Suicide is the second leading cause of death for adolescents 15 to 19 years old. This report updates the previous statement of the American Academy of Pediatrics and is intended to assist pediatricians, in collaboration with other child and adolescent health care professionals, in the identification and management of the adolescent at risk for suicide. Suicide risk can only be reduced, not eliminated, and risk factors provide no more than guidance. Nonetheless, care for suicidal adolescents may be improved with the pediatrician’s knowledge, skill, and comfort with the topic, as well as ready access to appropriate community resources and mental health professionals.

Suicide is the third-leading cause of death for adolescents 15 to 19 years old. Pediatricians can take steps to help reduce the incidence of adolescent suicide by screening for depression and suicidal ideation and behavior. This report updates the previous statement of the American Academy of Pediatrics and is intended to assist the pediatrician in the identification and management of the adolescent at risk of suicide. The extent to which pediatricians provide appropriate care for suicidal adolescents depends on their knowledge, skill, comfort with the topic, and ready access to appropriate community resources. All teenagers with suicidal thoughts or behaviors should know that their pleas for assistance are heard and that pediatricians are willing to serve as advocates to help resolve the crisis.

Tobacco use and secondhand tobacco-smoke (SHS) exposure are major national and international health concerns. Pediatricians and other clinicians who care for children are uniquely positioned to assist patients and families with tobacco-use prevention and treatment. Understanding the nature and extent of tobacco use and SHS exposure is an essential first step toward the goal of eliminating tobacco use and its consequences in the pediatric population. The next steps include counseling patients and family members to avoid SHS exposures or cease tobacco use; advocacy for policies that protect children from SHS exposure; and elimination of tobacco use in the media, public places, and homes. Three overarching principles of this policy can be identified: (1) there is no safe way to use tobacco; (2) there is no safe level or duration of exposure to SHS; and (3) the financial and political power of individuals, organizations, and government should be used to support tobacco control. Pediatricians are advised not to smoke or use tobacco; to make their homes, cars, and workplaces tobacco free; to consider tobacco control when making personal and professional decisions; to support and advocate for comprehensive tobacco control; and to advise parents and patients not to start using tobacco or to quit if they are already using tobacco. Prohibiting both tobacco advertising and the use of tobacco products in the media is recommended. Recommendations for eliminating SHS exposure and reducing tobacco use include attaining universal (1) smoke-free home, car, school, work, and play environments, both inside and outside, (2) treatment of tobacco use and dependence through employer, insurance, state, and federal supports, (3) implementation and enforcement of evidence-based tobacco-control measures in local, state, national, and international jurisdictions, and (4) financial and systems support for training in and research of effective ways to prevent and treat tobacco use and SHS exposure. Pediatricians, their staff and colleagues, and the American Academy of Pediatrics have key responsibilities in tobacco control to promote the health of children, adolescents, and young adults.

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This policy statement is an update of the American Academy of Pediatrics policy statement “Legalization of Marijuana: Potential Impact on Youth,” published in 2004. Pediatricians have special expertise in the care of children and adolescents and may be called on to advise legislators about the potential impact of changes in the legal status of marijuana on adolescents. Parents also may look to pediatricians for advice as they consider whether to support state-level initiatives that propose to legalize the use of marijuana for medical and nonmedical purposes or to decriminalize the possession of small amounts of marijuana. This policy statement provides the position of the American Academy of Pediatrics on the issue of marijuana legalization. The accompanying technical report reviews what is currently known about the relationships of marijuana use with health and the developing brain and the legal status of marijuana and adolescents’ use of marijuana to better understand how change in legal status might influence the degree of marijuana use by adolescents in the future.

In recent years, there has been an increased national focus on assessing and improving the quality of health care. This statement provides recommendations and criteria for assessment of the quality of primary care delivered to adolescents in the United States. Consistent implementation of American Academy of Pediatrics recommendations (periodicity of visits and confidentiality issues), renewed attention to professional quality-improvement activities (access and immunizations) and public education, and modification of existing quality-measurement activities to ensure that quality is delivered are proposed as strategies that would lead to improved care for youth.

Prevalence rates of many sexually transmitted infections (STIs) are highest among adolescents. If nonviral STIs are detected early, they can be treated, transmission to others can be eliminated, and sequelae can be averted. The US Preventive Services Task Force and the Centers for Disease Control and Prevention have published chlamydia, gonorrhea, and syphilis screening guidelines that recommend screening those at risk on the basis of epidemiologic and clinical outcomes data. This policy statement specifically focuses on these curable, nonviral STIs and reviews the evidence for nonviral STI screening in adolescents, communicates the value of screening, and outlines recommendations for routine nonviral STI screening of adolescents. Pediatrics 2014;134:e302-e311 EVIDENCE TO SUPPORT NONVIRAL STI SCREENINGThe goal of sexually transmitted infection (STI) screening is to identify and treat individuals with treatable infections, reduce transmission to others, avoid or minimize long-term consequences, identify other exposed and potentially infected individuals, and decrease the prevalence of infection in a community. Healthy People 2020 objectives for sexually transmitted diseases 1 include items that address screening for chlamydia in sexually active females younger than 25 years and set targets for decreased rates of chlamydia, gonorrhea, and syphilis in specific populations. The US Preventive Services Task Force (USPSTF), an independent panel of prevention and evidence-based medicine experts, has published chlamydia, 2 gonorrhea, 3 and syphilis 4,5 screening guidelines that recommend screening those at risk on the basis of epidemiologic and clinical outcomes data. The Centers for Disease Control and Prevention (CDC) publishes evidence-based STI screening recommendations for specific at-risk populations that are not addressed by the USPSTF but that pose public health challenges for disease prevention and control. 6-8 Major professional medical organizations, including the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians, have also published STI screening guidelines for specific populations. 7-10 The American Academy of Pediatrics' (AAP) Bright Futures guidelines for health supervision recommend chlamydia and gonorrhea screening as appropriate for the patient population and the clinical setting. 11 Recent AAP clinical reports addressing gynecologic examinations and male reproductive and sexual health care discuss clinic issues and provider COMMITTEE ON ADOLESCENCE and SOCIETY FOR ADOLESCENT HEALTH AND MEDICINE