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April 2001

Study: Birth Control Pills + Heavy Smoking = A Deadly Mix
Women who are taking birth control pills and who are also chain smokers have a much greater risk of having heart attacks than their counterparts who do not smoke and who are not on the pill, according to a new study.
Previous research has shown that oral contraceptives (OC) containing 50 micrograms or more of estrogen were associated with an increased risk of heart attacks among current users who were also heavy smokers. In this study, researchers examined the newer, low-dose oral contraceptives that contain less than 50 micrograms of estrogen (on average 30 to 35 micrograms), and found that women who smoked heavily (25 cigarettes per day) still faced greater risk of having a heart attack.
"Heavy smokers who are on the pill have a greater risk of having a heart attack than nonsmokers and light smokers who were on the pill," says lead author Lynn Rosenberg, ScD, at the Slone Epidemiology Unit, Boston University School of Public Health in Brookline, Massachusetts.
In a large study involving 75 hospitals in the greater Boston and Philadelphia areas, researchers studied more than 600 young women (under the age of 45) who were admitted to the hospital with a nonfatal first heart attack during the years of 1985 and 1998. They used more than 2,000 female hospital controls at similar age.
Researchers analyzed interviews with the study participants and reached the conclusion that current oral contraceptive use had little or no influence on the risk of a nonfatal first heart attack among women who did not smoke or who smoked fewer than 25 cigarettes a day. But researchers say that current OC use together with heavy smoking increases the risk of heart attack to a level about 30 times that of nonsmokers who do not use OCs.
Researchers say that they had hoped to find that by reducing the doses of estrogen and progestin in the oral contraceptives, it would be safer for all women to use the pills. "But our study shows that it is not safer for heavy smokers to use low-dose oral contraceptives," says Rosenberg.
Daniel Mishell, Jr., MD, chair of the department of obstetrics and gynecology at the Keck School of Medicine at the University of Southern California in Los Angeles, California, says that the findings are consistent with earlier research on the use of higher-dose oral contraceptives among heavy smokers and their heart attack risk.
"There is no increased risk of heart attacks among oral contraceptive users who don't smoke," says Mishell. "For smokers, lower-dose pills seem to have the same increased risk of heart attacks as higher-dose pills."
Mishell points out that oral contraceptives increase the risk of heart attack more than smoking itself. Although the mechanism behind smoking and oral contraceptives and the effect on heart attacks remains unclear, Mishell says that it is speculated that smoking along with oral contraceptives may increase the blood clots in the arteries. "It may be more likely to have a clot in the coronary arteries," says Mishell.
The word of caution is that "women who are heavy smokers and who are over the age of 35 should not take oral contraceptives," says Mishell.
Source: The study is published in the April 23 issue of the Archives of Internal Medicine, part of the Journal of the American Medical Association family of journals.

Autistic Kids May Not Recognize Mom From Early
An inability to recognize familiar faces by the age of 1 year may signal the type of abnormal brain development characteristic of autism, new study findings suggest.
According to Dr. Geraldine Dawson of the University of Washington in Seattle, checking for face recognition may be one of a battery of tests for autism that could be given to young infants. Other behaviors that can be assessed include gestures such as pointing and showing, and turning toward a voice when the infant's name is called, Dawson told Reuters Health.
"These behaviors have been found to discriminate between 12-month-old infants later diagnosed with autism, and normal infants of the same age," she said.
Currently, children are not diagnosed with the developmental disorder until they are about 3 or 4 years old.
"If we can detect autism very early in life, we can begin intervention early, when the brain is still developing and plastic," Dawson explained. "This may result in a better outcome for children with autism."
Her study showed that the brain activity of autistic 3- and 4-year-old children was the same whether they viewed images of their mother or images of a stranger. However, Dawson and her colleagues also found that an image of a favorite toy sparked a different type of brain activity than the sight of an unfamiliar toy did.
Indeed, hallmarks of autism include an inability to communicate and interact socially and a preference for inanimate objects.
In contrast, Dawson's team found, a group of healthy children and another group of mentally retarded children showed similar patterns of brain activity when shown images of favorite and unfamiliar toys. But the children's brain activity differed when they viewed images of their mothers or a stranger.
Dawson presented the findings recently in Minneapolis, Minnesota, at a meeting of the Society for Research in Child Development.
While the study was conducted in children at ages three and four, the findings could be used in testing much younger infants. These results support previous studies demonstrating that healthy children as young as 6 months have different patterns of brain activity when they are shown pictures of their mother and pictures of a stranger.
Earlier work by Dawson examining home videotapes of infants who were later diagnosed with autism found that a failure to look at the face of another person was "the best discriminator of infants with autism," she said.
Source: Society for Research in Child Development.

Raising Cigarette Price Curbs Teen Smoking
Although previous studies have suggested that cigarette prices do not significantly influence teen smokers, new study findings show that increasing the price of cigarettes may indeed decrease the likelihood that adolescents will start smoking.
"The Centers for Disease Control and Prevention estimate that 3,000 youth start daily-smoking each day," lead study author Dr. John A. Tauras of the University of Illinois at Chicago told Reuters Health. "My study suggests that if cigarette prices were to increase by 10% nationally, we could prevent many kids from initiating cigarette smoking and significantly reduce the future burden of tobacco-related disease in the United States."
Taurus and his co-authors, Drs. Patrick M. O'Malley and Lloyd D. Johnston, both of the University of Michigan, analyzed survey data from three groups of individuals who were involved in the Monitoring the Future project at the University of Michigan. Each group, including 2,000 eighth graders and 2,000 tenth graders, were surveyed about their cigarette, alcohol and illicit drug use in 1991-1993 and participated in at least two follow-up surveys through 1998.
Study findings show that the price of cigarettes was the most significant factor in determining whether or not the adolescents became regular smokers.
For example, "in places where the price of cigarettes was high, there were less individuals who smoked," Taurus said. The opposite was true in places with low cigarette prices.
In light of this finding, the authors next determined how responsive adolescents would be to changes in cigarette prices.
The investigators found that an estimated 10% increase in the price of cigarettes would lead to a 10% decrease in the number of adolescents who become daily smokers, the report indicates.
"The implications are very important," Tauras said. "If you want to prevent kids from starting to smoke, then raise excise taxes." Excise taxes, which vary from state to state, are the tax per unit or pack of cigarettes.
"If excise taxes were raised even higher, we would likely see even more substantial reductions in youth smoking initiation," he said.
Minimum age laws, restricting smoking in public schools, and restricting the distribution of free tobacco samples may also be effective in decreasing the number of adolescents who start smoking, the authors note.
In other findings, young teens were more likely to start smoking than older teens; whites were more likely to smoke than their African-American, Mexican, Asian-American and Latino peers; and youth who lived with at least one parent were less likely to start smoking than those who did not live with a parent. Also, among the students who said they smoked a half pack of cigarettes daily, males were more likely to start smoking than females.

Brain Injury Reality Scares Young Felons Straight
Better than reality television, taking juvenile offenders to see people who have traumatic brain injury turns them away from crime. Or, if they do re-offend, they turn to less violent crimes.
This is what researchers who work with juvenile offenders found after working for 5 years in a program that gives youth a dose of reality.
More than anything, youth find the reality of permanent sexual, bowel and bladder dysfunction resulting from brain injury scarier than death from violence, the researchers said, and such reality affects their behavior.
A summary of the center's experience was presented at the 70th annual meeting of the American Association of Neurological Surgeons by Mimi Sutherland, a nurse and program director of the Juvenile Firearm Offender Program at Jackson Memorial Hospital in Miami, Florida.
The three-part program has a 6-month curriculum that offenders under the age of 16 must attend after a court order. Participants must attend 2-hour classes twice weekly.
The first part focuses on the consequences of brain trauma, including severe neurological consequences and death, put in the context of what would happen to a younger sibling of the offender. The offenders are taken for educational visits to a trauma resuscitation unit, a pediatric intensive care unit, a pediatric rehabilitation center and even to funeral homes.
The second portion of the program covers risk-taking behaviors such as using drugs, risky sexual behavior and joining gangs, and their consequences. The third part addresses how to improve behavior through anger management and conflict resolution techniques.
Data were presented on 39 juveniles aged 12 to 15 who went through the program. Only 18% lived with their biological parents, while 20% had a parent who was in jail.
Ten of the offenders had committed violent offenses, including manslaughter and aggravated assault. Other offenses included robbery and bomb threats.
A total of 33 of the children had used some sort of gun in their crime. Of these, 33% used handguns, 3% paintball guns, and 6% each for long guns, BB guns and toy guns.
Four years after the program, four of the juveniles had committed crimes, but no weapons were involved. Another 40% brought friends and siblings to attend the courses. Half stayed in touch with program leaders, which demonstrates that they had positive associations with the program.
Source: American Association of Neurological Surgeons

Bullying Common in US Schools, May Lead to Violence
It's official: one third of US school children have either been bullied or bullied someone, according to a new study. Experts say the problem calls for more research and preventive measures.
Until now, there has been no nationwide research on the prevalence of youth bullying in the US. Most studies on bullying have been done in Europe and Australia. But a new survey, published in the April 25 issue of the Journal of the American Medical Association, examined the frequency of youth bullying in the US, and figured out the association between bullying and being bullied, and its psychosocial effects. Researchers also looked at the incidence of bullying by gender and age.
"Almost 30% of the students reported moderate or frequent involvement in bullying," says the study's lead author, Tonja Nansel, PhD, of the National Institute of Child Health and Human Development in Bethesda, Maryland.
In this study, researchers analyzed data from a nationally representative sample of more than 15,000 students in grades 6 through 10 in both public and private schools. Researchers found that boys were more likely than girls to be both bullies and targets of bullying. They also found that the experience of being a bully and being bullied was associated with poorer psychosocial adjustment, including problem behavior.
"Bullying is not just a right of passage," says Nansel. "It's a serious public health problem that we need to pay attention to. It's associated with adverse psychosocial adjustment for both kids who are bullying and who are bullied. We need to engage in some work to decrease the amount of bullying among kids."
Researchers say the definition of bullying is widely accepted as a specific type of aggression, in which:

The behavior is intended to harm or disturb.
The behavior occurs repeatedly over time.
There is an imbalance of power, with a more powerful person or group attacking a less powerful one.

Bullying can be both physical (hitting), psychological (rumors, shunning/exclusion) and verbal (calling names, and threats). Researchers also say that the study is specifically designed to reflect races in the US. Among the three racial groups examined, Hispanic youth reported slightly higher rates of bullying others, compared to African Americans and Caucasian Americans. African-American youth reported slightly lower rates of being bullied, compared to Caucasian Americans and Hispanic Americans.
In addition, researchers found very little difference between urban, rural, and suburban areas.
"We hope the study will provide impetus for more research in this area," says Nansel. "We know that prevention programs can be effective as shown in other countries. We hope some of those efforts will be adopted here in the US."
Howard Spivak, MD, vice president for community health programs at the New England Medical Center in Boston, Massachusetts, wrote an editorial accompanying the study. He says that the findings highlight a very important issue that has been largely ignored, despite the high-profile school violence of recent years.
"In the short run, these kids need attention in services, and in the long run, some of these kids are at risk of being involved in violence later on," says Spivak, who is also a professor of pediatrics and community health at Tufts University School of Medicine in Boston.
Studies done in Norway have shown that school intervention programs can reduce the amount of bullying dramatically, Spivak says. The research also showed that individuals with history of bullying are four times more likely to be arrested for criminal behavior by their early 20s. Almost a third of those individuals had multiple criminal convictions.
Spivak says that other studies have shown that individuals with history of being bullied have a significantly higher rate of depression and poor self-esteem. "It's important to recognize that both those who bully and those who are bullied are of concern," says Spivak. "Kids who get in trouble with the law and kids who have depression are at risk of being involved in violence."
Despite the study's significant finding, however, Spivak cautions that researchers did not do a long follow-up. "[The study] doesn't give us a sense of how many of these kids will go on to some more serious and concerning behaviors," he says. "More research is needed to both understand and respond to bullying more aggressively and effectively in this country--both with prevention as well as services."
Source: April 25 issue of the Journal of the American Medical Association

Mom's Warmth Influences Kid's Ability To Get Along With Others
A Penn State study has shown that elementary school children who have depressed mothers may have trouble regulating their emotions and getting along with other kids because their moms are unable to show them enough warmth and sensitivity. Dr. Mark T. Greenberg, who holds the Edna Peterson Bennett Chair in Prevention Research, says, "Researchers have known for some time that maternal depression places a child at risk for problems in emotion regulation and peer relationships. Our recent study has shown that at least part of the risk can be explained by the fact that depressed mothers show less warmth toward their children." The study, which is part of the doctoral dissertation of Greenberg's student, Dr. Chi-Ming Kam, is one of only a few to trace the lasting influence of maternal depression to a lack of warmth. The researchers say the findings suggest that programs that help parents enjoy their relationships with their children can be helpful.
In addition, Greenberg says, "Since most people who are depressed don't go to mental health professionals for treatment, doctors and nurses who see women regularly should be alert for depressive symptoms. Early detection and treatment can have positive effects on the children as well as the mothers."
Kam will present the study results in a poster, "Effects of Maternal Depression on Children's Social and Emotional Functioning During the Early School Years," today (April 21) at the biennial meeting of the Society for Research in Child Development in Minneapolis, MN.
He says the study data were drawn from observations made as part of the Fast Track project that involves schools and parents working together to help at-risk children. Fast Track is both a service and research program that operates in Durham, N.C., Seattle, Wash., and Nashville, Tenn., as well as central Pennsylvania. While helping individual children overcome learning obstacles and behavior patterns that prevent them from growing into productive members of society, the researchers are, at the same time, developing new theories and treatments.
The study participants included 358 mother/child pairs from whom the researchers assembled data from the time the children started first grade until they entered grade 3. In school, teachers rated the children's ability to regulate their emotions. The children's classmates rated how well they were accepted by the other kids at school.
In addition, trained observers visited the study participant's homes where they asked the mothers, each year, to complete a survey questionnaire about any depressive symptoms they may have had. The observers also asked the mothers and kids to work on several tasks as they watched. These tasks included five-minute sessions of free play; parent-directed play and building with interlocking blocks. The observers watched the mother/child pairs as they worked on the task to see if the mothers encouraged their children, gave hints, showed enjoyment, and exhibited sensitivity and enthusiasm for the child's efforts.
The researchers found that the more symptoms of depression the mother reported in the questionnaire, the less warmth they showed to their child. Some depressed mothers were unable to show any response at all. Others were highly critical of their child's efforts or were hostile during the observation period.
In addition, the researchers found that the more symptoms of depression the mother had, the more likely the child was to have problems regulating their emotions and getting along with other kids. Kam says, "Our study showed that one possible reason these children may have trouble getting along might be the inability of depressed mothers to cultivate emotion regulation skills in their children. Emotion regulation skills have been found to be an important component of social competence."
Source: Penn State. The study was supported by a grant from the National Institute of Mental Health.

Hospital wards for adolescents should be considered
National survey of use of hospital beds by adolescents aged 12 to 19 in the United Kingdom
Enough 12 to 19 year-olds are admitted to British hospitals to justify separate hospital facilities specifically for adolescents, argues Russell Viner, Consultant in Adolescent Medicine at University College London, in this week's BMJ.
By examining the numbers of hospital bed days of inpatients and day case patients aged 12 to 19 years in 37 health authorities and boards across Britain, he found that the use of hospital beds increases rather than decreases through adolescence. This contradicts the assumption that adolescents use hospitals rarely and do not merit separate facilities.
Although dedicated wards for adolescents may not be possible in many hospitals, says the author, the provision of other facilities should be considered, he concludes.
This view is reiterated by adolescent health experts, Aidan Macfarlane and Robert Blum, in an accompanying editorial. They write, "even where the numbers do not justify a separate ward for adolescents, a multidisciplinary approach from health professionals with interest and expertise in adolescent health is still feasible in every hospital."
British Medical Journal

Sport can keep teenagers off drugs
THE key to keeping teenagers drug-free is encouraging involvement in sport and early checking of anti-social behaviour, a new study has found. Almost 4,000 adolescents in England, Ireland, Germany, Italy and Holland were questioned about their lifestyles. A higher rate of substance abuse was found by youths in the UK and Ireland. In areas where there was most risk in England and Ireland, stable family backgrounds were no longer a safeguard against boys becoming involved in drugs.
Girls in traditional families were more restrained and limited their contact with older boys who may otherwise have influenced them. The teenagers were asked if they had taken cannabis, amphetamines, ecstasy, tranquillisers or LSD. Of the five cities surveyed, Newcastle had the highest rate of drug use at 29.8 per cent; followed by Dublin at 29.7; Bremen with 22.9; Rome 22.9 per cent and Groningen with 19 per cent.
Dr Paul McArdle, of Newcastle University's Department of Child Health, led a 13-strong European Commission-funded team examining international variations in drug use among youths. It looked into the effect of the behaviour of individuals, peer and family influences and geographical factors.
For boys and girls, a strong correlation was found between sport and a reduced incidence of involvement with drugs. Delinquent behaviour was closely linked with a greater risk of drug use. The report concluded that drug-taking was not regarded as normal behaviour despite its prevalence.
The report said: "While significant numbers of young people use drugs in the absence of major risk factors, drug use should not be regarded as an inevitable or likely phase of mid-adolescent development."
SOURCE: Newcastle University: Department of Child Health

Poorly Educated Young Moms, Early Violence Signal Later Violent Life
Boys who are violent early on and whose mothers are young and poorly educated are more likely to lead a violent life than others, a new study suggests.
For the first time, researchers have developed methods that are able to predict which children will be violent at an early age and who will continue to be violent later on. They also identified two maternal markers that distinguished the boys who started violent and stayed violent from those who started violent but stopped later in life.
"Poor education and teenage motherhood were the two maternal characteristics that distinguished these boys from others," says lead author Daniel Nagin, PhD, Heinz professor of public policy at Carnegie Mellon University in Pittsburgh, Pennsylvania.
Researchers analyzed data on more than 1,000 boys aged between 6 and 15 years from Montreal, Canada. They categorized the children into four developmental patterns (trajectories):

Never physically aggressive--a relatively small group of boys, 15% of the population
Modestly physically aggressive but the aggression declines with age--a large group of boys, 50% of the population
Highly physically aggressive at early age but declining aggression after age 6--30% of the population
Highly aggressive and stay that way--a very small group, less than 5% of the population

Researchers used behavior ratings that included physical aggression, opposition, hyperactivity, inattention, anxieties, and prosocial behavior. They found that the most powerful predictors of high aggression were high levels of hyperactivity and opposition assessed in kindergarten.
Opposition was measured by five items: not sharing materials, irritability, disobedience, blaming others and inconsiderateness. Hyperactivity was assessed on the basis how squirmy or fidgety the children were or if they could not keep still.
Researchers say boys who showed strong opposition and hyperactivity behaviors tend to fall in the highly aggressive group. "Boys who at age 6 are already highly physically aggressive and have mothers with these characteristics, [and] are at greatly elevated risk for persisting in this aggression unless some intervention is taken to help them control these violent aggressions," says Nagin. Researchers say such boys have a nine-times-greater chance of persisting in a high-level physical aggression than boys without such characteristics. "Such boys are primary target for intervention," says Nagin. "Prevention programs should be targeted on children who have these high-risk mothers and various support services [should] be provided to these mothers and help them become more effective parents."
Alfred Blumstein, PhD, director of the National Consortium on Violent Research, says that the findings are very important because they provide new methods to identify other kinds of undesirable behaviors. "The study has developed methods that allow one to sort out at an early stage who are the folks who are at high risk for violence later on," says Blumstein, who is also a university professor at the Heinz School of Public Policy and Management in Pittsburgh, Pennsylvania. "They demonstrated the importance of using these methods to identify over time what are the characteristics of the people who display other kinds of inappropriate behaviors. We can generalize these methods and apply them to other kinds of undesirable behaviors such as substance abuse."
Blumstein points out that parental intervention is critical in preventing persistent violent behaviors. He notes that the groups who stopped being violent later on may have had effective parental intervention. "The findings suggest where we can effectively focus on parenting skills for those mothers," says Blumstein. "Let's provide parenting support and education for these young women who have children who have low education and who don't have a supportive environment that's going to help them become more effective parents, particularly for the kids who at an early age start to show signs of violence."
Blumstein says although the study results are encouraging, they need to be replicated in different settings and in different ethnic and racial environments.
The study was published in the April issue of the Archives of General Psychiatry.

Older Dads Linked to Schizophrenic Children
Older fathers are considerably more likely to have children with schizophrenia, a new study suggests.
The study, led by researchers at Columbia University College of Physicians & Surgeons (CUCPS), found that men between the ages of 45 and 49 are twice as likely as their 25-year-old counterparts to have children with the disabling and chronic mental illness, marked by delusions, disordered thinking and social isolation. Men age 50 and older appear to be at three times the risk.
The findings extend a growing body of evidence that show "a man has a biological clock, too," says Dolores Malaspina, MD, the study's lead author and an associate professor of clinical psychiatry at Columbia University in New York City. "Men should be aware of these risks when they do their family planning."
As men age, sperm cells can accumulate mutations that are passed on to their children, the study's authors say. Older dads are more likely to have children with a wide variety of gene-influenced illnesses, which include prostate cancer, neurofibromatosis (Elephant Man's disease) and Marfan syndrome, which involves defects of the eyes, bones, heart and blood vessels. The research marks the first time advancing paternal age has been linked to a psychiatric rather than physical illness.
But the new study isn't simply a sociological message for older fathers. The research provides an important clue in the hunt for the elusive genes associated with schizophrenia, experts agree. Schizophrenia is believed to be caused by an as-yet poorly understood mix of genes that confer susceptibility to the disease, and environmental factors, such as stress, that trigger the actual symptoms.
"One of the major challenges in this illness is to find the susceptibility genes," says David A. Lewis, a professor of psychiatry and neuroscience at the University of Pittsburgh, and a leading schizophrenia researcher. "Schizophrenia hasn't followed the model of other inherited diseases. If this finding is correct, it raises new ideas for pursuing genetic strategies and devising new research for identifying schizophrenia's causes."
The new findings don't identify the genetic culprits, but they help shed light on a longstanding mystery. One of the puzzles of schizophrenia is that its incidence is strikingly consistent across human populations--about 1% of all populations is affected worldwide. The research shows how, in each generation, new genetic mutations may replenish the genes for schizophrenia and keep the incidence stable.
"I would guess our study is just the tip of the iceberg," says Susan Harlap, MD, research professor of epidemiology in the department of Obstetrics and Gynecology and NY University School of Medicine and an author of the study. "Eventually it would seem that the father's sperm is going to turn out to be just as important as the mother's egg.
Women's eggs may also develop chromosomal abnormalities, but these typically involve larger changes that are easier to catch though genetic tests. Sperm mutations, which are tiny, are nearly impossible to catch without knowing in advance what mutations to look for.
The research, a collaboration with New York University School of Medicine and the Israel Ministry of Health, was conducted by reviewing the records of 87,907 people born in Jerusalem between 1964 and 1976 and linking the records to those of the Israel Psychiatric Registry. Over a quarter of the schizophrenia cases appeared to be linked to paternal age, an effect not observed for other psychiatric illnesses.
The study appears in this month's issue of the Archives of General Psychiatry.

Emulating Mom Boosts Self-Esteem and Body Image
Little girls who emulate their mothers are less likely to suffer from low self-esteem and eating disorders, regardless of the mother's own body image, psychologists reported.
"We found that if little girls said, 'I want to be like my mom,' they had a better body image, less eating disorders, and better self-esteem--all these great things," lead author Dr. Jane Ellen Smith, a professor of psychology at the University of New Mexico in Albuquerque, told Reuters Health. "We don't know what it is about wanting to be like your mom that contributes to better self-esteem."
The investigators originally set out to examine why moms often get blamed when their daughters develop eating problems.
The team studied 92 mother-daughter pairs of 8- to 13-year-old Hispanic and white girls from public schools in New Mexico. All the girls fell within normal body weights and were selected for either having an especially high or especially low body self-image.
The girls were all asked to rate their body image, their self-esteem, and their relationship with their mother. The findings are published in the May issue of the International Journal of Eating Disorders.
Overall, girls on the thinner side had a higher satisfaction with their body types than girls who were heavier, even though all the girls were within normal weight limits. Race did not play a factor in body image, the researchers found, but age did. The older girls nearing puberty showed significantly more dissatisfaction with their bodies than the younger girls.
The study did not find that having a mother with poor eating attitudes and body perception necessarily led to her daughter having the same problems.
Instead, the crucial factor was whether the girl strove to be like her mother or not. Girls who identified with and tried to emulate their mother's personality types were less likely to have eating disorders or a negative body image--even if their mothers' bodies were far from swimsuit model standards.
Many of the mothers in the study were overweight and were not particularly proud of their own bodies, Smith added, but the strong bond with their daughters seems to give them enough ammunition to dodge those issues.
The study also found that mothers with high self-esteem generally had daughters with high self-esteem. Similarly, mothers with low self-esteem tended to have daughters with low self-esteem, although no evidence was found that the daughters had subsequent body-image issues as well.
"If the moms don't feel good about themselves, maybe they should do something to feel better," Smith said. "Because there is a relation to their daughter's self-esteem."
SOURCE: International Journal of Eating Disorders 2001;29: 429-440

Study: TV Violence Impairs Memory
After viewing violence on television, people are less likely to remember things they see or hear shortly afterward--such as commercials, according to new research.
"If you're an advertiser, you'd have to be absolutely crazy to sponsor a violent program, if you want your potential customers to remember the ads," says Brad J. Bushman, PhD, psychology professor at Iowa State University, and lead author of a new analysis of previous studies that looked at television's effect on memory.
The researchers looked at 12 studies on the topic. They found that people watching violent TV shows had a hard time recalling what commercials they saw during the programs. The effects of violent images are both immediate and lasting, Bushman says--24 hours later, people still didn't remember the commercials.
"I think the results are very important because previous research has shown that viewing violence increases societal violence," he says.
Bushman says the findings of his analysis may be important for another reason. "Moral appeals are unlikely to change the amount of violence on television, and if advertisers refuse to sponsor violent programs, there would be no violent programs on television," he says. "This research directly contradicts the myth that violence sells. Violence doesn't sell."
The negative effects on memory were found for people of all ages--adults and children, both men and women, and also for people who said they like to watch violent TV shows as well as those who don't like violence, he says.
There are several ideas as to why impairment might happen. For one, people might be put in a bad mood by the violence, and it takes a lot of effort to repair a bad mood, which would make them less likely to pay attention to commercials. Negative moods might also interfere with the brain's memory encoding process, or the effect could occur because it triggers a person's own aggressive thoughts.
These theories are all plausible, says David Walsh, PhD, president of the National Institute on Media and the Family and author of Dr. Dave's Cyberhood (Simon & Schuster, 2001).
Bushman's analysis shows that the audience watching a given TV program may not be what they seem. "What this research does is, it basically says to those advertisers and people making those kind of decisions, that if you're just making those decisions on ratings or demographics, you might want to think again," Walsh says. "It just adds another interesting twist to the debate on violence in the media."
Violent content is an attention-getter, he continues, but if the purpose of the program is to "deliver consumers to advertisers," as a network executive is quoted in Bushman's paper as saying, the programs themselves may be getting far more attention than the commercials.
"Even though those eyeballs might be there for the advertisements, the brains behind the eyeballs may not be registering the content of the ads," Walsh says.
The effect that televised violence has on memory doesn't just apply to advertisers, Bushman says. A lot of children and teens like to do homework with the TV on, and violent programs may hamper their ability to learn and recall the information they are studying.
SOURCE: Bushman's article, co-authored by Iowa State's Colleen M. Phillips, appears in the April issue of the American Psychological Society journal Current Directions in Psychological Science.

Ecstasy kills memory — British study
The drug Ecstasy makes users unreliable as colleagues or friends, and may cause long-term brain damage among young people, research shows. It significantly affects the part of memory linked to planning and remembering daily activities, producing symptoms similar to Alzheimer's disease and amnesia.
he result is that users suffer impaired ability to remember to pass on messages, pay bills, turn up on dates, lock the door, or even to remember what they are saying.
Experts have known for years that Ecstasy, taken by an estimated one million people in Britain a week, can also significantly lower levels of the brain chemical serotonin, an important controller of mood which is linked with depression, and that it can affect long-term memory.
Tom Heffernan of the University of Northumbria, co-author of the research on short-term memory, told a British Psychological Society conference that the findings could have far-reaching implications.
"There is a belief that soft drugs -- which many consider Ecstasy to be -- should be legalised when in fact research suggests that regular use can have a very damaging effect on your cognitive health," he said.
Heffernan and his colleagues studied 40 Ecstasy users, who took the drug six to 12 times a month and who had an average age of 23. The results of a memory questionnaire were compared with answers from 39 adults who did not use Ecstasy. Compared with the non-users, the users suffered significant impairments in all of the everyday memory measures used, even after making allowances for outside factors including use of alcohol and other drugs such as cannabis. It was likely that two separate effects accounted for the memory deficits.
"Structural damage is occurring to the frontal and pre-frontal areas of the brain, the part to do with planning. The second possibility is that Ecstasy is depleting neuro transmitters which carry messages around the brain."
Source: The Times, London

Getting Tough Early Makes Parenting Teens Easier
To keep kids out of trouble, parents must hold the reins tightly during the middle school years, results of a new study suggest.
While criminologists agree that children with behavioral problems are more likely to become criminal adults, "only about 50% of antisocial children become antisocial adults," according to Ronald L. Simons of Iowa State University, and colleagues.
Simons and his research team set out to find out why some problem children become problem teens and others do not. They followed 149 boys and 157 girls and their families for 4 years. On average, the children were between 12 and 13 years when the study began. The researchers interviewed parents and children, and also observed family interactions.
One hypothesis holds that a difficult child will become increasingly involved with peers who are themselves "deviant" as he or she gets older, and that the quality of parenting can do little to change this path. But the researchers found otherwise.
In fact, the investigators found, difficult children make it tougher for parents to set limits or discipline their child, which in turn made it more likely that a child would start hanging out with deviant peers. These "oppositional/defiant" children threw temper tantrums, talked back, bullied other children, were selfish and blamed others. "They almost train you to be a bad parent," Simons told Reuters Health in an interview. "Over time you become more and more lax with your difficult child."
Better-behaved children, conversely, made it easier for their parents to be effective. Effective parents, the authors note, "show warmth and support, set standards for their children, monitor their behavior, engage in consistent discipline, use inductive reasoning to explain rules, and eschew harsh punishments."
The parents of the better-behaved children gave their children more freedom as they entered adolescence, but those with problem children got stricter instead. But the parents of the bad kids were still exerting much less control over their teens at the end of the study period than the parents of the well-behaved children were.
Simon and his colleagues looked at children on two extremes of the behavior continuum. "Most kids are probably in the middle," he noted.
"Our results show it's particularly important that the parent is monitoring and exerting control during those middle school years," Simon told Reuters Health. "That's going to predict what kind of behavior unfolds during the adolescent years."
He added, "During the adolescent years it's really tough to make a dent in your child's delinquency." But all is not lost for parents of troubled adolescents, Simon said. At this stage, these parents can still help their children stay on the straight and narrow by making sure they stay away from deviant and delinquent peers.
SOURCE: Journal of Marriage and Family 2001;63:63-79.

Sleepy Teens Lose Out
Each summer, sleep researcher Mary Carskadon, PhD, has a group of teenagers stay at her laboratory near Brown University in Rhode Island. Just like going to summer camp, the teenagers play games, eat, and sleep, and sleep some more--to the tune of 11-hours a day.
But there's a catch: Instead of the usual 24-hour days we're all accustomed to, the days at sleeping camp are secretly made 28-hours long. The idea is to see if their natural body rhythms can change to fit a more rigorous schedule. No such luck.
"The beating of their internal clock does not adapt to a 28-hour day," says Carskadon, a professor of psychiatry and human behavior at Brown who adds that the normal teenage routine, like getting up early for school, is the opposite of what adolescents are naturally built for.
Carskadon's research confirms what many parents already know. Get kids up before their bodies are ready to move, and it's like waking a zombie. Later in the day when most adults are naturally winding down, there's a spark of alertness in adolescents, making it harder for them to fall asleep at a decent time.
Outside the lab the situation is worse. Bad breakups with a first love, hanging out in coffee shops after school, and surfing the web until the wee hours can make for many restless nights. What this all means, says Carskadon, is that teenagers need far more sleep than they're getting.
"They have bigger tanks to fill and they're not filling them with sleep," she says.
Adults are hardly getting enough shuteye, either. A recent survey found that nearly two-thirds of grown ups do not get their recommend 8-hours of sleep a night. But teenagers need at least 9 and a half-hours, says Carskadon. Without it, kids can have trouble in school, get quickly agitated, and may even risk serious harm if they drive their parents car with too little sleep.
Indeed, Carskadon and other experts speaking today at the National Institutes of Health outlined plenty of reasons why adults and kids should run home and go to bed. When it comes to the new science of snoozing, it seems no one is immune from sleep deprivation.
But too little sleep can cause specific problems for teenagers, such as bad grades and low SAT scores. Few kids have missed the lecture on getting plenty of sleep the night before a big test. What sinks in less, says Robert Stickgold, PhD, is that sleeping helps people retain information in the first place. Looking at a group of Harvard students, Stickgold found that good sleeping habits were a major reason for high test scores.
"IQ doesn’t matter…or if they went to prep school, or how much money their dad makes," explains Stickgold, who teaches psychiatry at the Harvard University Medical School. "80% of how well they do on tests is based on the quality of sleep they get on the nights in between."
Most of these warnings have been issued before. But Eve Van Cauter, PhD, a professor of medicine at the University of Chicago has found something new to worry about. Based on an ongoing study, she says there is reason to think that poor sleep disrupts important hormones, which may possibly lead to weight gain and diabetes. Bad enough, yet there's more: "Sleep deprivation can increase appetites," and cravings for "fat filled foods," says Van Cauter.
And for those who think a power nap will set everything straight, David Dinges, PhD, of the University of Pennsylvania offers reason for caution. After putting 90 people though a range of different sleeping times, he found that naps could help restore some mental sharpness, but nothing beats a good nights rest.
"There's no shortcut here," he says. "Chronically living on little nocturnal sleep and using naps to fill the tanks doesn’t seem to really work."

Teens on Depo-Provera Less Likely to Use Condoms
Teenage girls using Depo-Provera, an injected hormonal birth control method, are less likely to use a condom than girls taking birth control pills, new research suggests.'
Depo-Provera and oral contraceptive pills work similarly in the body, but neither provides protection against sexually transmitted diseases, Dr. Pamela J. Murray, director of adolescent medicine at the Children's Hospital of Pittsburgh, Pennsylvania, told Reuters Health. Murray is director of adolescent medicine at the Children's Hospital of Pittsburgh and lead author of a study published in the February issue of the Journal of Adolescent Health. She presented the report at the Society for Adolescent Medicine meeting this past weekend.
Murray and colleagues surveyed 300 sexually active girls aged 14 to 18 who visited an adolescent clinic or community health center in the Pittsburgh area in the past year.
The girls were asked to divulge what methods of birth control they had used in the past and what methods they were likely to use with a new or regular sex partner in the future. The girls were also asked to frankly assess the odds they would stick to their stated intentions.
During their most recent sexual encounter, 63% of the girls on birth control pills reported they also used a condom, compared with 52% of girls on Depo-Provera.
The researchers also found that 97% of the girls who reported using birth control pills had used condoms in the past, compared with only 89% of the girls who reported using Depo-Provera.
"These are different girls with different experiences making these choices," Dr. Julie S. Downs, a research scientist at Carnegie Mellon University and one of the study's co-authors, told Reuters Health. "We don't want to claim choosing the Pill leads to different condom use. It's more of an indication to physicians that girls on Depo-Provera may have had a different experience."
By finding out the reasons why sexually active girls who take Depo-Provera are less likely to also use a condom, healthcare workers could design more effective interventions to encourage condom use, the researchers said.
For example, the girls who were on Depo-Provera were less likely than girls on oral contraceptives to believe that a condom would prevent a sexually transmitted disease, Downs noted. Girls on Depo-Provera also were less likely to believe their partners would participate in using a condom.
Interventions based on this knowledge could seek to improve girls' condom negotiating skills and address their lack of knowledge about a condom's ability to prevent disease transmission, she explained.
Researchers from Carnegie Mellon University and Slippery Rock University also collaborated on the study, which was funded by the National Institute for Allergy and Infectious Diseases and Magee-Womens Hospital in Pittsburgh.
SOURCE: Journal of Adolescent Health 2001;28:128

Profile of US Single Mom is Changing
About one third of US children are born out-of-wedlock, but the make up of this new American family is different from the common public perception, researchers report. National statistics show that only a minority of these births are to teenage mothers, and many single mothers are living with their babies' fathers.
In 1970, only 11% of children were born outside marriage, and half of these births were to teenage mothers. By 1999, one in every three American children were born to single parents, with teen moms accounting for fewer than 30% of these births, according to a report from Child Trends, a Washington, DC-based, non-profit research center.
Using data from the National Center for Health Statistics, Elizabeth Terry-Humen and her colleagues found that out-of-wedlock births in the US grew rapidly during the 1970s and 1980s, then leveled out between 1994 and 1999.
The researchers also found that in 1999, women in their early 20s--and not teens--had the highest rate of births outside of marriage. And more than one third of out-of-wedlock births were to women older than 25. In addition, the number of children born to parents who are living together is on the rise. By 1994, 39% of out-of-wedlock births were to cohabiting couples--up from 29% a decade earlier.
Another popular perception belied by actual statistics, according to the authors, is that out-of-wedlock births are a "racial and ethnic minority issue." For instance, while the nonmarital birth rate remains higher among black women compared with white women, the rate has more than doubled among whites since 1970, but declined by one quarter among blacks, the report indicates.
"The increase in childbearing outside of marriage reflects a reduction in the likelihood of marriage at all ages," according to Terry-Humen and her colleagues. The researchers note that the slow-down in out-of-wedlock births in the 1990s may be related to economic growth, changes in contraceptive use, Welfare reforms targeting births to single parents, and increased concern over HIV and other sexually transmitted diseases.
The authors also point out that although the typical single mother has changed since 1970, statistics still indicate unmarried mothers are more likely to have low incomes, and their children face a higher risk for poor school performance and for having children outside of marriage themselves.

Anorexic Teens Use Herbal Remedies to Lose
With increasing numbers of American adults turning to herbal supplements and other forms of alternative medicine, it should be no surprise that adolescents are doing the same. But according to a group of Canadian researchers, some of these young people are using herbal supplements not to improve their health, but to damage it.
"In our study of young people with eating disorders, we found out that these adolescents are using herbal remedies, both for weight control purposes and for non-weight control purposes," Dr. Debra Katzman of the University of Toronto told Reuters Health.
Katzman and colleagues presented their research findings at the annual meeting of the Society for Adolescent Medicine held in San Diego earlier this month. The study included 47 patients between the ages of 10 and 17, mostly female, who had been diagnosed with an eating disorder such as anorexia or bulimia.
Overall, 37% of the youngsters reported using herbal remedies, and 35% said they used these remedies to induce vomiting or decrease their appetite. Despite this widespread use of herbal products, however, 41% of participants said they knew "nothing at all" about herbal remedies. Furthermore, only 24% reported that their doctors had asked them about use of such products.
"This is a pretty important public health issue," Katzman told Reuters Health. "These medications are associated with health risks, and some of them can be severe. The kids and their parents need to know this."
Katzman described a study published last year in a prestigious medical journal about the use and health risks of ephedra. Ephedra, also known as ma huang, is used in traditional Chinese medicine to treat upper respiratory problems, but is also a common ingredient in herbal remedies that claim to help users lose weight.
"That article reported 10 deaths and 13 serious disabilities associated with this common weight-loss drug," Katzman stated. "And in our study, 6% of the kids we surveyed had used ephedra, and had no idea it could hurt them."
What's needed, Katzman stressed, is education. "As parents, as physicians, we need to educate ourselves and our kids, and give them the best information possible. As physicians, we need to ask our patients, adults and adolescents alike, about whether they use any of these remedies."

Children Mimic TV Sex and Violence, Psychiatrist's Study Says
Counselors urged to catalog the media habits of troubled youths
A sweeping new survey of research on media violence, sex and risky behavior over the past 10 years concludes that what children watch can directly influence their behavior.
The survey, by a Johns Hopkins University psychiatrist, reflects the growing concern of mental health experts about the impact on youngsters of the sexually suggestive, violent and aggressive content that frequently permeates television today.
The classic studies linking TV violence and aggression and youth behavior were done in the 1970s and 1980s, "with material that wasn't very violent" by today's standards, said Dr. Susan Villani.
But now, "it's more violent and more graphic and more sexual," she said. "Children are being exposed to more graphic content at younger and younger ages."
Villani proposes that health care professionals treating disturbed children compile a "media history" of what they've watched as well as the traditional medical history.
Concerns about television sex and violence have led to a fierce debate about the government's role in regulating content, a voluntary ratings system to warn viewers about subject matter, and increasing sensitivity about content among some networks and producers. But for the most part, networks have been reluctant to concede that their shows influence behavior.
Though anecdotal evidence abounds, a real link between televised sex and violence and actual behavior has been difficult to prove. Villani said the research in the past decade has strengthened previously reported links between television violence and increased aggressive behavior in preschoolers. Risky behavior depicted in entertainment media has been associated with increases in sexual activity, drinking, smoking and drug use, she said.
One major study cited by Villani showed that viewers of violent TV content learned aggressive behaviors and attitudes, became desensitized to violence, and became fearful of being victimized.
Villani's review of a decade's worth of research on the media's impact on children and adolescence is published in the April issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
Researchers in the 1990s have probed the impact of rock music and music videos, she finds. In one study, patients in a hospital for mentally ill offenders became less likely to get embroiled in assaults after a television showing MTV music videos was removed from the ward.
Even children's cartoons are becoming violent, said Kimberly Thompson of the Harvard School of Public Health. She studied G-rated animated films from 1937 to the recent past, and found that depictions of violence increased steadily - to the point that children could be disturbed, Thompson said.
Currently, Thompson said, she is studying the content of video games. Villani, in her survey, said there has been little research to date on the negative or positive impacts of video games. But she did mention studies in Japan that found little support for the theory that video games cause aggressive behavior.
Still, Thompson said she is concerned about the kind of games reportedly watched by some adolescents who carried out school shootings, because those games depict simulated killings.
Harvard researcher Jay Winsten, who heads the Center for Health Communication at the school of public health, cautioned that media exposure is only one factor shaping behavior, and that some children are more vulnerable because they live in abusive or unsupportive families.
"We have to be cautious in interpreting these studies" that show an association between media content and behavior, he said.
Villani said parents should spend more time monitoring what children watch and protecting them from having their values shaped in negative ways.
One trend she applauded is the development of "media literacy" programs in schools. In these programs, teachers highlight the messages that are being conveyed in movies and TV shows and music videos. With this information, children are better able to be critical and resist the messages, said Villani.
Source: April 2001 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Getting Firm Early Makes Parenting Teens Easier
To keep kids out of trouble, parents must hold the reins tightly during the middle school years, results of a new study suggest.
While criminologists agree that children with behavioral problems are more likely to become criminal adults, "only about 50% of antisocial children become antisocial adults," according to Ronald L. Simons of Iowa State University, and colleagues.
Simons and his research team set out to find out why some problem children become problem teens and others do not. They followed 149 boys and 157 girls and their families for 4 years. On average, the children were between 12 and 13 years when the study began. The researchers interviewed parents and children, and also observed family interactions.
One hypothesis holds that a difficult child will become increasingly involved with peers who are themselves "deviant" as he or she gets older, and that the quality of parenting can do little to change this path. But the researchers found otherwise.
In fact, the investigators found, difficult children make it tougher for parents to set limits or discipline their child, which in turn made it more likely that a child would start hanging out with deviant peers. These "oppositional/defiant" children threw temper tantrums, talked back, bullied other children, were selfish and blamed others. "They almost train you to be a bad parent," Simons told Reuters Health in an interview. "Over time you become more and more lax with your difficult child."
Better-behaved children, conversely, made it easier for their parents to be effective. Effective parents, the authors note, "show warmth and support, set standards for their children, monitor their behavior, engage in consistent discipline, use inductive reasoning to explain rules, and eschew harsh punishments."
The parents of the better-behaved children gave their children more freedom as they entered adolescence, but those with problem children got stricter instead. But the parents of the bad kids were still exerting much less control over their teens at the end of the study period than the parents of the well-behaved children were.
Simon and his colleagues looked at children on two extremes of the behavior continuum. "Most kids are probably in the middle," he noted.
"Our results show it's particularly important that the parent is monitoring and exerting control during those middle school years," Simon told Reuters Health. "That's going to predict what kind of behavior unfolds during the adolescent years."
He added, "During the adolescent years it's really tough to make a dent in your child's delinquency." But all is not lost for parents of troubled adolescents, Simon said. At this stage, these parents can still help their children stay on the straight and narrow by making sure they stay away from deviant and delinquent peers.
SOURCE: Journal of Marriage and Family 2001;63:63-79.

Profile of US Single Mom is Changing
bout one third of US children are born out-of-wedlock, but the make up of this new American family is different from the common public perception, researchers report. National statistics show that only a minority of these births are to teenage mothers, and many single mothers are living with their babies' fathers.
In 1970, only 11% of children were born outside marriage, and half of these births were to teenage mothers. By 1999, one in every three American children were born to single parents, with teen moms accounting for fewer than 30% of these births, according to a report from Child Trends, a Washington, DC-based, non-profit research center.
Using data from the National Center for Health Statistics, Elizabeth Terry-Humen and her colleagues found that out-of-wedlock births in the US grew rapidly during the 1970s and 1980s, then leveled out between 1994 and 1999.
The researchers also found that in 1999, women in their early 20s--and not teens--had the highest rate of births outside of marriage. And more than one third of out-of-wedlock births were to women older than 25. In addition, the number of children born to parents who are living together is on the rise. By 1994, 39% of out-of-wedlock births were to cohabiting couples--up from 29% a decade earlier.
Another popular perception belied by actual statistics, according to the authors, is that out-of-wedlock births are a "racial and ethnic minority issue." For instance, while the nonmarital birth rate remains higher among black women compared with white women, the rate has more than doubled among whites since 1970, but declined by one quarter among blacks, the report indicates.
"The increase in childbearing outside of marriage reflects a reduction in the likelihood of marriage at all ages," according to Terry-Humen and her colleagues. The researchers note that the slow-down in out-of-wedlock births in the 1990s may be related to economic growth, changes in contraceptive use, Welfare reforms targeting births to single parents, and increased concern over HIV and other sexually transmitted diseases.
The authors also point out that although the typical single mother has changed since 1970, statistics still indicate unmarried mothers are more likely to have low incomes, and their children face a higher risk for poor school performance and for having children outside of marriage themselves.
Source: Child Trends

Anorexic Teens Use Herbal Remedies to Lose Weight
With increasing numbers of American adults turning to herbal supplements and other forms of alternative medicine, it should be no surprise that adolescents are doing the same. But according to a group of Canadian researchers, some of these young people are using herbal supplements not to improve their health, but to damage it.
"In our study of young people with eating disorders, we found out that these adolescents are using herbal remedies, both for weight control purposes and for non-weight control purposes," Dr. Debra Katzman of the University of Toronto told Reuters Health.
Katzman and colleagues presented their research findings at the annual meeting of the Society for Adolescent Medicine held in San Diego earlier this month. The study included 47 patients between the ages of 10 and 17, mostly female, who had been diagnosed with an eating disorder such as anorexia or bulimia.
Overall, 37% of the youngsters reported using herbal remedies, and 35% said they used these remedies to induce vomiting or decrease their appetite. Despite this widespread use of herbal products, however, 41% of participants said they knew "nothing at all" about herbal remedies. Furthermore, only 24% reported that their doctors had asked them about use of such products.
"This is a pretty important public health issue," Katzman told Reuters Health. "These medications are associated with health risks, and some of them can be severe. The kids and their parents need to know this."
Katzman described a study published last year in a prestigious medical journal about the use and health risks of ephedra. Ephedra, also known as ma huang, is used in traditional Chinese medicine to treat upper respiratory problems, but is also a common ingredient in herbal remedies that claim to help users lose weight.
"That article reported 10 deaths and 13 serious disabilities associated with this common weight-loss drug," Katzman stated. "And in our study, 6% of the kids we surveyed had used ephedra, and had no idea it could hurt them."
What's needed, Katzman stressed, is education. "As parents, as physicians, we need to educate ourselves and our kids, and give them the best information possible. As physicians, we need to ask our patients, adults and adolescents alike, about whether they use any of these remedies."
Society for Adolescent Medicine

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