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February 2001

Stars` Onscreen Smoking Influences Teen Tobacco Use
Teenagers' smoking behavior is directly linked to the portrayal of tobacco use by their favorite movie stars. A new study suggests that adolescents who favor movie stars that use tobacco onscreen are significantly more likely to smoke and have more favorable attitudes toward smoking than adolescents who favor non-smoking stars.
Previous research has focused on movie stars' tobacco use onscreen and the effect on teen smoking behavior. In this study, researchers asked the teens to identify their favorite movie stars and examined particular movie stars' onscreen tobacco use and its influence on adolescents' smoking behavior.
"We found a nice association between onscreen smoking of the favorite movie stars and the adolescents' likelihood to take up smoking or have positive attitude about smoking," says study author Jennifer Tickle, a PhD-candidate at Dartmouth College in Hanover, New Hampshire. "Although the study didn't address a causal element, the potential that actors' portrayal of smoking onscreen are affecting adolescents is a quite good one."
Researchers evaluated 632 students between the ages 10 and 19 (sixth through 12th grades) from five rural New England public schools in 1996. Researchers divided the students into five groups based on their smoking behavior and their smoking susceptibility: non-susceptible never smokers, susceptible never smokers, non-current experimenters, current experimenters, and established smokers.
Researchers studied the tobacco use by 43 movie stars identified by at least five students as their favorite stars in films between 1994 and 1996. Of the 43 stars, 65% used tobacco at least once, and 42% portrayed smoking as an essential character trait in one or more films. Researchers say that stars who smoked more than twice in a film were considered smokers.
According to researchers, the more teens' favorite stars smoked onscreen, the more likely it was for those teens to take up smoking. "Even among never smokers, those who chose stars who were smokers in three or more films were much more likely to have favorable attitudes toward smoking," says Tickle. "We should take a closer look at what's being portrayed in movies."
Sean Duren, director of tobacco control and comprehensive school health education at the American Cancer Society region 17 in New Jersey, says that studies like this will certainly raise the awareness of how smoking is portrayed in movies. "Movie stars are teen idols," says Duren. "When it comes to certain behaviors, teens tend to imitate them."
Duren says that he hopes in the future, the amount of smoking seen in movies will be looked at a bit differently with all the anti-tobacco campaigns going on. "I think movies already over- represent smoking," says Duren. "More and more people are aware of the negative health consequences of smoking, and many have quit."
Danny McGoldrick, research director at the Campaign for Tobacco Free Kids in Washington, D.C., says that the findings are not surprising. They confirm that cultural influence have a big impact on young people who get many positive cues about tobacco. "We need to counter the environment that puts a positive image of smoking in movies," says McGoldrick. "We should change the cultural norm of tobacco use."
McGoldrick says that teens smoking increased by a third from 1991 to 1997, and it has leveled off since then. But due to the incredible promotion by the tobacco industry, kids tend to overestimate the number of their peers and adults who smoke. "Movies already over represent smoking, hopefully, if we are successful in reducing smoking among adolescents and adults, Hollywood will get a clue and diminish the appearance of onscreen smoking."
The study is published in the Feb. 27 issue of the British specialty journal Tobacco Control.

Unexpected Divorce May Be Worse for Kids
Adults in unhappy marriages who stay married for their children's benefit may be doing more harm than good to their children if the marriage involves a lot of fighting, results of a recent study suggest. On the other hand, an "unexpected" divorce between silently battling partners may leave a child feeling worse after the split than children with similar parents who choose to stick it out, study findings show.
"In general, our results suggest that divorce may be beneficial or harmful to children, depending on whether it reduces or increases the amount of stress to which children are exposed," according to study authors Dr. Alan Booth and Dr. Paul R. Amato of Pennsylvania State University in University Park.
Booth and Amato conducted a 17-year study of more than 2,000 married individuals and nearly 700 children. Eighty-five divorces occurred during the study period.
The researchers found that pre-divorce marital conflict had more of an impact on the child's well-being than the divorce itself, Booth and Amato report in the February issue of the Journal of Marriage and Family.
For example, children of parents who rarely fought or disagreed were less happy after their parent's divorce than children of low-conflict parents who remained married, findings show. In contrast, children of parents in high-conflict relationships reported higher levels of well-being after their parents' divorce than did children of high-conflict parents who did not split up.
"Children suffer greatly when parents in a low-conflict marriage divorce compared to those who experience the divorce of parents who fight a lot," Booth told Reuters Health. "From the child's perspective, there is no evidence that anything is drastically wrong," he said in a statement.
In their second study Booth and Amato examined the factors that influence divorce among parents in low-conflict relationships. The authors found that these couples were less rooted in their communities than similar couples who did not divorce. They were less likely to have a network of friends or belong to religious organizations that may have presented incentives to stay together, the authors explain. Low-conflict couples who divorced were also less likely to own a home, moved more often, and had fewer friends than those who remained married, the authors report.
"With little encouragement or criticism, it's easier to get a divorce," Booth said. "Both the personal commitment to a marriage and barriers to leaving it are weak."
"The take home message is that if the marriage can't be preserved until the child is a young adult, parents should make every effort to ensure that their children's needs are given first priority when the divorce occurs," Booth said.
SOURCE: Journal of Marriage and Family 2001;63:197-212.

Abused Boys More Likely to Hurt Partner as Teens
Teenage boys who were abused as children are more than three times as likely as other boys to use physical violence against someone they are dating, study findings show.
These boys are also nearly three times as likely to threaten to harm their dating partner, report researchers in the March issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
The findings underscore the need for services that can help children with histories of maltreatment, explain Dr. David A. Wolfe from the University of Western Ontario in Canada, and colleagues.
"Education and early intervention concerning healthy, non-abusive relationships through the school system may significantly reduce the incidence of domestic violence and, in future generations, child abuse and neglect," Wolfe told Reuters Health.
Children who have been physically, sexually or emotionally abused or neglected learn to adapt by avoiding close relationships, learning to distrust others and developing coping mechanisms such as fear and anxiety.
"Such behaviors are indeed adaptive in childhood (because children) get hurt less often but as they grow older these same behaviors lead to peer problems, learning difficulties and relationship violence as a victim, offender or both," Wolfe explained.
In the study, the researchers interviewed more than 1,400 boys and girls from 10 high schools in Canada.
One-third of the surveyed teens, who ranged in age from 14 to 19 years old, reported that they were abused as children. Girls with a history of abuse were more likely to be angry, depressed and anxious. They were also about ten times more likely to report post-traumatic stress-related problems compared with girls who had not been abused, and to engage in violent and non-violent delinquency. Boys with a history of abuse also had higher levels of depression and post-traumatic stress but they were less likely than girls exhibit delinquent behavior.
Their findings point to important gender differences that can result from abuse, the authors conclude. They also note that it is not clear how often teens who are violent or threatening in relationships continue that behavior into adulthood.
"Although abusive behavior toward dating partners in adolescence may not yet fully reflect adult-like patterns of violence, the transition from adolescent dating violence to adult abusive behavior warrants further investigation," the researchers conclude.
SOURCE: Journal of the American Academy of Child and Adolescent Psychiatry 2001;40:282-289.

UN Body Reports on Drug Abuse Trends
The widespread overuse of controlled drugs such as benzodiazepines and various amphetamine-type stimulants to treat psychological problems continues to be a growing socially accepted habit, warns the annual report of the International Narcotics Control Board (INCB), released this Wednesday.
The International Narcotics Control Board (INCB), whose members are elected by the UN Economic and Social Council, is a UN-funded body with the responsibility to promote government compliance with the international drug control treaties and to assist them in this effort.
"Loose regulation, unreliable estimates and information as regards actual medical needs of controlled drugs, coupled with aggressive marketing techniques, improper or even unethical prescription practices together add to a situation of easy availability of psychotropic substances in especially, but not only, the developed countries," says the INCB.
Regarding abuse of illicit drugs, the INCB points out that the problem appears to be on the rise in most countries of Africa while drug availability is increasing in Europe. While the rate of cocaine abuse among adolescents has declined by 14% from 1998-1999 in the US, in Canada drug abuse among secondary school students is showing an increase according to some surveys.
Also, "Cultivation of highly potent cannabis, hydroponically grown, is spreading in Canada and parts of the US and continues to constitute a major concern to law enforcement authorities," says the INCB report.
"MDMA (Ecstasy) of western European origin is increasingly being abused by young people in North America," according to the report. There has been a sharp increase in the seizures of Ecstasy in the US in 2000, says the INCB.
The report also describes the growing traffic in drugs over the Internet. With 600 million internet users at present and growing, the INCB has urged governments to enact legislation to control online pharmacies and drug stores that illegally supply controlled narcotic drugs and psychotropic substances without requiring prescriptions.

Ecstasy Blamed in Rising Number of Car Accidents
More young adults in the US appear to be using the drug Ecstasy, which in turn appears to be contributing to a growing number of auto accidents.
"Originally it was predominantly imported from Europe. But now there is evidence that more and more of it is being synthesized in the United States," Dr. Barry Logan of the Director of the Forensic Laboratory Services Bureau in Washington State told attendees of the 53rd annual meeting of the American Academy of Forensic Sciences here Monday.
Evidence from many different sources suggests that usage of the drug is increasing dramatically in some cities across the United States and that the drug is now beginning to be used by younger people. More teenagers between the ages of 15 and 18 years appear to be experimenting with Ecstasy than ever before, researchers say.
Ecstasy is also known as MDMA (methylenedioxymethamphetamine). Taken in pill form, the drug usually produces sensations such as euphoria and enhanced self-confidence one to two hours after ingestion. Ecstasy's effects can last anywhere from 4 to 24 hours, Logan noted.
"A person who is impaired by their Ecstasy use can be just as intoxicated as somebody who has taken alcohol," he explained in an interview with Reuters Health. "Our experience is still rather limited...but we are seeing increased accidents due to Ecstasy use."
Logan said that even in very low doses the drug can affect concentration and driving ability.
"People on the drug feel more powerful and they will have a tendency to drive faster," said Dr. Paul Forne of the University of Paris. "Everybody knows that driving under the influence of alcohol is dangerous and that people know when they are drunk. But that is not the case with MDMA and that is why it is important for us to give politicians and the police the information that driving under the influence of MDMA is also dangerous."
Forne told Reuters Health that public education campaigns are needed in the United States as well as in many European countries where Ecstasy use is also on the rise. Warning individuals that Ecstasy and driving can be a potentially deadly mix should become a top priority, he said.
SOURCE: Reuters Health and American Academy of Forensic Sciences

Obesity Linked to Asthma in UK Children 
There appears to be a positive association between body mass index (BMI) and asthma symptoms in children, UK researchers report in the February issue of Thorax.
Dr. Jose I. Figueroa-Munoz and colleagues, from King's College, London, note that previous studies of obesity and asthma in children generally have had shortcomings, including being small and using "unsound" methodology.
To investigate the association further, the researchers conducted a cross-sectional analysis of data from 14,908 children (aged 4 to 11 years). The children involved were from Scottish and English representative samples and from an English inner city sample.
Among factors included in the analyses were the relationship between asthma symptoms and BMI and measures based on the sum of triceps and subscapular skinfold thickness.
Obesity, based on BMI, was associated with asthma attacks and wheeze. However, skinfold thickness showed no such relationship in most analyses.
In addition, say the investigators, the asthma and BMI association "was stronger in girls than in boys in the inner city sample, but less convincingly in the representative sample."
The researchers point out that BMI appears to be a better measure than skinfold thickness in such studies, and conclude that on this basis, "there is clear evidence that fatness is associated with asthma in children."
Nevertheless, Dr. Figueroa-Munoz, told Reuters Health, "as our study was cross-sectional, we cannot determine the direction of the association. Is obesity a risk factor for asthma or do asthmatic children become overweight and obese more than nonasthmatic children?"
Should obesity precede asthma, he added, appropriate studies should be carried out "to determine whether the prevention of obesity in children will have an impact on the development of asthma and asthma symptoms."
SOURCE: Thorax 2001;56:133-137.

Drug Addiction Demystified Through the Genome Map 
Knowledge gained from the human genome-mapping project is leading to a better understanding of how drugs and alcohol act on the molecular and cellular mechanisms and brain pathways to cause addiction, a University of Texas Southwestern Medical Center at Dallas researcher and his colleague say.
Drs. Eric J. Nestler and David Landsman reported on the progress made in the field of drug addiction in the February 15 issue of Nature, which is dedicated to results of genome research and gains to be expected. Nestler, a world-renowned molecular psychiatrist specializing in the mechanisms of alcohol and drugs in the brain, is chairman of psychiatry at UT Southwestern. Landsman is a leading authority on bioinformatics at the National Center for Biotechnology Information, National Library of Medicine, in Bethesda, Maryland.
In the essay, the authors stressed that addiction represents a biological process caused by the effects of repeated drug exposure on a vulnerable brain and defined it as the compulsive seeking and taking of a drug or alcohol despite adverse consequences.
"The decoding of the human genome will prove incredibly important in all areas of human research, none more so than in alcohol and drug addiction," Nestler said. "In order to understand addiction, it is important to define the types of molecular and cellular adaptations at the levels of neurons and synapses that account for tolerance, sensitization and dependence, terms that are often used to define an addicted state."
The authors explain that genome sequencing — both in humans and in other mammals — will foster an understanding of the biology of addiction by enabling researchers to identify specific genes that contribute to individual addiction risk as well as those involved directly in the addiction process caused by drugs.
Nestler said addiction researchers have come to believe that drugs of abuse act on brain circuits developed at a much earlier time. These circuits are a part of the limbic system, located in the frontal lobe and thought to be associated with emotions. Researchers think these circuits regulate individual responses to such things as food, sex, or risk-taking activities, all of which may act as "natural reinforcers." Thus, the addict can become "addicted" to things other than drugs.
"The loss of control that addicts show with respect to drug seeking and taking may relate to the ability of drugs of abuse to commandeer these natural-reward circuits and disrupt a person's motivation and drive for normal reinforcers," Nestler said.
He said there is scientific evidence that "natural addictions," such as overeating, pathological gambling, compulsive shopping, and perhaps excessive exercise, may involve analogous mechanisms to the chemical kind.
Nestler said that a major focus in addiction research today is exploring the neurobiology of such addictive conditions. He explained that both the person's intense cravings for the drug, as well as the increased risk of relapse the person experiences, make it clear that major changes have taken place in the brain. "The molecular and cellular adaptations related to tolerance, sensitization (increased sensitivity), and dependence do not persist long enough to account for the more permanent behavioral changes associated with addiction," he said.
He said that this kind of change may well be associated with memory and/or learning behavior, "but little information is available concerning the molecular and cellular basis of essentially life-long memories. Proposed changes in the conversational connections between nerve cells or chromosomal organization remain speculative."
Nestler added that many changes taking place after multiple drug exposure have now been uncovered.
"Because of such major gains like the genome project, today DNA technology makes it possible to investigate thousands of gene products simultaneously after drug exposure. Soon, by combining new genetic tools with increasingly sophisticated models of addiction in animals, it will be possible to identify patterns of altered gene expression that are associated with particular features of the addicted state, such as tolerance, sensitization, dependence, craving, and relapse," he said.
SOURCE: Nature. 2001;409(6822):000-000

Parents` Bad Marriage Doesn`t Always Doom Romance
Just because your parents had a terrible marriage, it doesn't mean you should resign yourself to a similar fate, researchers report.
Investigators found that young adults tend to be more successful in their romantic relationships if their parents were warm and supportive toward them while growing up, regardless of the relationship the parents had.
The findings "go against the common idea that we learn to relate to our partners by watching our parents relate with each other," Rand D. Conger, of Iowa State University's Institute for Social and Behavioral Research, said in a statement.
"Children appear to mimic the way their parents behave towards children, not the way parents behave towards each other," he told Reuters Health. This means that "having parents involved in a miserable marriage doesn't mean you're doomed to having a miserable marriage yourself," he added. It also suggests that children from single-parent families may do just as well in romance as those from two-parent families, according to the report published in the Journal of Personality and Social Psychology.
Conger explained that "those doing well in early adult romantic relationships are those who were taught by their parents how to treat other people well."
Conger and colleagues annually videotaped the family interactions between a group of adolescents, their parents and their siblings when the adolescents were in grades 7 through 10. They conducted similar video-taped sessions 5 years later to observe the interactions between these individuals, now in their 20s, and their current romantic partners.
The data, compiled from 193 individuals observed over 11 years, suggests that "the competence of these young people was most enhanced by effective parenting practices," Conger said.
These practices include being supportive, showing minimal hostility and anger, effectively monitoring their children, paying attention to good behaviors, and providing appropriate consequences for misbehaviors.
"Kids grow up with the least damage if the parenting environment remains sound and effective," Conger noted. Even when parents are in conflict, children can learn how to appropriately treat others when good parenting practices are employed.
SOURCE: Journal of Personality and Social Psychology 

How to Help Teen Parents Succeed
Sometimes teen parents need help getting on their feet and other times their problems can be more serious, while still others may seem to have everything under control.
Since most teen parents will be in contact with a pediatrician--either the doctor they have visited since they themselves were in diapers, or their child's doctor-- a pediatricians' organization has issued new guidelines on how to help those who have become parents before they themselves may have fully grown up.
In 1997, over 489,000 children were born to young women between the ages of 15 and 19 in the United States, according to the report.
"Certainly the issue of teenage pregnancy is a very controversial issue that our society has been struggling to deal with for decades, both in terms of trying to prevent unintended pregnancy but also to be able to provide optimal care," says David W. Kaplan, MD, MPH, chair of the American Academy of Pediatrics (AAP) Committee on Adolescence, one of two committees that authored the statement.
The new statement updates an older one written in 1989, Kaplan says. Between then and now, more long-term research has been done on teen parents and their children, more comprehensive programs have been developed to help these families, and a number of new contraceptives have been introduced. The report has specific suggestions for mothers in particular, as well as some for teen fathers.
Pediatricians can be real advocates for teen parents' needs, Kaplan says. For instance, teen mothers who attend regular high school can have a hard time, which can range from finding childcare during the day to making time for homework at night. "Oftentimes a pediatrician can be very helpful in working with a school," he says, to help school officials offer additional assistance teen parents might need. Helping teen parents complete their education is crucial, he says.
Not all teen parents will feel comfortable going to their child's pediatrician for their own checkups, but often that can be an ideal situation, Kaplan says. Still, "even if the pediatrician were not providing care for the teenager, he or she is still going to be an advocate for the infant" and would be well aware of the problems facing the mother, he says.
A very careful assessment of the teen parent's individual situation is vital, says child psychiatrist Elizabeth Berger, MD. "Teen parents are not all the same," she says.
While Berger stresses that not all teens are unprepared when it comes to parenting, some may not be ready for the new role and may not fully understand what it requires. They may have very mixed feelings about the arrival of the baby.
As a result, many adults, such as the teen's parents, relatives, and older acquaintances, may try to offer help. But it can be hard to know when to offer how much.
"Many young parents really do need all kinds of help," she says, such as respite from the demands of parenting, time for their own personal growth and development, and even cold, hard cash.
Sensitivity and tact are key when dealing with teen parents, Berger says. Maintain a respect for the teen's role as parent, and don't be condescending: Keep in mind that parents, no matter what age, generally know what is best for their child, she says.
Preventing teen pregnancies in the first place and helping teen parents avoid a second one if they aren't ready are other goals, Kaplan says, but he says it's not as easy as prescribing the Pill or passing out condoms.
Berger agrees. "I am a firm believer that accidental pregnancy is not accidental," she says, since it often reflects something going on in the parents' lives.
Berger says broad social change is what is really needed to deal with all the problems of teen parenthood. A drive toward more personal medical care is a start, she says, and it is happening. She points to how doctors now often ask women if they have been exposed to domestic violence.
"Understanding the reality that the patient is working within is really the first piece of being able to offer something of value to them," Berger says. But few health professionals and community leaders actually have the time to sit down with a teen parent and try and minister to a teen's real needs. "It's everybody's job, and it's nobody's job," she says.
Teen parents' success often depends on the community, Kaplan says, and help from the community is often lacking. "I think communities really need to look at what kinds of services might be available to this population and then if there really isn't anything then they should really consider getting something started," he says.
SOURCE: The recommendation from Kaplan's committee and the AAP Committee on Early Childhood, Adoption and Dependent Care appears in the February issue of the journal Pediatrics.

Ever-Younger Puberty Puzzles Researchers 
Scientists have known for several years that girls and boys are reaching puberty earlier, but they still don't know why this is happening, or what the consequences might be, experts said at a forum here Monday. In 1997, a landmark study of 17,000 girls found that the average starting age of puberty had dipped a year from previous studies of Caucasian girls, to 9.7 years. 
African-American girls hit puberty even earlier, at an average age of about 8, said Marcia Herman-Giddens, principal author of that study and a professor at the University of North at Carolina Chapel Hill. 
Data on when puberty starts has been skimpy over the years--especially for African Americans. But, said Herman-Giddens, "I'm confident that this trend is a real trend," adding that adolescence seems to be starting earlier and lasting longer in children worldwide. She is currently analyzing data on American boys. 
"What we're seeing is a symptom of a very serious public health problem," said Herman-Giddens, noting that the long term physical and mental health impact of early puberty are not understood. 
Being obese or overweight, which has been associated with premature puberty, may be one potential cause. Others include genetics, low birthweight, poor diet, lack of activity, and surprisingly, an absentee father or a non-relative male in the house have also been offered as explanations. 
Scientists have also been exploring whether so-called "endocrine disrupters"--a group of chemicals thought to interfere with hormonal function--might be spurring or delaying puberty, said Herman-Giddens. 
John Peterson Myers, director of the W. Alton Jones Foundation and author of a book on chemical contamination and fetal development, said some of these chemicals have retarded sexual development in rat fetuses. 
Among the most controversial of these chemicals are phthalate esters, which are found in toys, vinyl flooring, detergents, and cosmetics and lotions. The chemical and cosmetics industry says phthalates have been proven safe and that they have no role in causing early puberty. 
"The science is not certain, but there is a plausible link," contends Myers. 
Diana Zuckerman, executive director of the National Center for Policy Research for Women & Families, said she worries about the psychological impact of early puberty on young girls. 
Previous studies have shown that girls who develop at a young age begin dating earlier, have sex sooner, are subject to more psychological stress, more behavioral problems, and were more likely to drink and smoke, said Zuckerman. 
"No matter what they look like, they are still little girls," she said. Zuckerman also added that early puberty places additional stress on parents who have to explain sexuality at a younger age. 
SOURCE: Reuters Health

No Evidence of an Autism `Epidemic`
Reports that there is an "epidemic" of autism and similar pervasive developmental disorders (PDDs) in the US and elsewhere are unfounded and likely due to misinterpretations of data, according to a new report.
"People tend to confuse two different things," explains Eric Fombonne, MD, a fellow of the Royal College of Psychologists, as well as reader in epidemiological child psychiatry and a consultant in the Pervasive Developmental Disorder Clinic at the Maudsley Hospital in London. Fombonne is author of a commentary on the topic in the February issue of the journal Pediatrics.
"In epidemiology we use two different measures of disease occurrence in the population. One is prevalence and one is incidence," he says. In other words, just counting how many people have autism and PDDs does not account for other factors, some as simple as an overall increase in population.
"If you look at that, and only that, indeed the prevalence estimate that we have in most countries at the moment for autism and PDDs are much higher than used to be the case 20 years ago, and even more than 40 years ago. So people have used this increase in the prevalence rates as evidence that the incidence of autism is rising," Fombonne says. "That is the wrong interpretation of the findings of prevalence."
The fact that more people are formally diagnosed with autism than 20 or 40 years ago--rather than the fact that more people actually have the disorder--is one reason for the increase, he says. The guidelines used for diagnosing disorders of this kind have gone through several changes in the past 20 years, making the definition of PDDs broader. This can mean that a person diagnosed with a PDD by one set of guidelines may not have the disorder when diagnosed by different criteria, and vice versa. Diagnosis of children at younger ages can also affect the number of overall cases.
One set of data that has received considerable attention--some of it through "misuse" of the information, as Fombonne writes in the commentary--was a 1999 report from California's Department of Developmental Services. "It just shows that there are more children which are identified in the system in California, but there are many reasons for which that may be the case," he says.
"There are absolutely no grounds to claim there is an epidemic, that there is something going on. I think what is happening is just that their system is catching up with children which were not detected before, and because of the increased awareness of autism people are looking for more services, they bring their children for assessment at a much earlier age, and all these facts are sufficient to explain the apparent increase in California," he says.
Some people, he notes, have used the California report to link autism with the MMR vaccine, the combination measles-mumps-rubella vaccine generally given to children between the ages of 13 and 18 months--around the time when many parents first begin to notice symptoms of PDDs in their children. Widespread use of the MMR vaccine in children began around the 1980s, about the time autism cases appeared to increase.
The connection in time between the two events does not mean that there is a causal connection, Fombonne says. The argument that the two are connected is "absolutely fraught with errors of reasoning," he says. Further research in the area has not proven any link, he adds.
Some parents of autistic children have inquired about the possible role of MMR in their child's development of autism, Fombonne says, but most believe, as many researchers do, that there is a strong genetic propensity toward autism and PDDs.
"Autism is such a distressing disorder that I understand parents who are very willing to explain this very puzzling problem with anything they can," he says.
When the California report came out, it received a lot of attention, agrees Bruce G. Gellin, MD, MPH, assistant professor in the department of pediatrics at Vanderbilt University and executive director of the National Network for Immunization Information (NNII). While the report cautiously stated that it did not indicate that the incidence of autism in the population had increased, some people still interpreted it that way, he says.
Gellin points to one chart from the California report that he says is particularly misleading. It measures the number of persons enrolled in California autism programs since the early 1960s on one axis, with the year of their birth on the other. The line moves sharply upward between the years 1980 and 1989--to show that more people born in those years were diagnosed and recognized as having autism as those who were older. Fombonne also included the chart in his commentary.
"It's important for people to understand what numbers actually mean," Gellin says, and not be swayed by charts presented in a misleading way--not necessarily by the authors of the original report, but by those who use it to defend a link between autism and vaccines, for instance.
"As with any question and concern, you can only make good decisions if you have good information," Gellin says.
The NNII is a partnership of professional medical societies dedicated to providing reliable information on vaccines and immunization policies and practices, Gellin says. More information on vaccines and immunization, and the autism question, is available on the NNII Web site. 
SOURCE: February 2001 issue of Pediatrics

TV Viewing Not the Best Cure for Bored Young Patients 
For children, spending time in the hospital can mean long, boring hours spent in bed, so many young patients turn to the television for relief. But the American Academy of Pediatrics warns that television can promote dangerous behavior in youngsters.
The group urges pediatricians and hospitals to remove TV sets from their waiting rooms and to develop special programming for children, as well as to screen stations for violent, sexually explicit and potentially upsetting shows.
The recommendation is part of an updated statement on children, adolescents and television by the American Academy of Pediatrics.
"TV is perhaps the most powerful teacher kids will ever have," Dr. Victor Strasburger, one of the report's authors and a professor at the University of New Mexico in Albuquerque, told Reuters Health. "It is hypocritical for us to criticize parents for not getting the TV out of their children's bedroom while it is blaring loud and clear in waiting rooms and hospital rooms."
According to the statement published in the February issue of Pediatrics, nearly one third of 2- to 7-year-olds and nearly two thirds of 8- to 18-year-olds have a TV set in their bedroom.
"Parents have no right to criticize their kids' bad language or aggressive behavior if they are going to allow them to have a TV in their bedroom," Strasburger said.
Other recommendations encourage parents to use the v-chip and the ratings system to screen programs. The v-chip, which is installed in most new television sets, allows parents to block out certain shows. The ratings system tells parents whether a show contains violence, sexual content or offensive language.
According to the report, the average child or teen watches nearly 3 hours of television a day. Educating parents and children on the power of the media can reduce violence and substance abuse among adolescents, the report indicates. Many such programs are now routinely offered in early elementary schools nationwide.
"Children and adolescents are particularly vulnerable to the messages conveyed through television, which influence their perceptions and behaviors," the statement explains. "Many younger children cannot discriminate between what they see and what is real."
SOURCE: Pediatrics 2001;107:423-426.

Sleepy Children at Risk of Injury 
Young children who miss naps and lack sleep may be more prone to accidental injury, according to Italian researchers.
The investigators found that sleeping less than 10 hours a day including naps put children at an 86% higher risk of injuries caused by accidents such as slipping, tripping or falling.
Especially vulnerable were children aged 3 to 5, Dr. Francesca Valent of the University of Udine and colleagues report. And boys in particular saw their injury risk increase by up to four times if they had been awake for at least 8 hours straight.
The researchers evaluated the sleeping habits of 311 children who came into an emergency department to be treated for an accidental injury. Parents filled out a questionnaire that included the numbers of hours the child slept, hour-by-hour, in the 2 days before their injury. The researchers' aim was to compare sleeping patterns on a day when no injury occurred, with sleep on the day of the injury.
"Overall, more children had longer hours of sleep" 2 days prior to their injury compared with the 24 hours before the injury, Valent and colleagues report. Their findings are published in the February online issue of the journal Pediatrics.
"It makes sense and seems logical that little kids are more prone to accidents when they are not getting enough sleep," Dr. George Cohen, a spokesperson for the American Academy of Pediatrics, told Reuters Health.
Boys also tend to be more likely to be physically careless--like jumping off a chair or wrestling with other children--explained Cohen. "So the result that boys may be more vulnerable to accidents when they are tired is not surprising," he said.
However, Cohen noted that the study identified only a small difference in sleep--about 20 minutes--between the well-rested period 2 days before the injury and the "sleep-deprived" period just prior to visiting the emergency department.
"This makes it harder to draw many specific conclusions from the study," Cohen said.
SOURCE: Pediatrics 2001;107:e23.

Adult-Type Diabetes Developing in Children
The incidence of type 2 diabetes has been increasing in children at an alarming rate, especially in those who are obese and have a strong family history of type 2 diabetes, according to Kenneth Lee Jones, MD, a leading childhood diabetes expert who spoke today at an American Medical Association media briefing on advances in diabetes treatment and care. Type 2 diabetes primarily affects obese adults.
"About 10 years ago, some of us started seeing what we thought was type 2 diabetes in obese Mexican-American and African-American children with diabetes in their families," said Dr. Jones, professor of pediatrics at the University of California, San Diego. "When we treated them for type 1 diabetes, the only diabetes previously recognized in children, their response was different from the typical child with type 1 who is insulin deficient. The children with type 2 diabetes were insulin resistant and treating them with insulin resulted in weight gain which worsened the insulin resistance."
Previously considered an adult disease, type 2 diabetes begins as an insulin-resistant condition, with comorbidities in addition to high blood glucose that must be addressed, such as abnormalities of blood lipids, high blood pressure, and coagulation disorders that are risk factors for cardiovascular disease. Often children with type 2 diabetes also present with acanthosis nigricans. In addition, the question of when to intervene in dyslipidemia, hypertension, and coagulation disorders is also a consideration in treating children with type 2 diabetes.
Dr. Jones continued, "As a nation, we are all getting obese and it is starting in childhood. One of the major consequences of this is that more and more of our children will develop type 2 diabetes," he said. "This is a major public health problem and we are going to have to make major lifestyle changes to prevent it. This will not be easy and will resemble the problem society has faced with lung cancer and smoking. We need to change very basic aspects of our lifestyle, how we eat, what we eat, the amount we eat, and how much we exercise."
Most practitioners who see children for medical problems, including diabetes, were told throughout their training that type 2 diabetes does not exist in children. As a result, they are hesitant to consider this or make it the initial diagnosis, Dr. Jones observed.
"Physicians are also facing a treatment dilemma in type 2 diabetes in children. Will the same medications used in treating type 2 diabetes in adults work as safely and efficaciously in children; are the same treatment strategies appropriate?" questioned Dr. Jones. "In adults, the treatment traditionally has started with suggested lifestyle change: increase your activity, change your diet and lose weight. In my experience, this has not been terribly effective for adolescents."
Dr. Jones announced that metformin, a drug frequently used in adults with diabetes, is both safe and effective in children. He was the principal investigator on the first study evaluating metformin as a therapy for children. The paper has been submitted for publication, and Dr. Jones reported the abstract reporting the results was well received at the American Diabetes Association meeting last June.
"I predict that in a few years we will have found that many of the diabetes drugs currently used for adults are efficacious and safe for use in children and that treatment strategies used in adults with type 2 diabetes will prove appropriate for children as well," Dr. Jones predicted. However, he emphasized that the most important role for the pediatrician is in promoting prevention through reducing obesity, increasing physicial activity, and improving eating habits in young patients. In addition, the support and good example of parents is essential.
SOURCE: American Medical Association media briefing

Study Casts Doubt on Gateway Theory
Researchers say that today's young people who use marijuana are not likely to become hard drug users when they get older, the Associated Press reported Feb. 1. According to the report, people born after the 1960s are less likely than baby boomers to go from using marijuana to heroin and other hard drugs. "The drug subculture among inner city youth today encourages marijuana use but discourages use of hard drugs," said Andrew Golub of the National Development and Research Institute, the study's main author. "Many of these kids witnessed the devastating effects of crack and heroin on their own families and neighborhoods."
Golub and his team of researchers examined data about adolescent drug use reported by more than 100,000 people who participated in the government's annual National Household Survey on Drug Abuse between 1979 and 1997.
The private study challenges the "gateway" theory of drug abuse, which states that those who use marijuana are more likely to use cocaine, crack, or heroin.
Bob Weiner, spokesman for the Office of National Drug Control Policy, said he had doubts about Golub's conclusions. Weiner cited recent research that showed young people who regularly use marijuana are 80 times more likely to use cocaine. "The parents of the children who have gone on to cocaine would have more common sense than his findings seem to come out with," Weiner said.
SOURCE:  February2001 edition of the American Journal of Public Health.

Can Ads Aimed at Thrill-Seeking Teens Cut Down on Marijuana Use?
More kids are saying 'No' to marijuana, thanks to an intensive television campaign targeting teens classified as "high sensation-seekers."
Sensation seeking, researchers have found, is a type of personality that requires constant stimulation from new and risky things. Experts say teens that score high on sensation seeking are more likely to use drugs than other kids.
Anti-drug messages aimed at thrill seekers are more effective than more generalized campaigns for adolescents, says Philip Palmgreen, professor of communications at the University of Kentucky. "If you aim [messages] to the low sensation-seekers, you are preaching to the converted," he says. "They're extremely unlikely to become drug users."
Palmgreen and his colleagues tested the effectiveness of televised public service announcements (PSAs) targeted at sensation seekers in Fayette County, Kentucky and in Knox County, Tennessee. Before, during and after airing the PSAs, investigators randomly interviewed a different set of 100 young people from each county every month to determine marijuana use (32 months, approximately 6,400 kids overall).
After the ads ran for 4 months in Fayette County only, the survey found pot use dropped in Fayette County, but continued to go up in Knox County. Investigators then ran the PSAs for another 4 months in both counties, and found pot use fell in both areas.
A few months after the PSA campaign in Knox County, researchers found a 26.7% drop in marijuana use. The decrease in Fayette County was reportedly even more dramatic--about 40%--since two separate TV campaigns ran in that area.
The results show how effective media campaigns targeted at sensation seekers can be, says Palmgreen. "Anti-drug media campaigns using televised ads alone can actually affect drug use behavior and reduce it," he says.
Although experts such as those at the Centers for Disease Control and Prevention (CDC) have long backed multi-faceted programs, Palmgreen says his research is the first scientific study to show that televised anti-drug PSAs on their own "can actually affect drug use and reduce it."
The TV ads aimed at thrill-seeking teens were 30-second mini-dramas aired during hours when such teens were thought to be watching. The mini-dramas relayed the consequences of marijuana use, such as getting into trouble with the law, damaging relationships with parents, friends, girlfriends and boyfriends, and affecting performance in school, on jobs and in sports.
At least one expert doubts that this particular TV campaign will have lasting success.
High sensation-seeking people "are after novelty and excessive arousal so telling them, 'Gee, you're not going to perform well in school' is no big deal, or that '[marijuana use] is going to affect your relationship with your parents'--that's no big deal," says Bernardo Carducci, PhD, professor of psychology and director of the Shyness Research Institute at Indiana University Southeast.
What will work with thrill-seeking people, says Carducci, is providing them with an alternative that will satisfy their craving for variety and stimulation. He recommends encouraging kids to participate in afterschool programs, taking them on trips, or having them take on part-time jobs.
"We need to provide these kids with the stimulation that they are seeking elsewhere that's destructive," adds Carducci.
SOURCE: February 2001 issue of the American Journal of Public Health.

Daytime Wetting Is Common in Young Schoolchildren
The embarrassing problem of "having an accident" in school occurs among young children more often than teachers and professionals may realize, Australian researchers report.
And although parents may be aware of their child's daytime wetting problem, many fail to seek medical attention.
In a survey of 1,419 Australian first-graders, investigators found that while teachers report that 3% of children wet their pants during the day, parents claim more than 19% have the problem. Over 4% of children wet themselves more than once a month, according to the report by Premala Sureshkumar of Royal Alexandra Hospital for Children in Sydney and colleagues. Their findings are published in a recent issue of The Journal of Pediatrics.
"This is truly a physical problem that can be dealt with much more effectively from that perspective," commented Dr. Steven G. Docimo, director of pediatric urology at Children's Hospital in Pittsburgh. "(We need) to get away from the notion that this is a behavioral problem."
Children in the study with moderate to severe and even mild urinary incontinence associated symptoms such as sudden urgency, dribbling, squatting, and bed-wetting with their condition.
The investigators also found that recent emotional stress, a family history of wetting (especially in the father's family), and a fear of school or home toilets increased the risk of daytime wetting.
Almost 28% of mild daytime wetting could be attributed to these factors, the report indicates.
Previous studies from Denmark and Sweden claim that at least 1 in 10 school-age children have a problem wetting their pants, according to Docimo.
"I think it's very important for teachers to understand that this is a physical problem; that it is not an uncommon physical problem, and that it is a very embarrassing problem," Docimo told Reuters Health.
"They really should respond to it with understanding, with trying to get the child into a situation where as few of their peers as possible are aware that they had this problem," he added.
Teachers can also play a big role in helping solve daytime wetting problems, he suggested, by helping facilitate timed voiding regimens--a common treatment recommendation. Setting up a system such as this where the child has breaks at various times of the day to go to the bathroom often prevents further accidents, Docimo explained.
In the study, only 16% of parents pursued medical attention for their child's problem, according to the Australian researchers.
Docimo emphasizes to parents, however, that oftentimes something can be done.
Daytime wetting can be associated with urinary infections, uncontrolled bladder contractions, and high-pressure voiding. New therapies can retrain and relax children's pelvic muscles to help control bladder reflexes, Docimo pointed out.
"One of the reasons why parents haven't sought medical attention for this problem is that we (as doctors) haven't dealt with it very well," Docimo said.
"I think that we really are getting better at dealing with this as physicians," he added. "Pediatric urologists are devoting a tremendous amount of attention to this area right now, and so there may be more reason to seek medical attention now than in the past."
SOURCE: The Journal of Pediatrics 2000;137:814-818.

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