Health and Quality of Life: Years of Potential Life Lost - A Pediatric Perspective

George H. Durham II, M.D., F.A.A.P.

There is a concept in epidemiology called YPLL or years of potential life lost. Physicians have identified behaviors and strategies that contribute to a full lifetime. In any decade of human life, there are behaviors and advice—which if followed—statistically may reduce years of potential life lost. For those of us who are grandparents such behaviors include cancer screenings (colonoscopy, mammograms), lipid profile evaluations, exercise, and weight control activities.

Several years ago, the American Academy of Pediatrics identified six areas of emphasis for those of our families in their second decade of life (ages 10 – 20). These six included:

  • Always Wear a Seatbelt: Accidents are probably the leading cause of mortality and morbidity in the second decade of life. Being careful—such as in always wearing a seatbelt—contributes to reducing YPLL. In the state of Utah, the leading causes of accidental deaths are automobile accidents, drowning, and often unintentional firearm accidents (children playing with guns).
  • Never Get In a Car with Someone Who Has Been Drinking or Using Drugs: This advice is similar to number one but includes the realization that as children become young drivers themselves—and often feel immortal—there are others on the road who may be impaired drivers. In the era of cell phones, I advise parents and teens to have a strategy to be picked up—without embarrassment—whenever the teen is in a situation where there are no designated drivers.
  • Don’t Smoke: Tobacco and related diseases are still significant sources of morbidity in the United States. In spite of recent decreases in tobacco use in the United States many are introduced to tobacco and become addicted at ages 10, 11, and 12. This emphasis permits parent-child discussion about other legal and illegal substances.
  • The Safest Sex is No Sex: The median age of first intercourse in the United States is stated to be at age 17. The epidemics of STD’s including HIV, HPV, Chlamydia, and others are evidence of the adage that when we choose to be intimate with another person we are being intimate with every person with whom that person has been intimate. Parents need to be comfortable in discussing these realities as well as responsible practices when individuals choose to become sexually active. Many men and women diagnosed with AIDS in their 20’s and 30’s probably contracted the virus in their teens.
  • Eat Your Fruit and Vegetables: There is an obesity epidemic in the United States. There is plenty of blame to go around including the practice twenty years and more ago when pediatricians would suggest introducing juice to infants as young as 4-6 months. This has changed! If juice is introduced at all—after one year of age—it should be limited to four ounces daily and probably diluted with water. Certainly soft drinks, fast foods, the “supersize” portions have all played a role as well. Teens should be encouraged to have 3-5 servings daily each of fruit and vegetables.
  • Get Regular Aerobic Exercise: Much has been said of the couch potato generation. Pediatricians advise that children and teens limit their “screen time” to two hours or less daily. Walk, exercise, bike, swim, ski. move…do something! Thirty minutes daily is a minimum goal.