Comment: "Highly recommended to any thinking person interested in understanding and recovering from their addiction. Some meth addiction treatment methodologies like those found at the Matrix Institute (or the matrix model) have been developed specifically for meth addicts. The first and easiest step to make when a meth addict wishes to get treatment for a meth addiction is to go to the doctor. Meth addiction, like all addictions, is a medical and mental health issue and should always be handled by professionals. Meth addiction is serious and the health effects of meth addiction and meth addiction treatment should not be taken lightly. A doctor can also provide the crystal meth addict with meth addiction resources and meth addiction treatment information. Meth addiction is known to be a huge problem, particularly in urban areas, so the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the US Department of Health and Human Services, has built a Substance Abuse Treatment Facility Locator. The Substance Abuse Treatment Facility Locator provides information on where a crystal meth addict can get help, also where people suffering from other addictions can get help. There are more than 11,000 treatment programs listed and they include:Residential treatment centersOutpatient treatment programsHospital inpatient programsTreatment centers listed typically help any drug addiction, meth addiction included. These treatment facilities also typically handle mental health issues as well as meth addiction treatment. A sliding scale means that facility charges based on how much a client can pay. Individual meth addiction facilities should be contacted regarding specific policies. For low or no-cost meth addiction treatment, crystal meth addicts may also contact the State Substance Abuse Agency or call a SAMHSA help line for further details on meth addiction services. Substance Abuse and Mental Health Services Administration (SAMHSA): http://www.

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It is what makes us get up in the morning and face the coming day buy generic viagra sublingual 100mg on-line. Even in the face of adversity or drudgery we are motivated to endure order viagra sublingual toronto, because we envision an end to these conditions and a better future at some later date discount 100 mg viagra sublingual with visa. Anticipation of future events is what makes our body ready itself for the sex act order viagra sublingual canada, it is what motivates us to amass wealth and power, to buy a lotto ticket, to set goals and have aspirations. Even the diehard sofa potato looks to the future as told to him by the upcoming programs in the television listings, and of course there is that next thirst quenching beer and resultant belch, to look forward to. We all have a need for something to look forward to, if we lose all hope that the future holds anything positive or that our present pain will ever end, most of us will depress. Knowing what is happening to us goes a long way in being able to regain control over our life and our emotions. But real healing will not be possible until the depression is lifted. I recommend that anyone who is depressed and having suicidal thoughts, seek help. There are drugs which may help to maintain a depression free life, and therapy is needed to help us better understand why we became depressed and what we need to do in order to live our life in control of our emotions. This manuscript was conceived while I sat on a ledge overlooking the abyss of hell. I would contemplate if I should follow the intense urge to jump and end it all, or if I could muster the strength to take control of my emotions and of my life. I tried so very hard to picture the future - with me in it. I hope that relating the knowledge I have gained from my experience and my pain, might somehow help ease your pain. Knowing what is happening to you and some of the reasons why it is happening, might help you regain a positive view of your future, a view that includes both, you and me. If someone tells you they are thinking about suicide, you should take their distress seriously, listen nonjudgmentally, and help them get to a professional for depression evaluation and treatment. People consider suicide when they are hopeless and unable to see alternative solutions to problems. Suicidal behavior is most often related to a mental disorder ( depression ) or to alcohol or other substance abuse. Suicidal behavior is also more likely to occur when people experience stressful events (major losses, incarceration). If someone is in imminent danger of harming himself or herself, do not leave the person alone. You may need to take emergency steps to get help, such as calling 911. When someone is in a suicidal crisis, it is important to limit access to firearms or other lethal means of committing suicide. Firearms are the most commonly used method of suicide for men and women, accounting for 60 percent of all suicides. Nearly 80 percent of all firearm suicides are committed by white males. The second most common method for men is hanging; for women, the second most common method is self-poisoning including drug overdose. The presence of a firearm in the home has been found to be an independent, additional risk factor for suicide. Thus, when a family member or health care provider is faced with an individual at risk for suicide, they should make sure that firearms are removed from the home. More than four times as many men as women die by suicide; but women attempt suicide more often during their lives than do men, and women report higher rates of depression. Several explanations have been offered: a) Completed suicide is associated with aggressive behavior that is more common in men, and which may in turn be related to some of the biological differences identified in suicidality. Women in all countries are more likely to ingest poisons than men. In countries where the poisons are highly lethal and/or where treatment resources scarce, rescue is rare and hence female suicides outnumber males. More research is needed on the social-cultural factors that may protect women from completing suicide, and how to encourage men to recognize and seek treatment for their distress, instead of resorting to suicide. There is a common perception that suicide rates are highest among the young. However, it is the elderly, particularly older white males that have the highest rates. And among white males 65 and older, risk goes up with age. White men 85 and older have a suicide rate that is six times that of the overall national rate. White males are more deliberate in their suicide intentions; they use more lethal methods (firearms), and are less likely to talk about their plans. It may also be that older persons are less likely to survive attempts because they are less likely to recuperate. Over 70 percent of older suicide victims have been to their primary care physician within the month of their death, many with a depressive illness that was not detected. Despite good intentions and extensive efforts to develop suicide awareness and prevention programs for youth in schools, few programs have been evaluated to see if they work. Many of these programs are designed to reduce the stigma of talking about suicide and encourage distressed youth to seek help. Of the programs that were evaluated, none has proven to be effective. In fact, some programs have had unintended negative effects by making at-risk youth more distressed and less likely to seek help. By describing suicide and its risk factors, some curricula may have the unintended effect of suggesting that suicide is an option for many young people who have some of the risk factors and in that sense "normalize" it???just the opposite message intended. Prevention efforts must be carefully planned, implemented and scientifically tested. Because of the tremendous effort and cost involved in starting and maintaining programs, we should be certain that they are safe and effective before they are further used or promoted. There are number of prevention approaches that are less likely to have negative effects, and have broader positive outcomes in addition to reducing suicide. One approach is to promote overall mental health among school-aged children by reducing early risk factors for depression, substance abuse and aggressive behaviors. In addition to the potential for saving lives, many more youth benefit from overall enhancement of academic performance and reduction in peer and family conflict. A second approach is to detect youth most likely to be suicidal by confidentially screening for depression, substance abuse, and suicidal ideation. If a youth reports any of these, further evaluation of the youth takes place by professionals, followed by referral for treatment as needed. Adequate treatment of mental disorder among youth, whether they are suicidal or not, has important academic, peer and family relationship benefits. With regard to completed suicide, there are no national statistics for suicide rates among gay, lesbian or bisexual (GLB) persons. Sexual orientation is not a question on the death certificate, and to determine whether rates are higher for GLB persons, we would need to know the proportion of the U. This is particularly a problem when considering GLB youth who may be less certain of their sexual orientation and less open. In the few studies examining risk factors for suicide where sexual orientation was assessed, the risk for gay or lesbian persons did not appear any greater than among heterosexuals, once mental and substance abuse disorders were taken into account. With regard to suicide attempts, several state and national studies have reported that high school students who report to be homosexually and bisexually active have higher rates of suicide thoughts and attempts in the past year compared to youth with heterosexual experience. Experts have not been in complete agreement about the best way to measure reports of adolescent suicide attempts, or sexual orientation, so the data are subject to question. But they do agree that efforts should focus on how to help GLB youth grow up to be healthy and successful despite the obstacles that they face. Because school based suicide awareness programs have not proven effective for youth in general, and in some cases have caused increased distress in vulnerable youth, they are not likely to be helpful for GLB youth either. Because young people should not be exposed to programs that do not work, and certainly not to programs that increase risk, more research is needed to develop safe and effective programs. Historically, African Americans have had much lower rates of suicides compared to white Americans.