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EXTRACTS FROM OTHER JOURNALS RELATING TO CHILDREN, YOUTH AND FAMILIES — IN THE FIELDS OF HEALTH, SUBSTANCE ABUSE, EDUCATION, PSYCHOLOGY, SCIENCE

August 2001

Rewards a Key Component to Addiction Therapy
A new study found that rewards, such as vouchers for food or clothing, are effective in addiction therapy when coupled with a medication regimen, according to an Aug. 17 press release from Yale University.
The study by Yale researchers was aimed at evaluating the best way to encourage patients addicted to opioids to take naltrexone regularly.  "When patients take methadone, they stop feeling sick. Naltrexone doesn't have that kind of immediate reinforcement. It is, though, a very important tool because, if patients use it consistently, it will block the opioid receptors in the brain so that they don't experience euphoria if they use heroin," explained Kathleen Carroll, professor of psychiatry at Yale School of Medicine and principal investigator of the study.
For the study, 127 patients were divided into three groups. One group received naltrexone three times a week and attended group therapy once a week. A second group also received vouchers redeemable for goods and services if they met program goals. The third group was offered, in addition to the vouchers and naltrexone, family-therapy sessions with a relative or friend.
The researchers found that use of the vouchers significantly improved treatment retention and naltrexone compliance.
"One man had pawned his mother's jewelry, and he used the vouchers to get her jewelry back," Carroll said. "Others had inconsistent involvement in their children's lives, so they used the vouchers to pay for their child's birthday party or Christmas presents. There were some very touching ways in which they used this program to help them stop using and move out of drug-using patterns."
She concluded from the study that, "Research suggests that the usual level of compliance with any medication is around 50 percent. It's possible these types of strategies also could be used with any other medications."

Nonverbal Audiovisual Training Improves Reading in Dyslexic Children
A nonverbal audiovisual training program, in which children match shapes with sounds on a computer screen, appears to improve reading skills, as well as electrophysiological and behavioral measures, in dyslexic children, according to a report in the Proceedings of the National Academy of Sciences for August 28.
"There are two competing views of dyslexia," lead author Dr. Teija Kujala told Reuters Health. One view is that dyslexia is specific to the linguistic system, while the other view is that a more fundamental perceptual dysfunction in discriminating sensory input underlies dyslexia. "This study lends support to the latter view."
Dr. Kujala, from the University of Helsinki, and colleagues assigned 48 dyslexic children who were 7 years old to nonverbal audiovisual training or a control group. The children in the training group had 14 training sessions that were given twice a week and lasted for about 10 minutes each.
In each session, the children were asked to match a sequence of horizontal rectangles with various sounds, which were represented by different sized rectangles, or to identify the last rectangle in a sequence of rectangles. After 7 weeks, the children who received training read significantly more words correctly compared with controls (p < 0.03) and also had a marginally significant increase in reading speed (p < 0.07), the researchers found.
To measure brain activity, the researchers recorded mismatch negativity (MMN), "which accurately reflects auditory discrimination without such biasing factors as attention, decision making or motor response," the researchers explain.
They found that MMN amplitude was considerably increased among children who underwent training compared with controls (p < 0.03). MMN amplitude was also significantly larger after training than before training (p < 0.03), while no such change was seen among controls.
"We have shown that it is possible, with training, to affect the sensory problems that underlie dyslexia and to help children read better," Dr. Kujala said. "We have also shown that the auditory system is closely related to problems of dyslexia."
Proc Natl Acad Sci 2001;98:10509-10514.

Sports Supplements and Teens: Dangerous Game?
More teens are taking the supplement creatine to boost their athletic performance, according to a new study. But is it safe? Nobody is sure, says the study's lead author, Jordan D. Metzl, MD, medical director of the Institute for Young Athletes at the Hospital for Special Surgery in New York City.
Metzl and his co-authors surveyed over 1,000 teen athletes in middle and high schools about their sports participation and creatine use. They found that 5.6% of the athletes overall reported using creatine: 44% of grade 12 athletes said they use the supplement.
Creatine forms through a combination of amino acids and is involved in the body's utilization of energy. It is produced naturally by the body but is also found in small amounts in protein-rich foods as well as in nutritional supplement form. But little research has been done on the effects of creatine in general, and even less on its effects on teenagers, says Metzl. Some reports have linked creatine use to health problems, he adds.
Another potentially damaging effect that the survey highlights is the enthusiasm of some young people for using supplements, Metzl notes. The top reason for creatine use, according to the students surveyed, was that they hoped to improve their sports performance. "It's the whole mindset of kids taking drugs to improve their sports performance" that can also be dangerous, Metzl says. "You hear so many stories about professional athletes taking supplements to improve their performance, and it's trickling down to kids."
A recent report from a panel of the American College of Sports Medicine (ACSM) looked at what is known about creatine, and issued both recommendations and cautions concerning its use. The report concluded that creatine should not be used immediately before exercise, and the panel does not recommend it for pregnant or breast-feeding women or for children and teens--with the very rare exception of medical use by people with serious muscle problems and genetic defects, according to one of the report's authors.
"The reason the statement was made in the report is that there's [just] about a total lack of any research or reports on the safety and efficacy in the pediatric population," says Ronald Terjung, PhD, professor of biomedical science at the University of Missouri College of Veterinary Science and chair of the ACSM roundtable report, which was published in March 2000.
Also, the expectations of people who start using creatine are often quite different from the actual effects of the supplement, Terjung notes. "Any value of creatine is really of limited efficacy, even in the adult population," he says, but many people expect it to do more for them than it actually will. It seems to be most effective when taken during a period of weight training, he says.
It's also tough to perform research studies on creatine because if you have one group of people taking creatine and a second control group receiving a placebo substance, the group taking creatine knows they are taking the supplement because the effects--bloating and weight gain due to water retention--are almost immediate, Terjung says, which can affect the study's outcome.
Aside from the health effects of creatine itself, Metzl says it's also important to be aware that as with all nutritional supplements, the Food and Drug Administration has no control over the contents of these products, so what you see on the product label may not always be what you get. "Parents and coaches often do not understand how little the supplement industry is regulated because of DSHEA [the 1994 Dietary Supplement Health and Education Act]--they assume that if it is sold on the market shelves it must be safe," says Priscilla M. Clarkson, PhD, Professor and Associate Dean in the Department of Exercise Science at the University of Massachusetts School of Public Health and Health Sciences.
The number of young people who reported creatine use in Metzl's study seems to reflect the view of many people that these supplements are safe, Clarkson adds. "The data do not surprise me since creatine is easily obtained over the counter and many people believe it to be a safe nutritional supplement," she says.
Training the old fashioned way--practice, practice, practice--is probably the best and safest way for young people to improve their performance, says Metzl.
"Working on your skills is probably a much better way to get yourself to be a better athlete," he says.
The study from Metzl's group appears in the August issue of the journal Pediatrics.

Recreational Drug Use a Risk Factor for Renal Disease in the General Population
The use of heroin or other opiates appears to contribute more to the incidence of end-stage renal disease (ESRD) than data from the US Renal Data System indicate.
In a population-based study, Dr. Thomas V. Perneger, now at Geneva University Hospitals in Switzerland, and colleagues in the US conducted telephone interviews with 716 treated ESRD patients, 20 years to 64 years of age, and with 361 age-matched controls randomly selected from the general populations of Maryland, Virginia, West Virginia and Washington, DC.
Among those with ESRD, the majority of whom were African American and male, the use of heroin or other opiates was associated with a 19-fold increased risk for ESRD compared with controls, Dr. Perneger's group found.
In this group the use of cocaine or "crack" was independently associated with a fivefold increased risk of ESRD. However, this increase was only marginally significant (p = 0.056), the researchers report in the July issue of the American Journal of Kidney Diseases.
Assuming that opiate use is a cause of ESRD, Dr. Perneger and colleagues believe that it accounted for 5.6% of all the cases of ESRD in their cohort, a significantly higher figure than the 0.14% estimated by the US Renal Data System. They speculate that "reducing the use of heroin and other opiates would contribute to the prevention of ESRD in the general population."
Source: Am J Kidney Dis 2001;38:49-56.

Dating Violence Increases Addiction and Suicide Risk
A new study shows that high-school girls who have been physically or sexually abused by a dating partner are more at risk for addiction, suicide, and other harmful behaviors, the Associated Press reported July 31.
In a survey of 4,163 public-school students in Massachusetts, researchers at Harvard University's School of Public Health found that one in five American high-school girls experienced violence at the hands of a dating partner.
When questioned about recent risky behavior, the victimized girls were three to five times more likely to use cocaine; eight to nine times more likely to have attempted suicide in the previous year; four to six times more likely to have been pregnant; and three to four times more likely to have used unhealthy dieting methods, such as laxatives or vomiting.
"With women in violent relationships, the violence tends to permeate all of their lives; every aspect of their lives becomes impacted," said lead author Jay G. Silverman.
The study is published in the Aug. 1 edition of the Journal of the American Medical Association.

Suicide Attempts More Likely Among Adolescents With Same-Sex Sexual Orientation
Adolescent boys and girls with a same-sex sexual orientation are twice as likely to attempt suicide compared with other adolescents, according to a report in the August issue of the American Journal of Public Health.
"We find that there is a strong link between same-sex sexual orientation and adolescent suicidal thought and attempts," Dr. Stephen T. Russell, from the University of California at Davis, told Reuters Health.
Using data from the Add Health Study, Dr. Russell and his colleague, Dr. Kara Joyner from Cornell University in Ithaca, New York, evaluated a national sample of 6254 adolescent girls and 5686 adolescent boys. Approximately 7% of these subjects reported having a same-sex romantic attraction or relationship.
When Drs. Russell and Joyner looked at the 458 youths who reported a suicide attempt, they found that approximately 15% reported having a same-sex sexual orientation. Both males and females who reported a same-sex orientation were more likely than other adolescents to report suicidal thoughts (odds ratio 1.68 for males; 2.14 for females) and suicide attempts (odds ratio 2.45 for males and 2.48 for females).
This risk has to be viewed within the context of the general risk factors for adolescent suicide, Dr. Russell said, which include substance abuse, depression, hopelessness, and the suicide attempt of a family member or friend. These risk factors, he added, largely explain the increased suicide risk among these adolescents.
"Gay kids are at risk of suicide not just because they are gay, but because of the other things that are going on in their lives," Dr. Russell stressed. "Being gay just puts these kids at greater risk for other known risk factors for suicide, because for many of these gay kids their school, home and social environments are compromised."
Dr. Russell believes physicians need to be aware of the risks associated with same-sex sexual orientation and to be comfortable in counseling these adolescents.
SOURCE: Am J Public Health 2001;91:1276-1281.

Dating Violence Against Teenage Girls Increases Health Risk Behaviors
About 20% of female public high school students in the US are assaulted by dating partners, investigators report in The Journal of the American Medical Association for August 1. Dating violence was found to increase girls' risk of pregnancy, substance abuse, risky sexual behavior, eating disorders, and suicide.
The Massachusetts Youth Risk Behavior Survey includes a question assessing lifetime prevalence of physical and sexual violence from dating partners. This survey was administered to students in grades 9 through 12 in 1997 and again in 1999. More than 4000 girls responded.
Dr. Jay G. Silverman, of Harvard School of Public Health in Boston, and associates report that physical abuse alone was experienced by about 10% of girls. Sexual assault in the absence of physical abuse was reported by 4%, while both types of abuse were reported by about 6%.
Experience of dating violence was significantly associated with heavy smoking, binge drinking and cocaine use, unhealthy weight control practices, intercourse before the age of 15 years and having sex with three or more partners in the past 3 months.
"Our findings around pregnancy and attempted suicide were somewhat startling," Dr. Silverman told Reuters Health. "These young women who had experienced dating violence were eight to 10 times more likely to have attempted suicide than their peers." They were at about five times the risk of becoming pregnant during high school years, he added.
"Don't place the emphasis on 'what is wrong with these women,' " said Dr. Silverman. "We need to understand why men are doing these things, why they feel entitled to control and abuse the women they date...and we need to find ways to stop that."
Another critical problem Dr. Silverman finds is the lack of services for teenage girls who are victimized by boyfriends.
"Tremendous numbers of young women suffer in silence, not telling anyone out of fear or shame or not wanting to lose the relationship," he said. "Even for those young victims who choose to speak out, there are very few specialized services."
"A great deal needs to be done to achieve safety and allay these very serious risks to health that follow more [than] the immediate risk from injury," he added.
Dr. Silverman recommends that pediatricians follow American Medical Association guidelines for adult women in terms of screening teenage girls for intimate partner violence and providing appropriate referrals.
JAMA 2001;286:572-579. [Abstract: http://jama.ama-assn.org/issues/v286n5/abs/joc02015.html]

Dissatisfied Teens More Likely to Carry Weapons
Researchers found that teens who are unhappy with their lives are more likely to carry weapons and are at a higher risk for violent and aggressive behavior, Reuters reported July 27.
The survey conducted by researchers at the University of South Carolina included 5,000 public high-school students in South Carolina. Researchers found that white females who were unhappy with their lives were four times more likely than their satisfied peers to have carried a gun to school in the past month, and were twice as likely to have fought at school in the past year.
Unhappy white males and black males and females were twice as likely to have carried a weapon in the past month, with discontented black males more than three times more likely to have been involved in a physical fight that required medical treatment.
"There are some very unhappy kids out there, and their lack of life satisfaction shows up in violent and aggressive behaviors," said lead study author Dr. Robert F. Valois, a psychologist at the University of South Carolina. "Adolescents dissatisfied with life might engage in physical fighting as a result of poor communication skills and the inability to manage stress, resulting in poor conflict resolution and a physical altercation."
For the study, teens were asked to rate their levels of satisfaction with their families, friends, school experiences, living environment, and themselves. Most teens were dissatisfied with school.
The study is published in the July/August issue of the American Journal of Health Behavior.

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