Youth Cognitive Testing Informational Materials

ELECTRONIC CIGARETTES WHAT’S THE BOTTOM LINE?

» E-cigarettes have the potential to benefit adult smokers who are not
pregnant if used as a complete substitute for regular cigarettes and
other smoked tobacco products.
» E-cigarettes are not safe for youth, young adults, pregnant women, or
adults who do not currently use tobacco products.
» While e-cigarettes have the potential to benefit some people and harm
others, scientists still have a lot to learn about whether e-cigarettes are
effective for quitting smoking.
» If you’ve never smoked or used other tobacco products or e-cigarettes,
don’t start.

WHAT ARE E-CIGARETTES?
» E-cigarettes are known by many different names. They are sometimes called “e-cigs,” “e-hookahs,”
“mods,” “vape pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems.”
» Some e-cigarettes are made to look like regular cigarettes, cigars, or pipes. Some resemble pens,
USB sticks, and other everyday items.
» E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine—the addictive
drug in regular cigarettes, cigars, and other tobacco products—flavorings, and other chemicals
that help to make the aerosol. Users inhale this aerosol into their lungs. Bystanders can also
breathe in this aerosol when the user exhales into the air.
» E-cigarettes can be used to deliver marijuana and other drugs.
Rechargeable
e-cigarette

Disposable
e-cigarette

CS298852-A

Tanks & Mods

For Print Only

WHAT IS IN E-CIGARETTE AEROSOL?
THE E-CIGARETTE AEROSOL THAT USERS BREATHE FROM THE DEVICE AND
EXHALE CAN CONTAIN HARMFUL AND POTENTIALLY HARMFUL SUBSTANCES:

CANCER-CAUSING
CHEMICALS

VOLATILE
ORGANIC
COMPOUNDS
ULTRAFINE
PARTICLES
NICOTINE

HEAVY METALS SUCH AS
NICKEL, TIN, AND LEAD
FLAVORING SUCH AS
DIACETYL, A CHEMICAL
LINKED TO A SERIOUS
LUNG DISEASE

It is difficult for consumers to know what e-cigarette products contain. For example,
some e-cigarettes marketed as containing zero percent nicotine have been found to
contain nicotine.

ARE E-CIGARETTES LESS HARMFUL THAN REGULAR CIGARETTES?

VS
YES, but that doesn’t

E-cigarette aerosol generally contains fewer toxic
chemicals than the deadly mix of 7,000 chemicals in
smoke from regular cigarettes. However, e-cigarette
aerosol is not harmless. It can contain harmful and
potentially harmful substances, including nicotine,
heavy metals like lead, volatile organic compounds,
and cancer-causing agents.

mean e-cigarettes are safe.

For Print Only

WHAT ARE THE HEALTH EFFECTS OF USING E-CIGARETTES?
SCIENTISTS ARE STILL LEARNING ABOUT THE LONG-TERM HEALTH EFFECTS
OF E-CIGARETTES. HERE IS WHAT WE KNOW NOW.

1

Most e-cigarettes contain nicotine, which has
known health effects
»» Nicotine is highly addictive.
»» Nicotine is toxic to developing fetuses.
» Nicotine can harm adolescent brain development,
which continues into the early to mid-20s.
» Nicotine is a health danger for pregnant women
and their developing babies.

2

Besides nicotine, e-cigarette aerosol can contain
substances that harm the body.
»» This includes cancer-causing chemicals and tiny particles
that reach deep into lungs. However, e-cigarette aerosol
generally contains fewer harmful chemicals than smoke
from burned tobacco products.

3

E-cigarettes can cause unintended injuries.
»» Defective e-cigarette batteries have caused fires and
explosions, some of which have resulted in serious
injuries.
»» In addition, acute nicotine exposure can be toxic.
Children and adults have been poisoned by swallowing,
breathing, or absorbing e-cigarette liquid.

For Print Only

CAN E-CIGARETTES HELP ADULTS QUIT SMOKING CIGARETTES?

E-CIGARETTES ARE NOT CURRENTLY APPROVED BY THE
FDA AS A QUIT SMOKING AID.
The U.S. Preventive Services Task Force, a group of health experts that makes recommendations
about preventive health care, concluded that the evidence is insufficient to recommend e-cigarettes
for smoking cessation in adults, including pregnant women.

HOWEVER, e-cigarettes

may help non-pregnant adult
smokers if used as a complete
substitute for all cigarettes and
other smoked tobacco products.

TO DATE, THE FEW STUDIES ON THE ISSUE ARE MIXED.
Evidence from two randomized controlled trials found that e-cigarettes with nicotine can help smokers
stop smoking in the long term compared with placebo (non-nicotine) e-cigarettes.

A recent CDC study found that many adults are using e-cigarettes in an attempt to quit smoking.
However, most adult e-cigarette users do not stop smoking cigarettes and are instead continuing
to use both products (“dual use”). Because smoking even a few cigarettes a day can be
dangerous, quitting smoking completely is very important to protect your health.

For Print Only

WHO IS USING E-CIGARETTES?
E-CIGARETTES ARE THE MOST COMMONLY USED
TOBACCO PRODUCT AMONG YOUTH.
In 2018, more than

3.6 MILLION

U.S. middle and high school
students used e-cigarettes in
the past 30 days, including:

4.9%

MIDDLE SCHOOL
STUDENTS

IN THE U.S.,
YOUTH ARE
MORE LIKELY
THAN ADULTS
TO USE
E-CIGARETTE

20.8%
HIGH SCHOOL
STUDENTS

AMONG CURRENT E-CIGARETTE USERS AGED 45 YEARS AND OLDER
in 2015, most were either current or former regular cigarette smokers, and
1.3% had never been cigarette smokers.
IN CONTRAST, AMONG CURRENT E-CIGARETTE USERS AGED 18–24 YEARS,

40.0% had NEVER BEEN regular cigarette smokers
In 2017,

IN 2015, AMONG ADULT E-CIGARETTE
USERS OVERALL:

29.8%

were former
regular cigarette
smokers

2.8%

of U.S. adults were current
e-cigarette users

58.8%

were current regular
cigarette smokers

11.4%

had never been
regular cigarette
smokers

For Print Only

3/16/2020

Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults | CDC

Smoking & Tobacco Use

Quick Facts on the Risks of E-cigarettes for Kids,
Teens, and Young Adults
What’s the Bottom Line on the Risks of E-cigarettes for Kids, Teens, and Young
Adults?
The use of e-cigarettes is unsafe for kids, teens, and young adults.
Most e-cigarettes contain nicotine. Nicotine is highly addictive and can harm adolescent brain development, which
continues into the early to mid-20s.1
E-cigarettes can contain other harmful substances besides nicotine.
Young people who use e-cigarettes may be more likely to smoke cigarettes in the future.

The use of e-cigarettes is unsafe for kids, teens, and young adults.

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html

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Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults | CDC

Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products

What Are E-cigarettes?
E-cigarettes are electronic devices that heat a liquid and produce an aerosol, or mix of small particles in the air.
E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid.
Some e-cigarettes look like regular cigarettes, cigars, or pipes. Some look like USB ash drives, pens, and other
everyday items. Larger devices such as tank systems, or “mods,” do not look like other tobacco products.
E-cigarettes are known by many di erent names. They are sometimes called “e-cigs,” “e-hookahs,” “mods,” “vape
pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems (ENDS).”
Using an e-cigarette is sometimes called “vaping” or “JUULing.”

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html

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Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults | CDC

Some e-cigarettes look like regular cigarettes, cigars, or pipes.
Some look like USB ash drives, pens, and other everyday items.

How Do E-cigarettes Work?
E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, avorings, and other chemicals
that help to make the aerosol.
The liquid used in e-cigarettes often contains nicotine and avorings. This liquid is sometimes called “e-juice,” “eliquid,” “vape juice,” or “vape liquid.”
Users inhale e-cigarette aerosol into their lungs. Bystanders can also breathe in this aerosol when the user
exhales it into the air.
E-cigarette devices can be used to deliver marijuana and other drugs.

What Is JUUL?

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html

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Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults | CDC

News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms
and bathrooms.
JUUL is a brand of e-cigarette that is shaped like a USB ash drive. Like other e-cigarettes, JUUL is a batterypowered device that heats a nicotine-containing liquid to produce an aerosol that is inhaled.
All JUUL e-cigarettes have a high level of nicotine. According to the manufacturer, a single JUUL pod contains as
much nicotine as a pack of 20 regular cigarettes.2
JUUL is one of a few e-cigarettes that use nicotine salts, which allow particularly high levels of nicotine to be
inhaled more easily and with less irritation than the free-base nicotine that has traditionally been used in tobacco
products, including e-cigarettes.
News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms
and bathrooms.
Approximately two-thirds of JUUL users aged 15 – 24 do not know that JUUL always contains nicotine.
Although JUUL is currently the top-selling e-cigarette brand in the United States, other companies sell e-cigarettes
that look like USB ash drives. Examples include the MarkTen Elite, a nicotine delivery device, and the PAX Era, a
marijuana delivery device that looks like JUUL.
Additional information about USB-shaped e-cigarettes and actions that parents, educators, and health care
providers can take to protect kids is available at CDC’s Infographic  [PDF – 1.2MB]

Why Is Nicotine Unsafe for Kids, Teens, and Young Adults?
Most e-cigarettes contain nicotine—the addictive drug in regular cigarettes, cigars, and other tobacco products.
A recent CDC study found that 99% of the e-cigarettes sold in assessed venues in the United States contained
nicotine.
Some e-cigarette labels do not disclose that they contain nicotine, and some e-cigarettes marketed as containing
0% nicotine have been found to contain nicotine.
Nicotine can harm the developing adolescent brain.1 The brain keeps developing until about age 25.
Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and
impulse control.1
Each time a new memory is created or a new skill is learned, stronger connections – or synapses – are built
between brain cells. Young people’s brains build synapses faster than adult brains. Nicotine changes the way
th
f
d
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Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults | CDC

these synapses are formed.
Using nicotine in adolescence may also increase risk for future addiction to other drugs.1

What Are the Other Risks of E-cigarettes for Kids, Teens, and Young Adults?
Scientists are still learning about the long-term health e ects of e-cigarettes.
Some of the ingredients in e-cigarette aerosol could also be harmful to the lungs in the long-term. For example,
some e-cigarette avorings may be safe to eat but not to inhale because the gut can process more substances
than the lungs.1
Defective e-cigarette batteries have caused some res and explosions, a few of which have resulted in serious
injuries.
Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their
skin or eyes. Nationally, approximately 50% of calls to poison control centers for e-cigarettes are for kids 5 years of
age or younger.

What Is in E-cigarette Aerosol?
E-cigarette aerosol is NOT harmless “water vapor.”
The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially
harmful substances, including:
Nicotine
Ultra ne particles that can be inhaled deep into the lungs
Flavorings such as diacetyl, a chemical linked to a serious lung disease
Volatile organic compounds
Cancer-causing chemicals
Heavy metals such as nickel, tin, and lead1
The aerosol that users inhale and exhale from e-cigarettes can expose both themselves and bystanders to
harmful substances.
It is di cult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed
as containing zero percent nicotine have been found to contain nicotine.3

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html

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Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults | CDC

Flavors and Marketing Make E-cigarettes Appealing to Youth
Many e-cigarettes come in fruit, candy, and other kid-friendly avors, such as mango, fruit and crème.
A majority of youth e-cigarette users report using avored varieties, most youth e-cigarette users rst start using
e-cigarettes with a avored variety, and avors are the primary reason youth report using e-cigarettes.
E-cigarettes are also advertised using the same themes and tactics that have been shown to increase youth
initiation of other tobacco products, including cigarettes. In 2016, about 8 in 10 middle school and high school
students—more than 20 million youth—said they had seen e-cigarette advertising.
Widespread advertising for these products, including via media for which advertising for conventional tobacco
products is prohibited (e.g., TV), and the lower costs of some of these products relative to conventional cigarettes
has contributed to the increase in e-cigarette use among youth.
Many youth also report using e-cigarettes because they are curious about these new products, and because they
believe these products to be less harmful than conventional cigarettes.

Can Using E-cigarettes Lead to Future Cigarette Smoking Among Kids, Teens, and
Young Adults?
Many young people who use e-cigarettes also smoke cigarettes.1 There is some evidence that young people who
use e-cigarettes may be more likely to smoke cigarettes in the future.
Speci cally, a 2018 National Academy of Medicine report found that there was some evidence that e-cigarette use
increases the frequency and amount of cigarette smoking in the future.4
E-cigarettes also can be used to deliver other drugs, including marijuana; in 2016, approximately one-third of U.S.
middle and high school students who have ever used an e-cigarette reported using marijuana in the device.
But e-cigarette use among young people is unsafe, even if they do not progress to future cigarette smoking.

Aren’t E-cigarettes Safer Than Cigarettes?
E-cigarettes expose users to fewer harmful chemicals than burned cigarettes.1 But burned cigarettes are
extraordinarily dangerous, killing half of all people who smoke long-term.
The use of any tobacco product, including e-cigarettes, is unsafe for young people.

Are E-cigarettes Regulated at the Federal Level?
Yes. In August 2016, the regulatory authority of the FDA was extended to cover e-cigarettes through the agency’s
“deeming rule.”
Through authority granted by the Family Smoking Prevention and Tobacco Control Act (FSPTCA), FDA has authority
to develop regulations that address the manufacturing, marketing, and sale of e-cigarettes.
However, the FSPTCA does not prevent states and communities from adopting many strategies related to ecigarettes. There are also many strategies that FDA does not have authority to implement and that states can do,
such as including e-cigarettes in smoke-free policies, pricing strategies, and increasing the age of sale for tobacco
products to 21.

Are There Any National Public Education Prevention Campaigns Focused on Youth
and E-cigarettes?
Yes. In 2018, the FDA expanded its successful youth tobacco prevention campaign  , “The Real Cost,” to reach
the more than 10 million youth aged 12–17 who have used e-cigarettes or are open to trying them. The campaign
educates youth about the potential risks of using e-cigarettes.
The “Real Cost” reaches teens where they spend most of their time: in school and online. The campaign is also
https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html

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Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults | CDC

placing e-cigarette prevention materials in high schools across the nation, both in school bathrooms and on
educational digital platforms accessed by students during the school day.

The Truth Initiative® launched the “Safer ≠ Safe” campaign in 2018, focusing on correcting youth misperceptions
and providing accurate information about e-cigarettes and youth. The campaign is being promoted on digital and
social media, including the Safer ≠ Safe website  , which features videos, articles and interactive activities for
youth.

What Do We Know About Heated Tobacco Products?
Heated tobacco products (HTPs) like IQOS and Eclipse, sometimes marketed as “heat-not-burn” technology,
represent a diverse class of products that heat the tobacco leaf to produce an inhaled aerosol. They are di erent
from e-cigarettes, which heat a liquid that can contain nicotine derived from tobacco.
HTPs are available in at least 40 countries and have several have been authorized for sale in the United States by
the FDA. In 2018, few U.S. adults (2.4% of all surveyed, including 6.7% of current smokers surveyed) had ever used
HTPs. Youth use of HTPs is unknown, but monitoring is underway.
Scientists are still learning about the short-term and long-term health e ects of HTPs, but the available science
shows they contain harmful and potentially harmful ingredients. Youth use of any tobacco products, including
heated products, is unsafe.
It is important that we continue to modernize proven tobacco prevention and control strategies to include newer
products entering the market such as HTPs.

What Can I Do to Prevent My Child from Using E-cigarettes or to Help Them Stop?

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html

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Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults | CDC

Talk to your child or teen about why e-cigarettes are harmful for them. It’s never too late.
Set a good example by being tobacco-free and ensure that your kid is not exposed to the secondhand emissions
from any tobacco products, including e-cigarettes.
If you use tobacco, it’s never too late to quit. For free help, visit smokefree.gov  or call 1-800-QUIT-NOW.
Talk to your child or teen about why e-cigarettes are harmful for them. It’s never too late.
Get the Talk With Your Teen About E-cigarettes   [PDF – 5.2MB] tip sheet for parents. Start the conversation
early with children about why e-cigarettes are harmful for them.
Let your child know that you want them to stay away from all tobacco products, including e-cigarettes, because
they are not safe for them. Seek help and get involved.
Set up an appointment with your child’s health care provider so that they can hear from a medical
professional about the health risks of tobacco products, including e-cigarettes.
Speak with your child’s teacher and school administrator about enforcement of tobacco-free school grounds
policies and tobacco prevention curriculum.
Encourage your child to learn the facts and get tips for quitting tobacco products at Teen.smokefree.gov  .

Where Can I Learn More?
E-cigarettes and Youth: Toolkit for Partners  [PDF–13 MB]
Surgeon General’s Advisory on E-cigarette Use Among Youth
Download  [PDF–572 KB] 
SAMHSA—Understanding Addiction 
Anyone can experience addiction. Learn the common signs of addiction at the SAMHSA website.
E-cigarettes Shaped Like Flash Drives: Information for Parents, Educators, and Health Care Providers
Teachers and Parents: That USB Stick Might Be an E-cigarette
E-cigarettes.surgeongeneral.gov 
Information from the Surgeon General on the risks of e-cigarettes for young people, and includes free tools
such as a parent tip sheet for talking to teens about e-cigarettes   [PDF – 5.2MB].
Teen.smokefree.gov 
Information to help teens who want to quit using e-cigarettes.
Truth Initiative’s This is Quitting Program 
This free mobile program is designed to help young people quit e-cigarettes. Resources are available for
teens and young adults as well as parents.
Find Treatment 
Find a list of addiction treatment centers using the SAMHSA website. Please contact a center directly to ask if
they treat e-cigarette dependence.
Electronic Cigarettes
Basic information about e-cigarettes from CDC’s O ce on Smoking and Health.

Resources

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html

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Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults | CDC

Fact Sheet for Parents

Download the PDF  [PDF–832 KB]
or order a free hard copy

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html

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Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults | CDC

Fact Sheet for Health Care Providers
Download the PDF  [PDF–826 KB]
or order a free hard copy

Fact Sheet for Educators

Download the PDF  [PDF–814 KB]
or order a free hard copy

E-cigarette, or Vaping, Products Visual Dictionary

This product is intended for educational purposes only for public health o cials and healthcare providers. The
devices and brands presented in this pamphlet are intended to highlight the di erent e-cigarette, or vaping, product
generations and substances used in these devices.
 [PDF - 3 MB]

Multimedia about E-cigarettes

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html

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Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults | CDC

Sources
1. US Department of Health and Human Services. E-cigarette Use Among Youth and Young Adults: A Report of the
Surgeon General  [PDF – 8.47MB]. Atlanta, GA: US Department of Health and Human Services, CDC; 2016.
Accessed July 27, 2018.
2. Willett JG, Bennett M, Hair EC, et al Recognition, use and perceptions of JUUL among youth and young adults.
Tobacco Control Published Online First: 18 April 2018. doi: 10.1136/tobaccocontrol-2018-054273
3. Goniewicz ML, Gupta R, Lee YH, et al. Nicotine levels in electronic cigarette re ll solutions: a comparative analysis
of products from the United States, Korea, and Poland. Int J Drug Policy. 2015;26(6):583–588.
4. National Academies of Sciences, Engineering, and Medicine. 2018. Public health consequences of e-cigarettes  .
Washington, DC: The National Academies Press.

"One Brain" :30 PSA [MP3-469KB]

“One Brain” PSA Transcript  [PDF – 14KB]

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html

Page last reviewed: February 3, 2020

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Quit Vaping | Smokefree Teen

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Quit Vaping
Quitting vaping can be tough, but we have resources that can help. Find out how to
quit vaping and stay vape-free.

How to Quit Vaping
Quitting vapes can be easier when you prepare in advance and have a plan. Find out what you can
do to get ready to quit.

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Dealing with cravings is one of the hardest parts of quitting vaping. Try these tips and strategies
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Triggers are the things that make you want to vape. Knowing your triggers and having a plan to
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TEEN
DEPRESSION
Being a teenager can be tough. There are changes
taking place in your body and brain that can affect
how you learn, think, and behave. And if you are
facing tough or stressful situations, it is normal to
have emotional ups and downs.
But if you have been overwhelmingly sad for a long
time (a few weeks to months) and you’re not able to
concentrate or do the things you usually enjoy, you may
want to talk to a trusted adult about depression.

What Is Depression?
Depression (major depressive disorder) is a medical illness that can
interfere with your ability to handle your daily activities, such as sleeping,
eating, or managing your school work. Depression is common but that
doesn’t mean it isn’t serious. Treatment may be needed for someone to feel
better. Depression can happen at any age, but often symptoms begin in the
teens or early 20s or 30s. It can occur along with other mental disorders,
substance abuse, and other health conditions.

Why can’t you just ‘snap out’ of depression?
Well-meaning friends or family members may try to tell someone with
depression to “snap out of it,” “just be positive,” or “you can be happier if
you just try harder.” But depression is not a sign of weakness or a character
flaw. Most people with depression need treatment to get better.

What Are the Signs and
Symptoms of Depression?
Sadness is something we all experience. It is a normal reaction to a loss or
a setback, but it usually passes with a little time. Depression is different.
If you are wondering if you may have depression, ask yourself
these questions:
" Do you constantly feel sad, anxious, or even “empty,” like you
feel nothing?
" Do you feel hopeless or like everything is going wrong?

! Do you feel like you’re worthless or helpless? Do you feel guilty
about things?
! Do you feel irritable much of the time?
! Do you find yourself spending more time alone and withdrawing
from friends and family?
! Are you grades dropping?
! Have you lost interest or pleasure in activities and hobbies that you used to
enjoy?
! Have your eating or sleeping habits changed (eating or sleeping more
than usual or less than usual)?
! Do you always feel tired? Like you have less energy than normal or no
energy at all?
! Do you feel restless or have trouble sitting still?
! Do you feel like you have trouble concentrating, remembering
information, or making decisions?
! Do you have aches or pains, headaches, cramps, or stomach problems
without a clear cause?
! Do you ever think about dying or suicide? Have you ever tried
to harm yourself?

What Should I Do If I am Considering Suicide
or Harming Myself?
If you are in crisis and need help, call this toll-free number for the
National Suicide Prevention Lifeline (NSPL), available 24 hours a day,
every day: 1-800-273-TALK (8255). The service is available to
everyone. The deaf and hard of hearing can contact the Lifeline via
TTY at 1-800-799-4889. All calls are confidential. You can also visit the
Lifeline’s website at www.suicidepreventionlifeline.org.
The Crisis Text Line is another free, confidential resource available 24
hours a day, seven days a week. Text “HOME” to 741741 and a trained
crisis counselor will respond to you with support and information over
text message. Visit www.crisistextline.org.
Not everyone with depression experiences every symptom. Some people
experience only a few symptoms. Others may have many. The symptoms
and how long they last will vary from person to person.

How Do I Get Help?
If you think you might have depression, you are not alone. Depression is
common, but it is also treatable. Ask for help! Here are a few steps you
can take:
! Step 1: Try talking to a trusted adult, such as your parent or guardian,
your teacher, or a school counselor. If you don’t feel comfortable
speaking to an adult, try talking to a friend. If you are not sure where to
turn, you can use TXT 4 HELP Interactive (www.nationalsafeplace.org/
txt-4-help), which allows you to text live with a mental health professional.

For more ideas and a list of health hotlines, visit www.nimh.nih.gov
(search words: children and adolescents).
! Step 2: If you’re under the age of 18, ask your parent or guardian to
make an appointment with your doctor for an evaluation. Your doctor
can make sure you don’t have a physical illness that may be affecting
your mental health. Your doctor may also talk to you about the
possibility of seeing a mental health professional, such as a psychiatrist,
counselor, psychologist, or therapist. These practitioners can diagnose
and treat depression and other mental disorders.

How is Depression Treated?
Depression is usually treated with psychotherapy, medication, or a
combination of the two.

What is psychotherapy?
Psychotherapy (sometimes called “talk therapy”) is a term for treatment
techniques that can help you identify and manage troubling emotions,
thoughts, and behavior. Psychotherapy can take place in a one-on-one
meeting with you and a licensed mental health professional. Sometimes
you might be part of a group guided by a mental health professional.
Read more about psychotherapy at www.nimh.nih.gov/health/topics/
psychotherapies.

What medications treat depression?
If your doctor thinks you need medicine to treat your depression, he or she
might prescribe an antidepressant.
When you are taking an antidepressant, it is important to carefully follow
your doctor’s directions for taking your medicine. The medication could take
up to six weeks to work and you should not stop taking it without the help of
a doctor. You should also avoid using alcohol or drugs that have not been
prescribed to you so that your medications can work.
When it is time to stop the medication, the doctor will help you slowly and
safely decrease the dose so that your body can adjust. If you stop taking the
medication too soon, your depression symptoms may return. Another reason
to stop medication gradually is that stopping suddenly can cause withdrawal
symptoms like anxiety and irritability.
Antidepressants can have side effects. These side effects are usually mild
(possible stomach upsets or headaches) and may go away on their own. But
talk to your doctor about any side effects that you experience because your
doctor might adjust the dose or change the medicine. For more information
about side effects, visit www.fda.gov.
Although antidepressants can be effective, they may present serious
risks to some, especially children and teens. Anyone taking antidepressants
should be monitored closely, especially when they first start taking them.
Severe anxiety or agitation early in treatment can be especially
distressing and should be reported to the doctor immediately.

For many people, the risks of untreated depression outweigh the side
effects of antidepressant medications when they are used under a
doctor’s careful supervision. Information about medications changes
frequently. Talk to your doctor and visit the U.S. Food and Drug
Administration (FDA) website
for the latest safety information.

What else can I do to help manage my depression?
Be patient and know that treatment takes time to work. In the meantime,
you can:
! Stay active and exercise, even if it’s just going for a walk.
! Try to keep a regular sleep schedule.
! Spend time with friends and family.
! Break down school or work tasks into smaller ones and organize them in
order of what needs to get done first. Then, do what you can.

What Can I Do If Someone
I Know Might Have Depression?
If you think your friend might have depression, first help him or her talk to a trusted
adult who can connect your friend to a health professional. You can also:
! Be supportive, patient, and encouraging, even if you don’t fully
understand what’s going on.
! Invite your friend to activities, social events, or just to hang out.

! Remind your friend that getting help is important and that with time and
treatment, he or she will feel better.
! Never ignore comments about death and suicide, even if it seems like a
joke or overdramatic. Talking about suicide is not just a bid for attention
but should be taken seriously. Talk to a trusted adult such as a parent,
teacher or older sibling as soon as you can.

What Should I Do If Someone
I Know Is Considering Suicide?
Often, family and friends are the first to recognize the warning signs of
suicide and can take the first step toward helping the person find help.
Remember:
! If someone is telling you that he or she is going to kill himself or herself,
do not leave him or her alone.
! Do not promise anyone that you will keep his or her suicidal thoughts a
secret. Make sure to tell a trusted friend or family member, or an adult with
whom you feel comfortable.
! Get help as soon as possible. Call 911 for emergency services and/or take
the person to the nearest hospital emergency room.
You can also call 1-800-273-TALK (8255), the toll-free number for the
National Suicide Prevention Lifeline (NSPL), which is available 24 hours
a day, every day. The service is available to everyone. All calls are free
and confidential. You can also chat with the NSPL online (http://www.
suicidepreventionlifeline.org).

The Crisis Text Line is another free, confidential resource available 24
hours a day, seven days a week. Text “HOME” to 741741 and a trained crisis
counselor will respond to you with support and information via text message.
Visit https://www.crisistextline.org.

What if someone is posting suicidal messages
or something disturbing on social media?
If you see messages or live streaming suicidal behavior on social media, call
911 immediately, contact the toll-free National Suicide Prevention Lifeline at
1-800-273-TALK (8255), or text the Crisis Text Line (text HOME to 741741).
Some social media sites also have a process to report suicidal content and
get help for the person posting the message. Each offers different options on
how to respond if you see concerning posts about suicide. For example:
" Facebook Suicide Prevention webpage can be found at www.facebook.
com/help/ [use the search term “suicide” or “suicide prevention”].
" Instagram uses automated tools in the app to provide resources, which
can also be found online at https://help.instagram.com [use the search
term, “suicide,” “self-injury,” or “suicide prevention”].
" Snapchat’s Support provides guidance at https://support.snapchat.com
[use the search term, “suicide” or “suicide prevention”].

! Tumblr Counseling and Prevention Resources webpage can be found at
https://tumblr.zendesk.com [use the search term “counseling” or
“prevention,” then click on “Counseling and prevention resources”].
! Twitter’s Best Practices in Dealing With Self-Harm and Suicide at
https://support.twitter.com [use the search term “suicide,” “self-harm,”
or “suicide prevention”].
! YouTube’s Safety Center webpage can be found at https://support.
google.com/youtube [use the search term “suicide and self-injury”].
Because help via these processes may be delayed, it is still important to
call 911 if someone is posting suicidal messages or something disturbing on
social media. People—even strangers—have saved lives by being vigilant.

For More Information
For more information on depression and suicide prevention, visit the
National Institute of Mental Health (NIMH) website (www.nimh.nih.gov).

Related Resources:
! Medline Plus (National Library of Medicine): https://medlineplus.
gov/teenhealth.html (En spañol: https://medlineplus.gov/
spanish/teenhealth.html)
! NIDA for Teens, Drugs & Health:
! National Suicide Prevention Lifeline: http://www.
suicidepreventionlifeline.org, 1-800-273-TALK (8255), free 24-hour help
! Anti-Bullying: https://www.stopbullying.gov

Reprints
This publication is in the public domain and may be reproduced or copied
without permission from NIMH. Citation of NIMH as a source is appreciated.
We encourage you to reproduce it and use it in your efforts to improve public
health. However, using government materials inappropriately can raise legal
or ethical concerns, so we ask you to use these guidelines:
" NIMH does not endorse or recommend any commercial products,
processes, or services, and our publications may not be used for
advertising or endorsement purposes.
" NIMH does not provide specific medical advice or treatment
recommendations or referrals; our materials may not be used in a manner
that has the appearance of providing such information.
" NIMH requests that non-Federal organizations not alter our
publications in ways that will jeopardize the integrity and “brand”
when using the publication.
" The addition of non-Federal Government logos and website links may not
have the appearance of NIMH endorsement of any specific commercial
products or services, or medical treatments or services.
" Images used in publications are of models and are used for illustrative
purposes only. Use of some images is restricted.
If you have questions regarding these guidelines and use of NIMH
publications, please contact the NIMH Information Resource Center at
or e-mail at [email protected].

National Institute of Mental Health
Office of Science Policy, Planning, and Communications
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301–443–4513 or
Toll-free: 1–866–615–NIMH (6464)
TTY Toll-free: 1–866–415–8051
Fax: 301–443–4279
E-mail: [email protected]
Website: www.nimh.nih.gov

U.S. Department of Health and Human Services
National Institutes of Health
NIH Publication No.
M 80
Revised 2018

Children and Mental Health
Is This Just a Stage?
Points to Remember
Always seek immediate help if a child engages in
unsafe behavior or talks about wanting to hurt
him or herself or someone else.
! Seek help when a child’s behavior or emotional
difficulties last for more than a few weeks and
are causing problems at school, at home, or with
friends.
! A thorough evaluation can help determine if
treatment is necessary, and which treatments
may be most effective.
! Early treatment can help address a child’s current
difficulties and can also help prevent more
serious problems in the future.
!

When to Seek Help
Even under the best of circumstances, it can be
hard to tell the difference between challenging
behaviors and emotions that are consistent with
typical child development and those that are cause
for concern. It is important to remember that many
disorders like anxiety, attention deficit hyperactivity
disorder, and depression, do occur during
childhood. In fact, many adults who seek treatment
reflect back on how these disorders affected their
childhood and wish that they had received help

sooner. In general, if a child’s behavior persists for a
few weeks or longer, causes distress for the child or
the child’s family, and interferes with functioning at
school, at home, or with friends, then consider
seeking help. If a child’s behavior is unsafe, or if a
child talks about wanting to hurt him or herself or
someone else, then seek help immediately.
Young children may benefit from an evaluation and
treatment if they:
! Have frequent tantrums or are intensely irritable
much of the time
! Often talk about fears or worries
! Complain about frequent stomachaches or
headaches with no known medical cause
! Are in constant motion and cannot sit quietly
(except when they are watching videos or
playing videogames)
! Sleep too much or too little, have frequent
nightmares, or seem sleepy during the day
! Are not interested in playing with other children
or have difficulty making friends
! Struggle academically or have experienced a
recent decline in grades
! Repeat actions or check things many times out of
fear that something bad may happen.

Older children and adolescents may benefit from an
evaluation if they:
! Have lost interest in things that they used to
enjoy
! Have low energy
! Sleep too much or too little, or seem sleepy
throughout the day
! Are spending more and more time alone, and
avoid social activities with friends or family
! Fear gaining weight, or diet or exercise
excessively
! Engage in self-harm behaviors (e.g., cutting or
burning their skin)
! Smoke, drink, or use drugs
! Engage in risky or destructive behavior alone or
with friends
! Have thoughts of suicide
! Have periods of highly elevated energy and
activity, and require much less sleep than usual
! Say that they think someone is trying to control
their mind or that they hear things that other
people cannot hear.

First Steps for Parents
If you are concerned about your child, where do
you begin?
! Talk with your child’s teacher. What is the
child’s behavior like in school, daycare, or on
the playground?
! Talk with your child’s pediatrician. Describe the
behavior, and report what you have observed
and learned from talking with others.
! Ask for a referral to a mental health professional
who has experience and expertise dealing with
children. (Additional information on identifying
a mental health professional is at the end of
this brochure.)
2

Finding Answers
An evaluation by a health professional can help
clarify problems that may be underlying a child’s
behavior and provide reassurance or
recommendations for next steps. It provides an
opportunity to learn about a child’s strengths and
weaknesses and determine which interventions
might be most helpful.
A comprehensive assessment of a child’s mental
health includes the following:
! An interview with parents addressing a child’s
developmental history, temperament,
relationships with friends and family, medical
history, interests, abilities, and any prior
treatment. It is important to get a picture of the
child’s current situation, for example: has he or
she changed schools recently, has there been an
illness in the family, or a change with an impact
on the child’s daily life.
! Information gathering from school, such as
standardized tests, reports on behavior,
capabilities, and difficulties.
! An interview with the child about his or her
experiences, as well as testing and behavioral
observations, if needed.

Treatment Options
Assessment results may suggest that a child’s
behavior is related to changes or stresses at home
or school; or is the result of a disorder for which
treatment would be recommended. Treatment
recommendations may include:
! Psychotherapy (“talk therapy”). There are many
different approaches to psychotherapy, including
structured psychotherapies directed at specific
conditions. Information about types of
psychotherapies is available on the National

Institute of Mental Health (NIMH)
Psychotherapies page (www.nimh.nih.gov/
index.shtml; search term: psychotherapies).
Effective psychotherapy for children always
includes:
$ Parent involvement in the treatment
(especially for children and adolescents)
$ Teaching skills and practicing skills at
home or at school (between session
“homework assignments”)
$ Measures of progress (e.g., rating scales,
improvements on homework assignments)
that are tracked over time.

Medications. Medication may be used along with
psychotherapy. As with adults, the type of
medications used for children depends on the
diagnosis and may include antidepressants,
stimulants, mood stabilizers, and others. General
information on specific classes of medications is
available on NIMH’s Mental Health Medications
page (www.nimh.nih.gov/index.shtml; search
term: medications). Medications are often used
in combination with psychotherapy. If different
specialists are involved, treatment should
be coordinated.
! Family counseling. Including parents and other
members of the family in treatment can help
families understand how a child’s individual
challenges may affect relationships with parents
and siblings and vice versa.
! Support for parents. Individual or group sessions
that include training and the opportunity to talk
with other parents can provide new strategies for
supporting a child and managing difficult
behavior in a positive way. The therapist can also
coach parents on how to deal with schools.
!

To find information about treatment options for
specific disorders, visit www.nimh.nih.gov/health/.

Choosing a Mental
Health Professional
It’s especially important to look for a child mental
health professional who has training and experience
treating the specific problems that your child is
experiencing. Ask the following questions when
meeting with prospective treatment providers:
! Do you use treatment approaches that are
supported by research?
! Do you involve parents in the treatment? If so,
how are parents involved?
! Will there be homework between sessions?
! How will progress from treatment be evaluated?
! How soon can we expect to see progress?
! How long should treatment last?
Additional information related to identifying a
qualified mental health professional and effective
treatment options is available on the NIMH website
at www.nimh.nih.gov/findhelp as well as through
other organizations listed in the Resources section
of this brochure.

Working with the School
If your child has behavioral or emotional challenges
that interfere with his or her success in school, he or
she may be able to benefit from plans or
accommodations that are provided under laws
originally enacted to prevent discrimination against
3

children with disabilities. The health professionals
who are caring for your child can help you
communicate with the school. A first step may be to
ask the school whether an individualized education
program or a 504 plan is appropriate for your child.
Accommodations might include simple measures
such as providing a child with a tape recorder for
taking notes, permitting flexibility with the amount
of time allowed for tests, or adjusting seating in the
classroom to reduce distraction. There are many
sources of information on what schools can and, in
some cases, must provide for children who would
benefit from accommodations and how parents can
request evaluation and services for their child:
! There are Parent Training and Information
Centers and Community Parent Resource
Centers throughout the United States. The
Center for Parent Information and Resources
website lists centers in each state (www.
parentcenterhub.org/find-your-center/).
! The U.S. Department of Education (ED: (www.
ed.gov/) has detailed information on laws that
establish mechanisms for providing children with
accommodations tailored to their individual needs
and aimed at helping them succeed in school. The
ED also has a website on the Individuals with
Disabilities Education Act (https://sites.ed.gov/
idea/), and the ED’s Office of Civil Rights (www2.
ed.gov/about/offices/list/ocr/frontpage/prostudents/disability-pr.html) has information on
other federal laws that prohibit discrimination based
on disability in public programs, such as schools.
! Many of the organizations listed in this brochure
as additional resources also offer information on
working with schools as well as other more
general information on disorders affecting children.

Learn More
Information on specific disorders is available on the
NIMH website (www.nimh.nih.gov/index.shtml)
and in our publications (www.nimh.nih.gov/health/
publications/index.shtml) and health information
pages (www.nimh.nih.gov/health/topics/index.
shtml). The organizations below also have information
on symptoms, treatments, and support for childhood
mental disorders. Participating in voluntary groups
can provide an avenue for connecting with other
parents dealing with similar issues.
Researchers continue to explore new means of
treatment for childhood mental disorders; the “Join
4

a Study” section listed in the Resources provides
information on participating in clinical research.

Resources
Please Note: This resource list is provided for
informational purposes only. It not
comprehensive and does not constitute an
endorsement by NIMH.
The following organizations and agencies have
information on mental health issues in children.
Some offer guidance for working with schools and
finding health professionals:
! American Academy of Child and Adolescent
Psychiatry (www.aacap.org/) See Facts for
Families (/www.aacap.org/AACAP/Families_
and_Youth/Facts_for_Families/FFF-Guide/
FFF-Guide-Table-of-Contents.aspx) on
many topics.
! Association for Behavioral and Cognitive
Therapies (www.abct.org/Home/)
! Society for Clinical Child and Adolescent
Psychology (https://sccap53.org/)
! EffectiveChildTherapy.org (http://
effectivechildtherapy.org/)
! Centers for Disease Control and Prevention
(www.cdc.gov/). See the Children’s Mental Health
page (www.cdc.gov/childrensmentalhealth/
symptoms.html)
! Children and Adults with Attention Deficit/
Hyperactivity Disorder (www.chadd.org/)
! Depression and Bipolar Support Alliance
(www.dbsalliance.org)
! Interagency Autism Coordinating Committee
(https://iacc.hhs.gov/) See these webpages on
Autism: Federal Agencies (https://iacc.hhs.gov/
resources/federal-agencies/); Private and
Non-Profit Organizations (https://iacc.hhs.gov/
resources/private-organizations/); and State
Resources (https://iacc.hhs.gov/resources/
state-resources/)
! International OCD Foundation (https://iocdf.org/)
! Mental Health America
(www.mentalhealthamerica.net/)
! National Alliance on Mental Illness
(www.nami.org/)
! National Association of School Psychologists
(www.nasponline.org/resources-andpublications/families-and-educators)

National Federation of Families for Children’s
Mental Health (www.ffcmh.org/)
! Stopbullying.gov (www.stopbullying.gov/)
! Substance Abuse and Mental Health Services
Administration Behavioral Health Treatment
Services Locator (https://findtreatment.samhsa.
gov/)
! Tourette Association of America
(www.tourette.org/)
!

Addressing Disorders
Affecting Children
The NIMH is conducting and supporting research
that could help find new and improved ways to
diagnose and treat mental disorders that occur in
childhood. This research includes studies of risk
factors, including those related to genetics and to
experience and the environment, which may
provide clues to how these disorders develop and
how to identify them early. NIMH also supports
efforts to develop and test new interventions,
including behavioral, psychotherapeutic, and
medication treatments. In addition to providing
ways to diagnose and treat disorders in childhood,
research can help determine whether beneficial
effects of treatment in childhood continue into
adolescence and adulthood.

Participating in a Research
Study for Children
Children are not little adults, yet they are often
given medicines and treatments that were only
tested in adults. There is a lot of evidence that
children’s developing brains and bodies can
respond to medicines and treatments differently
than how adults’ brains and bodies respond.

The way to get the best treatments for children is
through research designed specifically for them.
NIMH supports a wide range of research, including
clinical trials that look at new ways to prevent,
detect, or treat diseases and conditions. During
clinical trials on conditions affecting mental health,
treatments being tested might be new behavioral
treatments, new drugs or new combinations of
drugs, or new approaches to enhance existing
treatments. The goal of clinical trials is to determine
if a new test or treatment works and is safe.
Although individual participants may benefit from
being part of a clinical trial, participants should be
aware that the primary purpose of a clinical trial is to
gain new scientific knowledge so that others may
be better helped in the future.
Please Note: Decisions about whether to apply
for a clinical trial and which ones are suited for
your child are best made in collaboration with his
or her licensed mental health professional. For
more information on clinical research, visit NIH
Clinical Research Trials and You: For Parents
and Children (www.nih.gov/health-information/
nih-clinical-research-trials-you/parents-children).
FINDING A CLINICAL STUDY
Researchers at the NIMH conduct research on
numerous areas of study, including cognition,
genetics, epidemiology, and psychiatry. These
NIMH studies take place at the National Institutes of
Health’s Clinical Center in Bethesda, Maryland, and
require regular visits. To find studies for children
and teens being conducted at NIMH, visit Join a
Study: Children (www.nimh.nih.gov/labs-at-nimh/
join-a-study/children/index.shtml). You can find out
whether a study would be appropriate for your child
by talking with the contacts listed for each study.
In addition to trials underway at NIMH, there are
clinical trials testing mental health treatments that
are being conducted across the United States and
around the world. To find a clinical trial near you, you
can visit ClinicalTrials.gov (https://clinicaltrials.gov/).
This is a searchable registry and results database of
federally and privately supported clinical trials.
ClinicalTrials.gov gives you information about a
trial’s purpose, who funds it, who may participate,
locations, and phone numbers for more details. This
information should be used in conjunction with
advice from mental health professionals.
5

Reprints

QUESTIONS TO ASK YOUR DOCTOR

This publication is in the public domain and may be
reproduced or copied without permission from
NIMH. Citation of NIMH as a source is appreciated.
We encourage you to reproduce it and use it in your
efforts to improve public health. However, using
government materials inappropriately can raise
legal or ethical concerns, so we ask you to use
these guidelines:
! NIMH does not endorse or recommend any
commercial products, processes, or services, and
our publications may not be used for advertising
or endorsement purposes.
! NIMH does not provide specific medical advice
or treatment recommendations or referrals; our
materials may not be used in a manner that has
the appearance of providing such information.
! NIMH requests that non-Federal organizations
not alter our publications in ways that will
jeopardize the integrity and “brand” when using
the publication.
! The addition of non-Federal Government logos
and website links may not have the appearance
of NIMH endorsement of any specific commercial
products or services, or medical treatments
or services.
! Images used in publications are of models and
are used for illustrative purposes only. Use of
some images is restricted.

Asking questions and providing information to
your doctor or health care provider can improve
your care. Talking with your doctor builds trust
and leads to better results, quality, safety,
and satisfaction. Visit the Agency for
Healthcare Research and Quality website for
tips at www.ahrq.gov/patients-consumers.

If you have questions regarding these guidelines and
use of NIMH publications, please contact the NIMH
Information Resource Center at 1–866–615–6464
or e-mail [email protected].

For more information on conditions that affect mental
health, resources, and research, go to MentalHealth.
gov at www.mentalhealth.gov, or the NIMH
website at www.nimh.nih.gov. In addition, the
National Library of Medicine’s MedlinePlus service
(https://medlineplus.gov/) (En español: http://
medlineplus.gov/spanish) has information on a
wide variety of health topics, including conditions
that affect mental health.
For information on clinical trials, visit:
ClinicalTrials.gov: www.clinicaltrials.gov
(En español: http://salud.nih.gov/investigacion-clinica/)
National Institute of Mental Health
Office of Science Policy, Planning, and
Communications
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301–443–4513 or
Toll-free: 1–866–615–NIMH (6464)
TTY Toll-free: 1–866–415–8051
Fax: 301–443–4279
E-mail: [email protected]
Website: www.nimh.nih.gov

For More Information
MENTAL HEALTH TREATMENT LOCATOR
The Substance Abuse and Mental Health Services
Administration (SAMHSA) provides this online
resource for locating mental health treatment
facilities and programs. The Mental Health
Treatment Locator section of the Behavioral
Health Treatment Services Locator lists facilities
providing mental health services to persons with
mental illness. Find a facility in your state at
https://findtreatment.samhsa.gov/. For additional
resources, visit www.nimh.nih.gov/findhelp.

6

U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
National Institutes of Health
NIH Publication No.
Revised 2018