Parents and pediatricians worry that this high school graduation rite is far from wholesome. The authors offer reassurance and suggestions for reducing risky behaviors.
Parents and pediatricians worry that this high school graduation rite is far from wholesome. The authors offer reassurance along with suggestions for reducing risky behaviors.
For high school seniors in the Atlantic coastal states, "beach week" has become as much a part of festivities associated with graduation as the traditional school prom. About half of graduating seniors from suburban high schools in Delaware, Maryland, Virginia, and the Carolinas participate in the event. One major beach resort alone, Ocean City, Md., drew more than 100,000 graduates during a three-week period in June 2000. Communities in the heartland of the United States have their own versions of beach week, and in some of these areas students migrate to the coasts or even to Cancun or other spots on the coast of Mexico.
Beach week offers an opportunity to spend a few relaxing days in the sun. But it is much more. Beach week has symbolic value. It is a rite of passagefrom school to college or employment and from parental and teacher control to greater independence. Although some student groups take along an adult chaperon, parental supervision is not the rule. For most graduates, beach week marks the first time they have been on their own. It's a highly concentrated foretaste of what's to come.
The risks are many, and a blistering sunburn or sand flea bites are only the beginning. Added to the sun and sand are other temptations, such as alcohol, tobacco and other drugs, sexual activity, and, in recent years, body piercing and tattooing.
Some of these activitiesfor example, acquiring a tattoohave primarily personal consequences. Others pose serious health risks and also concern the beach community's residents, health officials, and police officers.14
Many of the teenagers attending beach week pay their own way with money earned from a part-time job, while others go at their parents' expense. Few parents want to stop their child from attending a much-anticipated event, but they often spend beach week worrying about what their child is doing. Some parents set ground rules and discuss their expectations with their child before they take off; however, once checked into their rooming house or beach motel, the youngsters are on their own. To determine how best to advise teenagers and their parents about beach week and limit risky behaviors, pediatricians need to know how participants really behave.
Concerned about reports of beach week activity among our suburban Virginia patient population, we surveyed 59 girls in our area who attended beach week in 1996.5 We asked about the girls' use of cigarettes, alcohol, and other drugs before and during beach week as well as about whether they had sexual intercourse during those periods.
What the girls purchased and did before they left for beach week shows how they expected to spend their time. Three quarters of them bought sun screen, more than a quarter took an oral contraceptive, and almost one fifth purchased male condoms. Some even bought Mace spray as a protection against possible assault.
We found that use of tobacco, alcohol, and other drugs was indeed widespread at the beach. More than half of the girls smoked at least five cigarettes daily during beach week, more than twice as many who smoked this much before beach week.
Three quarters of the girls became drunk every day during beach week. This was not the first time any of these girls had been drunk, however. Use of illicit drugs was less common than use of alcohol. Nonetheless, eight girls smoked marijuana almost every day during the week. Two tried marijuana for the first time. Of the 16 girls who said they had been high on drugs more than 10 times before beach week, five said they did not use drugs at all during beach week. Three of the 16 got high more than 10 times during beach week, however.
Nearly half (46%) of the girls had sexual intercourse during beach week. This was the first time for four girls; three of these four had sex with their steady boyfriends. In fact, the partner of 60% of the girls who had sex during beach week was their steady boyfriend. More than three quarters (86%) of the girls who had sex said that they were drunk when it happened.
According to our study, therefore, the girls' behavior during beach week was an exaggerated version of their behavior at home. Those who drank and smoked on their home turf did so at beach week, though even more than they did at home. Few of the girls had sex or took drugs for the first time during beach week.
Fifteen percent of the girls reported that they or a close friend required medical care during beach week because of an injury or problem that developed when they were drunk or high. No girl reported being raped, and none appeared to suffer posttraumatic stress disorder. Among the girls who completed the survey after beach week was over (almost half answered the survey during the week), however, nearly one third said they had persistent negative feelings. These included a sense of worthlessness or depression, concern about getting a bad reputation, or worry about being pregnant.
What lessons can pediatricians learn from the results of our survey of beach week attendees? How can they use this information to counsel their patients and help parents deal with their concerns about their teen's participation in beach week?
It is tempting to bypass these difficult questions entirelyby providing alternatives to the traditional beach week. Some communities, for example, have introduced chaperoned trips to a theme park or a major city as alternatives to beach week. Groups of parents in other areas rent beach houses for a week and encourage their teens to invite a half dozen or so friends to spend the week there, under the supervision of a parent. One beach community in our area, Ocean City, has mounted an aggressive prevention and enforcement campaign that is producing positive results. "Playing it safe in Ocean City," suggests how beach week norms can be changed.
Ocean City, Md., is a city of some 15,000 permanent residents. It is the only beach resort in Maryland. In a typical summer, the population of the city swells to 300,000. And in 2000, some 100,000 "June bugs"the city's nickname for high school graduatesflocked to this small city to celebrate. Community merchants, restaurateurs and members of the housing industry, and community residents welcomed the young visitors but also made clear that they have high expectations. Underage drinking, as well as use of other illicit drugs, is no longer tolerated. Two programsone aimed at prevention and another at enforcementare at the heart of this city's successful effort to change the norms of beach week and alcohol use in Ocean City.
Play It Safe, the prevention arm of the effort, has three major components: public awareness and education, provision of alternative drug-free activities, and community organization. A 28-page booklet, "Play It Safe: Passport to Fun!" is the most visible part of the prevention program. Sixty thousand copies were printed in 2000. Local prevention coordinators distributed the booklet throughout the area; copies were also available at Ocean City motels, hotels, and restaurants.
The Play It Safe booklet is full of solid information about the consequences of drug and alcohol use, sexual activity, and body art. The message is clearly stated: "You are responsible for yourself and your choices." It summarizes state underage drinking laws and penalties. An entire page is devoted to seaside first aid. Included is the phone number of the Ocean City Youth Health Center and other emergency numbers.
The booklet also contains dozens of discount coupons for services and products available at local merchants, as well as a full schedule for three weeks of free activitiesall sponsored by the Play It Safe programthat range from dances to volleyball to karaoke contests to moonlight bowling. In 2000, 32 Play It Safe events were held, attracting more than 5,000 participants. The last page of the booklet, "Just for Parents," describes the Play It Safe program. It encourages the parent to send a signed medical release to ensure that their child receives emergency medical care should it be needed. It also provides the number of the Parent Network, which parents can call 24 hours a day.
RAAM (Reducing the Availability of Alcohol to Minors) also shares credit for changing norms in Ocean City. The major focus of this enforcement project is to educate retailers. Although the relationship between retailers and police has traditionally been somewhat adversarial, sellers and servers in Ocean City have become partners with the police force. Beverage servers and liquor stores are trained to detect fraudulent age documents and to turn away underage drinkers. Meanwhile, police officers, in uniform and plain clothes, maintain a strong presence in the areas surrounding liquor stores and in restaurants. Citations bring a mandatory court appearancea final strong deterrent. When RAAM began in 1995, the city issued about 450 alcohol citations each summer. The current summer average is about 3,000 citations.
Some parents grant their teen permission to participate in a typical beach week only if they follow preestablished guidelines. The teen is allowed to attend if responsible parents go alongone parent for every 10 teens, for example. Such parent chaperons typically impose rules that teens agree to in writing in advance. These might relate to curfews, daily check-ins, or requiring that the teen call home every other day. For most teens, however, beach week is not beach week if it is chaperoned or otherwise supervised. It is a time for teens to test their wings and to be faced with choices and accept the consequences of those choices. An effective ground rule might be to eliminate coeducational housing, which was the choice of nearly half of the girls in our study group. For more on these issues, see "A week to remember," the response to our study of a young woman who attended a beach week.
The preceding article highlights the activities that do take place during beach week.5 Most of the findings mirrored what the beach week experience was like for my high school. There was coed rooming, there were parties, and most everyone received funding from parents. I was able to attend my beach week just after my high school graduation. Although I do believe that kids who attend beach week involve themselves in "risk-taking behavior," I do not believe that the behavior started there, nor do I think that it is the start of a major problem. It has become a week-long celebration of high school graduation and one last time to get together with friends before they go different ways.
If parents are concerned about what their kids may be getting themselves into at the beach, they should talk about it with them. They should let the kids know what worries they have and make sure the kids know what to do in case of an emergency. I believe that the "chaperoning" idea is an extremely poor solution, and the notion of a curfew would not be respected by any teen. I was lucky to have parents who trusted my judgment, respected my independence, and didn't give a second thought to my wishes for this graduation present.
As noted in the article, almost all of the participants in the survey saw beach week as a positive experience in retrospect. My experience at beach week was one that I will always remember. Looking back, I can see how if parents were given an inside look at beach week they would cringe. But everyone who was there will look back and smile, and I will even go so far as to say that when I have kids, they will be the first ones to sign up.
Reprinted from Stockman JA (ed): The Year Book of Pediatrics. St. Louis, Mo., Mosby, 2000
Pediatricians who know that some of their young patients are in their senior year and about to graduate might do well to initiate a conversation about beach week. Such a conversation might begin with basic health information, such as the importance of restricting time in the sun, using sun screen and insect repellent, and drinking enough water, and might even address the patient's swimming and boating skills.
If the pediatrician knows that a female patient is already sexually active, he or she may question her about ongoing use of contraception. If the girl is a virgin, the pediatrician may want to initiate a discussion of issues of sexuality, the fact that abstinence is an option, and the possible need for contraception. Likewise, if the patient is a young man, the pediatrician may use beach week as an opportunity to emphasize the importance of responsible sexual behavior and condom use and answer any questions the patient may have.
If the teen would rather not talk about sexuality and other personal issues in the parents' presence, the pediatrician may want to talk with him separately. Pediatricians can emphasize that the prospect of beach week offers a good opportunity for parents to have heart-to-heart conversations with their teens on important matters that may already have been too long deferred and that certainly will still be issues when beach week is over.
Pediatricians, as well as parents, will want to help teens who attend a traditional beach week understand that engaging in high-risk activities may result in considerable consequences: injury from a car crash, a fight, or an accident; drug overdose; sexually transmitted disease; infection from a contaminated tattoo needle; pregnancy; and encounters with the police department, including citations for alcohol possession.
It is important to note that three of the girls in our survey said that their parents agreed to let them attend beach week only after a "strong battle." The pediatrician needs to talk to the teenand to the parentabout such arguments. The pediatrician may want to serve as an intermediary in these situations, sharing with parents his or her understanding of what actually goes on at beach weeks or informing them of effective local programs. Last, the pediatrician should have a supply of emergency treatment permission forms for parents to sign and remind teens to take along the form and medical insurance information.
Let's face it. Teens will drink during beach week even if coordinated prevention and enforcement projects are in place. Some may use other illicit drugs. Others may come home sporting new tattoos or a pierced navel. Many will have sexual intercourse. We need to recognize that teens go to beach week fully prepared for such activitiesas seen by the number of girls in our survey who obtained an oral contraceptive or condoms before leaving home.
On the other hand, as our survey also pointed out, not all teens who go to beach week drink, smoke, do drugs, or have sex. Two thirds of the girls in our survey did not use illicit drugs during beach week, even though they had far more independence than they had at home and faced considerable peer pressure. Likewise, more than half did not have sexual intercourse, and 12% did not get drunk once during the week. And keep in mind that a teen's conduct during beach week is strongly related to his or her conduct at home.
1. Nelson DF: The dangers of Beachweek 1996. Parents' Association to Neutralize Drug and Alcohol Abuse Newsletter 1995;15:2
2. Wright J: Students, parents, and "Beach Week." Washington Post, May 21, 1996, p B5
3. Burka M: Beer and beachers: Key ingredients in brewing up rite of passage. Virginia Times, June 27, 1996, p 1, 3
4. McCaffrey S: Teens: Don't ruin fun of traditional beach week. Sun Gazette, March 20, 1997, p 1, 32
5. Schwartz RH, Milteer R, Sheridan MJ, et al: Beach week: A high school graduation rite of passage for sun, sand, suds, and sex. Arch Pediatric Adolesc Med 1999;153:180
Richard Schwartz. Beach Week: Sand and swimming or sex and swilling?. Contemporary Pediatrics 2001;4:63.